ATI RN
Cardiovascular Test Bank Questions
Question 1 of 5
Priority nursing interventions when a client is on heparin include the following:
Correct Answer: B
Rationale: The correct answer is B: Monitor the IV site for extravasation. This is crucial because heparin is an anticoagulant medication that can cause bleeding if it leaks into the surrounding tissue. By monitoring the IV site for extravasation, nurses can prevent potential complications such as tissue damage or excessive bleeding. Antacids for digestive upset (Choice A) are not directly related to heparin administration. Monitoring signs of acute blood loss (Choice C) is important but not a priority compared to preventing extravasation. Monitoring the respiratory rate (Choice D) is also important but not as directly related to heparin administration as monitoring the IV site for extravasation.
Question 2 of 5
The client is on a statin medication. The nurse tells the client that the purpose of taking a statin drug is what?
Correct Answer: B
Rationale: The correct answer is B: To reduce total and LDL cholesterol. Statin medications work by blocking an enzyme in the liver that is responsible for producing cholesterol, thereby lowering total and LDL cholesterol levels in the blood. This helps to reduce the risk of cardiovascular events such as heart attacks and strokes. Choice A is incorrect as statins do not directly thin the blood. Choice C is incorrect as statins do not break up existing plaques in the arteries. Choice D is incorrect as statins do not destabilize cholesterol plaques.
Question 3 of 5
The client has a resting heart rate of 80 and a regular rhythm. What is the likely source of electrical activity in this client?
Correct Answer: A
Rationale: The correct answer is A: The sino-atrial node. The SA node is the primary pacemaker of the heart, responsible for initiating the electrical impulses that regulate the heart rate. It is located in the right atrium and typically generates a resting heart rate of around 60-100 beats per minute. In this scenario, with a resting heart rate of 80 and a regular rhythm, the SA node is most likely the source of electrical activity. The other choices (B: AV node, C: Purkinje fibers, D: Bundle of His) are involved in the conduction of electrical impulses within the heart but are not responsible for the initiation of the heartbeat at rest.
Question 4 of 5
The client has a heart rate of 70 and a P wave that comes early and is malformed. What is the likely cause of this?
Correct Answer: B
Rationale: The correct answer is B: Premature atrial contractions. This is because the client's heart rate is normal (70 bpm) and the P wave is early and malformed, which are classic signs of premature atrial contractions. These occur when the electrical impulse in the atria depolarizes prematurely, causing an early P wave on the ECG. Other choices are incorrect because: A: Normal sinus rhythm would not have an early and malformed P wave. C: Frequent PVCs present with a wide QRS complex, not a malformed P wave. D: Ventricular escape rhythm would have a slow heart rate and not an early P wave.
Question 5 of 5
The client is being fitted for a Holter Monitor. What does the nurse tell the client in preparation for the test?
Correct Answer: D
Rationale: The correct answer is D because the client should record the time of any palpable events, such as palpitations, during the Holter Monitor test to provide valuable information to healthcare providers. This step is crucial for correlating symptoms with the recorded heart activity. Choice A is incorrect because clients are encouraged to continue their normal activities during the test. Choice B is incorrect as clients can bathe while wearing the monitor. Choice C is incorrect as the Holter Monitor test typically lasts for 24-48 hours, not just 30 minutes.