Prep U Exam #1

Estudiar
The nurse is caring for an 82-year-old client. The nurse knows that changes in cardiac
structure and function occur in older adults. What is a normal change expected in the aging
heart of an older adult?

a) Decreased left ventricular ejection time

b) Decreased connective tissue in the SA and AV nodes and bundle branches
c) Thinning and flaccidity of the cardiac values
d) Widening of the aorta
d) Widening of the aorta
Which assessments should a nurse perform when caring for a client following a cardiac
catheterization? Select all that apply.

a) Monitor BP and pulse frequently.

b) Inspect pressure dressing for signs of bleeding.
c) Palpate the pulse in different locations.
d) Inspect the color in every extremity.
e) Palpate the insertion site for tenderness.
a) Monitor BP and pulse frequently.
b) Inspect pressure dressing for signs of bleeding
c) Palpate the pulse in different locations.
A critical care nurse is caring for a client with a pulmonary artery catheter in place. What does
this catheter measure that is particularly important in critically ill clients?

a) Pulmonary artery systolic pressure

b) Right ventricular afterload
c) Pulmonary artery pressure
d) Left ventricular preload
d) Left ventricular preload
Which of the following would be a factor that may decrease myocardial contractility?

a) Acidosis
b) Alkalosis
c) Sympathetic activity
d) Administration of digoxin (Lanoxin)
a) Acidosis
An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the
assessment, the nurse should be cognizant of what signs and symptoms of MI that are
particularly common in female clients? Select all that apply.
a) Shortness of breath
b) Chest pain
c) Anxiety
d) Indigestion
e) Nausea
d) Indigestion
e) Nausea
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse
should instruct the patient to do which of the following? Select all of the teaching points that
apply.

a) Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all
times and be accessible quickly, when needed.
b) Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed
between the teeth but not swallowed.
c) Keep the tablets at home on the kitchen counter or bedside table so they can be reached
quickly.
d) Renew the supply every 6 months.
e) Take the tablet in anticipation of any activity that can produce pain.
f) Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
b) Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed
between the teeth but not swallowed.
d) Renew the supply every 6 months.
e) Take the tablet in anticipation of any activity that can produce pain.
f) Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
After 2-hour onset of acute chest pain, the client is brought to the emergency department for
evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an
acute myocardial infarction at this time?

a) Troponin I
b) Myoglobin
c) WBC (white blood cell) count
d) C-reactive protein
b) Myoglobin
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia,
slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory
depression, the nurse suspects which electrolyte imbalance?

a) Hypokalemia
b) Hyperkalemia
c) Hypermagnesemia
d) Hypomagnesemia
c) Hypermagnesemia
A nurse is educating a client with coronary artery disease about nitroglycerin administration.
The nurse tells the client that nitroglycerin has what actions? Select all that apply.

a) Reduces myocardial oxygen consumption

b) Decreases the urge to use tobacco
c) Dilates blood vessels
d) Decreases ischemia
e) Relieves pain
a) Reduces myocardial oxygen consumption
c) Dilates blood vessels
d) Decreases ischemia
e) Relieves pain
What ECG findings does the nurse observe in a patient who has had a myocardial infarction
(MI)? (Select all that apply.)

a) An absent P wave
b) An abnormal Q wave
c) T-wave inversion
d) ST-segment elevation
e) Prolonged P-R interval
b) An abnormal Q wave
c) T-wave inversion
d) ST-segment elevation
The nurse is reviewing the laboratory results for a patient having a suspected myocardial
infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell
damage?

a) Alkaline phosphatase
b) Creatine kinase MB
c) Myoglobin
d) Troponin
b) Creatine kinase MB
A client presents to the emergency department reporting chest pain. Which order should the
nurse complete first?

a) 12-lead ECG
b) 2 L oxygen via nasal cannula
c) Troponin level
d) Aspirin 325 mg orally
a) 12-lead ECG
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) Assess the client's level of pain and administer prescribed analgesics.

b) Assess the client's level of anxiety and provide emotional support.
c) Prepare the client for pulmonary artery catheterization.
d) Ensure that the client's family is kept informed of the client's status.
a) Assess the client's level of pain and administer prescribed analgesics.
A client has a blockage in the proximal portion of a coronary artery. After learning about
treatment options, the client decides to undergo percutaneous transluminal coronary
angioplasty (PTCA). During this procedure, the nurse expects to administer an:

a) antibiotic.
b) anticoagulant.
c) antihypertensive.
d) anticonvulsant.
b) anticoagulant.
A client with chest pain arrives in the emergency department and receives nitroglycerin,
morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome.
When the client arrives on the unit, vital signs are stable and the client does not report any
pain. In addition to the medications already given, which medication does the nurse expect
the health care provider to order?

a) Carvedilol
b) Digoxin
c) Furosemide
d) Nitroprusside
a) Carvedilol
A nurse teaches a client with angina pectoris that he or she needs to take up to three
sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care
provider if chest pain doesn't subside within 15 minutes. What symptoms may the client
experience after taking the nitroglycerin?

a) Nausea, vomiting, depression, fatigue, and impotence.

b) Sedation, nausea, vomiting, constipation, and respiratory depression.
c) Headache, hypotension, dizziness, and flushing.
d) Flushing, dizziness, headache, and pedal edema.
c) Headache, hypotension, dizziness, and flushing.
A client is admitted for treatment of Prinzmetal's angina. When developing this client's care
plan, the nurse should keep in mind that this type of angina is a result of what trigger?

a) Activities that increase myocardial oxygen demand.

b) An unpredictable amount of activity.
c) Coronary artery spasm.
d) The same type of activity that caused previous angina episodes.
c) Coronary artery spasm.
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing
diagnosis takes highest priority at this time?

a) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or
impaired electrical conduction
b) Anxiety related to an actual threat to health status, invasive procedures, and pain
c) Disabled family coping related to knowledge deficit and a temporary change in family
dynamics
d) Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass
time
a) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or
impaired electrical conduction
A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which
outcome indicates that the client is responding favorably to therapy?

a) The client demonstrates ability to tolerate more activity without chest pain.
b) The client exhibits a heart rate above 100 beats/minute.
c) The client verbalizes the intention of making all necessary lifestyle changes except for
stopping smoking.
d) The client states that sublingual nitroglycerin usually relieves his chest pain.
a) The client demonstrates ability to tolerate more activity without chest pain.
The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin.
The client requires bleeding precautions. Bleeding precautions include which measure?

a) Avoid continuous BP monitoring

b) Avoid subcutaneous injections
c) Use an electric toothbrush
d) Avoid the use of nail clippers
a) Avoid continuous BP monitoring
The staff educator is presenting a class on cardiac dysrhythmias. How would the educator
describe the characteristic pattern of the atrial waves in atrial flutter?
a) Sinusoidal
b) Triangular
c) Sawtooth
d) Square
c) Sawtooth
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor.
The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis
for this client would be which of the following?

a) Decreased cardiac output

b) Ineffective health maintenance
c) Ineffective breathing pattern
d) Risk for vascular trauma
a) Decreased cardiac output
A nurse is caring for a client who has premature ventricular contractions. What sign would
the nurse assess in this client?

a) Fluttering/heart skipping
b) Nausea
c) Hypotension
d) Fever
a) Fluttering/heart skipping
Treatment of symptomatic bradycardia includes which of the following?

a) Atropine
b) Lidocaine
c) Cardioversion
d) Adenocard
a) Atropine
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate
consistently above 105 beats/minute. What type of dysrhythmia would the cardiologist likely
diagnose?

a) sinus tachycardia
b) sinus bradycardia
c) supraventricular tachycardia
d) supraventricular bradycardia
a) sinus tachycardia
A client is undergoing preoperative teaching before his cardiac surgery and the nurse is aware
that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in
the care of the client's pacemaker?
a) Monitoring for pacemaker malfunction or battery failure
b) Determining when it is appropriate to remove the pacemaker
c) Making necessary changes to the pacemaker settings
d) Selecting alternatives to future pacemaker use
a) Monitoring for pacemaker malfunction or battery failure
The nurse is writing a plan of care for a client with a cardiac dysrhythmia. What would be the
priority goal for the client?

a) Maintain a resting heart rate below 70 bpm.

b) Maintain adequate control of chest pain.
c) Maintain adequate cardiac output.
d) Maintain normal cardiac structure
c) Maintain adequate cardiac output.
The nurse is caring for a client who has just undergone catheter ablation therapy. The nurse
in the step-down unit should prioritize what assessment?

a) Cardiac monitoring
b) Monitoring the implanted device signal
c) Pain assessment
d) Monitoring the client's level of consciousness (LOC)
a) Cardiac monitoring
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client
is pulseless, the nurse should prepare for what intervention?

a) Defibrillation
b) ECG monitoring
c) Implantation of a cardioverter defibrillator
d) Angioplasty
a) Defibrillation
A nurse and nursing student are caring for a client with coronary heart disease and providing
information about the disease process to the client. When client care is completed, the
student asks the nurse what things stimulate the heart to beat faster. The correct response
would be which of the following?

a) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"

b) "Anything that stimulates the parasympathetic nervous system (negative chronotropy)"
c) "Hypothyroidism"
d) "Beta-adrenergic blocking agents"
a) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"
The nurse enters the client's room and finds the client pulseless and unresponsive. What
would be the treatment of choice for this client?

a) IV lidocaine
b) Chemical cardioversion
c) Immediate defibrillation
d) Electric cardioversion
c) Immediate defibrillation
A nurse completes a shift assessment on a client admitted to the telemetry unit with a
diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg.
The client is also experiencing dizziness and shortness of breath. Which medication will the
nurse anticipate administering to the client based on these clinical findings?

a) Atropine
b) Lidocaine
c) Pronestyl
d) Cardizem
a) Atropine
What is the drug of choice for a stable client with ventricular tachycardia?

a) Atropine
b) Amiodarone
c) Procainamide
d) Lidocaine
b) Amiodarone
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which
waveform pattern needs attention first?

a) Sustained asystole
b) Supraventricular tachycardia
c) Atrial fibrillation
d) Ventricular fibrillation
d) Ventricular fibrillation
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25
small, square boxes within an RR interval. The nurse correctly identifies the client heart rate
as

a) 60 bpm.
b) 100 bpm.
c) 80 bpm.
d) 70 bpm.
a) 60 bpm.
The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in
lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed
which ventricular dysrhythmia?

a) Ventricular bigeminy
b) Ventricular tachycardia
c) Premature ventricular contraction
d) Ventricular fibrillation
c) Premature ventricular contraction
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of
ventricular tachycardia?

a) Calcium and magnesium

b) Potassium and calcium
c) Magnesium and potassium
d) Potassium and sodium
c) Magnesium and potassium
The nurse is assessing a client with mitral regurgitation. The nurse expects to note what
finding in this client?

a) Dyspnea, fatigue, and weakness

b) Dizziness, syncope, and palpitations
c) Orthopnea, angina, and pulmonary edema
d) Dry cough, wheezing, and hemoptysis
a) Dyspnea, fatigue, and weakness
The nurse explains to the patient with PACs that there are many causes, some of which are
modifiable. Select all that apply.

a) Hyperkalemia
b) Hypoxemia
c) Atrial ischemia
d) Hypovolemia
e) Alcohol
f) Anxiety
b) Hypoxemia
c) Atrial ischemia
e) Alcohol
f) Anxiety
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction
(MI). During the nursing assessment, the client reports shortness of breath and chest pain. In
addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm,
and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which
action should the nurse complete first?

a) Initiate transcutaneous pacing

b) Prepare for defibrillation
c) Administer 1 mg of IV atropine
d) Obtain a 12-lead ECG
a) Initiate transcutaneous pacing
A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later,
the physician suspects that the client has aspirated stomach contents. The nurse knows that
this client is at highest risk for:

a) chronic obstructive pulmonary disease (COPD).

b) bronchial asthma.
c) acute respiratory distress syndrome (ARDS)
d) renal failure.
c) acute respiratory distress syndrome (ARDS)
The nurse is caring for a client at risk for atelectasis. The nurse implements a first-line
measure to prevent atelectasis development in the client. What is an example of a first-line
measure to minimize atelectasis?

a) Incentive spirometry
b) Intermittent positive-pressure breathing (IPPB)
c) Positive end-expiratory pressure (PEEP)
d) Bronchoscopy
a) Incentive spirometry
A client is brought to the emergency department following a motor vehicle accident. Which
of the following nursing assessments is significant in diagnosing this client with flail chest?

a) Respiratory acidosis
b) Paradoxical chest movement
c) Chest pain on inspiration
d) Clubbing of fingers and toes
b) Paradoxical chest movement
A sputum study has been ordered for a client who has developed coarse chest crackles and a
fever. At what time should the nurse best collect the sample?

a) Immediately after a meal

b) First thing in the morning
c) At bedtime
d) After a period of exercise
b) First thing in the morning
A nurse is caring for a client after a lung biopsy. Which assessment finding requires
immediate intervention?

a) Respiratory rate of 44 breaths/minute

b) Oxygen saturation level of 96% on 3 L of oxygen
c) Client stating pain level of 7 out of 10 that decreases with pain medication
d) Client dozing when left alone but awakening easily
a) Respiratory rate of 44 breaths/minute
The nurse is caring for a client who has returned to the unit following a bronchoscopy. The
client is asking for something to drink. Which criterion will determine when the nurse should
allow the client to drink fluids?

a) Presence of a cough and gag reflex

b) Absence of nausea
c) Ability to demonstrate deep inspiration
d) Oxygen saturation of ≥92%
a) Presence of a cough and gag reflex
The nurse is caring for an adolescent client injured in a snowboarding accident. The client has
a head injury, a fractured right rib, and various abrasions and contusions. The client has a
blood pressure of 142/88 mm Hg, pulse of 102 beats/minute, and respirations of 26
breaths/minute. Which laboratory test best provides data on a potential impairment in
ventilation?

a) Blood gases
b) Complete blood count
c) Blood chemistry
d) Serum alkaline phosphate
a) Blood gases
Which term is used to describe the inability to breathe easily except in an upright position?

a) Dyspnea
b) Orthopnea
c) Hemoptysis
d) Hypoxemia
b) Orthopnea
A medical nurse has admitted a client to the unit with a diagnosis of failure to thrive. The
client has developed a fever and cough, so a sputum specimen has been obtained. The nurse
notes that the sputum is greenish and that there is a large quantity of it. The nurse notifies
the client's physician because these symptoms are suggestive of what?

a) Pneumothorax
b) Lung tumors
c) Infection
d) Pulmonary edema
c) Infection
The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is
scheduled for a lung scan. The nurse knows that lung scans need the use of radioisotopes and
a scanning machine. Before the perfusion scan, what must the client be assessed for?

a) Bleeding
b) Iodine allergy
c) Dysrhythmias
d) Inflammation
b) Iodine allergy
While conducting the physical examination during assessment of the respiratory system,
which conditions does the nurse assess by inspecting and palpating the trachea?

a) Evidence of exudate
b) Color of the mucous membranes
c) Deviation from the midline
d) Evidence of muscle weakness
c) Deviation from the midline
A nurse is caring for a client after a thoracotomy for a lung mass. Which nursing diagnosis
should be the first priority?

a) Anxiety
b) Impaired gas exchange
c) Impaired physical mobility
d) Deficient knowledge: Home care
b) Impaired gas exchange
Constant bubbling in the water seal of a chest drainage system indicates which problem?

a) Air leak
b) Tidaling
c) Tension pneumothorax
d) Increased drainage
a) Air leak
For a client who has a chest tube connected to a closed water-seal drainage system, the nurse
should include which action in the care plan?
a) Measuring and documenting the drainage in the collection chamber
b) Maintaining continuous bubbling in the water-seal chamber
c) Keeping the collection chamber at chest level
d) Stripping the chest tube every hour
a) Measuring and documenting the drainage in the collection chamber
When performing endotracheal suctioning, the nurse applies suctioning while withdrawing
and gently rotating the catheter 360 degrees for how long?

a) 0 to 5 seconds
b) 10 to 15 seconds
c) 30 to 35 seconds
d) 20 to 25 seconds
b) 10 to 15 seconds
The nurse received a client from the post-anesthesia care unit (PACU) who has a chest tube to
a closed drainage system. Report from the PACU nurse included drainage in the chest tube at
80 mL of bloody fluid. Fifteen minutes after transfer from the PACU, the chest tube indicates
drainage as pictured. The client is reporting pain at "8" on a scale of 0 to 10. The first action of
the nurse is to:

a) Notify the physician.

b) Assess pulse and blood pressure.
c) Administer prescribed pain medication.
d) Lay the client's head to a flat position.
b) Assess pulse and blood pressure.
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable
chest drainage system. The nurse observes that the drainage system is functioning correctly
when she notes tidal movements or fluctuations in which compartment of the system as the
client breathes?

a) Water-seal chamber
b) Air-leak chamber
c) Collection chamber
d) Suction control chamber
a) Water-seal chamber
After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this
client, the nurse must:

a) report fluctuations in the water-seal chamber.

b) clamp the chest tube once every shift.
c) encourage coughing and deep breathing.
d) milk the chest tube every 2 hours.
c) encourage coughing and deep breathing.