Question

A nurse is caring for a client who was admitted for pain between their shoulder blades.

Answer 1

Correct Answers

Blank 1 Correct Option: angina
Blank 2 Correct Option: cardiac panel

Rationale :

♦️Angina pectoris is chest discomfort caused by myocardial ischemia without actual cell death.

♦️The client's pain between the shoulder blades that is precipitated by activity and relieved by rest and morphine is classic for anginal pain, particularly in individuals with diabetes and hypertension, who often present with atypical pain patterns (e.g., back or jaw pain).

♦️The cardiac panel supports this diagnosis: Troponin I (0.03 ng/mL) and Troponin T (0.09 ng/mL) are at or below the upper normal limits, indicating no myocardial infarction, as an MI would produce elevated cardiac enzymes due to muscle necrosis.

♦️Additionally, the ECG showing sinus rhythm with PVCs but no ischemic changes supports myocardial irritability rather than infarction.

♦️The client’s high LDL (165 mg/dL), low HDL (35 mg/dL), elevated cholesterol (300 mg/dL), high CRP, and elevated homocysteine signify atherosclerotic risk, predisposing them to coronary artery disease and angina.

♦️Nursing management should focus on oxygen administration, pain relief, cardiac monitoring, and risk factor modification (diet, statins, exercise, and glucose control).

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Answer 2

Correct Answers:

Atropine

Rationale :

✔️The ECG strip shows atrial flutter, characterized by rapid atrial depolarizations producing a “saw-tooth” pattern on the baseline.

✔️Atrial flutter results from a reentrant circuit in the atria, leading to atrial rates of 250–350 beats/min, with variable ventricular conduction.

✔️Atropine is a parasympatholytic drug that increases SA node firing and AV node conduction, thereby raising heart rate—it is used for bradyarrhythmias, not tachyarrhythmias like atrial flutter.

✔️Administering atropine would worsen the tachycardia and increase ventricular response, placing the client at risk for hemodynamic instability.

✔️Instead, medications such as diltiazem (a calcium channel blocker) and metoprolol (a beta-blocker) help slow ventricular rate, while apixaban is used to prevent thromboembolic complications due to atrial stasis.

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Answer 3

Correct Answers

Blank 1 Correct Option: Sublingual nitroglycerin
Blank 2 Correct Option: Stable angina pectoris

Rationale :

☑️Stable angina pectoris occurs when myocardial oxygen demand exceeds supply during exertion (e.g., yard work, climbing stairs) and is relieved by rest or nitroglycerin.

☑️This client’s pain began with activity and improved with rest, fitting the classic pattern.

☑️The normal troponin (0.01 ng/mL) and normal CK-MB (10 IU/L) confirm that no myocardial infarction or cardiac muscle injury is occurring — further supporting stable ischemia rather than infarction.

☑️Sublingual nitroglycerin works by causing vasodilation, which decreases myocardial oxygen demand (via preload and afterload reduction) and increases coronary blood flow, thus relieving chest pain within minutes.

☑️Metoprolol IV may be used as adjunct therapy later, but not for acute symptom relief, and methylprednisolone is unrelated to ischemic pain management.

☑️The nurse should also educate the client about resting when pain begins, avoiding overexertion, and reporting pain that persists after 3 nitroglycerin doses or rest, which could indicate unstable angina or MI.

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Answer 4

Correct Answers:

3

Rationale :

✍️Ordered dose: 900 mg

✍️Available dose: 300 mg per capsule

✍️Formula:

♦️Number of capsules=Dose ordered/Dose available

♦️Number of capsules=900/300

3 capsules

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Answer 5

Correct Answers:

Cholesterol levels, Hypertension, and Smoking

Rationale :

➡️These are modifiable risk factors for coronary artery disease (CAD) because they can be improved through lifestyle changes and medical treatment.

➡️Elevated cholesterol contributes to atherosclerotic plaque formation that narrows coronary arteries, reducing blood flow to the heart.

➡️Hypertension causes endothelial damage and increases the heart’s workload, accelerating the development of CAD.

➡️Smoking leads to vasoconstriction, increases platelet aggregation, and reduces oxygen delivery to the myocardium, heightening ischemic risk.

➡️Managing these risk factors through diet modification, medication, exercise, and smoking cessation can significantly reduce CAD progression.

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Answer 6

Correct Answers:

Dyspnea
Jugular vein distention
Confusion

Rationale :

Dyspnea

🔵Dyspnea is an early, sensitive sign of transfusion-associated circulatory overload (TACO), especially in clients with heart failure.

🔵Excess transfusion volume raises preload and pulmonary venous pressure, causing interstitial and alveolar fluid and resulting in tachypnea, orthopnea, and crackles.

🔵Monitoring for increasing work of breathing, new oxygen needs, or declining SpO₂ helps catch overload before frank pulmonary edema develops.

🔵If dyspnea appears, the nurse should stop or slow the transfusion, place the client upright, apply oxygen, and anticipate IV diuretics per protocol.

Jugular vein distention (JVD)

🔵JVD reflects elevated central venous pressure, a hallmark of volume overload from the added intravascular volume of RBCs.

🔵In heart failure, limited cardiac reserve means even modest volume can back up into the venous system, making JVP rise visible at 30–45°.

🔵Trending JVP (along with S3, hepatomegaly, peripheral edema) provides a hemodynamic window into right-sided strain during transfusion.

🔵Early recognition allows rate reduction, diuretic therapy, and careful I&O to prevent progression to acute decompensation.

Confusion

🔵Acute confusion or agitation signals possible cerebral hypoxia from worsening pulmonary congestion or falling cardiac output.

🔵Older adults with heart failure are particularly vulnerable; subtle mental-status changes may precede obvious respiratory signs.

🔵Continuous assessment of LOC, orientation, and restlessness alongside vitals and SpO₂ can unmask evolving overload.

🔵Prompt action (positioning, oxygen, slowing/stopping transfusion, notifying the provider) can prevent respiratory failure.

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Answer 7

Correct Answers:

Appearance of the right foot
Blood pressure
Breath sounds
Pedal pulses

Rationale :

Appearance of the right foot

💎 The right foot shows hallmark signs of peripheral arterial disease (PAD) — shiny skin, hair loss, dry texture, dependent rubor, pallor with elevation, and a nonhealing ulcer on the great toe.

💎 The ulceration on the toe indicates poor perfusion and ischemia, putting the client at risk for infection or gangrene.

💎 Rest pain that improves when the leg is dangling (dependent position) suggests critical limb ischemia, an advanced stage of PAD requiring urgent vascular evaluation.

💎 Immediate follow-up ensures prevention of tissue necrosis or potential amputation through antiplatelet therapy, revascularization, and smoking cessation.

Blood pressure

💎 A reading of 168/80 mm Hg indicates uncontrolled hypertension, a major contributor to atherosclerosis and PAD progression.

💎 Chronic elevated pressure damages arterial walls, promoting plaque buildup and endothelial dysfunction, worsening the client’s ischemic leg pain.

💎 Tight blood pressure control with antihypertensives, sodium restriction, and weight management is essential to prevent further vascular injury and cardiac complications.

💎 This finding requires prompt follow-up for medication optimization and cardiovascular risk reduction.

Breath sounds

💎 Scattered rhonchi suggest the presence of airway congestion, possibly from chronic bronchitis or COPD, which is consistent with the client’s 45-year smoking history.

💎 This warrants further pulmonary assessment and interventions such as chest physiotherapy, bronchodilators, or smoking cessation counseling.

💎 COPD is frequently associated with cor pulmonale and decreased oxygenation, increasing cardiovascular strain.

💎 Ongoing monitoring of respiratory status and O₂ saturation is needed to prevent acute exacerbation or hypoxemia.

Pedal pulses

💎 Right pedal pulse is 1+ (weak) compared to the left at 2+ (normal), indicating impaired arterial perfusion to the affected limb.

💎 This asymmetry supports arterial narrowing or occlusion, consistent with PAD findings.

💎 Weak pulses demand follow-up vascular studies (e.g., Ankle-Brachial Index, Doppler ultrasound) to quantify the degree of obstruction.

💎 Early identification allows initiation of antiplatelet therapy and lifestyle modification to reduce risk of critical ischemia and limb loss.

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Answer 8

Correct Answers

Serum lipid values [ Atherosclerosis ; Peripheral arterial disease ]
Pressure injury location [ Chronic venous insufficiency ; Peripheral arterial disease ]
Skin on the right leg [ Chronic venous insufficiency ; Peripheral arterial disease ]
Pedal pulses [ Atherosclerosis ; Peripheral arterial disease ]

Rationale :

Serum lipid values → Atherosclerosis | Peripheral arterial disease (PAD)

◼Hyperlipidemia (↑LDL 175, ↓HDL 30, ↑Total Chol 250) accelerates atherosclerotic plaque formation within medium–large arteries, the pathologic basis of PAD.

◼LDL infiltration into the intima triggers oxidation and macrophage uptake, forming foam cells and fatty streaks, which mature into fibroatheromas that narrow arterial lumen.

◼Low HDL reduces reverse cholesterol transport, diminishing the body’s ability to clear arterial cholesterol, thereby promoting plaque growth.

◼Systemic atherosclerosis explains multisite arterial insufficiency (e.g., coronary disease + limb ischemia), consistent with claudication here.

◼ Lipid control (diet, statins, lifestyle) reduces MACE (major adverse cardiovascular events) and limb ischemia progression.

Pressure injury/ulcer location → Chronic venous insufficiency (CVI) | PAD

◼ CVI ulcers typically occur at the medial malleolus/ankle due to venous hypertension, valve reflux, and tissue edema causing shallow, exudative wounds with irregular borders.

◼ PAD ulcers occur at distal pressure points—toes, lateral foot, bony prominences—from critical ischemia; they’re often “punched-out,” dry, painful, and slow to heal.

◼ This client’s ulcer on the tip of the great toe plus rest pain and relief in dependency aligns with arterial insufficiency, supporting PAD.

◼ Ulcer location is a high-yield anatomical clue that helps differentiate venous (ankle/medial) from arterial (toe/distal) disease for targeted management.

◼ Correct classification drives care (e.g., compression for CVI vs perfusion/revascularization for PAD).

Skin on the right leg → CVI | PAD

◼ PAD skin changes: Shiny, dry, hairless skin, pallor on elevation, dependent rubor, cool temperature—all reflect chronic tissue hypoperfusion and autonomic tone shifts.

◼ These match the client’s shiny, hair-sparse, color-changing leg.

◼ CVI skin changes: Brown hyperpigmentation (hemosiderin), thickened/woody edema, varicosities, and stasis dermatitis from venous hypertension and RBC leakage into tissues.

◼ The client’s dependent hyperpigmentation can be seen in venous disease, but the pallor on elevation and trophic changes (shiny, hair loss, dry) are more specific for PAD.

◼ Recognizing these contrasting cutaneous patterns prevents mismanagement (e.g., inappropriate compression in severely ischemic limbs).

◼ Documenting temperature, capillary refill, color with position, hair distribution supports trend monitoring and vascular referral.

Pedal pulses → Atherosclerosis | PAD

◼ Diminished right pedal pulse (1+) versus left (2+) signals asymmetric arterial flow, consistent with focal atherosclerotic stenosis in lower-extremity arteries (e.g., SFA, popliteal).

◼ Atherosclerotic narrowing reduces distal pulse amplitude, especially with exercise-induced flow demands, explaining intermittent claudication and rest pain in advanced disease.

◼ Pulse asymmetry warrants objective testing (e.g., ABI ≤0.90, segmental pressures, duplex ultrasound) to stage PAD and guide revascularization decisions.

◼ Weak pulses correlate with poor wound healing (e.g., the client’s toe ulcer) and limb threat if critical limb ischemia evolves.

◼ Addressing upstream risk factors (smoking cessation, statins, antiplatelets, BP control) improves limb and cardiovascular outcomes.

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Answer 9

Correct Answers:

Infection.
Tissue necrosis.

Rationale :

Infection

🟣The client has peripheral arterial disease (PAD), evidenced by diminished pedal pulse, rest pain, shiny, hairless skin, and a toe ulcer.

🟣Poor arterial perfusion reduces oxygen and nutrient delivery, impairing wound healing and making the tissue highly susceptible to infection.

🟣Even minor trauma or ulcers can progress rapidly to cellulitis or osteomyelitis due to ischemic tissue being unable to mount an effective immune response.

🟣The toe ulcer described is an ideal portal of entry for microorganisms, particularly in clients with smoking history, hyperlipidemia, and elevated blood pressure, which further compromise vascular flow.

🟣Preventive care includes meticulous foot hygiene, daily inspection, and prompt treatment of any skin breaks or infections to prevent systemic spread.

Tissue Necrosis

🟣Tissue necrosis (gangrene) is the most severe complication of PAD and occurs when critical limb ischemia develops, leading to complete loss of blood supply to distal tissues.

🟣The client’s rest pain, dependent rubor, pallor on elevation, and nonhealing toe ulcer signal advanced ischemia, where tissue oxygenation is insufficient even at rest.

🟣Without timely revascularization or management, ischemic ulcers can progress to dry or wet gangrene, necessitating amputation to prevent sepsis.

🟣Contributing risk factors—smoking, elevated LDL, and hypertension—further accelerate atherosclerotic blockage, worsening perfusion.

🟣Close monitoring for color changes, coldness, or blackening of tissue is critical to detect necrosis early.

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Answer 10

Correct Answers

Place an ice bag on the right lower extremity for 30 min every hour. [ Contraindicated ]
Atorvastatin 40 mg PO once daily. [ Anticipated ]
Elevate the client's feet above the heart when in bed. [ Contraindicated ]
Clopidogrel 75 mg PO once daily. [ Anticipated ]
Place the client on bedrest. [ Contraindicated ]

Rationale :

Ice bag on right lower extremity – Contraindicated

💎Clients with Peripheral Arterial Disease (PAD) have impaired arterial blood flow; cold causes vasoconstriction, which further reduces perfusion to already ischemic tissues.

💎Applying ice can increase pain, delay healing, and worsen ischemia, possibly leading to necrosis.

💎Instead, the nurse should promote warmth (never direct heat) and keep the extremity protected from cold exposure.

Atorvastatin 40 mg PO once daily – Anticipated

💎Atorvastatin lowers LDL cholesterol and stabilizes atherosclerotic plaques, directly addressing the client’s elevated LDL (175 mg/dL) and total cholesterol (250 mg/dL).

💎Statin therapy reduces the risk of myocardial infarction, stroke, and further arterial occlusion in PAD.

💎It is a first-line medication in managing atherosclerotic cardiovascular disease (ASCVD) risk.

Elevate the client’s feet above the heart when in bed – Contraindicated

💎In PAD, elevation decreases arterial flow and exacerbates ischemic pain, as noted in the client’s report that pain worsens with elevation and improves in a dependent position.

💎Keeping the legs in a neutral or dependent position promotes gravity-assisted perfusion to the distal extremities.

💎Elevation is appropriate for venous disease, not arterial insufficiency.

Clopidogrel 75 mg PO once daily – Anticipated

💎Clopidogrel (Plavix) is an antiplatelet agent that prevents platelet aggregation and thrombus formation in narrowed arteries.

💎It improves circulation, reduces risk of acute occlusion, and prevents stroke or MI in clients with PAD.

💎Combined with lifestyle modification (e.g., smoking cessation, walking program), it helps maintain limb perfusion and reduce cardiovascular mortality.

Place the client on bedrest – Contraindicated

💎Bedrest reduces circulation and exacerbates arterial stasis, increasing the risk of thrombus formation and further ischemia.

💎A supervised walking or exercise program enhances collateral vessel development and tissue perfusion.

💎Mobility within tolerance is therapeutic, unless contraindicated by severe rest pain or gangrene.

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Test	Client Value	Reference Range
Total Creatine Kinase (CK)	135 units/L	Male: 55-170 units/L	Female: 30-135 units/L
CK-MB	0%	0%
Cardiac troponin T	0.09 ng/mL	< 0.1 ng/mL
Cardiac troponin I	0.03 ng/mL	< 0.03 ng/mL
AST	34 units/L	0 to 35 units/L

Test	Client Value	Reference Range
HDL	35 mg/dL	Male: > 45 mg/dL	Female: > 55 mg/dL
LDL	165 mg/dL	< 130 mg/dL
Cholesterol	300 mg/dL	< 200 mg/dL
Triglycerides	180 mg/dL	Male: 40-160 mg/dL	Female: 35-135 mg/dL
C-reactive protein	3.1 mg/dL	< 1.0 mg/dL
Homocysteine	21 μmol/L	4 to 14 μmol/L

Test	Client Value	Reference Range
Total Calcium	7 mg/dL	9.0-10.5 mg/dL
Chloride	101 mEq/L	98-106 mEq/L
Glucose	105 mg/dL	70-110 mg/dL (fasting)
Potassium	4.0 mEq/L	3.5-5.0 mEq/L
Sodium	140 mEq/L	136-145 mEq/L

Potential Order	Anticipated	Contraindicated
Place an ice bag on the right lower extremity for 30 min every hour.
Atorvastatin 40 mg PO once daily.
Elevate the client's feet above the heart when in bed.
Clopidogrel 75 mg PO once daily.
Place the client on bedrest.

Custom 2201 Unit 3 Exam 2025

No.

1 :
A nurse is caring for a client who was admitted for pain between their shoulder blades.

Correct Answers

3 :
Patient's data.

Correct Answers

6 :
A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.)

7 :
A nurse in the emergency department (ED) is caring for a male client.

Answer Options

8 :
A nurse in the emergency department (ED) is caring for a male client.

Correct Answers

9 :
A nurse in the emergency department (ED) is caring for a male client.

Answer Options

10 :
A nurse in the emergency department (ED) is caring for a male client.

Correct Answers

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Assessment Findings	Atherosclerosis	Chronic venous insufficiency	Peripheral arterial disease
Serum lipid values
Pressure injury location
Skin on the right leg
Pedal pulses

Custom 2201 Unit 3 Exam 2025

No.

1 : A nurse is caring for a client who was admitted for pain between their shoulder blades.

Correct Answers

3 : Patient's data.

Correct Answers

6 : A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.)

7 : A nurse in the emergency department (ED) is caring for a male client.

Answer Options

8 : A nurse in the emergency department (ED) is caring for a male client.

Correct Answers

9 : A nurse in the emergency department (ED) is caring for a male client.

Answer Options

10 : A nurse in the emergency department (ED) is caring for a male client.

Correct Answers

1 :
A nurse is caring for a client who was admitted for pain between their shoulder blades.

3 :
Patient's data.

6 :
A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.)

7 :
A nurse in the emergency department (ED) is caring for a male client.

8 :
A nurse in the emergency department (ED) is caring for a male client.

9 :
A nurse in the emergency department (ED) is caring for a male client.

10 :
A nurse in the emergency department (ED) is caring for a male client.