Med Surg 2 Exam Practice Questions

Exam 1 Med Surge 1. A nurse should inform a client who is diagnosed w angina that angina pain usually differs from the pain of a myocardial infarction (MI) in that angina pain - Is often relieved by pain 2. While caring for a client w angina, the nurse plans interventions that decrease myocardial oxygen demand and promote coronary blood flow. Appropriate interventions are those that primarily prevent - An increase in heart rate 3. When instructing a client in the proper administration of sublingual nitroglycerin (NTG), the nurse should include in the teaching that the client should -repeat the dosage every 5 minutes for three times if pain is not relieved 4. A nurse is instructing a client who has stable angina. Which of these client responses would indicate to the nurse that the client has a proper understanding of their condition? - my chest pain can occur if I overexert myself 5. A nurse is working in the emergency department (ED) when a client arrives complaining of substernal and left arm discomfort that has been going on for about 3 hours. All of these baseline laboratory tests are drawn. Which of these lab values will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome (ACS) standard orders? -Troponin 6. a nurse is performing an assessment on a client who had a cardiac catheterization 3 hours ago. Which of the following findings would require immediate intervention? -catheterized extremity cold w decreased peripheral pulses 7. a client reports episodes of “palpitations”. The HCP prescribes a Holter monitor. The nurse should plan to include which of the following instructions to the client? -keep a record of daily activities 8. in developing a standard teaching plan for the outpatient unit where stress testing is performed, the nurse should include information that the -test may cause the client to experience chest pain 9. A nurse is caring for a client scheduled for a cardiac catheterization. Which of the following information would be of highest priority for the nurse to obtain before the procedure? -allergy to iodine 10. a nurse is caring for a client following a percutaneous transluminal coronary angioplasty (PTCA). Which of these interventions should the nurse include in the plan of care? -encourage oral fluids for the client 11. A nurse is discussing pre procedure instructions w a client who is scheduled for a resting electrocardiogram (ECG). Which of the following instructions should the nurse give to the client? -you must lie as still as possible during the procedure 12. A nurse is caring for a male client admitted for increasing episodes of angina pain. Which of the following tests/procedures should the nurse plan to discuss with the client regarding the determination of the location and severity of the coronary artery blockage? -cardiac catheterization 13. a client has coronary angiography with the entrance site in the left femoral artery . 2 hours after the procedure the nurse is unable to palpate the left pedal pulse. What is the nurse’s most appropriate action at this time? -attempt to locate pulse using a Doppler 14. a client is scheduled for cardiac catheterization. Which of these actions should the nurse implement? SELECT ALL THAT APPLY. -check for iodine sensitivity -verify that written consent has been obtained -withhold food and oral fluids 15. a client who has atherosclerosis is attempting to stop cigarette smoking with the use of a nicotine patch. What specific instructions regarding this therapy should the nurse give to the client? -smoking while using this patch increases the risk of heart attack 16. a nurse is observing the electrocardiogram monitor of a client who is admitted to the emergency department with a report of chest pain. Which of the following should the nurse assess as a possible myocardial infarction rather than angina? -S-T segment elevation 17. a nurse receives report at 0730 from the previous shift on a cardiac telemetry unit. Which of the following clients should the nurse plan to assess first? -a 65 year old client admitted last night with MI, history of chronic obstructive pulmonary disease (COPD), morphine sulfate being administered, scheduled for coronary angiography. 18. when developing an educated plan for a client w a diagnosis of coronary artery disease, the nurse should explain that SELECT ALL THAT APPLY -weight reduction can reduce blood pressure -weight reduction can reduce cholesterol -weight reduction can decrease risk for diabetes mellitus 19. a client with elevated serum cholesterol has been placed on simvastatin (zocor). The client asks the nurse how this drug will help to lower cholesterol levels. What is the nurse’s best response? -this drug lowers LDL and triglycerides levels 20. the nurse has written an outcome goal “demonstrates tolerance for increased activity” for a client diagnosed w congestive heart failure. Which intervention should the nurse implement to assist the client to achieve this outcome? -plan for frequent rest periods 21. a charge nurse is a long term- care (LTC) facility that has RN, LPN/LVN and nursing assistant staff members, has developed a plan for ongoing assessment of all residents w a diagnosis of heart failure. Which of these activities included in the plan is most appropriate to delegate to nursing assistant staff? -weigh all residents w heart failure each morning 22. a nurse is performing a respiratory assessment on a client who has left ventricular failure. The nurse should anticipate the finding of -crackles in the lung bases 23. a client diagnosed w essential hypertension asks the nurse to explain how this type of HTN develops. What is the nurse’s best response? -there is no known case for this type of HTN 24. the nurse is caring for a client with newly diagnosed hypertension. What dietary teaching should be included in the plan of care for this client? -avoid the use of canned or processed foods 25. a nurse is teaching a client about the medication regimen for the treatment of HTN. Which statement by the client indicates a need for additional teaching? -When my BP becomes normal, I wont need to take medication. 26. A client in a hypertensive crisis has sustained B/P of 180/120. The nurse recognizes that the optimum pressure target in the first 2 hrs of reduction therapy is: 135/90 27. A client is being treated for HTN. Which of the following outcomes demonstrates the nurse effective management of client’s HTN? There is no indication of target organ damage 28. A nurse is reviewing the history and physical on a client newly diagnosed with HTN. Which physical assessment data would the nurse expect to document? Fundoscopic examination for changes in retinal vessels 29. A nurse is working in a community center. For a client diagnosed with HTN who reports being really motivated about losing weight, the nurse should recognize the need for additional teaching when: Use over the counter appetite suppressants 30. a nurse is caring for a client with an admitting diagnosis of acute myocardial infarction. As an appropriate breakfast menu, the nurse should suggest: Bran flakes with skim milk, apple slices, and orange juice 31. A client admitted to the telemetry unit with diagnosis of MI within the last 24 hrs. The immediate care plan for this client includes: Use of bedside commode for bowel movements 32. A client with MI is admitted to the coronary care unit. The client begins to develop bilateral crackles, an increase in heart rate from 82 to 102, and cold, clammy skin. Which of the following actions should the nurse implement? All that apply Place the client in semi-fowler’s position, Administer O at 2L/min as ordered, Notify the physician 33. Along with persistent, crushing chest pain, which clinical manifestations should lead the nurse to suspect the client is experiencing a MI? Diaphoresis and cool, clammy skin 34. While ambulating a client on the telemetry unit who has recently experienced a MI, the nurse observes diaphoresis and increasing shortness of breath. The most appropriate nursing intervention at this time: Return client to bed 35. A nurse is caring for a client who is 1 hr post PTCA. Which of these is a priority assessment? Bleeding 36. Which instruction should be included in the teaching plan for a client being discharged after CABG surgery? Take your pulse before, midway through, and after exercising 37. Which intervention suggested to the client with Buerger’s disease is aimed at limiting disease progression? Cease smoking 38. A nurse is performing a physical assessment of the distal extremities for a client who has Buerger’s disease. The findings most likely to reveal are extremities which are: Reddened and have diminished distal pulses 39. Which nursing measure would be a priority in the care plan for a client who has DVT? Elevating lower extremities 40. What instructions should the nurse provide to a client at risk of DVT who is being discharged home with low-molecular weight heparin? Notify your doctor if your stools appear tarry 41. A nurse is assessing a client following a lengthy abdominal surgery. An assessment finding that would indicate a possible complication from surgery would be: Localized warmth and tenderness in a lower extremity 42. The nurse should understand (Picture) “A” represents atrial depolarization, “B” ventricular depolarization, “C” ventricular repolarization 43. A nurse is caring for a newly admitted client on the telemetry floor and notes the following. The nurse documents this rhythm as: Sinus Tachycardia 44. A nurse is evaluating a cleint’s telemetry strip. The nurse should document the HR as approximately: 90-140 beats/min 45. The nurse assesses the complex as “A” on the following 6 sec strip as a: PVC 46. A nurse assesses an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 sec, and QRS complexes measure 0.06 sec. The overall HR is 64 beats/min. The nurse documents the cardiac rhythm as: Normal sinus rhythm 47. A nurse is caring for a client admitted to the telemetry unit with dysrhythmias and left ventricular failure. Which of the following is a priority assessment? Ausculatate breath sounds 48. A client’s telemetry reading shows a P-wave before each QRS complex, a regular P-R interval, and the rate is 78. Which of the following actions should the nurse perform next? Document this as normal sinus rhythm 49. In evaluating a client’s ECG tracing, the nurse notes three small squares between the upstroke and down stroke of the QRS wave. The nurse should record the QRS interval as: 0.12 50. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse notes the absence of electrocardiogram complexes on the screen. The first action by the nurse would be to: Check the client status and lead placement 51. A nurse is performing a cardiac assessment on a client. In auscultating heart sounds, the nurse hears the closure of the aortic and pulmonic valves. The nurse documents this as The S2 heart sound 52. A client who is admitted for chest pain asks the nurse the reason for having an exercise stress test. The nurse should explain to a client that an exercise ECG is useful as one means of detecting Coronary artery disease 53. After saying that “everybody always tells me coke is bad for your heart”, a young adult client asks the nurse. What does cocaine do? The nurse should respond A fight-or flight reaction occurs when cocaine is used, stressing the heart, often beyond its capacity. 54. A nurse is participating in a community health screening. Which of the following findings presents the highest risk for the development of coronary atherosclerotic heart disease? Postmenopausal female, uncontrolled type 2 diabetes, family history of heart disease 55. A nurse is developing a program for a group of individuals attending a community seminar on atherosclerotic heart disease. Which client is most at risk of developing internal injury leading to atherosclerosis? A client With diabetes who smokes one pack of cigarettes/day 56. A nurse is a cardiac step-down unit is preparing discharge instructions which include dietary information. Which breakfast food recommendations should be most appropriate for a client with coronary heart disease? Skim milk, oatmeal, banana, decaffeinated coffee 57. When assessing a client who is diagnosed with left ventricular heart failure, the nurse interprets which of the following statements the correlate with the diagnosis I cannot climb the stairs in my house without becoming SOB 58. A nurse should determine that teaching regarding a 2-gram sodium diet for a client who has a history of cardiac disease, is effective if the client states I can eat most foods as long as I do not add salt when cooking or at the table 59. When taking a history from a client, which of these should the nurse ask when assessing a client for paroxysmal nocturnal dyspnea Are you waking up SOB 60. The nurse is assessing an older client admitted with SOB 3+ bilateral pitting edema, and crackles at bases on auscultation. Which of the following should the nurse assess first? Blood pressure 61. Which of the following statements is an indication that a client needs additional teaching regarding a treatment regimen for heart failure? I should only weigh myself once a month and watch for fluid retention 62. A nurse is caring for a client who has been admitted with heart failure after experiencing a MI six months ago. The client asks the nurse how he developed heart failure. The nurse explains the etiology of hear failure after MI as the Impairment of the contractile function of the ventricle 63. A nurse is assessing a client with left sided heart failure and finds bilateral 2+ pitting edema of the ankles. Which of the following signs or symptoms should the nurse also anticipate findings? Jugular venous distention 64. A nurse is caring for a client with an admitting diagnosis of HF. The medical record contains a notation that the client is orthopneic. The most appropriate nursing intervention to assist with this client’s problem would be to Provide several additional pillows for sleeping 65. A nurse is monitoring a client with congestive heart failure. Which of the following would require further evaluation by the nurse? Weight gain of 1.5 pounds in 24 hours 66. A client who experiences a MI develops left ventricular heart failure. For which sign of poor organ perfusion should the nurse monitor this client? Urine output of 50 ml in two hours 67. A nurse is caring for a client with congestive heart failure. A priority assessment at this time would be to Obtain daily weights 68. A client who has A-Fib is ambulation in the hallway on the coronary stepdown unit and suddenly tells the nurse. I feel really dizzy. After assisting the client to sit down, which of the following interventions should become a priority for the nurse? Select all that apply Check the client’s apical heart rate Take the client’s blood pressure 69. A client is diagnosed with hypertension. Initial nursing assessment reveals a body mass index of 30, reports a sedentary lifestyle, and smoked half a pack of cigarettes daily. For the behavioral change with the most immediate and positive impact on his blood pressure, the nurse should focus one Regular exercise 70. A nurse is participating in a health screening fair to screen for hypertension. Which of the following blood pressure findings for an adult client with no known medical problems should be evaluated further for hypertension? The person with a blood pressure of select all that apply 124/86 mm Hg 138/78 mm Hg 140/96 mm Hg 71. The RN is teamed with a LPN in caring for a group of clients on the cardiac unit. Which action by the LPN indicated the need by the RN to intervene immediately? The LPN Assists a client to the bathroom 30 minutes after the client has returned from a cardiac catheterization 72. A RN and an UAP are caring for four clients on a telemetry floor. Which nursing task would be best for the nurse to delegate to the UAP? Help position the client who is having a portable x-ray done 73. A client is admitted with a diagnosis of MI. which information should the nurse include in the discharge planning? Begin walking for short periods every day 74. A nurse is caring for a client admitted to the hospital with a complaint of chest pain. After receiving a total of three nitroglycerin sublingual tablets, the client states that there is no change in their pain level. Which of these actions should the nurse implement first? Notify the HCP 75. When a client with a history of coronary artery disease is at home and experiences chest pain or suspects they are having a heart attack, the HCP will typically advise the client to Ingest aspirin 76. After measuring 3.5 small boxes between the onset of the Q wave and the completion of the S wave, the nurse would record the QRS duration as 0.14 second 77. The nurse is preparing a community presentation for a group of women about risk factors for cardiovascular disease. Which of the following clients is a risk for cardiovascular disease? A woman (SATA) With elevated LDL levels With abdominal obesity 78. In assessing the following telemetry strip, the nurse should document this rhythm as Atrial fibrillation 79. A nurse is caring for a client with a serum potassium level of 6.6 mEq/L. Which of the following characteristics ECG configurations would be most likely to occur in this client? Tall, peaked T waves with a narrow base, Shortened QT interval. ST-segment depression. 80. A client is admitted following an acute myocardial infarction to the inferior wall. Which of the following outcomes should indicate to the nurse that tissue perfusion is ineffective? Urine output of 22ml/ hr for 2 consecutive hours 81. A client with congestive heart failure is on digoxin therapy. The nurse notes that the digoxin level is 2.6 ng/ml. the nurse should No tiene respuesta 82. A client with congestive heart failure has tachypnea, severe dyspnea, and a SaO2 of 84%. The nurse identifies a nursing diagnosis of impaired gas exchange related to increased preload and mechanical failure. An appropriate nursing intervention for this diagnosis is to Place the client in a high- fowlers position with the feet dangling 83. A client in a hypertensive crisis has a sustained blood pressure of 200/140 mm Hg and is being treated with hypertensive protocol. The nurse recognizes that the optimum pressure target for the client in the first two hours of reduction therapy is No tiene respuesta 84. An older adult client is admitted with a suspected myocardial infarction. Which of these clinical manifestations of myocardial infarction should the nurse expect to see in an older adult Disorientation or confusion 85. A client is admitted to the emergency room after developing severe chest pain while mowing the lawn. He has dull pain in the midchest are and a normal ECG. The physician orders a cardiac catherization with coronary angiography and possible percutaneous transluminal coronary angioplasty (PTCA). The nurse prepares the client for the procedure by explaining that it is used to Visualize any blockages in the coronary arteries and if necessary, to dilate an obstructed artery with the use of a small ballon 86. Creatine kinase (CK-MB) and troponin levels are ordered for a client who experienced chest pain and aching for the past four days. The nurse interprets the results with the understanding that The presence of myocardial damage occurring several days earlier can be validated best by the troponin level 87. Providing care to a client who is being treated for hypertensive crisis. A priority for the nurse would be to monitor the BP carefully during the first 2 hours to prevent Renal ischemia 88. A nurse is caring for a client who has a history of hypotension and cardiac failure. In performing a breath sound assessment on the client, the nurse should anticipate the finding of No tiene respuesta 89. In planning care for a client following an acute myocardial infarction, the nursing action most appropriate to prevent cardiogenic shock is to No tiene respuesta 90. A nurse determines that additional discharge teaching is needed when the client with chronic congestive heart failure states I should weight myself daily and go on a diet if I gain more than 2 pounds in two days 91. When assessing a client who has untreated hypertension, which of these clinical manifestations should the nurse recognize as an indication of possible “target organ” damage? (SATA) Headaches Retinal changes BUN 28 mg/dl and creatinine 1.8 mg/ dl 92. A nurse is observing the electrocardiogram monitor of a client who is admitted to the emergency department with a report of chest pain. Which of the following should the nurse assess a possible myocardial infarction rather than angina? No tiene respuesta 93.A client who has left-sided heart failure develops bilateral 2+ pitting edema of the ankles, the nurse should assess that this could be an early manifestation of  Right sided failure 94.A client is at his health clinic for an annual physical exam. After walking from the car to the clinic, he develops a substernal pain. He also reports discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. His wife indicates that this has occurred frequently over the past few months with similar exertion. This client is most likely experiencing  Stable angina