Chapter 35: Care of Patients with Cardiac Problems: Medical-Surgical Nursing, 8th Edition.

Question 1

1. A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?
   a. A 36-year-old woman with aortic stenosis
   b. A 42-year-old man with pulmonary hypertension
   c. A 59-year-old woman who smokes cigarettes daily
   d. A 70-year-old man who had a cerebral vascular accident

Answer 1

a. A 36-year-old woman with aortic stenosis

Question 2

2. A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?
   a. I have been drinking more water than usual.
   b. I am awakened by the need to urinate at night.
   c. I must stop halfway up the stairs to catch my breath.
   d. I have experienced blurred vision on several occasions.

Answer 2

c. I must stop halfway up the stairs to catch my breath.

Question 3

3. A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?
   a. I sleep with four pillows at night.
   b. My shoes fit really tight lately.
   c. I wake up coughing every night.
   d. I have trouble catching my breath.

Answer 3

b. My shoes fit really tight lately.

Question 4

4. While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. Which action should the nurse take next?
   a. Assess for symptoms of left-sided heart failure.
   b. Document this as a normal finding.
   c. Call the health care provider immediately.
   d. Transfer the client to the intensive care unit

Answer 4

a. Assess for symptoms of left-sided heart failure.

Question 5

5. A nurse cares for a client with right-sided heart failure. The client asks, Why do I need to weigh myself every day? How should the nurse respond?
   a. Weight is the best indication that you are gaining or losing fluid.
   b. Daily weights will help us make sure that youre eating properly.
   c. The hospital requires that all inpatients be weighed daily.
   d. You need to lose weight to decrease the incidence of heart failure.

Answer 5

a. Weight is the best indication that you are gaining or losing fluid.

Question 6

6. A nurse is teaching a client with heart failure who has been prescribed enalapril (Vasotec). Which statement should the nurse include in this clients teaching?
   a. Avoid using salt substitutes.
   b. Take your medication with food.
   c. Avoid using aspirin-containing products.
   d. Check your pulse daily.

Answer 6

a. Avoid using salt substitutes.

Question 7

7. After administering newly prescribed captopril (Capoten) to a client with heart failure, the nurse implements interventions to decrease complications. Which priority intervention should the nurse implement for this client?
   a. Provide food to decrease nausea and aid in absorption.
   b. Instruct the client to ask for assistance when rising from bed.
   c. Collaborate with unlicensed assistive personnel to bathe the client.
   d. Monitor potassium levels and check for symptoms of hypokalemia

Answer 7

b. Instruct the client to ask for assistance when rising from bed.

Question 8

A nurse assesses a client after administering isosorbide mononitrate (Imdur). The client reports a headache. Which action should the nurse take?

a. Initiate oxygen therapy.
b. Hold the next dose of Imdur.
c. Instruct the client to drink water.
d. Administer PRN acetaminophen.

Answer 8

d. Administer PRN acetaminophen.

Question 9

9. A nurse teaches a client who is prescribed digoxin (Lanoxin) therapy. Which statement should the nurse include in this clients teaching?
   a. Avoid taking aspirin or aspirin-containing products.
   b. Increase your intake of foods that are high in potassium.
   c. Hold this medication if your pulse rate is below 80 beats/min.
   d. Do not take this medication within 1 hour of taking an antacid.

Answer 9

d. Do not take this medication within 1 hour of taking an antacid.

Question 10

10. A nurse teaches a client who has a history of heart failure. Which statement should the nurse include in this clients discharge teaching?
    a. Avoid drinking more than 3 quarts of liquids each day.
    b. Eat six small meals daily instead of three larger meals.
    c. When you feel short of breath, take an additional diuretic.
    d. Weigh yourself daily while wearing the same amount of clothing.

Answer 10

d. Weigh yourself daily while wearing the same amount of clothing.

Question 11

11. A nurse admits a client who is experiencing an exacerbation of heart failure. Which action should the nurse take first?
    a. Assess the clients respiratory status.
    b. Draw blood to assess the clients serum electrolytes.
    c. Administer intravenous furosemide (Lasix).
    d. Ask the client about current medications.

Answer 11

a. Assess the clients respiratory status.

Question 12

12. A nurse assesses a client with mitral valve stenosis. What clinical manifestation should alert the nurse to the possibility that the clients stenosis has progressed?
    a. Oxygen saturation of 92%
    b. Dyspnea on exertion
    c. Muted systolic murmur
    d. Upper extremity weakness

Answer 12

b. Dyspnea on exertion

Question 13

13. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, Why will I need to take anticoagulants for the rest of my life? How should the nurse respond?
    a. The prosthetic valve places you at greater risk for a heart attack.
    b. Blood clots form more easily in artificial replacement valves.
    c. The vein taken from your leg reduces circulation in the leg.
    d. The surgery left a lot of small clots in your heart and lungs.

Answer 13

b. Blood clots form more easily in artificial replacement valves.

Question 14

14. After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the clients understanding. Which client statement indicates a need for additional teaching?
    a. Ill be able to carry heavy loads after 6 months of rest.
    b. I will have my teeth cleaned by my dentist in 2 weeks.
    c. I must avoid eating foods high in vitamin K, like spinach.
    d. I must use an electric razor instead of a straight razor to shave

Answer 14

b. I will have my teeth cleaned by my dentist in 2 weeks.

Question 15

15. A nurse cares for a client with infective endocarditis. Which infection control precautions should the nurse use?
    a. Standard Precautions
    b. Bleeding precautions
    c. Reverse isolation
    d. Contact isolation

Answer 15

a. Standard Precautions

Question 16

16. A nurse assesses a client with pericarditis. Which assessment finding should the nurse expect to find?
    a. Heart rate that speeds up and slows down
    b. Friction rub at the left lower sternal border
    c. Presence of a regular gallop rhythm
    d. Coarse crackles in bilateral lung bases

Answer 16

b. Friction rub at the left lower sternal border

Question 17

17. After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, Why is this important? How should the nurse respond?
    a. Rapid position changes can create shear and friction forces, which can tear out your internal vascular sutures.
    b. Your new vascular connections are more sensitive to position changes, leading to increased intravascular pressure and dizziness.
    c. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes.
    d. While your heart is recovering, blood flow is diverted away from the brain, increasing the risk for stroke when you stand up.

Answer 17

c. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes.

Question 18

18. A nurse teaches a client recovering from a heart transplant who is prescribed cyclosporine (Sandimmune). Which statement should the nurse include in this clients discharge teaching?
    a. Use a soft-bristled toothbrush and avoid flossing.
    b. Avoid large crowds and people who are sick.
    c. Change positions slowly to avoid hypotension.
    d. Check your heart rate before taking the medication

Answer 18

b. Avoid large crowds and people who are sick.

Question 19

19. A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, I know a transplant is my last chance, but I dont want to become a vegetable. How should the nurse respond?
    a. Would you like to speak with a priest or chaplain?
    b. I will arrange for a psychiatrist to speak with you.
    c. Do you want to come off the transplant list?
    d. Would you like information about advance directive

Answer 19

d. Would you like information about advance directives?

Question 20

20. A nurse assesses a client who has a history of heart failure. Which question should the nurse ask to assess the extent of the clients heart failure?
    a. Do you have trouble breathing or chest pain?
    b. Are you able to walk upstairs without fatigue?
    c. Do you awake with breathlessness during the night?
    d. Do you have new-onset heaviness in your legs?

Answer 20

b. Are you able to walk upstairs without fatigue?

Question 21

21. A nurse cares for an older adult client with heart failure. The client states, I dont know what to do. I dont want to be a burden to my daughter, but I cant do it alone. Maybe I should die. How should the nurse respond?
    a. Would you like to talk more about this?
    b. You are lucky to have such a devoted daughter.
    c. It is normal to feel as though you are a burden.
    d. Would you like to meet with the chaplain?

Answer 21

a. Would you like to talk more about this?

Question 22

22. A nurse teaches a client with heart failure about energy conservation. Which statement should the nurse include in this clients teaching?
    a. Walk until you become short of breath, and then walk back home.
    b. Gather everything you need for a chore before you begin.
    c. Pull rather than push or carry items heavier than 5 pounds.
    d. Take a walk after dinner every day to build up your strength.

Answer 22

b. Gather everything you need for a chore before you begin.

Question 23

23. A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure should the nurse implement?
    a. Apply an ice pack to the clients chest.
    b. Provide a neck rub, especially on the left side.
    c. Allow the client to lie in bed with the lights down.
    d. Sit the client up with a pillow to lean forward on

Answer 23

d. Sit the client up with a pillow to lean forward on

Question 24

24. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia should the nurse assess?
    a. Preventricular contractions
    b. Atrial fibrillation
    c. Symptomatic bradycardia
    d. Sinus tachycardia

Answer 24

b. Atrial fibrillation

Question 25

1. A nurse is assessing a client with left-sided heart failure. For which clinical manifestations should the nurse assess? (Select all that apply.)
   a. Pulmonary crackles
   b. Confusion, restlessness
   c. Pulmonary hypertension
   d. Dependent edema
   e. Cough that worsens at night

Answer 25

a. Pulmonary crackles
b. Confusion, restlessness
e. Cough that worsens at night

Question 26

2. A nurse evaluates laboratory results for a client with heart failure. Which results should the nurse expect? (Select all that apply.)
   a. Hematocrit: 32.8%
   b. Serum sodium: 130 mEq/L
   c. Serum potassium: 4.0 mEq/L
   d. Serum creatinine: 1.0 mg/dL
   e. Proteinuria
   f. Microalbuminuria

Answer 26

a. Hematocrit: 32.8%
b. Serum sodium: 130 mEq/L
e. Proteinuria
f. Microalbuminuria

Question 27

3. A nurse assesses clients on a cardiac unit. Which clients should the nurse identify as at greatest risk for the development of acute pericarditis? (Select all that apply.)
   a. A 36-year-old woman with systemic lupus erythematosus (SLE)
   b. A 42-year-old man recovering from coronary artery bypass graft surgery
   c. A 59-year-old woman recovering from a hysterectomy
   d. An 80-year-old man with a bacterial infection of the respiratory tract
   e. An 88-year-old woman with a stage III sacral ulcer

Answer 27

a. A 36-year-old woman with systemic lupus erythematosus (SLE)
b. A 42-year-old man recovering from coronary artery bypass graft surgery
d. An 80-year-old man with a bacterial infection of the respiratory tract

Question 28

4. After teaching a client with congestive heart failure (CHF), the nurse assesses the clients understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.)
   a. Ill read the nutritional labels on food items for salt content.
   b. I will drink at least 3 liters of water each day.
   c. Using salt in moderation will reduce the workload of my heart.
   d. I will eat oatmeal for breakfast instead of ham and eggs.
   e. Substituting fresh vegetables for canned ones will lower my salt intake.

Answer 28

a. Ill read the nutritional labels on food items for salt content.
d. I will eat oatmeal for breakfast instead of ham and eggs.
e. Substituting fresh vegetables for canned ones will lower my salt intake.

Question 29

5. A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client with congestive heart failure. Which instructions should the nurse provide to the UAP when delegating care for this client? (Select all that apply.)
   a. Reposition the client every 2 hours.
   b. Teach the client to perform deep-breathing exercises.
   c. Accurately record intake and output.
   d. Use the same scale to weigh the client each morning.
   e. Place the client on oxygen if the client becomes short of breath.

Answer 29

a. Reposition the client every 2 hours.
c. Accurately record intake and output.
d. Use the same scale to weigh the client each morning.

Question 30

6. A nurse prepares to discharge a client who has heart failure. Based on the Heart Failure Core Measure Set, which actions should the nurse complete prior to discharging this client? (Select all that apply.)
   a. Teach the client about dietary restrictions.
   b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor.
   c. Encourage the client to take a baby aspirin each day.
   d. Confirm that an echocardiogram has been completed.
   e. Consult a social worker for additional resources.

Answer 30

a. Teach the client about dietary restrictions.
b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor.
d. Confirm that an echocardiogram has been completed.

Question 31

7. A nurse prepares to discharge a client who has heart failure. Which questions should the nurse ask to ensure this clients safety prior to discharging home? (Select all that apply.)
   a. Are your bedroom and bathroom on the first floor?
   b. What social support do you have at home?
   c. Will you be able to afford your oxygen therapy?
   d. What spiritual beliefs may impact your recovery?
   e. Are you able to accurately weigh yourself at home?

Answer 31

a. Are your bedroom and bathroom on the first floor?
b. What social support do you have at home?
d. What spiritual beliefs may impact your recovery?

Question 32

8. A nurse assesses a client who is recovering from a heart transplant. Which assessment findings should alert the nurse to the possibility of heart transplant rejection? (Select all that apply.)
   a. Shortness of breath
   b. Abdominal bloating
   c. New-onset bradycardia
   d. Increased ejection fraction
   e. Hypertension

Answer 32

a. Shortness of breath
b. Abdominal bloating
c. New-onset bradycardia

Question 33

9. A nurse assesses a client who is diagnosed with infective endocarditis. Which assessment findings should the nurse expect? (Select all that apply.)
   a. Weight gain
   b. Night sweats
   c. Cardiac murmur
   d. Abdominal bloating
   e. Oslers nodes

Answer 33

b. Night sweats
c. Cardiac murmur
e. Oslers nodes