Nokea
The client is being evaluated for valvular heart disease. Which information would be most significant?
- A. The client has a history of coronary artery disease.
- B. There is a family history of valvular heart disease.
- C. The client has a history of smoking for 10 years.
- D. The client has a history of rheumatic heart disease.
Correct Answer: D
Rationale: Rheumatic heart disease (D) is a major cause of valvular disease, especially mitral/aortic. CAD (A), family history (B), and smoking (C) are less directly causative.
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An adult has a coagulation time of 20 minutes. The nurse should observe the client for which of the following?
- A. Blood clots
- B. Ecchymotic areas
- C. Jaundice
- D. Infection
Correct Answer: B
Rationale: The normal clotting time is 9 to 12 minutes. A prolonged clotting time suggests a bleeding tendency, so the client should be observed for signs of bleeding, such as ecchymotic areas. Blood clots would occur with a shorter clotting time. Jaundice is related to liver damage or red blood cell breakdown. Infection is associated with low white blood cell counts.
The nurse is teaching an adult who has angina about taking nitroglycerin. The nurse tells him he will know the nitroglycerin is effective when:
- A. he experiences tingling under the tongue.
- B. his pulse rate increases.
- C. his pain subsides.
- D. his activity tolerance increases.
Correct Answer: C
Rationale: The effectiveness of nitroglycerin is indicated by the relief of anginal pain. Tingling, increased pulse rate, or improved activity tolerance are not direct indicators of its effectiveness.
A client who has been treated for angina is discharged in stable condition. At a clinic visit, he tells the nurse he has anginal pain when he has sexual intercourse with his wife. What is the best response for the nurse to make?
- A. Do you have ambivalent feelings toward your wife?'
- B. Many persons with angina have less pain when their partner assumes the top position.'
- C. Be sure that you attempt intercourse only when you are well rested and relaxed.'
- D. You might try having a cocktail before sexual activity to help you relax.'
Correct Answer: C
Rationale: Engaging in sexual activity when well-rested and relaxed reduces cardiac demand, minimizing angina risk. Questioning feelings, suggesting positions, or recommending alcohol are less appropriate or potentially harmful.
When the client asks why the physician ordered the ECG, how does the nurse correctly explain its purpose?
- A. It will show how the heart performs during exercise.
- B. It will determine the client's potential target heart rate.
- C. It will verify how much the client needs to improve fitness.
- D. It will help predict whether the client will have a heart attack soon.
Correct Answer: A
Rationale: A stress ECG evaluates heart function under physical stress, detecting ischemia or abnormal rhythms indicative of coronary artery disease.
Which prothrombin time value would be considered normal for a client who is receiving warfarin (Coumadin)?
- A. 12 seconds
- B. 20 seconds
- C. 60 seconds
- D. 98 seconds
Correct Answer: B
Rationale: For a client receiving warfarin, the prothrombin time should be 1.5 to 2 times the normal value (11 to 12.5 seconds). Twenty seconds falls within this therapeutic range. Twelve seconds is normal for someone not on warfarin. Sixty seconds is normal for a partial thromboplastin time (PTT) test, and 98 seconds would be therapeutic for heparin, not warfarin.