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Which finding in a client with an arterial disorder indicates a worsening condition?
- A. Cool, pale skin on the affected leg
- B. Mild leg pain at rest
- C. Heart rate of 75 beats per minute
- D. Blood pressure of 125/80 mmHg
Correct Answer: A
Rationale: Cool, pale skin indicates worsening arterial insufficiency, suggesting reduced blood flow to the limb.
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The nurse is teaching a client about home blood pressure monitoring. Which instruction is most important?
- A. Take your blood pressure at the same time each day.
- B. Use a wrist cuff for the most accurate readings.
- C. Sit with your legs crossed during measurement.
- D. Check your blood pressure only when you feel ill.
Correct Answer: A
Rationale: Consistency in timing ensures accurate trending of blood pressure readings.
Which complication should the nurse monitor for in a client with valvular heart disease?
- A. Pulmonary embolism
- B. Heart failure
- C. Liver failure
- D. Pneumonia
Correct Answer: B
Rationale: Valvular heart disease can lead to heart failure due to increased cardiac workload and impaired pump function.
The client with cardiomyopathy is prescribed a beta-blocker. What is the primary purpose of this medication?
- A. Increase heart rate
- B. Reduce cardiac workload
- C. Prevent blood clots
- D. Remove excess fluid
Correct Answer: B
Rationale: Beta-blockers reduce heart rate and myocardial oxygen demand, decreasing cardiac workload.
Which laboratory value should the nurse monitor closely in a client with heart failure? Select all that apply.
- A. B-type natriuretic peptide (BNP)
- B. Serum potassium
- C. Blood urea nitrogen (BUN)
- D. Hemoglobin A1c
- E. Serum sodium
- F. Platelet count
Correct Answer: A,B,C,E
Rationale: BNP indicates heart failure severity, potassium and sodium affect fluid balance and medication safety, and BUN reflects renal perfusion.
Which finding should the nurse report immediately in a client with a deep vein thrombosis (DVT)?
- A. Warm, red skin over the affected area
- B. Mild leg pain
- C. Heart rate of 80 beats per minute
- D. Blood pressure of 130/85 mmHg
Correct Answer: A
Rationale: Warm, red skin over the affected area may indicate worsening DVT or complications like thrombophlebitis, requiring immediate attention.