Perfusion Practice Questions

Perfusion Practice Questions Leave the first rating Students also studied Terms in this set (41) Science MedicineNursing Save ABCP Board Exam Practice 326 terms no_se_nadaPreview Practice Perfusion NCLEX Questions...28 terms dawn_h_carroll Preview

NCLEX style questions: Perfusion

20 terms hannahk0729Preview Perfusi Teacher MW The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. The client wants to know why her doctor told her she had an extra heart sound at the last visit. Which response by the nurse is appropriate?

• "You will need to have an echocardiogram to

determine the reason for the extra sound."

• "You are likely experiencing heart failure due to the

extra fluid that accumulates during this time in pregnancy."

• "You have what is known as a ventricular gallop, and it

can be a normal finding during this trimester of pregnancy."

• "You have what is known as atrial gallop, and this is

cause for concern." C The nurse is concerned that a client with an alteration in perfusion is at risk for inadequate oxygenation. What should the nurse consider when planning for this client's potential health problem?

• Encouraging ambulation every 30 minutes
• Instructing on deep breathing
• Administering medications appropriate to increase

heart rate

• Positioning to increase blood return

B

An older adult client is diagnosed with cardiomyopathy and a cardiac dysrhythmia. What would the nurse expect to be prescribed for this client?

• Beta blocker
• Digoxin
• Nitrate medications
• Fluids

A The nurse is caring for a client admitted to the hospital with lower extremity edema and shortness of breath.Which electrocardiogram finding indicates the client is at risk for an alteration in perfusion?

• P wave smooth and round
• Absent U wave
• PR interval 0.30 seconds
• ST segment isoelectric

C The nurse is instructing a client on lifestyle changes to promote a healthy cardiovascular system. Which of the following should be included in this teaching session?Select all that apply.

• Limit exercise to 15 minutes a day
• Reduce saturated fats in the diet
• Avoid cigarette smoking
• Wear elastic hose
• Limit fluid intake

B, C The nurse is preparing to conduct a cardiac assessment for a pediatric client. Which location will the nurse use when auscultating the apical pulse?

• At the fifth intercostal space
• At the left nipple
• At the right nipple
• At the eighth intercostal space

B The nurse is caring for a client who is scheduled to receive metoprolol (Lopressor). What should the nurse teach the client about this medication?

• Expect a rapid heart rate.
• Change positions slowly.
• Reduce protein intake.
• Increase fluids.

B Which statements are correct regarding the various layers of the heart? Select all that apply.

• The endocardium covers the entire heart and great

vessels.

• The endocardium is the muscular layer of the heart that

contracts during each heartbeat.

• The outermost layer of the heart is the epicardium.
• The myocardium consists of myofibril cells.
• The myocardium has four layers.

C, D

A client's stroke volume (SV) is 85mL/beat and the heart rate (HR) is 71 beats per minute (bpm). What is the client's cardiac output (CO) rounded to the nearest liter?

• Liters (L)

Blood pressure is influenced by all except which factor?

• Pumping action of the heart
• Peripheral vascular resistance
• Heart rate
• Blood volume

C Which nursing intervention related to perfusion can be performed independently?

• Administration of drug regimens
• Insertion of device to measure central venous pressure

(CVP)

• Teaching relaxation techniques
• Thoracentesis

C The nurse is reviewing objective data obtained during the assessment of a pregnant woman in her 34th week of gestation. Which finding would be cause for concern?

• Pulse 103 bpm
• Blood pressure 108/70
• Hematocrit 24%
• WBC count 10,340/mm3

C The nurse is caring for a client diagnosed with dilated cardiomyopathy. Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.

• Fatigue
• Lower extremity edema
• Syncope
• Dyspnea
• Angina

A, B, D

A client states to the nurse, "I know I have high blood pressure, but I don't want to take medication." Based on this data, which health problem is the client at risk for developing?

• Gastritis
• Diabetes
• Cardiomyopathy
• Metabolic syndrome

C A client diagnosed with cardiomyopathy reports having to rest between activities during the day. The client asks the nurse why this is occurring. Which reason should the nurse include in the response to the client?

• Increased stroke volume
• Decreased cardiac output
• An elongated and dilated aorta
• Increased blood pressure

B

A client admitted with the diagnosis of cardiomyopathy becomes short of breath with ambulation and eating and fatigued with routine care activities. Which nursing diagnosis does the nurse include in the client's plan of care?

A) Imbalanced Nutrition: Less than Body Requirements

• Deficient Knowledge
• Activity Intolerance
• Self-Care Deficit

C The nurse identifies the diagnosis of Excess Fluid Volume as appropriate for a client with cardiomyopathy. Which interventions should the nurse emphasize when planning this client's care? Select all that apply.

• Monitor B-type natriuretic peptide (BNP) level.
• Provide oxygen as prescribed.
• Assess respiratory status and lung sounds every 4

hours and as needed.

• Provide information about activity upon discharge.
• Monitor intake and output.

C, E The nurse is providing teaching to a client diagnosed with cardiomyopathy. What statement made by the client indicates the discharge teaching was effective?

• "I will exercise as much as possible, regardless of

feeling weak and short of breath."

• "My pants getting tight around the waist means I'm

eating too much and should cut back on food."

• "I will eat foods containing sodium only if drinking

water with them."

• "I will see my cardiologist next week to discuss

implanting a pacemaker." D The nurse is caring for a client with hypertrophic cardiomyopathy. Based on this diagnosis, which class of medications does the nurse anticipate being prescribed?

• Digoxin
• Vasodilators
• Nitrates
• Beta blockers

D A client with cardiomyopathy receiving diuretic therapy has a urine output of 200 mL in 8 hours. Which action by the nurse is correct?

• Assist the client to ambulate.
• Document a normal urine output.
• Notify the healthcare provider.
• Measure abdominal girth.

C