RN Cardiovascular Hematologic and Lymphatic Systems
EAQ
A client hospitalized for heart failure is receiving digoxin and will continue taking the
drug after discharge. What should be included in the plan of care for the next few
days?
A. Monitoring vital signs and encouraging a vigorous aerobic exercise program
B. Providing written material on the adverse effects of the medication
C. Contacting Social Services for a home health nursing consultation
D. Teaching the client how to count the pulse - ANSWER: D. Teaching the client how
to count the pulse
A nurse is caring for a client who had a splenectomy. Which complication in the
immediate postoperative period is priority for the nurse to assess for in this client?
A. Infection
B. Peritonitis
C. Hemorrhage
D. Intestinal obstruction - ANSWER: C. Hemorrhage
What is the most essential nursing care for a client who just had a cardiac
catheterization?
A. Maintain the semi-Fowler position.
B. Monitor the apical pulse and blood pressure.
C. Take the temperature hourly until it stabilizes.
D. Encourage frequent coughing and deep breathing. - ANSWER: B. Monitor the
apical pulse and blood pressure.
When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so
sick to my stomach. The medication is useless." What is the best response by the
nurse that uses the technique of paraphrasing?
A. "You get sick to your stomach."
B. "Tell me more about how you feel."
C. "I'll get a prescription for an antiemetic."
D. "You don't think the medication is helping you." - ANSWER: D. "You don't think
the medication is helping you."
How does the human body conserve heat? Select all that apply.
A. By decreasing muscle activity in the body
B. Through peripheral vasodilation in the body
C. Through peripheral vasoconstriction in body
D. By shunting blood to superficial body tissues
, E. By shunting blood away from the skin surface - ANSWER: A. By decreasing muscle
activity in the body
C. Through peripheral vasoconstriction in body
E. By shunting blood away from the skin surface
When assessing the client with peripheral arterial disease, the nurse anticipates the
presence of which clinical manifestations? Select all that apply.
A. Dependent rubor
B. Warm extremities
C. Ulcers on the toes
D. Thick, hardened skin
E. Delayed capillary refill - ANSWER: A. Dependent rubor
C. Ulcers on the toes
E. Delayed capillary refill
The nurse is assessing a client with the diagnosis of chronic heart failure. Which
clinical finding should the nurse expect the client to experience?
A. Dependent edema in the evening
B. Chest pain that decreases with rest
C. Palpitations in the chest when resting
D. Frequent coughing with yellow sputum - ANSWER: A. Dependent edema in the
evening
A client has a thermodilution pulmonary catheter inserted for monitoring
cardiovascular status. With this type of catheter, what is the most accurate
measurement of the client's left ventricular pressure?
A. Right atrial pressure
B. Cardiac output by thermodilution
C. Pulmonary artery diastolic pressure
D. Pulmonary capillary wedge pressure - ANSWER: D. Pulmonary capillary wedge
pressure
The nurse assesses a client for orthostatic hypotension. The results are:
Lying heart rate = 70 beats/minute, BP = 110/70;
Sitting heart rate = 78 beats/minute, BP = 106/66;
Standing heart rate = 85 beats/minute, BP = 100/64.
The nurse would expect which prescription from the primary healthcare provider?
A. Increase furosemide from 20 mg by mouth (PO) to 40 mg PO daily
B. Give 1 L of 0.9% normal saline (NS) bolus over 4 hours
C. Start intravenous (IV) infusion of D5 ½ NS to run at 150 mL/hr
D. No prescription change - ANSWER: D. No prescription change
(decrease of more than 20 mm Hg of systolic pressure or more than 10 mm Hg of the
diastolic pressure would be orthostatic hypotension and need intervention)
EAQ
A client hospitalized for heart failure is receiving digoxin and will continue taking the
drug after discharge. What should be included in the plan of care for the next few
days?
A. Monitoring vital signs and encouraging a vigorous aerobic exercise program
B. Providing written material on the adverse effects of the medication
C. Contacting Social Services for a home health nursing consultation
D. Teaching the client how to count the pulse - ANSWER: D. Teaching the client how
to count the pulse
A nurse is caring for a client who had a splenectomy. Which complication in the
immediate postoperative period is priority for the nurse to assess for in this client?
A. Infection
B. Peritonitis
C. Hemorrhage
D. Intestinal obstruction - ANSWER: C. Hemorrhage
What is the most essential nursing care for a client who just had a cardiac
catheterization?
A. Maintain the semi-Fowler position.
B. Monitor the apical pulse and blood pressure.
C. Take the temperature hourly until it stabilizes.
D. Encourage frequent coughing and deep breathing. - ANSWER: B. Monitor the
apical pulse and blood pressure.
When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so
sick to my stomach. The medication is useless." What is the best response by the
nurse that uses the technique of paraphrasing?
A. "You get sick to your stomach."
B. "Tell me more about how you feel."
C. "I'll get a prescription for an antiemetic."
D. "You don't think the medication is helping you." - ANSWER: D. "You don't think
the medication is helping you."
How does the human body conserve heat? Select all that apply.
A. By decreasing muscle activity in the body
B. Through peripheral vasodilation in the body
C. Through peripheral vasoconstriction in body
D. By shunting blood to superficial body tissues
, E. By shunting blood away from the skin surface - ANSWER: A. By decreasing muscle
activity in the body
C. Through peripheral vasoconstriction in body
E. By shunting blood away from the skin surface
When assessing the client with peripheral arterial disease, the nurse anticipates the
presence of which clinical manifestations? Select all that apply.
A. Dependent rubor
B. Warm extremities
C. Ulcers on the toes
D. Thick, hardened skin
E. Delayed capillary refill - ANSWER: A. Dependent rubor
C. Ulcers on the toes
E. Delayed capillary refill
The nurse is assessing a client with the diagnosis of chronic heart failure. Which
clinical finding should the nurse expect the client to experience?
A. Dependent edema in the evening
B. Chest pain that decreases with rest
C. Palpitations in the chest when resting
D. Frequent coughing with yellow sputum - ANSWER: A. Dependent edema in the
evening
A client has a thermodilution pulmonary catheter inserted for monitoring
cardiovascular status. With this type of catheter, what is the most accurate
measurement of the client's left ventricular pressure?
A. Right atrial pressure
B. Cardiac output by thermodilution
C. Pulmonary artery diastolic pressure
D. Pulmonary capillary wedge pressure - ANSWER: D. Pulmonary capillary wedge
pressure
The nurse assesses a client for orthostatic hypotension. The results are:
Lying heart rate = 70 beats/minute, BP = 110/70;
Sitting heart rate = 78 beats/minute, BP = 106/66;
Standing heart rate = 85 beats/minute, BP = 100/64.
The nurse would expect which prescription from the primary healthcare provider?
A. Increase furosemide from 20 mg by mouth (PO) to 40 mg PO daily
B. Give 1 L of 0.9% normal saline (NS) bolus over 4 hours
C. Start intravenous (IV) infusion of D5 ½ NS to run at 150 mL/hr
D. No prescription change - ANSWER: D. No prescription change
(decrease of more than 20 mm Hg of systolic pressure or more than 10 mm Hg of the
diastolic pressure would be orthostatic hypotension and need intervention)
