Hesi on Cardio HTN, PAD, CAD, HF, Anemia

12. Which topic is most important for the nurse to include when teaching about prevention of coronary artery disease (CAD) for a 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg), smokes 1 pack a day of cigarettes, and has siblings with CAD? Select all that apply. One, some, or all responses may be correct. A. Age B. Height C. Weight D. Tobacco use E. Family history

C. Weight D. Tobacco use Rationale The focus of teaching about CAD prevention would be on modifiable risk factors such as weight and tobacco use. Although the incidence of CAD does increase with age, age is not a modifiable risk factor. Height affects body mass index but is not a modifiable risk factor for CAD. Family history of CAD does increase CAD risk but is not a modifiable risk factor.

19. Which information obtained by the nurse about a client would represent a risk factor for the client's admission diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct. A. Daily use of 1 aspirin B. Occasional cocaine use C. Reduced hemoglobin level D. African American/Black heritage E. Increased high-density lipoprotein (HDL)

B. Occasional cocaine use D. African American/Black heritage Rationale Cocaine is a stimulant that causes tachycardia and hypertension. Hypertension is more prevalent in African Americans/Blacks in the United States. Aspirin decreases platelet aggregation, thus reducing the risk for cardiovascular disease, but does not affect blood pressure. Lowered hemoglobin may increase the heart rate, not the blood pressure. Increased HDL reduces the risk for cardiovascular disease, and it does not affect hypertension.

6. Which instruction would the nurse include when preparing discharge instructions for a client who will take enalapril for hypertension? A. "Change to a standing position slowly." B. "This may color your urine green." C. "The medication may cause a sore throat for the first few days." D. "Schedule blood tests weekly for the first 2 months."

A. "Change to a standing position slowly." Rationale Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. Like many antihypertensives, it can cause orthostatic hypotension. Clients should be advised to change positions slowly to minimize this effect. This medication does not alter the color of urine or cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.

5. When assessing a client with right ventricular heart failure, the nurse would expect which finding? Select all that apply. One, some, or all responses may be correct. A. Dependent edema B. Swollen hands and fingers C. Collapsed neck veins D. Right upper quadrant discomfort E. Oliguria

A. Dependent edema B. Swollen hands and fingers D. Right upper quadrant discomfort Rationale With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. Jugular venous collapse and oliguria are key features of left-sided heart failure. Left-sided heart failure is associated with decreased cardiac output.

3. Which instruction would the nurse give an unlicensed assistive personnel (UAP) to perform while caring for a client prescribed captopril? Select all that apply. One, some, or all responses may be correct. A. Obtain blood pressure. B. Measure intake and output. C. Weigh the client every morning. D. Notify the nurse if the client has a dry cough. E. Assist the client to change positions slowly.

A. Obtain blood pressure. B. Measure intake and output. C. Weigh the client every morning. D. Notify the nurse if the client has a dry cough. E. Assist the client to change positions slowly. Rationale ACE inhibitors such as captopril are prescribed for the management of hypertension, heart failure, and diabetic nephropathy. The nurse would ask the UAP caring for a client taking captopril to perform several tasks. The UAP would obtain the client's blood pressure. The UAP would also measure the client's intake and output as well as obtain a daily weight in the morning. This data would help the nurse determine the client's fluid volume status and is an important component of heart failure management. The UAP would be aware that a dry cough is a common side effect of ACE inhibitors. Because of the blood pressure-lowering effects of this medication, the nurse would instruct the UAP to assist the client to make sure the client changes positions slowly.

10. Which medication prescribed for a client with an acute episode of heart failure would the nurse question? * A. Diuretic B. Beta blocker C. Long-acting nitrate D. Angiotensin receptor blocker

B. Beta blocker Rationale Beta blockers reduce cardiac output and are contraindicated for clients with acute heart failure, although they are frequently used to prevent progression of chronic heart failure. Diuretics are used in acute heart failure to decrease hypervolemia and congestion. Long-acting nitrates are used in heart failure to reduce preload. Angiotensin receptor blockers are used in heart failure to decrease fluid overload and afterload.

9. Which statement by the client would the nurse expect when assessing a client with a diagnosis of left ventricular failure? A. "My ankles are swollen." B. "My appetite is not very good." C. "When I eat a large meal, I feel bloated." D. "I have trouble breathing when I walk rapidly."

D. "I have trouble breathing when I walk rapidly." Rationale Dyspnea (difficulty breathing) on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "My appetite is not very good" is more consistent with right ventricular failure. The statement "When I eat a large meal, I feel bloated" is more typical with right ventricular failure.

40. Which client would the nurse provide care for first based on priority of condition and findings? CLIENT: CONDITION/ FINDINGS Client A: Cardiomyopathy / Lower extremities swollen, Weight gain Client B: Peripheral artery disease / Painful cramping in hip region, Weakness and numbness in leg Client C: Aortic aneurysm/ Breathing difficulty, Chest pain Client D: Chest trauma/ Breathing difficulty, Coughing up blood A. Client A B. Client B C. Client C D. Client D

D. Client D Rationale Client D with chest trauma who is coughing up blood and experiencing difficulty breathing should be cared for first. Client A with cardiomyopathy and swelling of the lower extremities and weight gain can be treated later because the client can wait for treatment. Client B with peripheral artery disease can be treated after treating the clients with emergency conditions because this client can wait for treatment. Client C with an aortic aneurysm and chest pain with difficulty breathing can be cared for after client D because there is no sign that the aneurysm has ruptured.

17. Which symptom would the nurse include when teaching a group of female clients about clinical manifestations of coronary artery disease that are more common in women? Select all that apply. One, some, or all responses may be correct. A. Dyspnea B. Indigestion C. Unusual fatigue D. Left chest pain E. Substernal pressure

A. Dyspnea B. Indigestion C. Unusual fatigue Rationale Dyspnea, indigestion, and unusual fatigue are more commonly reported by women than by men with coronary artery disease. It is important that these atypical angina symptoms be recognized so that further evaluation for coronary artery disease can be done. Left chest pain is a more "classic" symptom of coronary artery disease and may be reported by both men and women. Substernal pressure is a more "classic" angina symptom and may be reported by both men and women.

18. Which action would the nurse include in the plan of care for a client admitted with heart failure who has gained 20 pounds in 3 weeks? Select all that apply. One, some, or all responses may be correct. A. Diuretics B. Low-salt diet C. Daily weight checks D. Fluid restriction E. Intake and output F. Oxygen administration

A. Diuretics B. Low-salt diet C. Daily weight checks D. Fluid restriction E. Intake and output F. Oxygen administration Rationale Interventions for a client with heart failure who has sustained a 20-pound weight gain would be focused on decreasing fluid retention. Interventions could include diuretic administration to increase fluid removal; a low-salt diet with fluid restriction; daily weight checks and measuring intake/output; and oxygen administration, particularly if the client has fluid in the lungs.

30. Which lifestyle factor, that may have contributed to the ankle swelling, would a nurse ask about when questioning a client with heart failure and new onset ankle edema? Select all that apply. One, some, or all responses may be correct. *** A. Intake of salty foods B. Dietary fat intake C. Medication compliance D. Family stresses E. Recent travel

A. Intake of salty foods C. Medication compliance E. Recent travel Rationale Fluid retention in heart failure may be caused by increased salt intake, with associated water retention. Poor adherence to medication used to treat heart failure, such as angiotensin-converting enzyme inhibitors and diuretics, may also cause fluid retention. Recent travel may cause fluid retention because of changes in environmental temperature, effects of airplane travel on fluid retention, or changes in dietary sodium intake. Increased or decreased dietary fat intake will not cause fluid retention. Stress is not a contributor to fluid retention.

37. Which diet choice by a client who has heart failure indicates that the nurse's teaching about diet has been effective? Select all that apply. One, some, or all responses may be correct. A. Lean steak B. Fruit salad C. Broiled chicken D. Smoked salmon E. Roasted potatoes F. Macaroni and cheese

A. Lean steak B. Fruit salad C. Broiled chicken E. Roasted potatoes Rationale The priority dietary change for clients with heart failure is a low-sodium diet. Lean steak, fruit salad, broiled chicken, and roasted potatoes are all low in sodium. Smoked meats such as smoked salmon are high in sodium. Cheese is high in sodium.

25. After the nurse teaches a client with coronary artery disease about healthy food choices, which dietary choices by the client indicate that the teaching was effective? Select all that apply. One, some, or all responses may be correct. A. Olive oil B. Whole milk C. Whole-grain bread D. Vegetables and fruits E. Red meats, such as beef F. Liver and other glandular organ meats

A. Olive oil C. Whole-grain bread D. Vegetables and fruits Rationale Olive oil is an unsaturated fat, which is a healthy choice. Whole-grain bread is high in soluble fiber, which may lower the risk for heart disease. Vegetables and fruits are low in fat and high in soluble fiber, thus lowering risk for heart disease. Whole milk is high in saturated fats, and low-fat or nonfat milk are recommended. Red meats are high in saturated fats and should be limited. Liver and other glandular meats are high in saturated fats and cholesterol and should be limited or avoided.

11. Which clinical finding would the nurse expect to identify when caring for a client with a left leg venous thrombosis? Select all that apply. One, some, or all responses may be correct. * A. Pain in the left calf B. intermittent claudication C. Redness in the affected area D. Swelling of the lower left leg E. Ecchymotic areas at the left ankle F. Localized warmth in the lower left leg

A. Pain in the left calf C. Redness in the affected area D. Swelling of the lower left leg F. Localized warmth in the lower left leg Rationale Pain is related to the edema associated with the inflammatory response. Redness is related to vasodilation and the inflammatory response. Edema distal to the venous thrombosis occurs because of increased venous pressure. Warmth in the affected part of the leg occurs due to the inflammatory response. Intermittent claudication (pain when walking, resulting from tissue ischemia) may occur with peripheral arterial disease. Ecchymosis is a sign of bleeding and would not be seen with venous thrombosis.

4. Which finding would the nurse expect when assessing a client with peripheral arterial disease? Select all that apply. One, some, or all responses may be correct. A. Pallor of feet B. Warm extremities C. Ulcers on the toes D. Thick, hardened skin E. Delayed capillary refill

A. Pallor of feet C. Ulcers on the toes E. Delayed capillary refill Rationale Peripheral arterial disease affects arterial circulation and results in delayed and impaired circulation to the extremities. As a result, the extremities exhibit pallor, ulcers on the feet and toes, cool skin, and capillary refill longer than 3 seconds. Warm extremities occur with venous disease. Venous disease leads to thick, hardened skin on the legs.

13. The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. Which is the pathophysiological reason for the excessive edema? A. Shift of fluid into the interstitial spaces B. Weakening of the cell wall C. Increased intravascular compliance D. Increased intracellular fluid volume

A. Shift of fluid into the interstitial spaces Rationale Edema is defined as the accumulation of fluid in the interstitial spaces. When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. Weakening of the cell wall may cause leakage of fluid, but this is not the pathological reason related to heart failure. Increased intravascular compliance would prevent fluid from shifting into the tissue. Intracellular volume is maintained within the cell and not in the tissue.

Which modifiable risk factor would the nurse include in a community presentation on cardiovascular risk factors? Select all that apply. One, some, or all responses may be correct. ** A. Weight B. Inactivity C. Cholesterol D. Tobacco use E. Homocysteine

A. Weight B. Inactivity C. Cholesterol D. Tobacco use E. Homocysteine Rationale Modifiable risk factors are those a person can change. Modifiable risk factors for cardiovascular disease include maintaining a healthy weight, getting regular physical activity, keeping cholesterol levels within normal limits, refraining from using tobacco, and monitoring homocysteine levels to make sure they are within the normal range.

15. The nurse completes an admission assessment on a child with sickle cell anemia who is experiencing a painful vaso-occlusive crisis. Which nursing action would be a priority for the nurse to implement? CLIENT CHART Physical assessment: Fatigue Anorexia Irritability Pulse oximetry of 92% on room air Pain in the knees; 9 on a scale of 1-10 Painful swollen feet; 4 on a scale of 1-10 Laboratory tests: Hemoglobin: 8.1 g/dL Vital signs: Temperature: 99.6 °F (37.6 °C), orally Pulse: 94 beats/min, regular rhythm Respirations: 22 breaths/min, unlabored Blood pressure: 132/80 mm Hg A. Provide oxygen therapy B. Administer an analgesic C. Initiate a blood transfusion D. Monitor intravenous fluids

B. Administer an analgesic Rationale The pain experienced by the vaso-occlusive crisis is caused by sickle-shaped red blood cells that block blood flow through tiny blood vessels to the chest, abdomen, joints, and bones. Pain management is priority. If the client has evidence of hypoxia, then oxygen should be administered. Although a blood transfusion may be needed to treat the anemia and intravenous fluids may be used to reduce the viscosity of the sickled blood, these interventions will not immediately relieve the pain.

33. Which action would the nurse anticipate when admitting a client having a sickle cell crisis to the nursing unit? Select all that apply. One, some, or all responses may be correct. ** A. Place on strict isolation. B. Administer hydroxyurea. C. Administer aspirin 325 mg daily. D. Apply oxygen via nasal cannula. E. Administer intravenous (IV) hydration. F. Avoid opiate-type analgesics.

B. Administer hydroxyurea. D. Apply oxygen via nasal cannula. E. Administer intravenous (IV) hydration. Rationale Hydroxyurea can reduce the number of sickling and pain episodes by stimulating fetal hemoglobin production. Providing oxygen via nasal cannula provides additional oxygen, which decreases red blood cell sickling and improves tissue oxygenation. Intravenous hydration will decrease the clumping of sickled cells and decrease obstruction of blood flow. Strict isolation is not needed for clients in sickle cell crisis. Aspirin is not helpful because the obstruction of blood flow is caused by clumping of sickled cells, not by clotting. Tissue ischemia caused by obstruction of blood flow by sickled cells is very painful, and opiate analgesics are frequently needed for pain management.

34. Which outcome would the nurse anticipate when metoprolol is administered with digoxin to a client with hypertensive heart disease who had an acute episode of heart failure? ** A. Headaches B. Bradycardia C. Hypertension D. Junctional tachycardia

B. Bradycardia Rationale Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These medications may cause hypotension, not hypertension. These medications may depress nodal conduction; therefore junctional tachycardia would be less likely to occur.

1. Which symptom requires the most rapid action by the nurse when caring for a client with known peripheral arterial disease who calls the clinic and tells the nurse about experiencing several symptoms? A. Anxiety B. Chest pain C. Weak pulse quaity D. Cool and pale lower legs

B. Chest pain Rationale Because atherosclerosis is a systenic disease, dlients with peripheral arterial disease are likely to have Corona artery disease as well. The client's chest pain may indicate acute coronary syndrome, and the nurse should notify the health care provider or have the client activate the emergency response system immediately. Anxiety can have many causes, and the nurse could further assess the client or assist the client to schedule an appointment. Weak pulse quality is expected with peripheral arterial disease; the client's disease may be progressing, but no rapid action is needed. Cool and pale lower extremities are expected with peripheral arterial disease; the client may need further evaluation for progression of disease but this is not urgent.

16. Which change would the nurse expect to find in a client with left ventricular heart failure and supraventricular tachycardia when the prescribed digoxin 0.25 mg daily is therapeutically effective? Select all that apply. One, some, or all responses may be correct. A. Confident B. Diuresis C. Tachycardia D. Decreased edema E. Decreased pulse rate F. Reduced heart murmur G. Jugular vein distention

B. Diuresis D. Decreased edema E. Decreased pulse rate Rationale Digoxin increases kidney perfusion, which results in urine formation and diuresis. The urine output increases because of improved cardiac output and kidney perfusion, resulting in a reduction in edema. Because of digoxin's inotropic and chronotropic effects, the heart rate will decrease. Digoxin increases the force of contractions (inotropic effect) and decreases the heart rate (chronotropic effect). Digoxin does not affect a heart murmur. Jugular vein distention is a specific sign of right ventricular heart failure; it is treated with diuretics to reduce the intravascular volume and venous pressure.

36. When performing a focused assessment on a client with a possible diagnosis of iron deficiency anemia, which locations would the nurse examine? Select all that apply. One, some, or all responses may be correct. ** A. Sclera B. Nail beds C. Conjunctivae D. Palms of hands E. Bony prominences

B. Nail beds C. Conjunctivae D. Palms of hands Rationale Nail beds lose their pink coloration because of reduced hemoglobin. A reduced amount of hemoglobin decreases pink color of the lining of the eyelids (conjunctiva). Palms of the hands will become pale because of the decreased hemoglobin. Sclera is observed for signs of jaundice, not anemia, when they become pale yellow to orange. Bony prominences are not assessed when a client has anemia. Bony prominences are examined for redness caused by pressure that, if prolonged, can lead to a break in the skin and development of pressure injuries.

29. Which laboratory test provides evidence consistent with a client having renal impairment? Select all that apply. One, some, or all responses may be correct. A. Serum albumin: 4.7 g/dL(6.815 umol/L) B. Serum creatinine: 2.0 mg/dL (176.8 umol/L) C. Serum potassium: 5.9 mEq/L (5.9 mmol/L) D. Serum cholesterol: 120 mg/dL (3.108 mmol/L) E. Blood urea nitrogen (BUN): 32 mg/dL (11.424 mmol/L)

B. Serum creatinine: 2.0 mg/dL (176.8 umol/L) C. Serum potassium: 5.9 mEq/L (5.9 mmol/L) E. Blood urea nitrogen (BUN): 32 mg/dL (11.424 mmol/L) Rationale Renal impairment is marked by increased serum creatinine concentration, BUN, and potassium ion concentration levels. The normal serum creatinine concentration lies between 0.5 and 1.5 mg/dL (44.2-132.6 umol/L). A serum creatinine value of 2.0 mg/dL (176.8 mol/L) indicates renal impairment. The normal concentration of potassium ions in serum ranges from 3.5 to 5 mEg/L (3.5-5 mmol/L). A potassium ion concentration of 5.9 mEg/L (5.9 mmol/L) indicates kidney dysfunction. The normal value of BUN lies between 7 and 20 mg/dL (2.45-7.14 mmol/L). A BUN value of 32 mg/dL (11.424 mmol/L) indicates renal impairment. The normal range of serum albumin concentration lies between 3.5 to 5.5 g/dL (5.075-7.975 umol/L). A cholesterol value less than 200 mg/dL (5.18 mmol/L) is normal.

26. Which clinical finding would the nurse expect for a client with hypertensive emergency? A. Increased urine output B. Severe pounding headache C. Heart rate 110 beats/minute D. Weak and thready radial pulses

B. Severe pounding headache Rationale Hypertensive emergency often causes hypertensive encephalopathy because of increased cerebral capillary permeability, leading to severe headache, nausea, vomiting, and confusion or coma. Increased urine output would not be expected because acute kidney injury can occur with hypertensive emergency. Tachycardia is not typically seen with hypertensive emergency; high blood pressure can lead to bradycardia because of increased pressure on the carotid sinus and bodies. Radial pulses would be bounding with hypertensive emergency.

39. Which topic would the nurse include in teaching for a client with a new diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct. A. Reason for daily low-dose aspirin use B. Use of a home blood pressure monitor C. Adverse effects of tobacco on blood pressure D. Avoidance of any alcohol consumption E. Benefits of moderate daily exercise

B. Use of a home blood pressure monitor C. Adverse effects of tobacco on blood pressure E. Benefits of moderate daily exercise Rationale Lifestyle management of blood pressure includes monitoring blood pressure at home frequently using a home blood pressure monitor, avoiding tobacco products, and a physically active lifestyle that includes moderate daily exercise. Daily aspirin is not recommended for clients who have hypertension, although it may be recommended for clients with known coronary artery disease or additional risk factors for cardiovascular disease. Although excessive alcohol use should be avoided, moderate alcohol consumption (2 alcoholic drinks/day for men and 1 alcoholic drink/day for women and lighter-weight men) is acceptable for clients with hypertension.

7. Which action would the nurse prioritize after applying pressure to the nose of a client who is being treated for uncontrolled hypertension and develops a nosebleed? A. Add humidity to the client's oxygen. B. Teach the client how to avoid nosebleeds. C. Assess the client's blood pressure. D. Obtain the client's pulse rate.

C. Assess the client's blood pressure. Rationale Nosebleeds in adults may indicate hypertension. The nurse would check the blood pressure and then notify the health care provider if intervention is needed to lower the blood pressure. Although oxygen can dry out the mucus membranes in the nose, the priority will be to assess for and mange hypertension. Teaching the client how to avoid nosebleeds is appropriate, but not the priority action. Blood pressure, rather than pulse rate, is the priority because of the client's known uncontrolled hypertension.

22. Which laboratory result will be important for the nurse to review when a client is admitted to the hospital with a long history of uncontrolled hypertension? A. Blood glucose level B. White blood cell count C. Blood urea nitrogen D. Lactic dehydrogenase

C. Blood urea nitrogen Rationale Hypertension leads to changes in renal blood flow and eventually to decreased renal function, which is tested with blood urea nitrogen levels. All of the other results would also be reviewed by the nurse, but they are not associated with complications of hypertension. Changes in blood glucose level are not associated with hypertension, although if the client also has diabetes then there will be more risk for kidney disease. White blood cell count is not affected by hypertension, but it would be assessed for any possible infectious or inflammatory process. Lactic dehydrogenase is an enzyme associated with multiple other diagnoses, but it is not affected by hypertension.

32. Which medication therapy is indicated for management of Wernicke encephalopathy associated with Korsakoff syndrome? **** A. Traditional phenothiazines B. Judicious use of antipsychotics C. Intramuscular injections of thiamine D. Oral administration of chlorpromazine

C. Intramuscular injections of thiamine Rationale Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics must be avoided; their use has a higher risk of toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, cannot be used because it is severely toxic to the liver.

14. Based on the information in the chart of a client with emphysema and recovering from an acute myocardial infarction, which prescribed medication would the nurse consider the priority at this time? CLIENT CHART Laboratory Test Results WBC: 10,000 mm* (10 x 10°/4) Hemoglobin: 11 gm/dL (110 mmol/L) Hematocrit: 34% INR: 2.5 Vital signs Temperature: 100 °F (37.8 °C) Pulse: 100 beats/min, regular rhythm Respirations: 24 breaths/min Blood pressure: 176/96 mm Hg Physical assessment Using pursed lip breathing Pulse bounding Face appears flushed Reports a headache and dizziness A. Albuterol B. Warfarin C. Metoprolol D. Acetaminophen

C. Metoprolol Rationale Metoprolol is indicated for the control of a blood pressure of 176/96 and a pulse of 100, which increases the cardiac workload and may lead to myocardial ischemia. Albuterol, a bronchodilator, is not the priority at this time; its administration may be delayed until the blood pressure is controlled because side effects of this medication include tachycardia and hypertension. Warfarin, an anticoagulant, is not the priority at this time; the international normalized ratio (INR) is within the therapeutic range of 2 to 3. A slight temperature increase is an expected response to a myocardial infarction; however, the administration of the antipyretic acetaminophen is not the priority.

38. Which condition in a clients history would lead the nurse to assess for the development of pernicious anemia? A. Acute gastritis B. Diabetes mellitus C. Partial gastrectomy D. Unhealthy dietary habits

C. Partial gastrectomy Rationale Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B 12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.

35. Which condition would the nurse consider as the most likely cause of pain for a client who tells the nurse, "My legs begin to hurt after walking for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking."? * A. Spinal stenosis B. Buerger disease C. Rheumatoid arthritis D. Intermittent claudication

D. Intermittent claudication Rationale Pain that develops during exercise (intermittent claudication) is a classic symptom of peripheral arterial occlusive disease; arterial occlusion prevents adequate blood flow to the muscles of the legs, causing ischemia and pain. Spinal stenosis is associated with chronic back pain. Buerger disease is associated with foot pain and cramping; rubor may be present, and pedal pulses may be absent. Rheumatoid arthritis is associated with joint pain, erythema, and swelling; pain may be present with or without activity, particularly when one is awakening.

2. Which information will the nurse include when teaching a client with hypertension about metoprolol? A. Do not abruptly discontinue the medication. B. Consume alcoholic beverages in moderation. C. Report a heart rate of less than 70 beats per minute. D. Increase the medication dosage if chest pain occurs.

A. Do not abruptly discontinue the medication. Rationale Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. The pulse rate can go lower than 70 beats per minute as long as the client is asymptomatic. Clients should never increase medications without medical direction.

31. Which is the best action for the nurse to take when a client with hypertension tells the nurse, "I took the blood pressure pills for a few weeks, but I didn't feel any different, so l decided I'd only take them when I feel sick." ? A. Educate the client about the complications associated with high blood pressure. B. Ask the client questions to determine the current understanding of high blood pressure. C. Emphasize the importance of taking blood pressure medications now to continue to feel well. D. Show the client the current blood pressure and compare that with normal blood pressure levels.

B. Ask the client questions to determine the current understanding of high blood pressure. Rationale Further assessment of the client's understanding of hypertension and treatment is important before the nurse can develop an effective plan to change the client's behavior. Education about complications of hypertension may be helpful, but first the nurse needs to know what the client already understands about the long-term effects of high blood pressure. An emphasis on taking medications now to ensure future health may be appropriate for this client, but further assessment is needed before using this strategy. Many clients may respond to actually seeing the difference between their blood pressures and the expected normals, but more information about the client's knowledge is needed to know if this will be a useful strategy for this client.

21. Which action would the nurse take first when a client with heart failure has an episode of paroxysmal nocturnal dyspnea (PND)? *** A. Assess the client's oxygen saturation level. B. Assist the client to sit on the edge of the bed. C. Ask whether the client is experiencing chest discomfort. D. Offer the client an explanation about the cause of the PND.

B. Assist the client to sit on the edge of the bed. Rationale Because PND is caused by reabsorption of fluid from dependent body areas when the client lies flat, sitting on the edge of the bed will decrease venous return and improve the ability to take deep breaths. The oxygen saturation level would be assessed, but the first action would be to relieve the dyspnea by helping the client sit up. Because the client may have coronary artery disease, it is appropriate to ask about chest pain, but only after taking action to improve the respiratory status. An explanation about the causes of PND may be needed once the client is able to breathe more easily and may be receptive to teaching.

8. Which action would the home health nurse suggest to decrease risk for injury for an older adult with peripheral arterial disease? A. Move into an assisted living community. B. Lower the thermostat setting on the hot water tank. C. Reduce fluid intake to less than 2500 mL/day. D. Limit physical activity to a short daily walk.

B. Lower the thermostat setting on the hot water tank. Rationale Because peripheral arterial disease. may decrease the ability to feel extremes of heat and increases risk for burn injuries, lowering the temperature of the hot water tank can reduce injury risk. There is no indication that this client needs assistance with any activities of daily living, so there is no need to move the client to an assisted living community. Reduction of fluid intake is not indicated for clients with peripheral arterial disease. Walking is encouraged because it improves blood flow and encourages collateral circulation to the legs.

23. Which assessment finding for a client with heart failure who is taking digoxin will be most important to communicate to the health care provider? *** A. Apical heart rate 55 beats per minute B. Premature ventricular contractions C. Serum potassium level 3.9 mEq/L (3.9 mmol/L) D. Bilateral swelling of the lower extremities

B. Premature ventricular contractions Rationale Digoxin toxicity can manifest with premature ventricular contractions (PVCs) or other ventricular dysrhythmias such as ventricular tachycardia or fibrillation. The nurse would communicate the presence of PVCs to the provider and anticipate collaborative actions such as checking digoxin level and potassium level. An apical heart rate of 55 would be reported, but some providers prefer a heart rate of 50 to 60 beats per minute, and no immediate change in treatment would be needed. Hypokalemia can lead to digoxin toxicity, but a serum potassium level of 3.9 mEq/L (3.9 mmol/L) would not increase the risk for digoxin toxicity but should be monitored. Bilateral swelling of the lower extremities in a client with heart failure indicates a possible need for a change in treatment but is not life-threatening.

Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina? A. Blood pressure 142/90 mm Hg B. Report of chest pain when walking C. Sinus bradycardia, rate 54 on monitor D. Large Q waves on the eletrocardiogram

C. Sinus bradycardia, rate 54 on monitor Rationale Because beta blockers such as metoprolol decrease heart rate, the nurse would communicate with the health care provider before giving metoprolol to a client with a slow heart rate. Administration of metoprolol to a client with a mildly elevated blood pressure is appropriate, because beta blockers lower blood pressure. Chest pain with exertion indicates possible myocardial ischemia and metoprolol will decrease cardiac oxygen demand and ischemia. Large Q waves on the electrocardiogram indicate that the client may have a history of myocardial infarction and metoprolol is appropriate to prevent further ischemia.

24. After the nurse teaches a client with hyperlipidemia about dietary changes, which client statement indicates that the teaching has been effective? A. "I guess I will need to cut out all fat or cholesterol in my diet." B. "I love fried foods, but I will plan to use hydrogenated oil for frying." C. "The main important dietary change will be to avoid eating any eggs." D. "I like steak but will plan to broil it and have a salad along with the meat."

D. "I like steak but will plan to broil it and have a salad along with the meat." Rationale Broiling of meat and an increase in the intake of fresh vegetables are suggested for a low-fat and low-cholesterol diet. It is not possible or desirable to completely eliminate fat and cholesterol from the diet. Fried foods, especially the use of hydrogenated oils, should be avoided by clients with hyperlipidemia. Eggs are high in cholesterol, but they do not need to be completely avoided; a decrease in high-fat foods as well as high-cholesterol foods is recommended for clients with hyperlipidemia.

27. Which antihypertensive medication class would the nurse identify as the likely cause of the cough in a client taking multiple medications for hypertension who develops a persistent, hacking cough? A. Thiazide diuretics B. Calcium channel blockers C. Direct renin inhibitors D. Angiotensin-converting enzyme (ACE) inhibitors

D. Angiotensin-converting enzyme (ACE) inhibitors Rationale The ACE breaks down kinins. When ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or direct renin inhibitors.