After noting a pulse deficit when assessing a patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require A) a. a 2-D echocardiogram. B) b. a cardiac catheterization. C) c. hourly blood pressure (BP) checks. D) d. electrocardiographic (ECG) monitoring. | D electrocardiographic (ECG) monitoring. | When reviewing the 12-lead electrocardiograph (ECG) for a healthy 86-year-old patient who is having an annual physical examination, which of the following will be of most concern to the nurse? A) a.
The heart rate (HR) is 43 beats/minute. B) b. The PR interval is 0. 21 seconds. C) c. There is a right bundle-branch block. D) d. The QRS duration is 0. 13 seconds. | A The heart rate (HR) is 43 beats/minute. | During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to A) a. document that the PMI is in the normal anatomic location. B) b. ask the patient about risk factors for coronary artery disease. C) c. auscultate both the carotid arteries for the presence of a bruit. D) d. assess the patient for symptoms of left ventricular hypertrophy. | D assess the patient for symptoms of left ventricular hypertrophy. | To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the A) a. bell of the stethoscope with the patient in the left lateral position. B) b. bell of the stethoscope with the patient sitting and leaning forward. C) c. diaphragm of the stethoscope with the patient in a reclining position. D) d. diaphragm of the stethoscope with the patient lying flat on the left side.
A bell of the stethoscope with the patient in the left lateral position. | To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? A) a. Myoglobin B) b. Homocysteine (Hcy) C) c. Low-density lipoprotein (LDL) D) d. B-type natriuretic peptide (BNP)| D B-type natriuretic peptide (BNP)| While doing the admission assessment for a thin 72-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? A) a. Notify the hospital rapid response team.
Check vital signs B. Place patient in high Fowlers position. C. Place patient in semi-Fowlers position. D. Administer diuretic. | B. Place patient in high Fowlers position. | 5) Which of the following is not effective nursing management of heart failure? A. High Fowlers position B. Assisting with rigorous exercise 2x a day C. Daily weights, intake & output monitoring D. Continuous EKG monitoring| B. Assisting with rigorous exercise 2x a day| 6) Which of the following is not a correct nursing and collaborative management action for heart failure? A.
High Fowlers position B. Improve gas exchange and oxygenation C. Increase fluid intake D. ECG monitoring| C. Increase fluid intake| 7) Which test is most important for the nurse to carry out if heart failure is suspected in a patient? A. 12-lead EKG B. BNP C. ABG D. Exercise treadmill testing| B. BNP| 8) A nurse is assessing the client with left sided heart failure. The client states that he needs to use 3 pillows under the head and chest at night to be able to breathe comfortably while sleeping. The documents that the client is experience: A. ORTHOPNEA B.