CAD and AS

During the 48 hours after a myocardial infarction, a nurse should assign the highest priority to monitoring the patient for: 1 Dysrhythmias 2 Anxiety and fear 3 Metabolic acidosis 4 Medication side effects

1 The nurse must be most alert for dysrhythmias, which may signal another MI or impending complications. The nurse should also be alert for increased anxiety, which may cause pain and lead to a secondary infarction. Anxiety and fear are highly likely but secondary in importance to monitoring the patient for dysrhythmias.

Which drug prevents platelet aggregation by inhibiting cyclooxygenase? 1 Aspirin 2 Heparin 3 Abciximab 4 Clopidogrel

1 Aspirin produces antiplatelet activity by inhibiting cyclooxygenase, which in turn produces thromboxane A2, a potent platelet activator.

A nurse is reviewing a drug therapy regimen for a postmenopausal, obese female for prevention of coronary artery disease. The regimen includes low-dose aspirin. Which specific assessments should the nurse perform to ensure that it is safe for the client to take the aspirin? Select all that apply. 1 Check the blood pressure 2 Obtain the history of chest pain 3 Check liver function test reports 4 Obtain the history of gastrointestinal bleeding

1, 4 Aspirin is an antiplatelet drug that can be used to prevent the development of coronary artery disease. It prevents the aggregation of platelets, which can prevent plaque from increasing in size. If blood pressure is high, aspirin can cause bleeding. People with a history of gastrointestinal bleeding are more susceptible to bleeding with aspirin administration. Therefore, before prescribing aspirin, the nurse should assess whether the patient is hypertensive and whether the patient has a history of gastrointestinal bleeding. Aspirin is used as a premedication for the prevention of autonomic symptoms like flushing associated with the use of niacin. Aspirin is also used as an analgesic for treating pain. Unlike statin drugs, low-dose aspirin does not alter liver function. Text Reference - p. 740

Which individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)? 1 A 45-year-old depressed male with a high-stress job 2 A 60-year-old male with below normal homocysteine levels

1. The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD

Which nursing intervention is most important for a patient during the first several days after a myocardial infarction? 1 Determining the patient's ability to tolerate a regular diet 2 Instructing the patient in how to utilize a bedside commode

2 To prevent complications such as cardiac rupture and reinfarction, it is important for the patient to cease any unnecessary activity, thereby decreasing cardiac demands.

What instruction should the nurse give to the patient who has a body mass index of 30.0 kg/m2? Select all that apply. 1 "Eat bacon." 2 "Eat soybeans." 3 "Eat red yeast rice." 4 "Eat cream cheese." 5 "Consume palm oil.

2, 3 The patient has a body mass index of 30.0 kg/m2, which is above the healthy range of 18.5 to 24.9 kg/m2. The patient can eat soybeans, because they are a lipid-lowering agent.

A nurse is teaching about coronary artery disease to a group of nursing students. To evaluate their understanding, the nurse asks them to explain why pain is referred to the shoulder, neck, and jaw in a case of stable angina. Prioritize the pathophysiologic events causing referred pain in stable angina. 1. Accumulation of lactic acid in the myocardium 2. Reduced blood supply to the myocardium 3. Inadequate aerobic metabolism in the myocardium 4. Transmission of pain impulses in the cardiac and upper thoracic posterior nerves 5. Irritation of nerve fibers of the myocardial tissue

2, 3, 1, 5, 4 Coronary occlusion causes a reduced blood supply to the heart, thereby leading to myocardial ischemia. Because the blood supply is compromised, there is inadequate oxygen delivery to the myocardium for aerobic metabolism to take place. Anaerobic metabolism begins and leads to the accumulation of lactic acid. Lactic acid irritates the myocardial nerve fibers, and pain impulses are transmitted to the cardiac nerves and upper thoracic posterior nerve roots. This causes referred cardiac pain to the shoulder, neck, lower jaw, and arms. Text Reference - p. 740

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? Select all that apply. 1 Flushing 2 Ashen skin 3 Diaphoresis 4 Nausea and vomiting 5 S3 or S4 heart sounds

2, 3, 4, 5 During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain.

A nurse is advising a 24-year-old obese female about smoking cessation, because smoking can lead to coronary artery disease. Why does the nurse discourage cigarette smoking? Select all that apply. 1 Tobacco decreases blood pressure. 2 Tobacco causes release of catecholamines. 3 Tobacco increases the estrogen levels in the body. 4 Smoking decreases the oxygen levels in the blood. 5 Tobacco increases the low-density lipoprotein levels.

2, 4, 5 Nicotine present in tobacco smoke stimulates the release of catecholamines. Catecholamines have a stimulatory effect on the sympathetic nervous system that causes an increase in heart rate and blood pressure. Carbon monoxide present in tobacco smoke has a greater affinity to hemoglobin than does oxygen. Therefore carbon monoxide reduces the oxygen-carrying capacity of blood. Tobacco smoke is known to increase the level of low-density lipoproteins and subsequently a decrease in high-density lipoproteins. All of these factors can lead to atherosclerosis. Tobacco smoke is known to decrease estrogen levels in premenopausal women, thereby increasing their susceptibility to get coronary artery disease. Text Reference - p. 734

The nurse is performing an assessment of a patient whose older brother recently had a myocardial infarction (MI). Which assessment data indicates to the nurse that the patient has additional risk factors for coronary artery disease (CAD)? Select all that apply. 1 Smoking cessation three years ago 2 Serum cholesterol level of 260 mg/dL 3 Fasting triglyceride level of 110 mg/dL 4 Multiple family problems over last two years 5 Living together with son who smokes two packs of cigarettes per day 6 Clerk job in an accounting firm and not exercising

2, 4, 5, 6 Serum cholesterol level greater than 200 mg/dL is a risk factor for CAD. Stress is an additional risk factor for developing CAD. Secondhand smoke increases the risk of CAD. A sedentary job and lack of exercising are risk factors for CAD. Smoking cessation will lead to a reduced mortality rate after a period of 12 months. Fasting triglyceride levels above 150 mg/dL are a risk factor for CAD. Text Reference - p. 732

A patient with a history of diabetes is diagnosed with chronic stable angina. Which drug would be beneficial to this patient? 1 Diltiazem 2 Sirolimus 3 Captopril 4 Bivalirudin

3 A patient with a history of diabetes who has chronic stable angina has a high risk for a cardiac event. An angiotensin II converting enzyme (ACE) inhibitor such as captopril can be safely used in this patient. Beta blockers such as diltiazem mask the signs of hypoglycemia and are used cautiously in patients with diabetes.

The nurse assesses a patient with papillary muscle dysfunction. Which observation supports the patient's diagnosis? 1 S3 or S4 heart sounds 2 Crackles 3 Murmur at the cardiac apex 4 Deep sound noted while auscultating at the lower sternal border

3 Papillary muscle dysfunction occurs if the papillary muscles attached to the mitral valves are involved in infarction

A patient who uses nonsmoking tobacco complains of chest pain when at rest. His or her electrocardiogram (ECG) shows ST segment elevation. Which condition is the patient experiencing? 1 Silent ischemia 2 Angina decubitus 3 Prinzmetal's angina 4 Chronic stable angina

3 Prinzmetal's angina often occurs at rest, usually in response to spasms of a major coronary artery due to nicotine, which cause the release of catecholamines such as epinephrine and norepinephrine. When the spasms occur, the patient experiences pain and ST segment elevation

he nurse is reviewing a plan of care for emergency treatment of a patient with chest pain. The nurse should question which item listed on the plan? 1 Initiate supplemental oxygen. 2 Administer emergency medications intravenously. 3 Instruct the patient to perform breathing exercises immediately. 4 Monitor the blood pressure and for Q and ST wave abnormalities regularly.

3 Rapid diagnosis and providing treatment to a patient with acute coronary syndrome help preserve cardiac muscle function. The initial treatment is to manage chest pain; therefore, the patient needs to rest and limit activities (including breathing exercises) for 12 to 24 hours. The nurse should make sure that the oxygen saturation stays at an acceptable level by initiating supplemental oxygen. The intravenous route for emergency medication therapy is preferred for patients with chest pain because this route is faster than oral administration. Continuous monitoring of electrocardiogram, vital signs, and pulse oximetry helps to evaluate the effectiveness of the treatments and monitor for complications. Text Reference - p. 750

The nurse recognizes that which type of medication may be prescribed for a patient with an ejection fraction of 25%? 1 Lipid lowering agent 2 Beta-adrenergic blocker 3 Calcium channel blocker 4 Angiotensin-converting enzyme (ACE) inhibitor

4 Angiotensin converting enzyme inhibitors improve ejection fraction, prevents ventricular remodeling, and prevents the progression of heart failure in the patient.

A nurse is assessing an older adult patient who is diagnosed with coronary artery disease. An angiogram reveals that the patient has 80 percent blockage of the left circumflex artery and 70 percent blockage of the right coronary artery. The patient does not show any symptoms of coronary ischemia. What is the most appropriate reason for this finding? 1 Lowering of low-density lipoprotein (LDL) levels in the body 2 Pulmonary artery supplies oxygenated blood to the heart 3 Formation of collaterals in the coronary circulation 4 Increased production of C-reactive proteins in the liver

3 This patient is an older adult and, therefore, the occlusion may have occurred slowly over a long period of time. Collateral circulation may have developed which provides adequate blood supply to the myocardium, thereby preventing ischemia.

The primary health care provider suggests the patient with stable angina who is receiving treatment avoid isosorbide dinitrate at night unless symptoms occur. The risk of which complication is reduced through this intervention? Select all that apply. 1 Depression 2 Atherosclerosis 3 Medication Tolerance 4 Orthostatic hypotension 5 Raynaud's phenomenon

3, 4 The patient receiving nitrates must be on a nitrate-free period every day usually for eight hours in the night to limit the effect of orthostatic hypotension, which is caused by venous dilation. Patient tolerance to medication-induced vasodilation can be avoided through eight-hour breaks in dosage.

The nurse is teaching a patient with chronic stable angina on the use of nitroglycerin (NTG). Which statement made by the patient indicates effective learning? 1 "I should dissolve the tablets in a glass of water." 2 "I should store the medications in a light area." 3 "I should replace the tablets in the container every 18 months." 4 "I should take a tablet one half-hour before beginning activities."

4 Nitroglycerine is a first line treatment for patients with chronic stable angina. The patient should take nitroglycerin (NTG) before beginning any strenuous activities in order to prevent an anginal episode. The patient should keep nitroglycerin tablets away from light and heat sources to protect them from degradation. Therefore, the medication should be stored in a shady area. The patient should replace the tablets in the container every six months. Text Reference - p. 743

For which problem is percutaneous coronary intervention (PCI) most clearly indicated? 1 Chronic stable angina 2 Left-sided heart failure 3 Coronary artery disease (CAD) 4 Acute myocardial infarction

4 PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD normally are treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.

What is the most appropriate nursing intervention for a patient who smokes cigarettes and is predisposed to developing coronary artery disease? 1 Recommend smokeless tobacco. 2 Encourage the use of filtered cigarettes. 3 Suggest smoking low nicotine cigarettes. 4 Discuss medication to assist with smoking cessation

4 The patient must be encouraged to quit smoking. Smoking cessation medications such as bupropion can be used to prevent the withdrawal symptoms of nicotine. Even if the patient is using smokeless tobacco, the risk of developing coronary artery disease is the same. Changing to filtered cigarettes does not affect the risk of developing coronary artery disease.

5. A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately a. apply a compression stocking to the leg. b. elevate the leg above the level of the heart. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

5. A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately a. apply a compression stocking to the leg. b. elevate the leg above the level of the heart. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position. ANS: D The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg.

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? A Administer ordered morphine sulfate. B Position patient in a semi-Fowler's position. C Position patient on left side with head of bed flat. D Instruct patient on the use of relaxation techniques. E Use a calm, reassuring approach while talking to patient.

A Administer ordered morphine sulfate. B Position patient in a semi-Fowler's position. D Instruct patient on the use of relaxation techniques. E Use a calm, reassuring approach while talking to patient. Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A Reduce preload. B Decrease afterload. C Increase contractility. D Promote vasodilation.

A Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

The nurse is reviewing the laboratory test results for a 68-year-old patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. The nurse concludes that the patient is in the most stable condition for surgery after noting which INR (international normalized ratio) result? A. 1.0 B. 1.8 C. 2.7 D. 3.4

A. 1.0 The therapeutic range for INR is 2.0 to 3.0 for many clinical diagnoses. The larger the INR number, the greater the amount of anticoagulation. For this reason, the safest value before surgery is 1.0, meaning that the anticoagulation has been reversed.

Which person should the nurse identify as having the highest risk for abdominal aortic aneurysm? A. A 70-year-old male, with high cholesterol and hypertension B. A 40-year-old female with obesity and metabolic syndrome C. A 60-year-old male with renal insufficiency who is physically inactive

A. A 70-year-old male, with high cholesterol and hypertension The most common etiology of descending abdominal aortic aneurysm (AAA) is atherosclerosis. Male gender, age 65 years or older, and tobacco use are the major risk factors for AAAs of atherosclerotic origin. Other risk factors include the presence of coronary or peripheral artery disease, high blood pressure, and high cholesterol.

1. When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 147/82 and an ankle pressure of 112/74. The nurse calculates the patient's ankle-brachial index (ABI) as ________ (round up to the nearest hundredth).

ANS: 0.76 The ABI is calculated by dividing the ankle systolic BP by the brachial systolic BP.

4. A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of medications will the nurse plan to include when providing patient teaching about PAD management? a. Statins b. Antibiotics c. Thrombolytics d. Anticoagulants

ANS: A Current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.

27. A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene? a. The LPN/LVN has the patient sit in a chair for 90 minutes. b. The LPN/LVN assists the patient to walk 40 feet in the hallway. c. The LPN/LVN gives the ordered aspirin 160 mg after breakfast. d. The LPN/LVN places the patient in a Fowler's position for meals.

ANS: A The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

8. When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will a. have to buy some loose clothes that do not bind across my legs or waist." b. use a heating pad on my feet at night to increase the circulation and warmth in my feet." c. change my position every hour and avoid long periods of sitting with my legs crossed." d. walk to the point of pain, rest, and walk again until the pain returns for at least 30 minutes 3 times a week."

ANS: B Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.

12. When developing a community health program to decrease the incidence of rheumatic fever, which action would be most important for the community health nurse to include? a. Vaccinate high-risk groups in the community with streptococcal vaccine. b. Teach community members to seek treatment for streptococcal pharyngitis. c. Teach about the importance of monitoring temperature when sore throats occur. d. Teach about prophylactic antibiotics to those with a family history of rheumatic fever.

ANS: B The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Teaching about monitoring temperature will not decrease the incidence of rheumatic fever.

7. The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find a. dilated superficial veins. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. a serosanguineous drainage from the ulcer.

ANS: C Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

19. A 23-year-old patient tells the health care provider about experiencing cold, numb fingers when running during the winter and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for a. hyperglycemia. b. hyperlipidemia. c. autoimmune disorders. d. coronary artery disease.

ANS: C Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis. Patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hyperglycemia, or coronary artery disease.

13. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

ANS: C The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.

35. The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question? a. Use of treadmill for exercise b. Referral for dietary instruction c. Exercising to the point of discomfort d. Combined clopidogrel and omeprazole therapy

ANS: D Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this prescription with the health care provider. The other interventions are appropriate for a patient with peripheral artery disease.

6. A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should a. check for the presence of tortuous veins bilaterally on the legs. b. ask about any skin color changes that occur in response to cold. c. assess for unilateral swelling, redness, and tenderness of either leg. d. assess for the presence of the dorsalis pedis and posterior tibial pulses.

ANS: D The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism (VTE).

The nurse teaches a student nurse about acute pericarditis. Which statement made by the student nurse indicates effective learning? 1 "I should massage the patient in the chest region to relieve symptoms." 2 "The patient's chest pain can be relieved by sitting in the forward position." 3 "Acute pericarditis should be treated immediately by intravenous heparin."

Acute pericarditits is an inflammation of the pericardium that may occur within two to three days of acute myocardial infarction. The patient's chest pain is relieved after sitting in the forward position. The pain may return after a change in position or inspiration. Massaging the chest region may aggravate the symptoms. Intravenous heparin is given to a patient with an unstable thrombus or coronary artery spasm.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A High-potassium foods B Drugs to treat erectile dysfunction C Nonsteroidal antiinflammatory drugs D Over-the-counter H2 -receptor blockers

B Drugs to treat erectile dysfunction The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? A Acute anxiety B Hypotension and tachycardia C Peripheral edema and weight gain D Paroxysmal nocturnal dyspnea (PND)

B Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

A patient with varicose veins has been prescribed compression stockings. How should the nurse teach the patient to use these? A. "Try to keep your stockings on 24 hours a day, as much as possible." B. "While you're still lying in bed in the morning, put on your stockings." C. "Dangle your feet at your bedside for 5 minutes before putting on your stockings."

B. "While you're still lying in bed in the morning, put on your stockings." The patient with varicose veins should apply stockings in bed, before rising in the morning. Stockings should not be worn continuously, but they should not be removed several times daily. Dangling at the bedside prior to application is likely to decrease their effectiveness.

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely? A. Buttock, upper outer quadrant B. Abdomen, anterior-lateral aspect C. Back of the arm, 2 inches away from a mole D. Anterolateral thigh, with no scar tissue nearby

B. Abdomen, anterior-lateral aspect Enoxaparin (Lovenox) is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. All subcutaneous injections should be given away from scars, lesions, or moles.

A 73-year-old man with dementia has a venous ulcer related to chronic venous insufficiency. The nurse should provide education on which type of diet for this patient and his caregiver? A. Low-fat diet B. High-protein diet C. Calorie-restricted diet D. High-carbohydrate diet

B. High-protein diet A patient with a venous ulcer should have a balanced diet with adequate protein, calories, and micronutrients; this type of diet is essential for healing. Nutrients most important for healing include protein, vitamins A and C, and zinc. Foods high in

A patient was just diagnosed with acute arterial ischemia in the left leg secondary to atrial fibrillation. Which early clinical manifestation must be reported to the physician immediately to save the patient's limb? A. Paralysis B. Paresthesia C. Crampiness D. Referred pain

B. Paresthesia The physician must be notified immediately if any of the six Ps of acute arterial ischemia occur to prevent ischemia from quickly progressing to tissue necrosis and gangrene. The six Ps are paresthesia, pain, pallor, pulselessness, and poikilothermia, with paralysis being a very late sign indicating the death of nerves to the extremity. Crampy leg sensation is more common with varicose veins. The pain is not referred.

The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed? A. Decreased cardiac output B. Increased blood pressure C. Cerebral or pulmonary emboli D. Excessive bleeding from incision or IV sites

C. Cerebral or pulmonary emboli Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could again form. If one or more thrombi detach from the atrial wall, they could travel as cerebral emboli from the left atrium or pulmonary emboli from the right atrium.

The nurse would determine that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noting what during a routine shift assessment? A. Generalized weakness and fatigue B. Crackles bilaterally in the lung bases C. Pain and swelling in lower extremity D. Abdominal pain with decreased bowel sounds

C. Pain and swelling in lower extremity Enoxaparin is a low-molecular-weight heparin used to prevent the development of deep vein thromboses (DVTs) in the postoperative period. Pain and swelling in the lower extremity can indicate development of DVT and therefore may signal ineffective medication therapy.

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? A. Hematocrit (Hct) B. Hemoglobin (Hgb) C. Prothrombin time (PT) D. Partial thromboplastin time (PTT)

C. Prothrombin time (PT) Vitamin K counteracts hypoprothrombinemia and/or reverses the effects of warfarin (Coumadin) and thus decreases the risk of bleeding. High values for either the prothrombin time (PT) or the international normalized ratio (INR) demonstrates the need for this medication.

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? A Muscle aches B Constipation C Pounding headache D Anorexia and nausea

D Anorexia and nausea Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? A Taper the patient off his current medications. B Continue education for the patient and his family. C Pursue experimental therapies or surgical options. D Choose interventions to promote comfort

D Choose interventions to promote comfort and prevent suffering. The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

A male patient was admitted for a possible ruptured aortic aneurysm, but had no back pain. Ten minutes later his assessment includes the following: sinus tachycardia at 138, BP palpable at 65 mm Hg, increasing waist circumference, and no urine output. How should the nurse interpret this assessment about the patient's aneurysm? A. Tamponade will soon occur. B. The renal arteries are involved. C. Perfusion to the legs is impaired. D. He is bleeding into the abdomen.

D. He is bleeding into the abdomen. The lack of back pain indicates the patient is most likely exsanguinating into the abdominal space, and the bleeding is likely to continue without surgical repair. A blockade of the blood flow will not occur in the abdominal space as it would in the retroperitoneal space where surrounding anatomic structures may control the bleeding. The lack of urine output does not indicate renal artery involvement, but that the bleeding is occurring above the renal arteries, which decreases the blood flow to the kidneys. There is no assessment data indicating decreased perfusion to the legs.

10. A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. Based on these findings, which nursing diagnosis would be most appropriate? a. Pain related to permanent joint fixation b. Activity intolerance related to arthralgia c. Risk for infection related to open skin lesions d. Risk for impaired skin integrity related to pruritus

NS: B The patient's joint pain will lead to difficulty with activity. The skin lesions seen in rheumatic fever are not open or pruritic.

The nurse notes that the patient was taking clopidogrel at home. The nurse knows that this medication belongs to which drug class? 1 Vitamin K antagonist 2 Nonsteroidal antiinflammatory drug (NSAID) 3 Opioid analgesic 4 Antiplatelet

Plavix is an antiplatelet medication, used commonly in patients with cardiovascular disease. Plavix is not an opioid analgesic, NSAID, or vitamin K antagonist.

Which statement made by the student nurse indicates effective learning regarding the instructions to be given to a patient who is on nitroglycerin? 1 "I should direct the patient to inhale the spray containing medication." 2 "I should ask the patient to change position rapidly after the medication use."

Short-acting nitrates such as nitroglycerin (NTG) are first-line medications for angina. The nurse has to instruct the patient on NTG to report any changes in the pattern of pain, frequency of attack, or nocturnal angina to the health care provider. The nurse must direct the patient to spray the medication on his or her tongue. The nurse should ask the patient to slowly change positions after NTG use to avoid the effects of orthostatic hypotension. The nurse should ask the patient to take NTG every five minutes for a maximum of three doses if symptoms are not resolved. Text Reference - p. 743

what cause dep

beta block

cause prinzmetals angina

raynauds

When the patient is being examined for venous thromboembolism (VTE) in the calf, what diagnostic test should the nurse expect to teach the patient about first? ■ Duplex ultrasound ■ Contrast venography ■ Magnetic resonance venography ■ Computed tomography venography

■ Duplex ultrasound The duplex ultrasound is the most widely used test to diagnose VTE. Contrast venography is rarely used now. Magnetic resonance venography is less accurate for calf veins than pelvic and proximal veins. Computed tomography venography may be used but is invasive and much more expensive than the duplex ultrasound.

The patient has CVI and a venous ulcer. The unlicensed assistive personnel (UAP) decides to apply compression stockings because that is what these patients always have ordered. What assessment by the nurse would cause the application of compression stockings to harm the patient? ■ Rest pain ■ High blood pressure ■ Elevated blood sugar ■ Dry, itchy, flaky skin

■ Rest pain Rest pain occurs as peripheral artery disease (PAD) progresses and involves multiple arterial segments. Compression stockings should not be used on patients with PAD. Elevated blood glucose, possibly indicating uncontrolled diabetes mellitus, and hypertension may or may not indicate arterial problems. Dry, itchy, flaky skin indicates venous insufficiency. The RN should be the one to obtain the order and instruct the UAP to apply compression stockings if they are ordered.

The patient had aortic aneurysm repair. What priority nursing action will the nurse use to maintain graft patency? ■ Assess output for renal dysfunction. ■ Use IV fluids to maintain adequate BP. ■ Use oral antihypertensives to maintain cardiac output. ■ Maintain a low BP to prevent pressure on surgical site

■ Use IV fluids to maintain adequate BP. The priority is to maintain an adequate BP (determined by the surgeon) to maintain graft patency. A prolonged low BP may result in graft thrombosis, and hypertension may cause undue stress on arterial anastomoses resulting in leakage of blood or rupture at the suture lines, which is when IV antihypertensives may be used. Renal output will be assessed when the aneurysm repair is above the renal arteries to assess graft patency, not maintain it.