ATI RN
Cardiovascular System Exam
1. The client on amiodarone develops pulmonary fibrosis. What action should the nurse take?
- A. Notify the healthcare provider immediately.
- B. Continue the medication and monitor lung function.
- C. Discontinue the medication and start oxygen therapy.
- D. Reduce the dose and monitor respiratory status.
Correct answer: A
Rationale: When a client on amiodarone develops pulmonary fibrosis, a serious side effect, the immediate action the nurse should take is to notify the healthcare provider. This is crucial because pulmonary fibrosis can lead to severe respiratory compromise and requires prompt evaluation and management by the healthcare provider. Continuing the medication (choice B) can worsen the condition, and delaying action by reducing the dose and monitoring respiratory status (choice D) may not be appropriate given the seriousness of pulmonary fibrosis. Discontinuing the medication and starting oxygen therapy (choice C) may be necessary, but the priority is to notify the healthcare provider first for further assessment and guidance.
2. Which condition involves the tearing of the aorta, leading to severe pain and internal bleeding?
- A. Aortic dissection
- B. Aneurysm
- C. Stroke
- D. Myocardial infarction
Correct answer: A
Rationale: The correct answer is Aortic dissection. Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, causing severe chest or back pain and internal bleeding, requiring immediate medical attention. Choice B, aneurysm, involves a bulging or weakening of a blood vessel wall, which is different from a tear in the aorta. Choices C and D, stroke and myocardial infarction, do not directly involve the tearing of the aorta and are distinct conditions.
3. Which of the following is a chronic lung disease that includes conditions such as chronic bronchitis and emphysema, characterized by obstructed airflow from the lungs?
- A. Chronic obstructive pulmonary disease (COPD)
- B. Pulmonary fibrosis
- C. Asthma
- D. Pneumonia
Correct answer: A
Rationale: The correct answer is A, Chronic obstructive pulmonary disease (COPD). COPD is a chronic lung disease that encompasses conditions like chronic bronchitis and emphysema. These conditions lead to obstructed airflow from the lungs, causing symptoms such as cough, shortness of breath, and wheezing. Choice B, Pulmonary fibrosis, involves scarring of the lung tissue, leading to breathing difficulties but is not specifically characterized by obstructed airflow like COPD. Asthma (Choice C) is a chronic condition characterized by airway inflammation and bronchoconstriction, not always resulting in obstructed airflow. Pneumonia (Choice D) is an acute infection of the lung tissue, causing symptoms like fever, cough, and difficulty breathing, but is not a chronic condition like COPD.
4. Which heart chamber receives oxygenated blood from the four pulmonary veins and serves as a reservoir during ventricular systole?
- A. Right atrium
- B. Left atrium
- C. Right ventricle
- D. Left ventricle
Correct answer: B
Rationale: The correct answer is B, Left atrium. The left atrium receives oxygenated blood from the lungs via the four pulmonary veins and acts as a holding chamber before the blood is pumped into the left ventricle. Choice A, Right atrium, is incorrect as it receives deoxygenated blood from the body via the vena cava. Choices C and D, Right ventricle and Left ventricle, are incorrect as they receive blood from the atria, not the pulmonary veins.
5. The nurse is caring for a heart client on digoxin and notes a potassium level of 2.5. What is the appropriate priority nursing intervention?
- A. Do nothing as this is a normal potassium level.
- B. The potassium level is low so the nurse asks for an order for potassium.
- C. The nurse asks to check the digoxin level as low potassium can increase digoxin toxicity.
- D. The nurse stops the digoxin.
Correct answer: C
Rationale: The correct answer is C. When caring for a client on digoxin with a low potassium level, the priority nursing intervention is to check the digoxin level. Low potassium can increase the risk of digoxin toxicity. Checking the digoxin level will help determine if any adjustments to the medication regimen are needed to prevent potential harm. Choice A is incorrect as a potassium level of 2.5 is low, not normal. Choice B is not the priority as simply giving potassium may not address the underlying issue of potential digoxin toxicity. Choice D is not the initial action to take without assessing the digoxin level first.
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