Nokea
To auscultate for S3 or S4 gallops in the mitral area, which of the following should the nurse implement?
- A. Use the bell of the stethoscope with the patient in the left lateral position.
- B. Use the bell of the stethoscope with the patient sitting and leaning forward.
- C. Use the diaphragm of the stethoscope with the patient in a reclining position.
- D. Use the diaphragm of the stethoscope with the patient lying flat on the left side.
Correct Answer: A
Rationale: Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher pitched sounds such as S1 and S2.
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Which of the following information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI?
- A. The patient has an allergy to shellfish and iodine.
- B. The patient has a history of coronary artery disease.
- C. The patient has a permanent ventricular pacemaker in place.
- D. The patient took all the prescribed cardiac medications today.
Correct Answer: C
Rationale: MRI is contraindicated for patients with implanted metallic devices such as pacemakers as the magnets can alter the function of the device. The other information also will be reported to the health care provider but does not impact whether or not the patient can have an MRI.
The nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill. Which of the following assessment findings requires the most rapid action by the nurse?
- A. Patient complaint of feeling tired
- B. Pulse change from 80 to 96 beats/minute
- C. BP increase from 134/68 to 150/80 mm Hg
- D. Electrocardiographic changes indicating coronary ischemia
Correct Answer: D
Rationale: ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately. Increases in BP and heart rate (HR) are normal responses to aerobic exercise. Tiredness also is normal as the intensity of exercise increases during the stress testing.
The RN is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse implements which of the following interventions?
- A. Places the patient in the left lateral position to check for the point of maximal impulse (PMI).
- B. Presses on the skin over the tibia for 10 seconds to check for edema.
- C. Palpates both carotid arteries simultaneously to compare pulse quality.
- D. Documents a murmur heard along the left sternal border as an aortic murmur.
Correct Answer: C
Rationale: The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow. The other assessment techniques also need to be corrected. However, they are not dangerous to the patient.
Which of the following actions should the nurse implement for a patient who arrives for a calcium-scoring CT scan?
- A. Administer oral sedative medications.
- B. Teach the patient about the procedure.
- C. Ask whether the patient has eaten today.
- D. Insert a large gauge intravenous catheter.
Correct Answer: B
Rationale: The nurse will need to teach the patient that the procedure is rapid and involves little risk. The other actions are not necessary.
The nurse is assessing the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. Which of the following laboratory results is most important for the nurse to review?
- A. LDL cholesterol
- B. Troponins T and I
- C. C-reactive protein
- D. Creatine kinase-MB (CK-MB)
Correct Answer: B
Rationale: Cardiac troponins start to elevate hours (average 4-6 hours) after myocardial injury and are specific to myocardium. Creatine kinase-MB (CK-MB) is specific to myocardial injury and infarction, but it does not increase until 6 hours after the infarction occurs. LDL cholesterol and C-reactive protein are useful in assessing cardiovascular risk but are not helpful in determining whether a patient is having an acute myocardial infarction.