Nokea
What term is defined as the volume of blood ejected by the heart in 1 minute?
- A. Afterload
- B. Cardiac cycle
- C. Stroke volume
- D. Cardiac output
Correct Answer: D
Rationale: Cardiac output is the volume of blood ejected by the heart per minute, calculated as heart rate times stroke volume. Afterload is resistance to ventricular ejection, cardiac cycle is the sequence of atrial and ventricular contraction, and stroke volume is the blood ejected per contraction.
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After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond?
- A. Elevate the affected extremity.
- B. Notify the practitioner of the observation.
- C. Record data on the assessment flow record.
- D. Apply warm compresses to the insertion site.
Correct Answer: C
Rationale: A weaker pulse post-catheterization is expected initially and should be documented as a baseline for monitoring. The pulse should strengthen over hours. Elevation, warm compresses, or immediate notification are unnecessary unless neurovascular changes occur.
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?
- A. 60 beats/min
- B. 90 beats/min
- C. 100 beats/min
- D. 120 beats/min
Correct Answer: B
Rationale: For infants and young children, digoxin is withheld if the 1-minute apical pulse is below 90 beats/min to prevent toxicity. A rate of 60 is the adult threshold, and 100-120 beats/min are acceptable for administration.
After returning from cardiac catheterization, the nurse monitors the childs vital signs. The heart rate should be counted for how many seconds?
- A. 15
- B. 30
- C. 60
- D. 120
Correct Answer: C
Rationale: Counting the heart rate for 60 seconds ensures accurate detection of arrhythmias or bradycardia. Shorter durations (15 or 30 seconds) are insufficient, and 120 seconds is unnecessarily long for routine assessment.
What clinical manifestation is a common sign of digoxin toxicity?
- A. Seizures
- B. Vomiting
- C. Bradypnea
- D. Tachycardia
Correct Answer: B
Rationale: Vomiting, unrelated to feedings, is a common sign of digoxin toxicity due to its narrow therapeutic range. Seizures are not associated, bradycardia (not bradypnea or tachycardia) may occur, but vomiting is a key indicator.
A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?
- A. Cyanosis
- B. Heart failure
- C. Decreased pulmonary blood flow
- D. Bounding pulses in upper extremities
Correct Answer: B
Rationale: Left-to-right shunting increases pulmonary blood flow, overloading the right heart and leading to heart failure. Cyanosis and decreased pulmonary flow occur with right-to-left shunts, and bounding pulses are specific to coarctation of the aorta.