Notes for Medical Surgical Class Answer Key

1.A patient with history of hypertension treated with a diuretic and an angiotensin-converting enzyme ACE inhibitor arrive in the emergency Department complaining of a severe headache pressure (BP) of 238 / 118 mm HG. which question should the nurse ask first? c. Have you been consistently taking your medication. 4. The nurse is assessing a client who has been admitted to the intensive care unit ICU with a hypertensive emergency which finding is most important to report to the provider? a. urine output over 8 hours in 250ML less than the fluid intake b. the patient cannot move the left arm and leg when asked to do so c. the patient complained of a headache with pain at level 6 of 10 (0 to 10 scale) d. tremors are noted in the finger when the patient extend the arm 5. the client receive an antihypertensive medication report feeling dizzy and … when…from a a. Heart rhythm B. Blood pressure c. Pulse oximetry d. Breath sounds 11. The nurse obtained the following information from a client newly diagnosed with hypertensive which finding is most important to address with the client a. low dietary fiber intake b. wait is £5 above ideal weight c. drink a beer with dinner every night d. no regular physical exercise 25. the charge nurse observe a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for (Vasotec) the charge nurse will need to intervene if the new RN tell the patient to. a. Make an appointment with the dietician for teaching b .Check your blood pressure at home at least once daily c. Increase the dietary intake of high potassium food d. Monitor slowly when going from a lying to standing position 26. the health care provider prescribes an angiotensin converting enzyme ACE inhibitor for the client diagnosed with essential hypertension. What statement is the most appropriate for administering this medication? a. ACE inhibitor block alpha receptor in the vascular smooth muscle b. ACE inhibitors prevent vasoconstriction and sodium water retention c. ACE inhibitors prevent beta stimulation in the heart muscle d. ACE inhibitor work by blocking vascular smooth muscle 29. which assessment finding in a client receiving intravenous Furosemide to treat stage 2 hypertension is most important to report to the health care provider. a. Recent blood pressure of 168/98 mm hg b. Orthostatic systolic bp decrease of 10 mm hg c. Serum potassium level of 30 mEg L d. Blood glycose level of 175 mg dL 31. Which information should the nurse include when teaching a patient with a new diagnosis hypertension? a. Increase physical activity will control blood pressure (BP) for most potent b. Hypertension is usually asymptomatic until target organ damage occurs c. Annual BP checks are needed to monitor treatment effectiveness d. Most patient are able to control BP through dietary changes 33. The nurse is assessing a client with hypertension. Which client outcome indicates effective hypertension management? a. The blood pressure is 148/94 mm hg b. No evidence of renal impairment found c. No complaints of sexual dysfunction d. The abdominal girth measurement is decreased 37. The client with hypertension is discharged on benazepril 5mg by mouth daily. After the teaching session which statement by the client indicates a need for further teaching. 40. The nurse is teaching a client who has hypertension abuse and your prescription for metoprolol which statement indicates an understanding of the teaching? a. I should have my clotting time check twice a week b. I will call my provider if my heart rate is less than 60 c. I will report any ringing in my ears d. I should place the tablet under my tongue 44. The client diagnosed with essential hypertension ask the nurse. Why do I have high blood pressure which response by the nurse ….be most appropriate? a. You shouldn't worry yourself so much it will make your pressure go up b. There is no specific cause of hypertension but there are many known risk factors 46. When discussing the effects of hypertension with a client diagnosed with hypertension the nurse refers to target organ damage. Which organ of the body is the nurse referring to as being most effected by hypertension? select all that apply a. heart b. kidney c. eye d. liver e. lungs 10. Which of the following are considered manifestations of acute coronary syndrome ACS (select all that apply) a. Non St segment elevation myocardial infraction in (STEMI ) b. stable angina c. St segment elevation myocardial infarction (STEMI) d. unstable angina e. Dysrhythmias 11. The nurse understands that area of infraction or necrosis or indicate on a client 12 lead let your cardiogram ECG as evidenced by which pattern? A. St segment elevation B. St segment depression C. pathological Q wave D. T wave inversion 12. The client with the left anterior descending a (LAD) with a 90% blockage has crushing chest pain that is unrelieved by sublingual Nitroglycerin. Which is the most concerning ECG finding should the nurse report to the health care provider HCP stat? a. Q wave b. peaked T wave c. St segment elevation d. Flipped T waves 13. The client having burning chest pain that radiates to the left shoulder and calls for the nurse. Which prescription intervention should the nurse implement first? a. nitroglycerin 0.4 MG sublingual b. stat- 12 lead Electrocardiogram ECG c. morphine sulfate 2.4 milligram Ivy PRN d. oxygen 4 liters by nasal cannula 14. The nurse is assessing a client following a myocardial infraction am I obtain this vital sign BP 78 / 38 H R128RR32 the nurse notify the health care provider concern that the client may be experiencing which most life threatening complication? a. cardiogenic shock b. pulmonary embolism c. cardio myopathy d. pericardial infusion 15. To detect an three the most common and potentially life threatening complication of an MI that often occur within the 1st 24 hours. The nurse should implement which of the following findings. a. b. c. d. Maintain hourly urine output initiate continuous cardiac monitoring monitor vital sign every four hours auscultate breath sound for crackles 16. Along with persistent crushing chest pain, which additional signs or symptoms would make the nurse suspect that the client was experiencing a myocardial infarction MI? a. neck vein distention on edema b. nausea, vomiting, and diaphoresis c. midepigastric pain and cramps d. intermittent Claudication an pallor 17. When instructing the client with angina about taking sublingual nitroglycerin. What should the nurse include in the teaching plan? a. Stop the medication and notify the HCP if a severe headache occurs b. to lie down and place one tablet under the tongue while chest pain occur c. if one tablet does not relieve the pain within 15 minutes go to the hospital d. take the tablet with warm water so that it dissolves quickly 18. Chest pain that occurs at rest or increases in the number and severity of the attack is known as. a. Variant angina b. Prinzmetals angina c. unstable angina d. stable angina 19. Which statement is true regarding the use of thrombolytics therapy in the treatment of a myocardial infraction am I select all that apply a. is a treatment option in the management of unstable angina an STEMI and STEMI b. Reperfusion is indicated by continue ST segment elevation. c. is contraindicate if the client has had intracranial or intraspinal surgery within the past two months d. it is contraindicated in the presence of severe hypotension e. two to three Ivy line must be placed following a administration of the tromba lyrics 20. Which diagnostic tests should be performed within 10 minutes of arrival to the emergency Department with client presenting with chest pain. a. electrocardiogram b. cardiac catheterization c. echocardiogram d. profusion image 21. In the setting of a myocardial infraction, morphine is administered IV for all of the following reason except for. a. antiplatelet b. severe pain c. anxiety d. vasodilation 22. A client arrived in the emergency Department with a potential diagnosis of myocardial infraction the nurse administers 4 chewable aspirin for which effect a. antiplatelet b. antipyretic c. Anti-inflammatory d. Analgesic 23. The nurses reviewing the serum laboratory result for a client admitting six hours ago for chest pain possible myocardial infraction. What is the most reliable biomarker that aids in the definition diagnosis of MI is? a. Creatine kinase (CPK) b. Serum myoglobin c. Highly sensitivity C reactive protein d. Troponin 1 & troponin T 24. The nurse is caring for a client presenting to the emergency Department with chest pain. After placing the client on oxygen, the nurse assesses and secures the IV insertion by the paramedics. The primary purpose of obtaining IV Access is in this setting is for which reason? a. to administer emergency medication for treatment of dysrhythmias b. to maintain the nurse competency in caring for intravenous line c. To administer Ivy fluids to prevent dehydration due to diaphoresis d. to replace lost fluid following the administration of diuretic 25. The nurse is caring for a client with a myocardial infraction am I on the cardiac progressive care unit the nurse recognizes that which of the following prescription by the HCP needed clarification. a. oxygen 2 liters slash min visa nasal cannula to keep auto saturate over 95% b. morphine sulfate 2 milligram ivy for chest pain every four hours prn c. obtain a set of cardiac biomarkers an admission to the unit d. 0.9% normal saline continuous IV at 200 mL/hr 26. A client is prescribed aspirin 81 mg clopidogrel Plavix following an episode of angina. the nurse recognizes that clopidogrel belong to what drug classification. a. Antiplatelet b. anticoagulant c. fibrinolytic d. Thrombolytic 27. A client is placed on a print therapy following cardiac catheterization with stent placement. The nurse's on hand which medication if needed as an antidote for heparin. a. protamine sulfate (protamine) b. Coumadin (warfarin) c. aminocaproic acid (Amicar) d. vitamin K phytonadione 28. A client is ordered to receive digoxin (lanoxin) to treat congestive heart failure. The nurse is most concerned about which assessment finding? a. 1+ pitting edema of lower leg b. heart rate 56 beats per minute c. blood pressure of 138 /90 mm Hg d. respiration 12 beat / minutes 29. A client taking finasteride (Lasix) 40 mg by mouth daily now present to the emergency Department (ED) with an exacerbation of heart failure. The ATP order finasteride Lacy 60 MG IV. Stat. What is the primary rationale for changing both the route and dose of this medication? a. The client is unable to tolerate swallowing oral medication b. the client has been non-compliant with prescribed medication c. the medication will work more rapidly to relieve symptoms d. all medication are given intravenously in the Ed 30. The nurse is assessing a client with right side heart failure. Which assessment finding does the nurse expect to find in this client? a. Orthopnea b. weight loss c. pitting edema d. Nocturia 31. The nurse assess a client with coronary artery disease and notes the presence of an S 3 gallop. What is the nurse’s best intervention? a. Assessing for signs of left sided heart failure b. transfer the client to the intensive care unit c. notify the L care provider immediately d. document defining as a normal heart sound 32. The nurse is assessing a client in the emergency Department Ed. Which kind statements alert the nurse to possible heart failure? a. I see Halos floating around my eyes b. I often have trouble remembering things c. I get short of breath when I climb stairs d. I have lost weight over the past month 33. The nurse has an order to give a client the scheduled dose of the digoxin (lanoxin). Prior to administrating the medication, the nurse assesses for which of the following manifestation that could indicate to digoxin toxicity? a. dyspnea edema and palpitation b. chest pain hypotension and parathesias c. Constipation dry mouth and insomnia d. nausea loss of appetite and visual changes 34. Which of the following statement made by the client would alert the nurse to the possibility of right sided heart failure? a. I woke up coughing every morning b. I sleep with four pillows at night c. my shoes feel tight by the end of the day d. I have trouble catching my breath 35. A client is admitted with signs of heart failure. Which of the following breath sound is most indicate if of left sided heart failure? a. bilateral crackles b. scattered rhonchi c. pleural fiction rub d. Exploratory wheezes 36. The nurse caring for a client with heart failure is complaining of shortness of breath. Which action should the nurse initiate first? a. elevate head of the bed b. auscultate breath sound c. get a pulse oximeter reading d. place the client in oxygen 37. A client arrived to the emergency Department in pulmonary edema. Which of the following manifestation are expected finding? (select all that apply) a. tachypnea b. thick yellow sputum c. president of AN S3 gallop d. orthopnea e. jugular vein distinction f. dyspnea 38. A common diagnostic test that is used in the diagnosis of heart failure, measure ejection, provide information about the heart valve, and hard wall motion is known as a. a. Electrophysiology study b. exercise stress test c. echocardiogram d. electrocardiogram 39. Inotropic drugs that increase the force and contraction of the heart and or use in the management of heart failure included which of the following medication select all that apply a. dobutamine b. Milrinone c. Propranolol d. Dopamine 40. The New York Heart Association in (NYHA) guideline for classifying person with heart disease and heart failure is based on which principle? a. pulmonary artery pressure b. oxygen saturation c. degree of dyspnea d. tolerate to physical activity 41. Ischemia an injury of the art cell can be represented by what finding in the EKG a. ST and T wave changes b. peak T wave c. Q wave abnormalities d. wide QRS complex 42. A client with heart failure asked the nurse why is it important to be weighed every day. What is the nurse’s best response? a. daily weight will help us monitor protein and muscle loss b. weight is the best indication of fluid gain or losses in the body c. the hospital requires that all person with heart disease be weighed daily d. you will need to lose weight to decrease your risk of heart disease 43. In discussing physical activity in the prevention of coronary artery disease the nurse should include which of the following statement (select all that apply) a. weight training should be a part of daily exercise program b. the intensity of the physical activity is based on the heart rate c. physical activity session should be at least 30 minutes long d. one of the best forms of physical activity is walking e. regular physical exercise can help reduce HDL cholesterol 44. A client admitted with diagnosis of chronic stable angina. When completely in the admission assessment, the nurse is aware that stable angina varies in the quality of pain or discomfort. Which qualitative description have been associated with the discomfort? select all that apply a. pressure b. dull, aching c. tightness d. squeezing e. stabbing, sharp