Cardiovascular

Following a bone marrow transplant, the patient exhibits a 10-pound weight gain in 3 days, increased abdominal circumference, and yellow tinge to the sclera and skin. The nurse notifies the provider and prepares to perform which intervention?  

The nurse is caring for the patient who is at the nadir for bone marrow suppression. Which order does the nurse clarify with the provider?  

The nurse assesses the patient with acute myelogenous leukemia after a bone marrow transplant. Which symptom concerns the nurse the most?

The patient’s activated partial thromboplastin time (aPTT) is 138 seconds. Review the chart to determine the most important question for the charge nurse to ask the bedside nurse.

Which intervention is most important for the 38-week-gestation neonate who was antenatally diagnosed with hypoplastic left heart syndrome and born 2 hours ago?  

The nurse in a tertiary medical center with attached pediatric hospital is caring for the 28-year-old gravida 3 para 2 woman who is 40-weeks pregnant and presents to the labor and delivery unit 1 hour after spontaneous rupture of membranes. Patient had good prenatal care, an amniotic fluid index of 12, and pregnancy is complicated only by the antenatal diagnosis of fetal single ventricle anatomy.  Labor is progressing well and the fetus is tolerating contractions well with moderate variability in fetal heart tones. The nurse is most concerned with having which item in the delivery room? 

The nurse is caring for the patient recently diagnosed with colon cancer. Which assessment prompts the nurse to call for the provider immediately?  

The home health nurse is assessing the patient with a colostomy. Which finding indicates the patient is performing the tap water irrigations too frequently?  

The patient is brought to the emergency department following a gunshot wound to the right chest. The patient is noted to have tracheal deviation to the left side with absent breath sounds on the right. Review of the chest radiograph indicates a large amount of free air in the superior chest as well as fluid in the inferior chest. Which procedure is performed first? 

The nurse is providing health promotion teaching to the parents of a child recently diagnosed with sickle cell anemia. Which statement does the nurse include in teaching? 

The nurse is caring for a 12-year-old male patient with hemophilia A. Which statement is most likely true? 

The patient is brought to the emergency department complaining of sudden onset crushing substernal chest pain. He is pale, diaphoretic, and can only speak in short sentences. His vital signs are notable for a heart rate of 118 bpm, respiratory rate of 22, and a blood pressure of 94/52 mmHg. Upon assessment, peripheral pulses are palpable but weak; lungs are clear; mild jugular venous distention is noted. The emergency medical services administered aspirin on arrival to the scene. The nurse anticipates performing which intervention first? 

The 72-year-old patient is brought via the ambulance to the emergency department after his wife observed him collapsing after dinner. At the scene, emergency medical service (EMS) personnel determined he was in asystole, and began cardiopulmonary resuscitation (CPR). An advanced airway was placed and a peripheral intravenous catheter was inserted. The defibrillator was placed and read ventricular fibrillation; a shock was administered, chest compressions were restarted, and a 1 mg epinephrine dose was administered via peripheral IV. Upon arrival to the emergency department, the patient was found to be in pulseless electrical activity after 5 complete rounds of CPR (including epinephrine, defibrillation, and 30:2 chest compressions to ventilated breaths ratio). The nurse advocates for which intervention?

The 4-year-old patient with a history of sickle cell disease is brought to the emergency room complaining of severe chest pain and cough. Upon assessment, the nurse notes a respiratory rate of 32, a temperature of 39.1°C, and a heart rate of 128 bpm. Which test results does the nurse anticipate? Select all that apply.

The parent of the 8-year-old with sickle cell disease (SCD) reports the child complains of constant generalized pain rated at 4/10. Which response by the nurse is most appropriate?  

During a routine physical, the 58-year-old patient reports aching chest pain that occurs only when doing yardwork or heavy cleaning. However, it does not occur every time he is performing these chores. He denies regular exercise and reports a sedentary lifestyle. The nurse anticipates providing which instruction to the patient related to the patient's new prescription for this condition?   

The 15-year-old patient attempted suicide by ingesting an entire bottle of her father’s metoprolol. She is found unresponsive by emergency medical services and is intubated due to an inability to manage her own airway. Upon arrival to the emergency department, her blood pressure is 49/32 mmHg, heart rate is 24 bpm, and the pulse oximeter reads 82%. An 18-gauge peripheral IV is placed in the left antecubital vein and a 22-gauge IV is placed in the right antecubital vein. Which interventions are included in care? Select all that apply.  

The 18-year-old patient presents with pallor, shortness of breath, and bleeding from the gums. Extensive testing is performed and a diagnosis of very severe aplastic anemia is made. Which additional information is most important to direct treatment? 

The 1-year-old with sickle cell disease is in crisis following gastroenteritis. While hospitalized, the patient abruptly exhibits seizures, decreased level of consciousness, right-sided facial asymmetry when crying, coughing and sputtering during a bottle feeding, and decreased movement of the right leg and arm. The nurse contacts the provider and prepares to provide which initial interventions? Select all that apply.  

The 3-year-old with sickle cell disease is preparing for discharge following a crisis during which the patient received several blood transfusions. The nurse is providing teaching regarding appropriate food choices for the child. Which foods, if selected by the parents, indicate a need for further teaching? Select all that apply.  

The 18-year-old patient in sickle cell crisis has received multiple blood transfusions. During the shift assessment, the nurse notes the patient’s heart rate is 132 bpm, blood pressure is 102/58 mmHg, and the sclera are yellow. Which lab result would be surprising for this patient?  

The 8-year-old male patient presents complaining of warm, painful, swollen joints with decreased range of motion. Upon assessment, he is pale and tachycardic. The parent reports easy bruising and frequent nosebleeds. Which does the nurse most anticipate administering? 

The nurse is providing discharge education to the parents of the 7-day-old neonate who required a blood transfusion due to blood loss following circumcision. Which instruction is most important?  

The 12-year-old child who weighs 35 kg with hemophilia B is brought to the emergency department with signs of increased intracranial pressure after being hit in the head at a baseball game. The nurse prepares to carry out which order?  

The 18-year-old female patient reports menorrhagia, easy bruising, and epistaxis. Her family history is notable for maternal hypertension, a brother with hemophilia A, and a father who died of stroke at age 48. Which question is most important to ask the patient?   

The 58-year-old patient presents to the clinic for a follow-up appointment. Upon assessment, the nurse notes expiratory wheezes across all lung fields. Review the patient’s chart to determine the most likely cause of this new symptom.

The nurse reviews the patient’s chart and advocates for which intervention?

The 71-year-old patient with a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus is brought to the emergency department 3 hours after exhibiting right-sided facial weakness, drooping of the right eye, and slurring of the words. Appendicular tone is normal and the patient has no issues walking or standing from a sitting position. The nurse prepares the patient for which intervention first? 

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient’s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54mmHg. The patient received maintenance fluids during the procedure and no blood transfusions. How many liters of isotonic fluid does the nurse anticipate administering to the patient during the postoperative period? Enter your response using a whole number. 

The patient is brought to the emergency room after briefly losing consciousness. He states, “I feel like my heart has been racing for days now. I just assumed it was stress, but now it feels so much worse.” He is pale, diaphoretic, and tachypneic. His heart rate is 118 bpm and his blood pressure is 86/52 mmHg. An electrocardiogram shows an irregularly irregular RR interval without distinct P waves. The nurse prepares the patient for which intervention? 

The 34-year-old male patient is brought by ambulance to the emergency department an hour after a witnessed car accident occurred in which he sustained a laceration to his right femoral artery. The paramedics placed a tourniquet and held pressure until arrival to the emergency department, but significant blood loss is estimated. The nurse anticipates the initial complete blood count will reveal which results?  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient is admitted to the intensive care unit for further management and observation. The ICU nurse includes which interventions in the plan of care? Select all that apply.  

The 75-year-old patient presents to the emergency department complaining of a severe headache that is localized behind the right eye. The patient is nauseous and vomits upon standing. While wearing glasses, the visual acuity is 20/25 in the left eye and 20/110 in the right (records show it is normally also 20/25 corrected). Her left pupil is equal, round, and reactive to light and accommodation; it is measured at 3 mm. Her right pupil reacts only minimally to light and measures at 5 mm; it is round. The provider palpates the eye and reports that it is tense. Her heart rate is 102 bpm and blood pressure is 118/84 mmHg. The nurse anticipates providing which intervention first?  

The 50-year-old previously healthy patient complains of shortness of breath, especially on exertion or when laying down to sleep. She takes over-the-counter allergy medicine for seasonal allergies and melatonin to help her sleep sometimes. Her vital signs are heart rate of 64 bpm, respirations 22, oxygen saturation 99%, and blood pressure 114/68 mmHg. Her assessment is notable for crackles over the bilateral lung bases and a moderate diastolic apical murmur. The nurse prepares the patient for which initial tests? Select all that apply. 

The 50-year-old previously healthy patient complains of shortness of breath, especially on exertion or when laying down to sleep. She takes over-the-counter allergy medicine for seasonal allergies and melatonin to help her sleep sometimes. Her vital signs are heart rate of 64 bpm, respirations 22, oxygen saturation 99%, and blood pressure 114/68 mmHg. Her assessment is notable for crackles over the bilateral lung bases and a moderate diastolic apical murmur. Her electrocardiogram is normal. Her echocardiogram shows normal function of the left ventricle and severe stenosis of the mitral valve. The nurse provides which information to the patient?  

The 58-year-old patient presents to the emergency department complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. Which assessment is most important? 

The 58-year-old patient presents to the emergency department of a community hospital complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. A pulsating abdominal mass is noted; otherwise, his assessment is benign. The nurse advocates for which treatment option? 

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a significant amount of blood coming from her vagina. Which action is most important? 

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a small amount of blood coming from her vagina. Which assessment prompts the nurse to prepare the patient for an emergency cesarean section? 

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?  

The patient with cirrhosis is admitted with severe confusion, ascites, and jaundice. He has gained 10 kg in 2 weeks. He has been coughing blood and his stool is dark and tarry. Therapeutic paracentesis results are concerning for infection.  The nurse anticipates the patient to report not taking which medications that are ordered? Select all that apply.  

The 20-year-old healthy soccer player is brought to the emergency department after collapsing at the end of a summer soccer game. The patient is lethargic and confused about the event. Upon assessment, the nurse notes flushed, dry skin that is warm to the touch. The oral mucosa is dry, as well. Vitals are as follows: temperature 40.7°C, heart rate 122 bpm, respiratory rate 20, and blood pressure 116/64 mmHg. Which lab studies does the nurse obtain? Select all that apply.  

The nurse witnesses a 19-year-old collapse while playing soccer. The individual is arousable but confused and irritable. The skin is warm, dry, and flushed. Which actions are most helpful? Select all that apply.  

The nurse witnesses a healthy 19-year-old collapse while playing football. The individual is arousable but confused and irritable. The skin is warm, dry, and flushed. The nurse instructs a teammate to bring the water cooler and pours it over the victim. The teammate shouts, “Why did you do that?! Won’t he go into shock?”  The nurse bases the response on the need for rapid cooling to prevent which conditions? Select all that apply.  

The 20-year-old healthy soccer player is brought to the emergency department after collapsing at the end of a summer soccer game. The patient is lethargic and confused about the event. Upon assessment, the nurse notes flushed, dry skin that is warm to the touch. The oral mucosa is dry, as well. Vitals are as follows: temperature 40.7°C, heart rate 122 bpm, respiratory rate 20, and blood pressure 116/64 mmHg. Which order does the nurse carry out first?  

The nurse is teaching a community class on cardiopulmonary resuscitation (CPR). Which rationale is best to give the class for the difference between infant CPR with one rescuer, infant CPR with two rescuers, adult CPR with one rescuer, and adult CPR with two rescuers?

The nurse is attempting to perform an electrocardiogram on a patient. The machine alerts the nurse that the V1, V4, and V5 electrodes are not picking up correctly. The nurse adjusts the leads in which locations? Select all that apply.  

The nurse performs an electrocardiogram on a patient and notes right axis deviation. The nurse suspects the patient has which undiagnosed condition? 

The nurse performs a 12-lead electrocardiogram on the 6-hour-old 39-week-gestation neonate admitted to the neonatal intensive care unit for respiratory distress syndrome. The baby initially required continuous positive airway pressure (CPAP) but is now comfortably tachypneic on room air, with an oxygen saturation of 98% in both the right and left hands. The chest x-ray indicates transient tachypnea of the newborn. Right axis deviation suggesting right ventricular hypertrophy is noted on the ECG. The nurse anticipates the provider to give the parents which information?