NULD 6501 Saunders Questions & Answers
• Cardiac
601. A client with a history of type 2 diabetes is admitted to the hospital with chest pain. The
... [Show More] client is scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?
1. Glipizide 2. Metformin
3. Repaglinide
4. Regular insulin
602. A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed?
1. Administer digoxin.
2. Defibrillate the client.
3. Continue to monitor the client.
4. Prepare for transcutaneous pacing.
603. The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the primary health care provider and prepares to implement which priority interventions? Select all that apply.
1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low-Fowler’s side-lying position
604. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client’s breath sounds?
1. Stridor 2. Crackles
3. Scattered rhonchi
4. Diminished breath sounds
605. A client with myocardial infarction is developing cardiogenic shock. What condition should the nurse carefully assess the client for?
1. Pulsus paradoxus
2. Ventricular dysrhythmias
3. Rising diastolic blood pressure
4. Falling central venous pressure
606. A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hr for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL
(16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem?
1. Hypovolemia
2. Acute kidney injury
3. Glomerulonephritis
4. Urinary tract infection
607. The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats per minute. Which action should the nurse take?
1. Check vital signs.
2. Check laboratory test results. 3. Monitor for any rhythm change.
4. Notify the primary health care provider.
608. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action?
1. Call a code.
2. Check the client’s status.
3. Call the health care provider.
4. Document the lack of complexes.
609. The nurse is watching the cardiac monitor and notices that a client’s rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats per minute. The nurse determines that the client is experiencing which dysrhythmia?
1. Sinus tachycardia
2. Ventricular fibrillation 3. Ventricular tachycardia
4. Premature ventricular contractions
610. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia?
1. It can develop into ventricular fibrillation at any time.
2. It is almost impossible to convert to a normal rhythm.
3. It is uncomfortable for the client, giving a sense of impending doom.
4. It produces a high cardiac output with cerebral and myocardial ischemia.
611. A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item?
1. Causative factors, such as caffeine
2. Sensation of fluttering or palpitations 3. Blood pressure and oxygen saturation
4. Precipitating factors, such as infection
612. The client has developed atrial fibrillation, with a ventricular rate of 150 beats per minute. The nurse should assess the client for which associated signs and/or symptoms? Select all that apply.
1. Syncope
2. Dizziness
3. Palpitations
4. Hypertension
5. Flat neck veins
613. The nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse interpret the client’s heart rhythm?
1. Atrial fibrillation
2. Sinus tachycardia
3. Ventricular fibrillation
4. Ventricular tachycardia
614. The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pads on the client’s chest and before discharging the device, which intervention is a priority?
1. Ensure that the client has been intubated.
2. Set the defibrillator to the “synchronize” mode.
3. Administer an amiodarone bolus intravenously. 4. Confirm that the rhythm is ventricular fibrillation.
615. A client in ventricular fibrillation is about to be defibrillated. To convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? 1. 50 J
2. 120 J
3. 200 J
4. 360 J
616. The nurse should evaluate that defibrillation of a client was most successful if which observation was made?
1. Arousable, sinus rhythm, blood pressure (BP) 116/72 mm Hg
2. Nonarousable, sinus rhythm, BP 88/60 mm Hg
3. Arousable, marked bradycardia, BP 86/54 mm Hg
4. Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg
617. The nurse is evaluating a client’s response to cardioversion. Which assessment would be the priority?
1. Blood pressure 2. Airway patency
3. Oxygen flow rate
4. Level of consciousness
618. The nurse is caring for a client who has just had implantation of an automatic internal cardioverter- defibrillator. The nurse should assess which item based on priority?
1. Anxiety level of the client and family
2. Activation status and settings of the device
3. Presence of a MedicAlert card for the client to carry
4. Knowledge of restrictions on postdischarge physical activity
619. A client’s electrocardiogram strip shows atrial and ventricular rates of 110 beats per minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse interpret this rhythm?
1. Sinus tachycardia
2. Sinus bradycardia
3. Sinus dysrhythmia
4. Normal sinus rhythm
620. The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How should the nurse interpret the client’s neurovascular status? 1. The neurovascular status is normal because of increased blood flow through the leg.
2. The neurovascular status is moderately impaired, and the surgeon should be called.
3. The neurovascular status is slightly deteriorating and should be monitored for another hour.
4. The neurovascular status shows adequate arterial flow, but venous complications are arising.
621. The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective?
1. Muffled heart sounds
2. Client reports dyspnea 3. A rise in blood pressure
4. Jugular venous distention
622. The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150 mL/hr, unchanged for the last 10 hours. The client’s urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client’s blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is the priority?
1. Check the serum albumin level.
2. Check the urine specific gravity.
3. Continue monitoring urine output.
4. Call the primary health care provider (PHCP).
623. A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching?
1. “I should notify my cardiologist if my feet or legs start to swell.”
2. “I am supposed to report to my cardiologist if my pulse rate decreases below 60.”
3. “Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast.”
4. “My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning.”
624. The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client’s rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse interpret this rhythm?
1. Asystole
2. Atrial fibrillation
3. Ventricular fibrillation
4. Ventricular tachycardia
625. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results?
1. Prothrombin time of 12.5 seconds
2. Activated partial thromboplastin time of 28 seconds 3. Activated partial thromboplastin time of 60 seconds
4. Activated partial thromboplastin time longer than 120 seconds
626. The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching?
1. “I will avoid alcohol consumption.”
2. “I will take my pills every day at the same time.”
3. “I have already called my family to pick up a MedicAlert bracelet.”
4. “I will take coated aspirin for my headaches because it will coat my stomach.”
627. A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range?
1. 0.5 ng/mL (0.63 nmol/L)
2. 0.8 ng/mL (1.02 nmol/L)
3. 0.9 ng/mL (1.14 nmol/L)
4. 2.2 ng/mL (2.8 nmol/L)
628. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
1. Obtain a 12-lead electrocardiogram.
2. Check the client’s fingerstick blood glucose level.
3. Auscultate the client’s apical pulse and blood pressure.
4. Measure the QRS interval duration on the rhythm strip.
629. The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication?
1. Report of infrequent insomnia
2. Development of expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after 2 doses of the medication
4. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication
630. A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client’s laboratory results?
1. Collaborate with the primary health care provider (PHCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
2. Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed.
3. Collaborate with the PHCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
4. Collaborate with the PHCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.
631. A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?
1. Monitor for kidney failure.
2. Monitor psychosocial status. 3. Monitor for signs of bleeding.
4. Have heparin sodium available.
632. The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply.
1. Sulfa allergy
2. Osteoporosis 3. Hypokalemia
4. Hypouricemia 5. Hyperglycemia 6. Hypercalcemia
633. The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (10 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching?
1. “Constipation and bloating might be a problem.”
2. “I’ll continue to watch my diet and reduce my fats.”
3. “Walking a mile each day will help the whole process.”
4. “I’ll continue my nicotinic acid from the health food store.”
634. The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply.
1. Tremors 2. Diarrhea
3. Irritability
4. Blurred vision
5. Nausea and vomiting
635. Prior to administering a client’s daily dose of digoxin to treat heart failure, the nurse reviews the client’s laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity?
1. Serum calcium level
2. Serum potassium level
3. Serum creatinine level 4. Serum magnesium level
636. The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the medication has achieved the expected effect?
1. Cough becomes productive of frothy pink sputum.
2. Urine output increases from 10 mL/hr to greater than 50 mL hourly.
3. The serum potassium level changes from 3.8 to 3.1 mEq/L (3.8 to 3.1 mmol/L).
4. B-type natriuretic peptide (BNP) factor increases from 200 to 262 ng/mL (200 to 262 mcg/L).
637. Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
1. Vitamin K
2. Protamine sulfate
3. Potassium chloride
4. Aminocaproic acid
638. A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions should the nurse anticipate? Select all that apply.
1. Stop the infusion.
2. Raise the head of the bed.
3. Administer protamine sulfate. 4. Administer diphenhydramine.
5. Call for the Rapid Response Team (RRT).
639. The nurse should report which assessment finding to the primary health care provider (PHCP) before initiating thrombolytic therapy in a client with pulmonary embolism?
1. Adventitious breath sounds
2. Temperature of 99.4° F (37.4° C) orally 3. Blood pressure of 198/110 mm Hg
4. Respiratory rate of 28 breaths per minute
640. The nurse provides instructions to the client about nicotinic acid prescribed for hyperlipidemia. Which statement by the client indicates understanding of the instructions?
1. “The medication should be taken with meals to decrease flushing.”
2. “It is not necessary to avoid the use of alcohol when taking nicotinic acid.”
3. “Clay-colored stools are a common side effect and should not be of concern.”
4. “Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing.”
• Respiratory
566. The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client?
1. A low respiratory rate
2. Diminished breath sounds
3. The presence of a barrel chest
4. A sucking sound at the site of injury
567. The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply.
1. A low arterial PCo2 level
2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise
4. A widened diaphragm noted on the chest x-ray
5. Pulmonary function tests that demonstrate increased vital capacity
568. The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually.
2. Avoid contact with other individuals, except family members, for at least 6 months. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated.
4. Respiratory isolation is not necessary, because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
6. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
569. The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the primary health care provider?
1. Dry cough
2. Hematuria
3. Bronchospasm
4. Blood-streaked sputum
570. The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding?
1. Slow, deep respirations
2. Rapid, deep respirations
3. Paradoxical respirations
4. Pain, especially with inspiration
571. A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest?
1. Cyanosis
2. Hypotension
3. Paradoxical chest movement
4. Dyspnea, especially on exhalation
572. The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome?
1. Bilateral wheezing
2. Inspiratory crackles
3. Intercostal retractions
4. Increased respiratory rate
573. The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? [Show Less]