ATI MED SURG CARDIOVASCULAR
. A nurse is preparing to transfuse 250 mL of packed red blood cells (RBCs) to a client over 4 hr.
A blood administration set is available that delivers 10 gtt/mL. The nurse should set the manual
blood transfusion to deliver how many gtt/min? (Fill in the blank with the numeric value only,
round the answer to the nearest whole number, and use a leading zero if applicable. Do not use
a trailing zero.) - questions and answers-10 mL
A charge nurse is observing a newly licensed nurse administer an IV medication to a client who
has an implanted venous access port. Which of the following observations requires intervention
by the charge nurse?
A. A dressing is not applied to the port site after use.
B. A 22-gauge non-coring needle is used to access the port.
C. Blood return is noted prior to administering the medication.
D. A solution of 5 mL heparin 1,000 units/mL has been prepared. - questions and answers-D. A
solution of 5 mL heparin 1,000 units/mL has been prepared.
A client who has thrombocytopenia asks the nurse why platelets are so important. Which of the
following responses should the nurse make?
A. "Platelets help the body fight infection."
B. "Platelets help break down clots in the body."
C. "Platelets plug breaks in blood vessels."
D. "Platelets produce the molecules that carry oxygen." - questions and answers-C. "Platelets
plug breaks in blood vessels."
A client who just learned that he has variant (Prinzmetal's) angina asks the nurse how this type
of angina compares with stable angina. Which of the following replies should the nurse make?
A. "Exertion often brings on pain."
B. "Variant angina occurs randomly at various times."
C. "Variant angina can cause changes on your electrocardiogram."
D. "Reducing your cholesterol can help you experience less pain." - questions and answers-C.
"Variant angina can cause changes on your electrocardiogram."
A nurse completing an assessment on a client. Which of the following findings should the nurse
identify as a risk factor for coronary artery disease? (Select all that apply.)
A. Hypothyroidism
B. Hypertension
C. Diabetes mellitus
D. Hyperlipidemia
E. Tobacco smoking - questions and answers-B. Hypertension
C. Diabetes mellitus
D. Hyperlipidemia
E. Tobacco smoking
,A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of
peripheral arterial disease. Which of the following findings should the nurse expect?
A. Pitting edema
B. Areas of reddish-brown pigmentation
C. Dry, pale skin with minimal body hair
D. Sunburned appearance with desquamation - questions and answers-C. Dry, pale skin with
minimal body hair
A nurse is administering a unit of packed red blood cells (RBCs) to a client who is postoperative.
The client reports itching and hives 30 min after the infusion begins. Which of the following
actions should the nurse take first?
A. Maintain IV access with 0.9% sodium chloride
B. Stop the infusion of blood
C. Send the blood container and tubing to the blood bank
D. Obtain a urine sample - questions and answers-B. Stop the infusion of blood
A nurse is admitting a client who is in sickle cell crisis. Besides pain management, which of the
following interventions should the nurse include in the client's plan of care?
A. Flexion of the extremities
B. Therapeutic hypothermia
C. Upright positioning
D. Ample hydration - questions and answers-D. Ample hydration
A nurse is assessing a client for manifestations of aplastic anemia. Which of the following
findings should the nurse expect?
A. Plethoric appearance of facial skin
B. Glossitis and weight loss
C. Jaundice with an enlarged liver
D. Petechiae and ecchymosis - questions and answers-D. Petechiae and ecchymosis
A nurse is assessing a client who had coronary artery bypass grafts for cardiac tamponade.
Which of the following actions should the nurse take?
A. Check for hypertension
B. Auscultate for loud, bounding heart sounds
C. Auscultate blood pressure for pulsus paradoxus
D. Check for a pulse deficit - questions and answers-C. Auscultate blood pressure for pulsus
paradoxus
A nurse is assessing a client who has an abdominal aortic aneurysm (AAA). Which of the
following findings indicates that the AAA is expanding?
A. Increased BP and decreased pulse rate
B. Jugular vein distention and peripheral edema
C. Report of sudden, severe back pain
, D. Report of retrosternal chest pain radiating to the left arm - questions and answers-B. Jugular
vein distention and peripheral edema
C. Report of sudden, severe back pain
A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the following
manifestations should the nurse expect?
A. Midsternal chest pain
B. Thrill
C. Pitting edema in lower extremities
D. Lower back discomfort - questions and answers-D. Lower back discomfort
A nurse is assessing a client who has deep-vein thrombosis in her left calf. Which of the
following manifestations should the nurse expect to find? (Select all that apply.)
A. Hardening along the blood vessel
B. Absence of a peripheral pulse
C. Tenderness in the calf
D. Cool skin on the leg
E. Increased leg circumference - questions and answers-A. Hardening along the blood vessel
C. Tenderness in the calf
E. Increased leg circumference
A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder.
Which of the following manifestations should the nurse expect? (Select all that apply.)
A. Jugular vein distension
B. Moist crackles
C. Postural hypotension
D. Increased heart rate
E. Fever - questions and answers-A. Jugular vein distension
B. Moist crackles
D. Increased heart rate
A nurse is assessing a client who has heart failure and is taking daily furosemide. The client's
apical pulse is weak and irregular. The nurse should identify these findings as manifestations of
which of the following electrolyte imbalances?
A. Hypokalemia
B. Hypophosphatemia
C. Hypercalcemia
D. Hypermagnesemia - questions and answers-A. Hypokalemia
A nurse is assessing a client who has isotonic dehydration. Which of the following findings
should the nurse expect?
A. Increased hematocrit level
B. Bradycardia
C. Distended neck veins
. A nurse is preparing to transfuse 250 mL of packed red blood cells (RBCs) to a client over 4 hr.
A blood administration set is available that delivers 10 gtt/mL. The nurse should set the manual
blood transfusion to deliver how many gtt/min? (Fill in the blank with the numeric value only,
round the answer to the nearest whole number, and use a leading zero if applicable. Do not use
a trailing zero.) - questions and answers-10 mL
A charge nurse is observing a newly licensed nurse administer an IV medication to a client who
has an implanted venous access port. Which of the following observations requires intervention
by the charge nurse?
A. A dressing is not applied to the port site after use.
B. A 22-gauge non-coring needle is used to access the port.
C. Blood return is noted prior to administering the medication.
D. A solution of 5 mL heparin 1,000 units/mL has been prepared. - questions and answers-D. A
solution of 5 mL heparin 1,000 units/mL has been prepared.
A client who has thrombocytopenia asks the nurse why platelets are so important. Which of the
following responses should the nurse make?
A. "Platelets help the body fight infection."
B. "Platelets help break down clots in the body."
C. "Platelets plug breaks in blood vessels."
D. "Platelets produce the molecules that carry oxygen." - questions and answers-C. "Platelets
plug breaks in blood vessels."
A client who just learned that he has variant (Prinzmetal's) angina asks the nurse how this type
of angina compares with stable angina. Which of the following replies should the nurse make?
A. "Exertion often brings on pain."
B. "Variant angina occurs randomly at various times."
C. "Variant angina can cause changes on your electrocardiogram."
D. "Reducing your cholesterol can help you experience less pain." - questions and answers-C.
"Variant angina can cause changes on your electrocardiogram."
A nurse completing an assessment on a client. Which of the following findings should the nurse
identify as a risk factor for coronary artery disease? (Select all that apply.)
A. Hypothyroidism
B. Hypertension
C. Diabetes mellitus
D. Hyperlipidemia
E. Tobacco smoking - questions and answers-B. Hypertension
C. Diabetes mellitus
D. Hyperlipidemia
E. Tobacco smoking
,A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of
peripheral arterial disease. Which of the following findings should the nurse expect?
A. Pitting edema
B. Areas of reddish-brown pigmentation
C. Dry, pale skin with minimal body hair
D. Sunburned appearance with desquamation - questions and answers-C. Dry, pale skin with
minimal body hair
A nurse is administering a unit of packed red blood cells (RBCs) to a client who is postoperative.
The client reports itching and hives 30 min after the infusion begins. Which of the following
actions should the nurse take first?
A. Maintain IV access with 0.9% sodium chloride
B. Stop the infusion of blood
C. Send the blood container and tubing to the blood bank
D. Obtain a urine sample - questions and answers-B. Stop the infusion of blood
A nurse is admitting a client who is in sickle cell crisis. Besides pain management, which of the
following interventions should the nurse include in the client's plan of care?
A. Flexion of the extremities
B. Therapeutic hypothermia
C. Upright positioning
D. Ample hydration - questions and answers-D. Ample hydration
A nurse is assessing a client for manifestations of aplastic anemia. Which of the following
findings should the nurse expect?
A. Plethoric appearance of facial skin
B. Glossitis and weight loss
C. Jaundice with an enlarged liver
D. Petechiae and ecchymosis - questions and answers-D. Petechiae and ecchymosis
A nurse is assessing a client who had coronary artery bypass grafts for cardiac tamponade.
Which of the following actions should the nurse take?
A. Check for hypertension
B. Auscultate for loud, bounding heart sounds
C. Auscultate blood pressure for pulsus paradoxus
D. Check for a pulse deficit - questions and answers-C. Auscultate blood pressure for pulsus
paradoxus
A nurse is assessing a client who has an abdominal aortic aneurysm (AAA). Which of the
following findings indicates that the AAA is expanding?
A. Increased BP and decreased pulse rate
B. Jugular vein distention and peripheral edema
C. Report of sudden, severe back pain
, D. Report of retrosternal chest pain radiating to the left arm - questions and answers-B. Jugular
vein distention and peripheral edema
C. Report of sudden, severe back pain
A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the following
manifestations should the nurse expect?
A. Midsternal chest pain
B. Thrill
C. Pitting edema in lower extremities
D. Lower back discomfort - questions and answers-D. Lower back discomfort
A nurse is assessing a client who has deep-vein thrombosis in her left calf. Which of the
following manifestations should the nurse expect to find? (Select all that apply.)
A. Hardening along the blood vessel
B. Absence of a peripheral pulse
C. Tenderness in the calf
D. Cool skin on the leg
E. Increased leg circumference - questions and answers-A. Hardening along the blood vessel
C. Tenderness in the calf
E. Increased leg circumference
A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder.
Which of the following manifestations should the nurse expect? (Select all that apply.)
A. Jugular vein distension
B. Moist crackles
C. Postural hypotension
D. Increased heart rate
E. Fever - questions and answers-A. Jugular vein distension
B. Moist crackles
D. Increased heart rate
A nurse is assessing a client who has heart failure and is taking daily furosemide. The client's
apical pulse is weak and irregular. The nurse should identify these findings as manifestations of
which of the following electrolyte imbalances?
A. Hypokalemia
B. Hypophosphatemia
C. Hypercalcemia
D. Hypermagnesemia - questions and answers-A. Hypokalemia
A nurse is assessing a client who has isotonic dehydration. Which of the following findings
should the nurse expect?
A. Increased hematocrit level
B. Bradycardia
C. Distended neck veins
