ATI RN
Physical Exam Cardiovascular System Questions
Question 1 of 5
A client on an ACE inhibitor reports a persistent cough. What is the nurse's best response?
Correct Answer: B
Rationale: The correct answer is B because a persistent cough could indicate a serious side effect of ACE inhibitors, such as angioedema or bronchospasm. Instructing the client to report the cough to the healthcare provider is crucial to evaluate the need to discontinue the medication. Choice A is incorrect as it downplays the potential seriousness of the cough. Choice C is incorrect because a humidifier may not address the underlying cause of the cough. Choice D is incorrect because using a cough suppressant without proper evaluation can mask symptoms of a serious side effect.
Question 2 of 5
The nurse is administering a beta blocker to a client with a heart rate of 58 bpm. What is the nurse's priority action?
Correct Answer: B
Rationale: The correct answer is B. Holding the beta blocker and notifying the healthcare provider is the priority action because a heart rate of 58 bpm may be too low to safely administer a beta blocker, which can further decrease heart rate and lead to complications like bradycardia or heart block. Increasing the dose (choice C) without assessing the current heart rate is risky. Administering the beta blocker as ordered (choice A) without considering the low heart rate is unsafe. Monitoring the client's heart rate (choice D) is important but not the priority when the initial heart rate is low.
Question 3 of 5
The client on furosemide (Lasix) is complaining of muscle cramps. What electrolyte imbalance should the nurse suspect?
Correct Answer: D
Rationale: The correct answer is D: Hypokalemia. Furosemide is a loop diuretic that causes potassium excretion, leading to low potassium levels and muscle cramps. Hypokalemia is associated with muscle weakness and cramps due to altered muscle function. Hyperkalemia (A) is high potassium levels, not typically associated with furosemide. Hyponatremia (B) is low sodium levels, not directly related to furosemide use. Hypocalcemia (C) is low calcium levels, which can cause muscle cramps but is not the most likely electrolyte imbalance with furosemide.
Question 4 of 5
The nurse is caring for a client on warfarin with an INR of 5.2. What is the most appropriate action?
Correct Answer: A
Rationale: The correct answer is A: Administer vitamin K as an antidote. A high INR level of 5.2 indicates the client is at risk of bleeding due to excess anticoagulation from warfarin. Vitamin K helps reverse the effects of warfarin by promoting clotting factor production. Administering vitamin K is crucial to prevent bleeding complications. Holding the next dose of warfarin (B) is not enough to rapidly lower the INR. Increasing the dose of warfarin (C) would worsen the situation. Monitoring the client's INR closely (D) is important, but immediate action with vitamin K is necessary in this case.
Question 5 of 5
A client on a beta blocker has a heart rate of 52 bpm. What is the nurse's priority action?
Correct Answer: A
Rationale: The correct answer is A: Hold the beta blocker and notify the healthcare provider. With a heart rate of 52 bpm, the client may be experiencing bradycardia, a potential side effect of beta blockers. Holding the medication and informing the healthcare provider is crucial to prevent further complications. Administering the beta blocker (B) can exacerbate bradycardia. Increasing the dose (C) can further decrease the heart rate. Continuing to monitor (D) without intervention can lead to worsening of the bradycardia.