ATI RN
Physical Exam Cardiovascular System
1. Which of the following is a type of heart valve disease where the aortic valve becomes narrowed, restricting blood flow from the heart to the rest of the body?
- A. Aortic stenosis
- B. Mitral stenosis
- C. Tricuspid regurgitation
- D. Pulmonary hypertension
Correct answer: A
Rationale: The correct answer is Aortic stenosis. In aortic stenosis, the aortic valve becomes narrowed, which obstructs the blood flow from the heart to the rest of the body. This condition can lead to symptoms like chest pain, shortness of breath, and fainting. Mitral stenosis (choice B) involves narrowing of the mitral valve, not the aortic valve. Tricuspid regurgitation (choice C) is a condition where the tricuspid valve leaks, causing blood to flow backward in the heart. Pulmonary hypertension (choice D) is high blood pressure in the arteries of the lungs.
2. 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.
3. The client on warfarin has an INR of 3.8. What is the most appropriate action by the nurse?
- A. Administer vitamin K.
- B. Hold the next dose of warfarin.
- C. Increase the dose of warfarin.
- D. Notify the healthcare provider immediately.
Correct answer: A
Rationale: An INR of 3.8 is elevated, indicating an increased risk of bleeding. Administering vitamin K can help reverse the effects of warfarin. Holding the next dose of warfarin would be appropriate if the INR was too high, but not as the first-line action. Increasing the dose of warfarin would worsen the situation by further increasing the INR. Notifying the healthcare provider is important, but immediate action to address the elevated INR is necessary.
4. Which heart chamber receives venous blood returning to the heart via the superior and inferior vena cava?
- A. Right atrium
- B. Left atrium
- C. Right ventricle
- D. Left ventricle
Correct answer: A
Rationale: The correct answer is A: Right atrium. The right atrium is the heart chamber that receives deoxygenated blood returning from the body via the superior and inferior vena cava. The blood enters the right atrium from the vena cava and then passes through the tricuspid valve into the right ventricle. Choices B, C, and D are incorrect because the left atrium receives oxygenated blood from the lungs, the right ventricle pumps blood to the lungs for oxygenation, and the left ventricle pumps oxygenated blood to the body.
5. The client is on a nitrate for angina. What is the most common side effect the nurse should monitor for?
- A. Headache
- B. Flushing
- C. Dizziness
- D. Nausea
Correct answer: A
Rationale: The correct answer is A, Headache. Nitrates commonly cause headaches as a side effect due to vasodilation. Flushing, dizziness, and nausea are less common side effects associated with nitrates. Flushing is more related to the dilation of blood vessels closer to the skin's surface, dizziness could occur but is not as common as headaches, and nausea is a less typical side effect of nitrates.
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