ATI RN
Physical Exam Cardiovascular System
1. What is the condition where the walls of the heart's ventricles become thickened, reducing the heart's ability to pump blood effectively?
- A. Ventricular hypertrophy
- B. Atrial fibrillation
- C. Restrictive cardiomyopathy
- D. Cardiomyopathy
Correct answer: A
Rationale: Ventricular hypertrophy is the correct answer. In ventricular hypertrophy, the walls of the heart's ventricles become thickened, which decreases the heart's efficiency in pumping blood. Atrial fibrillation (choice B) is an irregular and often rapid heart rate that can lead to poor blood flow. While restrictive cardiomyopathy (choice C) involves the heart muscle becoming rigid and less compliant, it is not specifically characterized by thickening of the ventricular walls. Cardiomyopathy (choice D) is a general term for diseases of the heart muscle, which can present with various symptoms and causes.
2. The nurse is caring for a client on enalapril (Vasotec). What is the most important side effect to monitor?
- A. Cough
- B. Hyperkalemia
- C. Hypotension
- D. Dizziness
Correct answer: A
Rationale: The correct answer is A: Cough. Enalapril is an ACE inhibitor, and cough is a common side effect associated with this class of medication. Monitoring for cough is crucial as it can indicate the development of a potentially serious condition known as angioedema. Hyperkalemia (choice B) is a possible side effect of ACE inhibitors but is not the most important side effect to monitor. Hypotension (choice C) and dizziness (choice D) are also potential side effects of enalapril; however, cough takes precedence due to its association with angioedema, a severe adverse reaction.
3. What is a condition where a blood clot forms in a deep vein, usually in the legs, and can lead to serious complications if it travels to the lungs?
- A. Deep vein thrombosis (DVT)
- B. Pulmonary embolism
- C. Varicose veins
- D. Raynaud's disease
Correct answer: A
Rationale: The correct answer is A, Deep vein thrombosis (DVT). Deep vein thrombosis occurs when a blood clot forms in a deep vein, usually in the legs. If the clot dislodges and travels to the lungs, it can lead to a serious condition called a pulmonary embolism. Choice B, pulmonary embolism, is incorrect as it is the consequence of a DVT clot traveling to the lungs, not the initial condition. Choices C and D, varicose veins, and Raynaud's disease, respectively, are unrelated conditions to the formation of blood clots in deep veins.
4. The client on digoxin has a potassium level of 2.7 mEq/L. 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. Administer potassium supplements.
Correct answer: A
Rationale: The correct answer is to hold the digoxin and notify the healthcare provider. A potassium level of 2.7 mEq/L is considered low and can increase the risk of digoxin toxicity. Holding the medication and informing the healthcare provider is crucial to prevent adverse effects. Administering the digoxin as ordered (Choice B) would put the client at a higher risk for toxicity. Increasing the dose of digoxin (Choice C) is not appropriate when the client's potassium level is low. Administering potassium supplements (Choice D) may be necessary but is not the priority action in this situation.
5. The client on atorvastatin (Lipitor) should be advised to report which of the following symptoms?
- A. Muscle pain
- B. Headache
- C. Nausea
- D. Dizziness
Correct answer: A
Rationale: The correct answer is A: Muscle pain. Muscle pain can be a sign of rhabdomyolysis, a serious side effect of statins like atorvastatin. Rhabdomyolysis is a condition where muscle fibers break down rapidly and release their contents into the bloodstream, which can lead to kidney damage. Headache, nausea, and dizziness are not commonly associated with atorvastatin use and are less likely to indicate a serious adverse reaction compared to muscle pain.
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