ATI RN
Physical Exam Cardiovascular System
1. 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.
2. What is a condition where the blood pressure in the arteries is consistently too high, increasing the risk of heart disease and stroke?
- A. Hypertension
- B. Hypotension
- C. Diabetes
- D. Hyperlipidemia
Correct answer: A
Rationale: Hypertension, also known as high blood pressure, is a condition where the force of the blood against the artery walls is consistently too high. This increased pressure can lead to serious health issues such as heart disease and stroke. Hypotension (choice B) refers to low blood pressure, which is not the correct term in this context. Diabetes (choice C) and hyperlipidemia (choice D) are also serious conditions but are not specifically characterized by consistently high blood pressure.
3. The nurse is caring for a client on digoxin. What is the most important assessment before administering this medication?
- A. Check the client’s heart rate.
- B. Check the client’s blood pressure.
- C. Check the client’s respiratory rate.
- D. Check the client’s oxygen saturation.
Correct answer: A
Rationale: The correct answer is to check the client’s heart rate before administering digoxin because one of the side effects of digoxin is bradycardia. Monitoring the heart rate is crucial to assess whether the client's heart rate is within the acceptable range before giving the medication. Checking the blood pressure (Choice B), respiratory rate (Choice C), or oxygen saturation (Choice D) are important assessments in general patient care, but they are not specifically related to the administration of digoxin.
4. What condition is characterized by the inflammation of the heart's outer lining, often causing chest pain and other symptoms?
- A. Pericarditis
- B. Endocarditis
- C. Myocarditis
- D. Valvular heart disease
Correct answer: A
Rationale: Pericarditis is the correct answer because it is the inflammation of the pericardium, the outer lining of the heart. This condition commonly presents with symptoms like chest pain. Endocarditis (choice B) is the inflammation of the inner lining of the heart chambers and valves. Myocarditis (choice C) is the inflammation of the heart muscle itself. Valvular heart disease (choice D) refers to various conditions affecting the heart valves, not specifically the outer lining of the heart.
5. Which condition is characterized by the narrowing or blockage of arteries that supply blood to the heart by plaque?
- A. Coronary artery disease (CAD)
- B. Atherosclerosis
- C. Peripheral artery disease
- D. Congestive heart failure
Correct answer: A
Rationale: The correct answer is A, Coronary artery disease (CAD). CAD specifically refers to the condition where the arteries supplying blood to the heart become narrowed or blocked by plaque buildup. Choice B, Atherosclerosis, is a general term for the hardening and narrowing of arteries due to plaque buildup but does not specifically mention the heart. Choice C, Peripheral artery disease, involves narrowing of arteries that supply blood to areas other than the heart. Choice D, Congestive heart failure, is a condition where the heart is unable to pump blood effectively but is not primarily caused by narrowed or blocked arteries.
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