Exam 6

26. Which findings would the nurse expect in a cli-ent with mitral valve stenosis? Select all that apply. A. A client with mild mitral valve stenosis will likely be asymptomatic. B. Classic signs include dyspnea, angina, and syncope. C. Rumbling apical diastolic murmur D. Syncope on exertion E. Sinus tachycardia F. Right-sided heart failure with jugular (neck) vein distention

26. A, B, C, F Key features of mitral valve stenosis include fatigue; dyspnea of exertion; orthopnea; parox-ysmal nocturnal dyspnea; hemoptysis; hepato-megaly; neck vein distention; pitting edema, atrial fibrillation; and rumbling apical diastolic murmur. Syncope on exertion occurs with aor-tic stenosis and sinus tachycardia with aortic regurgitation.

The nurse is admitting an 84-year-old client with heart failure to the emergency department with confusion, blurry vision, and an upset stomach. Which assessment data are most concerning? A. Digoxin therapy daily B. Daily metoprolol C. Furosemide twice daily D. Currently taking an antacid for upset stomach

A

What does the nurse suspect when assessment of a client with HF reveals pulses that alternate in strength? A. Pulsus alternans B. Pulsus paradoxus C. Orthostatic hypotension D. Angina

A

What early sign of left ventricular failure is a client most likely to report to the nurse? A. Nocturnal coughing B. Swollen legs C. Weight gain D. Nocturia

A

Which assessment finding will the nurse anticipate in a client with severe atherosclerotic disease? A. Carotid artery bruit B. HDL 60 mg/dL C. Palpable peripheral pulses D. BP 120/58 mm Hg

A

23. Which relatively new therapy would be tried for clients with familial hypercholesterolemia or for those who are unable to reduce LDLs with existing therapies? A. PCSK9 inhibitors B. Nicotinic acid C. Lovaza (omega-3 ethyl esters) D. Combination drugs (e.g., Caduet)

A The Food and Drug Administration (FDA) ap-proved the drug class, PCSK9 inhibitors, for use in clients with familial hypercholesterolemia or for those who are unable to reduce LDLs with existing therapies. Nicotinic acid (niacin) may lower LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels and increase HDL-C levels but is poorly tolerated due to side effects. Lovaza (omega-3 ethyl esters) is approved by the FDA as an adjunct to diet to reduce TGs that are greater than 500 mg/dL. Caduet is used to decrease blood pressure while decreasing triglycerides (TGs), increasing HDL, and lowering LDL

13. Which piece of equipment would the nurse recommend for a client to manage hypertension at home? A. Blood pressure monitoring device B. Stationary exercise bicycle C. Blood glucose monitoring device D. Kitchen food scale

A The nurse would teach the client to obtain an ambulatory BP monitoring (ABPM) device for use at home so the pressure can be checked daily. The nurse would also evaluate the client's and family's ability to use this device accurately and instruct the client to keep a record of blood pressure readings and report very low or high readings to the primary health care provider

15. What drug would the nurse expect to be prescribed for a client with hypertension and for whom lifestyle modifications have failed to control blood pressure? A. Thiazide diuretic B. Calcium channel blocker C. Angiotensin-converting enzyme inhibitor D. Beta blocker

A Thiazide (low-ceiling) diuretics, such as hydro-chlorothiazide, inhibit sodium, chloride, and water reabsorption in the distal tubules while promoting potassium, bicarbonate, and mag-nesium excretion. Because of the low cost and high effectiveness of thiazide-type diuretics, they are usually the drugs of choice for clients with uncomplicated hypertension

19. Which action increases the effectiveness of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in controlling hypertension for African-American clients? A. The ARB or ACEI is given with a diuretic, beta blocker, or a calcium channel blocker. B. A much higher dose of ARB or ACEI is prescribed for an African-American client. C. The ARB or ACEI is combined with rigorous lifestyle modifications. D. Clients take the ARB or ACEI around the clock on an individualized schedule.

A ACEIs and ARBs are not as effective in African Americans unless they are taken with diuretics or another drug category such as a beta-blocker or calcium channel blocker

30. Which urgent intervention is required when the nurse reviews the results of diagnostic testing for a client with aortic stenosis and discovers that the surface area of the valve is less than 1 cm? A. Surgical aortic heart valve replacement B. Aortic valvuloplasty in the cardiac catheterization laboratory C. Physical therapy to create an individualized exercise program D. Therapy with drugs that will increase myocardial contractility

A As stenosis worsens, cardiac output becomes fixed and cannot increase to meet the demands of the body during exertion and symptoms develop. Eventually, the left ventricle fails, blood backs up in the left atrium, and the pulmonary system becomes congested. Right-sided HF can occur late in the disease. When a client has aortic stenosis and the surface area of the valve becomes 1 cm or less, surgery is indicated on an urgent basis!

36. Which complication is a client at most risk for when the nurse notes that excessive fluid was seen in the pericardial cavity on echocardiogram? A. Cardiac tamponade B. Pericardial friction rub C. Systemic emboli D. Splinter hemorrhages

A Cardiac tamponade is compression of the myocardium by fluid that has accumulated around the heart. This compresses the atria and the ventricles, prevents them from filling adequately, and reduces cardiac output.

17. What are the priority nursing actions related to caring for an older adult client with HF who is prescribed digoxin? Select all that apply. A. Monitor the ECG strip for early signs of toxicity such as bradycardia. B. Auscultate the apical pulse heart rate and rhythm for a full minute before administering the drug. C. Observe for signs of toxicity, which are often nonspecific such as anorexia, fatigue, and blurred vision. D. Report any changes in heart rate or rhythm to the health care provider. E. Monitor serum digoxin and potassium levels. F. Check the health care provider's prescription for parameters to hold the drug

A, B, C, D, E, F All of these responses are appropriate to the care of an older adult with heart failure who has been prescribed digoxin. Often the cardiac heath care provider will have the nurse hold a clients digoxin dose if the heart rate is less than 50-60 bpm

24. Which features would the nurse recognize as indicating that a client had a venous ulcer? Select all that apply. A. No claudication or rest pain B. Ulcer located in the ankle area C. Brown pigmentation D. Very little granulation tissue present E. Ulcer bed is pink F. Pulses are present

A, B, C, E, F Characteristics of venous ulcers include: chronic nonhealing ulcer; no claudication or rest pain; moderate ulcer discomfort; client reports of ankle or leg swelling; location is the ankle area; brown pigmentation; the ulcer bed is pink; the ulcer is usually superficial, with uneven edges; granulation tissue present; ankle discoloration and edema; full veins when leg slightly dependent; no neurologic deficit; pulses present; and may have scarring from previous ulcers.

30. Which information would the nurse be sure to include when teaching a client with peripheral arterial disease about methods to promote vasodilation? Select all that apply. A. Maintain a warm environment at home. B. Wear socks or insulated shoes at all times. C. Prevent cold exposure to the affected limb. D. Apply direct heat to the involved limb with a heating pad. E. Completely abstain from smoking or chewing tobacco. F. Avoid emotional stress and excessive caffeine.

A, B, C, E, F Vasodilation can be achieved by providing warmth to the affected extremity and preventing long periods of exposure to cold (which causes vasoconstriction). Encourage clients to maintain a warm environment at home and to wear socks or insulated shoes at all times. Caution clients to avoid the application of direct heat to the limb with heating pads or extremely hot water because sensitivity in the affected limb is decreased and burns may result. Emotional stress, caffeine, and nicotine also can cause vasoconstriction. Stress that complete abstinence from smoking or chewing tobacco is essential to prevent vasoconstriction.

44. Which signs or symptoms would the nurse expect when assessing a client with chronic constrictive pericarditis? Select all that apply. A. Exertional fatigue and dyspnea B. Dependent edema C. Crackles and wheezes D. Hepatic engorgement E. Pink, frothy sputum F. Decreased appetite

A, B, D Clients with chronic constrictive pericarditis (lasting longer than 3 months) have signs of right-sided HF, including elevated systemic venous pressure with jugular distention, hepatic engorgement, and dependent edema. Exertional fatigue and dyspnea are common.

32. Which statements about percutaneous vascular interventions are accurate? Select all that apply. A. One or more arteries are dilated with a balloon catheter to open the vessel(s). B. Stents are often placed to ensure adequate blood flow. C. Placement of stents results in a longer hospitalization. D. Some clients are occlusion free for 3 to 5 years. E. Clients who are candidates must have occlusions or stenoses that are accessible to the catheter. F. A percutaneous vascular intervention is considered to be a minor surgical procedure

A, B, D, E A nonsurgical but invasive approach for im-proving arterial flow is the use of percutaneous vascular intervention (PVI). One or more arteries are dilated with a balloon catheter advanced through a cannula, which is inserted into or above an occluded or stenosed artery. When the procedure is successful, it opens the vessel and improves arterial blood flow. Clients who are candidates for percutaneous procedures must have occlusions or stenoses that are accessible to the catheter. Reocclusion may occur, and the procedure may be repeated. Some clients are occlusion-free for up to 3 to 5 years, whereas others may experience reocclusion within a year. During PVI, intravascular stents (wire meshlike devices) are usually inserted to assure adequate blood flow in a stenosed vessel. Clients often have these procedures in same-day surgery or ambulatory care centers (e.g., very short hospital stays).

37. Which assessment findings would cause the nurse to suspect cardiac tamponade in a client? Select all that apply. A. Neck vein distention B. Paradoxical pulse C. Hypertension D. Muffled heart sounds E. Tachycardia F. Petechiae

A, B, D, E Findings of cardiac tamponade include: jugular venous (neck vein) distention; paradoxical pulse, also known as pulsus paradoxus; tachycardia; muffled heart sounds; and hypotension (not hypertension)

19. Which are potential benefits of a client receiving the drug digoxin? select all that apply A. Reduced heart rate B. Increased contractility C. Venous vasodilation D. Slowed conduction through the AV node E. Inhibition of sympathetic activity with enhanced parasympathetic activity F. Enhanced renal excretion of sodium and water

A, B, D, E The potential benefits of digoxin include: in-creased contractility; reduced heart rate (HR); slowing of conduction through the atrioventricular node; and inhibition of sympathetic activity while enhancing parasympathetic activity. Diuretics (especially loop and thiazide) enhance excretion of water and sodium. Nitrates are venous vasodilators.

48. Which are potential causes of dilated cardiomyopathy? Select all that apply. A. Alcohol abuse B. Sedentary lifestyle C. Cigarette smoking D. Infection E. Chemotherapy F. Poor nutrition

A, D, E, F Causes of dilated cardiomyopathy may include alcohol abuse, chemotherapy, infection, inflammation, and poor nutrition.

33. What nursing actions are included in the routine postprocedural care for a client after percutaneous vascular intervention? Select all that apply. A. Observe for bleeding at the puncture site. B. Perform frequent distal pulse checks on both limbs. C. Provide supplemental oxygen at 5 L per nasal cannula. D. Administer antiplatelet therapy as prescribed. E. Monitor for signs of shock. F. Check vital signs frequently as ordered.

A, B, D, E, F All of these actions are appropriate to post procedure care for a client who had a percutaneous transluminal intervention. However, most clients will not need supplemental oxygen, especially at such a high flow rate as 5 L. This flow rate would tend to dry the nasal passages.

51. Which assessment findings would suggest to the nurse that a client who received a heart transplant was experiencing organ rejection? Select all that apply. A. Shortness of breath B. Hypotension C. Abdominal pain D. Decreased activity tolerance E. Fluid gain (edema, increased weight) F. Atrial fibrillation or flutter

A, B, D, E, F Signs and symptoms of heart transplant rejection include: shortness of breath; fatigue; fluid gain (edema, increased weight); abdominal bloating; new bradycardia; hypotension; atrial fibrillation or flutter; decreased activity tolerance; and decreased ejection fraction (late sign).

5. Which lifestyle changes would the nurse teach a client to help control hypertension? Select all that apply. A. Weight reduction if overweight or obese. B. Implement a healthy diet such as the DASH diet. C. Decrease smoking and nicotine use. D. Use relaxation techniques to decrease stress. E. Restrict sodium by not adding salt at the table. F. Increase activity by use of a structured exercise program

A, B, D, F The nurse would teach all clients about lifestyle changes to help control hypertension including: restrict dietary sodium according to ACC/AHA guidelines (not adding table salt is often not enough); reduce weight if overweight or obese; implement a heart-healthy diet, such as the DASH diet; increase physical activity with a structured exercise program; abstain or de-crease alcohol consumption (no more than one drink a day for women and two drinks a day for men); stop smoking and tobacco use; and use relaxation techniques to reduce stress.

31. Which drugs are useful in promoting circulation for clients with chronic peripheral arterial disease? Select all that apply. A. Aspirin B. Ezetimibe C. Pentoxifylline D. Clopidogrel E. Cilostazol F. Propranolol

A, C, D, E Clients with chronic peripheral arterial disease are prescribed hemorheologic and antiplatelet agents. Pentoxifylline is a hemorheologic agent that increases the flexibility of red blood cells. It decreases blood viscosity by inhibiting platelet aggregation and decreasing fibrinogen and thus increases blood flow in the extremities. Aspirin and clopidogrel are antiplatelet drugs used to reduce risk for myocardial infarction, stroke, and vascular death. Some clients receive both drugs (dual antiplatelet therapy). Clients who experience disabling intermittent claudication may also benefit from phosphodiesterase inhibitors such as cilostazol because it can help improve symptoms and increasing walking distance. Beta blockers are avoided because they may have drug-related claudication or a worsening of symptoms. Ezetimibe is a cholesterol-lowering drug

20. Which nursing interventions promote a client's compliance with antihypertensive therapy? Se-lect all that apply. A. Provide oral and written instructions related to all prescribed medications. B. Give the client a list of resources for finding additional information on prescribed drugs. C. Stress that suddenly stopping beta blockers can cause angina or heart attack. D. Suggest that the client have a home scale for weight monitoring. E. Advocate for medications that are taken three times a day for better BP control. F. Teach clients to report unpleasant side effects to the primary health care provider

A, C, D, F Health teaching is essential to help clients become successful in managing their BP. Pro-vide oral and written information about the indications, dosage, times of administration, side effects, and drug interactions for antihypertensives. Stress that medication must be taken as prescribed. Teach that suddenly stopping drugs such as beta blockers can result in angina (chest pain), myocardial infarction (MI), or rebound hypertension. e in the home for weight monitoring. Remember that clients are more compliant with the plan of care when drugs are given once a day. In-struct clients to report unpleasant side effects of antihypertensive drugs so that another drug may be prescribed to minimize those side effects

2. Which factors would the nurse note as increasing the risk for atherosclerosis with an older African-American client? Select all that apply. A. 20-year history of type 2 diabetes B. Nutrition includes three to four diet sodas per day C. Sedentary lifestyle D. 25 pounds overweight E. Father with history of colon cancer F. Grandmother died after heart attack

A, C, D, F Risk factors for atherosclerosis include: low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, diabetes mellitus, obe-sity, hypertension, sedentary lifestyle, smoking, stress, African American or Hispanic ethnicity, older adult, and diet high in saturated and trans fats, cholesterol, sodium, and sugar

28. Which are the characteristics that the nurse would expect when a client is diagnosed with mitral valve prolapse (MVP)? Select all that apply. A. Valve leaflets enlarge and bulge up into the left atrium during systole. B. Hepatomegaly is a late sign. C. Most clients are asymptomatic and this abnormality is benign. D. Many clients have normal heart rates and blood pressures. E. Older adults have increased risk for mitral valve prolapse. F. A midsystolic click and late systolic murmur is best heard at the apex of the heart.

A, C, D, F With MVP, the valvular leaflets enlarge and prolapse (bulge) upward into the left atrium during systole. This abnormality is usually benign. However, it may progress to pronounced mitral regurgitation in some clients. A normal heart rate and BP are usually found on physical examination. A midsystolic click and a late systolic murmur may be heard at the apex of the heart. MVP often begins in younger adults and has a familial tendency. Hepatomegaly occurs with mitral stenosis, not MVP.

38. Which statements are accurate about a client's true aneurysm? Select all that apply. A. The aneurysm may be described as fusiform or saccular. B. An aneurysm is formed when blood accumulates in the wall of an artery. C. The aneurysm creates a permanent dilation of an artery. D. A true aneurysm can occur as a result of trauma to the arterial walls. E. A congenitally weakened arterial wall may result in an aneurysm. F. The aneurysm section of the arterial wall is enlarged to at least twice its normal diameter.

A, C, E, F An aneurysm is a permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter. It may be described as fusiform (a diffuse dilation affecting the entire circumference of the artery) or saccular (an out-pouching affecting only a distinct portion of the artery). Aneurysms may also be described as true or false. In true aneurysms, the arterial wall is weakened by congenital or acquired problems. False aneurysms occur as a result of vessel injury or trauma to all three layers of the arterial wall. Dissecting aneurysms differ from true aneurysms in that they are formed when blood accumulates within the wall of an artery.

29. Which signs and symptoms would the nurse expect to assess when a client is diagnosed with aortic stenosis? Select all that apply. A. Dyspnea on exertion B. Atypical chest pain C. Angina D. Hemoptysis E. Harsh, systolic crescendo-decrescendo murmur F. Orthopnea

A, C, E, F Signs and symptoms of aortic stenosis include dyspnea on exertion; angina; syncope on exertion; fatigue, orthopnea, paroxysmal nocturnal dyspnea; and harsh, systolic crescendo-decrescendo murmur. Atypical chest pain is characteristic of mitral valve prolapse and hemoptysis occurs with mitral stenosis.

4. Which control systems play an important role in maintaining a client's blood pressure? Select all that apply. A. The arterial baroreceptor system B. Elevated lipid levels C. Regulation of body fluid volume D. Dietary saturated fats and sodium E. Vascular autoregulation F. The renin-angiotensin-aldosterone system

A, C, E, F Stabilizing mechanisms exist in the body to exert overall regulation of systemic arterial pressure and to prevent circulatory collapse. Four control systems play a major role in main-taining blood pressure: the arterial barorecep-tor system, regulation of body fluid volume, the renin-angiotensin-aldosterone system, and vascular autoregulation. Some elevated lipid levels contribute to development of atheroscle-rosis and arterial disease. A diet high in satu-rated fats and sodium is a risk factor for devel-opment of atherosclerosis

21. Which assessment findings indicate to the nurse that a client has stage III peripheral arterial disease (PAD)? Select all that apply. A. Pain is described as numbness, burning, toothache-type pain. B. Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. C. Pain is relieved by placing the extremity in a dependent position. D. Ulcers and blackened tissue occur on the toes, forefoot, and heel. E. Pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel). F. Pain while resting commonly awakens the client at night

A, C, E, F Stage III peripheral arterial pain is also called rest pain. Key features include: pain while resting which commonly awakens the client at night; the pain is described as numbness, burn-ing, or toothache-type pain; the pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel); and pain is relieved by placing the extremity in a dependent position. Muscle pain, cramping, or burning that occurs with exercise and is relieved with rest is a feature of stage II; and ulcers and blackened tissue occur on the toes, forefoot, and heel, which is characteristic of stage IV.

24. Which key points would the nurse include when teaching a client about signs and symp-toms of return or worsening of heart failure, that must be reported to the primary health care provider? Select all that apply. A. Cold symptoms (e.g., cough) lasting more than 3 to 5 days B. Rapid weight loss of 3 lb in a week C. Excessive awakening at night to urinate D. Increase in exercise tolerance lasting 2 to 3 days E. Development of dyspnea or angina at rest or worsening angina F. Increased swelling in feet, ankles, or hands

A, C, E, F Teach the client and caregiver to immediately report to the primary health care provider the occurrence of any of these symptoms, which could indicate worsening or recurrent heart failure: rapid weight gain (3 lb in a week or 1 to 2 lb overnight); decrease in exercise tolerance lasting 2 to 3 days; cold symptoms (cough) last-ing more than 3 to 5 days; excessive awakening at night to urinate; development of dyspnea or angina at rest or worsening angina; and in-creased swelling in the feet, ankles, or hands.

23. Which drugs would the nurse prepare to administer to a client with HF who has developed pulmonary edema? Select all that apply. A. Nitroglycerin sublingual B. Lorazepam IV C. Oxygen at 1 L/min nasal canula D. Furosemide IV E. Metoprolol IV F. Nitroglycerin IV

A, D, F If the client's systolic blood pressure is above 100, administer sublingual nitroglycerin (NTG) as prescribed to decrease afterload and preload every 5 minutes for three doses while establishing IV access for additional drug therapy. IV nitroglycerin may also be administered. Give furosemide (a rapid-acting loop diuretic) IV push (IVP) over 1 to 2 minutes to avoid ototoxicity. IV morphine sulfate may be prescribed, 1 to 2 mg at a time, to reduce venous return (pre-load), decrease anxiety, and reduce the work of breathing; however there is discussion about the benefits of using this drug for HF. Oxygen should be given high-flow with a face mask, not at 1 L/minute. Oral beta blockers are often prescribed for clients with heart failure and continued after discharge. IV lorazepam is used for sedation.

The nurse is teaching a client with heart failure about a newly prescribed medication, ivabradine. What teaching will the nurse include? Select all that apply. A. "Visual changes with exposure to light are expected initially." B. "Be sure to take this medication with food." C. "Call your health care provider if your pulse rate is low or irregular." D. "Use caution when driving in the sunlight." E. "Check your BP regularly and notify the health care provider if elevated.

A,B,C,D,E

The nurse is admitting a client with an ulcer on the right foot. Which client statement indicates venous insufficiency to the nurse? Select all that apply. A. "My ankles swell up all the time." B. "My leg hurts after I walk about a block." C. "My feet are always really cold." D. "My veins really stick out in my legs." E. "My ankles have been discolored for years."

A,D,E

. A client is admitted to the hospital with an abdominal aortic aneurysm. Which assessment data would cause the nurse to suspect that the aneurysm has ruptured? A. Shortness of breath and hemoptysis B. Sudden, severe low back pain and bruising along the flank C. Gradually increasing substernal chest pain and diaphoresis D. Rapid development of patchy blue mottling on feet and toes

B

The nurse is caring for a client receiving intravenous heparin for treatment of DVT who begins to begins to vomit blood. What action should the nurse be prepared to take? A. Administer vitamin K B. Stop the infusion of heparin C. Administer an antiemetic D. Insert a nasogastric tube

B

The nurse is caring for a client with heart failure who is prescribed spironolactone. Which client statement requires further nursing education? A. "I may need to take this drug every other day according to lab values." B. "I need to take potassium supplements with this medication." C. "I will try my best not to use table salt on my food." D. "This medication will cause me to urinate more often."

B

The nurse is caring for a hospitalized client with infective endocarditis who has been receiving antibiotics for 2 days. The client is now experiencing flank pain with hematuria. What complication will the nurse suspect? A. Pulmonary embolus B. Renal infarction C. Transient ischemic attack D. Splenic infarction

B

What is the priority concept for a client who has heart failure? A. Gas exchange B. Perfusion C. Comfort D. Infection

B

34. During which timeframe is it most important for the nurse to monitor a client for graft occlusion after receiving revascularization with graft placement? A. First 2 hours B. First 24 hours C. Days 1 and 2 postoperative D. During the first week

B Graft occlusion (blockage) is a postoperative emergency that can occur within the first 24 hours after arterial revascularization. Monitor the client for and report severe, continuous, and aching pain, which may be the first indicator of postoperative graft occlusion and ischemia

39. What is the nurse's best interpretation when reviewing a client's abdominal CT scan and noting that there is an outpouched segment coming off the abdominal aorta? A. Dissecting aneurysm B. Saccular aneurysm C. Fusiform aneurysm D. False aneurysm

B A saccular aneurysm is an outpouching affecting only a distinct portion of the artery. A fusiform aneurysm is a diffuse dilation affecting the entire circumference of the artery (often appears egg shaped on scans). A dissecting aneurysm is a false aneurysm which occurs when blood accumulates in the wall of an artery

25. Which statement by a client with heart failure indicates to the nurse the need for additional teaching? A. "If my heart feels like it's racing, I should call my health care provider." B. "I must weigh myself once a week and watch for signs of fluid retention." C. "I'll need periods of rest and activity and I should avoid activity after meals." D. "I'll need to consider and plan my activities for the day, and rest as needed."

B The client is taught to weigh himself or herself every day (not once a week). The other statements indicate that the client has an appropriate understanding of the treatment regimen for heart failure.

47. What is the definitive treatment for chronic constrictive pericarditis? A. Pericardiocentesis B. Surgical removal of the pericardium C. Placement of a pericardial drain D. Creation of a pericardial window

B The definitive treatment for chronic constrictive pericarditis is surgical excision of the pericardium (pericardiectomy). Pericardiocentesis, placement of a drain, or creation of a pericardial window are all interventions for clients with acute pericarditis.

22. What is the priority intervention when a client comes to the emergency department (ED) with extreme anxiety, tachycardia, struggling for air, and a moist cough productive of frothy and blood-tinged sputum? A. Prepare for endotracheal intubation and mechanical ventilation. B. Administer high-flow oxygen therapy by face mask. C. Prepare for continuous positive airway pressure ventilation. D. Apply a pulse oximeter and a cardiac monitor.

B The priority nursing action is to administer oxygen therapy at 5 to 12 L/min by simple face-mask or at 6 to 10 L/min by nonrebreathing mask with reservoir (which may deliver up to 100% oxygen) to promote gas exchange and perfusion. In addition, if the client is not hypotensive, place him or her in a sitting (high-Fowler) position with the legs down to decrease venous return to the heart. Apply a pulse oximeter and titrate the oxygen flow to keep the client's oxygen saturation above 90%. If supplemental oxygen does not resolve the client's respiratory distress, collaborate with the respiratory therapist and cardiac health care provider for more aggressive therapy, such as continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) ventilation. Intubation and mechanical ventilation may be needed for some clients.

36. What would the nurse expect to find in the history of a client admitted with acute arterial occlusion? A. History of chronic venous stasis disease treated with debridement B. Acute myocardial infarction or atrial fibrillation within the previous weeks C. Episode of blunt trauma that occurred several months ago D. Family history of coronary artery disease

B Acute arterial occlusion is most often caused by an embolus (piece of a clot that travels and lodges in a new area). Emboli originating from the heart are the most common cause of acute arterial occlusions. Most clients with an embolic occlusion have had an acute myocardial infarction (MI) and/or atrial fibrillation within the previous weeks.

Which drug would the nurse expect the primary health care provider to prescribe for a client to decrease blood pressure, decrease triglycerides, increase high-density lipoprotein cholesterol (HDL-C), and lower low-density lipoprotein cholesterol (LDL-C)? A. Advicor B. Caduet C. Vytorin D. Ezetimibe

B Amlodipine and atorvastatin are combined as Caduet to decrease blood pressure while de-creasing triglycerides (TGs), increasing HDL-C, and lowering LDL-C. Vytorin (ezetimibe and simvastatin) is a combination of a selective inhibitor of intestinal cholesterol and statin used to treat elevated cholesterol. Ezetimibe is in a class of medications called cholesterol-lowering medications. It works by preventing the absorption of cholesterol in the intestine. Advicor is a combination of niacin XR and lov-astatin used to lower cholesterol and triglycer-ide (fat) levels in the blood.

40. Which treatment best applies to the care of a client newly diagnosed with infective endocarditis? A. Long-term anticoagulant therapy with IV heparin followed by oral warfarin B. Hospitalization for initial IV antibiotics, followed by continued IV antibiotics at home C. Complete bedrest for the duration of the treatment with subcutaneous enoxaparin D. Administration of IV penicillin, followed by oral penicillin for 6 to 10 weeks

B Antimicrobials are the main treatment for infective endocarditis, with the choice of drug depending on the specific organism involved. Because vegetations surround and protect the offending microorganism, an appropriate drug must be given in a sufficiently high dose to ensure its destruction. Antimicrobials are usually given IV, with the course of treatment lasting 4 to 6 weeks. For most bacterial cases, the ideal antibiotic is one of the penicillins or cephalosporins. Clients may be hospitalized for several days to institute IV therapy and then are discharged for continued IV therapy at home.

3. What is the nurse's best response when a client asks about the difference between arteriosclerosis and atherosclerosis? A. Arteriosclerosis is the sudden blockage of an artery while atherosclerosis is formation of plaque in arteries. B. Atherosclerosis is forming plaques in arteries but arteriosclerosis is thickening of arterial walls associated with aging. C. Arteriosclerosis is hardening of arterial walls while atherosclerosis involves permanent localized dilation of arteries D. Atherosclerosis is thickening of arterial walls but arteriosclerosis is clot formation usually in the deep veins

B Arteriosclerosis is a thickening, or hardening, of the arterial wall which is often associated with aging. Atherosclerosis is a type of arterio-sclerosis that involves the formation of plaque within the arterial wall and is the leading con-tributor to coronary artery and cerebrovascular disease. A sudden blockage is an acute arterial occlusion. Permanent dilation of arteries oc-curs with an aneurysm. Clot formation in the deep veins is a deep vein thrombosis (DVT)

34. Which priority information would the nurse be sure to provide for a client who is scheduled for mitral valve replacement with a xenograft valve? A. "You will need an individualized exercise program to develop collateral circulation." B. "Your xenograft valve will need to be replaced in about 7 to 10 years." C. "You must take and record your temperature daily and watch for signs of rejection." D. "You will require frequent laboratory tests to monitor your coagulation status."

B Biologic valve replacements may be xenograft (from other species), such as a porcine valve (from a pig) or a bovine valve (from a cow). Because tissue valves are associated with little risk for clot formation, long-term anticoagulation is not indicated. Xenografts are not as durable as prosthetic valves and usually must be replaced every 7 to 10 years.

41. Which priority teaching would the nurse provide to a client with infective endocarditis who is scheduled for an invasive dental procedure? A. "Be sure to use your nitroglycerin whenever you experience chest pain." B. "Remind your health care provider to provide you with a prescription for prophylactic antibiotics." C. "Get up slowly after taking each dose of your antihypertensive medication." D. "Your health care provider will instruct you to have blood drawn to check your anticoagulation status."

B Clients with infective endocarditis must be taught to request a prescription for prophylactic antibiotics whenever any invasive dental or oral procedure is scheduled. This includes clients with a previous history of endocarditis and cardiac transplant or valve recipients.

17. For which client would the nurse question the prescription of hydrochlorothiazide? A. Client with asthma B. Client with hypokalemia C. Client with hyperkalemia D. Client with chronic airway limitation

B Hydrochlorothiazide (HCTZ) is a thiazide di-uretic. The most frequent side effect associated with thiazide and loop diuretics is hypokalemia (low potassium level). Monitor serum potassium levels and assess for an irregular pulse, dysrhythmias, and muscle weakness, which may indicate hypokalemia

31. Which type of heart valvular disease does the nurse suspect when a client's assessment reveals pitting edema? A. Aortic valve stenosis and regurgitation B. Mitral valve stenosis and regurgitation C. Mitral valve prolapse D. Tricuspid valve prolapse

B Pitting edema is characteristic of mitral valve stenosis and regurgitation. Left heart failure eventually leads to signs of right heart failure with signs of peripheral volume overload such as hepatomegaly and pitting edema.

20. When a client has an ejection fraction of less than 30%, about which potential treatment does the nurse prepare to educate the client? A. Heart transplant B. Implantable cardioverter/defibrillator C. Ventricular reconstructive procedure D. Implanted mechanical pump

B Because these clients are at high risk for sudden cardiac death, clients with an ejection fraction of less than 30% are considered candidates for an implantable cardioverter/defibrillator (ICD).

41. What would the nurse assess for when a client is suspected of having an abdominal aortic aneurysm? Select all that apply. A. Chest pain and shortness of breath B. Abdominal, flank, or back pain C. Gnawing pain unaffected by movement D. Pulsation in the upper abdomen E. Auscultation of a bruit in the upper abdomen F. Palpation of a mass in the upper abdomen

B, C, D, E Assessment findings for a client's AAA include: abdominal, flank, or back pain; pain that is usually described as steady with a gnawing quality, unaffected by movement, and lasting for hours or days; pulsation in the upper abdomen slightly to the left of the midline between the xiphoid process and the umbilicus (a detectable aneurysm is at least 5 cm in diameter); and auscultation of a bruit over the pulsatile mass. Avoid palpating the mass because it may be tender and there is risk for rupture of the aneurysm.

25. Which clients are at increased risk for peripheral arterial disease (PAD)? Select all that apply. A. Client with anemia B. Client with hypertension C. Client with diabetes mellitus D. Client who smokes cigarettes E. Client who is African American F. Client who is extremely thin

B, C, D, E Clients at risk for PAD have the same problems or characteristics as those at risk for hyper-tension. They include people with: low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, diabetes mellitus, obesity, hypertension, sedentary lifestyle, smoking, stress, African American or His-panic ethnicity, older adult, and diet high in saturated and trans fats, cholesterol, sodium, and sugar

39. Which findings does the nurse expect when assessing a client with infective endocarditis? Select all that apply. A. Grating pain that is aggravated by breathing B. Osler nodes on palms of hands and soles of feet C. Splinter hemorrhages D. Janeway lesions on the hands and feet E. Anorexia and weight loss F. Pericardial friction rub

B, C, D, E Manifestation of infective endocarditis include: fever associated with chills, night sweats, malaise, and fatigue; anorexia and weight loss; cardiac murmur (newly developed or change in existing); development of heart failure; evidence of systemic embolization; petechiae; splinter hemorrhages; Osler nodes (on palms of hands and soles of feet); Janeway lesions (flat, reddened maculae on hands and feet); Roth spots (hemorrhagic lesions that appear as round or oval spots on the retina); and positive blood cultures.

46. Which are proposed criteria for diagnosis of a client with acute pericarditis? Select all that apply. A. Chest pain that lasts longer than 3 months B. Pericardial chest pain C. Presence of a pericardial friction rub D. New ST elevation in all ECG leads or PR-segment depression E. New or worsening pericardial effusion F. Hepatic engorgement

B, C, D, E The proposed diagnostic criteria for acute peri-carditis are presence of two of the following: pericardial chest pain; presence of pericardial rub; new ST elevation in all ECG leads or PR-segment depression; and new or worsening pericardial effusion.

11. Which techniques would the nurse use when performing an initial cardiovascular assessment on a middle-aged client? Select all that apply. A. Check blood pressure on the dominant arm. B. Palpate all of the major pulse sites. C. Auscultate bruits in the radial and brachial arteries. D. Palpate and compare temperature differences in the lower extremities. E. Check the client for orthostatic hypotension. F. Perform bilateral but separate palpation on the carotid arteries.

B, C, D, E, F Because of the high incidence of hypertension in clients with atherosclerosis, assess the blood pressure in both arms. Palpate pulses at all the major sites on the body and note any differ-ences. Palpate each carotid artery separately to prevent blocking blood flow to the brain! Also feel for temperature differences in the lower extremities and check capillary filling. Pro-longed capillary filling (>3 seconds in young to middle-aged adults; >5 seconds in older adults) generally indicates poor circulation. Many cli-ents with vascular disease have a bruit in the larger arteries, which can be heard with a stethoscope or Doppler probe. A bruit is a tur-bulent, swishing sound, which can be soft or loud in pitch. It is heard as a result of blood trying to pass through a narrowed artery. A bruit is considered abnormal, but it does not indicate the severity of disease. Bruits often oc-cur in the carotid, aortic, femoral, and popliteal arteries. Orthostatic hypotension is checked

38. Which clients are at greatest risk for development of infective endocarditis? Select all that apply. A. Clients after myocardial infarction B. Clients who are IV drug users C. Clients with poor dental health D. Clients with opioid addictions E. Clients with systemic alterations in immunity F. Clients postoperative after valve replacement

B, C, D, E, F Infective endocarditis occurs primarily in clients with injection drug use (IDU), and who have had valve replacements, have experienced systemic alterations in immunity, or have structural cardiac defects. It is not associated with myocardial infarction or cardiac dysrhythmias. Possible ports of entry for infecting organisms include: the oral cavity (especially if dental procedures have been performed); skin rashes, lesions, or abscesses; infections (cutaneous, genitourinary, GI, systemic); and surgery or invasive procedures, including IV line placement. These clients are also at risk for infective endocarditis

50. Which criteria are appropriate for a client with dilated cardiomyopathy to become a candidate for heart transplant surgery? Select all that apply. A. Life expectancy greater than 2 years B. Age generally less than 65 years C. New York Heart Association Class III or IV D. Normal or only slightly increased pulmonary vascular resistance E. Consumes less than five to six beers per day F. Absence of active infection

B, C, D, F Candidate selection criteria for heart transplantation include life expectancy less than 1 year; age generally less than 65 years; New York Heart Association (NYHA) Class III or IV; normal or only slightly increased pulmonary vascular resistance; absence of active infection; stable psychosocial status; and no evidence of current drug or alcohol misuse.

35. Which topics would the nurse be sure to cover when providing discharge instructions for a client with prosthetic valve surgery? Select all that apply. A. Avoid heavy lifting for 3 to 6 weeks. B. Report dyspnea, syncope, dizziness, edema, and palpitations to your health care provider. C. Use an electric razor to avoid skin cuts. D. Increase your consumption of foods that are high in vitamin K. E. Notify your health provider for any bleeding or excessive bruising. F. Watch for and report any fever or drainage and redness at the surgical site.

B, C, E, F A client receiving a prosthetic valve will be taking anticoagulants for the rest of his or her life. Teach nutritional considerations (if taking warfarin) and the prevention of bleeding. For example, the client is taught to avoid foods high in vitamin K, especially dark green leafy vegetables, and to use an electric razor to avoid skin cuts. Also teach him or her to report any bleeding or excessive bruising to the primary health care provider. Reinforce how to care for the sternal incision and instruct him or her to watch for and report any fever, drainage, or redness at the site. Most clients return to normal activity after 6 weeks, but should avoid heavy physical activity involving their upper extremities for 3 to 6 months to allow the incision to heal. Teach the client to report any changes in cardiovascular status, such as dyspnea, syncope, dizziness, edema, and palpitations.

Which instructions would the nurse give a cli-ent for following dietary recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA)? Select all that apply. A. Consume a dietary pattern that emphasizes intake of lean protein. B. Consume low-fat dairy products, poultry, and fish. C. Lower sodium intake to no more than 2400 mg/day. D. Engage in aerobic physical activity six to seven times a week. E. Limit intake of sweets and red meats. F. Eat legumes, tropical vegetable oils (e.g., canola oil), and nut

B, C, E, F The ACC and AHA publish dietary recommen-dations for lowering LDL-C levels. These rec-ommendations are based on the best current evidence from randomized controlled trials and include: consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; consume low-fat dairy products, poultry (without the skin), fish, legumes, non-tropical (e.g., canola) vegetable oils, and nuts; limit intake of sweets, sugar-sweetened bever-ages, and red meats; aim for a dietary pattern that includes 5% to 6% of calories from satu-rated fat; and limit trans fats

6. When the nurse performs blood pressure screenings, which clients would be referred for further evaluation? Select all that apply. A. Diabetic client with blood pressure 118/76 mm Hg B. Client with heart disease and blood pressure 148/90 mm Hg C. Renal failure client with blood pressure of 180/90 mm Hg D. Client with no known health problems and blood pressure of 106/70 mm Hg E. Client with muscle cramping taking a statin drug with blood pressure 124/82 mm Hg F. COPD client with blood pressure 158/88 mm Hg

B, C, E, F The client with heart disease has stage 1 hyper-tension. The client with renal failure has very high blood pressure and stage 2 hypertension. The client taking the statin drug should be re-ferred for a change in drug therapy because muscle cramps are a side effect of these drugs and this indicates that the client is not tolerat-ing the statin. The client with COPD also has stage 2 hypertension (See Table 33.1). The dia-betic client and the client with no known health problems both have normal blood pressure readings

42. Which diagnostic tests would the health care provider prescribe to confirm a diagnosis of abdominal aortic aneurysm (AAA) suspected in a client? Select all that apply. A. Chest x-ray B. Ultrasound C. Electrocardiogram D. Magnetic resonance imaging E. Computed tomography scan F. Cardiac catheterization

B, E To confirm a diagnosis of AAA, computed tomography (CT) scanning with contrast is the standard tool for assessing the size and location of an abdominal or thoracic aneurysm. Ultra-sonography is also used.

What assessment findings would the nurse ex-pect to find in a client with right heart failure? Select all that apply. A. Weight loss B. Dependent edema C. Neck vein distention D. Angina E. Hepatomegaly F. Weak peripheral pulses

B,C,E

A client is diagnosed with left-sided heart failure. Which client assessment findings will the nurse anticipate? Select all that apply. A. Peripheral edema B. Crackles in both lungs C. Tachycardia D. Ascites E. Tachypnea F. S3 gallop

B,C,E,F

7. How does the nurse best interpret a client's low-density lipoprotein cholesterol (LDL-C) value which is greater than 190 mg/dL and does not respond to dietary intervention? A. The client should have total cholesterol and LDL-C testing repeated during the next routine examination. B. The client should be instructed to exercise 6 to 7 days per week to help bring the LDL-C level over time. C. The client should be evaluated for secondary causes of hyperlipidemia and treated with statin therapy because of the high LDL-C level. D. The client should be followed every 6 months routinely to check lipid profiles and detect trends in the values

C

A client who is receiving heparin therapy is started on warfarin. Which nursing explanation is appropriate? A. "You will need both drugs long-term to provide long-term anticoagulation." B. "Warfarin is easier on your stomach so you can take it long-term." C. "It takes several days for warfarin to begin working, so both drugs are required for a shorttime." D. "These drugs work the same, but one is taken by mouth, so it is easier to take at home."

C

A client who recently had a heart valve replacement is preparing for discharge. Which client statement indicates that the nurse will need to do additional health teaching? A. "I need to brush my teeth at least twice daily and rinse with water." B. "I will eat foods that are low in vitamin K, such as potatoes and iceberg lettuce." C. "I need to take a full course of antibiotics prior to my colonoscopy." D. "I will take my blood pressure every day and call if it is too high or low."

C

Based on the etiology and main cause of heart failure, the nurse knows that which client has the greatest need for health promotion mea-sures to prevent heart failure? A. Client with asthma B. Client with renal insufficiency C. Client with hypertension D. Client with Parkinson disease

C

The nurse is caring for a client with heart failure who is on oxygen at 2 L per nasal cannula with an oxygen saturation of 90%. The client states, "I feel short of breath." Which action will the nurse take first? A. Contact respiratory therapy. B. Increase the oxygen to 4 L. C. Place the client in a high-Fowler position. D. Draw arterial blood for arterial blood gas analysis.

C

When a client admits that he or she sometimes has trouble catching his or her breath, which question would the nurse ask to obtain more information about the client's symptoms? A. "Do you have a history of any medical problems like high blood pressure?" B. "What did your health care provider tell you about your diagnosis?" C. "What was your most strenuous activity during the past week?" D. "How do you feel about being told that you have heart failure?"

C

When a client develops heart failure, what ini-tial compensatory mechanism of the heart does the nurse expect to occur that will maintain cardiac output (CO)? A. Parasympathetic stimulation B. Ventricular hypertrophy C. Sympathetic stimulation D. Renin-angiotensin activation system

C

43. What is the best method for the nurse to use when auscultating a client's pericardial friction rub with a stethoscope? A. Place the bell just below the left clavicle. B. Place the diaphragm at the apex of the heart. C. Place the diaphragm at the left lower sternal border. D. Place the bell at several points while the client holds his or her breath

C A pericardial friction rub may be heard with the diaphragm of the stethoscope positioned at the left lower sternal border. This scratchy, high-pitched sound is produced when the inflamed, roughened pericardial layers create friction as their surfaces rub together.

45. What does the nurse instruct a client with pericarditis to do to make him or her will feel more comfortable? A. Lie down and bend the legs at the knees. B. Sit in a semi-Fowler position with pillows under each arm. C. Sit up and lean forward. D. Lie on the side in a fetal position

C The pain is worse when a client with acute peri-carditis is in the supine position and may be relieved by sitting up and leaning forward

33. Which essential medications would the nurse provide teaching about postoperatively for a cli-ent who received a prosthetic valve replacement? A. Immunosuppressants B. Antibiotics C. Anticoagulants D. Diuretic

C When a client has a mechanical valve, lifelong anticoagulant therapy with warfarin is required. Teach the client that the international normalized ratio (INR) will need to be monitored frequently. The therapeutic goal for clients with mechanical heart valves is 3.0 to 4.0

37. What would be the priority nursing action when a client experiences increasing pain, swelling, and tenseness after thrombectomy? A. Elevate the affected extremity and apply ice packs. B. Prepare to initiate systemic thrombolytic therapy. C. Report these symptoms to the health care provider immediately. D. Administer the prescribed pain medication as soon as possible.

C After thrombectomy, monitor for increasing pain, swelling, and tenseness. Report any of these symptoms to the health care provider immediately. These symptoms signal compartment syndrome which occurs when tissue pressure within a confined body space becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage and eventually tissue death

27. For which finding in a client with mitral valve stenosis would the nurse immediately notify the primary health care provider because of the potential for decompensation? A. Slow, bounding peripheral pulses associated with bradycardia B. An increase and decrease in pulse rate that follows inspiration and expiration C. An irregular heart rhythm and ECG strip that indicate atrial fibrillation D. An increase in pulse rate and blood pressure after exertion

C Because the development of atrial fibrillation in a client with mitral valve stenosis indicates that the client may decompensate, the health care provider should be notified immediately of changes to the heart rhythm. An increase and decrease in pulse rate that varies with inspiration and expiration is characteristic of sinus arrhythmia. An increase in heart rate and blood pressure is common for most clients. Bounding arterial pulses are associated with aortic regurgitation.

18. What would be the nurse's best action when a client reports dizziness when changing position from sitting to standing and a sudden dry cough after starting a prescription of captopril? A. Instruct the client to change positions slowly and take an over-the-counter cough syrup. B. Tell the client to take the drug at bedtime and use over-the-counter throat lozenges. C. Notify the primary health care provider immediately about these side effects. D. Teach the client to increase fluid intake to at least 3 L/day.

C Captopril is an angiotensin-converting enzyme inhibitor (ACEI). Antihypertensive drugs all have the potential to cause hypotension. However, the most common side effect of this group of drugs is a nagging, dry cough. The nurse should immediately notify the primary health care provider of this finding. Clients must also be taught to report this problem as soon as possible. If a cough develops, the drug is discontinued and the client is started on another drug therapy to control hypertension.

28. What is the nurse's best response when a client with peripheral arterial disease asks why he or she should exercise when walking causes pain? A. "This type of therapy is free and you can do it by yourself to improve the muscle tone in your legs." B. "The cramping will eventually stop if you continue the exercise routine. When you have too much pain, just rest a little while." C. "Exercise can improve blood flow to your legs because small blood vessels will compensate for the blood vessels that are blocked off." D. "Exercise is a nonsurgical, noninvasive technique used to increase arterial blood flow to your affected leg."

C Exercise may improve arterial blood flow to the affected leg through buildup of the collateral circulation. Collateral circulation provides blood to the affected area through smaller vessels that develop and compensate for the occluded vessels.

29. What would the nurse teach a client with peripheral arterial disease about positioning and position changes? A. Change positions slowly when getting out of bed. B. Sleep with legs elevated above the heart if legs are swollen. C. Avoid crossing legs at all times. D. Sit upright in a chair if legs are not swollen.

C Instruct all clients with the disease to avoid crossing their legs and avoid wearing restrictive clothing (e.g., garters to hold up nylon stockings commonly used by older women), which interfere with blood flow

12. What is the nurse's best explanation to a client for use of low-dose niacin to decrease LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels? A. It will prevent muscle myopathies. B. It works well to prevent elevated blood pressure. C. It helps reduce side effects of flushing and feeling too warm. D. It will help prevent the undesirable side effect of hypokalemia.

C Low doses of niacin are recommended because many clients experience flushing and a very warm feeling all over with higher doses. Higher doses can also result in an elevation of hepatic enzymes. In statin-intolerant clients, niacin can be useful to help lower LDL cholesterol levels in combination with other drug

18 To improve gas exchange, how much supple-mental oxygen would the nurse provide a client with HF? A. 2 L/min by nasal canula B. 100% by nonrebreather mask C. Within the range prescribed by the HCP to keep saturation at 90% or more D. 50% by en

C Provide the necessary amount of supplemental oxygen within a range prescribed by the cardiac health care provider to maintain oxygen saturation at 90% or greater

The nurse is caring for a diabetic client who will be discharged on hydrochlorothiazide (HCTZ). What information will the nurse include in the discharge teaching? Select all that apply. A. "This drug may cause a dry, nagging cough." B. "Take this drug with a snack, right before bed." C. "Try to increase your intake of potassium in your diet." D. "This drug can affect your glucose control." E. "Increased urination is expected with this drug.

C,D,E

27. What symptom would the nurse expect on assessment of a client with inflow peripheral arterial disease? A. Frequent episodes of rest pain B. Burning or cramping in the calves, ankles, feet, or toes after walking C. Waking often at night for pain relieved by hanging feet off the bed D. Discomfort in the lower back, buttocks, or thighs after walking

D Clients with inflow disease have discomfort in the lower back, buttocks, or thighs. Clients with mild inflow disease have discomfort after walk-ing about two blocks. This discomfort is not severe but causes them to stop walking. The discomfort is relieved with rest.

The nurse is caring for a client with intermittent claudication due to peripheral arterial disease. Which client statement indicates understanding of proper self-management? A. "I need to reduce the number of cigarettes that I smoke each day." B. "I'll elevate my legs above the level of my heart." C. "I'll use a heating pad to promote circulation." D. "I'll start to exercise gradually, stopping when I have pain."

D

The nurse is teaching a client with stage 1 hypertension. Which client statement indicates understanding of dietary modifications? A. "I will reduce my sodium intake to 2500 mg per day." B. "I will restrict my intake of daily dietary lean protein." C. "I am only going to drink one cup of coffee to start my day." D. "I will drink a glass of low-fat milk with my breakfast."

D

When would the nurse expect the release of B-type natriuretic peptide (BNP) for a client with heart failure? A. When the client has an enlarged liver B. When a client's ejection fraction is lower than normal C. When a client develops ventricular hypertrophy D. When a client has fluid overload

D

49. Which type of cardiomyopathy may present with sudden death as the first symptom? A. Dilated B. Arrhythmogenic right ventricular C. Restrictive D. Hypertrophic

D Sudden death may be the first symptom of hypertrophic cardiomyopathy (HCM), although the primary symptoms of HCM are exertional dyspnea, angina, and syncope. The chest pain is atypical in that it usually occurs at rest, is pro-longed, has no relation to exertion, and is not relieved by the administration of nitrates. A high incidence of ventricular dysrhythmias is also associated with HCM.

42. What does the nurse suspect when a client de-scribes substernal pain that radiates to the left shoulder, is grating, and worsens with inspiration and coughing? A. Chronic constrictive pericarditis B. Cardiac tamponade C. Hypertrophic cardiomyopathy D. Acute pericarditis

D A client with acute pericarditis would experience substernal precordial pain that radiates to the left side of the neck, the shoulder, or the back. The pain is classically grating and oppressive and is aggravated by breathing (mainly on inspiration), coughing, and swallowing. The pain is worse when the client is in the supine position and may be relieved by sitting up and leaning forward.

1. What are the priority nursing care concepts for clients with vascular problems? A. Perfusion and fluid balance B. Clotting and immunity C. Inflammation and perfusion D. Perfusion and clotting

D The priority care concepts for clients with vascular problems are perfusion and clotting. Inflammation is an interrelated concept for these clients.

40. Which location would the nurse expect to be the most common for a client to form an aneurysm? A. Femoral artery B. Radial artery C. Thoracic aorta D. Abdominal aorta

D Aneurysms tend to occur at specific anatomic sites, most commonly in the abdominal aorta. They often occur at a point where the artery is not supported by skeletal muscles or on the lines of curves or flexion in the arterial tree. Abdominal aortic aneurysms (AAAs) account for most true aneurysms. They are commonly asymptomatic, and frequently rupture. Most of these are located between the renal arteries and the aortic bifurcation (dividing area)

32. Which client with valvular heart disease would benefit from the nonsurgical invasive procedure balloon valvuloplasty? A. Older adult who needs a valve replacement B. Middle-aged adult whose open-heart surgery failed C. Young adult with a genetic valve defect D. Older adult who is not a surgical candidate

D Balloon valvuloplasty, an invasive nonsurgical procedure, is possible for stenotic mitral and aortic valves; however, careful selection of clients is needed. It may be the initial treatment of choice for people with noncalcified, mobile mitral valves. Clients selected for aortic valvuloplasty are usually older and are at high risk for surgical complications. The benefits of this procedure for aortic stenosis tend to be short-lived, rarely lasting longer than 6 months. Aor-tic valvuloplasty may be beneficial as a bridge to either surgical or percutaneous aortic valve replacement.

14. Which condition would the nurse suspect when a client has these findings (BP 200/130 mm Hg; sudden headache, blurred vision, and dyspnea)? A. Sustained hypertension B. Primary hypertension C. Secondary hypertension D. Malignant hypertension

D Hypertensive crisis (or malignant hypertension) is a severe type of elevated BP that rapidly pro-gresses and is considered a medical emer-gency. A person with this health problem usually has symptoms such as morning head-aches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine). Clients are often in their 30s, 40s, or 50s with their systolic BP greater than 200 mm Hg

26. Which symptom causes most clients to seek medical attention for peripheral arterial disease (PAD)? A. Pain at rest B. Rubor in the extremity C. Muscle atrophy D. Intermittent claudication

D Most clients initially seek medical attention for a classic leg pain known as intermittent claudication. Usually the client can walk only a certain distance before discomfort (e.g., cramping or burning muscular pain) forces them to stop. The pain goes away with rest. When clients resume walking, they walk the same distance and the pain returns. Because of this, the pain is considered reproducible. As the dis-ease progresses, the client can walk only shorter and shorter distances before pain re-curs. Ultimately, the pain may occur even while at rest.

16. What frequency of drug dosage therapy would the nurse advocate for an older client with hypertension who lives alone and is able to manage his or her self-care? A. Four times a day B. Three times a day C. Twice a day D. Once a day

D Research shows that clients, especially older adults, are more compliant with and able to manage self-care when drug dosages are prescribed once a day. The more frequently doses are scheduled, the more likely a client will be unable to follow the treatment regimen and miss doses of the prescribed drug

22. What would the nurse suspect when assessing a client's lower extremities and finding decreased pedal pulses, skin that is cool to touch, loss of hair, and thickened toenails? A. Peripheral venous disease B. Raynaud's syndrome C. Deep vein thrombosis D. Peripheral arterial disease

D Specific findings for PAD depend on the severity of the disease. Assess for loss of hair on the lower calf, ankle, and foot; dry, scaly, dusky, pale, or mottled skin; and thickened toenails. With severe arterial disease, the extremity is cold and gray-blue (cyanotic) or darkened. Pallor may occur when the extremity is elevated

10. What priority teaching would the nurse provide for a client who will be discharged with a prescription for atorvastatin? A. "Take over-the-counter ranitidine when you experience nausea or vomiting." B. "Go to the emergency department if you experience a nagging, nonproductive cough." C. "You can use acetaminophen if the drug causes mild to moderate headaches." D. "Immediately report any muscle cramping to your primary health care provider."

D Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Therefore, they are contraindicated in clients with active liver disease or during preg-nancy because they can cause muscle myopa-thies and marked decreases in liver function. Statins also have the potential for interactions with other drugs, such as warfarin, cyclospo-rine, and selected antibiotics. They are discon-tinued if the client has muscle cramping or elevated liver enzyme levels.

35. Which method would the postanesthesia care unit (PACU) nurse use to assess the patency of the graft after a client's arterial revascularization with graft placement? A. Gently palpate the site every 15 minutes for the first hour and assess for warmth, redness, and swelling. B. Ask the client if there is any pain or loss of sensation anywhere in the extremity. C. Check the dorsalis pedis and post tibial pulses for the first hour, then every 2 hours. D. Check the affected extremity, comparing it to the unaffected, for changes in color, temperature, and pulse intensity every 15 minutes for the first hour, then hourly.

D To assess graft patency after arterial revascularization, monitor the patency of the graft by checking the extremity every 15 minutes for the first hour and then hourly for changes in color, temperature, and pulse intensity. Compare the operative leg with the unaffected extremity. If the operative leg feels cold; becomes pale, ashen, or cyanotic; or has a decreased or absent pulse, contact the surgeon immediately

21. When a client with heart failure walks 200 feet down the hall and develops a feeling of heavi-ness in the legs, how does the nurse interpret this finding? A. The client is building endurance. B. The activity is appropriate. C. The client could walk farther. D. The activity is too stressful.

D Many clients with heart failure (HF) experience weakness or fatigue with activity or have a feel-ing of heaviness in their arms or legs while walking for a distance. Such activity may place an unacceptable demand on the failing heart.