CARDIAC DISORDERS COMPREHENSIVE EXAMINATION

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1 2504_Ch03_ qxd /4/10 9:45 PM Page 102 MED-SURG SUCCESS CARDIAC DISORDERS COMPREHENSIVE EXAMINATION 1. Which population is at a higher risk for dying from a myocardial infarction? 1. Caucasian males. 2. Hispanic females. 3. Asian males. 4. African American females. 2. Which preprocedure information should be taught to the female client having an exercise stress test in the morning? 1. Wear open-toed shoes to the stress test. 2. Inform the client not to wear a bra. 3. Do not eat anything for four (4) hours. 4. Take the beta blocker one (1) hour before the test. 3. Which intervention should the nurse implement with the client diagnosed with dilated cardiomyopathy? 1. Keep the client in the supine position with the legs elevated. 2. Discuss a heart transplant, which is the definitive treatment. 3. Prepare the client for coronary artery bypass graft. 4. Teach the client to take a calcium channel blocker in the morning. 4. Which medical client problem should the nurse include in the plan of care for a client diagnosed with cardiomyopathy? 1. Heart failure. 2. Activity intolerance. 3. Powerlessness. 4. Anticipatory grieving. 5. The client has an implantable cardioverter defibrillator (ICD). Which discharge instructions should the nurse teach the client? 1. Do not lift or carry more than 23 kg. 2. Have someone drive the car for the rest of your life. 3. Carry the cell phone on the opposite side of the ICD. 4. Avoid using the microwave oven in the home.

2 6. To what area should the nurse place the stethoscope to best auscultate the apical pulse? CHAPTER 3 CARDIAC DISORDERS 103 A B C D 1. A 2. B 3. C 4. D 7. The telemetry nurse notes a peaked T wave for the client diagnosed with congestive heart failure. Which laboratory data should the nurse assess? 1. CK-MB. 2. Troponin. 3. BNP. 4. Potassium. 8. The client comes to the emergency department saying, I am having a heart attack. Which question is most pertinent when assessing the client? 1. Can you describe your chest pain? 2. What were you doing when the pain started? 3. Did you have a high-fat meal today? 4. Does the pain get worse when you lie down? 9. The client with coronary artery disease is prescribed transdermal nitroglycerin, a coronary vasodilator. Which behavior indicates the client understands the discharge teaching concerning this medication? 1. The client places the medication under the tongue. 2. The client removes the old patch before placing the new. 3. The client applies the patch to a hairy area. 4. The client changes the patch every 36 hours. 10. Which client would most likely be misdiagnosed for having a myocardial infarction? 1. A 55-year-old Caucasian male with crushing chest pain and diaphoresis. 2. A 60-year-old Native American male with an elevated troponin level. 3. A 40-year-old Hispanic female with a normal electrocardiogram. 4. An 80-year-old Peruvian female with a normal CK-MB at 12 hours. 11. Which meal would indicate the client understands the discharge teaching concerning the recommended diet for coronary artery disease? 1. Baked fish, steamed broccoli, and garden salad. 2. Enchilada dinner with fried rice and refried beans. 3. Tuna salad sandwich on white bread and whole milk. 4. Fried chicken, mashed potatoes, and gravy.

3 104 MED-SURG SUCCESS 12. The unlicensed assistive personnel (UAP) tells the primary nurse that the client diagnosed with coronary artery disease is having chest pain. Which action should the nurse take first? 1. Tell the UAP to go take the client s vital signs. 2. Ask the UAP to have the telemetry nurse read the strip. 3. Notify the client s health-care provider. 4. Go to the room and assess the client s chest pain. 13. Which interventions should the nurse discuss with the client diagnosed with coronary artery disease? Select all that apply. 1. Instruct the client to stop smoking. 2. Encourage the client to exercise three (3) days a week. 3. Teach about coronary vasodilators. 4. Prepare the client for a carotid endarterectomy. 5. Eat foods high in monosaturated fats. 14. Which laboratory data confirm the diagnosis of congestive heart failure? 1. Chest x-ray (CXR). 2. Liver function tests. 3. Blood urea nitrogen (BUN). 4. Beta-type natriuretic peptide (BNP). 15. What is the priority problem in the client diagnosed with congestive heart failure? 1. Fluid volume overload. 2. Decreased cardiac output. 3. Activity intolerance. 4. Knowledge deficit. 16. Which data would cause the nurse to question administering digoxin to a client diagnosed with congestive heart failure? 1. The potassium level is 3.2 meq/l. 2. The digoxin level is 1.2 mcg/ml. 3. The client s apical pulse is The client denies yellow haze. 17. The nurse is caring for clients on a cardiac floor. Which client should the nurse assess first? 1. The client with three (3) unifocal PVCs in one (1) minute. 2. The client diagnosed with coronary artery disease who wants to ambulate. 3. The client diagnosed with mitral valve prolapse with an audible S The client diagnosed with pericarditis who is in normal sinus rhythm. 18. The nurse is told in report the client has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur? 1. Second intercostal space, right sternal notch. 2. Erb s point. 3. Second intercostal space, left sternal notch. 4. Fourth intercostal space, left sternal border. 19. The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first? 1. Call a code immediately. 2. Assess the client for a pulse. 3. Begin chest compressions. 4. Continue to monitor the client.

4 20. The nurse is assisting with a synchronized cardioversion on a client in atrial fibrillation. When the machine is activated, there is a pause. What action should the nurse take? 1. Wait until the machine discharges. 2. Shout all clear and don t touch the bed. 3. Make sure the client is all right. 4. Increase the joules and redischarge. 21. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement? 1. Notify the health-care provider. 2. Document that the pericarditis has resolved. 3. Ask the client to lean forward and listen again. 4. Prepare to insert a unilateral chest tube. 22. The nurse assessing the client with pericardial effusion at 1600 notes the apical pulse is 72 and the BP is 138/94. At 1800, the client has neck vein distention, the apical pulse is 70, and the BP is 106/94. Which action would the nurse implement first? 1. Stay with the client and use a calm voice. 2. Notify the health-care provider immediately. 3. Place the client left lateral recumbent. 4. Administer morphine intravenous push slowly. 23. The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select all that apply. 1. Obtain a midstream urine specimen. 2. Attach telemetry monitor to the client. 3. Start a saline lock in the right arm. 4. Draw a basal metabolic panel (BMP). 5. Request an order for a STAT 12-lead ECG. 24. The client is three (3) hours post myocardial infarction. Which data would warrant immediate intervention by the nurse? 1. Bilateral peripheral pulses The pulse oximeter reading is 96%. 3. The urine output is 240 ml in the last four (4) hours. 4. Cool, clammy, diaphoretic skin. 25. The nurse is transcribing the doctor s orders for a client with congestive heart failure. The order reads 2.5 mg of Lanoxin daily. Which action should the nurse implement? 1. Discuss the order with the health-care provider. 2. Take the client s apical pulse rate before administering. 3. Check the client s potassium level before giving the medication. 4. Determine if a digoxin level has been drawn. 26. The nurse is teaching basic cardiopulmonary resuscitation (CPR) to individuals in the community. Which is the order of basic CPR? List in order of performance. 1. Perform head-tilt chin-lift maneuver. 2. Give two (2) rescue breaths. 3. Look, listen, and feel for breathing. 4. Begin cardiac compressions. 5. Shake and shout. CHAPTER 3 CARDIAC DISORDERS 105

5 2504_Ch03_ qxd 11/4/10 9:45 PM Page MED-SURG SUCCESS 27. The nurse has received report when the telemetry technician notifies the nurse of the telemetry readings. Which client should the nurse assess first?

Outpatient/Community Health Nursing

2043_Ch08_125-144.qxd 9/25/08 3:37 PM Page 125 8 Outpatient/Community Health Nursing Intuition will tell the thinking mind where to look next. Jonas Salk ABBREVIATION LIST ACE AHA BP D5W ECG GERD HCP H&H