NUR 213 - TEST 2 SAUNDERS PERFUSION UPDATED EXAM WITH MOST
TESTED QUESTIONS AND ANSWERS | GRADED A+ | ASSURED SUCCESS
WITH DETAILED RATIONALES
1
The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure.
Which assessment finding would most specifically reflect left-sided heart dysfunction?
A. Palpable hepatomegaly
B. Peripheral and sacral edema
C. Jugular venous distention
D. Crackles in lung bases
✔ Correct Answer: D
Rationale: Left-sided failure causes pulmonary congestion (fluid in lungs) → crackles.
Hepatomegaly, JVD and peripheral edema are signs of right-sided failure.
2
A nurse is teaching lifestyle changes to a client with angina pectoris. The client repeatedly
changes the subject during teaching. The nurse should interpret this behavior most likely as:
A. Anxiety about making lifestyle changes
B. Boredom because the client already knows the material
C. Lack of understanding and embarrassment to ask questions
D. A defense mechanism of denial to avoid thinking about needed changes
✔ Correct Answer: D
Rationale: Avoidance/subject changing is classic denial — a defense to minimize perceived
threat. Anxiety may present differently (restlessness, tachycardia).
3
A client recovering from myocardial infarction (MI) is choosing a beverage from the menu.
Which should the nurse instruct the client to select?
A. Coffee
B. Cola
, ESTUDYR
C. Raspberry juice (caffeine-free)
D. Tea
✔ Correct Answer: C
Rationale: Caffeinated drinks (coffee, tea, cola) can increase myocardial oxygen
demand/vasoconstriction; caffeine-free juices are preferred post-MI.
4
Which client statement demonstrates correct understanding of lifestyle adaptations to
promote heart health with inadequate cardiac output?
A. “I will drink 3000–3500 mL fluid daily to help my kidneys.”
B. “I will try to exercise vigorously each day to strengthen my heart.”
C. “I will eat enough fiber to prevent straining at stool.”
D. “I will drink 2–3 oz of liquor nightly to open vessels.”
✔ Correct Answer: C
Rationale: Avoiding Valsalva/straining reduces vagal stimulation and cardiac stress. Excess
fluids, vigorous exercise, or alcohol can increase cardiac workload.
5
Which action should the nurse take to prepare a client for an echocardiogram?
A. Ask about allergies to iodine or shellfish
B. Obtain informed consent because it’s invasive
C. Keep the client NPO for 2 hours prior
D. Explain that the test is painless and takes ~30–60 minutes
✔ Correct Answer: D
Rationale: Echocardiography is noninvasive and painless; no special prep or iodine allergy
screening required (that is for contrast studies).
6
A client is undergoing cardiac catheterization. Which sensation should the nurse instruct the
client to report immediately during the procedure?
A. Pressure at the insertion site