115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy...

68 Cardiovascular system

1. Partial thromboplastin time (PTT) 11/2 to 2 times the control

2. Prothrombin time (PT) 11/2 to 2 times the control

3. International Normalized Ratio (INR) of 3 to 4

4. Hematocrit (HCT) of 32%Answer: 2. Warfarin is at a therapeutic level when the PT is 11/2 to 2 times the control. Values greater than this increase the risk of bleeding and hemorrhage; lower values increase the risk of blood clot formation. Heparin, not warfarin, prolongs PTT. The INR may also be used to determine whether war-farin is at a therapeutic level; however, an INR of 2 to 3, not 3 to 4, is considered therapeutic. HCT doesnt provide information on the effec-tiveness of warfarin. However, a falling HCT in a client taking warfarin may be a sign of hemorrhage.

NCLEX keysClient needs category: Physiological integrityClient needs subcategory: Pharmacological and parenteral therapiesCognitive level: Application

10. A client comes to the emergency department with a dissecting aortic aneurysm. The client is at greatest risk for:

1. septic shock.2. anaphylactic shock.3. cardiogenic shock.4. hypovolemic shock.

Answer: 4. A dissecting aortic aneurysm is a precursor to aortic rupture, which leads to hemorrhage and hypovolemic shock. Septic shock occurs with overwhelming infection. Anaphylactic shock is an allergic response. Cardiogenic shock is the result of ineffective cardiac function.

NCLEX keysClient needs category: Physiological integrityClient needs subcategory: Reduction of risk potentialCognitive level: Comprehension

7. Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which find-ing most strongly suggests left-sided heart failure?

1. A drop in central venous pressure2. An increase in the cardiac index3. A rise in pulmonary artery diastolic

pressure4. A decline in mean pulmonary artery

pressureAnswer: 3. A rise in pulmonary artery dia-stolic pressure suggests left-sided heart failure. Central venous pressure would rise in heart failure. The cardiac index would decline in heart failure. The mean pulmonary artery pressure would increase in heart failure.

NCLEX keysClient needs category: Physiological integrityClient needs subcategory: Physiological adaptationCognitive level: Application

8. A client with dilated cardiomyopathy, pulmonary edema, and severe dyspnea is placed on dobutamine. Which assessment finding indicates that the drug is effective?

1. Increased activity tolerance2. Absence of arrhythmias3. Negative Homans sign4. Blood pressure of 160/90 mm Hg

Answer: 1. Dobutamine should improve the clients symptoms and the client should expe-rience an increased tolerance for activity. The absence of arrhythmias doesnt indicate effec-tiveness of dobutamine. A negative Homans sign indicates absence of blood clots, which isnt a therapeutic effect of dobutamine.

NCLEX keysClient needs category: Physiological integrityClient needs subcategory: Pharmacological and parenteral therapiesCognitive level: Analysis

9. A nurse administers warfarin (Cou-madin) to a client with deep vein thrombo-phlebitis. Which laboratory value indicates that the client has a therapeutic level of warfarin?

Congrats! You finished the chapter.

My advice: Take a break to exercise

your body and give your mind a rest.

313419NCLEX-RN_Chap03.indd 68313419NCLEX-RN_Chap03.indd 68 4/8/2010 7:01:55 PM4/8/2010 7:01:55 PM

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