Heart Failure
Thrombocytopenia
Stable Angina
Arterial Rhythms
100
An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? A. Observe electrocardiogram reading and report deviations to the nurse B. Assist the client with ambulation three times during the shift C. Monitor vital signs Q 15 minutes and report each reading to the nurse D. Accurately weigh the patient, report finding to nurse, and chart finding.
Answer: D, Accurately weigh the patient, and report and record the readings. Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care.
100
A nurse is caring for a patient with a platelet count of 20,000/microliter. Which of the following is an important intervention? A. Observe for evidence of spontaneous bleeding.  B. Limit visitors to family only.  C. Give aspirin in case of headaches.  D. Impose immune precautions.
Answer: A Rationale: Platelet counts under 30,000/microliter may cause spontaneous petechiae and bruising, particularly in the extremities. When the count falls below 15,000, spontaneous bleeding into the brain and internal organs may occur. Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Thrombocytopenia does not compromise immunity, and there is no reason to limit visitors as long as any physical trauma is prevented.
100
The teaching plan for a client being started on long acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A. Dilating just the coronary arteries. B. Decreasing the blood pressure. C. Increasing contractility of the heart. D. Dilating arteries and veins.
Answer: D Rationale: Organic nitrates relax both arterial and venous smooth muscle. This in turn decreases myocardial oxygen demand by decreasing heart rate, decreasing preload, decreasing contractility, and decreasing afterload. The blood pressure might decrease secondary to venous vasodilation, but this is not the primary way in which angina is relieved.
100
Prior to discharge from the Emergency Department, the nurse prints a rhythm strip on a patient and notices that the P wave cannot be detected and the QRS complex is 0.24 seconds. This is a change in the patient’s condition. What is the best action for the nurse to take? A. Measure the PR interval B. Prepare the patient for discharge C. Notify the physician of this abnormal strip D. Continue to monitor for abnormalities
Answer: C. Rationale: Notifying the physician of the abnormal rhythm would be the appropriate response. The patient has experienced a rhythm change and requires further treatment.
200
Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication? A. Sublingual nitroglycerin B. Cardiac glycosides C. HMG- CoA reductase inhibitors D. Morphine Sulfate
Answer: A, Sublingual nitroglycerin Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.
200
The nurse is caring for a client who has autoimmune thrombocytopenic purpura. Which intervention does the nurse implement for this client? A. Infuse intravenous normal saline. B. Administer prescribed anticoagulants. C. Monitor for an increase in temperature. D. Avoid intramuscular injections.
Answer: D Rationale: With autoimmune thrombocytopenic purpura, the total number of circulating platelets is greatly reduced. As a result of the decreased platelet count, the client is at great risk for bleeding, and intramuscular injections should be avoided. Anticoagulants should not be given. A low platelet count is not treated with saline, and thrombocytopenia will not cause a change in body temperature.
200
The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that: A. Angina is relieved with nitroglycerin and rest. B. Angina can be fatal. C. MI pain always radiates to the left arm or jaw. D. MI pain cannot be treated.
Answer: A Rationale: Angina pain is uncomfortable, but rarely is fatal. It usually is relieved immediately by nitroglycerin.
200
The nurse discusses mineral therapy with a client diagnosed with atrial fibrillation. Which of the following deficiencies will the nurse most likely discuss with the client? A. Iron B. Calcium C. Magnesium D. Sodium
Answer: C. Rationale: Magnesium deficiency is associated with dysrhythmias, including atrial fibrillation, premature atrial and ventricular contractions, ventricular tachycardia, and ventricular fibrillation. This might be related to its role in maintaining intracellular potassium
300
A 64-year-old patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? A. IV sedation may be administered to help the patient relax. B. Food and fluids are restricted for 2 hours before the procedure. C. Ambulation is restricted for up to 6 hours before the procedure. D. Contrast medium is injected into the esophagus to enhance images.
Answer A. Rationale: IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing, but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.
300
Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? A. The platelet count is 52,000/μl. B. The patient is difficult to arouse. C. There are large bruises on the back. D. There are purpura on the oral mucosa.
Answer: B Rationale: Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported, but would not be unusual in a patient with thrombocytopenia.
300
A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? A. Women are less likely to delay seeking treatment than men. B. Women are more likely to have noncardiac symptoms of heart disease. C. Women are often less ill when presenting for treatment of heart disease. D. Women experience more symptoms of heart disease at a younger age than men.
Answer: B Rationale: Women often have atypical angina symptoms and non-pain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.
400
A client with congestive heart failure, CHF, is prescribed digoxin (Lanoxin) and furosemide (Lasix). Nursing interventions will include: (Select all that apply.) A. Encourage intake of water and fruit juices. B. Restrict intake of green, leafy vegetables. C. Checking apical pulse before administering medication. D. Monitor hemoglobin and hematocrit levels. E. Monitor serum electrolytes.
ANSWER: C, E Rationale: Digoxin is a cardiac glycoside. which can slow heart rate, and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF, which promotes not only water loss, but also loss of electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. H and H level do not need to be checked, and green, leafy vegetables would not need to be restricted.
400
The nurse is caring for a patient with immune thrombocytopenic purpura (ITP) who has an order for a platelet transfusion. Which patient information indicates that the nurse should consult with the health care provider before administering platelets? a. The platelet count is 42,000/L. b. Blood pressure (BP) is 94/56 mm Hg. c. Blood is oozing from the venipuncture site. d. Petechiae are present on the chest and back.
Answer: A. Rationale: Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/l unless the patient is actively bleeding, so the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and indicate that the platelet transfusion is appropriate.
400
A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of angina pain? A. Stable angina B. Variant angina C. Unstable angina D. Non-anginal pain
Answer: B Rationale: Variant angina is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.
500
The client is prescribed captopril (Capoten) for treatment of HF. The nurse teaches that the primary action of the drug is to A. Prevent influx of calcium. B. Lower peripheral resistance and reduce blood volume. C. Increase strength of ventricular contractions. D. Increase heart rate.
ANSWER : B Rationale: ACE inhibitors decrease peripheral resistance and reduce blood volume by enhancing the excretion of sodium and water. This results in decreased after load and increased cardiac output.
500
A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deepvein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT). Which action will the nurse include in the plan of care? A. Use low-molecular-weight heparin (LMWH) only. B. Flush all intermittent IV lines using normal saline. C. Administer the warfarin (Coumadin) at the scheduled time. D. Teach the patient about the purpose of platelet transfusions.
Answer: B. Rationale: All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/μl. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.
500
Which of the following conditions is the predominant cause of angina? A. Increased preload B. Decreased afterload C. Coronary artery spasm D. Inadequate oxygen supply to the myocardium
Answer D. Rationale: Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.
M
e
n
u