ATI RN
Physical Exam Cardiovascular System
1. A client on a beta blocker has a heart rate of 52 bpm. What is the nurse’s priority action?
- A. Hold the beta blocker and notify the healthcare provider.
- B. Administer the beta blocker as ordered.
- C. Increase the dose of the beta blocker.
- D. Continue to monitor the client and reassess in 30 minutes.
Correct answer: A
Rationale: The correct answer is to hold the beta blocker and notify the healthcare provider. A heart rate of 52 bpm is low, and beta blockers can further decrease the heart rate, potentially causing harm. Therefore, withholding the medication and promptly informing the healthcare provider is crucial for further assessment and possible adjustment of the treatment plan. Administering the beta blocker as ordered (Choice B) can exacerbate the bradycardia. Increasing the dose of the beta blocker (Choice C) would further suppress the heart rate. Continuing to monitor the client and reassessing in 30 minutes (Choice D) might delay necessary interventions and increase the risk of complications in a client with a heart rate of 52 bpm.
2. What is the term for a blood clot blocking an artery in the lungs, leading to symptoms like shortness of breath and chest pain?
- A. Pulmonary embolism
- B. Deep vein thrombosis (DVT)
- C. Myocardial infarction
- D. Pneumothorax
Correct answer: A
Rationale: The correct answer is A, pulmonary embolism. A pulmonary embolism occurs when a blood clot travels to the lungs and blocks an artery, causing symptoms like shortness of breath and chest pain. Choice B, deep vein thrombosis (DVT), involves a blood clot forming in a deep vein, usually in the legs. Choice C, myocardial infarction, refers to a heart attack due to blocked blood flow to the heart muscle. Choice D, pneumothorax, is a collapsed lung due to air leaking into the chest cavity.
3. The client is on furosemide (Lasix) and has a potassium level of 2.9 mEq/L. What is the nurse’s priority action?
- A. Administer potassium supplements.
- B. Hold the furosemide and notify the healthcare provider.
- C. Continue the current dose of furosemide.
- D. Decrease the dose of furosemide.
Correct answer: A
Rationale: The correct answer is A: Administer potassium supplements. A potassium level of 2.9 mEq/L indicates hypokalemia (low potassium levels). Furosemide (Lasix) is a loop diuretic that can cause potassium loss. Therefore, the priority action is to administer potassium supplements to correct the imbalance. Option B is incorrect because holding the furosemide without addressing the low potassium level could further worsen the imbalance. Option C is incorrect as continuing the current dose of furosemide without addressing the low potassium level could lead to complications. Option D is incorrect because decreasing the dose of furosemide does not directly address the low potassium level that needs immediate correction.
4. What is a chronic condition where the bronchial tubes in the lungs become inflamed and narrowed, often caused by smoking?
- A. Chronic bronchitis
- B. Emphysema
- C. Asthma
- D. Tuberculosis
Correct answer: A
Rationale: Chronic bronchitis is the correct answer because it is a long-term condition characterized by inflammation and narrowing of the bronchial tubes in the lungs, commonly triggered by smoking. Emphysema involves damage to the air sacs in the lungs, not specifically the bronchial tubes. Asthma is a condition of reversible airway obstruction usually due to allergies or other triggers, not solely smoking. Tuberculosis is a bacterial infection that primarily affects the lungs but is not directly related to inflammation and narrowing of the bronchial tubes.
5. Which condition is characterized by an inability to effectively pump blood, leading to fluid buildup and swelling in the body?
- A. Heart failure
- B. Cardiomyopathy
- C. Angina
- D. Myocarditis
Correct answer: A
Rationale: Heart failure is the correct answer. It is a condition where the heart is unable to pump blood effectively, resulting in fluid accumulation and swelling in the body. Cardiomyopathy is a disease of the heart muscle that affects its ability to pump blood but is not the specific condition described in the question. Angina is chest pain or discomfort caused by reduced blood flow to the heart, not directly related to fluid buildup and swelling. Myocarditis is inflammation of the heart muscle and does not necessarily involve the inability to pump blood effectively.
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