ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
1. A nurse is providing discharge teaching to an "I will notify my doctor before I have
adult female client who has infective endocardi- dental procedures"
tis about how to prevent recurrence. Which of Rationale: The nurse should inform
the following statements by the client indicates the client of ways to decrease the
an understanding of the teaching? risk of recurrence of infective en-
docarditis. The client should noti-
"I will ask my provider to change my contracep- fy the provider prior to invasive or
tion to an IUD" dental procedures due to the need
"I will notify my doctor before I have dental pro- for prophylactic antibiotic therapy
cedures" to reduce the risk of a streptococcal
"I will avoid using antiseptic mouthwash for oral infection.
care"
"I will wear a mask when I go out in public"
2. A nurse is caring for a client who had a MI Coarse crackles
5 days ago. The client has a sudden onset of Rationale: A client who had a recent
SOB and begins coughing frothy, pink sputum. myocardial infarction is at risk for
The nurse auscultates loud, bubbly sounds on left-sided heart failure. Crackles are
inspiration. Which of the following adventitious breath sounds caused by move-
breath sounds should the nurse document? ment of air through airways partial-
ly or intermittently occluded with
Coarse crackles fluid and are associated with heart
Wheezes failure and frothy sputum. Crack-
Rhonci ling sounds are heard at the end of
Friction rub inspiration and are not cleared by
coughing.
3. A nurse is assessing a client who has right-sided Dependent edema
heart failure. Which of the following findings Rationale: Blood return from the
should the nurse expect? venous system to the right atrium
is impaired by a weakened right
Decreased cap refill heart. The subsequent systemic ve-
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
Dyspnea nous backup leads to the develop-
Orthopnea ment of dependent edema.
Dependent edema
4. A nurse is assessing the hematologic system of Absence of hair on legs
an older adult client. The nurse should report Rationale: A progressive loss of hair
which of the following findings to the provider is common with aging. However,
as a possible indication of a hematologic disor- thinning or absence of hair on the
der? extremities indicates poor arterial
circulation to that area. The nurse
Pallor should look for further indications
Jaundice of arterial insufficiency and report
Absence of hair on the legs these findings to the provider.
Poor nail bed cap refill
5. A nurse observes tachycardia, dyspnea, a "Use a transfusion pump to regu-
cough, and distended neck veins in a client who late and maintain the transfusion at
is receiving a transfusion of packed red blood a slower rate"
cells (RBCs). Which of the following interven- Rationale: These are manifestations
tions should the nurse use to prevent these of a hypervolemic reaction due
manifestations with the client's next transfu- to circulatory overload, which like-
sion? ly occurs when blood transfusion
is too rapid for the client's size
"Warm the unit of blood to room temperature or status. To prevent this problem
before administering it" with future transfusions, the nurse
"Administer acetaminophen prior to the blood should use a transfusion pump to
transfusion" regulate the transfusion at a slower
"Give an antihistamine prior to the transfusion" rate.
"Use a transfusion pump to regulate and main-
tain the transfusion at a slower rate"
6. A nurse is teaching a client who has iron-defi- Lentils
ciency anemia. The nurse should encourage the Rationale: The nurse should en-
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
client to increase her consumption of which of courage the client to increase her
the following foods? consumption of iron-rich foods, in-
cluding meat, fish, poultry, and
"Lentils" dried beans and peas. A 1-cup
"Avocados" serving of lentils contains 3.6mg of
"Cabbage" iron.
"Broccoli"
7. A nurse is caring for a client who is postoper- "Position the client supine with his
ative following vein ligation and stripping for legs elevated when in bed"
varicose veins. Which of the following actions Rationale: The nurse should elevate
should the nurse take? the client's legs above his heart to
promote venous return by gravi-
"Position the client supine with his legs elevated ty. During discharge teaching, the
when in bed" nurse should reinforce the impor-
"Encourage the client to ambulate for 15 min tance of periodic positioning of the
every hour while awake for the first 24 hr" legs above the heart.
"Tell the client to sit with his legs dependent
after ambulating"
"Instruct the client to wear knee-length socks for
2 weeks after surgery"
8. A nurse is completing an assessment for a client "Chest pain lasts for longer than 15
who has a history of unstable angina. Which of min"
the following findings should the nurse expect? Rationale: A client who has unsta-
ble angina will have chest pain last-
"Chest pain is relieved soon after resting" ing longer than 15 minutes. This
"Nitroglycerin relieves chest pain" is due to reduced blood flow in a
Physical exertion does not precipitate chest coronary artery from atherosclerot-
pain" ic plaque and thrombus formation
"Chest pain lasts for longer than 15 min" causing partial arterial obstruction
or from an artery spasm.
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
9. A nurse is assessing a client who has left-sided "Crackles in the lung bases"
heart failure. Which of the following findings Rationale: Left-sided heart failure
should the nurse expect? precipitates pulmonary congestion
and edema, causing crackles in the
"Pitting peripheral edema" lungs.
"Crackles in the lung bases"
"Jugular vein distention"
"Hepatomegaly"
10. A client who just learned that he has variant "Variant angina can cause changes
(Prinzmetal's) angina asks the nurse how this on your electrocardiogram"
type of angina compares with stable angina. Rationale: Variant angina causes
Which of the following replies should the nurse ECG changes that reflect coronary
make? artery spasms, which results in less
oxygen supplying the myocardium.
"Exertion often brings on pain"
"Variant angina occurs randomly at various
times"
"Variant angina can cause changes on your elec-
trocardiogram"
"Reducing your cholesterol can help you experi-
ence less pain"
11. A nurse is assessing for disseminated intravas- Bleeding at the venipuncture site
cular coagulation (DIC) in a client who has septic Petechiae on the chest and arms
shock secondary to an untreated foot wound. Abdominal distension
Which of the following findings should the nurse Rationale: The formation of large
expect? (SATA) amounts of microemboli in the
circulation depletes the body's
Bradycardia platelets and clotting factors. As a
Bleeding at the venipuncture site result, uncontrollable bleeding can
Petechiae on the chest and arms occur, as manifested by bleeding at
Study online at https://quizlet.com/_dc3w6n
1. A nurse is providing discharge teaching to an "I will notify my doctor before I have
adult female client who has infective endocardi- dental procedures"
tis about how to prevent recurrence. Which of Rationale: The nurse should inform
the following statements by the client indicates the client of ways to decrease the
an understanding of the teaching? risk of recurrence of infective en-
docarditis. The client should noti-
"I will ask my provider to change my contracep- fy the provider prior to invasive or
tion to an IUD" dental procedures due to the need
"I will notify my doctor before I have dental pro- for prophylactic antibiotic therapy
cedures" to reduce the risk of a streptococcal
"I will avoid using antiseptic mouthwash for oral infection.
care"
"I will wear a mask when I go out in public"
2. A nurse is caring for a client who had a MI Coarse crackles
5 days ago. The client has a sudden onset of Rationale: A client who had a recent
SOB and begins coughing frothy, pink sputum. myocardial infarction is at risk for
The nurse auscultates loud, bubbly sounds on left-sided heart failure. Crackles are
inspiration. Which of the following adventitious breath sounds caused by move-
breath sounds should the nurse document? ment of air through airways partial-
ly or intermittently occluded with
Coarse crackles fluid and are associated with heart
Wheezes failure and frothy sputum. Crack-
Rhonci ling sounds are heard at the end of
Friction rub inspiration and are not cleared by
coughing.
3. A nurse is assessing a client who has right-sided Dependent edema
heart failure. Which of the following findings Rationale: Blood return from the
should the nurse expect? venous system to the right atrium
is impaired by a weakened right
Decreased cap refill heart. The subsequent systemic ve-
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
Dyspnea nous backup leads to the develop-
Orthopnea ment of dependent edema.
Dependent edema
4. A nurse is assessing the hematologic system of Absence of hair on legs
an older adult client. The nurse should report Rationale: A progressive loss of hair
which of the following findings to the provider is common with aging. However,
as a possible indication of a hematologic disor- thinning or absence of hair on the
der? extremities indicates poor arterial
circulation to that area. The nurse
Pallor should look for further indications
Jaundice of arterial insufficiency and report
Absence of hair on the legs these findings to the provider.
Poor nail bed cap refill
5. A nurse observes tachycardia, dyspnea, a "Use a transfusion pump to regu-
cough, and distended neck veins in a client who late and maintain the transfusion at
is receiving a transfusion of packed red blood a slower rate"
cells (RBCs). Which of the following interven- Rationale: These are manifestations
tions should the nurse use to prevent these of a hypervolemic reaction due
manifestations with the client's next transfu- to circulatory overload, which like-
sion? ly occurs when blood transfusion
is too rapid for the client's size
"Warm the unit of blood to room temperature or status. To prevent this problem
before administering it" with future transfusions, the nurse
"Administer acetaminophen prior to the blood should use a transfusion pump to
transfusion" regulate the transfusion at a slower
"Give an antihistamine prior to the transfusion" rate.
"Use a transfusion pump to regulate and main-
tain the transfusion at a slower rate"
6. A nurse is teaching a client who has iron-defi- Lentils
ciency anemia. The nurse should encourage the Rationale: The nurse should en-
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
client to increase her consumption of which of courage the client to increase her
the following foods? consumption of iron-rich foods, in-
cluding meat, fish, poultry, and
"Lentils" dried beans and peas. A 1-cup
"Avocados" serving of lentils contains 3.6mg of
"Cabbage" iron.
"Broccoli"
7. A nurse is caring for a client who is postoper- "Position the client supine with his
ative following vein ligation and stripping for legs elevated when in bed"
varicose veins. Which of the following actions Rationale: The nurse should elevate
should the nurse take? the client's legs above his heart to
promote venous return by gravi-
"Position the client supine with his legs elevated ty. During discharge teaching, the
when in bed" nurse should reinforce the impor-
"Encourage the client to ambulate for 15 min tance of periodic positioning of the
every hour while awake for the first 24 hr" legs above the heart.
"Tell the client to sit with his legs dependent
after ambulating"
"Instruct the client to wear knee-length socks for
2 weeks after surgery"
8. A nurse is completing an assessment for a client "Chest pain lasts for longer than 15
who has a history of unstable angina. Which of min"
the following findings should the nurse expect? Rationale: A client who has unsta-
ble angina will have chest pain last-
"Chest pain is relieved soon after resting" ing longer than 15 minutes. This
"Nitroglycerin relieves chest pain" is due to reduced blood flow in a
Physical exertion does not precipitate chest coronary artery from atherosclerot-
pain" ic plaque and thrombus formation
"Chest pain lasts for longer than 15 min" causing partial arterial obstruction
or from an artery spasm.
, ATI Med Surge: Cardio and Hematology
Study online at https://quizlet.com/_dc3w6n
9. A nurse is assessing a client who has left-sided "Crackles in the lung bases"
heart failure. Which of the following findings Rationale: Left-sided heart failure
should the nurse expect? precipitates pulmonary congestion
and edema, causing crackles in the
"Pitting peripheral edema" lungs.
"Crackles in the lung bases"
"Jugular vein distention"
"Hepatomegaly"
10. A client who just learned that he has variant "Variant angina can cause changes
(Prinzmetal's) angina asks the nurse how this on your electrocardiogram"
type of angina compares with stable angina. Rationale: Variant angina causes
Which of the following replies should the nurse ECG changes that reflect coronary
make? artery spasms, which results in less
oxygen supplying the myocardium.
"Exertion often brings on pain"
"Variant angina occurs randomly at various
times"
"Variant angina can cause changes on your elec-
trocardiogram"
"Reducing your cholesterol can help you experi-
ence less pain"
11. A nurse is assessing for disseminated intravas- Bleeding at the venipuncture site
cular coagulation (DIC) in a client who has septic Petechiae on the chest and arms
shock secondary to an untreated foot wound. Abdominal distension
Which of the following findings should the nurse Rationale: The formation of large
expect? (SATA) amounts of microemboli in the
circulation depletes the body's
Bradycardia platelets and clotting factors. As a
Bleeding at the venipuncture site result, uncontrollable bleeding can
Petechiae on the chest and arms occur, as manifested by bleeding at
