Cardiovascular

The nurse uses an understanding of which physiologic process to explain why the patient feels out of breath at high altitudes?

The provider orders hypertonic saline for a patient. The patient’s wife wants to know why this therapy is being given. Which of the following is the best statement regarding the rationale for this therapy?

A neonate is born at full term to a mother who did not receive prenatal care. The neonate required moderate resuscitation at birth. Upon assessment, the nurse notes poor muscle tone, a protruding tongue, low nasal bridge, and low-set ears. A loud continuous “machine-like” heart murmur is heard. The patient requires 85% FiO2 to maintain an oxygen saturation above 90%. Which of the following tests is the next best diagnostic step in the management of this patient?

The nurse is asked to help treat a patient brought in by ambulance in cardiogenic shock secondary to an acute ST-elevation myocardial infarction. The patient is cyanotic with significant jugular venous distention, peripheral edema, and dyspnea from pulmonary edema. Which of the following treatments would be most appropriate for this patient?

The nurse is assigned to a patient with chronic alcoholism and alcoholic cirrhosis. Examination of the patient is significant for dilated tortuous veins around his umbilicus and internal hemorrhoids. On the morning of his third day of the current admission, the patient acutely begins to vomit up large amounts of blood. Which describes the pathophysiology that most likely caused this event?

The nurse is assigned to a patient with malignant hypertension. The patient acutely develops mid-sternal “tearing” chest pain that radiates to the back. Which of the following additional clinical signs is most likely to be present in this patient?

The nurse is assigned a patient with Hodgkin’s lymphoma undergoing initial treatment. On the patient’s second day, he develops an acute painful swelling and erythema of the right gastrocnemius. The following morning, the patient develops an acute shortness of breath and pleuritic chest pain. Within minutes, the patient loses consciousness and dies. Which of the following interventions would most likely have prevented this patient’s death?

The nurse is assigned to a patient who is suffering from acute pericarditis. The patient suddenly becomes hypotensive with signs of peripheral vascular insufficiency. On exam, the patient has significant jugular venous distention and muffled heart sounds. Which statement best describes the pathophysiology of this patient’s condition?

The nurse is assigned a patient with a history of severe hypertension. He develops hematuria and elevated blood pressure. What is the lowest blood pressure consistent with a hypertensive emergency?

The nurse is caring for a patient with alcoholic liver cirrhosis complicated by abdominal ascites. A diagnostic paracentesis is performed. Shortly after the procedure, the patient becomes hypotensive and quickly loses consciousness. On exam, the patient is pale, peripheral pulses are faint, and extremities are cool to the touch. Which of the following is the most likely etiology of this patient’s condition?

The nurse is caring for a patient with unilateral left renal artery stenosis secondary to atherosclerotic disease. The patient is placed on an angiotensin converting enzyme (ACE) inhibitor and serum creatinine rises by 3 mg/dL. What is the most likely explanation for this reaction to this medication?

The nurse is caring for a patient with schizophrenia who has bacterial endocarditis secondary to intravenous drug use. The patient’s antipsychotic medication is changed from risperidone to clozapine. Within days, the patient develops a serious cardiac arrhythmia. The nurse attributes the patient’s arrhythmia to which cause?

A patient with moderate asthma is being treated for a recent myocardial infarction. Which of following statements most accurately describes the use of cardioselective beta-blockers in this patient?

The nurse is caring for a patient with severe congestive heart failure (CHF). Peripheral perfusion is stable at present on medical therapy. On exam, the patient has significant jugular venous distention and peripheral edema, as well as dyspnea secondary to pulmonary edema. Which of the following statements is most appropriate regarding this patient’s volume status and needs?

The nurse is assigned to care for a patient with a history of thromboembolism but in whom conventional anticoagulant therapy is contraindicated due a recent spinal injury. The nurse adds which preventative measure to the patient’s plan of care to prevent thromboembolism?

The nurse is on the treatment team for an African American patient who is being hospitalized for a recent hypertensive emergency. The nurse anticipates administering which medication?

The nurse has received report on four patients at 0700. Which patient should the nurse assess first?

A child with type 1 diabetes is undergoing treatment for diabetic ketoacidosis. For which life-threatening complications of treatment should the nurse be vigilant? Select all that apply.

A patient with diabetic ketoacidosis who is undergoing fluid resuscitation and normal insulin infusion had a brief period of improved level of consciousness followed by a decrease in level of consciousness. Lab studies show the patient’s metabolic condition is improving. Which medication does the nurse anticipate administering to this patient immediately?

A patient with type 2 diabetes is noted to be hypertensive at this and the last clinic appointments. Which nursing intervention is most appropriate?

The nurse educates the patient with newly-diagnosed type 2 diabetes mellitus about which long-term complications of poorly-controlled diabetes? Select all that apply.

A patient has a blood pressure of 135/86 mm/Hg which was taken after the patient rested quietly in a room for 30 minutes. Using the AHA guidelines, how does the nurse classify this patient’s blood pressure?

A patient is found to have hypertension. Which conditions, if present in the patient, indicate the patient has had hypertension for years without being diagnosed? Select all that apply.

A 35-year-old man presents to the emergency department following an unrestrained head-on collision where his chest struck the steering wheel. During the initial assessment, the patient abruptly begins complaining of incredibly severe chest pain that feels like ripping in the anterior chest. He states, “I’m going to die, I know it!” The nurse alerts the provider immediately due to suspicion for which condition?

A patient who is immobilized following surgery to repair a pelvic fracture is at risk for which life-threatening condition?

A patient is brought to the emergency department with right-sided weakness, right-sided facial drooping, slurring of the words, and aphasia. The nurse is most suspicious for which condition?

A nurse is reviewing the orders of a patient who presented to the emergency department with symptoms of a stroke and notes a toxicology screening has been ordered. Which is the most likely rationale for this test?

A nurse is performing tests to aid in the confirmation or exclusion of a stroke. Which tests may indicate the patient is experiencing a stroke mimic? Select all that apply.

A pregnant woman is diagnosed with an ischemic stroke and alteplase is discussed. The nurse is aware alteplase is in which pregnancy category?

The nurse is a first responder at a mass casualty event. According to the Simple Triage and Rapid Treatment (START) protocol, which patient will receive medical care first?

The nurse is a first responder following a multi-vehicle accident and performs triage on the victims while waiting for further assistance. A person walks up to the nurse with a minor head wound and asks to be treated. Which response by the nurse is appropriate?

The nurse is a first responder following a mass casualty incident and performs triage on these victims while waiting for assistance. List the patients in order they must be treated according to the Simple Triage and Rapid Treatment (START) protocol.

A patient is admitted with concern for heart failure. Which symptom is a major criterion of heart failure according to the Modified Framingham clinical criteria for the diagnosis of heart failure?

A patient with heart failure is unable to walk from the kitchen to the bedroom without becoming dyspneic. However, the dyspnea resolves with rest. The nurse recognizes this patient has which class of heart failure according to the New York Heart Association classification system?

A patient has been diagnosed with heart failure. The nurse educates the patient about which nonpharmacological treatments?

A patient presents to the emergency department complaining of weakness, fatigue, and nausea. The nurse observes distended neck veins and auscultates rales. The patient states, “I’ve had such trouble sleeping lately, but sleeping in my recliner seems to help.” The nurse anticipates the patient will be diagnosed with which condition?

A patient has been diagnosed with right-sided heart failure. The nurse expects the patient to exhibit which symptom(s)? Select all that apply.

A patient with heart failure requests assistance ordering a meal tray. Which meal does the nurse recommend for this patient?

The nurse is providing diet education to a patient with left-sided heart failure. Which meal, if ordered by the patient, indicates the teaching has been effective?

The nurse is reviewing the lab results of a patient with heart failure and notes a sodium of 126 mEq/dL. Which action by the nurse would be appropriate, if agreed to by the provider?

The patient with heart failure has been prescribed an angiotensin-converting enzyme inhibitor (ACEI). The patient reports to the nurse, “I can’t take this medication anymore. This cough is so annoying! It keeps me awake at night.” Which response by the nurse is most appropriate?

A patient has been admitted with acute decompensated heart failure (ADHF) and has gained 5 kg in the last week. Which medication does the nurse anticipate administering to address the patient’s fluid volume status?

A patient with heart failure has been prescribed a dobutamine infusion. The nurse is aware this drug will most strongly affect which of the patient’s receptors?

A patient is receiving multiple continuous infusions for the treatment of acute decompensated heart failure (ADHF). The nurse notes the patient’s central line, through which the drips are being infused, has cracked. After an alternate vascular access has been established, which drug should the nurse restart first?

The nurse is performing an initial assessment of a patient with heart failure. Two minutes after checking the patient’s pedal pulses, the nurse notes that fingertip indentions that are 5 mm deep are left on the patient’s feet. How does the nurse document this finding?

A patient presents in acute decompensated heart failure (ADHF) with a blood pressure of 75/42 mmHg. The nurse starts a continuous dopamine infusion as ordered at 0952. When does the nurse expect the peak effect to be achieved?

The school nurse observes a child collapse and become unresponsive after being stung by a bee. Loud wheezes are audible. Which of the following treatments is most appropriate for this patient?

The nurse begins an intravenous infusion of ampicillin. Ten minutes later, the patient states she has itching and swollen lips. What is the nurse’s first action?

An individual experiencing anaphylaxis due to ingestion of peanuts has received epinephrine via autoinjector. Following the injection, the individual’s respirations have become less labored. In which position should the individual be placed while waiting for emergency medical personnel to arrive?

The nurse notes the patient’s electrocardiogram shows peaked T waves with a prolonged PR interval. Which lab test does the nurse expect the provider to order?