ATI RN
Physical Exam Cardiovascular System
1. What is a condition characterized by the presence of air or gas in the pleural space, leading to the collapse of the lung?
- A. Pneumothorax
- B. Pulmonary embolism
- C. Pleural effusion
- D. Atelectasis
Correct answer: A
Rationale: The correct answer is Pneumothorax. Pneumothorax occurs when air or gas accumulates in the pleural space, causing the lung to collapse. This condition can result in symptoms such as chest pain and difficulty breathing. Pulmonary embolism (choice B) is a blockage in one of the pulmonary arteries in the lungs, usually caused by a blood clot. Pleural effusion (choice C) is the accumulation of excess fluid in the pleural space, not air or gas. Atelectasis (choice D) refers to the collapse or closure of a lung resulting in reduced or absent gas exchange.
2. When administering enoxaparin (Lovenox) to a client for DVT prophylaxis, what is the most important lab value to monitor?
- A. Platelet count
- B. PT/INR
- C. aPTT
- D. Hemoglobin
Correct answer: A
Rationale: The correct answer is A: Platelet count. When administering enoxaparin (Lovenox) for DVT prophylaxis, it is crucial to monitor the platelet count as enoxaparin can lead to thrombocytopenia, a decrease in platelet levels. Monitoring the platelet count helps in early detection of this potential adverse effect. Choices B, C, and D are incorrect because PT/INR, aPTT, and hemoglobin levels are not the most important lab values to monitor specifically for enoxaparin administration and DVT prophylaxis.
3. What is a chronic condition where the heart is unable to pump blood efficiently, leading to fluid buildup in the lungs and other parts of the body?
- A. Heart failure
- B. Cardiomyopathy
- C. Pericarditis
- D. Aortic stenosis
Correct answer: A
Rationale: Heart failure is the correct answer. It is a chronic condition characterized by the heart's inability to pump blood efficiently, resulting in symptoms like fluid buildup in the lungs and other parts of the body, shortness of breath, fatigue, and fluid retention. Cardiomyopathy (choice B) refers to diseases of the heart muscle, but it is a broader category that includes various conditions affecting the heart muscle. Pericarditis (choice C) is the inflammation of the pericardium, the sac surrounding the heart, and aortic stenosis (choice D) is a condition where the aortic valve narrows, restricting blood flow from the heart.
4. What is a surgical procedure to create an opening in the windpipe to assist with breathing?
- A. Tracheostomy
- B. Lobectomy
- C. Thoracotomy
- D. Pleurodesis
Correct answer: A
Rationale: Tracheostomy is the correct answer. It is a surgical procedure to create an opening in the windpipe (trachea) to assist with breathing. This procedure is commonly used for patients who require long-term ventilation support. Choice B, Lobectomy, involves the removal of a lobe of the lung and is not related to creating an opening in the windpipe. Choice C, Thoracotomy, is a surgical incision into the chest wall and is not specifically related to creating an opening in the windpipe. Choice D, Pleurodesis, is a procedure to treat recurrent pleural effusions by causing the pleural layers to stick together, and it is not related to creating an opening in the windpipe.
5. The nurse is caring for a client on heparin. What is the most important lab value to monitor?
- A. aPTT
- B. INR
- C. Platelet count
- D. Hemoglobin
Correct answer: A
Rationale: The correct answer is A: aPTT. When a client is on heparin therapy, monitoring the aPTT is crucial. The aPTT helps assess the effectiveness of heparin in preventing blood clots and guides dose adjustments as needed. INR (Choice B) is more commonly used to monitor warfarin therapy. Platelet count (Choice C) is important to assess for potential bleeding disorders or thrombocytopenia but is not the primary lab value to monitor for heparin therapy. Hemoglobin (Choice D) is essential for assessing oxygen-carrying capacity but is not the most important lab value to monitor when a client is on heparin.
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