The standard policy on the cardiac unit states, “Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg.”. Which patient should the nurse call the health care provider about?

Newly admitted patient with a BP of 150/87 mm Hg.

Patient with left ventricular failure who has a BP of 110/70 mm Hg.

Postoperative patient with a BP of 116/42 mm Hg.

Patient with a myocardial infarction who has a BP of 140/86 mm Hg.

Answer and Explanation

The Correct Answer is C

The patient with a blood pressure of 116/42 mm Hg has a mean arterial pressure (MAP) of approximately 67 mm Hg, which is less than the standard policy of 70 mm Hg. This could indicate inadequate blood flow to the vital organs, necessitating notification of the healthcare provider.

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Correct Answer is A

Explanation

Choice A rationale
Left heart failure is a common cause of right heart failure. When the left side of the heart is unable to pump blood efficiently, it can cause increased pressure in the lungs, which can then lead to right heart failure.
Choice B rationale
Pericarditis, an inflammation of the sac-like covering around the heart, is not typically a direct cause of right heart failure.
Choice C rationale
While hypertension, or high blood pressure, can contribute to heart failure, it typically affects the left side of the heart more than the right.
Choice D rationale
Acute pneumonia, an infection that inflames the air sacs in one or both lungs, is not typically a direct cause of right heart failure.

A. Pleural friction rub B. Distended neck veins C. Widening pulse pressure D. Bradycardia .

Correct Answer is B

Explanation

Choice A rationale
A pleural friction rub is an audible raspy breathing sound, a medical sign present in some patients with pleurisy and other conditions affecting the chest cavity. It is not a typical symptom of cardiac tamponade.
Choice B rationale
Distended neck veins are a result of the collapsed blood vessels that should return blood to the heart. This is a common symptom of cardiac tamponade.
Choice C rationale
Widening pulse pressure occurs with valvular heart disease, not typically with cardiac tamponade.
Choice D rationale
Bradycardia, or a slower-than-normal heart rate, is not typically associated with cardiac tamponade.

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The standard policy on the cardiac unit states, “Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg.”. Which patient should the nurse call the health care provider about?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 73-year-old patient has increased pulmonary pressure resulting in right heart failure. What could be a potential cause for the right heart to fail?

Correct Answer is A

Explanation

A nurse is caring for a client who has developed cardiac tamponade. Which of the following symptoms should the nurse expect to observe?

Correct Answer is B

Explanation

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