Exam 5

139 _Question :A client is being discharged from the hospital after being treated for infective endocarditis. The nurse

provides the client with which discharge instructions ?Options :

1 . Take acetaminophen (Tylenol) if the chest pain worsens .

2 . Use a firm bristle toothbrush and floss vigorously to prevent cavities .

3 . Take antibiotics until the chest pain is fully resolved .

4 . Notify all health care providers of the history of infective endocarditis before any invasive procedures.

Answer: 4 . Rationale :

The client should alert any health care provider about the history of infective endocarditis before any procedure that involves instrumentation. The provider should place the client on prophylactic antibiotics. Antibiotics should be taken for the full course of therapy. The client should notify the physician if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a

portal of entry for bacterial infection .140 _Question :

A nurse is concerned about the adequacy of peripheral tissue perfusion in the post–cardiac surgery client. Which action would the nurse avoid in giving care to this

client ?Options :

1 . Use of the knee gatch on the bed 2 . Covering the legs lightly when sitting in chair 3 . Performing range-of-motion (ROM) exercises to the

ankles 4 . Applying pneumatic boots

Answer :1 . Rationale :

The nurse plans postoperative measures to prevent venous stasis. These include applying elastic stockings or leg wraps, use of pneumatic compression boots, discouraging leg-crossing, avoiding use of the knee gatch on the bed, performing passive and active ROM exercises, and omitting placement of pillows in the popliteal space. Covering the legs with a light blanket during sitting promotes warmth

and vasodilation of the leg vessels .141 _Question :

A nurse is instructing the post–cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse would include which of the

following items in the instructions? Options :1 . Activities that involve straining can be resumed so

long as they do not cause pain .2 . Driving is permitted so long as the lap and shoulder

seat belts are worn .3 . Lifting should be restricted to objects that do not

weigh more than 25 pounds . 4 . Use the arms for balance, not weight support, when

getting out of bed or a chair .Answer :4 . Rationale :

Typical discharge activity instructions for the first six weeks include instructing the client to lift nothing heavier than 5 pounds , to not drive , and to avoid any activities that cause straining . The client is taught to use the arms for balance, but not weight support, to avoid the effects of straining. These limitations are to allow for sternal healing , which takes approximately 6

weeks . 142 _Question :

A nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The P waves and QRS complexes are regular. The PR interval is 0.14 second , and the QRS complexes measure 0.08 second . The overall heart rate is 82 beats/min . The nurse interprets the cardiac rhythm to

be : Options :

1 . Sinus bradycardia 2 . Sick sinus syndrome 3 . Normal sinus rhythm

4 . First-degree heart block Answer :3 . Rationale :

Normal sinus rhythm is defined as a regular rhythm with an overall rate of 60 to 100 beats/min . The PR and QRS measurements are normal , measuring 0.12 to 0.20 second

and 0.04 to 0.10 second , respectively .143 _Question :

A client ’s electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min . The PR interval is 0.16 second , the QRS complex measures 0.06 second , and the PP interval is slightly irregular. The

nurse interprets this rhythm to be :Options :

1 . Sinus bradycardia 2 . Normal sinus rhythm

3 . Sinus tachycardia 4 . Sinus arrhythmia

Answer :

4 . Rationale :

Sinus arrhythmia has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration.

Cardiac output is not affected .144 _Question :

A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows wavy lines.

The nurse interprets that the client is experiencing :Options :

1 . Premature ventricular contractions (PVCs) 2 . Sinus tachycardia

3 . Ventricular tachycardia 4 . Ventricular fibrillation


Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Each of the incorrect options has a recognizable complex that

appears on the monitoring screen ..144 -Question :

A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows wavy lines.

The nurse interprets that the client is experiencing :Options :

1 . Premature ventricular contractions (PVCs) 2 . Sinus tachycardia

3 . Ventricular tachycardia 4 . Ventricular fibrillation


Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Each of the incorrect options has a recognizable complex that

appears on the monitoring screen .145 -Question :

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which of the

following medications available for immediate use ?Options :

1 . Digoxin (Lanoxin) 2 . Metoprolol (Lopressor)

3 . Verapamil (Calan) 4 . Procainamide (Pronestyl)


Procainamide is an antiarrhythmic that may be used to treat ventricular arrhythmias in clients who are allergic to lidocaine. Digoxin is a cardiac glycoside; metoprolol is a beta-adrenergic blocking agent; verapamil is a

calcium channel–blocking agent .

146 -Question :A client has received antiarrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse would evaluate this therapy as most effective

if the client ’s PVCs continued to: Options :1 . Be multifocal in appearance

2 . Occur in pairs 3 . Decrease to a frequency of less than 6/min

4 . Fall on the second half of the T wave Answer: 3 . Rationale :

PVCs are considered dangerous when they are frequent (more than 6/min) , occur in pairs or couplets , are multifocal (multiform), or fall on the T wave. In each of these instances, the client ’s cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly

arrhythmias .147-Question :

A client has received antiarrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse would evaluate this therapy as most effective

if the client ’s PVCs continued to: Options :1 . Be multifocal in appearance

2 . Occur in pairs 3 . Decrease to a frequency of less than 6/min

4 . Fall on the second half of the T wave Answer :3 . Rationale :

PVCs are considered dangerous when they are frequent (more than 6/min) , occur in pairs or couplets , are multifocal (multiform), or fall on the T wave. In each of these instances, the client ’s cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly

arrhythmias .148 -Question :

An adult client has been defibrillated three times unsuccessfully for ventricular fibrillation, and cardiopulmonary resuscitation (CPR) is resumed. The nurse confirms that CPR is being administered effectively by

noting that :Options :

1 . The ratio of compressions to ventilations is 30:2 . 2 . Respirations are given at a rate of 12 breaths/min . 3 . The chest compressions are given at a depth of 1.5 to

2 inches . 4 . The carotid pulse is palpable with each compression .


Correct procedure for CPR with two rescuers includes a compression -to-ventilation ratio of 30:2 . With adults , compressions are performed at a depth of 1.5 to 2 inches . The 30:2 compression -ventilation ratio yields an effective rate of 12 breaths/min . With effective compressions , carotid pulsations should be present . At its best , CPR produces only 30% of the normal cardiac

output , so correct technique is vital . 149 -Question :

A nurse is assessing the client ’s condition after cardioversion. Which of the following observations would

be of highest priority to the nurse ?Options :

1 . Status of airway 2 . Oxygen flow rate

3 . Level of consciousness 4 . Blood pressure


Nursing responsibilities after cardioversion include maintenance of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and arrhythmia detection. Airway, however, is always the

highest priority .

150 -Question :A home health nurse makes a home visit to a client who has an implantable cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and arrhythmias with the client. Which client statement

indicates that further teaching is necessary ?Options :

1“ . If I feel an internal defibrillator shock, I should sit down” .

2“ . I can stop taking my antiarrhythmic medicine now, because I have a pacemaker” .

3“ . My wife knows how to call the emergency medical services if I need it” .

4“ . I won ’t be able to have a magnetic resonance imaging test” .Answer :2 . Rationale :

Clients with an ICD usually continue to receive antiarrhythmic medications after discharge from the hospital. The nurse should stress the importance of continuing to take these medications as prescribed. The nurse should provide clear instructions about the purposes of the medications, dosage schedule, and side effects to report . Options 1 , 3 , and 4 are correct statements regarding this implantable device

151 -Question :A client with complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of

pacemaker spikes :Options :

1 . Just after each T wave 2 . Before each QRS complex 3 . Just after each P wave

4 . Before each P wave Answer :2 . Rationale :

If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted. A demand pacemaker fires only when needed and should therefore discharge only when no electrical activity is occurring in the client ’s own

heart .152 -Question :

A client complains of calf tenderness. On assessment, the nurse notes the presence of Homans ’sign. The nurse next

assesses the client for :Options :

1 . Coolness and pallor of the affected limb 2 . Diminished distal peripheral pulses

3 . Increased calf circumference 4 . Bilateral edema


The client with thrombophlebitis, also known as deep vein

thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, Homans ’sign, and increased calf circumference in the affected extremity. Pedal pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often, thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a

complication .153 -Question :

A nurse is implementing a plan of care for a client with deep vein thrombosis of the right leg. Which intervention would be inappropriate for the nurse to include in

delivering care to this client? Options :1 . Elevation of the right leg

2 . Ambulation in the hall twice per shift 3 . Application of moist heat to the right leg

4 . Administration of acetaminophen (Tylenol) Answer :2 . Rationale :

Standard management of the client with deep vein thrombosis includes bed rest for possibly 5 to 7 days , limb elevation, relief of discomfort with warm moist heat and analgesics as needed, anticoagulant therapy, and monitoring for signs of pulmonary embolism. Ambulation is contraindicated, because it increases the likelihood of dislodgment of the tail of the thrombus, which could

travel to the lungs as a pulmonary embolism .154 -Question :

A client has been diagnosed with thromboangiitis obliterans (Buerger ’s disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to

refer the client to a :Options :

1 . Medical social worker 2 . Dietitian

3 . Smoking cessation program 4 . Pain management clinic


Buerger ’s disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger ’s disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking cessation program may be helpful for many clients. For many clients with Burger ’s

disease, symptoms are relieved or alleviated once smoking stops . Options 1 , 2 , and 4 are not specifically associated with the lifestyle changes required in this

disorder .155 -Question :

A home health nurse is visiting a client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this

surgery ?Options :

1“ . I threw away my straight razor and bought an electric razor” .

2“ . I have to go to the bathroom frequently because of my medication” .

3“ . I need to count my pulse every day” .4“ . I have to do deep breathing exercises every 2

hours” . Answer :1 . Rationale :

Prosthetic valves require long-term anticoagulation to prevent clots from forming on the “foreign “tissue implanted in the client ’s body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding , such as use of straight razors . Options 2 , 3 , and 4 are not specifically related to postoperative care after prosthetic valve replacement . Option 2 relates to a client taking a diuretic . Option 3 relates to a client with a pacemaker. Option 4 is

necessary in the immediate postoperative period . .156-Question :

A nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which of the following items would be inappropriate for the nurse to include on a list of

suggestions for the client ?Options :

1 . Cut down on the amount of fats consumed in the diet .2 . Use a heating pad on the legs to aid vasodilation .3 . Walk each day to increase circulation to the legs .

4 . Be careful not to injure the legs or feet .Answer :2 . Rationale :

Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Application of a heating pad directly to the extremity is contraindicated. The affected extremity may have

decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and

nutritional requirements of the tissue even further .157 -Question :

A home health nurse visits a client recovering from cardiogenic shock secondary to an anterior myocardial infarction and provides home care instructions to the client. Which statement by the client indicates an

understanding of these home care measures ?Options :

1“ . I wear a medical identification bracelet” .2“ . I have planned periods of rest at 10 AM and 3 PM

daily” . 3“ . I ’ve lost four pounds since discharge” .

4“ . My daily pulse has remained between 65 and 80 beats a minute” .


The client recovering from cardiogenic shock secondary to a myocardial infarction will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated myocardial infarction. The complication of cardiogenic shock will increase recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing . Options 1 , 3 , and 4 are not related to the instructions needed after this diagnosis.

158 -Question :A client who had coronary artery bypass surgery states to the home health nurse: “I get so frustrated. I can ’t even do my gardening. ”The nurse assesses the client for activity level since the surgery. Which client statement

indicates a need for further teaching ?Options :

1“ . I plan regular rest periods during the day” .2“ . I pace my activities throughout the day” .

3“ . I avoid outdoor physical activity during the heat of the day” .

4“ . I try to walk immediately after lunch, after I ’ve finished my morning house cleaning” .Answer: 4 . Rationale :

Exercise is an integral part of the rehabilitation program. It is necessary for optimal physiological functioning and psychological well-being. Postoperative physical rehabilitation must be progressive with planned periods of rest. Exercise tolerance is judged by the

client ’s response, such as heart rate and endurance . Options 1 , 2 , and 3 identify appropriate client activities . Option 4 lacks planned periods of rest, and the client has grouped too many activities in a brief period of time, which will decrease endurance. Also, exercise after meals can decrease the client ’s tolerance because of shunting of blood to the gastrointestinal

tract for digestion .159 -Question :

A client in cardiogenic shock has a pulmonary artery catheter (Swan-Ganz type) placed. The nurse would interpret that the client is most unstable if which of the following cardiac output (CO) and pulmonary capillary

wedge pressure (PCWP) readings were obtained ?Options :

1 . CO 5 L/min , PCWP low 2 . CO 2 L/min , PCWP low 3 . CO 4 L/min , PCWP high 4 . CO 3 L/min , PCWP high


The normal cardiac output is 4 to 7 L/min . With cardiogenic shock , the CO falls below normal because of failure of the heart as a pump. The PCWP, however, rises because it is a reflection of the left ventricular end-

diastolic pressure, which rises with pump failure .160 -Question :

A client in cardiogenic shock had an intra- aortic balloon pump inserted 24 hours earlier via the left femoral approach. The nurse notes that the client ’s left foot is cool and mottled, and the left pedal pulse is weak. Which of the following is an appropriate

intervention by the nurse ?Options :

1 . Call the physician immediately .2 . Re- evaluate the neurovascular status in 1 hour .

3 . Increase the rate of intravenous nitroglycerin that is infusing .

4 . Document these findings, which are expected because of the catheter size .Answer :1 . Rationale :

The nursing interventions for the client with an intra-aortic balloon pump are the same as for any client who has had cardiovascular surgery. The peripheral circulation to the affected limb is monitored for signs of occlusion, such as coolness, mottling, pain, tingling, and decreased or absent distal pulse. Adverse changes are

reported immediately .

161 -Question :A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which of the following chambers of the heart as primarily

responsible for the client ’s symptoms ?Options :

1 . Left atrium 2 . Left ventricle

3 . Right atrium 4 . Right ventricle


Hypertension increases the workload of the left ventricle, because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time, this causes the left ventricle to fail, leading to signs and symptoms of heart failure. Left-sided heart failure is characterized by pulmonary signs and symptoms, because the lungs lie behind the left side of the heart from the perspective of circulation . Therefore options 1 , 3 , and 4 are

incorrect . .162 -Question :

A client has experienced a myocardial infarction. The nurse caring for the client understands that the client ’s chest pain is due to tissue hypoxia in which of the

following layers of the heart ?Options :

1 . Parietal pericardium 2 . Visceral pericardium

3 . Myocardium 4 . Endocardium


The myocardial layer of the heart is damaged when the client experiences a myocardial infarction. This is the middle layer that contains the striated muscle fibers responsible for the contractile force of the heart. The endocardium is the thin inner layer of cardiac tissue. The parietal pericardium and visceral pericardium are outer layers that protect the heart from injury and

infection .163 -Question :

A client is admitted to the hospital with a diagnosis of mitral stenosis. The nurse caring for the client understands that the narrowing of this valve impedes

circulation of blood from the :Options :

1 . Left atrium to left ventricle 2 . Left ventricle to aorta

3 . Right atrium to right ventricle 4 . Right ventricle to pulmonary artery


The mitral valve separates the left atrium from the left ventricle . Options 2 , 3 , and 4 describe the aortic ,

tricuspid, and pulmonic valves, respectively .164 -Question :

A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse caring for the client understands that the failure of the aortic valve to close completely allows blood to flow retrograde from:Options :

1 . The left ventricle to the left atrium 2 . The aorta to the left ventricle

3 . The right ventricle to the right atrium 4 . The pulmonary artery to the right ventricle


The aortic valve separates the aorta from the left ventricle . Options 1 , 3 , and 4 describe the mitral ,

tricuspid, and pulmonic valves, respectively .165 -Question :

A hospitalized client is experiencing a decrease in blood pressure. The nurse caring for the client anticipates that this change will have which of the following primary

effects on the client ’s heart? Options :1 . Increased resistance to electrical stimulation

2 . Decreased heart rate 3 . Increased contractility

4 . Decreased myocardial blood flow Answer: 4 . Rationale :

The primary effect of a decreased blood pressure is reduced blood flow to the myocardium. This in turn decreases the oxygenation to cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase in response to this change, not decrease. The effects of tissue ischemia will lead to

decreased contractility over time .166 -Question :

A hospitalized client ’s serum calcium level is 7.9 mg/dL . The nurse is immediately concerned , knowing that this

level could ultimately lead to :Options :

1 . High blood pressure

2 . Stroke 3 . Cardiac arrest

4 . Urinary stone formation Answer :3 . Rationale :

The normal calcium level is 8.6 to 10 mg/dL . A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization, and move back during repolarization . Depolarization is responsible for cardiac contraction . Options 1 and 2 are unrelated to calcium levels. Elevated calcium levels can lead to

urinary stone formation .167 -Question :

A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for

initiating electrical impulses is the :Options :

1 . Atrioventricular (AV) node 2 . Bundle of His 3 . Purkinje fibers

4 . Sinoatrial (SA) node Answer :4 . Rationale :

The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node, travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches, and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses

is called automaticity .168 -Question :

A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which of the following responses by the student indicates a need to further research anatomy and physiology related

to the heart ?Options :

1“ . The coronary arteries branch from the aorta” .2“ . The coronary arteries supply the heart muscle with

blood” .3“ . The left coronary artery provides blood for the left

atrium and the left ventricle” .4“ . The left coronary artery supplies the right atrium

and right ventricle with blood” .Answer :4 . Rationale :

The left coronary artery divides into the anterior descending artery and the circumflex artery, providing blood for the left atrium and left ventricle. The right coronary artery supplies the right atrium and right

ventricle . Options 1 , 2 , and 3 are correct . 169 -Question :

A nurse is assigned to care for a client with a cardiac disorder and is told that the client has an alteration in cardiac output. The nurse plans care with the understanding that the heart normally sends out how many

liters of blood per minute to the body ?Options :

1 . 2 L/min 2 . 5 L/min 3 . 10 L/min 4 . 15 L/min


The cardiac cycle consists of contraction and relaxation of the heart muscle. The heart normally sends out about 5

L of blood every minute to the body . 170 -Question :

A nurse is caring for a client who has lost a significant amount of blood as a result of complications of a surgical procedure. The nurse understands that which of the following client assessments will provide the

earliest indication of new decreases in fluid volume ?Options :

1 . Pulse rate 2 . Blood pressure (BP) 3 . Assessment for edema

4 . Lung auscultation for crackles Answer :1 . Rationale :

The cardiac output is determined by the volume of the circulating blood, the pumping action of the heart, and the tone of the vascular bed. Early decreases in fluid volume are compensated for by an increase in the pulse rate . Options 3 and 4 indicate an increase in fluid volume . Although the BP will decrease , it is not the

earliest indicator .171-Question :

A nurse is preparing to take an apical pulse on an

assigned client. The nurse places the diaphragm of the stethoscope over which cardiac site ?Options :

1 . Right atrium 2 . Right ventricle

3 . Mitral area 4 . Pulmonic valve


The diaphragm of the stethoscope is placed over the skin at the mitral area to listen to the apical pulse. S 1 (lub) and S2 (dub) should be distinguished . The pulse

should be counted for a full minute . 172 -Question :

A male client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. A nurse exercising nearby cautions him to check the pulse on only one side,

primarily because :Options :

1 . It is unnecessary to use both hands .2 . Feeling dual pulsations may lead to an incorrect

measurement .3 . The client could occlude the trachea .

4 . The heart rate and blood pressure could drop .Answer: 4 . Rationale :

Applying pressure to both carotid arteries at the same time is contraindicated. Excess pressure to the baroreceptors in the carotid vessels could cause the heart rate and blood pressure to reflexively drop. In addition, the manual pressure could interfere with the flow of blood to the brain, causing possible dizziness

and syncope .173 -Question :

A nursing student who is researching a medication at the nursing station asks the registered nurse (RN) what an α 1 - adrenergic receptor is . The RN responds by telling

the student that these receptors are found primarily in :Options :

1 . The heart, and when stimulated cause an increase in heart rate, atrioventricular (AV) node conduction, and contractility

2 . Arterial and bronchial walls, and when stimulated cause vasodilation and bronchodilation 3 . The peripheral arteries and veins, and when stimulated cause vasoconstriction

4 . Several tissues, and when stimulated cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation


Found in the peripheral arteries and veins, α 1 - adrenergic receptors cause a powerful vasoconstriction when stimulated . Options 1 , 2 , and 4 describe β 1 - ,

β2- , and α2- adrenergic receptors , respectively . 174 -Question :

A nurse reading the operative record for a client who had cardiac surgery notes that the client ’s cardiac output immediately after surgery was 3.6 L/min . The nurse

interprets that this measurement is : Options :1 . Above the normal range 2 . In the high-normal range

3 . In the low-normal range 4 . Below the normal range


The normal cardiac output for the adult can range from 4 to 8 L/min and varies greatly with body size . The heart

normally pumps 5 L of blood every minute . 175-Question :

A nurse who is auscultating a 56-year- old client ’s apical heart rate before administering digoxin (Lanoxin) notes that the heart rate is 52 beats/min . The nurse

interprets this heart rate as : Options :

1 . Normal, because of the client ’s age 2 . Normal, because this is the reason the client is

receiving digoxin 3 . Normal, as a result of the effects of digoxin

4 . Abnormal, requiring further assessment Answer :4 . Rationale :

The normal heart rate is 60 to 100 beats/min in an adult . On auscultating a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the physician. Options 1 , 2 , and 3 are incorrect because the heart rate of 52

beats/min is not normal . 176-Question :

A male client who is beginning an exercise program asks the nurse why his heart “feels like it ’s pounding ”when he is exercising vigorously. In formulating a response, the nurse understands that this is due to the client ’s

need for an increased :Options :

1 . Pulse rate 2 . Stroke volume

3 . Cardiac output 4 . Cardiac index


The client ’s symptoms are the direct result of the body ’s attempt to meet the metabolic demands of the body during exercise. An adequate cardiac output is needed to maintain perfusion to the vital organs of the body. With exercise, these demands increase, and the heart must beat faster (increased heart rate) and harder (increased stroke volume) to achieve this. Cardiac index is an artificial number used to determine the adequacy of the cardiac output for a given individual. It is calculated

by adjusting the cardiac output by body surface area .177 -Question :

A nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The physician tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse interprets that the physician is referring to which of the following

arteries ?Options :

1 . Left anterior descending coronary artery (LAD) 2 . Right coronary artery (RCA)

3 . Circumflex coronaryartery 4 . Posterior descending coronary artery (PDA)


The LAD bifurcates from the left main coronary artery to supply the anterior wall of the left ventricle and a few other structures. The RCA supplies the right side of the heart, including the atrium and ventricles. The circumflex coronary artery bifurcates from the left coronary artery, and supplies the left atrium and the lateral wall of the left ventricle. The PDA supplies the

posterior wall of the heart .178-Question :

A nurse is assigned to the care of a client hospitalized with a diagnosis of hypothermia. The nurse anticipates that the client will exhibit which of the following vital

signs ?Options :

1 . Increased heart rate and increased blood pressure 2 . Increased heart rate and decreased blood pressure 3 . Decreased heart rate and increased blood pressure 4 . Decreased heart rate and decreased blood pressure

Answer :4 .

Rationale :Hypothermia decreases the heart rate and blood pressure because the metabolic needs of the body are reduced in this condition. With fewer metabolic needs, the workload of the heart decreases, with drops in both the heart rate and the blood pressure.

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Exam 5