Chapter 23--Assessment of Cardiovascular and Hematological Function
MULTIPLE CHOICE
1. A client, receiving a transfusion of packed red blood cells, asks the nurse why it is needed since she knows the body makes ne
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Chapter 23--Assessment of Cardiovascular and Hematological Function
MULTIPLE CHOICE
1. A client, receiving a transfusion of packed red blood cells, asks the nurse why it is needed since she knows the body makes new blood. Which of the following should the nurse respond to this client?
1. “It will take 30 days for you body to make the new blood cells.”
2. “Your body will make the new blood cells in about 60 days.”
3. “It takes at least 3 months for your body to make enough blood cells to replace what you have lost.”
4. “Red blood cells last about 120 days. Your body needs to have a constant supply to replace them.”
PTS: 1 DIF: Apply REF: Erythrocytes
2. The nurse is reviewing a client’s white blood cell count. Which of the following would not be affected by the presence of an infection?
1. Basophils
2. Eosinophils
3. Lymphocytes
4. Neutrophils
PTS: 1 DIF: Analyze REF: White Blood Cells
3. A client is diagnosed with a parasitic infection. The nurse realizes that which of the following white blood cell counts will be elevated?
1. Basophils
2. Eosinophils
3. Lymphocytes
4. Neutrophils
PTS: 1 DIF: Analyze REF: White Blood Cells
4. A client is diagnosed with a low red blood cell count. Which of the following should the nurse assess in this client?
1. Urine output
2. Bowel sounds
3. Respirations
4. Consciousness
PTS: 1 DIF: Apply REF: Erythrocytes
5. A client is prescribed a vitamin B-12 injection every month. Which of the following should the nurse explain to the client as the purpose of this medication?
1. “It is needed to make new red blood cells.”
2. “It makes the red blood cells more flexible.”
3. “It makes the red blood cells hold more oxygen.”
4. “It makes the red blood cells hold their shape.”
PTS: 1 DIF: Apply REF: Erythrocytes
6. During the assessment of a client, the nurse identifies pinpoint hemorrhages under the skin that are dark red and less than 2 mm in size. How should the nurse document this finding?
1. Petechiae
2. Ecchymosis
3. Hematoma
4. Purpura
PTS: 1 DIF: Apply
REF: Table 23-3 Physical Assessment for Hematological Problems
7. The nurse is auscultating the area to the right of the sternum at the second intercostal space. The nurse is listening to which of the following valves?
1. Aortic
2. Mitral
3. Tricuspid
4. Pulmonic
PTS: 1 DIF: Apply REF: Assessment
8. A client is diagnosed with a normal ejection fraction. The nurse realizes that the client’s ejection fraction is most likely between:
1. 10% to 20%.
2. 30% to 40%.
3. 60% to 70%.
4. 80% to 90%.
PTS: 1 DIF: Analyze REF: Cardiac Cycle
9. A client is experiencing chest pain that occurs in the third costochondral joint. The onset was sudden; it radiated to the shoulders; and it becomes worse when taking a deep breath or twisting the torso. The nurse suspects that this client is experiencing:
1. aortic dissection.
2. pulmonary embolus.
3. pneumothorax.
4. musculoskeletal-costochondritis.
PTS: 1 DIF: Analyze REF: Table 23-7 Differentiating Chest Pain
10. The nurse applies pressure to the fingernail of a client and watches for the color to return after releasing the pressure. The nurse is assessing this client’s:
1. skin changes.
2. capillary refill.
3. skin turgor.
4. peripheral edema.
PTS: 1 DIF: Apply REF: Assessment
11. A client is having a diagnostic test that will evaluate the heart’s structure and function using an ultrasound. The client is most likely having a(n):
1. exercise electrocardiography.
2. electrocardiogram.
3. echocardiogram.
4. chest x-ray.
PTS: 1 DIF: Analyze REF: Diagnostic Tests
12. A client is scheduled for a cardiac catheterization. The nurse realizes that the indications for this diagnostic test would be:
1. hypertension.
2. peripheral edema.
3. cerebral vascular accident.
4. diagnose coronary artery disease.
PTS: 1 DIF: Analyze REF: Diagnostic Tests
13. Which of the following should the nurse instruct a client who is scheduled for a stress test?
1. Eat nothing before the test.
2. Expect to feel chest pain.
3. The test will take between 20 and 50 minutes.
4. You will be videotaped performing the test.
PTS: 1 DIF: Apply
REF: Patient Playbook: Preparing the Patient for a Stress Test
MULTIPLE RESPONSE
1. The nurse is administering an anticoagulant to a client. Which of the following medications are anticoagulants? (Select all that apply.)
1. Acetylsalicylic acid
2. Clopidogrel
3. Dalteparin
4. Reteplase
5. Tirofiban
6. Warfarin
PTS: 1 DIF: Analyze REF: Table 23-2 Medications That Alter Coagulation
2. During the assessment of a client’s thoracic region, the nurse determines that the client has a chest abnormality. Which of the following are common chest abnormalities? (Select all that apply.)
1. Barrel chest
2. Jugular vein distention
3. Pectus excavatum
4. Retracting rib cage
5. Pectus carinatum
6. Displaced trachea
PTS: 1 DIF: Analyze
REF: Table 23-8 Physical Abnormalities of the Chest
3. The nurse is assessing a client for a heart murmur. Which of the following should be included in this assessment? (Select all that apply.)
1. Blood pressure
2. Heart rate
3. Location
4. Radiation
5. Timing
6. Intensity
PTS: 1 DIF: Apply REF: Box 23-5 Assessment of Heart Murmur
4. The nurse is evaluating a client who is experiencing chest pain. Which of the following should be included in this assessment? (Select all that apply.)
1. Grade the pain on a scale of 1 to 10.
2. Precipitating factors.
3. Assess for sleep disturbance.
4. Determine what was used to eliminate the pain.
5. Assess for sweating.
6. Determine if the pain is related to an injury or surgery.
PTS: 1 DIF: Apply REF: Box 23-1 Chest Pain Evaluation
5. The nurse is assessing a client’s precordium. Which of the following should be included in this assessment? (Select all that apply.)
1. Palpate the precordium.
2. Palpate temperature and pulses of extremities.
3. Assess blood pressure.
4. Percuss the precordium.
5. Auscultate heart sounds.
6. Identify the location and timing of heart sounds.
PTS: 1 DIF: Apply
REF: Box. 23-4 Steps of the Precordium Assessment
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