Question

A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug?

Answer 1

Correct Answers:

Clopidogrel

Rationale :

🔴 Clopidogrel is an antiplatelet medication commonly prescribed after coronary artery stent placement to help prevent stent thrombosis and re-occlusion of the artery.

🔴 It works by inhibiting platelet aggregation, which reduces the risk of blood clot formation around the stent site.

🔴 This medication is often given in combination with aspirin as part of dual antiplatelet therapy (DAPT), which is essential for stent patency and prevention of major cardiac events.

🔴 Other options like dipyridamole and ibuprofen are not first-line agents post-stent, and acetaminophen does not provide antiplatelet effects.

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Answer 2

Correct Answers:

To help prevent blockages that can cause chest pain or heart attacks

Rationale :

🟡 Aspirin is prescribed daily in clients with coronary artery disease (CAD) for its antiplatelet effect, not for pain relief.

🟡 It works by inhibiting platelet aggregation, reducing the formation of blood clots that can block narrowed coronary arteries and trigger angina or myocardial infarction (heart attack).

🟡 This preventive action is a cornerstone of secondary prevention in CAD management.

🟡 Aspirin does not enhance oxygen transport or directly improve heart function, but rather lowers the risk of future cardiovascular events.

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Answer 3

Correct Answers:

Friction rub

Rationale :

🟥 A pericardial friction rub is the classic auscultatory finding in pericarditis. It results from inflammation of the pericardial layers rubbing against each other.

🟥 It is typically heard as a high-pitched, scratchy or grating sound, best heard with the diaphragm of the stethoscope at the left lower sternal border when the client is leaning forward.

🟥 It differs from lung sounds like wheezes or crackles, which originate in the airways or alveoli, not from the heart sac.

🟥 Recognizing a friction rub is important for diagnosing and managing inflammatory cardiac conditions.

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Answer 4

Correct Answers:

Sodium

Rationale :

🟦 In clients with cardiomyopathy, sodium levels are a priority to monitor because hyponatremia can indicate fluid overload and worsening heart failure, both of which are complications of cardiomyopathy.

🟦 Low sodium is associated with neurohormonal activation (e.g., increased ADH and RAAS activity), and it can signal a poor prognosis in advanced heart failure.

🟦 While liver enzymes (AST, ALT, bilirubin) may rise with hepatic congestion and BUN with renal involvement, serum sodium is more directly related to volume status and cardiac function.

🟦 Early identification of sodium imbalance supports fluid management and medication adjustments such as diuretics or vasopressin antagonists.

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Answer 5

Correct Answers:

Coronary arteriosclerosis

Rationale :

❤️ Angina pectoris is most commonly caused by coronary arteriosclerosis, which results in narrowing of the coronary arteries due to plaque buildup.

❤️ This narrowing limits oxygen-rich blood flow to the myocardium, especially during exertion or stress, when the heart’s oxygen demand increases.

❤️ The resulting transient ischemia causes the characteristic chest pain, which typically resolves with rest or nitroglycerin.

❤️ Unlike infarction, angina does not involve permanent myocardial damage, and cardiac output or contractility may remain normal between episodes.

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Answer 6

Correct Answers:

International normalized ratio (INR) between 2 and 3

Rationale :

🟢 The INR (International Normalized Ratio) is the most accurate and widely used measure to monitor the effectiveness of warfarin therapy, especially in clients being treated for conditions like deep vein thrombosis (DVT).

🟢 A therapeutic INR range of 2.0 to 3.0 indicates adequate anticoagulation for most conditions, including DVT and pulmonary embolism.

🟢 PT values alone are less reliable due to lab variability; the INR standardizes this measurement globally.

🟢 PTT is used for heparin monitoring, not warfarin, and hematocrit relates to anemia, not anticoagulation status.

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Answer 7

Correct Answers:

Arterial vasoconstriction

Rationale :

🔴 Afterload refers to the resistance the left ventricle must overcome to eject blood during systole.

🔴 Arterial vasoconstriction increases systemic vascular resistance, making it harder for the heart to pump blood into the aorta, thereby increasing afterload.

🔴 When afterload is elevated, the heart must work harder to maintain stroke volume, which can strain the myocardium over time.

🔴 In contrast, arterial vasodilation lowers afterload, and venous tone primarily influences preload, not afterload.

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Answer 8

Correct Answers:

Take the diuretic only on days when experiencing shortness of breath.

Rationale :

🟩 Oral diuretics promote increased urination by helping the kidneys excrete excess fluid, which is essential in managing heart failure symptoms such as edema and dyspnea.

🟩 Taking the diuretic in the morning helps prevent nocturia, which can disturb sleep and increase the risk of falls in older adults, especially during nighttime trips to the bathroom.

🟩 Diuretics should be taken consistently as prescribed, not just based on symptoms, and fluid restriction or dairy timing is not typically necessary unless otherwise directed.

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Answer 9

Correct Answers:

Ineffective coping related to pacemaker implantation

Rationale :

🟦 Signs of social isolation and depression following a medical procedure like pacemaker implantation suggest the client may be struggling with adjusting emotionally to lifestyle changes, physical limitations, or altered body image.

🟦 This supports a nursing diagnosis of ineffective coping, which refers to the inability to manage stressors or adapt to health-related challenges in a healthy manner.

🟦 Addressing this requires a focus on emotional support, psychosocial assessment, and appropriate referrals (e.g., counseling, support groups).

🟦 Other diagnoses (e.g., spiritual distress, decisional conflict) are not supported by the data provided.

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Answer 10

Correct Answers:

Increases platelet adhesion
Increases the blood carbon monoxide level
Raises the heart rate and blood pressure
Decreases the supply of oxygen to the myocardium

Rationale :

✅ 1. Increases platelet adhesion

🟥 Tobacco use causes endothelial injury and promotes inflammatory responses in the vascular system.

🟥 This leads to increased platelet adhesion and aggregation, which raises the risk of thrombus (clot) formation in the coronary arteries.

🟥 These clots can narrow or block coronary vessels, increasing the likelihood of acute coronary syndromes such as myocardial infarction.

🟥 This mechanism is a direct contributor to the progression of atherosclerosis and coronary artery disease (CAD).

✅ 2. Increases the blood carbon monoxide level

🟩 Inhaled tobacco smoke contains carbon monoxide (CO), which binds to hemoglobin with a greater affinity than oxygen, forming carboxyhemoglobin.

🟩 This reduces the blood's ability to carry oxygen to tissues, including the heart.

🟩 Elevated CO levels contribute to tissue hypoxia, forcing the heart to work harder to deliver oxygen, and worsen outcomes in clients with preexisting CAD.

✅ 3. Raises the heart rate and blood pressure

🟨 Nicotine in tobacco stimulates the sympathetic nervous system, leading to the release of catecholamines (epinephrine and norepinephrine).

🟨 This results in vasoconstriction, increased heart rate, and elevated blood pressure, all of which increase cardiac workload and myocardial oxygen demand.

🟨 Over time, these changes contribute to hypertension, endothelial damage, and left ventricular hypertrophy, accelerating the development of CAD.

✅ 4. Decreases the supply of oxygen to the myocardium

🟦 Tobacco impairs oxygen delivery through a combination of carbon monoxide exposure, vasoconstriction, and reduced hemoglobin oxygen-carrying capacity.

🟦 The resulting myocardial hypoxia can trigger angina and increase the risk of ischemic heart damage.

🟦 This effect is especially dangerous in individuals with narrowed coronary arteries, as it can lead to unstable angina or myocardial infarction.

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LPN Medsurg-2025 Summer Exam

No.

1 :
A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug?

2 :
The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why they have to take an aspirin every day if they don't have any pain. Which rationale for this intervention would be the best?

3 :
The nurse is auscultating the breath sounds of a client with pericarditis. Which finding is most consistent with this diagnosis?

4 :
A client is admitted to the critical care unit with a diagnosis of cardiomyopathy. When reviewing the client's most recent laboratory results, the nurse would prioritize assessment of which value?

5 :
A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause?

6 :
The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels?

7 :
The nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that which factor increases afterload?

8 :
The nurse is educating an 80-year-old client diagnosed with heart failure about the medication regimen. Which instruction would the nurse give this client about the use of oral diuretics?

9 :
The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?

10 :
A nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? What are the primary ways that tobacco use impacts CAD? Select all that apply.

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LPN Medsurg-2025 Summer Exam

No.

1 : A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug?

2 : The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why they have to take an aspirin every day if they don't have any pain. Which rationale for this intervention would be the best?

3 : The nurse is auscultating the breath sounds of a client with pericarditis. Which finding is most consistent with this diagnosis?

4 : A client is admitted to the critical care unit with a diagnosis of cardiomyopathy. When reviewing the client's most recent laboratory results, the nurse would prioritize assessment of which value?

5 : A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause?

6 : The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels?

7 : The nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that which factor increases afterload?

8 : The nurse is educating an 80-year-old client diagnosed with heart failure about the medication regimen. Which instruction would the nurse give this client about the use of oral diuretics?

9 : The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?

10 : A nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? What are the primary ways that tobacco use impacts CAD? Select all that apply.

1 :
A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug?

2 :
The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why they have to take an aspirin every day if they don't have any pain. Which rationale for this intervention would be the best?

3 :
The nurse is auscultating the breath sounds of a client with pericarditis. Which finding is most consistent with this diagnosis?

4 :
A client is admitted to the critical care unit with a diagnosis of cardiomyopathy. When reviewing the client's most recent laboratory results, the nurse would prioritize assessment of which value?

5 :
A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause?

6 :
The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels?

7 :
The nurse working on a cardiac care unit is caring for a client whose stroke volume has increased. The nurse is aware that afterload influences a client's stroke volume. The nurse recognizes that which factor increases afterload?

8 :
The nurse is educating an 80-year-old client diagnosed with heart failure about the medication regimen. Which instruction would the nurse give this client about the use of oral diuretics?

9 :
The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?

10 :
A nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? What are the primary ways that tobacco use impacts CAD? Select all that apply.