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When gathering nursing assessment data, which finding will adults with chronic cardiac diseases most frequently, the client is a good treatment.
- A. Barrel-shaped chest
- B. Flushed facial skin
- C. Clubbed fingertips
- D. Chest pain
Correct Answer: C
Rationale: Clubbed fingertips are common in chronic cardiac diseases due to chronic hypoxia.
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If the client understands the nurse's explanation of the heart's conduction system, which structure will the client identify as the site of the natural pacemaker? Place an X over the correct site.
- A. Sinoatrial node
- B. Atrioventricular node
- C. Bundle of His
- D. Purkinje fibers
Correct Answer: A
Rationale: The sinoatrial (SA) node is the heart's natural pacemaker, initiating electrical impulses.
Digoxin (Lanoxin) and furosemide (Lasix) are ordered for a client who has congestive heart failure. Which of the following would the nurse also expect to be ordered for this client?
- A. Potassium
- B. Calcium
- C. Aspirin
- D. Coumadin
Correct Answer: A
Rationale: Furosemide, a diuretic, can cause potassium loss, leading to hypokalemia, which increases the risk of digoxin toxicity. Potassium supplements are often ordered to maintain normal levels.
If the client is typical of others who have angina pectoris, the nurse should expect the client to report that chest pain is best relieved by which major medical measure?
- A. Taking a deep breath
- B. Resting in a chair
- C. Applying heat to the chest
- D. Rubbing the chest
Correct Answer: B
Rationale: Angina pectoris is relieved by rest, which reduces myocardial oxygen demand, allowing blood flow to meet the heart's needs.
As part of the discharge instructions, the nurse correctly instructs the client that which symptom is a sign of artificial pacemaker malfunction?
- A. Tingling in the chest area
- B. Dizziness during activity
- C. Pain radiating to the arm
- D. Tenderness beneath the skin
Correct Answer: B
Rationale: Dizziness during activity may indicate pacemaker failure to maintain adequate heart rate.
Please indicate with an X the best anatomic area for the nurse to auscultate mitral valve sounds.
- A. Apex of the heart
- B. Second right intercostal space
- C. Second left intercostal space
- D. Lower left sternal border
Correct Answer: A
Rationale: Mitral valve sounds are best heard at the apex (fifth intercostal space, midclavicular line).