Hesi Exit Family Nurse Practitioner Final Exams

HESI EXIT Family Nurse Practitioner FINAL EXAMS Family Nurse Practitioner AND Advanced Practice Registered Nurse (APRN) HESI EXIT Family Nurse Practitioner FINAL EXAMS (GRADED A,RATIONALE AND VERIFIED). Prepared by katejones ALL THE VERY BEST OF LUCK FROM KATEJONES INCASE YOU CAN EMAIL ME AT: jkate6667@gmail.com Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 1. The following sequence is recommended for well-child examinations up to the age of 5 years: 1. 2 weeks, 2 months, 4 months, 6 months, 1 year, 15 months, 18 months, and every year from ages 2-5. 2. 2 months, 4 months, 6 months, 9 months, and annually from years 1- 5. 3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. 4. The same intervals recommended for immunizations. 3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. Rationale: These are the recommended health evaluation intervals for children to obtain regular assessment information regarding growth and development and to administer recommended immunizations. 2. An appropriate treatment for overweight children under 8 years of age would be to: 1. Administer an appetite suppressant. 2. Eliminate all carbohydrates in the diet. 3. Plan a program of activity, balanced diet, and exercise. 4. Use vitamin therapy and herbal teas. 3. Plan a program of activity, balanced diet, and exercise. Rationale: An approach with a well-balanced diet, activity, and exercise is necessary for weight reduction. This allows for a slow approach to weight loss that incorporates healthy behavior habits. 3. The family nurse practitioner examines a 2-week-old newborn during a first clinic visit. The family nurse practitioner notes dysmorphic facial features. The family nurse practitioner's evaluation includes: 1. Ordering a chromosome analysis. 2. Completing a postnatal history. 3. Writing a detailed physical exam and perinatal history. 4. Avoiding discussion with parents until diagnostic studies are completed Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 3. Writing a detailed physical exam and perinatal history. Rationale: The first and most important part of all data gathering starts with a detailed history and physical exam. A detailed, objective description of the dysmorphic features is essential for comparison to textbook descriptions and other data. Although chromosome analysis will probably be ordered, it is not done initially. Parents should be included in the discussion of the findings and kept informed of the progress throughout the evaluation process. 4. An 18-month-old's feet turn inward. The mother is concerned, although the child is unaware of the problem. The differential diagnosis includes all except: 1. Femoral anteversion. 2. Metatarsus adductus. L -Perthes disease. 4. Adducted great toe. L -Perthes disease. Rationale: In-toeing is a common problem in children and can result L -Perthes disease is commonly seen in older children (ages 4 to 8 years) who have loss of hip medial rotation. 5. The characteristics of an innocent heart murmur in children include: 1. Asymptomatic, loud diastolic rumble, grades I to V. 2. Mid-systolic, no thrill, and asymptomatic. 3. Asymptomatic with an S4 heard at lower left sternal border. 4. May disappear on sitting and following any type of physical activity. 2. Mid-systolic, no thrill, and asymptomatic. Rationale: Characteristics of innocent murmurs include mid-systolic; asymptomatic; less than a grade III; loudest in pulmonic area (2–3 left intercostal space at the left sternal border); no radiation to other areas; may disappear on sitting; and may intensify with fever, activity, anemia, and stress. Any S4 sound is considered pathologic in children as well as in adults. Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 6. The family nurse practitioner is examining a 6-month-old infant. What would be the anticipated findings on examining the infant's fontanels? 1. Both anterior and posterior should be open. 2. The anterior should be open, the posterior closed. 3. Both anterior and posterior should be closed. 4. The anterior should be closed, the posterior open. 2. The anterior should be open, the posterior closed. Rationale: The posterior fontanel is usually closed by 2 months of age; the anterior fontanel closes at about 24 months of age. 7. Genu varum up to 20 degrees is normal until age: 1. 18 years. 2. 5 years. 3. 18 months. 4. 6 months. 3. 18 months. Rationale: Genu varum (bowleg) of up to 20 degrees is a normal finding in children until the age of 18 months. 8. When approaching a toddler to complete a cardiac assessment, the family nurse practitioner would: 1. Allow the toddler to handle the stethoscope while the history is being taken. 2. Explain in detail what procedures will take place and get the toddler involved. 3. Keep the child warm and covered to minimize discomfort. 4. Approach the child by cheerfully calling out his name. 1. Allow the toddler to handle the stethoscope while the history is being taken. Rationale: Toddlers like to make the first move (i.e., let them move closer and initiate eye contact first; do not call out their name because this might frighten them). Allowing them to handle the stethoscope will decrease their fear. Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 Detailed explanations and involvement are more appropriate when assessing a school-age child. 9. In performing a physical exam, the family nurse practitioner allows the child to touch the medical equipment first, and then begins by examining the extremities. This sequence would be most appropriate for a patient in what age group? 1. Infant. 2. Toddler. 3. School-age child. 4. Adolescent. 2. Toddler. Rationale: Allow a toddler to explore the instruments and start with the extremities. Save the most invasive exam (of the head) for last. In infants, auscultate the heart and lungs while the infant is quiet, then proceed to do a head-to-toe assessment. In school-age and adolescent children, a head-to-toe sequence is preferred. 10. An appropriate test to check for color perception in a preschooler would be: 1. Ishihara's test. 2. Bruchner's test. 3. Hirschberg's test. 4. Jaeger's test. 1 I R J k ’ :I ’ ’ k x; H k ’ p p k ;B ’ x; vision. 11. A client is admitted to the intensive care unit with diabetes insipidus due to a pituitary gland tumor. Which potential complication should the nurse monitor closely? A. Hypokalemia B. Ketonuria. C. Peripheral edema D. Elevated blood pressure Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 A. Hypokalemia Rationale Pituitary tumors that suppress antidiuretic hormone (ADH) result in diabetes insipidus, which causes massive polyuria and serum electrolyte imbalances, including hypokalemia, which can lead to lethal arrhythmias. 12. A 3-year-old boy was successfully toilet trained prior to his admission to the hospital for injuries sustained from a fall. His parents are very concerned about this regression in toileting. Which information should the nurse provide the parents? A. A retraining program will need to be initiated when the child returns home. B. Diapering will be provided since hospitalization is stressful to preschoolers. C. Children usually resume their toileting behaviors when they leave the hospital. D. A potty chair will be brought from home so he can maintain his toileting skills. C. Children usually resume their toileting behaviors when they leave the hospital. Rationale The parents should be reassured that once the child is back in his familiar environment, he is likely to resume using the toileting behaviors (C). Retraining (A) is unlikely to be needed and such information might be distressing to the parents. (B) does not address the parents' concern. Bringing a potty chair from home (B) is likely to increase the child's stress because he is being encouraged to perform toileting skills while he remains in unfamiliar surroundings. 13. The family of an older woman reports that they are no longer capable of caring for her at home. While performing the admission assessment at a longterm care facility, the nurse determines that the client is in continent of urine, has dry mucous membranes, and has a large bruise on the coccyx. What interventions should the nurse include in the plan of care? (Select all that apply.) A. Thicken liquids and provide pureed foods. B. Apply a barrier cream to perianal areas. C. Report suspicion of elder abuse. D. Implement toilet training program. E. Offer beverages at frequent intervals. Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 B. Apply a barrier cream to perianal areas. D. Implement toilet training program. E. Offer beverages at frequent intervals. Rationale The plan of care should include measures to prevent skin breakdown due to the incontinence using a barrier cream (B) and a toileting program (D) to help reduce the incidence of incontinence. Dry mucous membranes indicate the need for increased fluids (E). Further assessment is needed before the other interventions are indicated. 14. A nurse is providing nursing care in a neighborhood clinic to single, pregnant teens. Which of the following actions is the best example of using the counselor role as a nurse? A. Conducting a client interview and documenting the information on the client's chart B. Referring a teen who admits having suicidal thoughts to a mental health care specialist C. Searching the Internet for information on child care for the teens who wish to return to school D. Discussing the legal aspects of adoption for teens wishing to place their infants with a family B. Referring a teen who admits having suicidal thoughts to a mental health care specialist 15. A seven-month-old baby shows decreased abduction of his left leg, thigh fold asymmetry, and disparity of leg lengths. Choose the test maneuver or sign to evaluate the baby for developmental hip dysplasia: A. Ortolani test B. Barlow maneuver C Adam's forward bend test D Allis' sign Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 D. An infant older than three months who holds one knee higher than the other during flexion (Allis' sign) has developmental hip dysplasia. The methods to assess an infant younger than three months are Barlow's test (pressing on the child's knees to pressurize the femoral head during hip flexion, causing posterior subluxation) and Ortolani test (rotating the child's hips through range-of-motion and listening for a click during abduction, as the femoral head slips). Adam's forward bending test is an assessment for scoliosis in children ages 10 to 15, which requires the child to bend over at the waist—as in toe touching—and the screener observes the hips to determine if there is a difference in height. 16. . To meet Medicare's coverage requirements, the Nurse Practitioner's services must be: A. Provided under direct supervision B. Provided in a rural health clinic (RHC) or federally qualified health center (FQHC) C. Provided subject to state restrictions and supervision requirements D. Billed through a physician-directed clinic, health agency, or hospital 17. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated for patients with: o Diabetes mellitus o Heart failure o Renal failure o Hypertension Angiotensin-converting enzyme (ACE) inhibitors are contraindicated for patients with renal failure 18. The nurse practitioner should order which diagnostic study to confirm a suspected diagnosis of colorectal cancer? A. Stool Hematest Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 B. Carcinoembryonic antigen (CEA) C. Colonoscopy D. Abdominal computed tomography (CT) scan C: Used to visualize the entire colon, colonoscopy aids in the detection of colorectal cancers. A stool Hematest detects the presence of blood in the stool; it doesn't confirm a diagnosis of colorectal cancer. CEA may be elevated in colorectal cancer but isn't considered a confirming test. Abdominal CT scan is used to stage the presence of colorectal cancer. 19. The nurse practitioner is determining if a client's lesions are indicative of herpes zoster. The best way to determine this is that herpes zoster lesions are typically: A. grouped vesicles occurring on lips and oral mucous membranes. B. grouped vesicles occurring on the genitalia. C. rough, fresh, or gray skin protrusions. D. grouped vesicles in linear patches along a dermatome. D: Herpes zoster, or shingles, is an acute inflammation of the dorsal root ganglia, causing localized, vesicular skin lesions that follow a dermatome. Herpes simplex type 1 is a viral infection affecting the skin and mucous membranes, usually producing cold sores or fever blisters. Herpes simplex type 2 primarily affects the genital area, causing painful clusters of small ulcerations. Warts appear as rough, fresh, or gray skin protrusions. 20. A client with left-sided heart failure comes into the clinic complaining of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse practitioner recognizes these findings as signs and symptoms of: A. right-sided heart failure. B. acute pulmonary edema. C. pneumonia. D. cardiogenic shock. B: Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema characterized by shortness of breath, agitation, and pink-tinged, foamy sputum. In right-sided heart failure, the client exhibits hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client should have a temperature spike, and sputum that Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 varies in color. Cardiogenic shock involves signs of hypotension and tachycardia. 21. Patient-focused goal setting should be: o Simple o Reasonable, measurable, and achievable o Long-term rather than short-term o Mandated and controlled by the clinician Reasonable, measurable, and achievable 22. Your 20-year-old male patient has epistaxis. You observe him bleeding from both posterior nares and swallowing, so you apply topical vasoconstrictors and pack his nostrils. After 30 minutes, his bleeding stops. Choose the followup blood tests, if any: o No blood test is necessary for a simple nosebleed o Hematocrit and hemoglobin to determine his blood loss o Coagulation panel o Complete blood count Order hematocrit and hemoglobin to determine if his blood loss is significant. Kiesselbach's plexus in the anterior nares has plentiful vessels and bleeds easily. Bleeding in the posterior nares is more dangerous and can result in considerable blood loss. Bleeding from the anterior nares is usually confined to one nostril. However, posterior nares bleeding may flow through both nostrils or backward into the throat, and the patient may be observed swallowing blood. Cocaine abusers suffer nosebleeds because of mucosal damage. Bleeding should stop within 20 minutes. 23. Your 86-year-old patient has end-stage cardiac disease. Her doctor wrote a Do-Not-Resuscitate order in her chart. In her advance directive, your patient explicitly declined life-prolonging procedures. However, when your patient arrests, her daughter demands the nurses perform CPR. The staff should: o Proceed with CPR while calling the patient's physician to verify the DNR Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 order o Proceed with CPR, as the patient can no longer make her own decisions o Advise her daughter that CPR must be withheld, in accordance with her mother's wishes o Contact the Ethics Committee for guidance Advise her daughter that CPR must be withheld, in accordance with her mother's wishes 24. When wearing a Holter monitor, the patient should: o Refrain from taking cardiac medications o Restrict activities o Maintain an activity diary o Turn it off during the night 25. Your 70-year-old female patient has a gallop rhythm. You detected S3 occurring after S2 through auscultation, with your patient lying on her left side. This may be indicative of:  Heart failure or left ventricular failure  Pericarditis  Mitral stenosis  Aortic stenosis 26. K w ’ p p : o Insecure o Practical and goal-oriented o Lacking in self-direction o Unmotivated Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 27. Identify the smoking cessation medication you must monitor carefully because of its dangerous side- effects: o Nicotine nasal spray o Varenicline (Chantix®) o Bupropion (Zyban®) o Nicotine inhaler 28. The patient payer is a client who legally agrees to pay the Nurse Practitioner directly for providing a specific service, which is a: o Second-party system o Fee-for-service system o Third-party system o Contracted service system 29. Identify the behavioral change model that predicts a person takes a health action to avoid negative consequences, believing the action will prevent a negative outcome: Theory of reasoned action o Theory of planned behaviour o Stress appraisal and coping theory o Health belief model 30. Identify the members of the healthcare institution who are responsible for identifying performance improvement projects: o All staff o Nursing team leaders o Physicians o Administrative staff 31. Your patient is a 66-year-old male receiving Medicare. He is discharged with an open, draining chest wound that he cannot care for independently Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 because of poor vision. His 14- year-old grandson lives with him. The best solution is: o Refer him to a health agency that provides in-home care T y p ’ 14-year-old grandson to provide wound care o Keep your patient hospitalized until his wound heals o Transfer your patient to an extended care facility 31. Your patient receives unfractionated heparin therapy. His baseline platelet count was 120,000 mm3. After 5 days of treatment, his platelet count suddenly drops to 45,000 mm3 , suggesting heparin-induced thrombocytopenia. Your patient is at risk for: o Shock o Hemorrhage o Thrombosis and vessel occlusion o Infection. 32. To meet Medicare's coverage requirements, the Nurse Practitioner's services must be: o Provided under direct supervision o Provided in a rural health clinic (RHC) or federally qualified health center (FQHC) o Provided subject to state restrictions and supervision requirements o Billed through a physician-directed clinic, health agency, or hospital. 33. During cardiac auscultation, a soft first heart sound with a holosystolic apical murmur that radiates to the left axilla suggests? a. aortic stenosis b. mitral regurgitation c. mitral stenosis d. mitral valve prolapse Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 34. Which of the following statements about mitral valve prolapse is FALSE? a. It is generally asymptomatic and requires no treatment b. It affects less than 3% of the population c. It is more common in persons with connective tissue disorders such as Marfan syndrome d. All patients with mitral valve prolapse require immediate medical or surgical treatment 35. Which diagnostic test would NOT be indicated for a patient presenting with acute chest pain? a. Lab data b. Stress testing c. Echocardiography d. 12 lead ECG 36. Which of the following statements is NOT true? a. Approximately 90% of diagnoses of Acute coronary event is made from the patient's history, ECGs and lab data b. exercise tolerance tests should be obtained within 72hrs of presentation of chest pain in patients with unclear diagnosis of coronary ischema c. A positive exercise tolerance test is the development of ECG changes consistent with ischemia d. The ACC has recommended the use of CK and CK-MB as the new definitive diagnostic markers for Acute MI 37. A 70 year old female comes into the office for a cardiac examination. The patient reports symptoms of dyspnea, diaphoresis and "an ache in her chest." She denies radiation of the pain and denies feelings of squeezing or heavy pressure. Before beginning the physical examination, it is important for the NP to know that which of the following statements is true? a. It is unlikely that this patient is experiencing an acute cardiac event because typical angina is characterized by a squeezing or heavy pressure and radiates to the jaw, neck, arm or shoulder b. Elderly patients are less likely to present with typical angina when experiencing an acute cardiac event c. Elderly patients are more likely to report chest pain with radiation to the jaw/neck rather than to the arms/shoulder when experiencing an acute coronary event Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 d. The NP's next step should be to investigate the respiratory and GI systems, as this patient's symptoms are most likely caused by GERD or pneumonia 38. A woman brings her 8 year old son into the office with a chief complaint of chest pain. The NP performs a full history and physical examination. Which of the following information is MOST indicative of the chest pain having a cardiac etiology? a. The pain is increased upon palpation of the area b. The pain is poorly localized and wheezing is heard upon auscultation c. The pain is present during times of rest and normal daily activities d. The pain is described as "squeezing" and is triggered by exercise 39. Patent ductus arteriosus in a newborn is associated with which of the following? a. Cri-du-chat syndrome b. Glycogen storage disease c. Lithium exposure in utero d. Maternal rubella exposure in the 3rd trimester a. Cri-du-chat syndrome PDA is associated with cri-du-chat syndrome, DiGeorge syndrome, phenytoin exposure in utero and maternal rubells in the 1st trimester 40. A six year old boy who had an upper respiratory infection with Group A strep six months ago presents with; purposeless, involuntary movements, emotional liability and muscular incoordination, symptoms commonly associated with: a. Erythema marginatum b. Periungual desquamation c. Jones criteria d. St. Vitus' dance D. St. Vitus' dance Rationale: for the Jones criteria of RF diagnosis, you need either 2 major symptoms or 1 major symptom and 2 minor symptom 41. What clinical presentations are correct related to advance aortic stenosis? a. chest pain Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 b. syncope c. exercise intolerance d. all of the above 42. Your patient recently got diagnosed with aortic stenosis, what do you anticipate the murmur to present like upon auscultation? a. Diastolic Decrescendo b. Holosystolic c. Systolic Crescendo-decrescendo d. None of the above 43. The sac that surrounds and protects the heart is called the: a.Pericardium. b.Myocardium. c.Endocardium. d.Pleural space Rationale pericardium is a tough , fibrous, doubled wall sac that surrounds and protects the heart it has 2 layers (visceral and parietal) that contain serious pericardial fluid for lubrication) myocardium is the muscular layer of the heart endocardium is the inner layer of the heart pleural space is the area of the chest that contains the lungs 44. The direction of blood flow through the heart is best described by which of these? a.Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle b.Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 c.Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava d.Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle Rationale blood returns from the body to the right atrium and flows to the right ventricle via the tricuspid valve then it goes through the pulmonary artery to the lungs for gas exchange then goes through the pulmonary vein to the left atrium that goes down the left ventricle via the mitral valve then it goes up the aortic valve through the aorta and to the rest of the system 45. The nurse is reviewing the anatomy and physiologic functioning of the heart. Which statement best describes what is meant by atrial kick? a.The atria contract during systole and attempt to push against closed valves. b.Contraction of the atria at the beginning of diastole can be felt as a palpitation. c.Atrial kick is the pressure exerted against the atria as the ventricles contract during systole. d.The atria contract toward the end of diastole and push the remaining blood into the ventricles. Rationale toward the end of diastole, the atria contract and push the last amount of blood (apron 25% of stroke volume) into ventricles this active filling phase is called presystole or atrial systole, and sometimes that atrial kick 46. When listening to heart sounds, the nurse knows the valve closures that can be heard best at the base of the heart are: a.Mitral and tricuspid. b.Tricuspid and aortic. c.Aortic and pulmonic. d.Mitral and pulmonic. Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 Rationale the second heart sound (S2) occur with the closure of the semilunar (aortic and pulmonic) valves and signals the end of systole S2 is loudest at the base of the heart S1 is loaded at the apex of the heart and that is the closure of the mitral and tricuspid valve 47. Which of these statements describes the closure of the valves in a normal cardiac cycle? a.The aortic valve closes slightly before the tricuspid valve. b.The pulmonic valve closes slightly before the aortic valve. c.The tricuspid valve closes slightly later than the mitral valve. d.Both the tricuspid and pulmonic valves close at the same time. Rationale events occur slightly later in the right side of the heart because of the route of myocardial depolarization as a result, 2 distinct components to each of the heart sounds exist; sometimes they can be heard separately first heart sound, mitral component closes before the triscupid component pulmononic valve closes slightly after the aortic valve, not before pulmonic and triscupid valve closes slightly after the mitral and aortic valve, mitral and aortic valve close slightly before the pulmonic and aortic valve 48. he component of the conduction system referred to as the pacemaker of the heart is the: a.Atrioventricular (AV) node. b.Sinoatrial (SA) node. c.Bundle of His. d.Bundle branches. Rationale specialized cells in the SA node near the superior vena cava initiate an electrical impulse Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 because the SA node has an intrinsic rhythm, it is called the pacemaker of the heart 49. The electrical stimulus of the cardiac cycle follows which sequence? a.AV node SA node bundle of His b.Bundle of His AV node SA node c.SA node AV node bundle of His bundle branches d.AV node SA node bundle of His bundle branches Rationale specialized cells in the SA node near the superior vena cava initiate electrical impulse then it flows to the AV node in the atrial septum impulse travels to the bundle of his then to the right and left bundle branches and then through the ventricles. 50. The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates: a.Decreased fluid volume. b.Increased cardiac output. c.Narrowing of jugular veins. d.Elevated pressure related to heart failure. Rationale because no cardiac value exists to separate the superior vena cava from the right atrium, the jugular veins gives information about the activity on the right side of the heart they reflect filling pressure and volume changes normal jugular venous pulsation is 2 cm or less above sternal angle elevated pressure is more than 3 cm above the sternal angle at 45º and occurs with heart. 51. When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true? Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 a.The left ventricle is larger and weighs more than the right ventricle. b.The circulation of a newborn is identical to that of an adult. c.Blood can flow into the left side of the heart through an opening in the atrial septum. d.The foramen ovale closes just minutes before birth, and the ductus arteriosus closes immediately after. Rationale first, apron 2/3 of blood is shunted through an opening in atrial septum called the foreman oval into the left side of the heart which is then pumped out of the aorta to the system 1/3 is pumped into pulmonary artery which bypasses the lungs by the ductus arterious and enters into the aorta foramen ovale closes within the first hour after birth bc the pressure in the right side of the heart is lower than the left the ductus arteriosus closes within 10 - 15 hours after birth. 52. A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluating this change, what does the nurse know to be true? a.This decline in blood pressure is the result of peripheral vasodilatation and is an expected change. b.Because of increased cardiac output, the blood pressure should be higher at this time. c.This change in blood pressure is not an expected finding because it means a decrease in cardiac output. d.This decline in blood pressure means a decrease in circulating blood volume, which is dangerous for the fetus. Rationale despite the increased cardiac output, arterial blood pressure decreases pregnancy because of peripheral vasodilation the BP drops to its lowest point during the second trimester and then rises after that Gestational hypertension BP > 140/90 mm Hg on 2 separate measures without proteinuria starting after the 20th week of pregnancy Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 53. The nurse is caring for a patient prescribed warfarin (Coumadin) orally. The w p ’ p (PT) effectiveness of the medication. The nurse should also evaluate which of the following laboratory values? a) Partial thromboplastic time (PTT) b) Complete blood count (CBC) c) Sodium d) International normalized ratio (INR) Rationale The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin.The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis.The other laboratory values are not used to evaluate the effectiveness of Coumadin. 54. The nurse is caring for a patient in the ICU diagnosed with coronary artery disease (CAD). Which of the following assessment data indicates the patient is experiencing a decrease in cardiac output? a) BP 108/60 mm Hg, ascites, and crackles b) Disorientation, 20 mL of urine over the last 2 hours c) Reduced pulse pressure and heart murmur d) Elevated jugular venous distention (JVD) and postural changes in BP Rationale Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation. 55. The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing? a) ST-segment changes on the ECG b) BP changes; 148/80 mm Hg to 166/90 mm Hg Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 c) Dizziness and leg cramping d) Heart rate changes; 78 bpm to 112 bpm Rationale During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; BP; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue.The test is terminated when the target heart rate is achieved or if the patient experiences signs of myocardial ischemia.Further diagnostic testing, such as a cardiac catheterization, may be warranted if the patient develops chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias or STsegment changes on the ECG during the stress test. The other findings would not warrant the testing to be stopped. 56. The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include? a) “Contact your primary care provider if you develop a temperature above 102°F.” b) “Do not bend at the waist, strain, or lift heavy objects for the next 24 hours.” c) “If any discharge occurs at the puncture site, call 911 immediately.” d) “You can take a tub bath or a shower when you get home.” Rationale The nurse should instruct the patient to complete the following: If the artery of the groin was used, for the next 24 hours, do not bend at the waist, strain, or lift heavy objects; the primary provider should be contacted if any of the following occur: swelling, new bruising or pain from your procedure puncture site, temperature of 101°F or more. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The patient should not drive to the hospital. 57. The nurse is caring for a patient with clubbing of the fingers and toes. The nurse should complete which of the following actions given these findings? Downloaded by zena ahmad (zenaahmad772@gmail.com) lOMoARcPSD|35287698 a) Obtain an oxygen saturation level. b) Assess the patient for pitting edema. c) Obtain a 12-lead ECG tracing. d) Assess the patient’s capillary refill. Rationale Clubbing of the fingers and toes indicates chronic hemoglobin desaturation (decreased oxygen supply) and is associated with congenital heart disease.The nurse should assess the patient’s O2 saturation level and intervene as directed. The other assessments are not indicated. Downloaded by zena ahmad (zenaahmad772@gmail.com)