ATI RN
Cardiovascular System Practice Exam
1. The nurse is giving a client an IV bolus of heparin. What is the most important nursing action?
- A. Monitor the client's heart rate.
- B. Check the client's blood pressure.
- C. Check for signs of bleeding.
- D. Monitor the client's respiratory rate.
Correct answer: A
Rationale: When administering an IV bolus of heparin, the most important nursing action is to monitor the client's heart rate. Heparin can cause bradycardia as a side effect, making it crucial to assess the heart rate for any abnormalities. Checking the blood pressure (Choice B) is important but not as critical as monitoring the heart rate. While checking for signs of bleeding (Choice C) is essential, it is not the most crucial action when administering heparin. Monitoring the respiratory rate (Choice D) is also important but not as directly related to the potential side effects of heparin as monitoring the heart rate.
2. One reason for conducting a comprehensive medical exam on an applicant is:
- A. It is needed to protect the organization from legal actions.
- B. It is required after a strenuous interview.
- C. It is mandated by law.
- D. It is necessary to screen for disabilities that may impact employment.
Correct answer: A
Rationale: Conducting a comprehensive medical exam on an applicant is crucial to protect the organization from legal actions. This examination helps ensure that the applicant meets the health standards required for the job, reducing the risk of potential liabilities for the organization related to health issues that may arise during employment. Choice B is incorrect because the exam is not a follow-up to a strenuous interview. Choice C is incorrect as not all comprehensive medical exams are mandated by law; they are often part of an organization's policy. Choice D is incorrect as the primary goal of the exam is to assess the applicant's health status in relation to the job requirements, not to screen for disabilities.
3. A nurse is preparing to discontinue a client's indwelling urinary catheter. Which of the following actions should the nurse take first?
- A. Measure and document the urine in the drainage bag
- B. Remove the tape or device securing the catheter to the client's thigh
- C. Position the client supine
- D. Deflate the catheter balloon using a sterile syringe
Correct answer: A
Rationale: The correct first action the nurse should take when discontinuing a client's indwelling urinary catheter is to measure and document the urine in the drainage bag. This step is essential to assess the client's urinary output and bladder function before removing the catheter. Removing the tape securing the catheter (Choice B) or positioning the client supine (Choice C) should come after measuring and documenting the urine output. Deflating the catheter balloon (Choice D) is the last step in the process of removing the catheter.
4. Which electrolyte imbalance is a common concern in patients receiving loop diuretics?
- A. Hyperkalemia
- B. Hyponatremia
- C. Hypokalemia
- D. Hypercalcemia
Correct answer: C
Rationale: The correct answer is Hypokalemia (Choice C). Loop diuretics can lead to potassium loss in the urine, resulting in hypokalemia. This electrolyte imbalance is a common concern with loop diuretic therapy and necessitates regular monitoring. Hyperkalemia (Choice A) is not typically associated with loop diuretics but with conditions like renal failure. Hyponatremia (Choice B) is more common with thiazide diuretics. Hypercalcemia (Choice D) is not a typical concern with loop diuretic use.
5. A nurse is providing discharge teaching about food choices to a client who has hypokalemia. Which of the following foods should the nurse identify as the best source of potassium?
- A. 1 cup grapes
- B. 1 cup shredded lettuce
- C. 1 cup cooked tomatoes
- D. 1 cup apple slices
Correct answer: C
Rationale: Cooked tomatoes are high in potassium, which is crucial for maintaining normal cell function, nerve transmission, and muscle contraction, making them suitable for addressing hypokalemia.
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