ATI RN
ATI RN Custom Cardiovascular Med Surg Questions
Extract:
Question 1 of 5
While auscultating a patient's heart sounds, a nurse detects a fourth heart sound (S4). The nurse understands that this finding possibly indicates:
Correct Answer: An S4 heart sound is an extra sound that is heard late in diastole just before S1. It occurs due to resistance to blood flow in an enlarged ventricle, often due to forceful atrial contraction to overcome ventricular resistance. Other options are not directly associated with S4.
Rationale:
Question 2 of 5
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI?
Correct Answer: Cardiac-specific troponin is a protein that is released into the bloodstream when there is damage to the heart muscle, such as during an acute myocardial infarction (AMI). It is considered the most specific marker for AMI because it is found only in heart muscle.
Rationale:
Question 3 of 5
The nurse is caring for a patient with mitral regurgitation. Where would the nurse listen to best hear a murmur typical of mitral regurgitation?
Correct Answer: The apex of the heart is the best place to hear a murmur typical of mitral regurgitation. This is where the sound will be most audible. Other locations are less optimal for detecting this specific murmur.
Rationale:
Extract:
A nurse is caring for an adolescent in an emergency department.
Vital Signs.
2300: Medical History.
Blood pressure 120/78 mm Hg. Apical pulse rate 100/min.
Respiratory rate 20/min.
2400: Temperature 37.9° C (100.2° F). Oxygen saturation 98% on room air.
Nurses' Notes.
Blood pressure 112/64 mm Hg. Apical pulse rate 108/min.
Respiratory rate 28/min.
Temperature 38.9° C (102° F). Oxygen saturation 95% on room air.
Medical History.
History of rheumatic fever with resulting cardiac valve damage.
Nurses' Notes.
2300: Adolescent brought to emergency department by their parent.
Adolescent reports intermittent low-grade fever and anorexia.
Manifestations presented a few days after having dental work performed.
Now they are worse.
Adolescent noticed shortness of breath with exertion today.
Adolescent in semi-reclining position.
Respirations easy and unlabored while at rest.
Mild dyspnea observed when adolescent ambulated to the room.
Lung sounds clear bilaterally.
Oral mucous membranes pink with petechiae noted.
Adolescent reports diffuse joint pain as 2 on a scale of 0 to 10. 2400: Adolescent restless and sweating, sitting in high-Fowler's position.
Dyspnea noted at rest.
Adolescent reports pain in mid-chest as dull, aching, and as 2 on a scale of 0 to 10. Few coarse rales auscultated bilaterally
Question 4 of 5
A nurse is caring for an adolescent in an emergency department. Which of the following should the nurse anticipate the provider will prescribe?
Correct Answer: Obtaining blood cultures, administering antibiotics, and obtaining an echocardiogram are anticipated due to suspected endocarditis from recent dental work and symptoms like fever and dyspnea. Restricting dental hygiene and strenuous exercise are contraindicated as they could worsen the condition or are unnecessary.
Rationale:
Extract:
Question 5 of 5
A patient has pain due to acute pericarditis. Which action would the nurse take?
Correct Answer: Placing the patient in Fowler's position, leaning forward on the table, can help relieve the pain associated with acute pericarditis. Deep breaths, forced fluids, and ice bags are not effective for this purpose.
Rationale: