A client admitted to the hospital with chest pain and a history of type 2
diabetes mellitus is scheduled for cardiac catheterization. Which medication
would need to be withheld for 24 hours before the procedure and for 48 hours
after the procedure?
1. Regular insulin
2. Glipizide (Glucotrol)
3. Repaglinide (Prandin)
4. Metformin (Glucophage)
4. Metformin (Glucophage)
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 second, and QRS complexes measure
0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct
interpretation based on these characteristics?
1. Sinus bradycardia
2. Sick sinus syndrome
3. Normal sinus rhythm
4. First-degree heart block
3. Normal sinus rhythm
A client is wearing a continuous cardiac monitor, which begins to sound its
alarm. A nurse sees no electrocardiographic complexes on the screen. Which is
the priority action of the nurse?
1. Call a code.
2. Call the health care provider.
3. Check the client's status and lead placement.
4. Press the recorder button on the electrocardiogram console.
3. Check the client's status and lead placement.
A client is having frequent premature ventricular contractions. The nurse should
place priority on assessment of which item?
1. Sensation of palpitations
2. Causative factors, such as caffeine
3. Precipitating factors, such as infection
4. Blood pressure and oxygen saturation
4. Blood pressure and oxygen saturation
The nurse is evaluating a client's response to cardioversion. Which observation
would be of highest priority to the nurse?
1. Blood pressure
2. Status of airway
3. Oxygen flow rate
4. Level of consciousness
2. Status of airway
The nurse is caring for a client who has just had implantation of an automatic
internal cardioverter-defibrillator. The nurse
immediately would assess which item based on priority?
1. Anxiety level of the client and family
2. Presence of a Medic-Alert card for the client to carry
3. Knowledge of restrictions of postdischarge physical activity
4. Activation status of the device, heart rate cutoff, and number of shocks it
is programmed to deliver
4. Activation status of the device, heart rate cutoff, and number of shocks it
is programmed to deliver
A client's electrocardiogram strip shows atrial and ventricular rates of 110
beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08
second, and the PP and RR intervals are regular. How should the nurse correctly
interpret this rhythm?
1. Sinus dysrhythmia
2. Sinus tachycardia
3. Sinus bradycardia
4. Normal sinus rhythm
2. Sinus tachycardia
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 and unchanged from admission. How should the nurse correctly 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 is adequate from an arterial approach, but venous
complications are arising.
1. The neurovascular status is normal because of increased blood flow through
the leg.
The nurse is evaluating the condition of a client after pericardiocentesis
performed to treat cardiac tamponade. Which observation would indicate that the
procedure was unsuccessful?
1. Rising blood pressure
2. Clearly audible heart sounds
3. Client expressions of relief
4. Rising central venous pressure
4. Rising central venous pressure
A client with angina complains that the anginal 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 anginal
pain?
1. Stable angina
2. Variant angina
3. Unstable angina
4. Nonanginal pain
2. Variant angina
The nurse is monitoring a client with acute pericarditis for signs of cardiac
tamponade. Which assessment finding indicates the presence of this complication?
1. Flat neck veins
2. A pulse rate of 60 beats/min
3. Muffled or distant heart sounds
4. Wheezing on auscultation of the lungs
3. Muffled or distant heart sounds
The home care nurse is providing instructions to a client with an arterial
ischemic leg ulcer about home care management and self-care management. Which
statement, if made by the client, indicates a need for further
instruction?
1. "I need to be sure not to go barefoot around the house."
2. "If I cut my toenails, I need to be sure that I cut them straight across."
3. "It is all right to apply lanolin to my feet, but I shouldn't place it
between my toes."
4. "I need to be sure that I elevate my leg above my heart level for at least an
hour every day."
4. "I need to be sure that I elevate my leg above my heart level for at least an
hour every day."
The nurse is providing instructions to a client with a diagnosis of hypertension
regarding high-sodium items to be avoided. The nurse instructs the client to
avoid consuming which item?
1. Bananas
2. Broccoli
3. Antacids
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