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Ati med surg cardiology proctored exam

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Total Questions : 24

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Question 1:

A nurse is caring for a client who has an irregular heart rate. Which of the following actions should the nurse take?

A. Palpate the client's pulse at the third intercostal space. B. Auscultate the client's apical pulse. C. Check the clients heart rate for 30 sec. D. Ask the client to perform the Valsalva maneuver.

Answer and Explanation

Choice A:

Peripheral pulse assessment is typically done at sites such as the radial, brachial, or carotid arteries. Palpating at the third intercostal space is not a standard site for pulse assessment and would not provide accurate heart rate or rhythm information.

Choice B:

For clients with an irregular heart rate, the apical pulse provides the most accurate measurement. The nurse should auscultate at the fifth intercostal space at the midclavicular line (apical site) for a full minute to assess both rate and rhythm. This is especially important when the rhythm is irregular because peripheral pulses may be inconsistent or difficult to detect.

Choice C:

While counting for 30 seconds is sometimes acceptable for regular rhythms, it is not recommended for irregular rhythms. In irregular heart rhythms, a full 60-second assessment ensures accurate detection of variability and missed beats.

Choice D:

The Valsalva maneuver is a technique sometimes used to terminate certain supraventricular tachycardias, but it is not a standard assessment for measuring heart rate. Performing it without indication can be unsafe and is not part of routine evaluation for irregular heart rate.

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Question 2:

Which clinical manifestations are most commonly associated with left-sided heart failure? (Select all that apply)

A. Crackles in the lungs B. Jugular vein distension C. Ascites D. Shortness of breath E. Pulmonary congestion F. Wet, phlegmy cough G. Peripheral edema

Answer and Explanation

Choice A:

Fluid accumulation in the alveoli due to pulmonary venous congestion results in crackles (rales) heard on auscultation, particularly in the lower lobes. This is a hallmark sign of left-sided heart failure.

Choice B:

Jugular vein distension indicates systemic venous congestion, which is characteristic of right-sided heart failure, not left-sided. In left-sided failure, systemic venous pressure is usually normal unless there is biventricular involvement.

Choice C:

Ascites develops from right-sided heart failure, where elevated venous pressures lead to fluid accumulation in the peritoneal cavity. It is not a primary manifestation of left-sided failure.

Choice D:

Pulmonary congestion reduces gas exchange, leading to dyspnea, which may be worsened by exertion, lying flat (orthopnea), or awakening at night with sudden breathlessness (paroxysmal nocturnal dyspnea).

Choice E:

Left-sided ventricular failure causes increased pulmonary venous pressure, resulting in pulmonary edema, impaired oxygen diffusion, and the sensation of air hunger. Pulmonary congestion is a core pathophysiologic feature of left-sided heart failure.

Choice F:

Pulmonary edema can cause a moist, productive cough with frothy sputum, reflecting fluid accumulation in the alveoli and airways. This is a classic symptom of left-sided heart failure and is often worse at night.

Choice G:

Peripheral edema is associated with right-sided heart failure due to systemic venous congestion, leading to fluid accumulation in the lower extremities, sacrum, or dependent areas. In isolated left-sided failure, peripheral edema is typically absent.

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Question 3:

A nurse is preparing to administer atenolol 25 mg PO every 12 hr. The amount available is atenolol 50 mg/tab. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Answer and Explanation

Correct Answer: "0.5" tablets

Explanation

Step 1: Use the formula
Number of tablets = Desired dose ÷ Strength per tablet

Step 2: Insert known values
Number of tablets = 25 ÷ 50 = 0.5

Final Answer: 0.5 tablets

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Question 4:

A nurse is preparing to obtain an electronic blood pressure measurement on a client. Which of the following actions should the nurse plan to take?

A. Place the blood pressure cuff 5 cm (2 in) above the client's antecubital space. B. Elevate the client's arm above the level of the heart. C. Select a cuff that covers 50% of the client's upper arm. D. Align the artery indicator on the blood pressure cuff with the client's brachial artery.

Answer and Explanation

Choice A:

The cuff should be positioned 2–3 cm (about 1 inch) above the antecubital space, where the brachial artery is palpable. Placing the cuff too high (e.g., 5 cm) can interfere with proper inflation and pressure transmission, leading to inaccurate or falsely elevated readings.

Choice B:

The arm should be supported at heart level. If the arm is above heart level, the reading may be artificially low because the hydrostatic pressure in the arteries is reduced. Conversely, if the arm is below heart level, readings may be falsely high due to increased hydrostatic pressure.

Choice C:

The cuff bladder should cover 80–100% of the arm circumference and two-thirds of the arm length. A cuff that is too small (50%) compresses the artery too tightly, causing overestimation of blood pressure. A cuff that is too large can underestimate blood pressure. Using the correct cuff size is essential for accurate measurement.

Choice D:

Electronic blood pressure cuffs detect arterial pulsations through the bladder. Aligning the cuff’s artery marker with the brachial artery ensures that the oscillometric sensors are positioned correctly to measure systolic and diastolic pressures accurately. Proper placement minimizes measurement errors and is a standard part of correct blood pressure technique.

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Question 5:

A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Answer and Explanation

Correct Answer: "0.5" tablets

Explanation

Step 1: Convert units so they match
125 mcg = 0.125 mg

Step 2: Use the formula
Number of tablets = Desired dose ÷ Strength per tablet

Number of tablets = 0.125 ÷ 0.25 = 0.5

Final Answer: 0.5 tablets

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Question 6:

A nurse is assessing a client who has right ventricular failure. Which of the following findings should the nurse expect?

A. Dry, hacking cough B. Crackles in the lungs C. Hepatomegaly D. Dizziness

Answer and Explanation

Choice A:

A dry, hacking cough is a classic sign of left-sided heart failure, where blood backs up into the pulmonary circulation, causing pulmonary congestion and irritation of airway receptors. In isolated RV failure, pulmonary symptoms are usually minimal unless left-sided failure is also present (biventricular failure).

Choice B:

Crackles (rales) result from pulmonary edema, which is a hallmark of left-sided heart failure. In RV failure, the lungs are generally not congested, so crackles are not expected unless there is concomitant left ventricular dysfunction.

Choice C:

RV failure leads to increased venous pressure in the systemic circulation, causing congestion in the liver (hepatomegaly). This can manifest as right upper quadrant fullness or tenderness, impaired liver function, and in chronic cases, nutmeg liver from long-standing congestion. Other systemic signs include jugular vein distension, peripheral edema (especially in the lower extremities), ascites, and weight gain due to fluid retention.

Choice D:

While dizziness can occur in any form of heart failure due to decreased cardiac output, it is nonspecific and is not considered a primary or hallmark sign of right-sided heart failure.

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Question 7:

Which interventions are most appropriate for managing fluid retention in a patient with right-sided heart failure? (Select all that apply)

A. Restricting sodium in the diet B. Positioning the patient in Trendelenburg C. Administering calcium channel blockers D. Elevating the legs E. Performing thoracentesis F. Assessing jugular vein distension G. Administering furosemide H. Monitoring intake and output I. Compression stockings

Answer and Explanation

Choice A:

Limiting sodium intake helps reduce fluid retention because sodium promotes water retention. This is a key dietary intervention in managing edema associated with right-sided heart failure.

Choice B:

Trendelenburg positioning (head lower than feet) increases venous return and can worsen venous congestion and edema, making it inappropriate for patients with right-sided heart failure.

Choice C:

Calcium channel blockers are primarily used for hypertension, angina, and certain arrhythmias. They are not first-line therapy for managing fluid retention in right-sided heart failure.

Choice D:

Elevating the legs helps promote venous return from the lower extremities, reducing peripheral edema and discomfort associated with fluid accumulation.

Choice E:

Thoracentesis is used to remove pleural effusions, which are more common in left-sided or biventricular heart failure, not routine management of peripheral edema in right-sided failure.

Choice F:

Monitoring jugular vein distension (JVD) provides information about central venous pressure and helps assess the severity of fluid overload in right-sided heart failure.

Choice G:

Loop diuretics, such as furosemide, promote diuresis, reducing fluid overload, edema, and venous congestion. They are a mainstay of pharmacologic management in right-sided heart failure.

Choice H:

Tracking fluid intake and output is essential to evaluate fluid balance and the effectiveness of diuretics. Accurate monitoring helps prevent volume overload or dehydration.

Choice I:

Compression stockings help promote venous return from the lower extremities and reduce peripheral edema, supporting overall fluid management in right-sided heart failure.

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Question 8:

While performing an admission assessment for a client, the nurse notes that the client has varicose veins with ulcerations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses should the nurse identify as being the priority in the client's care?

A. Alteration in body image B. Impaired tissue perfusion C. Impaired skin integrity D. Alteration in activity tolerance

Answer and Explanation

Choice A:

While varicose veins and ulcerations may affect the client’s self-esteem and body image, this is a psychosocial concern. It does not pose an immediate risk to physiological health and therefore is not the priority in acute care planning.

Choice B:

The client’s varicose veins, lower extremity edema, ulcerations, and feelings of heaviness indicate venous insufficiency, which can compromise oxygen and nutrient delivery to tissues. If left unaddressed, this can lead to worsening ulcerations, delayed wound healing, infection, and potential tissue necrosis. Prioritizing this diagnosis ensures that interventions focus on restoring adequate circulation, reducing venous congestion, and promoting tissue health, which are critical for preventing serious complications.

Choice C:

The presence of ulcers reflects damage that has already occurred, but this is secondary to impaired tissue perfusion. Focusing solely on skin care without addressing circulation would not prevent further tissue breakdown or promote optimal healing.

Choice D:

The client’s report of leg heaviness may reduce mobility, but activity intolerance is a secondary effect of venous insufficiency. Ensuring adequate tissue perfusion and reducing edema takes precedence before addressing limitations in activity.

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Question 9:

A nurse in the emergency department is caring for a client who reports chest pressure and shortness of breath. Which of the following laboratory tests should the nurse anticipate the provider to prescribe?

A. Aspartate aminotransferase (AST) B. Troponin I C. Lipase D. B-type natriuretic peptide (BNP)

Answer and Explanation

Choice A:

AST is a liver enzyme used to assess hepatic function or hepatocellular injury. It is not a primary test for cardiac ischemia or chest pain evaluation.

Choice B:

Troponin I is a cardiac-specific biomarker that is released into the bloodstream during myocardial injury or infarction. In a client presenting with chest pressure and shortness of breath, troponin I helps diagnose acute coronary syndrome (ACS) and guides emergent cardiac management. Serial measurements are often performed to detect rising or falling trends indicative of myocardial damage.

Choice C:

Lipase is a pancreatic enzyme used to assess pancreatic injury or pancreatitis. While pancreatitis can sometimes cause epigastric pain, it is not the first-line test for chest pressure or suspected cardiac events.

Choice D:

BNP is a marker of ventricular stretch and heart failure. Although it helps evaluate shortness of breath related to volume overload, it is not the primary test for diagnosing acute myocardial ischemia or infarction in a client presenting with chest pressure.

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Question 10:

While auscultating a client's heart sounds, the nurse hears turbulence between the S, and S2 heart sounds. The nurse should document this finding as which of the following?

A. A systolic murmur B. A third heart sound (S3) C. An expected heart sound D. A fourth heart sound (S4)

Answer and Explanation

Choice A:

Turbulence heard between S1 and S2 corresponds to systole, the phase when the ventricles contract. A systolic murmur occurs due to turbulent blood flow through the heart valves or chambers during ventricular contraction. This can be innocent or pathological, depending on the characteristics and associated findings.

Choice B:

S3 occurs just after S2, during early diastole, when rapid ventricular filling causes vibrations. It is often associated with heart failure or volume overload in adults, but it does not occur between S1 and S2.

Choice C:

Turbulence between S1 and S2 is not an expected heart sound. Normal heart sounds are S1 and S2 only; additional sounds or murmurs indicate abnormal flow or pathology.

Choice D:

S4 occurs just before S1, during late diastole, when the atria contract against a stiff ventricle. It is not heard between S1 and S2 and is usually associated with ventricular hypertrophy or decreased compliance.

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Ati med surg cardiology proctored exam

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