NUR440 (UG24) A - Adult Health II / NUR 440 Final Exam 1 Review Guide with Q&A's Latest 2026 -California Baptist University.

NUR440 (UG24) A - Adult Health II / NUR 440 Final Exam 1 Review Guide with Q&A's Latest 2026 -California Baptist University. NUR 440 test 1 study guide Cardiac exam chapter 30,31,32 1. Identify the characteristics of: Normal Sinus: Regular rhythm  Normal rate (60-100)  P wave for every QRS complex  All P waves similar in shape and size  All QRS complexes similar in shape and size, duration is less than 0.12 seconds  Normal PR (0.12-0.20 seconds)  Normal (upright and round) T waves Tachycardia  Ventricular rhythm: regular  P wave: normal  QRS complex: normal  QT interval: may be low 0.36  Ventricular rate: 100 bpm  PR interval: normal  T wave: normalAtrial Fibrillation  Ventricular rhythm: irregularly irregular  Ventricular rate: controlled: 100 bpm; rapid ventricular response (RVR) or uncontrolled: 100-150 bpm  P wave: absent; replaced by fine fibrillatory waves  PR interval: indiscernible  QRS: normal  T wave: indiscernible  QT interval: unmeasurable 2. Identify:  Ventricular tachycardia:  A rapid ventricular rhythm defined as three or more consecutive PCVs.  can occur in short bursts, or runs, or may persist for more than 30 seconds (sustained ventricular tachycardia).  The rate is greater than 100 bpm, and the rhythm is usually regular. Reentry is the usual electrophysiologic mechanism responsible for VT. Myocardial ischemia and infarction are the most common predisposing factors for VT. It also is associated with cardiac structural disorders such as valvular disease, rheumatic heart disease, or cardiomyopathy o Ventricular rhythm: regular o Ventricular rate: 100-250 bpm o P wave: absent o QRS complex: wide and bizarre o T wave: opposite direction of QRS complex o QT interval: unmeasurable  How to treat: o Treatment for ventricular tachycardia with pulse: cardioversion Drugs: amiodarone,verapamil o Treatment for pulseless ventricular tachycardia:defibrillationDrugs: amiodarone, (ATI says lidocaine and epinephrine--but I remember Toro saying this is not used as much now that there are better meds--but probably good to know)  Ventricular Fibrillation: o Quivering not contracting LETHAL RHYTHM-There is no cardiac output. Also known as cardiac arrest. Death will follow the onset of VF within 4 minutes is rhythm is not recognized and terminated to regain perfusion.  Rate: too rapid to count o Rhythm: grossly irregular o P: QRS: no identifiable P waves o PR interval: none o QRS: bizarre, varying in shape and direction o An extremely rapid, chaotic ventricular depolarization causing the ventricles to quiver and cease contracting; there is no cardiac output. This is known as cardiac arrest. It is a medical emergency requiring immediate intervention with CPR. Death will follow the onset of VF within 4 minutes if the rhythm is not recognized and terminated and an effective perfusing rhythm reestablished. o Clinically, loss of ventricular contractions results in the absence of a palpable or audible pulse. The patient loses consciousness and stops breathing as perfusion ceases. The ECG shows grossly irregular, bizarre complexes with no discernible rate or rhythm.  Treatment: Immediate defibrillation, CPR/BLS!! 3. Know proper handling of continuous cardiac monitoring alarms and electrodes:  Provided by bedside and central monitoring stations.  Electrodes placed on chest which attach to the monitor worn around the neck or waist.  HR and rhythm visually displayed on bedside monitor connected to central monitor.  Central station allows simultaneous monitoring of multiple patients within a nursing unit.  Alarms on bedside monitor and central monitor will alert to rapid or slow HR and alarm limits are set by the nurse. 4. Understand continuous telemetry monitoring and how troubleshoot problems. 5. Define lab values related to cardiac conduction. 6. Identify nursing care of patient needing Cardioversion and Defibrillation:7. List all risk factors for Coronary heart disease (CHD):  Non-modifiable risk factors o age, gender, heredity, genetics  Modifiable risk factors o HTN, DM, abnormal lipids, cigarette smoking, obesity, physical inactivity, diet  Emerging modifiable risk factors o metabolic syndrome * Unique to women (premature menopause, oral contraceptive, hormone replacement therapy) 8. Define hyperlipidemia and medication used treatment. 9. Define the different types of chest pain, and How to apply MONA. 10. Define cardiac diagnostic test findings with 12 lead ECG, 11. Define ECG changes that happen with unstable angina: 12. What will Cardiac catheterization (PCI, Heart cath) diagnose and post procedure care and complications: 13. Identify the lab value that determines cardiac damage:  Creatinine kinase- important enzyme for cellular function found principally in cardiac and skeletal muscle and the brain. CK levels rise rapidly with damage to these tissues. o Normal range: male (12-80 units/L) female (10-70 units/L) o Primary tissue location: cardiac muscle, skeletal muscle, brain o Significance of elevation: Injury to muscle cells o Appears- 3-6 hours Peaks-12-24 hours Duration-24-48 hours (declines in 48-72 hours)  CK-MB-subset of CK specific to cardiac muscle. This isoenzyme of CK is considered the most sensitive indicator of a MI. Elevated CK alone is not specific for MI. Elevated Ck-MB greater than 5% is considered a + indicator of MI. These levels will not rise with chest pains from angina. o Normal Range: 0-3% of total CK o Significance of elevation: MI, cardiac ischemia, myocarditis, cardiac contusion, defibrillation o Appears- 4-8 hours Peaks-18-24 hours Duration- 48-72 hours  Troponin I (cTnI)- proteins released during myocardial infarction that are sensitive indicators of myocardial damage. o Normal Range: 3.1 mcg/L o Significance of elevation: acute MI, unstable angina o Appears- 2-4 hours Peaks-24-36 hours Duration-7-10 days  Troponin T (cTnT) proteins released during myocardial infarction that are sensitive indicators of myocardial damage o Normal Range: 0.2 mcg/L o Significance of elevation: acute MI, unstable angina o Appears- 2-4 hrs Peaks-24-36 hours Duration-10-14 days  Myoglobin- one of the first cardiac markers to be detectable in the blood after a MI. released within a few hours of symptom onset-lack of specificity to cardiac muscle and rapid excretion (gone within 24 hours) limits its use.  CBC- Elevation of the WBC due to inflammation of the injured myocardium in a MI Arterial blood gases- Drawn from an arterial line to determine the acid base balance within the blood system of a patient. 14. Rheumatic fever and relationship to rheumatic heart disease. List of percauses at discharge.  Rheumatic fever: is a systemic inflammatory disease caused by an abnormal immune response to pharyngeal infection by Group A beta hemolytic streptococci. o Only 10% of people who get rheumatic fever get rheumatic heart disease. o Begins with strep in the throat and 2-3 weeks later fever and migratory joint pain occurs along with a temporary non-pruritic skin rash (red lesions with clear borders and blanched centers found on the trunk and proximal extremities). Chest pain, friction rub and heart murmur can accompany the rheumatic fever.  Cardiac manifestations include tachycardia, chest pain, pericardial friction rub, and s3 or s4 murmur Rheumatic heart disease occurs when the valve leaflets become rigid and deformed, openings fuse and the chordae tendineae fibrose and shorten. This results in stenosis or regurgitation of the valve. The mitral valve is the most common valve affected. Teach the patient to take full course of antibiotics, have good dental care and inform dentist of condition, report to the doctor signs of heart failure, have a high protein and high carb diet. 15. Identify how to measure Cardiac output and Cardiac index:  Cardiac output: the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in 1 minute. Indicator of how well the heart functions as a pump o Average adult CO=4-8L/min o CO= HR x SV  Cardiac index is the CO adjusted for the patient’s body size(BSA). Because it takes into account the patient’s BSA, the CI provides more meaningful data about the heart’s ability to perfuse the tissues and therefore is more accurate indicator of the effectiveness of the circulation than the CO;  adjusted for the patient’s BSA weight and height. o CO adjusted for the patient’s body size. Body surface area (M2) CO/BSA; provides more data about hearts ability to perfuse the tissues and effectiveness of circulation. o Adequate levels are 2.5-4.2 L/min/m2 Examples: 2 patients with the same CO 4L/min o (Pt 1)54.5kg….4/1.54m2=2.6g L/min/m2 (normal) o (Pt 2) 81.7kg…4/2.52m2=1.6 L/min/m2 (Low) 16. Define why medications are used, nursing assessments, when to use: Fibrinolytic therapy (tPA), Statins, nitroglycerin tablets, furosemide, enalapril, digoxin and signs of digoxin toxicity.  Fibrinolytic therapy: (e.g. streptokinase) Drugs that dissolve or break up clots/ First line drugs to treat acute MI when cardiac catheterization lab for revascularization is not available./ activates the fibrinolytic system to “lyse” the clot. / Giving within 6h of MI onset limits heart damage./ o Contraindication: BLEEDING disorders, cerebrovascular disease, uncontrolled hypertension, pregnant, recent trauma or surgery in head/spine, neurosurgery within last 2 months, GI ulcers, diabetic hemorrhagic retinopathy. o Infusion care: Tell pt to keep extremity immobile.o During infusion: Assess for bleeding every 15 min first hour, every 30 min next 2h, then hourly/ Do not elevate head above 15 degrees. Tell pt to keep extremity still and straight./ keep antidysrrhythmic drugs by side. o Post-infusion: Bed rest 6H. Keep HOB below 15 degrees. When catheter is removed, apply pressure over site for at least 30 min. Administer platelet modifying drugs, aspirin, as ordered. REPORT reocclusion, change in ST segment, chest pain, or dysrhythmias.  Statins: Cholesterol lowering drugs. Inhibit the enzyme HMG-CoA reductase in liver. Lowers LDL. First line treatment for Elevated LDL/ Side effect: Rhabdomyolysis (breakdown of muscle fibers.) o NURSING RESPONSIBILITIES: Monitor serum cholesterol and liver enzymes before and during therapy for at least 12 weeks, then yearly after that./ Assess for muscle pain and tenderness. Monitor CPK level. Watch ALT/AST/alk. Phosphate/Bilirubin levels closely o EDUCATION: Report muscle pain, tenderness, weakness, rash, hives, change in skin color, abdominal pain, N/V. do not use if pregnant. o Brings down cholesterol.  Nitroglycerin tablets: o Drug of choice for acute MI used to prevent and treat//Sublingual (drug of choice) Acts within 1-2 min// decreases myocardial work and oxygen demand through dilation and reduces preload and afterload. o improves oxygen supply by dilating collateral blood vessels and reducing stenosis.// Buccal spray is easier to handle than nitro tablets. o Sublingual tablets, and sprays are used for only acute angina attacks-- Rapid acting// “Longer-acting”: oral tablets/ ointments/ patches/ used to PREVENT angina attacks (not to treat an acute attack). problem with long acting: tolerance (tolerance can be limited by a dosing schedule that involves a nitrate free period for 8-10h daily possible during sleep.) o Side effects: HEADACHE, nausea, dizzy, hypotension. o Reduces preload and afterload. Decrease workload of the heart/vasodilates o Nursing considerations: o Dilute IV Nitroglycerin (if giving IV). Use only glass bottles for mixing. Use non-PVC infusion tubing due to nitroglycerin adhering to PVC. Wear gloves when applying nitroglycerin paste or ointment. Spread evenly in a 2x3in area. Remove Nitroglycerin patches at night to prevent intolerance.  Digoxin toxicity: p.930 ch.31. o Interferes with ATPase and reduces preload and afterload. o Assess apical pulse BEFORE administering. o Notify provider if HR is 60bpm. Evaluate for scooped ST. o Assess potassium, Mg, C, and serum digoxin. Monitor pt with renal insufficiency and renal failure. o REVERSAL AGENT: Digibind (Digoxin immune fab) o Normal level: 0.5-2.0 for heart failure o For heart failure: 1.5-2.5 for arrhythmiaso Toxicity s/s: o anorexia, N/V, abdominal pain, weakness, vision change (diplopia, blurred, yellowgreen, white halos), dysrhythmias, hypokalemia. o Extreme high levels of medication can cause ST depression on ECG, vision changes (diplopia, blurred vision, yellow-green, white halos seen around objects. Impaired renal function patients may have hyperkalemia with extreme levels of digoxin in the blood. Increase conductivity for A Fib o Nursing Considerations: o assess apical pulse before administering medication (hold medication and notify provider if heart rate is less than 60 BPM) o evaluate ECG for spoon shaped ST segment, bradycardia and other dysrhythmias, assess potassium, magnesium, calcium and serum digoxin levels before giving digoxin, hypokalemia can precipitate toxicity even if levels are within range. o Prepare to administer DIGIBIND for digoxin toxicity. Furosemide: ch.31 p.930. Diuretic/ o Used to treat symptomatic HF. Helps relieve fluid retention. o NURSING RESPONSIBILITIES: o Has a rapid onset. o monitor BP, I/O, weight, turgor, edema. Assess volume depletion. o Report serum electrolyte levels. o Administer IV slowly, no faster than 20mg/min.Evaluate for ototoxicity. o DO NOT administer w/ aminoglycoside antibiotics (e.g. gentamicin). Evaluate for signs of ototoxicity. Enalapril: ch.32 p. 974. Vasotec. ACE inhibitor. Low BP. by preventing ang I to ang II. Contraindicated in black pt. o ACE inhibitor that prevents acute coronary events and reduce mortality in heart failure patients. o Assess BP and WBC before giving. Monitor BP for 2h after 1st dose. Administer PO 1h before meals, tabs may be crushed. Report: change in WBC, BUN, serum creatinine, hyperkalemia. Do not administer to pt with renal artery stenosis. Report angioedema, and d/c drug if occurs. o EDUCATION: report peripheral edema, infection, difficult breathing, cough. Change position slowly to prevent dizziness. DO NOT take potassium supplement. 17. Identify the cause, sign symptoms of chronic heart failure verses acute heart failure. o Chronic heart failure- progressive deterioration of the heart muscle due to cardiomyopathies, valvular disease or coronary heart disease. Both ventricles are generally affected to some degree in chronic heart failure. o Acute heart failure- abrupt onset of myocardial injury such as a massive MI resulting in suddenly decreased cardiac function and signs of decreased cardiac output. 6 months Cardiogenic shock--not indicative of volume status--occurs most with a patient who just had a MI or a history of MI. Develops suddenly and is a result of myocardial injury or low cardiac output. o Left sided heart failure- Coronary heart disease and hypertension are common causes of left sided heart failure. Left sided failure can lead to right sided failure as pressure in the pulmonary vascular system increase with congestion behind the failing left ventricle. Signs and symptoms: result from pulmonary congestion (backwards effects) and decreased cardiac output (forward effects). Fatigue, activity intolerance are early signs. Dizziness and syncope from decreased cardiac output. Pulmonary congestion causes dyspnea, shortness of breath and a cough. Orthopnea (trouble breathingwhile lying down), cyanosis from impaired gas exchange. Crackles upon auscultation (rales and wheezes) in lower lung bases. S3 gallop may be present. o Right sided heart failure- Often caused by conditions that restrict blood flow to the lungs such as acute or chronic pulmonary disease. Signs and symptoms-Increased pressures in the pulmonary vasculature or right ventricular damage can impair the right ventricles ability to pump blood into pulmonary circulation. Blood accumulates in the systemic venous system. Increased venous pressures cause abdominal organs to be congested and peripheral tissue edema (feet and legs), RUQ pain from enlarged liver, nausea and anorexia from GI tract vessel congestion, increased venous pressure can also cause distended neck veins. 18. Define nursing priority for acute heart failure. 19. What lab test is used to diagnosis heart failure?  Atrial natriuretic factor (ANF)  Brain natriuretic peptide: (BNP)100 are hormones released by the heart muscle in response to changes in blood volume. o N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is a rapid test readable in 15 minutes for BNP. **BNP may be elevated in women and people over the age of 60 who do not have heart failure** So this test alone cannot diagnosis heart failure. If the patient is symptomatic the number is relative to the patient’s symptoms****Left sided failure Serum electrolytes Urinalysis Liver function tests Thyroid function tests Arterial blood gases (ABGs) Chest x-ray Electrocardiography Echocardiography with Doppler flow studies Radionuclide imaging 20. Know nursing care of patients with hemodynamic monitoring; define central venous pressure (CVP) how is it used to care for patients. o measures blood volume and venous return. They reflect the right heart filling pressures. Pressures are elevated in right sided HF. o Used to monitor fluid volume status. o Used to monitor venous and arterial pressure. o Catheter is inserted in the internal jugular or subclavian vein. Distal tip of the catheter is positioned in the superior vena cava just above or inside the right atrium. CVP may be measured in centimeter of water (cm H2O) or in millimeters of mercury (mmHg). Water manometer is a clear tube which is attached between a central catheter and an IV fluid bag. Pressure in the venous system causes fluid in the manometer to rise or fall. CVP is recorded by noting the fluid level in the manometer. Normal Range (CVP): o 2-8 cm H2O // 2-6 mmHg.) o Hypovolemia and shock decrease CVPo Fluid overload, vasoconstriction, cardiac tamponade increases CVP 21. What causes pericarditis and define clinical characteristics and complications? Pericarditis: inflammation of the pericardium. o Infectious causes-viruses, bacteria, tuberculosis, parasites, syphilis. o Non-infectious causes-myocardial or pericardial injury, RHEUMATIC fever, uremia, neoplasms, radiation, trauma or surgery, myxedema, autoimmune disorders, connective tissue diseases, prescription/non-prescription drugs, post cardiac injury .  Clinical characteristics- SHARP chest pain that may radiate to back or neck and is relieved by sitting upright and leaning forward. Pericardial friction rub, fever, dyspnea, tachycardia.  Complications of Pericarditiso Pericardial Effusion: abnormal collection of fluid between the pericardial layers that threatens normal cardiac function. Normally holds 30-50ml of fluid but can stretch to hold up to 2L of fluid. Heart sounds may be muffled or distant. The patient may have a cough or mild dyspnea. o Cardiac tamponade: o MEDICAL EMERGENCY! Can occur from pericardial effusion compressing the heart, trauma, cardiac rupture or hemorrhage. Rapid collection of fluid in the pericardial sac interferes with ventricular filling and pumping, critically reducing CO. Treatment for this would be pericardiocentesis. o Chronic constrictive pericarditis-chronic pericardial inflammation can lead to scar formation between pericardial layers. Scar tissue contracts and restricts diastolic filling and elevating venous pressure. This may follow viral infection, radiation therapy or heart surgery. o Symptoms of chronic constrictive pericarditis-progressive dyspnea, fatigue and weakness. Ascites is common; peripheral edema may develop. Neck veins are distended especially during inspiration (Kussmaul's sign)--this occurs due to the right atriums inability to dilate to accommodate increased venous return during inspiration. 22. Identify Cardiac Tamponade signs symptoms and pericardiocentesis. 23. Cardiac tamponade:  MEDICAL EMERGENCY! Can occur from pericardial effusion compressing the heart, trauma, cardiac rupture or hemorrhage. Rapid collection of fluid in the pericardial sac interferes with ventricular filling and pumping, critically reducing CO. Treatment for this would be pericardiocentesis.  Symptoms of cardiac tamponade-pulsus paradoxus (palpation of the carotid or femoral pulse, pulse is diminished or absent during inspiration). Drop in systolic blood pressure drop of 10 mmHg during inspiration is also pulsus paradoxus. Muffled heart sounds, dyspnea, tachypnea, tachycardia, narrowed pulse pressure and distended neck veins. 24. Define heart sounds S3 and S4 meaning and illness associated with heart sounds S3: Fluid overload i. A woman who is pregnant can have S3 sounds that are normal . It can sound very rigid and is heard in left sided heart failure ii. Immediately follows S2, called a ventricular gallop results from myocardial failure and ventricular volume overload (CHF, mitral or tricuspid regurgitation) ventricle is filling up too rapidly S4 : Rigid ventricle that the blood is hitting against i. Immediately precedes S1 called an atrial gallop and results from increased resistance to ventricular filling after atrial contraction. (HTN, CAD, Aortic stenosis, cardiomyopathy) S3 and S4 together: Summation gallop and occurs with severe CHF25. Identify cause of a heart murmur? When the valves cause the flow of blood to not be smooth and the flow becomes turbulent it’s due to valvular diseases. o Stenosis: valves that don't allow enough blood through them o aortic-harsh systolic murmur: regurgitation- don't close properly and leak o mitral-loud, high pitched, rumbling murmur: Mitral valve prolapse-high pitched and late systolic murmur 26. Advantage and disadvantage between mechanical valve and biologic tissue valve: Mechanical Valve Biologic Tissue Valve Advantages:  good hemodynamics  long-term durability Advantages:  good hemodynamics  low incidence of thromboembolism  no long-term anticoagulation  quiet  infections are easier to treat Disadvantages:  lifetime anticoagulation meds  audible click  risk of thromboembolism  infections are harder to treat Disadvantages: prone to deterioration frequent replacement is required27. Warfarin anticoagulation therapy patient discharge instructions.Warfarin information: p.1000  Medication administration: Warfarin interferes with synthesis of vitamin K-dependent clotting factors by the liver. Inhibits extension of thrombi and clots. This action is more prolonged and cumulative than heparin. Needs monitoring// These following drugs do not need monitoring: Dabigratran (Pradaxa)-direct thrombin inhibitor and works directly on thrombin.….Rivaroxaban (Xarelto)-a selective factor X inhibitor inhibiting coagulation.  Nursing Responsibilities: Assess evidence of abnormal bleeding.//Note medication for interactions with warfarin.//do not give during pregnancy (congenital malformations).// Oral tablets MAY be crushed and given w/o regards to meals.//Dilute IV warfarin with diluent and administer within 4h by direct IV at 25mg/min.//Keep Vitamin K available to reverse effects if bleeding occurs.// Monitor PT or INR  Health Education: 1. Do not take your prescribed dose and notify your healthcare provider immediately if bleeding occurs (hematemesis, bright red or black, tarry feces, hematuria, bleeding gums, excessive bruising etc.) REPORT: Rash, hepatitis (dark urine, malaise, yellow skin or sclera.) 2. Take your warfarin at the same time every day; do not change brands as their effects may differ.// 3. Menstrual bleeding may be increased. Notify your healthcare provider if it increases too much. Use reliable birth control to prevent pregnancy while taking warfarin.// 4. Use a soft toothbrush, electrical razor, wear shoes, and use a night light, and avoid contact sports.// 5. Do not smoke, alcohol, or take any OTC drugs unless specifically told by your healthcare provider. 28. List the manifestation of hypertension crisis how it treated.  Malignant hypertension: rapid elevation in systolic (180) and/or diastolic (120) pressure, blurry vision, headache, confusion, motor and sensory deficit  Management of hypertensive crisisIV antihypertensive medications (vasodilators,calcium channel blockers, ACE inhibitors, adrenergic blockers) o Continuous BP monitoring-titrating medications to BP readings o Avoid rapid BP changes (Goal of care is to reduce the blood pressure by no more than 25% in the 1st hour- then towards 160/100 within 2-6 hours) Excessive blood pressure decrease may lead to renal,cardiac or cerebral ischemia) o Providing calm reassurance to the patient and family ( age 65 will be admitted) 29. Define the life style teaching changes for hypertension patients:  all patients with primary hypertension and their families need significant teaching to manage this chronic condition**  Lifestyle Modifications for hypertension (BP 120-139 /80-89 mmHg--prehypertension)  maintain normal body weight;lose weight if overweight.  make dietary modifications: eat diet rich in fruits, vegetables and low fat dairy products, reduce sodium intake, reduce intake of cholesterol total and saturated fat.  limited alcohol intake to no more than 1oz of ethanol. ½ for women and lighter weight women engage in aerobic exercise for 30 minutes most days of the week.  stop smoking  use stress management techniques such as relation therapy.  DASH diet recommendations (decrease sodium maintain intake of potassium and calcium) -decrease total and saturated fats  *grains-7-8 servings/ day *vegetables-4-5 servings/day *fruits 4-5 servings/day *nonfat/low fat dairy products- 2-3 servings/day *meats poultry and fish--2 or fewer 3 oz servings per day *nuts, seeds, dry beans-4-5 servings per week *fats and oils 2-3 servings/day *sweets- 5 servings/week  Stage 1 (140-159/90-99) and Stage 2 hypertension (160/100) need to be treated with medications. o *if patients are put on medication they need to be educated about the importance of monitoring blood pressure at home while taking medications to avoid falls from orthostatic hypotension and low heart rates with beta-blockers. 30. List the clinical manifestation of arterial thrombosis.  Arterial thrombosis: is a blood clot that adheres to the vessel wall. This occur in areas where intravenous factors stimulate coagulation (where a vessel is partially occluded and atherosclerosis is formed). Infection or inflammation or pooling of blood can cause thrombus formation. This can lead to ischemia.  tissue ischemia, paresthesia’s, cyanosis/mottling, paralysis/muscle spasms ,can't walk on it o Ischemic tissues are painful, pale and cool or cold. Distal pulses are absent. Paresthesias (numbness and tingling) develop in the extremity. Cyanosis and mottling are common. Paralysis and muscle spasms may develop. Line of demarcation between normal and ischemic tissue may be seen (particularly in embolism) Tissue below the line is cool or cold and pale cyanotic or mottled. Arterial occlusion can result in permanent vessel and limb damage. Complete arterial occlusion leads to tissue necrosis and gangrene if blood flow is not promptly restored. Questions: Chapter 29 1. A patient who is hemorrhaging has decreased preload. What physiological effects should the nurse expect to occur with this patient? a. Increased afterload b. Decreased cardiac output c. Decreased action potential d. Increased ejection fractionThe nurse is preparing to assess a patient who is experiencing chest pain. Which question should the nurse asked to learn more information about the intensity of the pain? a. “Did the pain move into your left arm?” b. “Was the pain a pressure, burning, or tightness?” c. “Was your pain relieved by resting or worse when you were busy?” d. “On a scale of zero (no pain) to 10 (worst pain) what number is your pain?” The nurse is preparing to assess a patient’s apical impulse. Which anatomical location should the nurse use to make this assessment? a. Right nipple line, any intercostal space b. Left substernal line, sixth intercostal space c. Left midclavicular line, fifth intercostal space d. Right midaxillary line, second intercostal space The nurse assess a patient's heart rate as being 50 beats per minute. How should the nurse document this finding? a. Bradycardia b. Tachycardia c. Hypotension d. Hypertension A patient’s laboratory value indicates a low red blood cell count. What subjective data should the nurse expect to assess that is consistent with this data? a. Fatigue b. Nausea c. Chest pain d. Sore throat A patient is being admitted for a low platelet count. Which finding should the nurse expect when conducting a physical assessment of this patient? a. Varicose veins b. Excessive bruising c. Enlarged lymph nodes d. Changes in pulse pressure The nurse determines that an older patient would benefit from interventions to address peripheral vascular resistance. What manifestations did the nurse assess in this patient? a. Joint pain b. Sunken eyeballs c. Distant bowel sounds d. Elevated blood pressure e. Lower extremity fatigue The nurse is preparing to assess a patient’s carotid arteries. Which techniques should the nurse use for this assessment? (Select all that apply) a. Palpate for pulse rate b. Inspect for pulsations c. Auscultate for rhythm d. Percuss for arterial wall density e. Palpate deeply for arterial wall integrity During the physical examination of the patient’s abdomen, the nurse auscultates a blowing sound over the aorta. How should the nurse document this finding? a. Bruit b. Dysrhythmia c. Bigeminal pulse d. Hypokinetic pulse A patient has been admitted with severe leg pain. The limb is cyanotic, cool to the touch, and peripheral pulses are absent. What should the nurse do first after this assessment.a. Document the findings b. Teach relaxation techniques c. Notify the physician immediately d. Ask how long the limb has been hurting Chapter 30 1. The nurse instructs a patient about modifiable risk factors for coronary artery disease. Which statements indicate that teaching has been effective? (Select all that apply) a. “I should stop smoking to reduce my risk of heart disease.” b. “Restricting my activity reduces the onset of heart disease.” c. “I should drink alcohol because this prevents heart disease.” d. “There is not much that can be done to prevent heart disease.” e. “Obesity is a risk factor that I can change to reduce the onset of heart disease.” A patient is prescribed lovastatin (Mevacor) for hyperlipidemia. What should the nurse instruct the patient about this medication? a. Abstain from alcohol use while taking this drug b. Take the drug with meals to minimize gastric distress c. Promptly report muscle pain or tenderness to the physician d. Consume a diet that includes no more than 20& of calories from standard saturated fat The nurse is caring for a patient with stable angina. Which assessment finding would be consistent with this medical diagnosis? a. Persistent ECG changes b. Increasing nocturnal pain c. Correlation between activity level and pain d. Evidence of impaired cardiac output such as weak peripheral pulses The nurse is caring for a patient with acute coronary syndrome. Which nursing diagnosis should be the priority for this patient? a. Anxiety related to unknown outcome of disorder b. Decreased CardIac Output related to myocardial ischemia c. Ineffective Health Maintenance related to lack of knowledge about coronary heart disease d. Ineffective Tissue Perfusion: Cardiopulmonary related to underlying coronary heart disease The nurse is caring for a patient recovering from a coronary angioplasty with stent placement. Which intervention is a priority for the patient at this time? a. Securing chest tubes to bedding b. Maintaining leg extension on the affected side c. Discontinue intravenous lines when taking oral fluids d. Treating chest pain with intravenous morphine as needed The nurse is planning care for a patient with acute myocardial infarction. What goals should the nurse use to guide this patient’s care? (Select all that apply) a. Relieve chest pain b. Prevent complications c. Reduce blood viscosity d. Decrease cardiac workload e. Reduce myocardial damage The nurse is determining nursing diagnoses appropriate for a patient scheduled for fibrinolytic therapy. Which nursing diagnosis would be a priority for this patient? a. Anxiety b. Ineffective Protection c. Risk for Powerlessness d. Ineffective Health Maintenance The nurse is reviewing laboratory results for a patient admitted with acute chest pain. Which laboratory value should cause the nurse the most concern? a. AST 65 units/Lb. Ck 320 UNITS/L c. Hematocrit 36% d. APTT 35 seconds The nurse recognizes that a patient has developed secondary AV block, type II (Mobitz II). Which action should the nurse take at this time? a. Record the finding in the chart b. Places the patient in Fowler’s position c. Prepare for temporary pacemaker insertion d. Administer a Class IB antidysrhythmic drug The nurse identifies that a patient has sinus bradycardia with a heart rate of 45 bpm. What should the nurse do first? a. Assess mental status and blood pressure b. Prepare to administer intravenous atropine c. Assess peripheral pulses on all four extremities d. Determine if an apical-radial pulse deficit is present Chapter 31 1. A patient with heart failure has an ejection fraction of 25%. What does this information indicate to the nurse about the patient’s health status? a. Ventricular function is severely impaired b. Cardiac output is greater than normal, which overtaxes the heart c. The amount of blood being ejected from the ventricle is within normal limits d. Twenty-five percent of the blood entering the ventricle remains in the ventricle after systole A patient admitted 24 hours previously with heart failure has lost 1kg (2.2 lb) of weight, has a heart rate of 88, which was 105 on admission, and now has crackles only in the bases of the lungs. How should the nurse interpret these assessment findings? a. More aggressive treatment is needed b. The patient’s condition is unchanged from admission c. The treatment regimen is achieving the desired effect d. No further treatment is required at this time because the failure has resolved. A patient is diagnosed with left ventricular failure. Which findings should the nurse recognize as being consistent with this diagnosis? (Select all that apply) a. Fatigue b. Substernal chest pain during exercise c. 5cm jugular vein distention at 30 degrees d. Bilateral inspiratory crackles to midscapulae e. Complaints of shortness of breath with minimal exertion The nurse is caring for a patient undergoing pulmonary artery pressure monitoring. What should the nurse include when caring for this patient? (Select all that apply) a. Maintain flush solution flow by gravity b. Calibrate and level the system by gravity c. Secure the intravenous line to the bed linens d. Change tubing to the insertion site every 72 hours e. Report waveform dampening during wedge pressure measurements A patient experiencing acute pulmonary edema is prescribed morphine sulfate 2 to 5 mg IV as needed for pain and dyspnea. What action should the nurse take with this prescribed medication? a. Administer the drug as ordered, monitoring respiratory status b. Withhold the frug until the patient’s respiratory status improves c. Question the order because no time intervals have been specified d. Administer the drug only when the patient complains of chest pain The nurse notes a granting heart sound when auscultating the apical pulse of a patient with pericarditis. What should the nurse do with this assessment data? a. Obtain an electrocardiogramb. Initiate resuscitation measures c. Immediately notify the physician d. Note the finding in the patient’s medical record The nurse is planning care for a patient with acute infective endocarditis. What would be an appropriate goal of nursing care for this patient? a. Resume usual activities within 1 week of treatment b. Relate the benign and self-limiting nature of the disease c. Consider cardiac transplantation as a viable treatment option d. State the importance of continuing intravenous antibiotic therapy as ordered The nurse is assessing heart sounds of a patient scheduled for mitral valve replacement surgery. Which sound should the nurse expect to auscultate in this patient? a. Cardiac heave b. Muffled heart sounds c. S3 and s4 heart sounds d. Diastolic murmur heard at the apex A patient considering heart valve replacement asks if a biologic or mechanical valve is better to use. How should the nurse respond to the patient? a. Biologic values tend to be more durable than mechanical valves b. The need to take drugs to prevent rejection of biologic tissue is a major consideration c. Clotting is a risk with mechanical valves, necessitating anticoagulant drug therapy after insertion d. Endocarditis is a risk following valve replacement that is more easily treated with mechanical valves The parents of a young athlete who collapsed and died due to hypertrophic cardiomyopathy ask how it is possible that their son had no symptoms of this disorder before experiencing sudden cardiac death. How should the nurse respond to the parents? a. “It is likely that your son had symptoms of the disorder before he died, but he may not have thought them important enough to tell someone about” b. “In this type of cardiomyopathy, the ventricle does not fill normally. During exercise, the heart may not be able to meet the body's needs for blood and oxygen.” c. “Cardiomyopathy results in destruction and scarring of cardiac muscle cells. As a result, the ventricle may rupture during strenuous exercise, leading to sudden death d. “Exercise causes the heart to contract more forcefully, and can lead to changed in the heart’s rhythm or the outflow of blood from the heart in people with hypertrophic cardiomyopathy.” Chapter 32 1. A patient whose blood pressure averages 180/106 mmHg on two different readings says to the nurse, “I don;t understand how it could be so high -I feel just fine.” What response should the nurse make to this patient?” a. “This is probably just a false reading due to ‘white coat syndrome’. Don;t worry about it.” b. “High blood pressure often has a few or no symptoms; that why it is called the silent killer.” c. “It is unusual that you are not having some symptoms such as severe headaches and nosebleeds” d. “You probably should have your blood pressure rechecked in 3 months or so and then follow up with your primary care provider if it is still high.” The nurse instructs a patient about the DASH diet for blood pressure control. Which patient statement indicates that additional teaching is necessary? a. “I will enjoy having frozen yogurt as my bedtime snack on occasion.” b. “Having a handful of nuts when the predinner ‘munchies’ hit is a good idea.” c. “It will be a challenge to incorporate all those servings of fruits and vegetables into my diet.” d. “I’m glad I can still eat as much as pasta s usual; I was afraid I would have to give up my weekly lasagna.” A patient is prescribed valsartan (Divan) for treatment of hypertension. What should the nurse include when teaching the patient about this medication? (Select all that apply)a. Report a persistent disruptive cough to your healthcare provider b. Use caution when rising from bed or chair to prevent dizziness c. Take the drug at bedtime to reduce the risk of falling due to lightheadedness d. Use a potassium-based salt substitute to prevent hypokalemia while taking this drug e. You may stop taking this drug once your blood pressure is within normal range for at least 2 months A patient is complaining of new onset calf and foot pain. The nurse notes that the leg below the knee is cool and pale and that dorsalis pedis and posterior tibial pulses are absent. What should the nurse do first to help this patient? a. Notify the healthcare provider b. Prepare to initiate heparin therapy c. Position the leg flat, supported in anatomic position d. Place a cradle over the leg to prevent pressure from bedding The nurse is caring for an 86-year-old patient with a newly diagnosed abdominal aortic aneurysm. What information should the nurse use to plan care for this patient? a. Surgery is indicated for type A aneurysms b. The risk of surgical repair is lower than the risk that the aneurysm will rupture c. Opening the abdomen for the surgical procedure greatly increases the risk of rupture d. A percutaneously inserted endovascular stent may be considered because of the patient’s age A patient is diagnosed with peripheral atherosclerosis. What should the nurse expect to assess in this patient? a. Pallor of the legs and feet when dependent b. Impaired sensation in the affected extremity c. Increased hair growth on the affected extremity d. Higher blood pressure readings in the affected extremity The nurse is planning care for a patient being discharged with peripheral vascular disease. In which order should the nurse provide teaching to this patient? a. Foot and leg (3) b. Smoking cessation (1) c. Weight loss strategies (5) d. Regular daily exercise (4) e. Daily inspection of feet and legs (2) The nurse provides discharge instructions to a patient with a deep venous thrombosis. Which patient statement indicates that teaching has been effective? a. “I’ll use a hard-backed, upright chair when sitting instead of my recliner.” b. “I understand why I am not allowed to exercise for the next six weeks and will take it easy.” c. “I’ll get my blood drawn as scheduled and notify the doctor if I have any unusual bleeding or bruising.” d. “I’ll have my wife buy a low-cholesterol cookbook and we’ll make an appointment with the dietician to learn about a low fat, low cholesterol diet.” A patient with visible varicose veins wants to have surgery to remove them because of leg pain. What would be the most appropriate response for the nurse to make to this patient? a. “Surgery will have a good cosmetic effect, but will not relieve the discomfort associated with varicose veins.” b. “All varicose veins should be surgically removed to restore adequate blood flow to your legs and prevent gangrene.” c. “Often measures such as elevating your legs and elastic stockings can relieve the discomfort associated with varicose veins.” d. “Surgery is never indicated unless the varicose veins are interfering with circulation. Have you tried cosmetic measures to cover them up?” The nurse is caring for a patient with lymphedema. Which nursing intervention is the highest priority for this patient?a. Elevate affected extremities at night b. Reinforce the importance of taking prescribed diuretics c. Assist to apply elastic compression stockings during the day d. Carefully dry and apply emollient lotion to affected extremities after bathing My nursing lab questions Cardiac 1. A nurse is providing care for a client just diagnosed with acute MI. The nurse carefully monitors the client for which manifestations that precede sudden cardiac death? Select all that apply. A. Severe chest pain B. Lightheadedness C. Palpitations D. Orthopnea E. Hypertension 2. A nurse in the intensive care unit is providing care for a client who is 6 hours post-MI. The health care provider has written an order for a liquid diet with no caffeine and no foods that are very hot or very cold. What foods would the nurse provide for this client? A. Cola-based carbonated beverages B. Gelatin C. Ice cream D. Regular coffee 2. A nurse is planning discharge teaching for a client newly prescribed sublingual nitroglycerin for angina. Which instructions would the nurse include in this teaching? A. Do not use nitroglycerin tablets that tingle when place under the tongue. B. Store no more than a 6 month supply of nitroglycerin. C. Store nitroglycerin in the refrigerator. D. Take nitroglycerin before activities known to cause chest pain. E. Get immediate medical attention if chest pain not relieved with three nitroglycerin tablets in 15 to 20 minutes. 2. A nurse is preparing educational material to be presented at a health fair for senior citizens at a community center. The primary focus of the educational material is health promotion and prevention of acute coronary syndrome (ACS). Which information would the nurse include in the educational materials? A. Maintain an active lifestyle with regular aerobic exercise. B. Call a health care provider if chest pain occurs. C. Eat a low-fat diet that includes fresh fruits and vegetables. D. Stop smoking. E. Have cholesterol levels checked regularly. 2. A nurse working in the intensive care unit is providing care for a client who is diagnosed with ACS and experiencing increasing episodes of premature ventricular contractions (PVCs). The nurse is concerned the client is at risk for sudden cardiac death based on which of the following factors? A. Tachycardia always precedes sudden cardiac death when caused by ACS. B. Increasing episodes of PVCs can signal impending sudden cardiac death. C. The client will not experience symptoms before sudden cardiac death from ACS. D. ACS is the leading identified cause of sudden cardiac death. E. A history of previous MI is not a factor in sudden cardiac death related to ACS. 2. A nurse on the medical-surgical unit is assessing a client who reports chest pain that is unpredictable and occurs even when the client is resting. The client also reports nausea and indigestion during chest pain episodes. The client reports feeling anxious during chest pain episodes as well. The nurse recognizes the client’s chest pain is related to which cardiac health issue?A. Unstable angina B. Prinzmetal angina C. Stable angina D. MI 2. A nurse is explaining the pathophysiology of MI to a client newly diagnosed with MI. What would the nurse include in this teaching? A. MI occurs when a coronary artery is partly blocked. B. Chest pain occurs when the blood flow to the heart is decreased. C. Damage to cardiac cells can be reversed up to 2 hours after the initial blockage of a coronary artery. D. MI causes damage to the cardiac cells by blocking the oxygen and nutrient supply to the cells. E. Angina that is becoming more severe and more frequent indicates an increased risk for MI. 2. A nurse is providing care for a client who is scheduled for percutaneous transluminal coronary angioplasty. When obtaining consent for this procedure, the nurse asks the client to state his or her understanding of the procedure. Which statement by the client indicates that the client understands the procedure? A. "My health care provider will use a machine to trim away the hardened plaque that is blocking my artery." B. "My health care provider will thread a tube to the arteries in my heart and use dye to see if I have blockages." C. "My health care provider will perform surgery to make a bypass around my blocked artery." D. "My health care provider will insert a tube into my blocked artery and inflate a balloon to open the blocked artery." 2. A nurse is instructing unlicensed assistive personnel (UAP) concerning how to perform a bedside ECG rhythm. What instructions would the nurse provide to the UAP? A. Gather the ECG machine, electrodes, lead wires, and monitor. B. Apply electrodes using the blue, red, and black lead wires. C. Make certain the precordial leads are applied to the arms and legs. D. Apply the electrodes to the client's chest, arms, and legs. E. Apply three leads: the positive, negative, and grounded. 2. A nurse is calculating the client’s ventricular rate from an ECG. How would the nurse calculate the client’s ventricular rate? A. Count the number of QRS complexes in a 6-seconds section of the reading and multiply by 10. B. Count the ST segments and multiply by 10. C. Calculate T waves in a 6-seconds section and multiply by 10. D. Count the number of P waves in a 6-seconds section of the reading and multiply by 10. 2. A nurse is providing care for a client with bradycardia. The client asks the nurse to describe the electrical pathway in the heart. Place the following in the correct order. A. Responses 1st SA fires in the upper right atrium. 2nd AV node fires in the lower right atrium. 3rd The conduction moves through the bundle of His. 4th The conduction moves through the right and left bundles. 5th The conduction moves through Purkinje system.6th The ventricular muscle is stimulated. 12. A nurse on the medical-surgical unit is planning care for an adult client. The client’s medical history states that the client has a heart rhythm that has damaged theclient’s AV node and decreased the atrial kick. The nurse anticipates the client will have what assessment finding? A. Lowered blood pressure B. Impaired ventricular contraction C. Increased peripheral perfusion D. Decreased heart rate 12. The nurse is reviewing a client’s ECG. The nurse is concerned that the client’s cardiac electrical conduction system is delayed between the SA node and the ventricles when the nurse observes a lengthening in what part of the ECG tracing? A. QRS complex B. U wave C. PR interval D. P wave 12. A nurse is reviewing the results of a recently completed 12-lead ECG. The results indicate a wave pattern that is very irregular and jagged. The nurse is unable to perform necessary measurements. The nurse determines that the tracing is a result of artifact, and the diagnostic test must be repeated. What intervention would the nurse use when repeating the ECG? A. Place fresh ECG paper in the machine. B. Instruct the client to lie still during the ECG. C. Perform a bedside ECG instead of a 12-lead ECG. D. Place the electrodes in a different location on the client's body. 12. The nurse analyzes the P wave as part of reviewing a client’s ECG rhythm. Which findings would the nurse consider for further assessment? A. The P wave is above the isoelectric line in lead II. B. The P wave changes in size and shape from complex to complex. C. The P wave is in front of the QRS complex. D. The P wave is absent in some of the complexes. E. The P wave interval is regular. 12. A nurse on the medical-surgical unit is reviewing laboratory values for a client with cardiovascular disease. What laboratory values would the nurse focus on to ensure proper cardiac electrical conduction? A. Calcium levels B. Sodium levels C. Potassium levels D. Phosphorus levels E. Bicarbonate levels 12. A 35-year-old client newly diagnosed with cardiomyopathy is scheduled for myocardial biopsy. The client asks the nurse why the biopsy is scheduled. What is the best response by the nurse? A. "A biopsy will determine if you also have cardiomegaly." B. "The biopsy will help determine if an inflammatory process has caused yourcardiomyopathy." C. "A biopsy will help identify which type of cancer caused your cardiomyopathy." D. "Biopsies are used to determine how large your ventricles are." 12. A nurse is preparing discharge teaching concerning disease process for a client newly diagnosed with restrictive cardiomyopathy. What would the nurse include in thisteaching? A. The manifestations will improve in a few months. B. Shortness of breath is an uncommon complication of this disorder. C. Strenuous exercise is encouraged as manifestations improve. D. Allow rest periods throughout the day.12. A nurse in the intensive care unit is reviewing medical records for a group of clients. The nurse recognizes which client needs further assessment for increased fluid overload? A. The client whose venous pressure has increased from 8 to 12 mmHg B. The client whose urinary output has increased from 150 mL/8 hr to 1000 mL/8 hr C. The client whose weight has decreased from 185 to 176 lb in 3 days D. The client whose venous pressure has decreased from 4 to 2 mmHg 12. A nurse on the medical-surgical unit is reviewing the medical records for a client. The nurse is concerned the client is at risk for heart failure based on what information found in the client’s records? A. The client is 74 years of age. B. The client has elevated cholesterol. C. The client has a history of hypertension. D. The client has a history of myocardial infarction. E. The client is African American. 12. A nurse is preparing discharge teaching concerning symptom management for a client newly diagnosed with dilated cardiomyopathy. What would the nurse include in thisteaching? A. Take all medications as prescribed. B. Avoid processed foods and canned soups. C. Limit rest periods to build activity tolerance. D. Limit fluid intake to help minimize fluid overload. E. Notify the health care provider for any sudden weight gain. 12. A client on the medical-surgical unit is diagnosed with heart failure. The client is experiencing edema in the feet and legs in addition to bilateral crackles in the lungs. What intervention would the nurse provide to lessen fluid retention? A. Encourage a low-sodium diet. B. Provide high-potassium foods. C. Push oral fluids. D. Weigh the client weekly. 12. A nurse is planning teaching for a client newly diagnosed with pulmonary edema. What information would the nurse include concerning on the causes of pulmonary edema? A. Pulmonary edema is caused by swelling in the lung tissue. B. Pulmonary edema is caused by increased contractions of the heart. C. Pulmonary edema is caused by an infection, either bacterial or viral. D. Pulmonary edema can be caused by weakened muscles in the heart. 12. A nurse is assessing a client with chronic hypertension and hypertrophic cardiomyopathy. The nurse anticipates which assessment findings for this client? A. Syncope B. S4 sound on auscultation C. Regurgitation murmur D. Angina E. Left ventricular hypertrophy 12. A nurse in the emergency department is obtaining history from a client admitted with possible pericarditis. Which piece of priority data would the nurse give to the health care provider in the emergency department? A. The client takes corticosteroids for arthritis. B. The client has a history of smoking. C. The client receives hemodialysis three times a week. D. The client has a history of strep throat as a child. 12. A nurse is providing care for a client diagnosed with pericarditis. The nurse notes that theclient’s heart tones are becoming increasingly muffled. The client is becoming restless and short of breath. Current critical vital signs are pulse, 120 beats/min; blood pressure, 90/40 mmHg; respirations, 32 breaths/min; and O2 saturation, 85% on room air. The nurse anticipates which order from the health care provider? A. Intravenous corticosteroidsB. Obtain consent for pericardiocentesis. C. Cardiac enzymes D. Intravenous antibiotics 12. A client is admitted to themedical-surgical unit with rheumatic heart disease and mitral stenosis. The client asks the nurse where the mitral valve is located in the heart. The nurse should point to what part of the pictured heart to show the client the location of the mitral valve? A. B-Right Side of the heart 12. A client is newly diagnosed with infective endocarditis. The client will be treated at home with intravenous vancomycin for 8 weeks. The nurse anticipates which type of intravenous device will be used to administer the vancomycin? A. Peripheral catheter B. Peripherally inserted central catheter (PICC) C. Tunneled catheter D. Implanted port 12. A nurse is providing care for a client with pericarditis. Because of this diagnosis, the nurse carefully monitors the client for which manifestations of cardiac tamponade? A. Bounding pedal pulses B. Mottled skin C. Decreased level of consciousness D. Muffled heart tones E. Distended neck veins 12. A nurse is assessing a client with rheumatic fever. The nurse notes that the client has anew-onset pericardial friction rub and tachycardia. The client reports sharp chest pain that improves when the client sits straight up. The nurse is concerned the client is experiencing which complication? A. Cardiac tamponade B. Infective endocarditis C. Pericarditis D. Pleuritis 12. A nurse is assessing a client with infective endocarditis. Which assessment finding is a priority to call to the health care provider? A. The client has distended neck veins. B. The client has splinter hemorrhages on the fingernails. C. The client's blood pressure is 106/56 mmHg. D. The client's heart rate is 90 beats/min. 12. A nurse is providing care for a client on bedrest because of rheumatic fever. The nurse instructs the client in the use of the pictured piece of equipment. What would the nurse include in thisinstruction? (Incentive Spirometer) A. "Breath rapidly several times before using the device." B. "Exhale while holding the tube in your mouth." C. "Inhle in quick short bursts to obtain maximum effect." D. "Inhale slowly while holding the tube in your mouth."