1. A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected?
A. Increased urinary output
B. Decreased edema
C. Decreased pain
D. Decreased blood pressure
2. There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor?
A. Obesity
B. Heredity
C. Gender
D. Age
3. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?
A. Worsening chest pain that began earlier in the evening.
B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.
4. Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?
A. Increases fitness and prevents future heart attacks.
B. Prevents bedsores.
C. Prevents DVT (deep vein thrombosis).
D. Prevent constipations.
5. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
A. Hypertension
B. Bradycardia
C. Bounding pulse
D. Confusion
6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?
A. Ask the patient to lie down on the exam table
B. Draw blood for chemistry panel and arterial blood gas (ABG)
C. Send the patient for a chest x-ray
D. Check blood pressure
7. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient?
A. Onset of pulmonary edema
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Parkinson’s disease type symptoms
8. A patient has recently experienced a (MI) within the last 4 hours. Which of the following medications would most like to be administered?
A. Streptokinase
B. Atropine
C. Acetaminophen
D. Coumadin
9. A 64 year-old male who has been diagnosed with COPD, and CHF exhibits an increase in total body weight of 10 lbs. over the last few days. The nurse should:
A. Contact the patient’s physician immediately.
B. Check the intake and output on the patient’s flow sheet.
C. Encourage the patient to ambulate to reduce lower extremity edema.
D. Check the patient’s vitals every 2 hours.
10. A 32 year-old male with a complaint of dizziness has an order for Morphine via. IV. The nurse should do which of the following first?
A. Check the patient’s chest x-ray results.
B. Retake vitals including blood pressure.
C. Perform a neurological screen on the patient.
D. Request the physician on-call assessment the patient.
11. A nurse is caring for a patient with heart disease is monitoring the patient closely for signs of congestive heart failure (CHF). The nurse assesses the infant for which early sign of CHF?
A. cough
B. pallor
C. tachycardia
D. slow and shallow breathing
12. Which of the following is the most common symptom of myocardial infarction?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitaions
13. Which of the following landmarks is the correct one for obtaining an apical pulse?
A. Left fifth intercostals space, midaxillary line
B. Left fifth intercostals space, midclavicular line
C. Left second intercostals space, midclavicular line
D. Left seventh intercostals space, midclavicular line
14. What is the primary reason for administering morphine to a client with a myocardial infarction?
A. To sedate the client
B. To decrease the client’s pain
C. To decrease the client’s anxiety
D. To decrease oxygen demand on the client’s heart
15. Which of the following conditions is most commonly responsible for myocardial infarction?
A. Aneurysm
B. Heart failure
C. Coronary artery thrombosis
D. Renal failure
C. Coronary artery thrombosis
D. Renal failure
16. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
A. “Tell me about your feelings right now.”
B. “When the doctor arrives, everything will be fine.”
C. “This is a bad situation, but you’ll feel better soon.”
D. “Please be assured we’re doing everything we can to make you feel better.”
17. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?
A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Narcotics
D. Nitrates
18. What is the most common complication of a myocardial infarction?
A. Cardiogenic shock
B. Heart failure
C. Arryhtmias
D. Pericardits
19. Which of the following disorders is jugular vein distention most prominent?
A. Abdominal aortic aneurysm
B. Heart failure
C. MI
D. Pneumothorax
20. which of the following symptoms might a client with right-sided heart failure exhibit?
A. Adequate urine output
B. Polyuria
C. Oliguria
D. Polydipsia
21. Which of the following condition is most closely associated with weight gain, nausea, and a decrease in urine output?
A. Angina Pectoris
B. Cardiomyopathy
C. Left-sided heart failure
D. Right-sided heart failure
22. What’s the first intervention for a patient experiencing chest pain and a Sp02 of 89%?
A. Administer morphine
B. Administer oxygen
C. Administer sublingual nitroglycerin
D. Obtain an electrocardiogram (ECC)
23. Which of the following positions would best aid breathing for a patient with acute pulmonary edema?
A. Lying flat in bed
B. Left side-lying position
C. High Fowler’s position
D. Semi-Fowler’s position
24. A 54-year-old client was put in Quinidine (a drug that decreases myocardial excitability) to prevent atrial fibrillation. He also has kidney disease. The nurse is aware that this drug, when given to a client with kidney disease, may
A. Cause cardiac arrest
B. Cause hypotension
C. Produce mild bradycardia
D. Be very toxic even in small doses
25. A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first nursing action would be to
A. Wait until the client's lab work is done
B. Not administer oxygen unless ordered by the physician
C. Administer oxygen at 2 liters flow per minute
D. Administer oxygen at 10 liters flow per minute and check the client's nail beds
26. A client complaining of severe shortness of breath is diagnosed with congestive heart failure. The nurse observes a falling pulse-oximetry. The client's color changes to gray and she expectorates large amounts of pink frothy sputum. The first action of the nurse would be which of the following?
A. Call the health care provider
B. Check vital signs
C. Position in high Fowler's
D. Administer oxygen
27. A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is to:
A. start a peripheral IV
B. initiate closed-chest massage
C. establish an airway
D. obtain the crash cart
28. A client is receiving digoxin (Lanoxin) 0.25 mg. Daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg. B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider?
A. Blood pressure 94/60
B. Heart rate 76
C. Urine output 50 ml/hour
D. Respiratory rate 16
29. A client admitted to the visiting nurse services for assessment and follow-up after being discharged from the hospital for new-onset congestive heart failure (CHF). The nurse teaches the client about the dietary restrictions required with CHF. Which statement by the client indicates that further teaching is needed?
A. “I’m going to have a ham and cheese sandwich and potato chips for lunch.”
B. I’m going to weigh myself daily to be sure I don’t gain too much fluid.”
C. “I can have most fresh fruits and fresh vegetables.”
D. “I’m not supposed to eat cold cuts.”
30. A nurse is trying to determine the ability of the client with MI to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge?
A. “I don’t have anyone to help me with doing housework at home.”
B. “I think I have a good understanding of what all my medications are for.”
C. “I will be sure to keep my appointment with the cardiologist.”
D. “I need to start exercising more to improve my health.”
31. A home care nurse has taught a client with a nursing diagnosis of decreased cardiac output about helpful lifestyle adaptations to promote health. Which of the following statements by the client best demonstrates an understanding of the information provided?
A. “I will eat enough daily fiber to prevent straining at stool.”
B. “Drinking 2 to 3 ounces of liquor each night will promote blood flow by
enlarging blood vessels.”
C. “I will drink 3000 to 3500 mL of fluid daily to promote good kidney function.”
D. “I will try to exercise vigorously to strengthen my heart muscle.”
32. A client recovering from pulmonary edema is preparing for discharge. The nurse plans to teach the client to do which of the following to manage or prevent recurrent symptoms after discharge?
A. Take a double dose of the diuretic if peripheral edema is noted
B. Withhold prescribed digoxin (Lanoxin) if slight respiratory distress occurs
C. Weigh himself on a daily basis
D. Sleep with the head of bed flat
33. A client receiving parenteral nutrition has a history of congestive heart failure. The physician has ordered furosemide (LAsix) 40 mg by mouth daily to prevent fluid overload. The nurse monitors which laboratory value to identify an adverse effect from this medication.
A. Glucose
B. Sodium
C. Potassium
D. Magnessium
34. A home health nurse is visiting an older cliuent whose family has gone out for the day. During the visit, the client experiences chest pain that is unrelieved by three sublingual nitroglycerin tablets given by the nurse. Which action by the nurse would be appropriate at this time?
A. Notify a family member who is the next of kin
B. Inform the home care agency supervisor that the visit may be prolonged
C. Call for an ambulance to transport the client to the hospital emergency department
D. Drive the client to the physician’s office
35. A client has experienced an episode of pulmonary edema. The nurse determines that the client’s respiratory status id improving after this episode if which of the following breath sounds are noted?
A. Crackles throughout the lung fields
B. Crackles in the base
C. Wheezes
D. Rhonchi
36. A client with pulmonary edema has an order to receive morphine sulfate intravenously. The nurse determines that the client is experiencing an intended effect of the medication as indicated by which of the following assessment findings?
A. Relief of apprehension
B. Decreased urine output
C. Increased pulse rate
D. Increased blood pressure
37. A client recovering from an exacerbation of left-sided heart failure has a nursing diagnosis of activity intolerance. Which of the following changes in vital signs during activity would be the best indicator that the client is tolerating mild exercise?
A. Pulse rate increased from 80 to 140 beats/min
B. Respiratory rate increased from 16 to 19 breaths/min
C. Oxygen saturation decreased from 96% to 91%
D. Blood pressure deceased from 140/86 mmHg to 112/72 mmHg
38. A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because:
A. the client is experiencing heart failure.
B. the client is going into cardiogenic shock.
C. the client shows signs of aneurysm rupture.
D. the client is in the early stage of right-sided heart failure.
39. The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?
A. Increase in blood pressure
B. Increase in blood volume
C. Low serum potassium level
D. High serum sodium level
40. Which of the following may NOT include clinical manifestation of left sided CHF?
A. Dyspnea on exertion
B. Insomnia
C. Orthopnea
D. None of the above
41. Which of the following may NOT include clinical manifestation of right sided CHF?
A. Weight gain
B. Nausea
C. Weight loss
D. Distended neck veins
42. Which of the following is a major cause of cardiac arrerst?
A. Ventricular Fibrilation
B. Congeniya heart disease
C. MI
D. Heart failure
43. Which of the following may NOT include clinical manifestation of cardiac arrest?
A. Immediate loss of consciousness
B. Absence of palpable pulse
C. Apnea
D. None of the above
44. Which of the following is NOT a major cause of acute pulmonary edema?
A. Left ventricular CHF
B. Right ventricular CHF
C. Lung injury
D. None of the above
45. Appropriate nursing diagnoses for patient with congestive heart failure include/s:
A. Activity Intolerance
B. Impaired gas exchange
C. Decreased cardiac output
D. All of the above
46. Which of the following may NOT include clinical manifestation of right sided CHF?
A. Ascites
B. Increase in appetite
C. Liver congestion
D. All of the above
47. Which of the following should a nurse teach to a patient with CHF?
A. High sodium diet
B. low potassium diet
C. High potassium diet
D. Force fluid intake
48. Which of the following would suggest that health teaching made by a nurse to a patient with CHF is effective would include?
A. The patient limits activities to level that permit s the heart to rest
B. The patient exhibit weight loss, indicating increased fluid consumption
C. The patient exhibit weight gain, indicating reduced fluid consumption
D. The patient verbalized anxiety towards the disease process
49. Which of the following is expected to laboratory findings in patients with CHF?
A. Cardiac atrophy
B. ECG findings inconsistent with hypertrophy or myocardial damage
C. ECG findings consistent with hypertrophy or myocardial damage
D. Cardiomegaly with normal lung status
50. A nurse should promote measures to provide rest for the heart of patient suffering from CHF. Which of the following would indicate EFFECTIVE nursing care?
A. Maintain bedrest with increased activity
B. Encouraged as many visitors as possible to motivated the patient
C. Cluster necessary nursing care to minimize disruptions
D. None of the above
51. A patient with cardiac arrest is seen by a nurse lying unconsciously in the floor. What should the nurse do first?
A. Initiate CPR immediately
B. Call the physician
C. Run to the nurses’ station and call for help
D. Assess the environment for possible assault done to the patient
52. A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
A. Slow, deep respirations
B. Stridor
C. Bradycardia
D. Air hunger
53. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?
A. Ask the patient to lie down on the exam table
B. Draw blood for chemistry panel and arterial blood gas (ABG)
C. Send the patient for a chest x-ray
D. Check blood pressure
54. Which of the following would a nurse include in a discharge plan for a patient who is recovering from acute pulmonary edema?
A. Annual weight measurement
B. Plan for rest periods, abruptly increasing daily activity
C. weigh patient every other day to provide rest periods for the patient
D. Plan for rest periods, gradually increasing daily activity
55. Which of the following would indicate that a patient recovering from acute pulmonary edema is complying with the treatment regimen?
A. Patient performs weight bearing activities
B. Patient sleeps at night with head of bed flat
C. Patient displays decreased anxiety
D. Patient demonstrates unstable cardiac rhythm, vital signs, and urine output
56. Which of the following would best suggest that the patient is suffering from pulmonary edema?
A. Dyspnea and cough producing copious blood-tinged, frothy sputum
B. Non-frothy sputum
C. Clear lung sounds
D. Crackles heard at the base of the lung fields
58. Which of the following is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body?
A. MI
B. CHF
C. Acute Pulmonary Edema
D. Cardiac arrest
59. Which of the following is the cessation of normal circulation of the blood due to failure of the heart to contract effectively?
A. MI
B. CHF
C. Acute Pulmonary Edema
D. Cardiac arrest
60. Which of the following is fluid accumulation in the lungs. It is due to failure of the heart to remove fluid from the lung circulation?
A. MI
B. CHF
C. Acute Pulmonary Edema
D. Cardiac arrest
For answers and rationale, click the link below:
http://ilovenurselouie.blogspot.com/2014/07/1.html
For answers and rationale, click the link below:
http://ilovenurselouie.blogspot.com/2014/07/1.html
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