ATI RN
Physical Exam Cardiovascular System
1. The client on nitroglycerin complains of a headache. How does the nurse explain this?
- A. This is a normal side effect of nitroglycerin.
- B. This is an allergic reaction to nitroglycerin.
- C. This is an indication of overdose.
- D. This is a sign of heart failure.
Correct answer: A
Rationale: The correct answer is A: 'This is a normal side effect of nitroglycerin.' Headaches are a common side effect of nitroglycerin due to vasodilation. Choice B is incorrect because allergic reactions to nitroglycerin typically present with symptoms like rash, itching, or shortness of breath. Choice C is incorrect as an overdose of nitroglycerin would likely present with symptoms beyond just a headache. Choice D is incorrect because headaches related to nitroglycerin are not indicative of heart failure.
2. What is the condition where the walls of the heart's ventricles become thickened, reducing the heart's ability to pump blood effectively?
- A. Ventricular hypertrophy
- B. Atrial fibrillation
- C. Restrictive cardiomyopathy
- D. Cardiomyopathy
Correct answer: A
Rationale: Ventricular hypertrophy is the correct answer. In ventricular hypertrophy, the walls of the heart's ventricles become thickened, which decreases the heart's efficiency in pumping blood. Atrial fibrillation (choice B) is an irregular and often rapid heart rate that can lead to poor blood flow. While restrictive cardiomyopathy (choice C) involves the heart muscle becoming rigid and less compliant, it is not specifically characterized by thickening of the ventricular walls. Cardiomyopathy (choice D) is a general term for diseases of the heart muscle, which can present with various symptoms and causes.
3. What is the condition where the lungs become filled with fluid, often due to heart failure, making it difficult to breathe?
- A. Pulmonary edema
- B. Pleural effusion
- C. Pulmonary hypertension
- D. Pneumothorax
Correct answer: A
Rationale: Pulmonary edema is the correct answer. It occurs when fluid fills the lungs, usually due to heart failure, leading to breathing difficulties. Pleural effusion is the accumulation of fluid around the lungs, not inside. Pulmonary hypertension is high blood pressure in the arteries of the lungs, and pneumothorax is the presence of air between the lung and chest wall.
4. 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.
5. What is the procedure where a device is used to shock the heart back into a normal rhythm during a life-threatening arrhythmia?
- A. Defibrillation
- B. Cardioversion
- C. Echocardiogram
- D. Ablation
Correct answer: A
Rationale: The correct answer is A, Defibrillation. Defibrillation is the procedure of using a device to deliver an electric shock to the heart during life-threatening arrhythmias like ventricular fibrillation or ventricular tachycardia to restore a normal rhythm. Choice B, Cardioversion, is similar but is typically used for less severe arrhythmias. Choice C, Echocardiogram, is a diagnostic test that uses sound waves to create images of the heart. Choice D, Ablation, is a procedure to treat certain types of arrhythmias by scarring or destroying tissue that triggers abnormal electrical signals.
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