MDC3 -3

MAKE SURE TO ANSWER ALL THE FOLLOW CAREFULLY AND CORRECTLY WITH CAREFUL UNDERSTANDING

1. Which of the following assessment findings are consistent with aortic regurgitation?

Atrial fibrillation

Systolic click

Pitting edema

Blowing decrescendo diastolic murmur

2. The nurse receives an order to infuse heparin 1000 units/hr IV. The IV bag contains 25.000 units heparin in 500ml. D5W. Calculate the IV rate in ml/hr___ ( record as a whole number)

3. The nurse is assessing a client with severe anemia. Which clinical manifestation does the nurse expect to see in this clients?

Dyspnea with activity

Hypertension

Bradycardia

Warm flushed skin

4. A nurse is caring for a 19 year old male recently diagnosed with leukemia. Which of the following nursing interventions is appropriate for the client?

Strict hand hygiene to prevent infection

Fluid restriction

Low residual diet

Therapeutic phlebotomy

5. The nurse assesses a client and documents the following findings edema 2+ bilateral ankles brown pigmentation of lower extremity skin aching pain of lower extremities when standing that resolves with elevation and 2+pedal pulses. What condition does the client likely have?

Deep vein thrombosis

Venous insufficiency

Peripheral arterial disease

Raynaud disease

6. The nurse is caring for a 65 year old female who presented to the emergency department with shortness of breath and chest discomfort. The client has not been feeling well for the past few days and complains of a productive cough of blood tinged sputum. Laboratory an elevated brain natriuretic peptide (BNP) and chest x-ray reveals pulmonary congestion , Based on the assessment findings which of the following diagnosis are consistent with these findings?

Heart failure(left- sided)

Pulmonary embolism

Heart failure(right-sided)

Lung cancer

7. A nurse is performing discharge teaching for a client who was recently diagnosed with heart failure. Which of the following should be included in the client and family teaching? (SATA)

Medication teaching

Low sodium diet

Fluid restriction

Weekly weight

Symptoms to report to the provider

8. A 65 year old female presented to the emergency room with complaints of progressively worsening fatigue shortness of breath, and palpitations. Upon assessment heart rate is 150 beats per minute and irregular, and there is positive jugular vein distention heart tones reveal a high pitched holosystolic murmur. Which of the following disorders are consistent with these findings?

Mitral regurgitation

Mitral stenosis

Aortic regurgitation

Mitral valve prolapse

9. Which of the following assessment findings is consistent with mitral valve prolapse?

Systolic click

Urinary frequency

Atrial fibrillation

Claudication

10. The nurse is caring for four clients on a post surgical unit . The nurse understands that monitoring the client for which post operative complication takes priority?

Constipation

Nausea

Urinary retention

Pneumonia

11. A nurse is caring for a client who was recently diagnosed with hemophilia. Which of the following laboratory tests is consistent with that diagnosis?

Decreased bleeding time

Prolonged activated partial thromboplastin time

Prolonged prothrombin time

Decreased platelet count

12. A 78 year old female presented to the emergency department with shortness of breath. Her daughter is at the bedside and shares that the client has a history of heart failure. You place the client on the cardiac monitor and find that the client is in atrial fibrillation at rate of 180 beats per minute. Which of the following are your concerns regarding this rhythm?(SATA)

Potential for embolic event

Hypotension due to elevated heart rate

Worsening heart failure

Dizziness and light headedness

Cerebral edema

13. Which of the following is the most common assessment finding related to autoimmune thrombocytopenic purpura?

Bruising

Fatigue

Confusion

Fever

14. A client is receiving treatment for the diagnosis of hemophilia A. Which of the following is most appropriate to include in the assessment of the client?

Appetite

Urine output

Joint pain and bruising

Respiratory rate

15. A nurse is caring for a client who recently underwent a heart transplant. Which of the following post operative nursing interventions is the priority?

Assess for signs and symptoms of rejection

Advanced diet as tolerated

Auscultated bowel sounds

Maintain strict bedrest

16. A nurse is caring for a client diagnosed with polycythemia vera. Which of the following should the nurse include in the client and family education?

Decrease fluid intake to no more than 1 liter per day

Wear support hose while awake

Diet high in vitamin K intake

Resume normal activity

17. The nurse knows that hemolytic reaction to blood transfusion occur most often within the —-first minutes of the infusion?

100

15

45

60

18. The family of a neutropenic client reports that the client confused and is not acting right, What action by the nurse is the priority?

Ask the client about pain

Assess the client for infection

Delegate taking a set of vital signs

Look at todays laboratory results

19. During hourly rounding the nurse enters a room where the client is unresponsive without a pulse. What is the nurses priority action?

Call the family

Begin ventilation at 1 breath every 6-8 seconds

Start chest compressions at a rate of 100-120 compression per minutes

Wait for the emergency response team for direction

20. Which of the following assessment findings is a priority during a blood transfusion?

Chest pain

Headache

Joint pain

Fatigue

21. A nurse is caring for a client with a history of an abdominal aortic aneurism. Which of the following assessment findings request immediate intervention?

Decreased urine output

Back pain

Nausea and vomiting

Absent peripheral pulses

22. A nurse is caring for a client who has heart failure and a prescription for digoxin 125mcg PO daily . Available is digoxin PO 0.25mg/tablet. How many tablets should the nurse administer per dose? (round nearest tenth)

23. A client admitted for sickle cell crisis is distraught after learning her child also has the disease. What response by the nurse is best?

Both you and the father are equally responsible for passing it on

I can see you are upset . I can stay here with you a while if you like

Its not your fault there is no way to know who will have this disease

There are many good treatments for sickle call disease these days

24. A female client is being treated for a deep vein thrombus she developed post operatively about one week ago and was treated with unfractionated heparin, Today she presents to the clinic with petechiae on bilateral hands and feet. Laboratory results show a platelet count of 42, 000/mm3(42* 109/L). The nurse is concerned about a drug reaction and anticipates the client has which of the following?

Heparin induced thrombocytopenia(HIT)

Hemophilia A (classic hemophilia)

Thrombotic thrombocytopenic purpura(TTP)

Sickle call crisis

25. The nurse educates the client on which of the following tests as the best tool for diagnosing heart failure?

Echocardiography

Pulmonary artery catheter

Radionuclide studies

Mitigated angiographic (MUGA) scan

26. Which of the following nursing interventions would be appropriate for a client with sickle cell disease? (SATA)

Administer IV morphine

Keep the client strictly NPO

Remove restrictive clothing

Prepare the client for surgery

Provide a cool environment

27. A nurse is caring for a client who was received in the emergency department with a heart rate of 220 beats per minute. The clients cardiac monitor displays supraventricular tachycardia(SVT) . Which of the following interventions should the nurse anticipate?

Apply compression stockings

Check blood glucose

Draw labs

Vagal maneuver

28. A nurse is caring for a client diagnosed with peripheral artery disease. Which of the following is a common assessment finding?

3+ pedal pulses

1+ pedal pulses

4+pedal pulses

Bounding pulses in all 4 extremities

29. A nurse is planning a client for a client who is iron deficient. Which of the following foods high in iron should the nurse include in the plan?

Oranges

Cashews

Red meat

Yogurt

30. A client states that their legs have pain with walking that decreases with rest. The nurse observes absence of hair on the clients lower extremities and the client has a thready weakened posterior tibial pulse. What would be the best position to have the clients legs?

Elevated on pillows

Crossed at the knee

Slightly bent with a pillow under the knees

Dependent position

31. A client diagnosed with stable angina is complaining of substernal chest pain, rating the pain 5 out of 10 what would be the priority action by the nurse?

Administer nitroglycerin 1 table sublingual immediately

Administer 81 mg of aspirin immediately

Administer the clients prescribed beta blocker

Administer morphine

32. A male client is presenting with radiating chest pain. Which of the following would the nurse recognize as indicators that an acute myocardial infarction may be occurring?(SATA)

Positive troponin markers

ST elevation on EKG on two contiguous leads

History of atherosclerosis

Pain radiating in jaw back shoulder or abdomen

Pain relieved with rest

33. Which of the following is a common early assessment finding consistent with a diagnosis of hereditary hemochromatosis?

Flank pain

Fever

Hypoglycemia

Liver dysfunction

34. Which of the following is a treatment option for a client with sickle cell disease?

Pain management with NSAIDs only

Arthrocentesis

NPO diet

IV fluid bolus

35. Which of the following medications are appropriate for the treatment of heart failure?(SATA)

Antibitics

Diuretics

Digoxin

Bronchodilators

Angiotensin- converting enzyme(ACE) inhibitors

36. Which of the following is a possible treatment plan for a client diagnosed with leukemia?

Therapeutic phlebotomy

Stem cell transplant

Splenectomy

Dialysis

37. You are caring for a client who presented to the emergency department with pulmonary edema. The clients is hypotensive with a pulse oximeter reading of 85% on room air. Which of the following is a nursing priority?

Administer diuretics

Administer IV fluids

Administer oxygen

Obtain a chest X-ray

38. The nurse is arriving at the beginning of her shift and taken report on four clients on a medical surgical unit. Which client should the nurse see first?

A client with pyelonephritis with nausea and vomiting

A client post total abdominal hysterectomy with 9/10 abdominal pain

A client with chronic obstructive pulmonary disease with an oxygen saturation of 89% on room air.

A client post prostatectomy with bright red blood and clots in his catheter

39. Which of the following interventions should be included in the nutrition care plan of the client with atherosclerosis?

Increase saturated fats

Increase daily intake of vegetables fruits and whole grains

Limit sodium intake to 6 g per day

Increase full fat dairy products

40. Which of the following is a treatment option for a client with infective endocarditis?

Antimicrobials

Antihypertensives

Diet modification

Bedrest

41. A nurse is caring for a client recently diagnosed with pericarditis which of the following is a common assessment finding with this disorders?

ST segment depression

Pericardial friction rub

Elevated troponin

Heart failure

42. A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?

Client with a blood pressure of 180/98mm Hg

Client who reports shortness of breath

Client who reports calf tenderness and swelling

Client with a swollen and painful left great toe

43. A nurse sets an infusion pump to infuse 1 L of D5NS at the rate of 100 ml/hr.

How many hours will it take to complete the infusion? __ hours (record whole number)

44. Which of the following is the priority nursing intervention for a client experiencing a transfusion reaction?

Stop transfusion immediately

Notify the provider

Flush the IV Line

Check vital signs

45. The nurse knows which of the following is the most common problem for a client with valvular heart disease?

Decreased cardiac output

Difficulty coping

Bradycardia

Altered body image

46. A nurse is caring for a 65 year old male who recently underwent an aortic valve replacement. Which of the following is a post operative nursing care priority?

Temperature monitoring

Advance diet as tolerated

Assess for bleeding

Dressing change

47. A nurse is caring for a client recently diagnosed with hypertension. Which of the following should be included in the discharge teaching?

Only check your blood pressure at a clinic or pharmacy

Diet changes are not recommended

Decrease physical activity to avoid spikes in blood pressure

Adhere to prescribed medications

48. The nurse is discharging home a client at risk for venous thromboembolism on enoxaparin sodium. What instruction is a priority for the nurse to provide to this client?

Notify your health care provider if your stools appear dark or tarry

Massage the injection site after the heparin is injected

You must have your PT/INR checked every 2 weeks

You must have you’re a PTT checked every 72 hours

49. A nurse is caring for a client who presented to the emergency department with complaints of fatigue. Palpitations and chest pain . Upon assessment the provider notes an S3 and S4 gallop. Weak peripheral pulses and tachycardia. The provider orders a chest x-ray and echocardiogram. Which reveals left ventricular dilation. Which of the following disorders is consistent with these findings?

Dilated cardiomyopathy

Restrictive cardiomyopathy

Pericarditis

Cardiac tamponade

50. A nurse is providing discharge teaching to a client who recently underwent a mechanical valve replacement which of the following statement by the client indicates the clients correct understanding of the discharge teaching regarding warfarin anticoagulant therapy?

I do not need to take my prescribed medication for the rest of my life

Additional monitoring is not required while on the anticoagulant

I can lead a normal life while on anticoagulants no restrictions are required

I may need to modify my diet while on this medication

51. Which of the following procedures are performed for a client with a pericardial effusion?

Coronary artery bypass graft

Thoracotomy

Pericardiocentesis

Thoracentesis

52. Which of the following is the treatment of choice for end stage heart failure?

Heart transplant

Coronary artery bypass grafting

Percutaneous angiogram

Medications

53. A nurse are caring for a client diagnosed with atherosclerosis. Which of the following is considered a risk factor for the development of the disorder?

High HDL-C/ Low LDL- C

Vegan diet

Low HDL C/High LDL-C

Diet high in vitamin K

54. Which of the following medications are utilized to treat peripheral artery disease(PAD)?

Antiplatelet drugs

Antibiotics

Nitroglycerin

Diuretics

55. Which of the following client is most at risk for developing endocarditis?

A client who recently underwent a valve replacement

A client with Marfans syndrome

A client recently diagnosed with mitral stenosis

A client who recently had a valve replacement and had dental work recently performed

56. A nurse is caring for a client who was recently diagnosed with left ventricular heart failure what is an early sign the client is most likely to report?

Abdominal distention

Weight gain

Swollen legs

Nocturnal coughing

57. A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia PH 7;51 PaCO2 28mm Hg PaO2 70 mmHg and HCO2 24 mEq/L. What do these values indicates?

Metabolic acidosis

Respiratory alkalosis

Respiratory acidosis

Metabolic alkalosis

58. You are providing care to a client with pericarditis. If left untreated which of the following is the client at risk of developing?

Cardiac tamponade

Pneumonia

Pulmonary embolism

Deep vein thrombosis

59. A nurse is caring for a client recently diagnosed with leukemia. Which of the following signs and symptoms are consistent with this diagnosis?(SATA)

Bleeding gums

Bone pain

Weight gain

Increased urination

Fatigue

60. A 65 year old male client is brought via EMS to the emergency department with chest pain , He rates the pain as a 10 on a scale from 0-10 the pain is located mid-sternum and radiates to his left arm, His heart rate is 126 bpm and blood pressure is 96/60 mm Hg A 12 lead electrocardiogram is performed and reveals ST segment elevation. Which of the following interventions does the nurse anticipate performing immediately?(SATA)

Administer oxygen

Administer nitroglycerin

Administer a beta blocker

Administer morphine

Administer a statin

61. The client is admitted for heart failure and has edema neck vein distension and ascites. What is the most accurate way to monitor fluid gain or loss in this client?

Check for pitting edema in the dependent body parts

Auscultate the lungs for crackles or wheezing

Assess skin turgor and the condition of mucus membranes

Weigh the client daily at the same time with the same scale

62. When educating a female client on the signs and symptoms of myocardial infarction the nurse recognizes that which of the following should be included in the teaching?

Pain usually resolves with rest and relaxation

Women often present with a typical sign and symptoms

Substernal chest pain is the most common symptom in women

Women experience intermittent claudication

63. The nurse questions which order for a client with thrombocytopenia?

Avoid IM injections

Administer enemas

Apply ice to areas of trauma

Test all urine and stool for the presence of occult blood

64. The nurse is caring for a 55 year old male who presented to his primary physicians office for his yearly check up. Upon the physical assessment the provider noted enlarged lymph nodes in the groin and neck region. The provider questioned joe regarding the possible causes of the findings. Which of the following diagnosis are consistent with this finding?

Lymphoma

Sickle cell anemia

Leukemia

Polycythemia vera

65. A nurse cares for a client who has a nasogastric tube attached to low suction because of a suspected bowel obstruction. Which of the following arterial blood gas results might be expected in this client?

pH 7.52 PCO2 54 mmHg

pH 7.42 PCO2 40 mmHg

pH &.25 PCO2 25 mm Hg

pH 7.38 PCO2 36 mm Hg

66. Which of the following is a pharmacologic treatment option for a client with dilated cardiomyopathy? (SATA)

Diuretics

Sodium tablets

Digoxin

Phentermine

Anticholinergic

67. The nurse is reviewing laboratory values for a client which of the following lab values should the nurse address immediately?

Creatinine 6.2mg/dl

Phosphorus 5.1mg/dl

Potassium 5.9mmo/L

Sodium 147 mEq/L

68. The nurse is caring for a client with mitral regurgitation which of the following would you anticipate the client to develop if left untreated?

Myocardial ischemia

Left sided heart failure

Right sided heart failure

Renal failure

69. A nurse is caring for four clients with leukemia after hand off report which client should the nurse see first?

Client who had two bloody diarrhea stools this morning

Client who has been premedicated for nausea prior to chemotherapy

Client with a respiratory rate change from 15 to 20 breaths /min

Client with an unchanged lesion to the lower right lateral malleolus

70. The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?

A client with hypertension with blood pressure of 172/92mm Hg

A client with a history of asthma complaining of increased dyspnea

A client ready for discharge education after treatment of an acute kidney injury

A client with pain that is two days post operative from a prostatectomy

71. A hospitalized client has a platelet count of 58, 00/mm3 (58*109/L) what action by the nurse is best?

Encourage high protein foods

Institute neutropenic precautions

Limit visitors to healthy adults

Apply ice to bruises or sites of injury

72. Which of the following clients would not be a candidate for thrombolytic therapy?

Client with a blood pressure of 100. 60 mm Hg

Client with a pulse of 102 beats/minute

Client with a history of hemorrhage stroke one month ago

Client age 65

73. Which of the following would predispose a client to mitral stenosis?

Obesity

Rheumatic fever

Diabetes

IV drug use

74. Missing

75. Which of the following is a priority nursing intervention for a client in atrial fibrillation with a rate of 180 beats per minute?

Apply compression stockings

Administer anticoagulants

Administer medication to slow that rate

Monitor urine output