Cardiac & some pediatrics

Which statements by the mother of a toddler should lead the nurse to suspect that the child is at risk for iron deficiency anemia? Select all that apply. 1. he drinks over four glasses of milk per day 2. I cannot keep enough apple juice in the house; he must drink over 10 oz per day 3. he refuses to eat more than 2 different kinds of vegetables 4. he does not like meat, but he will eat small amounts of it 5. he sleeps 12 hours every night, and takes a 2 hr nap

1, 2- toddlers should have between 2 and 3 servings of milk per day and no more than 6 oz of juice, if they are getting this much they probably aren't eating enough other foods like iron rich foods

When preparing a client for a cardiac angiogram, what actions should the nurse take? Select all that apply. 1. Determine if the client has an allergy to liquid contrast 2. Inform the client that an intravenous infusion will be started before the procedure 3. Remind the client to have nothing to eat or drink for 8 hours prior to the procedure 4. Instruct the client to remain still during the procedure 5. Explain that the client will receive a fast acting anesthetic

1,2,3,4

The nurse is caring for a client who recently experienced MI and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply 1. The client should report unexpected bleeding or bleeding that lasts a long time 2. The client should take clopidogrel with food 3. The client may bruise more easily and may experience bleeding gums 4. Clopidogrel works by preventing platelets from sticking together and forming a clot 5. The client should drink a glass of water after taking clopidogrel

1,3,4 - clopidogrel can be taken without regards to food and a glass of water is not necessary after taking

Good dental care is an important measure in reducing the risk of endocarditis. What should a teaching plan to promote good dental care in a client with mitral stenosis instruct the client to do? Select all that apply. 1. Brush teeth at least twice a day 2. Avoid use of an electronic toothbrush 3. Floss the teeth at least once a day 4. Take an antibiotic prior to oral surgery 5. Have regular dental checkups 6. Rinse the mouth with an antibiotic mouth wash once a day

1,4,5

An 18 month old with a congenital heart defect is to receive digoxin 2x a day. Which instructions should the nurse give the parents? 1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm 2. Signs of toxicity should include increased pulse and visual disturbances 3. Digoxin is absorbed better if taken with meals 4. If the child vomits within 15 minutes of administration the dosage should be repeated.

1- digoxin's effect is to slow the rate of electrical conduction through the heart and increase the strength of the heart's contraction

A 68 year old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The nurse should first: 1. Inquire about onset, duration, and severity and precipitating factors of the heaviness 2. Administer oxygen via nasal cannula 3. Offer pain medication for the heaviness 4. Inform the HCP of the chest heaviness

1- further assessment is needed, and you will need it to report to HCP because they will ask

A client admitted for a myocardial infarction develops cardiogenic shock. An arterial line is inserted. Which prescription from the healthcare provider should the nurse verify before implementing? 1. Call for urine output < 30 mL/hr for 2 consecutive hours 2. Administer metoprolol 5mg IV push 3. Prepare for a pulmonary artery catheter insertion 4. Titrate dobutamine to keep systolic BP > 100mm Hg

1- metoprolol is indicated in the treatment of hemodynamically stable clients with an acute MI to reduce cardiovascular mortality

An older adult has chest pain and shortness of breath. The HCP prescribes nitroglycerin tablets. What should the nurse instruct the client to do? 1. Place the tablet under the tongue until it is absorbed 2. Swallow the tablet with 120mL of water 3. Chew the tablet until it is dissolved 4. Place the tablet between cheek and gums until it disappears

1- nitroglycerin tablets aren't effective if chewed, swallowed, or placed between cheeks and gums

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving IV heparin sodium at 1,000 units/hour. During the second post procedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. The nurse should first: 1. Don gloves and Apple direct pressure over the site 2. Observe and document the bleeding 3. Notify HCP 4. Prepare protamine sulfate for IV administration

1- priority action is to stop blood loss from femoral artery , if bleeding cannot be controlled then call HCP

Which initial physical finding indicates the development of carditis in a child with rheumatic fever? 1. heart murmur 2. low blood pressure 3. irregular pulse 4. anterior chest wall pain

1- the most common sign of carditis is heart murmur

A 60 year old comes into the emergency department with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Admission prescriptions include oxygen via N/c 4L/min, CBC, chest radiograph, a 12 lead ECG, and 2mg of morphine sulfate given IV. The nurse should FIRST: 1. Administer the morphine 2. Obtain a 12 lead ECG 3. Obtain the blood work 4. Prescribe the chest radiograph

1- the nurses priority action is to relieve the crushing chest pain

A client has been admitted to the coronary care unit. The nurse observed a 3rd degree heart block at a rate of 35 bpm on the cardiac monitor. The client has a BP of 90/60. The nurse should first: 1. Prepare for transcutaneous pacing 2. Prepare to defibrillate the patient at 200 J 3. Administer an IV lidocaine infusion 4. Schedule an operating room for insertion of a permanent pacemaker

1- transcutaneous pacing provides an adequate heart rate to a client in an emergency situation

After teaching the parents of a child newly diagnosed with leukemia about the disease, which description if given by the parents BEST indicates understanding of the nature of leukemia? 1. the disease is an infection resulting in increased WBC production 2. the disease is a type of cancer characterized by an increase of immature white blood cells 3. the disease is an inflammation associated with enlargement of lymph nodes 4. the disease is an allergic disorder involving increased circulating antibodies in the blood

2

When administering a thrombolytic drug to the client who is experiencing a myocardial infarction and who has premature ventricular contractions, the expected outcome of the drug is to: 1. Promote hydration 2. Dissolve clots 3. Prevent kidney failure 4. Treat dysthymia

2

A client with unstable angina is scheduled to have a cardiac catheterization. The nurse explains to the client that this procedure is being used to: 1. Open and dilate the blocked coronary arteries 2. Assess the extent of the arterial blockage 3. Bypass obstructed vessels 4. Assess functional adequacy of the valves and heart muscle

2 - cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary blockage

Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply 1. fever 2. petechiae 3. epistaxis 4. anorexia 5. bone pain 6. shortness of breath

2,3

A client is scheduled for a cardiac catheterization. The nurse should do which preprocedure tasks? Select all that apply 1. Administer all prescribed oral meds 2. Check for iodine sensitivity 3. Verify that written consent has been obtained 4. Withhold food and oral fluids before the procedure 5. Insert a urinary drainage catheter

2,3,4

Which problem is the highest risk for a child with leukemia who's lab values are as follows: WBC 6,500mm3, platelet count 40,000 uL, and Hct 41.2%? 1. activity intolerance 2. bleeding 3. impaired tissue perfusion 4. infection

2- a low platelet count puts the child at risk for bruising and bleeding, normal platelet is 150,000-400,000

The nurse has completed an assessment on a client with a decreased cardiac output. Which finding should receive the HIGHEST PRIORITY? 1. BP 110/62, atrial fibrillation with HR 82, bilateral basilar crackles 2. Confusion, urine output 15mL over the last 2 hours, orthopnea 3. SPO2 92% on 2L nasal cannula, respiration's 20, 1+ edema of lower extremities 4. Weight gain of 1 kg in 3 days, bp 130/80, mild dyspnea with exercise

2- a low urine output and confusion are signs of decreased tissue perfusion

Which food should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? 1. Apples 2. Canned tomato juice 3. Whole wheat bread 4. Beef tenderloin

2- canned foods are typically high in sodium

When developing the plan of care for a newly admitted 2 year old with Kawasaki disease, which intervention should be the PRIORITY? 1. taking vital signs every 6 hr 2. monitoring intake and output every hour 3. minimizing skin discomfort 4. providing passive range of motion exercises

2- cardiac status must be monitored carefully in the first initial phase of KD because the child is at risk for CHF. so assess for signs of CHF (increased fluid volume or fluid retention)

A 10 year old with leukemia is taking immunosuppressive drugs. To maintain health, the nurse should instruct the child and parents to: 1. continue with immunizations 2. not receive any live attenuated vaccines 3. receive vitamin and mineral supplements 4. stay away from peers

2- children who are immunosuppressed should not receive any live vaccines, as they can develop severe cases of the illness

A 15 year old is admitted to the hospital with the diagnosis of acute leukemia. Which signs and symptoms require the most immediate nursing intervention? 1. fatigue and anorexia 2. fever and petechiae 3. swollen neck lymph glands and lethargy 4. enlarged liver and spleen

2- fever and petechiae associated with acute leukemia indicate a suppression of WBC and thrombocytes and put the client at risk for other infections and bleeding

The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, the nurse should include which instructions? 1. Exercise in cool temperatures 2. Drink at least 2 quarts of fluid per day 3. avoid contact sports 4. take anti-inflammatory medications before exercising

2- increasing fluid intake and being well hydrated will prevent cell stasis in the small vessels

An older client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the HCP has a written prescription to: 1. Limit the amount of protein in the diet prior to the cardiac catheterization 2. Withhold metformin prior to the cardiac catheterization 3. Administer metformin with only a sip of water prior to the cardiac catheterization 4. Give the metformin before breakfast

2- metformin is contraindicated with contrast dye

A client with chest pain is prescribed IV nitroglycerin. Which assessment is of the GREATEST concern for the nurse initiating the nitroglycerin drip? 1. Serum potassium 3.5 2. Blood pressure is 88/46 3. ST elevation is present on ECG 4. Heart rate is 61 bpm

2- nitroglycerin is a vasodilator that will lower BP

Which foods should the nurse encourage a parent to offer to a child with iron deficiency anemia? 1. rice cereal, whole milk, and yellow vegetables 2. potato, peas, and ham 3. macaroni, cheese, and ham 4. pudding, green vegetables, and rice

2- potatoes, peas, chicken, green vegetables, and fortified cereals contain significant amounts of iron

Which information should the nurse include when completing discharge instructions for the parents of a 12-month old child diagnosed with Kawasaki disease and being discharged home? 1. Offer the child extra fluids every 2 hrs for 2 weeks 2. Take the child's temperature daily for several days 3. Check the child's blood pressure daily until the follow up appointment 4. Call the HCP if the irritability lasts for 2 more weeks

2- the child's temperature should be taken for several days after discharge because recurrent fever may develop

The monitor technician informs the nurse that the client has started having premature ventricular contractions every other beat. What should the nurse do FIRST? 1. Activate the rapid response team 2. Assess the clients orientation and vital signs 3. Call the HCP 4. Administer a bolus of lidocaine

2- the priority action is to assess the client and determine whether the rhythm is life threatening, more information is needed before the rest of these actions

A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nurse administers furosemide to treat pulmonary congestion and begins a nitroprusside drip as prescribed. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and pulmonary wedge pressure. The nurse should first assess: 1. 12 lead EKG 2. Blood pressure 3. Lung sounds 4. Urine output

2- these 2 medications can cause severe hypotension

A middle aged client being admitted to the hospital has a history of hypertension and informs the nurse that his father died from a heart attack at age 60. The client reports having "indigestion". The nurse connects the client to a cardiac monitor which reveals eight premature ventricular contractions per minute. The nurse should next: 1. Call the HCP 2. Start an IV 3. Obtain a portable chest radiograph 4. Draw blood for laboratory studies

2- to prepare for advanced cardiac life support

A client has risk factors for coronary artery disease, including smoking, eating a diet high in saturated fat, and leading a sedentary lifestyle. The nurse can coach this client to improve health by: 1. Explaining how the risk factors lead to poor health 2. Withholding praise until the client changes the risky behavior 3. Helping the client establish a wellness vision to reduce the health risks 4. Instill a mild fear into the client about potential outcomes of the risky behavior

3

The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The nurse knows that the client understands the discharge plan when the client: 1. Selects a low cholesterol diet to control CAD 2. States a need for bed rest for 1 week after discharge 3. Verbalized safety precautions needed to prevent pacemaker malfunction 4. Explains signs and symptoms of MI

3

The nurse should teach the client that signs of digoxin toxicity include: 1. Rash over chest and back 2. Increased appetite 3. Visual disturbances such as seeing yellow spots 4. Elevated BP

3

A client is given amiodarone in the emergency department for dysrhythmia. Which finding indicates the drug is having the desired effect? 1. The ventricular rate is increasing 2. The absent pulse is now palpable 3. The number of premature ventricular contractions is decreasing 4. The fine ventricular fibrillation changes to coarse ventricular fibrillation

3- amiodarone is used for the treatment of premature ventricular contractions, v-tach with a pulse, atrial fibrillation, and atrial flutter

Upon assessment of 3rd degree heart block on the monitor, the nurse should do what first? 1. Call a code 2. Begin CPR 3. Place transcutaneous pacing pads on the client 4. Prepare for defibrillation

3- best treatment of choice , hemodynamic stability and pulse should be assessed prior to calling a code or initiating CPR, defibrillator is used for v-fib or v-tach with no pulse

The nurse is explaining to the parents of a 1-year old child admitted to the hospital in sickle cell crisis that the local tissue damage the child has on admission is caused by which factor? 1. autoimmune reaction complicated by hypoxia 2. lack of oxygen in the red blood cells 3. obstruction to circulation 4. elevated serum bilirubin concentration

3- characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis

Which is the most important initial post procedure nursing assessment for a client who had a cardiac catheterization? 1. Monitor laboratory values 2. Observe neurological function every 15 minutes 3. Observe the puncture site for swelling and bleeding 4. Monitor skin warmth and turgor

3- circulatory status is primary importance

The nurses discharge teaching plan for the client with heart failure should emphasize the importance of: 1. Maintaining a high fiber diet 2. Walking 2 miles every day 3. Obtaining daily weights at the same time every day 4. Remaining sedentary for most of the day

3- daily weights are very important in clients with heart failure, (fluid retention)

The client who experiences angina has been told to follow a low cholesterol diet. Which meal would be BEST? 1. Hamburger, salad, and milk shake 2. Baked liver, green beans, and coffee 3. Spaghetti with tomato sauce, salad, coffee 4. Fried chicken, green beans, and skim milk

3- hamburgers, liver, milk shakes, and fried foods are all high in cholesterol

A nurse is planning care for a 12-year old with rheumatic fever. The nurse should teach the parents to: 1. Observe the child closely 2. allow the child to participate in activities that will not tire him 3. provide adequate periods of rest between activities 4. encourage someone in the family to be with the child 24 hrs a day

3- the client should rest to decrease cardiac workload

A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse should wedge the catheter to gain information about: 1. Cardiac output 2. Right atrial blood flow 3. Left end diastolic pressure 4. Cardiac index

3- when wedged, the catheter is "pointing" indirectly at the left end diastolic pressure

The nurse should assess for digoxin toxicity if serum levels indicate that the client has a: 1. Low sodium level 2. High glucose level 3. High calcium level 4. Low potassium level

4- a low potassium level predisposes a client to digoxin toxicity

The nurse notices that a clients heart rate decreases from 63 to 50 bpm on the monitor. The nurse should FIRST: 1. Administer atropine 0.5mg IV push 2. Auscultate for abnormal heart sounds 3. Prepare for transcutaneous pacing 4. Take the clients blood pressure

4- the nurse should first assess the clients tolerance to the drop in HR by assessing BP and LOC and then determine if atropine is needed

Which client is at greatest risk for coronary artery disease? 1. A 32 year old female with mitral valve prolapse who quit smoking 10 years ago 2. A 43 year old male with a family history of CAD and a cholesterol level of 158 3. A 56 year old male with an HDL of 60 who takes atorvastatin 4. A 65 year old female who is obese with an LDL of 188

4- the woman is overweight and has an elevated LDL(bad cholesterol)

Which activity would be appropriate to delegate to UAP for a client diagnosed with an MI who is stable? 1. Evaluate lung sounds 2. Help the client identify risk factors for CAD 3. Provide teaching on 2-g sodium diet 4. Record I & O

4- this falls within their scope of practice, nothing else does

A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated lab value to the HCP prior to the stress test? 1. Cholesterol level 2. Erythrocyte sedimentation rate 3. Prothrombin time 4. Troponin

4. Elevated troponin indicates myocardial damage and would contraindicate the stress test (could cause more damage)

A client has chest pain rated at an 8 on a 10 point visual analog scale. The 12-lead ECG reveals ST elevation in the inferior leads, and troponin levels are elevated. What should the nurse do FIRST? 1. Monitor daily weights and urine output 2. Limit visitation by family and friends 3. Provide client information on medications and diet 4. Reduce pain and myocardial oxygen demand

4. Nursing management for a client with an MI should focus on pain management and decreasing myocardial oxygen demand