Nokea
The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?
- A. Whistling
- B. Rhonchi
- C. Crackles
- D. Coarseness
Correct Answer: C
Rationale: When the left side of the heart is pumping inefficiently, blood backs up into the pulmonary veins and lung tissue. Auscultation reveals a crackling sound. Wheezes and gurgles may also be heard.
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The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a comorbidity of multiple sclerosis, so the nurse knows the stress test will be drug induced. What drug will be used to dilate the coronary arteries?
- A. Thallium
- B. Lorazepam
- C. Diazepam
- D. Dobutamine
Correct Answer: D
Rationale: Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. The other drugs would not dilate the coronary arteries.
The nurse is reviewing lab work for a client whose blood CO2 level is elevated. The nurse is most correct to suspect an impairment of which?
- A. Alveoli
- B. Bronchi
- C. The pulmonary artery
- D. The pulmonary vein
Correct Answer: A
Rationale: Gas exchange occurs in the lung where oxygen in inspired air exchanges for CO2 in the venous blood. The CO2 is then transferred to the alveoli to be exhaled. No gas exchange occurs in the bronchi. The pulmonary artery carries deoxygenated blood to the lungs, and the pulmonary vein brings oxygenated blood back to the heart to be pumped to the tissues.
While being prepared for echocardiography, the client asks nurse why this test is necessary. What would be the nurse's best response?
- A. This test will find any congenital heart defects.
- B. This test can tell us a lot about your heart.
- C. Echocardiography is a way of determining the functioning of the left ventricle of your heart.
- D. Echocardiography will tell your doctor if you have cancer of the heart.
Correct Answer: C
Rationale: Echocardiography uses ultrasound waves to determine the functioning of the left ventricle and to detect cardiac tumors, congenital defects, and changes in the tissue layers of the heart. Explaining the procedure is the best answer because it addresses the client's question without making the client anxious or minimizing the question.
The nurse provides care for a client who is diagnosed with an infarction of the posterior wall of the right atrium. Which clinical finding should the nurse anticipate relating to the infarction location?
- A. Jugular vein distention
- B. Irregular heart rate
- C. Peripheral edema
- D. Fever
Correct Answer: B
Rationale: The posterior wall of the right atrium is the location of the sinoatrial node (SA node), which is the pacemaker of the heart. Damage to this location may result in an irregular heart rate due to a disturbance of electrical pulse initiation. Jugular vein distension and peripheral edema are anticipated for the client who is experiencing heart failure, not myocardial infarction (MI). Although fever can increase the client's heart rate, this is not an expected finding with an MI.
The following clients are in need of exercise electrocardiography. Which client would the nurse indicate as most appropriate for a drug-induced stress test?
- A. A 48-year-old policemen with history of knee replacement 4 years ago
- B. A 68-year-old housewife with history of osteoporosis
- C. A 72-year-old retired janitor obtaining a cardiac baseline
- D. A 55-year-old recovering from a fall and broken femur
Correct Answer: D
Rationale: An exercise electrocardiography or stress test monitors the electrical activity of the heart while the client walks on a treadmill. If a client has a sedentary lifestyle or physical disability, cardiac medications may be administered to stress the heart similar to activity. Even though the client is middle aged at 55 years old, the client is recovering from a broken femur thus would be unable to have vigorous exercise. None of the other clients have a history which precludes them from exercise electrocardiography.