Hematology/Cardio questions

A nurse is preparing medications. Which client's health problem motivates the nurse to question a prescription for a beta blocker?

Acute heart failure Beta blockers reduce cardiac output and must be started slowly, so they are contraindicated for clients with acute heart failure. Beta blockers are used to treat coronary artery disease because they decrease myocardial oxygen demand by reducing peripheral resistance and cardiac contractility. Beta blockers are used to treat essential hypertension because they cause vasodilation and decrease cardiac contractility. Beta blockers lower heart rate.

A client who had a myocardial infarction requests assistance to have a bowel movement. What should the nurse do?

Assist the client to a bedside commode. Defecation in the sitting position on a bedside commode uses less energy than walking to the bathroom or getting on and off a bedpan. Defecation is difficult on a bedpan and may cause straining and an increase in oxygen demands. Walking to the bathroom uses more energy than using a bedside commode. Although the use of a fracture pan takes less energy than using a regular bedpan, it takes more energy than using a commode.

Thrombus formation is a danger for postoperative clients. Which independent interventions should the nurse perform to prevent this complication? Select all that apply.

Avoiding crossing the ankles and legs relieves pressure against the veins in the legs and facilitates venous return. Alternating planter flexion and dorsiflexion contracts calf muscles, facilitating venous return. Increasing IV fluids keeps the client hydrated, preventing dehydration and hypercoagulability; however, this is not an independent function of the nurse, because it requires a primary healthcare provider's prescription. Massaging the client's legs is contraindicated, because any developing clot could be dislodged. Placing the client's legs in pneumatic stockings is not an independent function of the nurse. The nurse needs a primary healthcare provider's prescription to apply pneumatic stockings.

A client who has bone pain of insidious onset is suspected of having multiple myeloma. The nurse expects which diagnostic finding specific for multiple myeloma?

Bence Jones protein (globulin) results from tumor cell metabolites. It is present in clients with multiple myeloma. Occult blood in the stool is not specific for the diagnosis of multiple myeloma; it is a late complication of multiple myeloma related to coagulation defects. Hypercalcemia, not hypocalcemia, occurs with multiple myeloma because of bone erosion. Multiple myeloma is not caused by a bacterial infection.

A nurse is performing an assessment on a client with probable acute lymphocytic leukemia (ALL). Which clinical manifestation will the nurse expect to be present?

Ecchymosis Bleeding tendencies occur because of bone marrow suppression and rapidly proliferating leukocytes. Alopecia is associated with chemotherapy; there is no change in hair with leukemia. The client more likely will be sleeping excessively. Hypertension is not a clinical manifestation of leukemia.

A nurse is caring for two clients; one has polycythemia and the other has prolonged anemia. What do these clients have in common?

Increased cardiac workload With anemia, the heart works harder to compensate for the reduced oxygen-carrying ability of the blood. With polycythemia, the heart works harder to propel more viscous blood through the circulatory system. Urinary output is not increased; it may be decreased to maintain blood volume in anemia and decrease blood viscosity in polycythemia. The percent of hemoglobin molecules saturated with oxygen is not affected. Clients with polycythemia will have increased blood pressure because of increased viscosity of the blood.

A nurse is teaching a client with hypertension about a sodium-restricted diet. Which information should the nurse emphasize?

Liking the taste of table salt is learned, but it can be modified with practice. The taste for salt is learned from habitual use and can be unlearned or reduced with health improvement motivation and creative salt-free food preparation. Substitutes do not taste the same as salt. Using salt substitutes containing potassium chloride may be unsafe; excessive use can produce abnormally high serum potassium levels. The taste for salt is learned.

The nurse concludes that a client is experiencing hypovolemic shock. Which physical characteristic supports this conclusion?

Oliguria Urine output decreases to less than 20 to 30 mL/hr (oliguria) because of decreased renal perfusion secondary to a decreased circulating blood volume. Crackles are associated with pulmonary edema, not hypovolemic shock. Dyspnea may be associated with hypervolemia, not hypovolemia, as well as with pulmonary edema and respiratory disorders. Bounding pulse will occur with hypervolemia.

While recovering from abdominal surgery a client develops thrombophlebitis. Which clinical indicators of this complication should the nurse expect to identify when assessing the client? Select all that apply.

Pain in the calf Redness in the affected area Localized warmth in the lower extremity

A client with a history of heart failure on daily weights has a 2-pound (0.9 kilogram) weight gain and pitting edema in lower extremities bilaterally. Which action should the nurse take next?

Performing a head-to-toe assessment, including vital signs, would indicate symptoms, such as jugular distention with right-sided heart failure, or pulmonary issues (crackles) associated with left-sided heart failure. Checking the record for code status is not a priority and should have been established and known on an elderly client. Increasing intake will make the problem of fluid retention worse. Continuing to monitor daily weights without an assessment may miss worsening symptoms.

A client is brought to the emergency department with moderate substernal chest pain radiating to the inner aspect of the left arm, unrelieved by rest and nitroglycerin. The pain is associated with slight nausea and anxiety. Which is the priority nursing intervention for this client?

Provide pain medication. Providing for comfort reduces anxiety and subsequently decreases catecholamine release, indirectly decreasing myocardial oxygen requirements. The client's condition should be stabilized before transfer; relief of pain facilitates stabilization. Obtaining an electrocardiogram is important, but the client should be placed on continuous monitoring, not just receive a reading; therefore pain relief is the priority. The ECG is significant to examine for progressive myocardial changes. Securing blood for enzyme studies is not an emergency intervention, although a blood sample for cardiac enzymes is important for a definitive diagnosis.

To ensure accuracy when assessing a client's blood pressure, how does the nurse prevent a parallax error?

Read the manometer at eye level. A parallax error is the apparent displacement of an observed object, such as the indicators on the manometer, because of the position of the observer. Elevating the head of the bed is not associated with a parallax error. If the appropriate-sized cuff is not used, an inaccurate reading will result, but it will not be caused by a parallax error. If the cuff is not placed at the level of the heart, an inaccurate reading will result, but it will not be caused by a parallax error.

A nurse begins to develop a plan of care with a client who has left ventricular heart failure that resulted from a myocardial infarction (MI). Which goal is priority during the acute phase of recovery?

The major goal is to manage pain. Pain relief helps increase the oxygen supply and decrease myocardial oxygen demand, decreasing the workload of the heart. Increasing activity tolerance is the primary focus during the rehabilitative phase after an MI, not during the acute phase. While preventing dysrhythmia is important, it is not the priority. Although maintaining potassium intake is important, sodium should be limited to minimize fluid retention, which increases the workload on the heart.

How to do Blood transfusion ?

The nurse should first check the primary healthcare provider's prescription to notify the blood bank of what product will be needed. The next step is to obtain the client's baseline vital signs and ask whether the client has had previous transfusions and whether there were any untoward effects. Ascertaining the intravenous catheter size is at least 18 gauge will prevent hemolysis of red blood cells. The main line solution must be normal saline 0.9% to flush the line and use as a main line if the blood administration must occur because of a reaction. Other solutions can affect blood, causing it to clot. Checking the client identification and verification of blood product is necessary before proceeding.

An older adult tells the nurse, "I read about a vitamin that may be related to aging because of its antioxidant effects on the structure of cell walls. I wonder whether it is wise to take it." Which vitamin does the nurse conclude the client is describing?

Vitamin E has antioxidant properties. Vitamin K assists in synthesizing blood clotting factors. Vitamin B1 is necessary for protein and fat metabolism and for functioning of the nervous system. Vitamin C is used for formation of collagen, which is important for maintaining capillary strength, promoting wound healing, and resisting infection.