Nursing Elites

1. What test measures the electrical activity of the heart over a 24- or 48-hour period?

• A. Holter monitor
• B. Electrocardiogram
• C. Stress test
• D. Chest X-ray

Correct answer: A

Rationale: The correct answer is A, Holter monitor. A Holter monitor is a portable device that continuously records the heart's electrical activity over 24 to 48 hours, aiding in the diagnosis of arrhythmias and other heart conditions. Choice B, an Electrocardiogram, provides a snapshot of the heart's electrical activity at a specific point in time, not over an extended period like a Holter monitor. Choice C, a Stress test, measures how the heart responds to physical activity and is not used for continuous monitoring of electrical activity. Choice D, a Chest X-ray, is used to visualize the structures of the chest, not to measure the heart's electrical activity.

2. The nurse is caring for a client on amiodarone who develops a cough. What is the most appropriate action?

• A. Notify the healthcare provider immediately.
• B. Reassure the client that this is a common side effect.
• C. Continue the amiodarone and monitor the client’s symptoms.
• D. Discontinue the amiodarone immediately.

Correct answer: A

Rationale: The correct action when a client on amiodarone develops a cough, which can be a sign of pulmonary toxicity, a serious side effect of amiodarone, is to notify the healthcare provider immediately. This is crucial because pulmonary toxicity can lead to severe complications if not addressed promptly. Choices B and C are incorrect as they do not address the potential severity of the situation and may delay necessary intervention. Choice D of discontinuing amiodarone immediately without consulting the healthcare provider can be risky, as sudden discontinuation of the medication may have adverse effects on the client's condition.

3. What term refers to the degree of myocardial fiber stretch before contraction, related to the volume of blood distending the ventricles at the end of diastole, and determined by the amount of venous return?

• A. Preload
• B. Afterload
• C. Contractility
• D. Ejection fraction

Correct answer: A

Rationale: The correct answer is A: Preload. Preload is the degree of myocardial fiber stretch before contraction, influenced by the volume of blood returning to the heart. This parameter is related to the amount of blood in the ventricles at the end of diastole. Choice B, Afterload, refers to the pressure or resistance that the ventricles must overcome to eject blood. Choice C, Contractility, is the intrinsic ability of the heart muscle to contract. Choice D, Ejection fraction, is the percentage of blood pumped out of the ventricles with each contraction.

4. The client on warfarin has an INR of 1.2. What is the nurse’s priority action?

• A. Increase the dose of warfarin
• B. Administer vitamin K
• C. Monitor for signs of bleeding
• D. Hold the next dose and notify the healthcare provider

Correct answer: A

Rationale: The correct answer is to increase the dose of warfarin. An INR of 1.2 is below the therapeutic range for a client on warfarin, indicating that the dose is subtherapeutic. The priority action in this situation is to adjust the dose to achieve the target therapeutic INR range (usually 2-3) to prevent thromboembolic events. Administering vitamin K is not necessary as the INR is low, and there are no signs of bleeding. Monitoring for signs of bleeding is important but not the priority in this case since the INR is subtherapeutic. Holding the next dose and notifying the healthcare provider would delay the intervention needed to adjust the dose and achieve the therapeutic range.

5. This heart condition is characterized by decreased cardiac output and tissue perfusion, which can lead to organ failure.

• A. Cardiogenic shock
• B. Myocardial infarction
• C. Endocarditis
• D. Pericarditis

Correct answer: A

Rationale: The correct answer is A: Cardiogenic shock. Cardiogenic shock is a severe condition characterized by the heart's inability to pump enough blood, leading to decreased cardiac output and tissue perfusion, which can result in organ failure. Choice B, Myocardial infarction, specifically refers to a blockage of blood flow to the heart muscle. Choices C and D, Endocarditis and Pericarditis, do not directly involve decreased cardiac output leading to organ failure, making them incorrect in the context of the symptoms described in the question.

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