SI CARDIAC REVIEW QUESTIONS WITH
ANSWERS
, SI Cardiac Review Questions with answers:
Congestive Heart Failure
1. The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive
heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing
this client?
1. Apical pulse rate of 110 and 4+ pitting edema of feet.
2. Thick white sputum and crackles that clear with cough.
3. The client sleeping with no pillow and eupnea.
4. Radial pulse rate of 90 and CRT less than three (3) seconds.
2. The nurse is developing a nursing care plan for a client diagnosed with congestive heart
failure. A nursing diagnosis of “decreased cardiac output related to inability of the heart to
pump effectively” is written. Which short-term goal would be best for the client?
1. The client will be able to ambulate in the hall by date of discharge. more for
something like activity intolerance.
2. The client will have an audible S1 and S2 with no S3 heard by end of shift.
3. The client will turn, cough, and deep breathe every two (2) hours. nur intervention not
goal
4. The client will have a SaO2 reading of 98% by day two (2) of care. impaired gas
exchange
3. The nurse is developing a discharge-teaching plan for the client diagnosed with congestive
heart failure. Which interventions should be included in the plan? Select all that apply.
1. Notify the health-care provider of a weight gain of more than one (1) pound in a week.
more 2 lbs in one day is bad
2. Teach the client how to count the radial pulse when taking digoxin, a cardiac
glycoside. do not want to take of pulse less than 60
3. Instruct the client to remove the saltshaker from the dinner table. dec sodium to
decrease fluid retention
4. Encourage the client to monitor urine output for change in color to become dark.
should not happen
5. Discuss the importance of taking the loop diuretic furosemide at bedtime. morning
4. The nurse enters the room of the client diagnosed with congestive heart failure. The client is
lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which
intervention would the nurse implement first?
1. Sponge the client’s forehead.
2. Obtain a pulse oximetry reading.
3. Take the client’s vital signs.
4. Assist the client to a sitting position.
5. The nurse is assessing the client diagnosed with congestive heart failure. Which
signs/symptoms would indicate that the medical treatment has been effective?
1. The client’s peripheral pitting edema has gone from 3+ to 4+.
2. The client is able to take the radial pulse accurately.
3. The client is able to perform ADLs without dyspnea.
ANSWERS
, SI Cardiac Review Questions with answers:
Congestive Heart Failure
1. The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive
heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing
this client?
1. Apical pulse rate of 110 and 4+ pitting edema of feet.
2. Thick white sputum and crackles that clear with cough.
3. The client sleeping with no pillow and eupnea.
4. Radial pulse rate of 90 and CRT less than three (3) seconds.
2. The nurse is developing a nursing care plan for a client diagnosed with congestive heart
failure. A nursing diagnosis of “decreased cardiac output related to inability of the heart to
pump effectively” is written. Which short-term goal would be best for the client?
1. The client will be able to ambulate in the hall by date of discharge. more for
something like activity intolerance.
2. The client will have an audible S1 and S2 with no S3 heard by end of shift.
3. The client will turn, cough, and deep breathe every two (2) hours. nur intervention not
goal
4. The client will have a SaO2 reading of 98% by day two (2) of care. impaired gas
exchange
3. The nurse is developing a discharge-teaching plan for the client diagnosed with congestive
heart failure. Which interventions should be included in the plan? Select all that apply.
1. Notify the health-care provider of a weight gain of more than one (1) pound in a week.
more 2 lbs in one day is bad
2. Teach the client how to count the radial pulse when taking digoxin, a cardiac
glycoside. do not want to take of pulse less than 60
3. Instruct the client to remove the saltshaker from the dinner table. dec sodium to
decrease fluid retention
4. Encourage the client to monitor urine output for change in color to become dark.
should not happen
5. Discuss the importance of taking the loop diuretic furosemide at bedtime. morning
4. The nurse enters the room of the client diagnosed with congestive heart failure. The client is
lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which
intervention would the nurse implement first?
1. Sponge the client’s forehead.
2. Obtain a pulse oximetry reading.
3. Take the client’s vital signs.
4. Assist the client to a sitting position.
5. The nurse is assessing the client diagnosed with congestive heart failure. Which
signs/symptoms would indicate that the medical treatment has been effective?
1. The client’s peripheral pitting edema has gone from 3+ to 4+.
2. The client is able to take the radial pulse accurately.
3. The client is able to perform ADLs without dyspnea.
