ATI RN
Physical Exam Cardiovascular System
1. A client on an ACE inhibitor reports a persistent cough. What is the nurse’s best response?
- A. Reassure the client that the cough is a common side effect and is usually not serious.
- B. Instruct the client to report the cough to the healthcare provider as it may require discontinuation of the medication.
- C. Advise the client to use a humidifier at night to relieve the cough.
- D. Suggest the client take an over-the-counter cough suppressant.
Correct answer: B
Rationale: The correct answer is B. A persistent cough in a client on an ACE inhibitor may indicate a serious side effect that requires discontinuation of the medication. Instructing the client to report the cough to the healthcare provider is essential for proper evaluation and management. Choice A is incorrect because simply reassuring the client may delay necessary action. Choice C is incorrect as using a humidifier may not address the underlying cause of the cough. Choice D is incorrect because taking a cough suppressant without healthcare provider guidance may mask symptoms without addressing the cause.
2. What is a condition where the lung's air sacs (alveoli) are damaged and enlarged, leading to breathlessness?
- A. Emphysema
- B. Chronic bronchitis
- C. Asthma
- D. Pulmonary fibrosis
Correct answer: A
Rationale: Emphysema is the correct answer. It is a condition where the air sacs in the lungs are damaged and enlarged, leading to breathlessness. Chronic bronchitis is characterized by inflammation of the bronchial tubes, not the alveoli. Asthma involves airway inflammation and constriction, not alveolar damage. Pulmonary fibrosis is a condition where lung tissue becomes thickened and scarred, different from the alveolar damage seen in emphysema.
3. The nurse is administering digoxin to a client with a heart rate of 45 bpm. What is the nurse’s priority action?
- A. Hold the digoxin and notify the healthcare provider.
- B. Administer the digoxin as ordered.
- C. Increase the dose of digoxin.
- D. Monitor the client’s heart rate and reassess in 30 minutes.
Correct answer: A
Rationale: The correct answer is to hold the digoxin and notify the healthcare provider. A heart rate of 45 bpm is already low, and digoxin can further decrease the heart rate, leading to serious complications like bradycardia or heart block. Administering the medication can exacerbate the bradycardia, hence it should be withheld. Increasing the dose of digoxin is contraindicated due to the client's low heart rate. Monitoring the heart rate alone without taking immediate action to withhold the medication is not the priority when faced with the risk of further lowering the heart rate.
4. What type of therapy delivers high concentrations of oxygen to the lungs?
- A. Oxygen therapy
- B. Ventilator therapy
- C. Mechanical ventilation
- D. CPAP therapy
Correct answer: A
Rationale: Oxygen therapy is the correct answer because it specifically refers to a treatment that delivers high concentrations of oxygen to the lungs. This therapy is used for patients who require additional oxygen due to conditions affecting their breathing. Ventilator therapy (B), mechanical ventilation (C), and CPAP therapy (D) involve different mechanisms and purposes than delivering high concentrations of oxygen to the lungs.
5. Which type of lung cancer begins in the cells lining the bronchi and bronchioles?
- A. Adenocarcinoma
- B. Small cell lung cancer
- C. Squamous cell carcinoma
- D. Mesothelioma
Correct answer: A
Rationale: Adenocarcinoma is the correct answer because it is a type of lung cancer that originates in the cells lining the bronchi and bronchioles. Adenocarcinoma is one of the most common types of lung cancer, often found in non-smokers and more frequently in women. Small cell lung cancer (Choice B) typically starts in the bronchi, but it is characterized by its rapid growth and tendency to spread quickly. Squamous cell carcinoma (Choice C) usually begins in the squamous cells lining the bronchi and is strongly associated with smoking. Mesothelioma (Choice D) is a cancer that affects the lining of certain organs like the lungs, often caused by asbestos exposure, but it does not specifically start in the cells lining the bronchi and bronchioles.
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