Nursing Elites

1. Which surgical procedure involves opening or replacing a narrowed or blocked heart valve?

• A. Valve replacement
• B. Angioplasty
• C. Stent placement
• D. Coronary bypass surgery

Correct answer: A

Rationale: Valve replacement is the correct answer because it specifically involves surgically replacing a damaged or diseased heart valve with a prosthetic valve to address narrowing or blockage, thereby improving blood flow and heart function. Angioplasty (choice B) is a procedure to widen narrowed or obstructed arteries, typically using a balloon catheter. Stent placement (choice C) involves inserting a mesh tube to support a weakened artery. Coronary bypass surgery (choice D) is a procedure to create new routes for blood flow to the heart muscle by bypassing blocked arteries.

2. What is the approximate stroke volume of the heart?

• A. Approximately 60 mL of blood per beat
• B. Approximately 70 mL of blood per beat
• C. Approximately 80 mL of blood per beat
• D. Approximately 90 mL of blood per beat

Correct answer: B

Rationale: The correct answer is B: Approximately 70 mL of blood per beat. The stroke volume of the heart is typically around 70 mL, indicating the volume of blood ejected from the left ventricle with each contraction. Choices A, C, and D are incorrect as they do not represent the standard approximate stroke volume of the heart, which is around 70 mL per beat.

3. The nurse is giving the client digoxin for heart failure and recognizes that the drug has what type of effect on the heart?

• A. Negative inotropic, negative chronotropic effect
• B. Positive inotropic, negative chronotropic effect
• C. Negative inotropic, positive chronotropic effect
• D. Positive inotropic, positive chronotropic effect

Correct answer: B

Rationale: The correct answer is B: Positive inotropic, negative chronotropic effect. Digoxin strengthens the heart muscle, providing a positive inotropic effect, which increases the force of contraction. It also decreases the heart rate, having a negative chronotropic effect. Choice A is incorrect because digoxin has a positive inotropic effect, not a negative inotropic effect. Choice C is incorrect as digoxin does not have a positive chronotropic effect but a negative one. Choice D is incorrect because while digoxin has a positive inotropic effect, it does not have a positive chronotropic effect.

4. What is the procedure to remove a sample of tissue from the lung for examination under a microscope?

• A. Lung biopsy
• B. Bronchoscopy
• C. Thoracentesis
• D. Lobectomy

Correct answer: A

Rationale: The correct answer is A, lung biopsy. A lung biopsy involves removing a small sample of lung tissue for examination under a microscope to diagnose lung conditions. Choice B, bronchoscopy, is a procedure where a thin, flexible tube with a light and camera is inserted into the airways to view the lungs. This procedure is more for diagnostic purposes and not specifically for tissue removal. Choice C, thoracentesis, is a procedure to remove fluid from the pleural space around the lungs for diagnostic or therapeutic purposes, not for tissue biopsy. Choice D, lobectomy, is a surgical procedure to remove a lobe of the lung, usually done to treat conditions like lung cancer or severe infections, but it does not involve removing tissue for microscopic examination.

5. The nurse is caring for a client on warfarin with an INR of 1.8. What is the most appropriate action?

• A. Increase the dose of warfarin.
• B. Administer vitamin K.
• C. Hold the warfarin and notify the healthcare provider.
• D. Monitor the client’s INR closely.

Correct answer: D

Rationale: An INR of 1.8 is below the therapeutic range for a client on warfarin, indicating the need for monitoring closely to ensure that the INR levels reach the desired therapeutic range. Increasing the dose of warfarin (Choice A) without proper monitoring may lead to an increased risk of bleeding. Administering vitamin K (Choice B) is not typically recommended unless the client is experiencing major bleeding or requires rapid reversal of warfarin's effects. Holding the warfarin and notifying the healthcare provider (Choice C) may be necessary in certain situations, but the immediate action in this case should be to monitor the client's INR closely to guide further management.

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