Cue Cards on Cardiac & Renal

A nurse is planning care for a newly admitted client diagnosed with acute nephrotic syndrome. What interventions should the nurse include in the plan of care? SATA. 1. Monitor triglyceride level 2. Assess hydration status 3. Educate client on a 3 g sodium diet. 4. Auscultate lung sounds. 5. Monitor blood pressure. 6. Assess for venous thromboembolism (VTE).

1, 2, 4, 5, & 6. Correct: The liver increases the release of cholesterol and triglycerides while producing more needed albumin. The client could go into a fluid volume excess or fluid volume deficit depending on the severity of the disease. This client is at risk for heart failure, and pulmonary edema so the lungs should be auscultated and the blood pressure should be monitored. Without proteins, the blood can clot and put the client at risk for thrombosis or embolism. 3. Incorrect: The client should be on a low sodium diet (3 grams is too high). Carbohydrates are given liberally to provide energy.

Which signs or symptoms would a nurse expect to find in a client admitted to the hospital in the oliguric phase of acute kidney injury (AKI)? SATA. 1. Edema 2. Hypotension 3. Hyperkalemia 4. Decreased blood urea nitrogen 5. Metabolic acidosis

1, 3. & 5. Correct: Edema, fluid volume excess, hypertension will be seen in this phase of AKI. Oliguria reflects kidney damage so potassium, BUN and creatinine levels will increase. Metabolic acidosis occurs as well. 2. Incorrect: Due to the client retaining fluid, the nurse would see hypertension rather than hypotension. 4. Incorrect: Renal damage would cause the BUN to increase.

A nurse is taking care of a client with major partial thickness burns. Tobramycin 125mg IVPB has been prescribed. What is the priority lab assessment prior to administering this medication? 1. Creatinine 2. Potassium 3. Magnesium 4. Blood urea nitrogen

1. Correct: Tobramycin can cause nephrotoxicity. 2. Incorrect: This will not tell us if the kidneys are damaged. 3. Incorrect: This will not tell us if the kidneys are damaged. 4.Incorrect: BUN can elevate for reasons other than renal problems.

A client who was admitted to coronary care unit with a diagnosis of myocardial infarction is on continuous cardiac monitoring. Which cardiac change noted on the monitor would be of greatest concern? 1. Ventricular tachycardia > 100 bpm 2. Atrial fibrillation with atrial rate > 300 per minute 3. Four premature ventricular contractions within one minute 4. ST-segment depression of 0.5 mm

1. Correct: Ventricular tachycardia with a ventricular rate greater than 100 per minute can be a precursor to ventricular fibrillation. This rhythm is the most life-threatening and would be of greatest concern. 2. Incorrect: Clients diagnosed with atrial fibrillation are at high risk for the formation of thrombus. This is a serious concern, but not as great a concern as ventricular tachycardia. 3. Incorrect: Premature ventricular contractions (PVCs) that are less than 6 are worrisome but not considered a precursor to ventricular tachycardia or ventricular fibrillation. 4. Incorrect: ST-segment depression of 1 mm or more signifies myocardial ischemia.

What should a nurse include when planning an educational program for a group of women on how to prevent a urinary tract infection (UTI)? SATA. 1. Increase daily intake to at least 9 cups (2160 mL) of water. 2. Urinate within one hour after sexual intercourse. 3. Help soothe the peritoneum using bubble baths. 4. Wipe from the anal area to the vaginal area after a bowel movement. 5. Void when the urge occurs.

1., & 5. Correct: Water helps to dilute urine and flush out bacteria. Do not hold urine. When the urge occurs, void to prevent accumulation of bacteria. 2. Incorrect: Urination should occur within 15 minutes after sexual intercourse. 3. Incorrect: Avoid bubble baths. They cause irritation and lead to UTIs. 4. Incorrect: After bowel movements, always wipe from the vaginal area toward the rectum. This helps prevent bacteria in the anal area from spreading to the vagina and urethra.

What should the nurse include in the teaching plan for a client with right-sided heart failure? SATA. 1. There is a backup of blood in the right upper chamber of the heart. 2. There is swelling of lower extremities. 3. The heart rate decreases. 4. You may experience fatigue and depression. 5. You may awaken frequently at night to urinate.

1., 2. 4. & 5. Correct: The blood backs up into the right atrium and venous circulation. Vascular congestion is evident by swelling of the lower extremities. Clients usually experience fatigue and depression. Diuresis at rest is due to fluid in the peripheral tissue being mobilized and excreted. The client awakens during the night to urinate. 3. Incorrect: The heart rate increases in an attempt to increase cardiac output.

The nurse is monitoring the client's heart rhythm. The monitor shows sinus tachycardia. What is expected with this assessment finding? SATA. 1. Regular rhythm 2. Rate of 101-200 3. P-wave normal 4. P-R interval not measurable 5. QRS complex normal

1., 2., 3. & 5. Correct: Sinus tachycardia indicates a regular rhythm, although the rate is elevated. The term tachycardia is defined as a heart rate above 100. The P-wave is normal in a sinus rhythm. Sinus rhythms have a normal QRS complex. 4. Incorrect: P-R interval is not measurable in atrial flutter, atrial fib, PVCs, V-tach or V-fib.

What information should a community health nurse include while planning an educational program on prevention of deep vein thrombus formation for a group of people who attend a senior citizens center? SATA. 1. Exercise legs by raising and lowering heels while toes are on floor when traveling by plane. 2. Stop smoking 3. Lose weight 4. Stop every 4 hours to walk when traveling by car 5. Exercise daily

1., 2., 3., & 5. Correct: If on a plane, try to stand or walk occasionally. If unable to do that, at least try to exercise lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes while your heels are on the floor. Make lifestyle changes. Lose weight and quit smoking. Obesity and smoking increase your risk of deep vein thrombosis. Get regular exercise. Exercise lowers a person's risk of blood clots, which is especially important for people who have to sit a lot or travel frequently, 4. Incorrect: If traveling long distances by car, stop every hour or so and walk around.

A nurse is caring for a client post heart catheterization with a left femoral stick. What signs and symptoms would indicate to the nurse that the primary healthcare provider should be notified? SATA. 1. Capillary refill of 6 seconds to left toes. 2. Epigastric discomfort 3. Paresthesia to left leg 4. Left pedal pulse 0/4; Right pedal pulse 2+/4 5. Left foot pain 6. Temperature of 99.9º F (37.72º C)

1., 2., 3., 4. & 5. Correct: These signs and symptoms indicate an emergency with loss of circulation to the extremity. This is an emergency, and the primary healthcare provider is the only one that can save this foot from ischemia. Don't delay. Epigastric pain could indicate the client is having an MI. Always assume the worse! 6. Incorrect: Temperature of 101º F (38.3º C) or more indicates a problem.

Which signs and symptoms experienced by the client correlate with chronic renal failure diagnosis? SATA. 1. Fatigue 2. Anorexia 3. Dark skin pigmentation 4. Swollen extremities 5. Hyperkalemia

1., 2., 4. & 5. Correct: The client will have fatigue from anemia and anorexia from toxins. Fluid volume excess leads to swollen extremities. Hyperkalemia can be caused by reduced renal excretion or excessive intake. 3. Incorrect: The client will have an itchy frost not dark skin pigmentation.

During the admission examination of a client diagnosed with acute pyelonephritis, what signs or symptoms would the nurse expect to find? SATA. 1. Dysuria 2. Costovertebral angle tenderness 3. Weight loss 4. Chills 5. Urinary frequency

1., 2., 4., & 5. Correct: The client with acute pyelonephritis, will often exhibit these signs/symptoms due to kidney infection. 3. Incorrect: Weight loss is not a symptom of acute pyelonephritis. The client will more likely experience weight gain due to the decreased functioning of the kidneys.

After assessing a client, the nurse determines that the client has incomplete emptying of the bladder with reports of dribbling, hesitancy, and frequency. Which interventions should the nurse include for this client? SATA. 1. Encourage intake of cranberry juice daily. 2. Encourage the client to void at least every 8 hours. 3. Perform Credé method. 4. Place the client's hands in warm water. 5. Teach intermittent catheterization for retention if needed.

1., 3., 4. & 5. Correct: Encourage intake of cranberry juice daily. This keeps urine acidic. Place bedpan, urinal, or bedside commode within reach. Provide privacy. Have client listen to the sound of running water or place hands in warm water and/or pour warm water over perineum to stimulate urination. Offer fluids before voiding. Perform Credé method over bladder to increase bladder pressure. 2. Incorrect: Encourage client to void at least every 4 hours.

A client who has been diagnosed with chronic venous insufficiency has received teaching regarding how to prevent venous stasis ulcerations. Which statements by the client indicate to the nurse that teaching has been effective? SATA. 1. "Stationary standing should be kept to a minimum." 2. "It is important to avoid wearing constricting clothes longer than 2 hours." 3. "Elevation of my legs should be done for 15 minutes every 4-6 hours." 4. "Protecting my legs from trauma is very important." 5. "I will wear compression stockings every day." 6. "I will elevate the foot of my bed 6 inches (15.24 cm) when I sleep."

1., 4., 5., & 6. Correct: Minimize stationary standing as much as possible. Protect legs from trauma as this can lead to ulcerations. Elastic compression stockings are recommended for clients with chronic venous insufficiency to prevent pooling and promote venous return. Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (for at least 15-30 minutes every 2 hours). During the night, the client should sleep with the foot elevated approximately 6 inches (15.24 cm). 2. Incorrect: The client should avoid wearing any constricting clothing, even for short periods of time. This will decrease blood flow. 3. Incorrect: Leg elevation decreases edema, promotes venous return, and provides symptomatic relief. Legs should be elevated frequently throughout the day (at least 15 to 30 minutes every 2 hours).

A home heath nurse is educating a client about home care considerations for clean intermittent catheterization. Which statement by the client would let the nurse know that the client understands what has been taught? 1. "After insertion, I will tape the tubing to my upper thigh." 2. "I will wash the catheter thoroughly with soap and water after use." 3. "It is important that I keep the drainage bag below the level of my bladder." 4. "Catheterization should be done hourly."

2. Correct: For intermittent catheterization in the home, the client should follow clean technique. Wash catheters thoroughly with soap and water after use, dry, and store in a clean place. 1. Incorrect: First of all, with intermittent catheterization, you do not have a bag with tubing. There is no tubbing to secure. 3. Incorrect: With intermittent catheterization there is no drainage bag. 4. Incorrect: Catheterization is done when the client feels the need to void, but cannot void. Catheterizing this often can increase the risk of infection.

In order to maintain asepsis, what should the nurse teach the client on home peritoneal dialysis? SATA. 1. Drink only bottled water. 2. Cap Tenckhoff catheter when not in use. 3. Soak the dialysate in warm water. 4. Clean the arteriovenous fistula with hydrogen peroxide twice a day. 5. Wash around the catheter insertion site daily.

2., & 5. Correct: Capping the Tenckhoff catheter prevents dialysate leakage and bacterial invasion. Clean around insertion site to decrease the risk of bacterial infection. 1. Incorrect: What does drinking bottled water have to do with it? Nothing 3. Incorrect: Soaking the bags of solution in warm water can introduce bacteria to the exterior of the bags of solution . 4. Incorrect: Do you have an arteriovenous fistula? Not with peritoneal dialysis.

A client is admitted with arterial disease of the lower extremities. Which client teachings should the nurse initiate? SATA. 1. Elevate extremities above the level of the heart. 2. Discourage use of caffeine. 3. Protect extremities from cold exposure. 4. Maintain a warm environment at home. 5. Avoid isometric exercise.

2., 3. & 4. Correct: Caffeine, stress, and nicotine cause vasoconstriction and vasospasm, which impedes peripheral circulation. Warmth promotes arterial flow by preventing the vasoconstriction effects of chilling. Vasodilation will be increased by providing warmth in the environment. Cold causes vasoconstriction. 1. Incorrect: Lower the extremities below the level of the heart for arterial problems. Dependent extremities enhance arterial blood supply. 5. Incorrect: Isometric exercise and walking encourage the development of collateral circulation.

What should the nurse instruct a client to avoid when prescribed digoxin? 1. Corn 2. Apples 3. Black licorice 4. Milk

3. Correct: Black licorice can deplete the body of potassium which can result in digoxin toxicity. 1. Incorrect: Corn is a vegetable that can be eaten when digoxin is prescribed. 2. Incorrect: Apples can be eaten when digoxin is prescribed. 4. Incorrect: Milk can be consumed when digoxin is prescribed.

A client was admitted to the unit during the night shift with chronic hypertension. At 0830, the unlicensed assistive personnel (UAP) reports that the client's blood pressure is 198/94 mm Hg. What would be the best action for the charge nurse to delegate at this time? 1. Ask a nursing student to put the client back in bed immediately. 2. Tell the UAP to take the BP in the opposite arm in 15 minutes. 3. Have the staff RN administer the 0900 furosemide and enalapril now. 4. Ask the LPN/LVN to assess the client for pain.

3. Correct: These medications lower blood pressure. 1. Incorrect: This client is unstable and needs a licensed nurse caring for them. 2. Incorrect: This client is considered unstable and the UAP should not have assignments until stable. 4. Incorrect: This is not an appropriate action for the LPN/VN.

A small community has experienced a severe tornado that hit a shopping mall and caused extreme damage and suspected mass casualties and injuries. What should be done first? 1. Triage victims and tag according to injury. 2. Assess the immediate area for electrical wires on the ground. 3. Activate the community emergency response team. 4. Begin attending to injuries as they are encountered.

3. Correct: With mass casualties, community response teams are needed. 1. Incorrect: This would be the third step. 2. Incorrect: This would be the second step so that further injuries are not encountered. 4. Incorrect: Triage must occur before treatment of anyone so that an accurate assessment of level of injuries can be made. With mass casualties, a color tag system is usually implemented.

A construction worker comes into the occupational health nurse's clinic reporting chest heaviness. The nurse should assess for what additional signs and symptoms? SATA. 1. Severe headache 2. Dry, flushed skin 3. Lightheadedness 4. Dyspnea 5. Irregular pulse

3., 4. & 5. Correct: The nurse should be thinking myocardial infarction! All of these are signs of an MI. 1. Incorrect: Headaches do not commonly occur with MI. 2. Incorrect: Skin would be cool and clammy.

What teaching should the nurse provide the client regarding prevention of deep vein thrombosis when traveling by plane for a long period of time? SATA. 1. Do not cross legs longer than 15 minutes at a time. 2. Get up and move around the plane every 4 hours. 3. Wear compression stockings while traveling. 4. Perform foot pumps every 30 minutes. 5. Increase water intake.

3., 4., & 5. Correct: Compression stockings put gentle pressure on the leg muscles. It is important for passengers to perform foot pumps every 30 minutes to help the blood flow, even when waiting in the airport terminal. The client should maintain hydration by increasing their intake of water. 1. Incorrect: Do not cross legs at all. 2. Incorrect: The client should get up and move around at least every 2 hours. While walking the muscles of the legs squeeze the veins and move blood to the heart.

An elderly client with a recent diagnosis of atrial fibrillation (AF) caused by valvular heart disease, tells the nurse, "My daughter has AF and she only has to take one dabigatran pill a day. I have to take warfarin daily and have my blood checked every month. Why do I have to do all of this?" What education should the nurse provide to the client? 1. Your daughter's atrial fibrillation must not be caused by a heart valve problem so she can take a medication that does not require routine clotting studies. 2. Each primary healthcare provider may treat the this dysrhythmia differently based on what the provider is used to prescribing. 3. When your daughter gets older, her primary healthcare provider will switch her to Warfarin for the treatment of atrial fibrillation. 4. Your atrial fibrillation is caused by a heart valve problem which is treated best by warfarin, but clotting studies have to be done routinely.

4. Correct: This client has at least three risk factors, warranting more aggressive treatment. Typically warfarin is given to treat AF in the elderly with compounding risk factors. 1. Incorrect: Risk factors are the deciding factors for treatment. 2. Incorrect: Typical regimens are based on risk factors. 3. Incorrect: Acetylsalicylic acid is one treatment depending on number and severity of risk factors.

When an explosion occurs at a local shopping center, an off-duty nurse quickly begins to triage those injured. The nurse knows which client needs immediate attention? 1. An elderly adult with a traumatic left eye enucleation. 2. A child with an open, compound fracture of the femur. 3. An adult with a head laceration bleeding profusely. 4. An adolescent with a rigid, board-like lower abdomen.

4. Correct: This client's symptoms indicate the presence of internal bleeding. Without emergency surgery, this client will quickly develop hypovolemic shock and may not survive. 1. Incorrect: This client has lost the left eye due to trauma. Despite the fact that this client is elderly and may have other co-morbidities, and the eye injury is not considered life-threatening. 2. Incorrect: A fractured femur can lead to other issues, such as blood loss or fat emboli; however, even an open, compound fracture is not considered the most life-threatening injury here. 3. Incorrect: Lacerations of the face, head or hands generally do bleed profusely because the vessels are near the surface of the skin. However, this represents capillary blood and is not critical.