ATI RN
Cardiovascular System Exam
1. 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.
2. What is a chronic condition where the heart is unable to pump blood effectively, leading to fluid buildup in the lungs and other parts of the body?
- A. Heart failure
- B. Myocardial infarction
- C. Pericarditis
- D. Pulmonary edema
Correct answer: A
Rationale: The correct answer is A: Heart failure. Heart failure is a chronic condition characterized by the heart's inability to pump blood effectively, resulting in fluid accumulation in the lungs and other body tissues. Myocardial infarction (choice B) refers to a heart attack caused by a blocked coronary artery, leading to damage of heart muscle tissue. Pericarditis (choice C) is the inflammation of the pericardium, the protective sac around the heart. Pulmonary edema (choice D) is a condition where fluid builds up in the lungs, often as a result of heart failure.
3. What test uses sound waves to create images of the heart and assess its structure and function?
- A. Echocardiogram
- B. MRI
- C. CT scan
- D. X-ray
Correct answer: A
Rationale: An echocardiogram is the correct answer because it is a test specifically designed to use sound waves to create images of the heart, allowing healthcare providers to assess both its structure and function, as well as to detect any abnormalities. MRI (Choice B), CT scan (Choice C), and X-ray (Choice D) do not primarily use sound waves for imaging the heart; therefore, they are not the most appropriate choices for this scenario.
4. The nurse is administering a beta blocker to a client with a heart rate of 50 bpm. What is the priority action?
- A. Hold the beta blocker and notify the healthcare provider.
- B. Administer the beta blocker as ordered.
- C. Decrease the dose of the beta blocker.
- D. Monitor the client’s heart rate and reassess in 30 minutes.
Correct answer: A
Rationale: The correct action is to hold the beta blocker and notify the healthcare provider. A heart rate of 50 bpm is already low, and beta blockers can further decrease the heart rate, potentially causing adverse effects like bradycardia or heart block. Administering the beta blocker as ordered (Choice B) can exacerbate the low heart rate. Decreasing the dose of the beta blocker (Choice C) may not be sufficient to address the potential harm. Monitoring the client’s heart rate and reassessing in 30 minutes (Choice D) may delay necessary interventions if the heart rate drops further. Therefore, the priority is to hold the medication and seek guidance from the healthcare provider.
5. What is a condition where the heart's mitral valve does not close properly, causing blood to leak backward into the left atrium?
- A. Mitral valve prolapse
- B. Aortic stenosis
- C. Mitral stenosis
- D. Tricuspid regurgitation
Correct answer: A
Rationale: Mitral valve prolapse is the correct answer. It occurs when the mitral valve does not close properly, leading to blood leaking backward into the left atrium. This condition can manifest with symptoms such as palpitations and chest pain. Choices B, C, and D are incorrect because aortic stenosis involves narrowing of the aortic valve, mitral stenosis is the narrowing of the mitral valve, and tricuspid regurgitation is when blood leaks backward through the tricuspid valve.
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