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Test 2 HA Questions And Answers With Complete Solutions.
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Test 2 HA Questions And Answers With Complete Solutions.
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Test 2 HA Questions And Answers With Complete SolutionsA 25-year-old woman in her fifth month of pregnancy has a
blood pressure of 100/70 mm Hg. In reviewing her previous
examination, the nurse notes that her blood pressure in her
second month was 124/80 mm Hg. In evaluating this change,
what does the nurse know to be true?
a. This decline in blood pressure is the result of peripheral
vasodilatation and is an
expected change.
b. Because of increased cardiac output, the blood pressure
should be higher at this
time.
c. This change in blood pressure is not an expected finding
because it means a decrease in cardiac output.
d. This decline in blood pressure means a decrease in circulating
blood volume, which is dangerous for the fetus. Correct Answer
A
A 30-year-old woman with a history of mitral valve problems
states that she has been "very tired." She has started waking up
at night and feels like her "heart is pounding." During the
assessment, the nurse palpates a thrill and lift at the fifth left
intercostal space midclavicular line. In the same area, the nurse
also auscultates a blowing, swishing sound right after the S1.
What do these findings most likely indicate?
a. Heart failure
b. Aortic stenosis
c. Pulmonary edema
d. Mitral regurgitation Correct Answer D
,A 35-year-old recent immigrant is being seen in the clinic for
symptoms of a cough associated with rust-colored sputum, low-
grade afternoon fevers, and night sweats for the past 2 months.
Based on these findings, what is the most likely cause?
a. Pneumonia
b. Bronchitis
c. Tuberculosis
d. Pulmonary edema Correct Answer C
A 4-month-old child is at the clinic for a well-baby checkup and
immunizations. Which of these actions is most appropriate when
the nurse is assessing an infant's vital signs?
a. The infant's radial pulse should be palpated, and the nurse
should notice any
fluctuations resulting from activity or exercise.
b. The nurse should auscultate an apical rate for 1 minute and
then assess for any
normal irregularities, such as sinus dysrhythmia.
c. The infant's blood pressure should be assessed by by using a
stethoscope with a large
diaphragm piece to hear the soft muffled Korotkoff sounds.
d. The infant's chest should be observed and the respiratory rate
counted for 1
minute; the respiratory pattern may vary significantly. Correct
Answer B
A 45-year-old man is in the clinic for a routine physical
examination. During the recording of his health history, the
patient states that he has been having difficulty sleeping. "I'll be
sleeping great, and then I wake up and feel like I can't get my
breath." Which is the best response by the nurse?
,a. "When was your last electrocardiogram?"
b. "It's probably because it's been so hot at night."
c. "Do you have any history of problems with your heart?"
d. "Have you had a recent sinus infection or upper respiratory
infection?" Correct Answer C
A 60-year-old woman has developed reflexive sympathetic
dystrophy after arthroscopic repair of her shoulder. Which is a
key feature of this condition?
a. Affected extremity will eventually regain its function.
b. Pain is felt at one site but originates from another location.
c. Patient's pain will be associated with nausea, pallor, and
diaphoresis.
d. Slightest touch, such as a sleeve brushing against the arm,
causes severe and
intense pain. Correct Answer D
A 65-year-old patient with a history of heart failure comes to the
clinic stating "I keep waking up from sleep with shortness of
breath." Which action by the nurse is most appropriate?
a. Obtain a detailed health history of the patient's allergies and a
history of asthma.
b. Tell the patient to sleep on his or her right side to facilitate
ease of respirations.
c. Assess for other signs and symptoms of paroxysmal nocturnal
dyspnea.
d. Assure the patient that paroxysmal nocturnal dyspnea is
normal and will probably
resolve within the next week. Correct Answer C
, A 70-year-old patient is being seen in the clinic for severe
exacerbation of heart failure. Which finding is the nurse most
likely to observe in this patient?
a. Fever, dry nonproductive cough, and diminished breath
sounds
b. Rasping cough, thick mucoid sputum, wheezing, and
bronchitis
c. Productive cough, dyspnea, weight loss, anorexia, and
tuberculosis
d. Shortness of breath, orthopnea, paroxysmal nocturnal
dyspnea, and ankle edema Correct Answer D
A 70-year-old patient with a history of hypertension has a blood
pressure of 180/100 mm Hg and a heart rate of 90 beats per
minute. The nurse hears an extra heart sound at the apex
immediately before the S1. The sound is heard only with the bell
of the stethoscope while the patient is in the left lateral position.
Based on these findings and the patient's history, the nurse
should recognize this extra heart sound is most likely what?
a. Split S1
b. Atrial gallop
c. Diastolic murmur
d. Summation sound Correct Answer B
A mother brings her 3-month-old infant to the clinic for
evaluation of a cold. She tells the nurse that he has had "a runny
nose for a week." When performing the physical assessment, the
nurse notes that the child has nasal flaring and sternal and
intercostal retractions. What would the nurse do next?
a. Ask the mother if the infant has had trouble with feedings.
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