Elisabeth Questions

Front 1

A client with chest pain doesn’t respond to nitroglycerin. On admission to the emergency department, the health care team obtains an electrocardiogram and begins infusing I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarcion (MI) symptoms?
a. Within 12 hours
b. Within 24 hours
c. Within 24 to 48 hours
d. Within 5 to 7 days

Back 1

a. Within 12 hours

Rationale: For the best chance of salvaging the client’s myocardium, a thrombolytic agent must be administered within 12 hours after onset of chest pain or other signs or symptoms of MI. Within the first 24 hours after an MI, sudden death is most likely to occur. I.V. heparin therapy begins after administration of a thrombolytic agent and usually occurs for 5 to 7 days.

Front 2

An elderly client who underwent total hip replacement exhibits a red,painful area on the calf of the affected leg. What test validates presence of thromboembolism?
a. Romberg’s
b. Phalen’s
c.Rinne
d. Homan’s

Back 2

d. Homan’s

Rationale: A positive Homan’s sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Rombrg’s test assesses cerebellar function. Phalen’s test assesses carpal tunelsyndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

Front 3

After having several Stokes-Adams attacks over 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and spouse. Which safety precaution is appropriate for a client with a pacemaker?
a. Stay at least 2 feet away from microwave ovens
b. Never engage in activities that require vigorous arm and shoulder movements.
c. Avoid going through airport metal detectors.
d. Avoid having magnetic resonance imaging (MRI).

Back 3

d. Avoid having magnetic resonance imaging (MRI)

Rationale: A client with a pacemaker should avoid having an MRI because the magnet may disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5 feet away from microwaves, not 2 feet. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don’t harm pacemakers; however the client should notify airport security guards of the pacemaker because its metal casing and programming magnet may trigger the metal detector.

Front 4

The nurse would obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?
a. Calcium and magnesium
b. Potassium and calcium
c. Magnesium and potassium
d. Potassium and sodium

Back 4

c. Magnesium and potassium

Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don’t cause rhythm disturbances.

Front 5

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic indicates myocardial ischemia?
a. Prolonged PR interval
b. Absent Q wave
c. Elevated ST segment
d. Widened QRS complex

Back 5

c. Elevated ST segment

Rationale: Ischemic myocardial tissue changes cause elevation if the ST segment, a peaked or inverted T wave, and a pathologic Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; a MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the HIS-Purkinje system.

Front 6

The nurse is evaluating a client who had a myocardial infarction (MI) 7 days ago. Which outcome indicates that the client is responding favorably to therapy?
a. The client demonstrates the ability to tolerate increasing activity without chest pain.
b. The client exhibits a heart above 100 beats per minute
c. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking.
d. The client states that sublingual nitroglycerin usually relieves chest pain.

Back 6

a. The client demonstrates the ability to tolerate increasing activity without chest pain.

Rationale: The ability to tolerate increasing without chest pain indicates a favorable response to therapy in a client who is recovering from an MI or who has a history of coronary artery disease. The client should have a normal electrocardiogram with no arrythmias and a regular heart rate of 60 to 100 beats per minute. Smoking is a cardiovascular risk factor tat the client must be willing to eliminate. A client who responds favorably to therapy shouldn’t have chest pain.

Front 7

A client with end-stage heart failure is preparing for discharge. The client and his caregiver meet with the home care nurse and voice their concern that setting up a hospital bed in the bedroom will leave him feeling isolated. Which suggestion by the mone care nurse best addresses this concern?
a. Place a chair in the bedroom so guests can visit with the client.
b. Set up the hospital bed in the family room so the client can be part of the household activities
c. Set up the hospital bed the bedroom so the client can rest in a quiet environment.
d. Set up the hospital bed in the bedroom so the client can be assessed in a quiet environment.

Back 7

b. Set up the hospital bed in the family room so the client can be part of the household activities

Rationale: The client should be kept actively involved in the household to prevent feelings of isolation. This can be accomplished by setting up the hospital bed in the family room. Placing a chair in the bedroom allows the client periods of isolation when visitors aren’t present. It’s important for the client to have periods of rest; however, that can be accomplished without keeping the client isolated in a bedroom. The needs of the client should be considered before the needs of the nurse who assesses the client during an occasional visit.

Front 8

An increase in the creatine kinase-MB (CK-MB) can be caused by:
a. Cerebral bleeding
b. I.M. injection
c. Myocardial necrosis
d. Skeletal muscle damage due to a recent fall

Back 8

c. Myocardial necrosis

Rationale: An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal damage, which can be caused by M.I. injections or falls; muscular or neuromuscular disease; vigorous exercise, trauma, or surgery.

Front 9

A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?
a. Left-sided heart failure
b. Myocardial ischemia
c. Pulmonary hypertension
d. Left ventricular hypertrophy

Back 9

c. Pulmonary hypertension

Rationale: Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through stenotic valve, increasing pressure in the left atrium and pulmonary circulation. This may lead to low cardiac output, pulmonary hypertension, edema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vita organs. Myocardial ischemia may occur in a client wit coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis.

Front 10

The nurse is assigned with an ancillary staff member to care for a group of cardiac patients. Which client should be assessed first?
a. The client admitted with unstable angina who wants to be discarged.
b. The client who suffered an acute myocardial infarction (MI) who is complaining of constipation.
c. The client who had a pacemaker inserted yesterday and who is complaining of incisional pain.
d. The client who has his call light on.

Back 10

b. The client who suffered an acute myocardial infarction (MI) who is complaining of constipation.

Rationale: The client who suffered an acute MI who is complaining of constipation should be addressed first. If the client strains at stool after an MI, the vagal response may be stimulated causing bradycardia thereby provoking arrhythmias. The nurse should delegate answering the call light to the ancillary personnel. She can also delegate some of the discharge preparation, such as packing the client’s belongings. After addressing the MI client with constipation, the nurse should promptly address the pain relief needs of the client who had a pacemaker inserted the previous day.

Front 11

A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response b the nurse is best?
a. “It is too late to change your mind now.”
b. “We will have to ask your physician if this is possible.”
c. “Why do you want to do this?
d. “It’s not a problem to rescind your DNR order; I’ll let your physician know your wishes right away.”

Back 11

d. “It’s not a problem to rescind your DNR order; I’ll let your physician know your wishes right away.”

Rationale: The client is allowed to rescind a DNR order at any time. The client makes the decision about a DNR order with input from the physician. Questioning a client’s motives can make the client feel defensive and shut down communication with the nurse.

Front 12

A client is recovering from an acute myocardial infarction (MI). During the first week of recovery, the nurse should stay alert for which abnormal heart sound?
a. Opening snap
b. Graham Steel’s murmur
c. Ejection click
d. Pericardial friction rub

Back 12

d. Pericardial friction rub

Rationale: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week after an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardiam rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steel’s murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole.

Front 13

"I stayed over for a co-worker and covered 2 hours so she could attend her child's music program."

Back 13

Go ahead two spaces.

Front 14

"You called in on the first day of deer hunting when you were not ill."

Back 14

Go back three spaces.