MDC 3 FINAL EXAM CARDIOVASCULAR AND HEMATOLOGY

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? a.Age b.Obesity c.Inactivity d.Dyslipidemia - a.Age A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client? a.Age b.Impaired renal function c.Family history d.Dyslipidemia - d.Dyslipidemia Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? a.A client experiencing depression b.A client diagnosed with kidney disease c.A client of advanced age d.A client with excessive alcohol intake - b.A client diagnosed with kidney disease A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a.Reduce the blood pressure by 20% to 25% within the first hour of treatment. b.Reduce the blood pressure to about 140/80 mm Hg. c.Rapidly reduce the blood pressure so the client will not suffer a stroke. d.Reduce the blood pressure by 50% within the first hour of treatment. - a.Reduce the blood pressure by 20% to 25% within the first hour of treatment. An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? a.Postural hypertension and resulting injury b.Rebound hypertension c.Sexual dysfunction d.Postural hypotension and resulting injury - d.Postural hypotension and resulting injury The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? a.Lowering and controlling the blood pressure without adverse effects and without undue cost b.Making sure that the patient adheres to the therapeutic medication regimen c.Instructing the patient to enter a weight loss program and begin an exercise regimen d.Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence - a.Lowering and controlling the blood pressure without adverse effects and without undue cost Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a.Hypertensive emergency b.Hypertensive urgency c.Primary hypertension d.Secondary hypertension - a.Hypertensive emergency The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should the client's heart rate. the client's serum K+ level. the client's urine output. the client. - the client's heart rate. Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? a.Echocardiography b.Electrocardiography c.Blood chemistry d.Blood urea nitrogen - a.Echocardiography A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize? a.It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. b.The taste buds never adapt to decreased salt intake. c.There is usually no need to change alcohol consumption for clients with hypertension. d.A person with hypertension should never consume alcohol. - a.It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? a.Nausea and severe headache b.Chest pain score of 3 (on a scale of 1 to 10) c.Numbness and weakness in the left arm d.Urine output of 40 mL over the past hour - c.Numbness and weakness in the left arm It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine ases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. ases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. ases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. ases circulating blood volume. - ases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. According to the DASH diet, how many servings of vegetables should a person consume each day? a.2 or fewer b.2 or 3 c.4 or 5 d.7 or 8 - c.4 or 5 The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) a.Heart rate b.Respiratory rate c.Heart rhythm d.Character of apical and peripheral pulses e.Lung sounds - a.Heart rate c.Heart rhythm d.Character of apical and peripheral pulses Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension? ial vasoconstriction ic function um deficit -base imbalance - ial vasoconstriction Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. a.Heart failure b.Retinal damage c.Diabetes d.Hyperlipidemia e.Stroke - a.Heart failure b.Retinal damage e.Stroke A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? a.Purchasing a self-monitoring BP cuff b.Discussing methods for stress reduction c.Advising smoking cessation d.Administering glycemic control - a.Purchasing a self-monitoring BP cuff The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? heral edema -sided heart failure e nary insufficiency - e A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? a.Begin cardiopulmonary resuscitation b.Prepare for endotracheal intubation c.Provide electrical cardioversion d.Administer intravenous epinephrine - a.Begin cardiopulmonary resuscitation The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? oversion b.IV bolus of atropine c.IV bolus of dobutamine rillation - rillation The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? a.Administer an IV bolus of atropine. b.Send the client to the cardiac catheterization laboratory. c.Prepare to client for cardioversion. d.Review the client's medication record. - a.Administer an IV bolus of atropine. The nurse knows that what PR interval presents a first-degree heart block? a.0.14 seconds b.0.16 seconds c.0.18 seconds d.0.24 seconds - d.0.24 seconds The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? a.Alkalosis b.Hypokalemia c.Hypovolemia d.Bradycardia - b.Hypokalemia The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as l sinus rhythm. tachycardia. ional tachycardia. -degree atrioventricular block. - l sinus rhythm. The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias? a.Monitor blood pressure continuously. b.Monitor cardiac rhythm continuously. c.Provide supplemental oxygen. d.Palpate the client's pulse and observe the client's response. - b.Monitor cardiac rhythm continuously. The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? a.Variable heart rate, usually fewer than 90 bpm b.Irregular rhythm c.Delayed conduction, producing a prolonged PR interval d.P waves hidden within the QRS complex - c.Delayed conduction, producing a prolonged PR interval The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? a."The only difference is the heart rate." b."The P waves will be shaped differently." c."The QRS complex will be smaller in sinus bradycardia." d."The P-R interval will be prolonged in sinus bradycardia." - a."The only difference is the heart rate." A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6- second rhythm tracing. The nurse correctly identifies the client's heart rate as a.100 bpm. b.70 bpm. c.80 bpm. d.90 bpm. - d.90 bpm. After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? a.0.05 and 0.1 seconds. b.0.12 and 0.2 seconds. c.0.15 and 0.3 seconds. d.0.25 and 0.4 seconds. - b.0.12 and 0.2 seconds. Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a."It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." b."It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." c."It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." d."It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." - a."It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a.Premature ventricular contraction b.Atrial flutter c.Asystole d.Ventricular fibrillation - b.Atrial flutter A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a.Sinus tachycardia b.Ventricular tachycardia c.Normal sinus rhythm d.Sinus bradycardia - a.Sinus tachycardia The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a.The client is sedated before the procedure. b.It uses less electrical energy than cardioversion. c.It is a scheduled procedure 1 to 10 days in advance. d.It is used to eliminate ventricular dysrhythmias. - d.It is used to eliminate ventricular dysrhythmias. The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a.Atrial fibrillation b.Ventricular tachycardia c.Atrial flutter d.Ventricular fibrillation - c.Atrial flutter The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a.A client with third-degree heart block b.A client with atrial dysrhythmias c.A new myocardial infarction client d.A client with poor kidney perfusion - b.A client with atrial dysrhythmias A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a.Ventricular fibrillation b.Ventricular tachycardia c.Third-degree heart block d.Atrial fibrillation - a.Ventricular fibrillation A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a.Within 24 to 48 hours b.Within 12 hours c.Within 6 hours d.Within 5 to 7 days - c.Within 6 hours The nurse is caring for a client who is having chest pain associated with a myocardial infarction (MI). What medication will the nurse administer intravenously to reduce pain and anxiety? nyl ne sulfate ine sulfate morphone hydrochloride - ine sulfate A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a.Prepare the client for pulmonary artery catheterization. b.Assess the client's level of pain and administer prescribed analgesics. c.Ensure that the client's family is kept informed of the client's status. d.Assess the client's level of anxiety and provide emotional support. - b.Assess the client's level of pain and administer prescribed analgesics. A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? ise avoidance ng cessation xidant supplements d.a protein-rich diet - ng cessation The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? obin nin te dehydrogenase ine kinase - nin A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? a.Assess blood pressure and administer aspirin b.It is not important to assess the client or to notify the physician c.Assess the client's physical history d.Assess chest pain and administer prescribed drugs and oxygen - d.Assess chest pain and administer prescribed drugs and oxygen The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? ardial friction rub hermia ased white blood cell (WBC) count ased erythrocyte sedimentation rate (ESR) - ardial friction rub The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? deposits in the lumen of arteries sterol plugs in the lumen of veins clots in the arteries i in the veins - deposits in the lumen of arteries A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? a.The patient has had angina longer than 3 years. b.The patient has at least a 70% occlusion of a major coronary artery. c.The patient has compromised left ventricular function. d.The patient has an ejection fraction of 65%. - b.The patient has at least a 70% occlusion of a major coronary artery. A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? a.Central venous pressure reading of 1 b.Heart rate 66 bpm c.Blood pressure 110/68 mm Hg d.Pain score 5/10 - a.Central venous pressure reading of 1 The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. a.Physical inactivity b.Alcohol use c.Elevated blood pressure d.Family history e.Increasing age f.Obesity - a.Physical inactivity b.Alcohol use c.Elevated blood pressure f.Obesity A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? a.Described as crushing and substernal b.Relieved by rest and nitroglycerin c.Associated with nausea and vomiting d.Accompanied by diaphoresis and dyspnea - b.Relieved by rest and nitroglycerin The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? tal muscle damage due to a recent fall rdial necrosis c.I.M. injection ral bleeding - rdial necrosis A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle the prescription was filled 12 months ago. The nurse anticipates which order by the physician? a.Chest x-ray b.Ativan 1 mg orally c.Serum electrolytes d.Nitroglycerin SL - d.Nitroglycerin SL The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? a.ST elevation b.Sinus tachycardia c.Isolated premature ventricular contractions (PVCs) d.Frequent premature atrial contractions (PACs) - a.ST elevation The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? a. "What time did your chest pain start today?" b. "Do your parents have heart disease?" c. "What is your pain level on a scale of 1 to 10?" d. "How many sublingual nitroglycerin tablets did you take?" - a. "What time did your chest pain start today?" The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a.Decreased venous pressure b.Left ventricular hypertrophy c.Cardiac tamponade d.Hypertension - c.Cardiac tamponade A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? cardiogram ac catheterization l enzyme studies ardiogram - ardiogram A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? a.Mitral stenosis b.Cardiomyopathy c.Rheumatic fever d.Pericarditis - c.Rheumatic fever The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? a. "I will take antibiotics before getting my teeth cleaned." b. "I can get my tongue pierced at a store in the shopping mall." c. "I can get a tattoo at a local parlor." d. "I will avoid caffeine, alcohol, and smoking." - d. "I will avoid caffeine, alcohol, and smoking." In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? a.Dilated b.Hypertrophic c.Arrhythmogenic right ventricular d.Restrictive - b.Hypertrophic A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? a.Chest pain b.Fatigue c.Orthopnea d.Dyspnea - a.Chest pain On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard? a.Low-pitched, rumbling diastolic murmur at the apex of the heart b.Mitral valve click c.Diastolic murmur at the left sternal border of the heart d.High-pitched blowing sound at the apex - a.Low-pitched, rumbling diastolic murmur at the apex of the heart Which instruction should a nurse provide a client with a history of rheumatic fever before the client has any dental work done? a.To take aspirin b.To take prophylactic antibiotics c.To take steroids d.To avoid any kind of activity - b.To take prophylactic antibiotics A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response? a."Antibiotics will prevent vegetative growth on your valves." b."You are at risk of developing an infection in your heart." c."Your teeth will not bleed as much if you have antibiotics." d."This procedure may cause your valve to malfunction." - b."You are at risk of developing an infection in your heart." The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? a."Do you have a family history of endocarditis?" b."Have you recently vacationed outside of the United States?" c."Have you been to the dentist recently?" d."Do you live with any domesticated animals in your home?" - c."Have you been to the dentist recently?" A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? a.Balloon percutaneous valvuloplasty b.Placement of a xenograft valve c.Placement of an autograft valve d.Antibiotic therapy - a.Balloon percutaneous valvuloplasty Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? a.Allow unrestricted physical activity b.Check regularly for dependent edema c.Administer oxygen d.Maintain bed rest - b.Check regularly for dependent edema The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? a.Fatigue b.Dizziness c.An extra heart sound d.Syncope - c.An extra heart sound Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis? a.Exercise regimen b.Antihypertensive medication c.Potassium replacement d.Antibiotic therapy - d.Antibiotic therapy A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? a.The nurse has the client stand during auscultation. b.The nurse asks the client to hold the breath during auscultation. c.The nurse places the client flat for at least 4 minutes. d.There is really no question to ask the client to tell the difference. - b.The nurse asks the client to hold the breath during auscultation. The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply. ofen isone icine ethacin - ofen isone icine A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a.Pseudomonas aeruginosa b.Group A, beta-hemolytic streptococcus c.Serratia marcescens d.Staphylococcus aureus - b.Group A, beta-hemolytic streptococcus A nurse is teaching a client about mitral stenosis. What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis? nary circulation congestion l hypertrophy ased resistance of a narrowed orifice between the left atrium and the left ventricle quate left and right ventricle filling - ased resistance of a narrowed orifice between the left atrium and the left ventricle A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis? a.Cardiac catheterization b.Computed tomography c.Echocardiography d.Chest x-ray - c.Echocardiography The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? ng edema, chest discomfort, and nonspecific ST-segment elevation urine output secondary to left ventricular dysfunction , chest discomfort, and elevated erythrocyte sedimentation rate (ESR) rgy, anorexia, and heart failure - , chest discomfort, and elevated erythrocyte sedimentation rate (ESR) The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? ea ts of constant chest pain ted ESR and CRP ue lasting more than 1 month - ts of constant chest pain A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings? a."I told the patient that this is a normal complication and to take deep breaths." b."I anticipated this complication and I will call the health care provider right now." c."I instructed the patient to do coughing and deep breathing and I will reassess in 30 minutes." d."I placed the patient in a semi-Fowler's position and started an NPO diet." - b."I anticipated this complication and I will call the health care provider right now." A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? a.Alternate active periods with rest periods. b.Gradually work up to strenuous activity. c.Avoid all physical and emotional stress. d.Include isometric exercises in the daily routine. - a.Alternate active periods with rest periods. The nurse is teaching a client with heart failure about the ability for the heart to pump out blood. What diagnostic test will measure the ejection fraction of the heart? ardiogram b.MRI nary arterial pressure ar angiography - ardiogram A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? a.Analyze the arterial blood gas. b.Change oxygen delivery to a mask. c.Administer epinephrine. d.Stop all emergency measures. - c.Administer epinephrine. A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing action? a.Administer angiotensin II receptor blockers b.Administer diuretics c.Administer angiotensin-converting enzyme inhibitors d.Assess oxygen saturation - d.Assess oxygen saturation The nurse completes an assessment of a client admitted with a diagnosis of rightsided heart failure. What will be a significant clinical finding related to right-sided heart failure? ria ng edema c.S4 ventricular gallop sign ased O2 saturation levels - ng edema