AH3 EXAM 2 QUESTIONS AND ANSWERS
The nurse performs admission assessment for an older client admitted to the telemetry
floor. The client's history reveals type 2 diabetes, mitral valve prolapse, and
hypertension. Which assessment information is an important indication of risk for heart
failure (HF) (Select all that apply)?
a. The patient takes furosemide (Lasix) 20 mg/day.
b. The patient's potassium level is 4.7 mEq/L.
c. The patient is an African American man.
d. The patient's age is greater than 65. - Answers :c. The patient is an African American
man.
d. The patient's age is greater than 65.
The nurse is providing discharge education on fluid balance monitoring to a patient with
a new diagnosis of right-sided heart failure. The nurse will stress which priority
instruction for monitoring fluid balance?
a. Weigh daily at the same time in similar clothing
b. Take self-pulse rates and report findings below 60
c. Take blood pressure at the same time daily
d. Bowel movements should be logged - Answers :a. Weigh daily at the same time in
similar clothing
The nurse is caring for a patient with severe left ventricular dysfunction and understands
the client is at risk for sudden cardiac death. The nurse anticipates which medical
intervention?
a. Insertion of an implantable cardioverter defibrillator
b. Insertion of an implantable atrial pacemaker
c. Administration of thrombolytic agents
d. Cardioversion under light anesthesia - Answers :a. Insertion of an implantable
cardioverter defibrillator
The nurse is caring for a client who has been placed on long-term anticoagulation for
management of intracardiac thrombi found on the echocardiogram. The nurse includes
which health history reason for increased risk of intracardiac thrombi?
a. Atrial fibrillation
b. Pericarditis
c. Pleural effusion
d. Recent surgery - Answers :a. Atrial fibrillation
The nurse is caring for a client with heart failure who is receiving a prescribed
angiotensin-converting enzyme inhibitor (ACEI). The patient is asking how the drug
, works for heart failure. What will the nurse include in teaching the client about this
medication? (Select all that apply.)
a. The ACEI reduces fluid volume
b. The ACEI relaxes blood vessels and lowers blood pressure
c. The ACEI reduces workload on the heart
d. The ACEI decreases pulmonary venous pressure. - Answers :b. The ACEI relaxes
blood vessels and lowers blood pressure
c. The ACEI reduces workload on the heart
The nurse is performing an assessment on a client with a history of cardiovascular
disease, diabetes, hypertension, and hypothyroidism. The client is experiencing
exhaustion with simple activities of daily living and short ambulation, and states a 5
pound weight gain over 4 days. Assessment reveals 4+ edema to lower extremities and
jugular distention. The nurse will report findings to the health care provider and
anticipates which medical condition?
a. Acute pericarditis
b. Myocardial infarction
c. Left-sided heart failure
d. Right-sided heart failure - Answers :d. Right-sided heart failure
The nurse is assessing an elderly client admitted with a diagnosis of chronic heart
failure (HF). The spouse asks the nurse the primary cause for HF, and the nurse
responds that HF may be caused by:
a.Endocarditis
b. Pleural effusion
c. Atherosclerosis
d. Atrial-septal defect - Answers :c. Atherosclerosis
The nurse is caring for a hospitalized client with admitting diagnosis of right-sided heart
failure (HF). What assessment finding is most consistent with the client's diagnosis?
a. Pulmonary edema
b. Distended neck veins
c. Dry hacking cough
d. Orthopnea - Answers :b. Distended neck veins
The nurse is assessing a client admitted to the telemetry unit from the Emergency
Department with complaints of increasing shortness of breath, and is coughing pink-
tinged frothy sputum. During the history assessment, the nurse documents a history of
left-sided heart failure. The nurse recognizes the presenting signs and symptoms of
which health problem?
a. Right-sided heart failure
The nurse performs admission assessment for an older client admitted to the telemetry
floor. The client's history reveals type 2 diabetes, mitral valve prolapse, and
hypertension. Which assessment information is an important indication of risk for heart
failure (HF) (Select all that apply)?
a. The patient takes furosemide (Lasix) 20 mg/day.
b. The patient's potassium level is 4.7 mEq/L.
c. The patient is an African American man.
d. The patient's age is greater than 65. - Answers :c. The patient is an African American
man.
d. The patient's age is greater than 65.
The nurse is providing discharge education on fluid balance monitoring to a patient with
a new diagnosis of right-sided heart failure. The nurse will stress which priority
instruction for monitoring fluid balance?
a. Weigh daily at the same time in similar clothing
b. Take self-pulse rates and report findings below 60
c. Take blood pressure at the same time daily
d. Bowel movements should be logged - Answers :a. Weigh daily at the same time in
similar clothing
The nurse is caring for a patient with severe left ventricular dysfunction and understands
the client is at risk for sudden cardiac death. The nurse anticipates which medical
intervention?
a. Insertion of an implantable cardioverter defibrillator
b. Insertion of an implantable atrial pacemaker
c. Administration of thrombolytic agents
d. Cardioversion under light anesthesia - Answers :a. Insertion of an implantable
cardioverter defibrillator
The nurse is caring for a client who has been placed on long-term anticoagulation for
management of intracardiac thrombi found on the echocardiogram. The nurse includes
which health history reason for increased risk of intracardiac thrombi?
a. Atrial fibrillation
b. Pericarditis
c. Pleural effusion
d. Recent surgery - Answers :a. Atrial fibrillation
The nurse is caring for a client with heart failure who is receiving a prescribed
angiotensin-converting enzyme inhibitor (ACEI). The patient is asking how the drug
, works for heart failure. What will the nurse include in teaching the client about this
medication? (Select all that apply.)
a. The ACEI reduces fluid volume
b. The ACEI relaxes blood vessels and lowers blood pressure
c. The ACEI reduces workload on the heart
d. The ACEI decreases pulmonary venous pressure. - Answers :b. The ACEI relaxes
blood vessels and lowers blood pressure
c. The ACEI reduces workload on the heart
The nurse is performing an assessment on a client with a history of cardiovascular
disease, diabetes, hypertension, and hypothyroidism. The client is experiencing
exhaustion with simple activities of daily living and short ambulation, and states a 5
pound weight gain over 4 days. Assessment reveals 4+ edema to lower extremities and
jugular distention. The nurse will report findings to the health care provider and
anticipates which medical condition?
a. Acute pericarditis
b. Myocardial infarction
c. Left-sided heart failure
d. Right-sided heart failure - Answers :d. Right-sided heart failure
The nurse is assessing an elderly client admitted with a diagnosis of chronic heart
failure (HF). The spouse asks the nurse the primary cause for HF, and the nurse
responds that HF may be caused by:
a.Endocarditis
b. Pleural effusion
c. Atherosclerosis
d. Atrial-septal defect - Answers :c. Atherosclerosis
The nurse is caring for a hospitalized client with admitting diagnosis of right-sided heart
failure (HF). What assessment finding is most consistent with the client's diagnosis?
a. Pulmonary edema
b. Distended neck veins
c. Dry hacking cough
d. Orthopnea - Answers :b. Distended neck veins
The nurse is assessing a client admitted to the telemetry unit from the Emergency
Department with complaints of increasing shortness of breath, and is coughing pink-
tinged frothy sputum. During the history assessment, the nurse documents a history of
left-sided heart failure. The nurse recognizes the presenting signs and symptoms of
which health problem?
a. Right-sided heart failure
