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Ms. April Anne D.

Governor Pack Road, Baguio City, Philippines 2600 Tel. No.: (+6374) 442-3316, 442-8220; 444-2786; 442-2564; 442-8219; 442-8256; Fax No.: 442-6268
Email:; Website:

Level 3
Section 2

NCM 103 Lecture 7:30-10:20 THF (4003)

Assignment _____ Midterms


INSTRUCTIONS: read and answer the following questions. Submit your answers in the answer sheet provided for. There is no need for you to print and pass the questions. You are to pass ONLY PAGE 1 of this module. Please answer the questions ON YOUR OWN to maximize your learning for this module. References to the answers could be your Notes 5- Notes 7 and or any other textbook on medical surgical nursing. PUT A STAR on the box that best corresponds to the letter of your choice. STRICTLY no erasures. Papers with erasures and superimpositions will be returned UN-CHECKED.

ANSWER SHEET A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 B C D

Heart Failure and other Common Cardiovascular System Abnormal Findings: 1.Which client is most at risk of developing left-sided heart failure? A. 52-year-old female with mitral valve disease B. 60-year-old male with pulmonary hypertension C. 48-year-old female who smokes two packs of cigarettes daily D. 72-year-old male who has had a right ventricular myocardial infarction 2 .Which statement made by a client would alert the nurse to the possibility of heart failure? A. I am drinking more water than usual. B. I have been awakened by the need to urinate at night. C. I have to stop halfway up the stairs to catch my breath. D. I have experienced blurred vision on several occasions. 3 .A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night. What action should the nurse take at this time? A. Instruct the client to come to the clinic for evaluation. B. Instruct the client to increase fluid intake during waking hours. C. Instruct the client to use an over-the-counter cough suppressant before going to sleep. D. Instruct the client to use two pillows to facilitate drainage of postnasal secretions. 4 .Which statement made by a client would alert the nurse to the possibility of right-sided heart failure? A. I sleep with four pillows at night. B. My shoes fit really tight. C. I wake up coughing every night. D. I have trouble catching my breath. 5.A nurse is performing a cardiac assessment on a client with heart failure. In assessing the clients apical pulse, the nurse notes the pulse to be displaced to the left. What conclusion can be drawn from this assessment? A. This is a normal finding. B. The heart is hypertrophied. C. The left ventricle is contracted. D. The client is experiencing pulsus alternans. 6.During auscultation of the heart of a client with left ventricular failure, the nurse notes the presence of a third heart sound (S3) gallop. What can the nurse infer from this finding? A. Left ventricular pressure is increased. B. There is a decrease in ventricular compliance. C. The client has been noncompliant with the medication regimen. D. The client should be prepared for transfer to the intensive care unit. 7.A nurse is performing auscultation of the posterior lungs of a client admitted with heart failure. There are increasing crackles from the bases to the lower third of both lungs. What would be the nurses best action? A. Place the client in a semirecumbent position. B. Increase the intravenous fluid rate. C. Administer chest physiotherapy. D. Notify the health care provider. 8.The client with right heart failure asks the nurse to explain the necessity of taking a daily weight. What would be the nurses best response? A. Weight is the best indication that you are gaining or losing fluid. B. Weighing you every day will help us adjust your medication. C. It is required that all inpatients be weighed daily. D. Being overweight contributes to heart failure. 9.A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure. What primary collaborative problem should the nurse be most alert for in this client? A. Risk for aspiration B. Potential for acidosis

C. Risk for activity intolerance D. Potential for pulmonary edema 10.Which nursing diagnosis would be considered a priority for the client with heart failure? A. Anxiety related to hospitalization B. Altered Health Maintenance C. Impaired Gas Exchange D. Altered Comfort 11 .The client with heart failure is experiencing respiratory difficulty. Which is the nurses best intervention? A. Place the client in the high-Fowlers position. B. Suction the client. C. Auscultate the clients heart and lungs. D. Place the client on fluid restriction. 12.The client with heart failure is prescribed to take enalapril, an angiotensin-converting enzyme (ACE) inhibitor. Which of the following precautions or instructions should the nurse teach this client regarding drug therapy? A. Avoid salt substitutes. B. Be sure to take this medication with food. C. Avoid aspirin or aspirin-containing products while on this medication. D. Do not take this medication if your pulse rate is below 74 beats/min. 13.A 76-year-old client with heart failure has been prescribed captopril, an ACE inhibitor. What nursing intervention would be most appropriate when giving the first dose of this medication? A. Administer this medication 1 hour before meals to aid absorption. B. Instruct the client to ask for assistance when arising from the bed. C. Give the medication with milk to prevent stomach upset. D. Monitor for hypokalemia. 14.The client with heart failure is being treated with digoxin and has developed hypokalemia. What action should the nurse prepare to take? A. Administer digoxin twice daily. B. Reduce the digoxin dose to every other day. C. Administer an intravenous bolus of potassium. D. Monitor the client for toxic effects that can occur at normal doses. 15 .The client with moderate heart failure is going home. Which of the following activities or interventions will assist the client to identify a worsening of the condition? A. Avoid drinking more than 3 quarts of liquids each day. B. Stop your activity and rest at the first sign of chest pain. C. Weigh yourself every day at the same time wearing the same amount of clothes. D. If you forget to take your digoxin one day, do not take two doses the next day. 16 .The client who has just been started on isosorbide dinitrate (Isordil) complains of a headache. What is the nurses best first action? A. Titrate oxygen to relieve headache. B. Hold the next dose. C. Notify the physician. D. Administer prescribed PRN acetaminophen. 17.The client with heart failure has been ordered to receive a daily nitroglycerin transdermal patch. What action taken by the nurse would help avoid tolerance to the vasodilating effects of this medication? A. Place an occlusive dressing over the patch. B. Remove the patch overnight. C. Rotate the skin site of nitroglycerin administration. D. Administer a larger loading dose before the initiation of therapy.

18.A client admitted with heart failure who is taking a thiazide diuretic has been ordered to receive furosemide (Lasix). What side effect of these medications should the nurse be alert for? A. Cough B. Headache C. Bradycardia D. Hypokalemia 19.Which clinical manifestation should alert the nurse to the possibility of impending pulmonary edema in a 75-year-old client with heart failure? A. Confusion B. Dysphagia C. Sacral edema D. Irregular heart rate 20.A client with a history of heart failure is being discharged home. What discharge instructions will assist the client in the prevention of complications associated with heart failure? A. Drink at least 2 L of fluids daily. B. Eat six small meals daily instead of three larger meals. C. When you feel short of breath, take an additional diuretic. D. Weigh yourself daily wearing the same amount of clothing. 21.A client has been admitted to the acute care unit for an exacerbation of heart failure. Which of the following nursing actions should be performed first? A. Assessment of respiratory and oxygenation status B. Monitoring of serum electrolyte levels C. Administration of intravenous fluids D. Insertion of a Foley catheter 22.What assessment data obtained by the home care nurse suggest that the client with heart failure has poor tissue perfusion? A. The client has a right carotid bruit. B. The client has a dry, hacking cough. C. The client has a positive Allens test. D. The client has dyspnea while performing activities of daily living (ADLs). 23.The client has a mitral valve prolapse. Which of the following heart sounds should the nurse expect to auscultate with this client? A. Rumbling apical diastolic murmur B. Midsystolic click and late systolic murmur C. An S3 coupled with a high-pitched systolic murmur D. Continuing, loud diastolic murmur radiating to the left axilla 24 .A client with mitral stenosis presents to the clinic for a follow-up visit. What clinical manifestation alerts the nurse to the possibility that the client may be experiencing a worsening of this condition? A. The clients oxygen saturation is 92%. B. The client has dyspnea on exertion. C. The client has a systolic crescendo-decrescendo murmur. D. The client experiences a loss of strength in the upper extremities. 25.A client has been diagnosed with aortic stenosis. What alteration in the clients vital signs would the nurse expect to find upon assessment? A. A bounding arterial pulse B. A slow, faint arterial pulse C. A narrowed pulse pressure D. Elevated systolic and diastolic pressures 26 .A client has been diagnosed with mitral insufficiency. Which clinical manifestation would the nurse expect when assessing the client? A. Systolic click on auscultation

B. High-pitched holosystolic murmur C. Angina with exertion D. Cough with hemoptysis 27 .The client who has had a prosthetic valve replacement asks his nurse why he must take anticoagulants for the rest of his life. What is the nurses best response? A. You are now at greater risk for a heart attack, and the anticoagulants can reduce that risk. B. Blood clots form more easily on replacement valves and areas inside the heart where stitches have been placed. C. The vein taken from your leg reduces circulation in the leg, making blood return to the heart much slower. D. The surgery left a lot of small clots in your heart and lungs; the anticoagulants will slowly dissolve these unnecessary clots. 28.A client has just undergone a balloon valvuloplasty. What complication of this procedure should the nurse monitor this client for? A. Bleeding B. Acute tubular necrosis C. Short-term memory loss D. Pulmonary hypertension 29 .A client is preparing to be discharged home following mitral valve replacement. What statement made by the client indicates that the client requires further clarification? A. I wont be able to carry heavy loads for at least 6 months. B. I will have my teeth cleaned by the dentist in 2 weeks. C. I will avoid eating foods high in vitamin K. D. I can use my electric razor to shave. 30.What specific precautions or category of isolation should the nurse use when providing care to a client with infective endocarditis? A. Standard precautions B. Enteric precautions C. Protective isolation D. Respiratory isolation 31 .The home care nurse is assessing the client receiving antibiotic therapy in the home for infective endocarditis. Which of the following clinical manifestations requires re-evaluation of the treatment regimen? A. Fever B. Fingernail clubbing C. Resolving petechiae D. Pulse pressure of 36 mm Hg 32 .A nurse is providing care to a client with pericarditis and notes increasing difficulty in auscultating the clients heart sounds. What is the nurses best first action? A. Use a Doppler to assess heart sounds. B. Increase the intravenous flow rate. C. Administer oxygen by mask. D. Notify the physician. 33 .Which clinical manifestation in a client with pericarditis should the nurse expect to find when performing a cardiac assessment? A. An irregular heart rate that speeds up and slows down B. A friction rub at the left lower sternal border C. The presence of a gallop rhythm D. A substernal lift at the apex 34 .A nurse is caring for a client admitted with tachycardia, a pericardial friction rub, and the development of a new murmur. Which element of the clients history would lead the nurse to suspect this client has rheumatic carditis?

A. B. C. D.

The client was vacationing in the tropics 2 weeks ago. The client has had a sore throat for 1 week. The client is currently taking antibiotics. The client has a history of alcoholism.

35 .A client with atherosclerosis asks a nurse what factors are responsible for this condition. What is the nurses best response? A. Injury to the arteries causes them to spasm, reducing blood flow to the extremities. B. Excess fats in your diet are stored in the lining of your arteries, causing them to constrict. C. A combination of platelets and fats accumulate, narrowing the artery and reducing blood flow. D. Excess sodium from hypertension causes direct injury to the arteries, reducing blood flow and eventually causing obstruction.