Question 1

A nurse reviews a client's laboratory results.Which findings should alert the nurse to the possibility of atherosclerosis? (Select all that apply.)

Accepted Answer

A)   Total cholesterol: 280 mg/dL
B)   High-density lipoprotein cholesterol: 50 mg/dL
C)   Triglycerides: 200 mg/dL
D)   Serum albumin: 4 g/dL
E)   Low-density lipoprotein cholesterol: 160 mg/dL A,C,E

Question 2

A nurse assesses a client who is scheduled for a cardiac catheterization.Which assessment should the nurse complete prior to this procedure?

Accepted Answer

A)   Client's level of anxiety
B)   Ability to turn self in bed
C)   Cardiac rhythm and heart rate
D)   Allergies to iodine-based agents D

Question 3

A nurse teaches a client with diabetes mellitus and a body mass index of 42 who is at high risk for coronary artery disease.Which statement related to nutrition should the nurse include in this client's teaching?

Accepted Answer

A)   "The best way to lose weight is a high-protein, low-carbohydrate diet."
B)   "You should balance weight loss with consuming necessary nutrients."
C)   "A nutritionist will provide you with information about your new diet."
D)   "If you exercise more frequently, you won't need to change your diet." B

Question 4

An emergency room nurse assesses a female client.Which assessment findings should alert the nurse to request a prescription for an electrocardiogram? (Select all that apply.)

Accepted Answer

A)   Hypertension
B)   Fatigue despite adequate rest
C)   Indigestion
D)   Abdominal pain
E)   Shortness of breath

Question 5

A nurse cares for a client who is recovering from a myocardial infarction.The client states,"I will need to stop eating so much chili to keep that indigestion pain from returning." How should the nurse respond?

Accepted Answer

A)   "Chili is high in fat and calories; it would be a good idea to stop eating it."
B)   "The provider has prescribed an antacid for you to take every morning."
C)   "What do you understand about what happened to you?"
D)   "When did you start experiencing this indigestion?"

Question 6

A nurse prepares a client with acute renal insufficiency for a cardiac catheterization.The provider prescribes 0.9% normal saline to infuse at 125 mL/hr for renal protection.The nurse obtains gravity tubing with a drip rate of 15 drops/mL.At what rate (drops/min)should the nurse infuse the fluids? (Record your answer using a whole number,and rounding to the nearest drop.)_____ drops/min

Accepted Answer

The answer of A nurse prepares a client with acute...

Question 7

A nurse assesses an older adult client who is experiencing a myocardial infarction.Which clinical manifestation should the nurse expect?

Accepted Answer

A)   Excruciating pain on inspiration
B)   Left lateral chest wall pain
C)   Disorientation and confusion
D)   Numbness and tingling of the arm

Question 8

A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA)and is scheduled for bypass surgery.Which intervention should the nurse be prepared to implement while this client waits for surgery?

Accepted Answer

A)   Administration of IV furosemide (Lasix) 
B)   Initiation of an external pacemaker
C)   Assistance with endotracheal intubation
D)   Placement of central venous access

Question 9

A nurse assesses a client 2 hours after a cardiac angiography via the left femoral artery.The nurse notes that the left pedal pulse is weak.Which action should the nurse take?

Accepted Answer

A)   Elevate the leg and apply a sandbag to the entrance site.
B)   Increase the flow rate of intravenous fluids.
C)   Assess the color and temperature of the left leg.
D)   Document the finding as "left pedal pulse of +1/4."

Question 10

A nurse assesses a client who is recovering from a myocardial infarction.The client's pulmonary artery pressure reading is 25/12 mm Hg.Which action should the nurse take first?

Accepted Answer

A)   Compare the results with previous pulmonary artery pressure readings.
B)   Increase the intravenous fluid rate because these readings are low.
C)   Immediately notify the health care provider of the elevated pressures.
D)   Document the finding in the client's chart as the only action.

Question 11

A nurse obtains the health history of a client who is newly admitted to the medical unit.Which statement by the client should alert the nurse to the presence of edema?

Accepted Answer

A)   "I wake up to go to the bathroom at night."
B)   "My shoes fit tighter by the end of the day."
C)   "I seem to be feeling more anxious lately."
D)   "I drink at least eight glasses of water a day."

Question 12

A nurse cares for a client who has advanced cardiac disease and states,"I am having trouble sleeping at night." How should the nurse respond?

Accepted Answer

A)   "I will consult the provider to prescribe a sleep study to determine the problem."
B)   "You become hypoxic while sleeping; oxygen therapy via nasal cannula will help."
C)   "A continuous positive airway pressure, or CPAP, breathing mask will help you breathe at night."
D)   "Use pillows to elevate your head and chest while you are sleeping."

Question 13

A nurse auscultated heart tones on an older adult client.Which action should the nurse take based on heart tones heard?
(Click the media button to hear the audio clip.)

Accepted Answer

A)   Administer a diuretic.
B)   Document the finding.
C)   Decrease the IV flow rate.
D)   Evaluate the client's medications.

Question 14

A nurse assesses clients on a medical-surgical unit.Which client should the nurse identify as having the greatest risk for cardiovascular disease?

Accepted Answer

A)   An 86-year-old man with a history of asthma
B)   A 32-year-old Asian-American man with colorectal cancer
C)   A 45-year-old American Indian woman with diabetes mellitus
D)   A 53-year-old postmenopausal woman who is on hormone therapy

Question 15

A nurse assesses a client who has aortic regurgitation.In which location in the illustration shown below should the nurse auscultate to best hear a cardiac murmur related to aortic regurgitation?

Accepted Answer

A)   Location A
B)   Location B
C)   Location C
D)   Location D

Question 16

A nurse prepares a client for coronary artery bypass graft surgery.The client states,"I am afraid I might die." How should the nurse respond?

Accepted Answer

A)   "This is a routine surgery and the risk of death is very low."
B)   "Would you like to speak with a chaplain prior to surgery?"
C)   "Tell me more about your concerns about the surgery."
D)   "What support systems do you have to assist you?"

Question 17

A nurse cares for a client who is prescribed magnetic resonance imaging (MRI)of the heart.The client's health history includes a previous myocardial infarction and pacemaker implantation.Which action should the nurse take?

Accepted Answer

A)   Schedule an electrocardiogram just before the MRI.
B)   Notify the health care provider before scheduling the MRI.
C)   Call the physician and request a laboratory draw for cardiac enzymes.
D)   Instruct the client to increase fluid intake the day before the MRI.

Question 18

A nurse assesses an older adult client who has multiple chronic diseases.The client's heart rate is 48 beats/min.Which action should the nurse take first?

Accepted Answer

A)   Document the finding in the chart.
B)   Initiate external pacing.
C)   Assess the client's medications.
D)   Administer 1 mg of atropine.

Question 19

A nurse assesses a client who is recovering after a coronary catheterization.Which assessment findings in the first few hours after the procedure require immediate action by the nurse? (Select all that apply.)

Accepted Answer

A)   Blood pressure of 140/88 mm Hg
B)   Serum potassium of 2.9 mEq/L
C)   Warmth and redness at the site
D)   Expanding groin hematoma
E)   Rhythm changes on the cardiac monitor

Question 20

A nurse is caring for a client with a history of renal insufficiency who is scheduled for a cardiac catheterization.Which actions should the nurse take prior to the catheterization? (Select all that apply.)

Accepted Answer

A)   Assess for allergies to iodine.
B)   Administer intravenous fluids.
C)   Assess blood urea nitrogen (BUN)  and creatinine results.
D)   Insert a Foley catheter.
E)   Administer a prophylactic antibiotic.

Exam 33: Assessment of the Cardiovascular System