NURS 3375 NURSING OF ADULTS WITH COMPLEX NEEDS Exam 2 questions and Answers NEW COMPLETE UPDATE University of Texas at Arlington
1.The nurse identifies the nursing diagnosis of “decreased cardiac output, related to the valvular insufficiency” for a client with infective endocarditis (IE) bas...
NURS 3375 NURSING OF ADULTS WITH COMPLEX NEEDS Exam 2
questions and Answers NEW COMPLETE UPDATE University of Texas at
Arlington
1.The nurse identifies the nursing diagnosis of “decreased cardiac output, related to the valvular insufficiency” for a
client with infective endocarditis (IE) based on the assessment finding of
a. Fever, chills, and diaphoresis
b. Increase in pulse rate of 15 bpm
c. Urine output less than 30 mL
d. Petechiae of the buccal mucosa and conjunctiva
Decreased renal perfusion caused by inadequate cardiac output will lead to poor urine output.
Petechiae fever, chills and diaphoresis are symptoms of Infective endocarditis, but are not caused by
decreased cardiac output and increase in pulse rate of 15 beats per minute is normal with exercise.
2. A client’s low hemoglobin level has necessitated transfusion of packed RBCs. Prior to administration,
which action should the nurse perform?
a. Have the client identify the blood type in writing
b. Assess the client’s VS to establish baselines
c. Facilitate insertion of a central venous catheter for rapid infusion
d. Ensure the client has granted verbal consent.
Prior to a transfusion, the nurse must take the client's temperature, pulse, respiration, and blood
pressure to establish a baseline. Written consent is required in the client's blood. Type is determined by
type and crossmatch, not by the client’s self-declaration declaration. Peripheral venous access is
sufficient for blood transfusion.
3. The mixed venous oxygen saturation (SvO2) is decreasing in a client who has a severe pneumonia. To
determine the possible cause of the decreased SvO2, the nurse assesses the client for
a. An increase in BSA
b. Fever
c. Decrease urinary output
d. Increase in serum amylase
Elevated temperature increases metabolic demands and oxygen used by tissues, resulting in a drop in
oxygen saturation of mixed venous blood. Information about the client's weight, urinary output, and
amylase will not help in determining the cause of the client's drop in SVO2.
4. The nurse is assigned to the care of a client in the ICU who is in cardiogenic shock. What priority
nursing intervention isa necessary to conserve myocardial energy and decrease workload of the
heart?
a. Morphine sulfate 4mg IV
b. Dobutamine 3mcg/kg/min
c. Norepinephrine 2mg/min
d. LR at 150 mL/hr
,Opioid analgesics, such as morphine sulfate conserve myocardial energy and decrease the workload of
the heart. Opioids also relieve ischemic pain. Lactated ringers would help with fluid replacement, but
may overload the already damaged heart at the rate of 150 mL/hr. The administration of dobutamine
would increase contractility, which would increase myocardial energy. The administration of
norepinephrine would increase the workload of the heart.
,5. The physician’s order states: “If BP drops below 90/60 administer dopamine via continuous infusion and
titrate the drip to maintain a BP of 100/70.” The client’s BP was 84/50, and the nurse initiated the dopamine
drip. One hour later, the BP is 180/90. The nurse should
a. Start a nitroprusside drip
b. Administer a bolus of amiodarone
c. Discontinue dopamine and notify the physician that the client reacted to the drug
d. Decrease the dose of dopamine
Vasopressors should be titrated up and down according to the BP parameters. If BP is above the
defined parameters, the drug should be gradually decreased and should not be stopped immediately.
6. A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose
of this device. What would be the nurse’s best response?
a. To detect and treat asystole, in which the heart is beating inefficiently.
b. To detect and treat bradycardia, which is an excessively slow heart rate.
c. To shock your heart if you have a heart attack at home.
d. To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia.
ICD is a device that detects and terminates life threatening episodes of ventricular tachycardia and
ventricular fibrillation. It does not treat atrial fibrillation, MI or bradycardia.
7. A client has a temporary transvenous pacemaker for a third-degree AV block. The pacemaker begins to lose
capture and the client develops symptoms consistent with an inadequate cardiac output. The priority
nursing intervention to correct this pacemaker complication is to.
a. Increase the MA (milliamperage) output from the generator.
b. Increase tension on the pacemaker wires.
c. Notify the physician that the pacemaker electrodes are damaged.
d. Turn off the pacemaker generator.
Failure to capture is caused by low output. The nurse increases the output and observes if capture will
occur. If not, consider changing the battery, turning the client to the left side and checking the wires.
8. Your client's monitor displays the following rhythm. The blood pressure has dropped to 60/40 mmHg.
O2 saturation is 80% and the client is becoming confused. What is your first nursing action?
a. Cardiovert with 50 joules
b. Apply pads for transcutaneous pacemakers.
c. Administer adenosine 6 mg IV push
d. Administer epinephrine 1 mg IV push
, 9. You recognize which of the following is an indication for a coronary artery bypass graft (CABG) surgery?
a. Having persistent, medically uncontrolled angina.
b. Having severe dilated cardiomyopathy.
c. Having right heart failure.
d. Being a good candidate for angioplasty and stenting.
CABG surgery has become an acceptable treatment for CAD. Compared with medical treatment, CABG
surgery has proved effective in relieving angina and improving exercise tolerance and it prolongs life
and clients with left main CAD and three vessel disease with poor left ventricular function. The fact
that the client is a good candidate for angioplasty and stenting which are less invasive means that
CABG Surgery would be not indicated.
10. In the first 24 hours post myocardial infarction, the nurse should be most concerned with assessing the client
for.
a. Pericarditis.
b. Congestive heart failure.
c. Dysrhythmias.
d. Papillary muscle rupture.
In a post myocardial infarction, the client is at risk for dysrhythmias. The dysrhythmias can occur before
and after treatment removing the occlusion by placing A stent or infusing A fibrinolytic therapy;
reperfusion dysrhythmia.
11. Your client with a cardiac condition will be going home on simvastatin and gemfibrozil. Which of the
following assessment findings is most important to communicate to the health care provider?
a. Severe skin flushing.
b. Dark tea colored urine.
c. Generalized joint aches and pain.
d. Orthostatic hypotension.
This question requires you to know your medication classes and to be able to identify potentially life-
threatening side effects of medications. The combination of these drugs increases the risk of
rhabdomyolysis which can cause kidney injury due to the myoglobinuria which makes the urine a dark
color. The client should immediately report dark tea colored urine and muscle aches and pains after
starting statin therapy. Skin flushing can occur with niacin therapy, but is more annoying than harmful
and does not occur with gemfibrozil. Joint pain and postural hypotension are important to address.
12. A form of angina which develops at rest in response to spasms of a coronary artery would respond best to.
a. Beta blockers.
b. Isoproterenol.
c. Deep breathing exercises.
d. Calcium channel blockers.
Prinzmetal’s angina is caused by a sudden spasm of the coronary artery. This type of angina responds to
the vasodilator drugs, mainly calcium channel blockers.
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