UTA. AO4581 Exam 2

Question 4

UTA. AO4581 Exam 2. A client is admitted with temporary pacemakers. The pacemaker is set at a rate of 70 beats per minute. The nurse notes that the client’s native heart rate is 80 beats per minute, but the pacemaker continues to fire. The nurse recognizes that this is an example of failure to:

• Capture
• Sense
• Pace
• Output

Question 5

A nurse is preparing for a client admitted with acute coronary syndrome (ACS). Which intervention is a priority for the nurse to implement?

• Administer oxygen if $O_2$ saturation is less than 90%
• Obtain a chest X-ray
• Bed rest for 24 hours
• Administer sublingual nitroglycerin

Question 6

A client is monitoring telemetry. The nurse reports that the client is in second-degree type 1 AV block (Mobitz I / Wenckebach). Which rhythm strip finding confirms this interpretation?

• Constant PR interval followed by a dropped QRS
• Progressive lengthening of the PR interval until a QRS complex is dropped
• No relationship between P waves and QRS complexes UTA. AO4581 Exam 2
• PR interval greater than 0.20 seconds with every P wave conducted

Question 7

A patient with acute decompensated heart failure has a BP of 177/92 mmHg, bilateral pulmonary rales, Ejection Fraction (EF) of 25%, and dyspnea at rest. Which prescribed medication would most directly reduce the workload against which the left ventricle must pump (afterload)?

• Sodium nitroprusside
• Furosemide
• Dopamine
• Digoxin

Question 8

Information collected by a nurse caring for a client with a temporary transvenous pacemaker indicates that the patient is experiencing failure to capture. Which electrocardiogram (ECG) finding supports this conclusion?

• Pacemaker spikes are absent despite a slow intrinsic heart rate
• Pacemaker spikes occur within the T wave
• Pacemaker spikes are present without a following QRS complex or P wave
• Pacemaker spikes occur at irregular intervals

Question 9

Your client is receiving continuous IV infusions of dobutamine, norepinephrine, and nitroprusside. Hemodynamic readings show:

• Normal central venous pressure (CVP)
• Normal pulmonary artery wedge pressure (PAWP)
• High cardiac output (CO) of 7.2 L/min
• Low systemic vascular resistance (SVR) of 400 dynes/sec/cm⁻⁵

To safely manage this client, you should reduce the dose of which medication?

• Nitroprusside
• Dobutamine
• Norepinephrine
• None of the above

Question 10

Discharge teaching for the client following a biologic valve replacement includes explaining that the client will:

• Need long-term anticoagulation therapy
• Require short-term anticoagulants for a few months post-operatively
• Require lifelong antibiotic prophylaxis prior to dental procedures
• Need daily immunosuppressive therapy

Question 11

A client presents with a Blood Pressure of 180/100 mmHg, Heart Rate of 110 bpm, Respiratory Rate of 20 breaths/min, and Oxygen Saturation of 98%. Which of the following medications should the nurse anticipate administering?

• Nitroglycerin
• Beta Blocker
• Atropine
• Adenosine

Question 12

A client arrives at the emergency department reporting unrelieved chest pain that has persisted for approximately 20 minutes. On assessment, the nurse notes the client is diaphoretic and in severe distress. Given the urgency, which combination of orders should the nurse anticipate the primary healthcare provider will issue for immediate administration?

• Morphine, Oxygen, Nitroglycerin, and Aspirin (MONA)
• Clopidogrel and Heparin
• Oxygen and Beta-adrenergic blocker
• Tissue Plasminogen Activator (tPA) and Warfarin

Question 13

After the nurse administers IV atropine for symptomatic bradycardia, which finding indicates that the medication has been effective?

• Increase in heart rate
• Decrease in blood pressure
• Decrease in oxygen saturation
• Prolongation of the PR interval

Question 14

A nurse is caring for a patient who develops atrial fibrillation with a rapid ventricular response. Which priority intervention should the nurse perform first?

• Prepare for immediate synchronized cardioversion
• Assess the patient’s vital signs and clinical stability
• Administer a bolus of IV amiodarone
• Obtain a 12-lead ECG

Question 15

Before a elective synchronized cardioversion procedure, which priority action should the nurse verify?

• Turn on the “Sync” mode on the defibrillator/cardioverter
• Deliver an unsynchronized high-energy shock
• Administer IV atropine
• Ensure the patient has been fasting for 24 hours UTA. AO4581 Exam 2

Question 16

A client develops dilated cardiomyopathy after presenting with worsening systolic heart failure. Which structural change best explains the client’s decreased cardiac output?

• Hypertrophy of the ventricular walls
• Ventricular dilation and impaired contractility
• Fibrosis and stiffness of the myocardium
• Obstruction of left ventricular outflow

Question 17

Which clinical assessment finding is most indicative of left-sided heart failure?

• Bilateral pulmonary crackles and dyspnea
• Jugular venous distension (JVD)
• Peripheral edema
• Hepatomegaly

Question 18

A client with an implantable cardioverter-defibrillator (ICD) receives a shock. What is the priority nursing action?

• Assess the client’s airway, breathing, and circulation (ABCs)
• Call the healthcare provider immediately
• Administer CPR
• Reprogram the device settings

Question 19

A client with a history of heart failure is prescribed furosemide. Which lab value should the nurse monitor most closely for adverse effects?

• Serum potassium
• Serum sodium
• Blood urea nitrogen (BUN)
• Serum creatinine

Question 20

A client with altered perception and tachycardia should not be given vagal maneuvers if they present with:

• Carotid bruits or history of cerebrovascular disease
• Hypertension
• Atrial flutter
• Paroxysmal supraventricular tachycardia (PSVT)

Question 21

Which telemetry reading requires immediate evaluation by the nurse?

• Normal sinus rhythm at 72 bpm
• Sustained ventricular tachycardia
• Sinus bradycardia at 58 bpm
• First-degree AV block

Question 22

A client admitted with acute inferior wall myocardial infarction is at highest risk for developing which conduction disturbance?

• Atrioventricular (AV) block
• Premature atrial contractions (PACs)
• Bundle branch block
• Atrial fibrillation

Question 23

A client’s electrocardiogram shows a sawtooth pattern of P waves with a regular ventricular response. The nurse identifies this rhythm as:

• Atrial fibrillation
• Atrial flutter
• Ventricular tachycardia
• Sinus tachycardia

Question 24

A client is admitted with right-sided heart failure. Which assessment finding should the nurse expect to observe?

• Peripheral edema and jugular venous distension (JVD)
• Pulmonary congestion and crackles
• Hemoptysis
• Decreased peripheral pulse pressure

Question 25

A client presenting with Acute Coronary Syndrome (ACS) is evaluated. Which initial diagnostic test is highest priority?

• 12-lead Electrocardiogram (ECG)
• Serum Troponin I
• Chest X-ray
• Echocardiogram

Question 27

A client is having frequent premature ventricular contractions (PVCs) with a heart rate of 88 bpm and Blood Pressure of 118/76 mmHg. You call the doctor and anticipate receiving an order for:

• Amiodarone or Lidocaine
• Atropine
• Epinephrine
• Defibrillation

Question 28

Which of the following clinical manifestations is indicative of cardiac tamponade?

• Beck’s Triad (Muffled heart sounds, JVD, Hypotension)
• Hypertension, Bradycardia, Irregular respirations
• Tachycardia, Pulmonary crackles, Peripheral edema
• Wide QRS, ST elevation, Tall T waves

Question 29

A client post-coronary artery bypass graft (CABG) surgery has a chest tube output of 200 mL/hr over the last 2 hours. The priority action for the nurse is to:

• Notify the surgeon immediately
• Milk the chest tube tubing
• Increase the suction pressure
• Document the finding as normal

Question 30

The nurse is preparing to provide care for four clients. Which client should the nurse assess first?

• A client with chest pain rated 8/10 radiating to the left arm
• A client post-pacemaker insertion with mild surgical site discomfort
• A client with heart failure requesting a glass of water
• A client scheduled for discharge with stable vital signs

Question 31

Which EKG finding is characteristic of hyperkalemia?

• Tall, peaked T waves
• Prominent U waves
• ST-segment depression
• Prolonged QT interval

Question 32

A client telemetry strip shows complete heart block (Third-degree AV block). Which treatment should the nurse anticipate?

• Transcutaneous pacing
• IV Adenosine
• Synchronized cardioversion UTA. AO4581 Exam 2
• IV Diltiazem

Question 33

A client with a pacemaker set at a minimum programmed rate of 60 bpm presents with a telemetry reading showing a rate of 48 bpm with no pacemaker spikes. The nurse interprets this as:

• Failure to pace
• Normal pacemaker function
• Failure to capture
• Failure to sense

Question 34

A client with stable angina reports worsening chest pain with activity. Which finding on a 12-lead ECG during an episode would the nurse expect to see?

• ST-segment depression or T-wave inversion
• ST-segment elevation in contiguous leads
• Pathologic Q waves
• Broad QRS complexes

Question 35

In helping to diagnose myocardial infarction, which ECG change is of greatest concern when evaluating acute chest pain?

• ST-segment elevation
• PR interval prolongation
• Sinus arrhythmia
• Inverted P waves

Question 36

A client with telemetry monitoring displays a rapid heart rate. Looking at the provided strip showing a narrow-complex tachycardia at a rate around 190 bpm, the nurse identifies the rhythm as:

• Supraventricular Tachycardia (SVT)
• Ventricular Fibrillation
• Sinus Bradycardia
• Asystole

Question 37

A client experiencing symptomatic supraventricular tachycardia (SVT) is unresponsive to vagal maneuvers. The nurse prepares to administer which medication?

• Adenosine
• Atropine
• Epinephrine
• Metoprolol

Question 38

The nurse identifies pericardial friction rub upon auscultation. This finding is most indicative of:

• Pericarditis
• Infective Endocarditis
• Heart Failure
• Myocardial Infarction

Question 39

A form of angina which develops at rest in response to spasm of a coronary artery (Prinzmetal’s / Vasospastic angina) would respond best to:

• Calcium channel blockers
• Beta blockers
• Omeprazole
• High-dose aspirin

Question 40

Which information obtained by the nurse when caring for a client with an abdominal aortic aneurysm (AAA) requires immediate notification of the healthcare provider?

• Severe, sudden onset of lower back or abdominal pain
• Blood pressure reading of 122/78 mmHg
• Presence of a bruit over the abdomen
• Palpable abdominal mass

Question 41

You are assessing a client with severe peripheral artery disease (PAD). Which immediate action should be taken?

• Keep legs in a dependent position to promote arterial blood flow
• Elevate legs above the heart level
• Apply heating pads directly to the feet
• Encourage vigorous leg exercises

Question 42

During the first 24 hours post-myocardial infarction, the nurse primary focuses on monitoring the client for which most common complication?

• Cardiac dysrhythmias
• Heart failure
• Cardiogenic shock
• Pericarditis

Question 43

A client who has had a myocardial infarction is started on a cardiac rehabilitation program. The client asks the nurse why he must participate in this program. What is the most important information for the nurse to include in answering the question?

• Participation improves functional capacity and reduces long-term mortality
• Participation prevents future myocardial infarctions completely
• The program is mandatory required by insurance
• Participation eliminates the need for cardiac medications

Question 44

You recognize which of the following as an indication for coronary artery bypass graft (CABG) surgery?

• Unsuitable lesion for percutaneous coronary intervention (PCI) or multi-vessel disease
• Mild single-vessel coronary stenosis
• Asymptomatic stable angina
• Complete resolution of symptoms with medical therapy

Question 45

Which of the following is incorrect regarding adenosine administration?

• It should be administered as a slow IV push over 5 minutes
• The drug is used for narrow-complex tachycardia
• It should be administered rapidly IV push followed by a rapid saline flush
• A brief period of asystole may occur after administration

Question 46

Besides assessing left ventricular function, what is an additional function of a pulmonary artery catheter monitoring system? UTA. AO4581 Exam 2

• Measuring pulmonary artery wedge pressure (PAWP) and cardiac output
• Direct measurement of systemic arterial blood pressure
• Providing temporary electrical ventricular pacing
• Monitoring continuous intracranial pressure

Question 47

During a conference for a patient with Acute Coronary Syndrome (ACS), which primary goal should guide the care team’s selection of treatment?

• Restoring myocardial perfusion and decreasing oxygen demand
• Increasing systemic vascular resistance
• Delaying diagnostic testing until lab results return
• Elevating blood pressure above normal range

Question 48

A client displays the following telemetry rhythm (Second-Degree AV Block Mobitz II / Sinus pause) with dropped beats:

The client’s blood pressure drops to 80/40 mmHg, $O_2$ saturation is 88%, and the client is becoming confused. Which intervention should the nurse perform immediately?

• Prepare for transcutaneous pacing / administer atropine
• Administer IV Metoprolol
• Perform synchronized cardioversion
• Document as a normal variant

Question 49

A client with an end-stage cardiomyopathy is admitted with an inadequate cardiac output. The priority nursing diagnostic concern is:

• Decreased cardiac output related to impaired ventricular contractility
• Activity intolerance related to fatigue
• Anxiety related to hospital admission
• Risk for impaired skin integrity

Question 50

A client transferred to the Cardiac Intensive Care Unit post-percutaneous coronary intervention (PCI) with femoral sheath insertion requires which nursing intervention?

• Keep the affected extremity straight and maintain bed rest
• Elevate the head of the bed to 90 degrees
• Encourage immediate ambulation
• Flex the affected knee every hour

Question 51

The physician’s order states: “If BP drops below 90/60 mmHg, administer dopamine IV.” The client’s BP was 84/50 mmHg and the nurse started the dopamine drip. The current BP is 180/90 mmHg. The nurse should:

• Titrate down or discontinue dopamine and notify the physician
• Increase the dopamine infusion rate
• Continue the dopamine at the current rate
• Administer a bolus of IV fluids