Question: A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse’s priority?
Answer Choices:
The client experiences sudden weakness of one arm and leg., The client’s urine output is cloudy and odorous., The client’s ECG tracing shows irregular heart rate without P waves., The client has an aPTT of 80 seconds.
Answer: The client has an aPTT of 80 seconds
Question: A nurse is caring for an infant who has congenital heart disease.
Answer Choices:
Perform nasopharyngeal suctioning for a maximum of 5 seconds, Administer morphine via IV bolus, Place the infant in a knee-chest position, Prepare to assist with the insertion of a chest tube, Request a prescription for a diuretic, Provide 100% oxygen by face mask.
Answer: Place the infant in a knee-chest position
Question: A nurse is caring for a client with a ventricular pacemaker who is on ECG monitoring. The nurse understands that the pacemaker is functioning properly when which of the following appears on the monitor strip?
Answer Choices:
Pacemaker spikes before each QRS complex, Pacemaker spikes after each QRS complex, Pacemaker spikes before each P wave, Pacemaker spikes with each T wave.
Answer: Pacemaker spikes before each QRS complex
Question: A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse’s priority?
Answer Choices:
The client experiences sudden weakness of one arm and leg, The client’s urine output is cloudy and odorous, The client’s ECG tracing shows irregular heart rate without P waves, The client has an aPTT of 80 seconds.
Answer: The client has an aPTT of 80 seconds
Question: A nurse is assessing a client who has atrial fibrillation. Which of the following pulse characteristics should the nurse expect?
Answer Choices:
Not palpable, Slow, Irregular, Bounding
Answer: Irregular
Question: A nurse is teaching a client who has mitral valve stenosis that has not responded to pharmacological therapies about other treatment options. Which of the following statements should the nurse include in their teaching?
Answer Choices:
“A flexible catheter will be inserted into a vessel of the arm, neck, or groin and advanced to the heart to dilate a narrowed or occluded artery.”, “A small catheter with a balloon on the end is threaded into a vessel in the groin and advanced to the heart where the balloon will be inflated, and the narrowed valve will be dilated.”, “A heparin bolus is administered and followed with a continuous infusion to help keep the blood thinner.”, “Pentoxifylline can be administered to help the platelets from sticking together and occluding the vessels.”
Answer: “A small catheter with a balloon on the end is threaded into a vessel in the groin and advanced to the heart where the balloon will be inflated, and the narrowed valve will be dilated.”
Question: A nurse is assessing a client who has atrial fibrillation. Which of the following pulse characteristics should the nurse expect?
Answer Choices:
Not palpable, Slow, Irregular, Bounding.
Answer: Irregular
Question: A nurse is caring for a client who has atrial fibrillation. Which of the following pulse characteristics should the nurse expect?
Answer Choices:
Not palpable, Slow, Irregular, Bounding.
Answer: Irregular
Question: A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication?
Answer Choices:
Weight gain, Hypoglycemia, Leg cramps, Increased blood pressure
Answer: Leg cramps
Question: A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication?
Answer Choices:
Weight gain, Hypoglycemia, Leg cramps, Increased blood pressure.
Answer: Leg cramps
Question: A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzymes studies?
Answer Choices:
“Cardiac enzymes will identify the location of the MI.”, “These tests will enable the provider to determine the heart structure and mobility of the heart valves.”, “Cardiac enzymes assist in diagnosing the presence of pulmonary congestion.”, “These tests help determine the degree of damage to the heart tissues.”
Answer: “These tests help determine the degree of damage to the heart tissues.”
Question: A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider?
Answer Choices:
Dyspnea, Clusters of petechiae in the mouth, Fever, Splinter hemorrhages to the nails.
Answer: Dyspnea
Question: A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider?
Answer Choices:
Dyspnea, Clusters of petechiae in the mouth, Fever, Splinter hemorrhages to the nails
Answer: Dyspnea
Question: A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?
Answer Choices:
If a dose of the medication is missed, double the dose at the next scheduled time, Mild nosebleeds are common during initial treatment, Use an electric razor while on this medication, Increase fiber intake to reduce the adverse effect of constipation.
Answer: Use an electric razor while on this medication
Question: A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse’s priority?
Answer Choices:
The client experiences sudden weakness of one arm and leg, The client’s urine output is cloudy and odorous, The client’s ECG tracing shows irregular heart rate without P waves, The client has an aPTT of 80 seconds.
Answer: The client has an aPTT of 80 seconds
Question: A nurse is caring for an infant who has congenital heart disease. Which of the following actions should the nurse take? For each nursing action, click to specify if the action is indicated or contraindicated for the client.
Answer Choices:
Perform nasopharyngeal suctioning for a maximum of 5 seconds, Administer morphine via IV bolus, Place the infant in a knee-chest position, Prepare to assist with the insertion of a chest tube.
Answer: Place the infant in a knee-chest position
Question: A nurse is caring for a client with congestive heart failure who is receiving a loop diuretic. The nurse should monitor which of the following parameters as an indicator of a potentially serious complication related to the diuretic therapy?
Answer Choices:
Serum potassium levels, Blood urea nitrogen (BUN), Serum sodium levels, Urine specific gravity.
Answer: Serum potassium levels