ATI LPN
Cardiovascular Assessment Questions Questions
Question 1 of 5
Man in ER coma. Labs: Serum Na 131 mEq/L, K 2.9 mEq/L, Cl 70 mEq/L, CO2 21 mEq/L, blood urea nitrogen 34, creatinine 1.4 mg/dl, glucose 240 mg/dl, serum osmolality 320 mOsm/kg H2O, serum ketones weakly+, pH 7.53, PaCO2 25, and serum albumin 3.8. Which ONE of the following choices BEST describes his acid-base disturbance?
Correct Answer: D
Rationale: The combination of high anion gap metabolic acidosis from ketones, metabolic alkalosis from vomiting or diuretic use, and respiratory alkalosis from compensatory mechanisms explains the complex disturbance.
Question 2 of 5
Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.
Correct Answer: D
Rationale: When cardiac output is reduced, juxtaglomerular cells in the kidney release renin and initiate the renin-angiotensin-aldosterone cascade leading to salt and water retention by the kidney. Aldosterone is not released from juxtaglomerular cells. Norepinephrine is not released by cells within the kidney. Angiotensin is not involved in the process of cellular release within the kidneys.
Question 3 of 5
A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?
Correct Answer: C
Rationale: High Fowler's position (C) elevates the head to reduce pulmonary congestion and ease breathing in left-sided heart failure.
Question 4 of 5
Which blood pressure(BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension?
Correct Answer: B
Rationale: The 8th Joint National Committee's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with hypertension is a BP below 130/80 mm Hg. The BP of 98/56 mm Hg may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.
Question 5 of 5
Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure(BP) for a new patient?
Correct Answer: B
Rationale: The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.