Cardio Part 1 ATI

A nurse is reinforcing teaching with a client about how to prevent the onset of manifestations of Raynaud's phenomenon. Which of the following statements should the nurse identify as an indication that the client needs further teaching?

"I will keep my house at a cool temperature." (Raynaud's phenomenon occurs during exposure to extreme temperatures or from stress, resulting in painful vasoconstriction of peripheral blood vessels, typically in the hands and feet. Keeping the house comfortably warm can help prevent the manifestations of Raynaud's phenomenon.)

A nurse is reinforcing discharge teaching for a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication?

"I'll use my electric razor for shaving." (The nurse should emphasize that because this medication prolongs clotting times, the client should avoid situations that put him at risk for bleeding, such as shaving with a straight razor or a razor blade. An electric razor should be used instead.)

A nurse is reinforcing teaching with an older adult client who has been newly diagnosed with a heart term-2murmur. Which of the following statements should the nurse make?

"This indicates turbulent blood flow through a valve." (Turbulent blood flow through a valve generates a murmur, possibly due to a malfunctioning valve, increased blood flow, or a type of defect in the structures of or around the heart.)

A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?

Check the client's vital signs. (When using the airway, breathing, circulation approach to client care, the nurse should place the priority on obtaining vital signs. Nausea is a manifestation of digoxin toxicity, along with other manifestations such as muscle weakness, confusion, abdominal cramping, and changes in vision.)

A nurse is collecting data from a client who has mitral stenosis. Which of the following findings is a manifestation of this condition?

Dyspnea on exertion (Due to narrowing of the valve, pressure in the lungs leads to dyspnea on exertion.)

A nurse is collecting data from a client who has anemia due to excess blood loss during surgery. The nurse should expect which of the following findings?

Dyspnea on exertion (Dyspnea on exertion is a manifestation of anemia.)

A nurse is caring for a client who is postoperative following a total knee replacement. Which of the following actions should the nurse implement to prevent deep vein thrombophlebitis?

Encourage increased fluid intake. (Increased fluid intake will prevent dehydration, which can contribute to the development of deep vein thrombophlebitis.)

A nurse is assisting with the plan of care for a client immediately following a cardiac catheterization with coronary angiography. An arterial closure device was used to close the access site. Which of the following interventions should the nurse recommend?

Have the client rest in bed for 2 hr. (Clients who had manual or mechanical pressure after catheter removal require 6 hr of bed rest. Those who had a closure device or patch only need 2 hr of bed rest.)

A nurse is assisting with the plan of care for a client who has a new deep-vein thrombosis (DVT) in his leg. Which of the following interventions should the nurse include in the plan?

Keep the client's affected leg elevated. (The nurse should elevate the client's affected leg to reduce swelling and reduce the risk for an embolus.)

A nurse is collecting data from a client who has an acute myocardial infarction (MI). Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.)

Nausea Tachycardia Diaphoresis

A nurse is collecting data from a client who has right-sided heart failure. Which of the following findings should the nurse expect?

Peripheral edema (Peripheral edema is caused by weakness in the right side of the heart, allowing blood to back up into the venous system and leak into interstitial tissues.)

A nurse is collecting data from a client who has venous insufficiency. Which of the following findings should the nurse expect?

Pitting edema (Pitting edema is an expected finding for a client who has venous insufficiency. The venous system is unable to efficiently return blood to the heart resulting in increased venous pressure and an accumulation of fluid in the interstitial tissues.)

A nurse is reinforcing teaching with a newly licensed nurse about reading a client's ECG tracing. The nurse should include in the teaching that the P wave represents which of the following cardiac electrical activities?

​Atrial depolarization (The P wave represents atrial depolarization, typically initiated in the sinoatrial node.)

A nurse is caring for a client who has a hemoglobin of 10.8 g/dL and a hematocrit of 30%. The nurse should expect the client is at risk for which of the following conditions?

​Cellular hypoxia (The client's laboratory results indicate anemia, which places the client at risk for cellular hypoxia.)