NR-324 Adult Health I - Set 3 - Part 2

Correct Answer: Count the apical pulse for one full minute

Counting an apical rate is within the assistive personnel scope. It matters in atrial fibrillation because weak early beats never reach the wrist, so the radial pulse under reads and creates a pulse deficit. Option b is incorrect because rhythm interpretation requires nursing judgment and cannot be delegated. Reading a strip involves measuring intervals and naming a dysrhythmia, which sits well outside unlicensed practice. Option c is incorrect because client teaching belongs to the registered nurse. Anticoagulant instruction covers monitoring, diet and bleeding risk, and it demands assessment of what the client already understands. Option d is incorrect because assessment is a nursing responsibility that cannot be transferred. Recognizing hypotension, dyspnea and altered mentation as evidence of falling output calls for the nurse at the bedside.

Correct Answer: Color returns in under two seconds

Capillary refill is timed with the limb at or above heart level, and return of color in under two seconds is normal. Prolonged refill suggests reduced arterial inflow, hypovolemia or cold. Option a is incorrect because refill lasting four seconds exceeds the two second standard and signals sluggish arterial inflow. After casting it should prompt comparison with the opposite foot and a full neurovascular check. Option b is incorrect because five seconds is markedly delayed and raises concern that the cast is compressing circulation. Such a result belongs in a report to the provider, not in a normal assessment. Option c is incorrect because color should return on its own once pressure is released, without any help. Needing to rub the nail bed indicates that blood is not reaching the tissue adequately.

Correct Answer: Turn the synchronizer off and shock

The client is now in ventricular fibrillation, which has no R waves for the machine to synchronize to, so it refuses to fire. Switching the synchronizer off allows an unsynchronized defibrillation to be delivered. Option a is incorrect because energy is not the reason the device stayed silent. The machine is still hunting for an R wave it cannot find, and raising joules does not release that lockout. Option c is incorrect because a second lead is checked to confirm a flat line, not a chaotic one. The waveform and the absent pulse already establish fibrillation, and switching leads only delays the shock. Option d is incorrect because epinephrine is given during compressions after the first shock, every three to five minutes. Drug therapy never takes priority over defibrillation in a shockable arrest rhythm.

Correct Answer: Withhold the drug and notify the provider

Tinnitus signals ototoxicity, which loop diuretics cause when the dose is high or the injection is rapid, and hearing loss may be permanent. The drug is held and the provider notified before more is given. Option a is incorrect because ringing in the ears is never accepted as routine with this drug. Charting it without acting allows an injury that can become permanent to continue unchecked. Option b is incorrect because the problem lies in the inner ear rather than in wax or debris in the canal. Irrigation treats nothing here and postpones the decision the provider must make. Option d is incorrect because a fast infusion rate is precisely what drives the ototoxic risk with this agent. Speeding the remaining dose would compound the exposure that produced the symptom in the first place.

Correct Answer: The drug blocks constant adrenaline stimulation, and benefit builds over months.

Chronic sympathetic drive raises oxygen demand, shortens filling time and pushes remodeling forward. Blocking it lengthens diastole, lowers demand and lets receptors recover, so ejection fraction improves and survival lengthens over weeks to months rather than days. Option a is incorrect because this class is a negative inotrope that briefly reduces contractile force when it is started. Promising an immediate boost misstates the mechanism and sets the client up for disappointment. Option b is incorrect because the two drugs do different jobs and are taken together. Diuretics relieve congestion today while beta blockade slows disease progression, so neither one substitutes for the other. Option c is incorrect because nothing measurable happens on the first day. Therapy begins at a low dose in a client who is euvolemic and is titrated upward slowly, with a transient worsening expected early.

Correct Answer: Atrial fibrillation with an irregularly irregular response

Atrial fibrillation replaces P waves with chaotic fibrillatory waves and produces an irregularly irregular ventricular response through a narrow QRS. The absence of any repeating R to R pattern is its defining feature. Option b is incorrect because atrial flutter writes uniform sawtooth F waves on the baseline, and a fixed conduction ratio makes the ventricular rhythm regular. Neither feature appears in this description. Option c is incorrect because supraventricular tachycardia is regular, which is the single feature that separates it from fibrillation. Its P waves are hidden inside the preceding T wave rather than absent. Option d is incorrect because Wenckebach shows clear P waves with a progressively lengthening PR interval before a dropped QRS. Grouped beating gives a patterned irregularity, not the random spacing described here.

Correct Answer: A stiff ventricle fails while the fraction stays normal

This is diastolic failure, or heart failure with preserved ejection fraction. A thick stiff ventricle ejects a normal percentage of a small filling volume, so the fraction looks fine while stroke volume is inadequate. Option a is incorrect because roughly half of all heart failure occurs with a preserved fraction. A value above fifty percent excludes the reduced ejection type only, not the diagnosis of heart failure itself. Option b is incorrect because the long hypertensive history, the orthopnea and the basilar distribution all point toward congestion. Infection would usually bring fever, purulent sputum and a focal area rather than a symmetrical base pattern. Option c is incorrect because the study needs no repeat. Echocardiography is the definitive test for classifying heart failure, and this result already supplies the answer once the nurse understands what a preserved fraction means.

Correct Answer: Join cardiac rehabilitation and continue all your medicines

Cardiac rehabilitation combines supervised exercise, education and counseling and improves both survival and quality of life. Women are referred and enrolled less often, so an explicit referral alongside lifelong secondary prevention drugs is the highest-value teaching. Option a is incorrect because prolonged inactivity worsens outcomes rather than protecting the heart. Recovery depends on a graded, individually prescribed activity plan that increases as tolerated, which is exactly what a rehabilitation program provides. Option b is incorrect because dual antiplatelet therapy continues for at least six to twelve months after a stent. Stopping early causes stent thrombosis, which presents as a sudden infarction and carries high mortality. Option d is incorrect because waiting for symptoms abandons prevention altogether. Follow-up visits, risk-factor control and a written plan naming the warning signs and when to call emergency services are all part of discharge.

Correct Answer: Activate the catheterization laboratory immediately

ST elevation in two contiguous leads is a STEMI, and STEMI is diagnosed on the electrocardiogram before any laboratory value exists. The artery is occluded now, so reperfusion proceeds without waiting for troponin. Option a is incorrect because troponin lags several hours behind the onset of injury and may still read normal during a genuine infarction. Angiography and treatment are never delayed for an initially normal marker. Option c is incorrect because timed angiography within one to three days belongs to non-ST-elevation acute coronary syndrome, where the vessel is not completely occluded. Persistent ST elevation removes that option entirely. Option d is incorrect because the tracing is already diagnostic, so repeating it hours later wastes the window in which muscle can still be saved. Serial tracings are for equivocal findings, not confirmed elevation.

Correct Answer: Obtain the repeat troponin as ordered

Infarction is a process, not a single number, and the diagnosis rests on a rise or fall across serial samples with at least one value above the reference limit. The repeat draw is the action. Option b is incorrect because cancelling the follow-up sample removes the only way to show whether the marker is changing. Conventional assays are repeated at three to six hours, and high-sensitivity assays sooner. Option c is incorrect because one specimen cannot complete an evaluation for acute coronary syndrome. Serial electrocardiograms are also needed, since a normal tracing and a normal early marker together still fail to exclude ischemia. Option d is incorrect because myoglobin rises fastest but is released by any skeletal muscle injury, which makes a positive result nearly meaningless. High-sensitivity troponin assays have largely made this marker redundant.

Correct Answer: Assist the client with a bedside bath

Bathing at the bedside with help conserves energy, keeping activity and therefore heart rate, contractility and wall tension low. Rest is a genuine treatment after infarction because it lowers myocardial oxygen demand immediately and costs nothing. Option a is incorrect because walking to the lounge raises heart rate and contractility at the very time the myocardium cannot meet added workload. Early activity is graded by the provider, not offered freely on admission. Option b is incorrect because heavy meals divert blood to the gut and increase cardiac work, and the client may also be kept nothing by mouth pending catheterization. Small light portions are preferred after infarction. Option c is incorrect because unrelieved pain drives a sympathetic surge that raises catecholamines, heart rate and oxygen consumption. Reports of discomfort belong to the nurse immediately, since recurrent pain may signal extension of the infarct.

Correct Answer: Systolic failure with a reduced ejection fraction

An ejection fraction below forty percent defines reduced, or systolic, heart failure. Infarcted muscle cannot contract, so the ventricle dilates and ejects a small fraction of what it holds. An S3 gallop often accompanies it. Option b is incorrect because the preserved type carries a fraction above fifty percent and arises from a ventricle that cannot relax. Long standing hypertension, not an infarction, is the classic cause of that pattern. Option c is incorrect because a normal fraction sits near sixty percent. Thirty percent represents severe impairment of contraction and demands guideline therapy, so calling it incidental would leave the client without life prolonging drugs. Option d is incorrect because ejection fraction measures the left ventricle only. Cor pulmonale describes right ventricular failure driven by lung disease, and nothing in this client's history points to a respiratory origin.

Correct Answer: The left ventricle ejects thirty five percent of its end diastolic volume

Ejection fraction is the percentage of the volume present at the end of diastole that the left ventricle ejects with one contraction. Thirty five percent is a reduced fraction indicating systolic heart failure. Option a is incorrect because the fraction compares output to what that ventricle actually held, not to a healthy person's minute output. Repeating the student's error leaves the misunderstanding uncorrected and teaches nothing. Option b is incorrect because only the left ventricle is measured when an ejection fraction is reported. Naming the right ventricle substitutes one error for another and misses the chamber that drives systemic perfusion. Option d is incorrect because a healthy ventricle ejects roughly sixty percent of its contents, and anything at or below forty percent is reduced. This client needs treatment, not reassurance about a normal value.

Correct Answer: Stay with the client and summon help

Chest pain, dyspnea and crackles are acute target organ damage, so this is a hypertensive emergency. The nurse stays with the client, calls for help and prepares for monitoring and intravenous titratable therapy. Option a is incorrect because oral agents and hourly rechecks belong to hypertensive urgency, where no organ is being injured. This client needs intravenous titratable drugs started under continuous monitoring without delay. Option c is incorrect because walking away leaves an unstable client alone during the minutes when arrest is most likely. Help is summoned from the bedside using the call system rather than by searching. Option d is incorrect because repositioning may ease breathing but treats none of the organ injury already underway. Deferring the reading wastes the narrow window in which controlled pressure reduction prevents infarction and stroke.

Correct Answer: The marker may not have risen yet

Troponin begins to rise about three to four hours after myocardial injury, so a sample drawn ninety minutes into an event can be normal in a genuine infarction. A single negative value is never a discharge. Option a is incorrect because ruling out infarction requires serial sampling showing no rise or fall across time. One early value carries no such weight, and treatment is never withheld on the strength of it. Option b is incorrect because a noncardiac label cannot rest on timing alone. Ischemia is judged on the whole picture, including the electrocardiogram and the character of the discomfort, and normal markers early prove nothing. Option c is incorrect because there is nothing in the scenario suggesting a specimen problem. The result is exactly what physiology predicts this early, and blaming the laboratory delays the repeat draw the client actually needs.

Correct Answer: A woman with diabetes, dyspnea and diaphoresis

Autonomic neuropathy in diabetes produces silent ischemia, so this client may be infarcting without pain while dyspnea and diaphoresis are the only clues. Atypical presentations are triaged low and miss the reperfusion window. Option a is incorrect because pleuritic pain that worsens with breathing points away from ischemia toward a pericardial or pulmonary cause. He still needs evaluation, but he is not the one most likely to be missed. Option b is incorrect because chest tightness following heavy lifting in an adolescent most often reflects musculoskeletal strain. Coronary disease at that age is rare, so this presentation carries the lowest probability of acute ischemia. Option d is incorrect because epigastric burning after a meal suggests reflux, although it can accompany inferior ischemia and still deserves a tracing. It ranks behind a client already showing sympathetic signs of poor perfusion.

Correct Answer: Rest the arm at heart level, uncovered

An arm below heart level reads falsely high and an arm above reads falsely low, and clothing under the cuff distorts the result. Correct positioning on bare skin is required for a usable reading. Option b is incorrect because a cuff that is too small compresses the arm unevenly and produces a falsely high value. The bladder must encircle at least eighty percent of the upper arm. Option c is incorrect because crossed legs raise the measured pressure, as does an unsupported back or a full bladder. Clients should sit with feet flat on the floor and the back supported. Option d is incorrect because a single value is too unreliable to guide diagnosis or treatment decisions. Two or more readings taken at least one minute apart are averaged before anything is concluded.

Correct Answer: Jugular venous distention when semi upright

The right ventricle receives blood from the body, so its failure raises right atrial pressure and the column of blood in the neck veins rises with it. Jugular distention is the cleanest right-sided sign. Option a is incorrect because foamy blood tinged sputum comes from plasma crossing into flooded alveoli, which requires high pulmonary capillary pressure. With the left ventricle working, nothing is congesting the pulmonary bed. Option c is incorrect because lung fields stay clear in pure right-sided failure. Crackles arise when fluid enters small airways behind a failing left ventricle, and that ventricle is described as intact in this client. Option d is incorrect because orthopnea reflects blood redistributing centrally when the client lies down, overwhelming a left ventricle that cannot accept it. The right side alone creates no positional breathing problem.

Correct Answer: Bradycardia and constipation from nodal blockade

Verapamil is a non dihydropyridine that acts on the sinoatrial and atrioventricular nodes and the myocardium, so it slows the rate and conduction. Constipation is its characteristic non cardiac effect, and it is avoided in reduced ejection fraction failure. Option a is incorrect because ankle edema is the signature problem of the dipine agents, which dilate arterioles far more than venules. Verapamil works at the node rather than at the peripheral vessel wall. Option b is incorrect because a compensatory rise in rate follows drugs that drop resistance quickly, such as dihydropyridines and hydralazine. Verapamil blunts the heart rate instead of driving it upward. Option d is incorrect because flushing and headache accompany strong arteriolar dilators like nifedipine and amlodipine. The predominant action of verapamil is on conduction tissue, so cutaneous vasodilation is not prominent.

Correct Answer: The value supports heart failure and suggests greater severity

Ventricular stretch releases this peptide, so a value above roughly one hundred supports heart failure as the cause of breathlessness. There is no upper cutoff, and the higher the value the more severe the failure. Option a is incorrect because a raised level points toward the heart rather than away from it. A low result is what makes heart failure unlikely, since a stretched ventricle is what releases the hormone. Option c is incorrect because troponin is the marker drawn to identify infarction. Natriuretic peptide reflects chamber stretch from volume and pressure overload and says nothing about whether myocardium is currently dying. Option d is incorrect because the value is not a closed window. One course handout prints a range that implies higher numbers mean something else, yet severity climbs steadily with the result and has no ceiling.