ATI RN
Physical Exam Cardiovascular System
1. A client on an ACE inhibitor reports a persistent cough. What is the nurse’s best response?
- A. Reassure the client that the cough is a common side effect and is usually not serious.
- B. Instruct the client to report the cough to the healthcare provider as it may require discontinuation of the medication.
- C. Advise the client to use a humidifier at night to relieve the cough.
- D. Suggest the client take an over-the-counter cough suppressant.
Correct answer: B
Rationale: The correct answer is B. A persistent cough in a client on an ACE inhibitor may indicate a serious side effect that requires discontinuation of the medication. Instructing the client to report the cough to the healthcare provider is essential for proper evaluation and management. Choice A is incorrect because simply reassuring the client may delay necessary action. Choice C is incorrect as using a humidifier may not address the underlying cause of the cough. Choice D is incorrect because taking a cough suppressant without healthcare provider guidance may mask symptoms without addressing the cause.
2. What is the ability of cardiac cells to respond to an impulse by transmitting the impulse along cell membranes?
- A. Contractility
- B. Automaticity
- C. Conductivity
- D. Rhythmicity
Correct answer: C
Rationale: The correct answer is C, Conductivity. Conductivity refers to the ability of cardiac cells to transmit impulses along cell membranes. Contractility (Choice A) is the ability of cardiac cells to contract in response to an electrical stimulus, not transmit impulses. Automaticity (Choice B) is the ability of cardiac cells to spontaneously generate electrical impulses. Rhythmicity (Choice D) refers to the regular generation of electrical impulses by the heart's pacemaker cells, not the transmission of impulses along cell membranes.
3. Which of the following is a rare genetic disorder that affects the lungs, liver, and skin, causing the buildup of a specific protein that damages organs?
- A. Alpha-1 antitrypsin deficiency
- B. Cystic fibrosis
- C. Wegener's granulomatosis
- D. Marfan syndrome
Correct answer: A
Rationale: The correct answer is Alpha-1 antitrypsin deficiency. This disorder leads to the accumulation of a specific protein that can harm the lungs, liver, and skin. Choice B, Cystic fibrosis, is incorrect because it primarily affects the lungs and digestive system due to a defective gene. Choice C, Wegener's granulomatosis, is an autoimmune disease that involves inflammation of blood vessels, not protein buildup. Choice D, Marfan syndrome, is a connective tissue disorder impacting the heart, blood vessels, bones, and eyes, but not involving protein accumulation that damages organs.
4. From where do these originate, behind the cusps of the aortic valve, in an area known as Valsalva’s sinus?
- A. Pulmonary valve
- B. Aortic valve
- C. Tricuspid valve
- D. Mitral valve
Correct answer: B
Rationale: The correct answer is B, Aortic valve. The aortic valve is a semilunar valve located between the left ventricle and the aorta. It prevents the backflow of blood from the aorta into the left ventricle. The pulmonary valve (choice A) is located between the right ventricle and the pulmonary artery, not in the Valsalva’s sinus area. The tricuspid valve (choice C) is situated between the right atrium and right ventricle, and the mitral valve (choice D) is located between the left atrium and left ventricle, making them incorrect choices for this question.
5. When administering enoxaparin (Lovenox) to a client, what is the most important lab value to monitor?
- A. Platelet count
- B. aPTT
- C. Hemoglobin
- D. INR
Correct answer: A
Rationale: The correct answer is A: Platelet count. When administering enoxaparin (Lovenox), it is crucial to monitor the platelet count because enoxaparin can cause a rare but serious side effect known as heparin-induced thrombocytopenia, which is a decrease in platelet count that can lead to increased risk of bleeding. Monitoring the platelet count allows for early detection of this potential complication. Choices B, C, and D are incorrect because aPTT, Hemoglobin, and INR are not the most important lab values to monitor specifically when administering enoxaparin.
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