Part II    Care of the adult

3 Cardiovascular disorders 33

4 Hematologic & immune disorders 71

5 Respiratory disorders 95

6 Neurosensory disorders 135

7 Musculoskeletal disorders 169

8 Gastrointestinal disorders 197

9 Endocrine disorders 223

10 Genitourinary disorders 251

11 Integumentary disorders 279

1. A client's electrocardiogram (ECG) is showing ST elevation in Leads V2, V3, and V4. Which artery is most likely to be occluded?

1. Circumflex artery2. Internal mammary artery3. Left anterior descending artery4. Right coronary artery

2. A nurse on a telemetry unit teaches a student nurse how coronary arteries primarily receive blood flow. It would be most important for the nurse to emphasize that most of the blood flow to coronary arteries is supplied during which of the following?

1. During inspiration2. During diastole3. During expiration4. During systole

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3. Which of the following illnesses, if stated by a client, would indicate that he understands the leading cause of death in the United States?

1. Cancer2. Coronary artery disease (CAD)3. Liver failure4. Renal failure4. Which condition most commonly results in coronary artery disease (CAD)?

1. Atherosclerosis2. Diabetes mellitus3. Myocardial infarction (MI)4. Renal failure

5. A nurse describes atherosclerosis for client education. Which of the following statements, if made by the client, requires additional teaching?

1. Plaques obstruct the coronary artery.2. Plaques obstruct the vein.3. Hardened vessels can't dilate to allow blood to flow through.4. Atherosclerosis can cause angina.

6. Which risk factor for coronary artery disease is non-modifiable?

1. Cigarette smoking2. Diabetes mellitus3. Heredity4. Hypertension

7. Exceeding which serum cholesterol level significantly increases the risk of coronary artery disease (CAD)?

1. 100 mg/dl2. 150 mg/dl3. 175 mg/dl4. 240 mg/dl

8. Which action is the first priority of care for a client exhibiting signs

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and symptoms of coronary artery disease?

1. Decrease anxiety.2. Enhance myocardial oxygenation.3. Administer sublingual nitroglycerin.4. Educate the client about his symptoms.

9. Medical treatment of coronary artery disease (CAD) includes which procedure?

1. Cardiac catheterization2. Coronary artery bypass surgery3. Oral medication administration4. Percutaneous transluminal coronary angioplasty

10. A client's electrocardiogram shows ST elevation in leads II, III, and aVF, suggesting occlusion of the right coronary artery. Which area of the heart is experiencing an infarction?

1. Anterior2. Apical3. Inferior4. Lateral

11. Which is the most common symptom of myocardial infarction (MI)?

1. Chest pain2. Dyspnea3. Edema4. Palpitations

12. Which landmark is the correct one for obtaining an apical pulse?

1. Left fifth intercostal space, midaxillary line2. Left fifth intercostal space, midclavicular line3. Left second intercostal space, midclavicular line4. Left seventh intercostal space, midclavicular line

13. Which system is the most likely origin of pain the client describes

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as knifelike chest pain that increases in intensity with inspiration?

1. Cardiac2. Gastrointestinal3. Musculoskeletal4. Pulmonary14. While assessing a client's heart sounds, a murmur is heard at the second left intercostal space along the left sternal border. Which valve is most likely involved?

1. Aortic2. Mitral3. Pulmonic4. Tricuspid

15. Which blood test is the best indicator for myocardial injury?

1. Lactate dehydrogenase (LD)2. Complete blood count (CBC)3. Troponin I4. Creatine kinase (CK)

16. What is the primary reason for administering morphine to a client with a myocardial infarction?

1. To sedate the client2. To decrease the client's pain3. To decrease the client's anxiety4. To decrease oxygen demand on the client's heart

17. In caring for a client with cardiac problems, the nurse must know that the condition most likely responsible for myocardial infarction (MI) is which of the following?

1. Aneurysm2. Heart failure3. Coronary artery thrombosis4. Renal failure

18. What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)?

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1. Chloride2. Digoxin3. Potassium4. sodium

19. In order to anticipate problems in a client following a myocardial infarction (MI), the nurse should understand that which type of physiological changes will increase serum glucose levels and free fatty acid production?

1. Electrophysiologic2. Hematologic3. Mechanical4. Metabolic

20. Which complication is indicated by a third heart sound (S3)?

1. Ventricular dilation2. Systemic hypertension3. Aortic valve malfunction4. Increased atrial contractions

21. After an anterior-wall myocardial infarction (MI), which problem is indicated by auscultation of crackles in the lungs?

1. Left-sided heart failure2. Pulmonic valve malfunction3. Right-sided heart failure4. Tricuspid valve malfunction

22. A client who is being evaluated for myocardial infarction (MI) asks the nurse which diagnostic tool is most commonly used to determine the location of myocardial damage. Which of the following would be the best response by the nurse?

1. Cardiac catheterization2. Cardiac enzymes3. Echocardiogram4. Electrocardiogram (ECG)

23. What is the first intervention for a client experiencing myocardial

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infarction (MI)?

1. Administer morphine.2. Administer oxygen.3. Administer sublingual nitroglycerin.4. Obtain an electrocardiogram (ECG).

24. What is the most appropriate nursing response to a myocardial infarction (MI) client who is fearful of dying?

1. “Tell me about your feelings right now.”2. “When the doctor arrives, everything will be fine.”3. “This is a bad situation, but you'll feel better soon.”4. “Please be assured we're doing everything we can to make you

feel better.”

25. Which class of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

1. Beta-adrenergic blockers2. Calcium channel blockers3. Opioids4. Nitrates

26. What is the most common complication of a myocardial infarction (MI)?

1. Cardiogenic shock2. Heart failure3. Arrhythmias4. Pericarditis

27. With which disorder is jugular vein distention most prominent?

1. Abdominal aortic aneurysm2. Heart failure3. Myocardial infarction (MI)4. Pneumothorax

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28. In what position should the nurse place the head of the bed to obtain the most accurate reading of jugular vein distention?

1. High Fowler's2. Raised 10 degrees3. Raised 30 degrees4. supine

29. A client is ordered to start receving digoxin 0.25 mg P.O. Which parameter should be checked first before administering digoxin?

1. Apical pulse2. Blood pressure3. Radial pulse4. Respiratory rate

30. A client complains that he sees a green halo around lights. Upon reviewing the client's medication list, the nurse determines that this is most likely caused by a high level of which medication?

1. Digoxin2. Furosemide (Lasix)3. Metoprolol (Lopressor)4. Enalapril (Vasotec)

31. Which symptom is most commonly associated with left-sided heart failure?

1. Crackles2. Arrhythmias3. Hepatic engorgement4. Hypotension

32. In which disorder would the nurse expect to assess sacral edema in a bedridden client?

1. Diabetes mellitus2. Pulmonary emboli3. Chronic kidney disease

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4. Right-sided heart failure

33. Which symptom might a client with rightsided heart failure exhibit?

1. Adequate urine output2. Polyuria3. Oliguria4. Polydipsia

34. Which of the following drug classes should be administered to a client with heart failure to maximize cardiac performance by increasing ventricular contractility?

1. Beta-adrenergic blockers2. Calcium channel blockers3. Diuretics4. Inotropic agents

35. The heart rhythm of a client who has experienced cardiac arrest and is receiving cardiopulmonary resuscitation (CPR) deteriorates to ventricular fibrillation. Which action should the nurse perform first?

1. Administer 1 mg of epinephrine I.V.2. Defibrillate with 360 joules.3. Continue CPR.4. Administer vasopressin 40 units I.V.

36. Which condition is most closely associated with weight gain, nausea, and a decrease in urine output?

1. Angina pectoris2. Cardiomyopathy3. Left-sided heart failure4. Right-sided heart failure

37. A client's rhythm strip shows a regular rhythm with atrial and ventricular rates of 70 beats/minute, a PR interval of 0.24, and a QRS

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duration of 0.08 second. The nurse interprets this rhythm as:

1. normal sinus rhythm (NSR).2. NSR with 1-degree atrioventricular (AV) block.3. sinus arrhythmia.4. accelerated junctional rhythm.

38. A client with abdominal aortic aneurysm asks the nurse in which area are abdominal aortic aneurysms most commonly located. Which of the following would be the nurse's best response?

1. Distal to the iliac arteries2. Distal to the renal arteries3. Adjacent to the aortic arch4. Proximal to the renal arteries39. While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. This may indicate which condition?

1. Abdominal aortic aneurysm2. Enlarged spleen3. Gastric distention4. Gastritis

40. What is the most common symptom in a client with abdominal aortic aneurysm?

1. Abdominal pain2. Diaphoresis3. Headache4. Upper back pain

41. Which symptom usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

1. Abdominal pain2. Absent pedal pulses3. Angina4. Lower back pain

42. What is the definitive test used to diagnose an abdominal aortic aneurysm?

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1. Abdominal X-ray2. Aortogram3. Computed tomography (CT) scan4. Ultrasound

43. Which complication is of greatest concern when caring for a preoperative abdominal aortic aneurysm client?

1. Hypertension2. Aneurysm rupture3. Cardiac arrhythmias4. Diminished pedal pulses

44. Which precaution should a nurse take when caring for a client with a myocardial infarction who has received a thrombolytic agent?

1. Avoid puncture wounds2. Monitor potassium levels.3. Maintain a supine position.4. Encourage fluids.

45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

1. Right upper quadrant2. Directly over the umbilicus3. Middle lower abdomen to the left of the midline4. Middle lower abdomen to the right of the midline

46. Which condition is linked to more than 50% of clients with abdominal aortic aneurysms?

1. Diabetes mellitus2. Hypertension3. Peripheral vascular disease4. syphilis

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47. When auscultating the abdominal region of a client with abdominal aortic aneurysm, the nurse hears a bruit. Which of the following indicates the significance of this finding?

1. It is a normal finding.2. It reflects a partial arterial occlusion.3. It indicates a collection of fluid in the lungs.4. It shows an inflammation of the peritoneal surface.

48. Which group of symptoms indicates a ruptured abdominal aortic aneurysm?

1. Lower back pain, increased blood pressure, decreased red blood cell (RBC) count, increased white blood cell (WBC) count

2. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count

3. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased WBC count

4. Intermittent lower back pain, decreased blood pressure, decreased RBC count, increased WBC count

49. Which complication of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?

1. Hernia2. stage 1 pressure ulcer3. Retroperitoneal rupture at the repair site4. Rapid expansion of the aneurysm50. Which genetic disease is most closely linked to aneurysm?

1. Cystic fibrosis2. Hemophilia3. Marfan's syndrome4. sickle cell anemia

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51. What is the best treatment for a ruptured aneurysm?

1. Antihypertensive medication administration2. Aortogram3. Beta-adrenergic blocker administration4. Surgical intervention52. When teaching a client about cardiomyopathy, which statement by the client indicates that further teaching is needed related to the causes of cardiomyopathy?

1. “It is caused by a plaque in the arteries.”2. “It is caused by a virus.”3. “It is caused by bacteria.”4. “It is caused by certain drugs.”

53. The nurse is counseling a client on types of cardiomyopathy associated with childbirth. The nurse should teach the client about which of the following?

1. Dilated2. Hypertrophic obstructive3. Myocarditis4. Restrictive54. The nurse is reviewing a client's echocardiogram, which states, “hypertrophy of the ventricular septum.” The client should be further evaluated for which type of cardiomyopathy?

1. Congestive2. Dilated3. Hypertrophic obstructive4. Restrictive

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55. Which recurring condition most commonly occurs in clients with cardiomyopathy?

1. Heart failure2. Diabetes mellitus3. Myocardial infarction (MI)4. Pericardial effusion

56. While assessing a client with dilated cardiomyopathy, the nurse notices that the electrocardiogram (ECG) rhythm no longer has any P waves, only a fine wavy line. The ventricular rhythm is irregular with a QRS duration of 0.08 second. The heart rate is 110 beats/minute. The nurse interprets this rhythm as:

1. atrial fibrillation.2. ventricular fibrillation.3. atrial flutter.4. sinus tachycardia.57. Dyspnea, cough, weight gain, weakness, and edema are classic signs and symptoms of which condition?

1. Pericarditis2. Hypertension3. Myocardial infarction (MI)4. Heart failure

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58. In which type of cardiomyopathy does cardiac output remain normal?

1. Dilated2. Hypertrophic obstructive3. Obliterative4. Restrictive59. Which cardiac condition does a fourth heart sound (S4) indicate?

1. Dilated aorta2. Normally functioning heart3. Decreased myocardial contractility4. Failure of the ventricle to eject all the blood during systole

60. Which class of drugs is most widely used in the treatment of cardiomyopathy?

1. Anticoagulants2. Beta-adrenergic blockers3. Calcium channel blockers4. Nitrates61. If medical treatment for cardiomyopathy fails, the nurse should prepare the client for which of the following procedures?

1. Cardiac catheterization2. Coronary artery bypass graft (CABG)3. Heart transplantation4. Intra-aortic balloon pump (IABP)62. Which condition is associated with a predictable level of pain that occurs as a result of physical or emotional stress?

1. Anxiety2. stable angina

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3. Unstable angina4. Variant angina63. After undergoing a cardiac catheterization, a client has a large puddle of blood under his buttocks. Which step should the nurse take first?

1. Call for help.2. Obtain vital signs.3. Ask the client to “lift up.”4. Apply gloves and assess the groin site.

64. A client with angina pectoris has an electrocardiogram (ECG) performed during an episode of chest pain. Which change on the ECG indicates myocardial ischemia?

1. Increased QRS duration2. shortened PR interval3. Pathological Q-wave formation4. T-wave inversion65. Which type of angina is most closely associated with an impending myocardial infarction (MI)?

1. Variant angina2. Chronic stable angina3. Microvascular angina4. Unstable angina

66. A client with angina pectoris comes to the emergency room.

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Which of the following drugs can the nurse expect to administer as the drug of choice?

1. Aspirin2. Furosemide (Lasix)3. Nitroglycerin4. Nifedipine (Procardia)67. While assessing a client diagnosed with angina, the client asks what causes it. Which of the following responses by the nurse would be the most appropriate?

1. Increased preload2. Decreased afterload3. Coronary artery spasm4. Inadequate oxygen supply to the myocardium68. A nurse is preparing a client for cardiac catheterization. Which assessment is most important prior to the procedure?

1. Weight and height2. Allergy to iodine or shellfish3. Apical heart rate4. Cardiac rhythm69. The nurse is teaching a client about angina. Which statement by the nurse would be most accurate regarding the primary treatment goal?

1. Reversal of ischemia2. Reversal of infarction3. Reduction of stress and anxiety4. Reduction of associated risk factors

70. A 59-year-old female client is experiencing chest pain at rest that is unresponsive to nitroglycerine. The physician diagnoses unstable angina and alerts the nurse that the client will require treatment with immediate surgical intervention. Which treatment is most suitable?

1. Cardiac catheterization

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2. Echocardiogram3. Heart transplantation4. Percutaneous transluminal coronary angioplasty (PTCA)71. Which intervention should be the first priority when treating a client experiencing chest pain while walking?

1. Sit the client down.2. Get the client back to bed.3. Obtain an electrocardiogram (ECG).4. Administer sublingual nitroglycerin.72. The nurse is assessing a client with heart failure. The client is experiencing tachycardia, decreased blood pressure, and decreased peripheral pulses. The nurse interprets these symptoms as indicating which condition?

1. Anaphylactic shock2. Cardiogenic shock3. Distributive shock4. Myocardial infarction (MI)73. Which of the following conditions may result in cardiogenic shock?

1. Acute myocardial infarction (MI)2. Coronary artery disease (CAD)3. Decreased hemoglobin level4. Hypotension

74. Which percentage represents the amount of damage the myocardium must sustain before signs and symptoms of cardiogenic shock develop?

1. 10°%2. 25%3. 40%4. 90%75. Which of the following parameters increases as myocardial oxygen consumption increases?

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1. Preload, afterload, and cerebral blood flow2. Preload, afterload, and renal blood flow3. Preload, afterload, contractility, and heart rate4. Preload, afterload, cerebral blood flow, and heart rate76. Which factor would be most useful in detecting a client's risk of developing cardiogenic shock?

1. Decreased heart rate2. Decreased cardiac index3. Decreased blood pressure4. Decreased cerebral blood flow77. Which symptom is one of the earliest signs of cardiogenic shock?

1. Cyanosis2. Decreased urine output3. Presence of fourth heart sound (S4)4. Altered level of consciousness

78. Which diagnostic study can determine when cellular metabolism becomes anaerobic and when pH decreases?

1. Arterial blood gas (ABG) levels2. Complete blood count (CBC)3. Electrocardiogram (ECG)4. Lung scan79. What is the first treatment goal for cardiogenic shock?

1. Correct hypoxia2. Prevent infarction3. Correct metabolic acidosis4. Increase myocardial oxygen supply80. Which drug is most commonly used to treat cardiogenic shock?

1. Dopamine2. Enalapril (Vasotec)3. Furosemide (Lasix)

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4. Metoprolol (Lopressor)81. Which is the most important instrument used as a diagnostic and monitoring tool for determining the severity of a shock state?

1. Arterial line2. Indwelling urinary catheter3. Electrocardiogram (ECG) monitor4. Pulmonary artery catheter

82. A client has a continuous blood pressure reading of 142/90 mm Hg. Into which classification does this reading fall according to the Seventh Joint National Committee (JNC 7) on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure?

1. Stage 2 hypertension2. Prehypertension3. Stage 1 hypertension4. Normal83. Which sound will be heard during the first phase of Korotkoff's sounds?

1. Disappearance of sounds2. Faint, clear tapping sounds3. A murmur or swishing sounds4. Soft, muffling sounds84. Which of the following is a key point to include when teaching the nursing assistant about the major determinant of diastolic blood pressure?

1. Baroreceptors2. Cardiac output3. Renal function4. Vascular resistance85. A nurse knows that kidneys play an important role in regulating blood pressure. When hypertension occurs, which responses by the kidneys help normalize blood pressure?

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1. The kidneys retain sodium and excrete water.2. The kidneys excrete sodium and excrete water.3. The kidneys retain sodium and retain water.4. The kidneys excrete sodium and retain water.

86. Which change would indicate the baroreceptors in the carotid artery walls and aorta are functioning?

1. Changes in blood pressure2. Changes in arterial oxygen tension3. Changes in arterial carbon dioxide tension4. Changes in heart rate87. The nurse is teaching a client about blood pressure and hormones. Which of the following responses indicates the client understands which hormone raises arterial pressure and promotes venous return?

1. Angiotensin I2. Angiotensin II3. Thyroid hormone4. Insulin

88. Which term is used to describe persistently elevated blood pressure with an unknown cause that accounts for approximately 90% of hypertension cases?

1. Accelerated hypertension2. Malignant hypertension

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3. Primary hypertension4. Secondary hypertension89. The nurse is assessing a client with hypertension. The nurse should be alert for which of the most common symptoms of hypertension?

1. Blurred vision2. Epistaxis3. Headache4. Peripheral edema

90. The bell of the stethoscope is most commonly placed over which artery to obtain a blood pressure measurement?

1. Brachial2. Brachiocephalic3. Radial4. Ulnar91. Which of the following statements, if made by the client, indicates an understanding of why furosemide (Lasix) is administered to treat hypertension?

1. It dilates peripheral blood vessels.2. It decreases sympathetic cardioacceleration.3. It inhibits the angiotensin-converting enzyme.4. It inhibits reabsorption of sodium and water in the loop of

Henle.92. A 52-year-old client with a history of hypertension has just had a total hip replacement. The physician orders hydrochlorothiazide 35 mg oral solution by mouth, once per day. The label on the solution reads hydrochlorothiazide 50 mg/5 milliliters. To administer the correct dose, how many milliliters should the nurse pour? Record your answer using one decimal place. _______ ml

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93. Which statement by the nurse accurately explains the need for a client with hypertension to obtain an annual eye exam?

1. “By examining your corneas, an ophthalmologist can visualize microvascular hemorrhages in your eyes.”

2. “By examining the fovea in your eyes, an ophthalmologist can visualize microvascular venous occlusions in your eyes.”

3. “By examining the retina in your eyes, an ophthalmologist can detect changes in the arteries in your eyes.”

4. “By examining the sclera of your eyes, an ophthalmologist can detect changes in the arteries in your eyes.”

94. Based on which of the following conditions would the nurse suspect the client has varicose veins?

1. Tunica media tear2. Intraluminal occlusion3. Intraluminal valvular compression4. Intraluminal valvular incompetence95. A nurse determines that a client with varicose veins understands the factor causing primary varicose veins when the client states which of the following?

1. Hypertension2. Pregnancy3. Thrombosis4. Trauma96. The nurse assessing a client for varicose veins would look for which commonly occurring symptom?

1. Fatigue and pressure2. Fatigue and cool feet3. Sharp pain and fatigue4. Sharp pain and cool feet

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97. While planning to teach a client with varicose veins, the nurse should include in the teaching plan that varicose veins most commonly occur in which type of vein?

1. Brachial2. Femoral3. Renal4. Saphenous98. Which condition is caused by increased hydrostatic pressure and chronic venous stasis?

1. Venous occlusion2. Cool extremities3. Nocturnal calf muscle cramps4. Diminished blood supply to the feet99. The nurse is providing discharge instructions for a client with varicose veins. The nurse determines the need for further teaching when the client states which of the following?

1. “Exercise will make me feel better.”2. “I have to elevate my legs.”3. “Lying down can relieve my symptoms.”4. “Wearing tight clothes will not affect me.”

100. Which test demonstrates the backward flow of blood through incompetent valves of superficial veins?

1. Trendelenburg's test2. Manual compression test3. Perthes' test4. Plethysmography101. The nurse should assess for what signs and symptoms in a client with secondary varicose veins?

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1. Pallor and severe pain2. Severe pain and edema3. Edema and pigmentation4. Absent hair growth and pigmentation102. The nurse should prepare a client for which treatment to eliminate varicose veins?

1. Ablation therapy2. Cold therapy3. Ligation and stripping4. Radiation

103. Which treatment is recommended for postoperative management of a client who has undergone ligation and stripping?

1. Sitting2. Bed rest3. Ice packs4. Elastic leg compression104. Which client is most at risk for developing deep vein thrombosis (DVT)?

1. A 62-year-old female recovering from a total hip replacement.2. A 35-year-old female 2 days postpartum.3. A 33-year-old male runner with Achilles tendonitis.4. An ambulatory 70-year-old male who's recovering from

pneumonia.

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105. Which complication of lower extremity deep vein thrombosis is manifested by dyspnea, chest pain, and diminished breath sounds?

1. Hemothorax2. Pneumothorax3. Pulmonary embolism4. Pulmonary hypertension106. Which term refers to the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply?

1. Embolus2. Hypercoagulability3. Venous stasis4. Venous wall injury

107. Which characteristic is typical of the pain associated with deep vein thrombosis (DVT)?

1. Dull ache2. No pain3. Sudden onset4. Tingling108. A client is admitted with deep vein thrombosis (DVT). Which of the following treatments would be most appropriate to relieve the pain?

1. Application of heat2. Bed rest3. Exercise4. Leg elevation109. Which term best describes the findings on cautious palpation of the vein in typical superficial thrombophlebitis?

1. Dilated2. Knotty3. Smooth

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4. Tortuous110. While assessing a client with deep vein thrombosis (DVT), which of the following terms indicates calf pain experienced by the client due to sharp dorsiflexion of the foot?

1. Dyskinesia2. Eversion3. Positive Babinski's reflex4. Positive Homans' sign

111. A client is admitted to the unit with intermittent claudication (cramplike pain in the calves). Which of the following responses by the nurse would most accurately explain the cause of the condition to the client?

1. Inadequate blood supply2. Elevated leg position3. Dependent leg position4. Inadequate muscle oxygenation112. The nurse should prepare a client with intermittent claudication to receive which medical treatment?

1. Analgesics2. Warfarin (Coumadin)3. Heparin4. Pentoxifylline (Trental)113. Which oral medication is administered to prevent further thrombus formation?

1. Warfarin (Coumadin)2. Heparin3. Furosemide (Lasix)4. Metoprolol (Lopressor)

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114. A nurse should place the client with pulmonary edema in which position to facilitate breathing?

1. Lying flat in bed2. Left side-lying3. In high Fowler's position4. In semi-Fowler's position115. Which blood gas abnormality is initially most suggestive of pulmonary edema?

1. Anoxia2. Hypercapnia3. Hyperoxygenation4. Hypocapnia116. A nurse is caring for a 78-year-old female client with sick sinus syndrome who's awaiting permanent pacemaker placement. Given this client's risk of decreased cardiac output, what assessment findings would indicate that she's experiencing an initial drop in cardiac output?

1. Decreased blood pressure2. Alteration in level of consciousness (LOC)3. Decreased blood pressure and diuresis4. Increased blood pressure and fluid volume117. Which action is the appropriate initial response to a client coughing up pink, frothy sputum?

1. Call for help.2. Call the physician.3. Start an I.V. line.4. Suction the client.

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118. Which precaution should a client be instructed to take after an episode of acute pulmonary edema?

1. Limit caloric intake.2. Restrict carbohydrates.3. Measure weight twice per day.4. Call the physician if there is weight gain of more than 3 lb (1.5

kg) in 1 day.119. The nurse knows that a 45-year-old client with severe hypertension will experience increased workload of the heart due to which of the following?

1. Increased afterload2. Increased cardiac output3. Overload of the heart4. Increased preload120. A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse teaches him that this medication has been ordered for which reason?

1. To promote diuresis2. To increase contractility3. To decrease contractility4. To reduce blood pressure121. A client with acute pulmonary edema caused by heart failure asks the nurse which area of the heart is usually damaged. The best response by the nurse would be which of the following?

1. Left atrium2. Right atrium3. Left ventricle4. Right ventricle

122. Which statement by a nurse to the health care aide best explains the need to promptly report changes in respiratory rate for a client diagnosed with heart failure?

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1. “Pulmonary edema, a life-threatening condition, can develop in minutes.”

2. “Severe acute respiratory syndrome (SARS) is a complication of heart failure.”

3. “Pneumonia is a consequence of inadequate ventilation with heart failure.”

4. “Pneumothorax, a life-threatening condition, can develop in minutes.”

123. The nurse evaluates her teaching by asking the student nurse which term is used to describe the amount of stretch on the myocardium at the end of diastole. Which of the following is most accurate?

1. Afterload2. Cardiac index3. Cardiac output4. Preload124. Which action should a nurse take when administering a new blood pressure medication to a client?

1. Administer the medication to the client without explanation.2. Inform the client of the new drug only if he asks about it.3. Inform the client of the new medication, its name, use, and the

reason for the change in medication.4. Administer the medication, and inform the client that the

physician will later explain the medication.

125. Antihypertensives should be used cautiously in clients already taking which other drug?

1. Ibuprofen (Advil)2. Diphenhydramine (Benadryl)3. Thioridazine4. Vitamins126. A 57-year-old client with a history of bronchial asthma is prescribed propranolol (Inderal) to control hypertension. Before

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administering propranolol, which action should the nurse take first?

1. Monitor apical pulse rate.2. Instruct the client to take the medication with food.3. Question the physician about the order.4. Caution the client to rise slowly when standing.

127. One hour after I.V. furosemide (Lasix) is administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect?

1. Hypocalcemia2. Hypermagnesemia3. Hypokalemia4. Hypernatremia128. A client has a reduced serum high-density lipoprotein (HDL) level and an elevated low-density lipoprotein (LDL) level. Which dietary modification is appropriate for this client?

1. Fiber intake of less than 10% of total calories daily2. Less than 40% of calories from fat3. Cholesterol intake of less than 300 mg daily4. Less than 7% of calories from saturated fat129. A paradoxical pulse occurs in a client who had coronary artery bypass graft (CABG) surgery 2 days ago. Which surgical complication should the nurse suspect?

1. Left-sided heart failure2. Aortic regurgitation3. Complete heart block4. Pericardial tamponade

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130. A 35-year-old client was admitted to the coronary care unit (CCU) 2 days ago with an acute myocardial infarction. Which action would breach client confidentiality?

1. The CCU nurse gives a verbal report to the nurse on the telemetry unit before transferring the client to that unit.

2. The CCU nurse notifies the on-call physician about a change in the client's condition.

3. The emergency department (ED) nurse calls up the latest electrocardiogram results to check the client's progress.

4. At the client's request, the CCU nurse updates the client's wife on his condition.

131. A client arriving in the emergency department (ED) is receiving cardiopulmonary resuscitation from paramedics, who are giving ventilations through an endotracheal (ET) tube that they placed in the client's home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of 55 beats/minute with a palpable pulse. Which action should the nurse take first?

1. Start an I.V. line and administer amiodarone, 300 mg I.V. over 10 minutes.

2. Check ET tube placement.3. Obtain an arterial blood gas (ABG) sample.4. Administer atropine, 1 mg I.V.

132. After unsuccessful cardiopulmonary resuscitation efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take?

1. Allowing the client's family to perform the ritualistic washing2. Doing nothing; the Burial Society will perform a ritual cleansing3. Doing nothing; only the family and close friends may touch the

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body4. Providing routine postmortem care133. A 63-year-old client has Prinzmetal's angina. To reduce the risk of coronary artery spasms, which type of medication is the physician most likely to prescribe?

1. Beta-adrenergic blocker2. Angiotensin-converting enzyme (ACE) inhibitor3. Inotropic vasodilator4. Calcium channel blocker

134. An 86-year-old client with heart failure is receiving furosemide (Lasix), 40 mg I.V. The physician orders 40 mEq of potassium chloride in 100 ml of dextrose 5% in water, to infuse over 4 hours. The client's most recent serum potassium level is 3.0 mEq/L. At which infusion rate should the nurse set the I.V. pump?

1. 25 ml/hour2. 10 ml/hour3. 100 ml/hour4. 50 ml/hour135. A nurse is planning discharge instructions for a client who is being treated for ventricular tachycardia. Which of the following rationales for including bananas in the client's diet would be most accurate?

1. Because bananas are high in carbohydrate2. Because bananas are high in potassium3. Because bananas are low in sodium4. Because bananas are high in fiber

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136. After cardiac surgery, a client's blood pressure measures 126/80 mm Hg. The nurse determines that mean arterial pressure (MAP) is:

1. 46 mm Hg.2. 80 mm Hg.3. 95 mm Hg.4. 90 mm Hg.137. A charge nurse is preparing client care assignments for the next shift. A client who underwent femoral-popliteal bypass surgery is scheduled to return from the postanesthesia care unit. Which staff member should receive this client?

1. Registered nurse with 1 year of experience2. Licensed practical nurse (LPN) with 5 years of experience3. Nursing assistant with 15 years of experience4. Charge nurse with 10 years of experience138. An 18-year-old client who recently had an upper respiratory infection is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis?

1. Erythema marginatum, subcutaneous nodules, and fever2. Tachycardia, finger clubbing, and a loud second heart sound (S2)3. Dyspnea, cough, and palpitations4. Dyspnea, fatigue, and syncope

139. A client with new onset of atrial fibrillation is receiving warfarin (Coumadin) to help prevent thromboemboli. The warfarin dosage will reach therapeutic levels when the International Normalized Ratio (INR) falls within which range?

1. 1 to 22. 1.5 to 2.53. 2 to 34. 2.5 to 3.5

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140. A 38-year-old client comes to the emergency department complaining that his heart “suddenly began to race.” After attaching him to the cardiac monitor, the nurse observes atrial tachycardia. Which rhythm strip characteristics indicate this arrhythmia?

1. Atrial rate greater than the ventricular rate, sawtooth P waves2. Irregular rhythm, indiscernible atrial rate, absent P waves3. Regular atrial and ventricular rhythms, rate of 123 beats/minute4. Regular atrial and ventricular rhythms, P wave hidden in the T

wave, rate of 210 beats/minute141. A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide?

1. “Eat foods high in potassium.”2. “Take daily potassium supplements.”3. “Discontinue sodium restrictions.”4. “Avoid salt substitutes.”142. A 23-year-old client develops cardiac tamponade when the car he was driving hits a telephone pole; he wasn't wearing a seat belt. The nurse helps the physician perform pericardiocentesis. Which outcome would indicate that pericardiocentesis has been effective?

1. Neck vein distention2. Pulsus paradoxus3. Increased blood pressure4. Muffled heart sounds143. A client admitted with angina complains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which action should the nurse take first?

1. Activate the resuscitation team.2. Open the client's airway.3. Check for breathing.4. Check for signs of circulation.

144. A 54-year-old client is admitted with an acute inferior-wall myocardial infarction (MI). During the admission interview, he says he

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stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which nursing diagnosis takes priority for this client?

1. Anxiety2. Risk for decreased cardiac tissue perfusion3. Acute pain4. Ineffective family therapeutic regimen management145. A client comes to the emergency department with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a blood pressure of 82/45 mm Hg, a heart rate of 120 beats/minute, and a respiratory rate of 38 breaths/minute. The client's medical history includes diabetes mellitus, hypertension, and heart failure. Which disorder should the nurse suspect?

1. Pulmonary edema2. Pneumothorax3. Cardiac tamponade4. Pulmonary embolus146. A 57-year-old client with acute arterial occlusion of the left leg undergoes an emergency embolectomy. Six hours later, the nurse isn't able to obtain pulses in his left foot using Doppler ultrasound. She immediately notifies the physician, who asks her to prepare the client for surgery. As the nurse enters the client's room to prepare him, he states that he won't have any more surgery. Which action is the best initial response by the nurse?

1. Explaining the risks of not having the surgery2. Notifying the physician immediately3. Notifying the nursing supervisor4. Recording the client's refusal in the nurses' notes

147. The nurse coming on duty receives the report from the nurse going off duty. Which client should the on-duty nurse assess first?

1. The 58-year-old client who was admitted 2 days ago with heart failure, blood pressure of 126/76 mm Hg, and a respiratory rate

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of 22 breaths/minute2. The 89-year-old client with end-stage right-sided heart failure,

blood pressure of 78/50 mm Hg, and a “Do not resuscitate” order

3. The 62-year-old client who was admitted 1 day ago with thrombophlebitis and is receiving I.V. heparin

4. The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving I.V. diltiazem (Cardizem)

148. When developing a teaching plan for a client with endocarditis, which point is most essential for the nurse to include?

1. “Report fever, anorexia, and night sweats to the physician.”2. “Take prophylactic antibiotics after dental work and invasive

procedures.”3. “Include potassium-rich foods in your diet.”4. “Monitor your pulse rate daily.”149. Which finding suggests that fluid resuscitation has been effective for a 23-year-old client admitted in hypovolemic shock?

1. Urine output of 15 ml/hour2. Urine output of 20 ml/hour3. Urine output of 25 ml/hour4. Urine output of 30 ml/hour150. A client is being monitored via telemetry using a 3 lead system. Which graphic shows the correct electrode positions to monitor modified chest lead 1 (MCL1)?.

151. An e1derly client has a history of aortic stenosis. Identify the area where the nurse should place the stethoscope to best hear the murmur.

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152. A client with deep vein thrombosis has an I.V. infusion of heparin sodium infusing at 1,500 units/hour. The concentration in the bag is 25,000 units/500 ml. How many milliliters should the nurse document as intake from this infusion for an 8-hour shift? Record your answer using a whole number.

_________________milliliters

153. The nurse suspects that her client is in cardiac arrest. According to the American Heart Association (AHA), she should perform the actions listed below. Order these actions in the sequence that the nurse should perform them.

1. Activate the emergency response team.2. Assess responsiveness.3. Call for a defibrillator.4. Provide two slow breaths.5. Assess pulse.6. Assess breathing.

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