Med Surg II Exam 1 Questions and Verified answers

Med Surg II Exam 1 Questions and Verified answers The student nurse understands that when the heart ventricles are depolarizing, the atria are doing which of the following? a. Depolarizing b. Repolarizing c. Contracting d. Filling the ventricles with blood - Answersb. rationale: During ventricular depolarization, the atria are repolarizing (resting). The student nurse understands that when the ventricles are depolarizing, which action is taking place? (Select all that apply) a. The atria are contracting and pumping blood to the ventricles b. The ventricles are pumping blood to the body c. The ventricles are resting d. The atria are resting and receiving blood from the ventricles e. The ventricles are pumping blood to the lungs - Answersb. , e. rationale: During ventricular depolarization, the ventricles are contracting and sending the blood to the lungs. During ventricular depolarization, the ventricles are sending blood to the body. Remember, the atria do not receive blood from the ventricles. The nurse caring for a client with a poorly functioning SA node knows that which of the following will take over in the conduction pathway to maintain adequate heart rate and perfusion? a. Purkinje Fibers b. Bundle of His c. Right and Left Bundle Branches d. AV node - Answersd. rationale: It initiates the intrinsic rate of 40-60 bpm if the SA node is unable to initiate an electrical impulse. The student nurse is reviewing the electrical activity of the heart. The student nurse is aware that the electrical impulse begins with which of the following? a. SA Node b. Purkinje Fibers c. AV Node d. Bundle of His - Answersa. rationale: This is where the electrical conduction begins. A client who is in the cardiac unit and who suffers from heart failure has been given a dose of enalapril IV. What effect should most likely occur after the administration of this drug? a. Increased cardiac output and decreased blood pressure b. Decreased orthostatic hypotension with movement c. Decreased urinary output and increased peripheral edema d. Decreased clotting time and improved blood flow - Answersa. rationale: Enalapril (Vasotec) is a drug typically used to treat high blood pressure and heart failure in adults. Enalapril works to increase cardiac output and decrease blood pressure among clients with hypertension. It is considered an ACE inhibitor, or angiotensin-converting enzyme inhibitor. A client with heart failure has a new prescription for digoxin. What should be included as part of teaching this client about digoxin? Select all that apply. a. The drug may not be well absorbed if the client has a high-fiber meal b. Digoxin may be affected by concurrent intake of St. John's wort c. The drug could cause serious side effects, such as cardiac arrhythmias d. Common signs of drug toxicity include petechiae on the chest and hair loss e.The client should not take the drug with a pulse less than 60 - Answersa., b., c., e. rationale: Other items may affect absorption of digoxin, including a high-fiber meal or intake of some types of supplements. Digoxin is a cardiac medication that must be carefully monitored with patient use because of its effects. The patient should know his heart rate before taking digoxin, as the drug can cause changes in the rate. If the client has a pulse less than 60, they should hold the digoxin and recheck the pulse later to see if it is above 60. If it is above 60 at that time, the client may take the medication. A client has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions is the most appropriate in this situation? a. Administer stool softeners as ordered b. Administer IV fluid boluses to increase urinary output c. Increase activity by encouraging ambulation d. Maintain the client in the Trendelenburg position while in bed - Answersa. rationale: "Administer stool softeners as ordered" is correct. When a client has a nursing diagnosis of decreased cardiac output, the nurse should avoid any activities that would put undue stress on the client's heart. In this situation, the nurse can administer stool softeners so that the client does not have to strain to have a bowel movement, which would place less stress on the heart. The nurse is caring for a client taking lisinopril. The nurse knows that this medication works by doing which of the following? Select all that apply. a. Decreasing preload b. Decreasing afterload c. Increasing preload d. Increasing afterload e. Increasing contractility - Answersa., b. rationale: "Decreasing preload" and "Decreasing afterload" are correct. Lisinopril is an ACE inhibitor, commonly used in heart failure clients to decrease the work of the heart by decreasing preload and afterload. ACE inhibitors accomplish this by blocking the renin angiotensin aldosterone system, which allows blood vessels to dilate. A patient with heart failure has a new prescription for furosemide. Which information would the nurse include as part of teaching this patient about Lasix? Select all that apply. a. The medication is given to prevent fluid retention b. Furosemide should only be used if the client cannot urinate c. High doses of Lasix can cause hearing loss d. The patient should not take blood pressure medications with furosemide e. The patient may need to monitor his sodium and potassium intake with this medicine - Answersa. , c., e. rationale: The medication is given to prevent fluid retention", "High doses of furosemide can cause hearing loss" and "The patient may need to monitor his sodium and potassium intake with this medicine" are correct. Furosemide (Lasix) is a diuretic medication most commonly used to reduce edema associated with heart failure. Education for the client taking furosemide should include the reason for taking the medication, effects the drug will have on electrolyte levels, and the dangers of taking too much of the drug. A nurse is caring for a client who is using invasive hemodynamic monitoring. Which best describes a normal range for central venous pressure? a. 15 to 25 mmHg b. 30 to 40 mmHg c. 3 to 8 mmHg d. 10 to 18 mmHg - Answersc. rationale: "3 to 8 mmHg" is correct. Central venous pressure is a measure of right atrial pressure and ventricular preload. The nurse may monitor central venous pressure through invasive hemodynamic monitoring when a catheter has been inserted into the client's heart. The normal range of central venous pressure is 3 to 8 mmHg. A patient has a central line that is being used to measure central venous pressure (CVP). Which situation would most likely demonstrate an increase in CVP? a. Severe hemorrhage b. Hypovolemia c. Use of a nasogastric tube d. Heart failure - Answersd.