NMNC 4410 Exam #1

Which statement below is incorrect about a deep vein thrombosis (DVT)?* A. "Veins that are most susceptible to a deep vein thrombosis are the peroneal, posterior tibial, popliteal and superficial femoral." B. "DVTs tend to mostly occur in the lower extremities but can occur in the upper extremities too." C. "A deep vein thrombosis in the lower extremity has a low probability of becoming a pulmonary embolism." D. "A DVT is a type of venous thromboembolism (VTE), which is a blood clot that starts in the vein."

"A deep vein thrombosis in the lower extremity has a low probability of becoming a pulmonary embolism."

The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? "I will avoid adding salt to my food during or after cooking." "If I lose weight, I might not need to continue taking medications." "I can lower my blood pressure by switching to smokeless tobacco." "Diet changes can be as effective as taking blood pressure medications."

"I can lower my blood pressure by switching to smokeless tobacco." Rationale: Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (e.g., the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.

At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? "I will limit the amount of milk and cheese in my diet." "I can add salt when cooking foods but not at the table." "I will take an extra diuretic pill when I eat a lot of salt." "I can have unlimited amounts of foods labeled as reduced sodium."

"I will limit the amount of milk and cheese in my diet." Rationale: Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.

A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug?* A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice."

"I will monitor my heart rate and blood pressure while taking this medication."

A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding? "If I take this medication, I will not need to follow a special diet." "It is normal to have some swelling in my face while taking this medication." "I will need to eat foods such as bananas and potatoes that are high in potassium." "If I develop a dry cough while taking this medication, I should notify my doctor."

"If I develop a dry cough while taking this medication, I should notify my doctor." Rationale: Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced sodium diet.

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? "I should notify my cardiologist if my feet or legs start to swell." "I am supposed to report to my cardiologist if my pulse rate decreases below 60." "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

"My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

A patient is questioning the nurse about circulation and perfusion. Which is the best response by the nurse? "Perfusion assists the cell by delivering oxygen and removing waste products." "Perfusion assists the body by preventing clots and increasing stamina." "Perfusion assists the heart by increasing the cardiac output." "Perfusion assists the brain by increasing mental alertness."

"Perfusion assists the cell by delivering oxygen and removing waste products." Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.

6. You're providing education to a patient who will be undergoing a heart catheterization. Which statement by the patient requires you to re-educate the patient about this procedure?* A. "The brachial artery is most commonly used for this procedure." B. "A dye is injected into the coronary arteries to assess for blockages." C. "Not all patients who have a heart catheterization will need a stent placement." D. "I will not be completely asleep and will be able to breathe on my own during the procedure."

"The brachial artery is most commonly used for this procedure."

An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed to continue at home. What is the best response by the nurse? "The medication prevents blood clots from forming in your heart." "The medication dissolves clots that develop in your coronary arteries." "The medication reduces clotting by decreasing serum potassium levels." "The medication increases your heart rate so that clots do not form in your heart."

"The medication prevents blood clots from forming in your heart." Rationale: Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.

You're educating a patient about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the patient require you to re-educate them about how this medication works? Select all that apply:* A. "This medication will help dissolve the blood clot." B. "This medication will prevent another blood clot from forming." C. "This medication will help prevent the blood clot from becoming bigger in size." D. "This medication starts working immediately after the first dose."

"This medication will help dissolve the blood clot." "This medication starts working immediately after the first dose."

A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

"This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? "Do you have any allergies?" "Can you rate the pain on a 0 to 10 scale?" "What time did your pain begin?" "Do you take aspirin daily?"

"What time did your pain begin?"

A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports that he has a dry, nonproductive cough that is very bothersome. The nurse should respond by making which statement? "The cough must be the start of a respiratory infection." "When this happens typically your PCP will change your medication to an ARB". "The medication needs to be taken with large amounts of water to prevent the cough." "This sometimes happens, and you will need to take a cough medication with each dose of medication."

"When this happens typically your PCP will change your medication to an ARB".

The nurse performs an admission assessment on a client diagnosed with angina pectoris who takes nitroglycerin for chest pain at home. During the assessment, the client complains of chest pain. The nurse should immediately ask the client which of the following question? "Do you have your nitroglycerin with you?" "Are you having any nausea?" "Where is the pain located?" "Are you allergic to any medications?"

"Where is the pain located?"

A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. Which is the best response by the nurse? "Talk with your father about past events, and that will help with the confusion." "Your father may be having mini-strokes; I will notify his physician." "Your father is just confused about some things since he is in the hospital." "The confusion will pass. Your father just has to get up and move around."

"Your father may be having mini-strokes; I will notify his physician." Periods of confusion may be related to mini-strokes, or transient ischemic attacks (TIAs). Confusion during hospitalization does not occur with every patient. Talking with the patient or thinking the confusion may pass is not a viable solution. The patient should be assessed and the reason for the confusion identified.

A patient is scheduled to take Captopril. When is the best time to administer this medication? 1 hour before a meal At bedtime In the morning 30 minutes after a meal

1 hour before a meal

A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?* A. 0.5-2.5 times the normal value range B. 2-3 times the normal value range C. 1.5-2.5 times the normal value range D. 1-3.5 times the normal value range

1.5-2.5 times the normal value range

After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue?* A. 24 hours B. 2 days C. 10 days D. 6 hours

10 days

A 68-yr-old male patient presents to the emergency department with a BP 210/of 118 and reports a severe headache and vomiting. You know that his BP is dangerously high and must be lowered.

149

Which of the following patients does not have a risk factor for hypertension? A 68 year old male who reports smoking 2 packs of cigarettes a day. A 35 year old female with a total cholesterol level of 100. A 40 year old female with a family history of hypertension and diabetes. A 25 year old male with a BMI of 35.

A 35 year old female with a total cholesterol level of 100.

Which of the following patients is not a candidate for a beta blocker medication? A 25 year old female with migraines. A 45 year old male with angina. A 39 year old female with asthma. A 55 year old male with a history of two heart attacks.

A 39 year old female with asthma.

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication?* A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

A. 2-3

. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention?* A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient's blood pressure. D. All the options are incorrect.

A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders.

A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply:* A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure. B. A normal side effect of this medication is a dry cough. C. Avoid green leafy vegetables while taking Plavix. D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.

A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure. D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.

A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status:* A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time

A. Obtain a 12-lead EKG D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula

The nurse is assessing a client admitted to the telemetry unit from the Emergency Department with complaints of increasing shortness of breath, and is coughing pink-tinged frothy sputum. During the history assessment, the nurse documents a history of left-sided heart failure. The nurse recognizes the presenting signs and symptoms of which heart failure complication? Acute pulmonary edema Right-sided heart failure Myocardial infarction Bacterial pneumonia

Acute pulmonary edema

A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety? (Select all that apply.) Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Position patient on left side with head of bed flat. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.

Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient. Rationale: Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

A client with heart disease has developed pulmonary edema and is having difficulties breathing. The nurse notes that the client is breathing at a rate of 28/min and has an oxygen saturation of 90% on room air. Which best describes the first response of the nurse? Administer oxygen through a face mask to correct saturation levels Gather supplies to assist with intubation Prepare the client for a thoracentesis Administer pain medication to slow the client's breathing

Administer oxygen through a face mask to correct saturation levels

How do anti-hypertensive medications alter cardiac output? Increase Heart Rate Increase Stroke Volume Decrease Ejection Fraction Reduce Systemic Vascular Resistance

Reduce Systemic Vascular Resistance

A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication?* A. Argatroban B. Lovenox C. Levophed D. Tridil

Argatroban

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? Assess his adherence to therapy. Ask him to make an exercise plan. Teach him to follow the DASH diet. Request a prescription for a thiazide diuretic.

Assess his adherence to therapy. Rationale: A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to begin by assessing adherence to therapy.

A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? Review urinary output for the previous 24 hours. Restrict the patient's oral fluid intake to 500 mL/day. Assist the patient to a sitting position with arms on the overbed table. Teach the patient to use pursed-lip breathing until the dyspnea subsides.

Assist the patient to a sitting position with arms on the overbed table. Rationale: The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.

The nurse is assessing a client newly diagnosed with Stage 1 Hypertension. Which assessment finding should the nurse expect? Visual disturbances Shortness of breath Frequent nosebleeds Asymptomatic

Asymptomatic

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs? Auscultate lung sounds. Observe skin turgor. Measure blood pressure. Review intake and output.

Auscultate lung sounds.

The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching about the use of the patch, what should the nurse include? Avoid drugs to treat erectile dysfunction. Increase diet intake of high-potassium foods. Take an over-the-counter H2-receptor blocker. Avoid nonsteroidal antiinflammatory drugs (NSAIDS).

Avoid drugs to treat erectile dysfunction. Rationale: The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. NSAIDs do not pose a risk in combination with nitrates. There is no need to take an H2-receptor blocker or increase the dietary intake of high-potassium foods.

Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY:* A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression

B, C, D, and F. B. ST-segment elevation C. T-wave inversion D. Tall t-waves F. ST-segment depression

Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply:* A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer. B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes.

B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes.

Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation

Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure:* A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

B. A side effect of these drugs include bradycardia. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate

Blood pressure Rationale: Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?* A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

B. Assist the patient up slowing and gradually.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?* A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

B. BNP 820

A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?* A. Take another dose of Nitroglycerin in 5 minutes. B. Call 911 immediately C. Lie down and rest to see if that helps with relieving the pain D. Take two doses of Nitroglycerin in 5 minutes

B. Call 911 immediately

A patient taking Zocor is reporting muscle pain. You are evaluating the patient's lab work and note that which of the following findings could cause muscle pain?* A. Elevated potassium level B. Elevated CPK (creatine kinase level) C. Decreased potassium level D. Decreased CPK (creatine kinase level)

B. Elevated CPK (creatine kinase level)

Which of the following is a common side effect of Spironolactone?* A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

B. Hyperkalemia

Select all the correct statements about educating the patient with heart failure:* A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

B. Persistent cough D. Crackles F. Orthopnea

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? BP 128/78 mm Hg Weight loss of 2 lb Absence of ankle edema Output of 600 mL per 8 hours

BP 128/78 mm Hg Rationale: Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? Dehydration Infection Malnutrition Bleeding

Bleeding

An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? Urine output Heart rhythm Breath sounds Blood pressure

Blood pressure Rationale: The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

The nurse is caring for a 76-year-old male who was admitted for extreme weakness, dizziness, and orthopnea. A diagnosis of heart failure is confirmed by the cardiologist observing JVD and reading is Echo Cardiogram. Which of the following tests was most helpful in determining the diagnosis of heart failure? Brain natriuretic peptide (BNP) Renal Function Panel 12-lead EKG Complete Metabolic Panel (CMP)

Brain natriuretic peptide (BNP)

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? Hypocapnia Tachycardia Bronchospasm Nausea and vomiting

Bronchospasm Rationale: Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

The nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? Clonidine (Catapres) Bumetanide (Bumex) Amiloride (Midamor) Spironolactone (Aldactone)

Bumetanide (Bumex) Rationale: Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.

Based on Virchow's Triad, select which patients below are at RISK for the development of a deep vein thrombosis? Select all that apply:* A. A 55-year-old male with hyperlipidemia and diabetes. B. A 70-year-old female with severe sepsis. C. A 25-year-old male who uses intravenous drugs. D. A 65-year-old female who is post-op day 1 after joint replacement surgery.

C. A 25-year-old male who uses intravenous drugs. D. A 65-year-old female who is post-op day 1 after joint replacement surgery.

Which of the following systems of the body are affected by hypertension? Cardiovascular, gastrointestinal, reproductive, and kidney Brain, respiratory, kidney, cardiovascular None of the options are correct Cardiovascular, brain, kidney, eyes

Cardiovascular, brain, kidney, eyes

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?* A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

C. Assist the patient into High Fowler's position

Select all the factors regarding a deep vein thrombosis that are included in Virchow's Triad:* A. Hypocoagulability B. Atherosclerosis C. Endothelial damage D. Stasis of venous blood E. Excessive coagulability F. Increased venous blood flow

C. Endothelial damage D. Stasis of venous blood E. Excessive coagulability

A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action?* A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.

C. Hold the dose and notify the physician of the digoxin level.

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?* A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

C. K+ 8.0

Which of the following drugs is NOT considered an Angiotension Receptor Blocker (ARBs) medication used in hypertension? Valsartan Catapres Benicar Losartan

Catapres

The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein thrombosis is present?* A. Cool extremity B. Decreases pulses C. Redness D. Pain E. Warm extremity F. Swelling G. Cyanosis

C. Redness D. Pain E. Warm extremity F. Swelling

A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:* A. Unstable angina B. Variant angina C. Stable angina D. Prinzmetal angina

C. Stable angina

Which family of drugs are the following medications considered: Amlodipine, Verapamil, Diltiazem? Beta blockers (BB) Calcium Channel Blockers (CCBs) ACE Inhibitors (ACEI) Angiotension Receptor Blockers (ARBs)

Calcium Channel Blockers (CCBs)

A patient is scheduled for a heart transplant. What is a major cause of death beyond the first year after a heart transplant? Infection Acute rejection Immunosuppression Cardiac vasculopathy

Cardiac vasculopathy Rationale: Beyond the first year after a heart transplant, cancer (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

The provider orders an antihypertensive medication for a client whose blood pressure is 205/110 mm Hg. What assessment findings does the student nurse expect for this patient? Select All That Apply. Chest Pain Diminished pulses Pale Cool Skin Blurred Vision Severe Headache

Chest Pain Blurred Vision Severe Headache

A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options. Choose interventions to promote comfort and prevent suffering.

Choose interventions to promote comfort and prevent suffering. Rationale: The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not used in the care of hospice patients.

Which valve allows oxygen-poor blood to enter the right ventricle from the right atrium? aortic mitral tricuspid pulmonic

tricuspid

A provider (PHCP) stating that a client diagnosed with disseminated intravascular coagulation (DIC) requires a transfusion. Which blood product should the nurse anticipate that the PHCP will write a prescription for? Platelets Packed red blood cells Cryoprecipitate Albumin

Cryoprecipitate

You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?* A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

D. "I will limit my consumption of frozen meals.

These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?* A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

D. Angiotensin-converting-enzyme inhibitors

A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication?* A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate. B. Check your glucose regularly because this medication can cause hyperglycemia. C. Check your blood pressure regularly because this medication can cause hypertension. D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.

D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.

Which of the following is a late sign of heart failure?* A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

D. Frothy-blood tinged sputum

The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?* A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

D. Hold the dose and notify the physician about the potassium level

A patient, who is receiving continuous IV Heparin for the treatment of a DVT, has an aPTT of 110 seconds. What is your next nursing action per protocol?* A. Continue with the infusion because no change is needed based on this aPTT. B. Increase the drip rate per protocol because the aPTT is too low. C. Re-draw the aPTT STAT. D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.

D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.

Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

D. Holter monitoring

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

D. Left ventricular diastolic dysfunction

Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body?* A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels. B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels. C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels. D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.

D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses _______ and this result means?* A. fibrin degradation fragment; positive for a blood clot B. platelet degradation protein; negative for a blood clot C. clotting factors; positive for a blood clot D. fibrin degradation fragment; negative for a blood clot

D. fibrin degradation fragment; negative for a blood clot

True or False: The left anterior descending coronary artery provides blood supply to the left ventricle, front of the septum and part of the right ventricle.* True False

true

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of an obese patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec Waiting 2 minutes after position changes to take orthostatic pressures Taking the blood pressure with the patient's arm at the level of the heart Taking a forearm blood pressure if the largest cuff will not fit the patient's upper arm

Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec Rationale: The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. The arm should be supported at the level of the heart for accurate blood pressure measurements. Using a cuff that is too small causes a falsely high reading and too large causes a falsely low reading. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.

The nurse is monitoring a client with heart failure who takes digoxin and whose morning lab level = 2.5. What patient presentation should the nurse assess for? Tremors Diarrhea Irritability Blurred Vision Nausea & Vomiting A controlled heart rate increased urine output

Diarrhea Blurred Vision Nausea & Vomiting

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?* A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

Digibind

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?* A. Lisinopril B. Losartan C. Lasix D. Digoxin

Digoxin

The nurse is caring for a hospitalized client with admitting diagnosis of right-sided heart failure (HF). What assessment finding is most consistent with the client's diagnosis? Distended neck veins Pulmonary edema Dry hacking cough Orthopnea

Distended neck veins

A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? Is the patient pregnant? Does the patient need to urinate? Does the patient have a headache or confusion? Is the patient taking antiseizure medications as prescribed?

Does the patient have a headache or confusion? Rationale: The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. In addition, headache or confusion could represent signs and symptoms of a hemorrhagic stroke. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.

A client brought to the emergency department states that he has accidentally been taking 2 times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action? Draw a sample for type and crossmatch and transfuse the client. Prepare to administer an antidote. Draw a sample for prothrombin time (PT) and international normalized ratio (INR). Draw a sample for an activated partial thromboplastin time (aPTT) level.

Draw a sample for prothrombin time (PT) and international normalized ratio (INR).

A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?* A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

E. Options A and B are correct.

The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session? Elevated low-density lipoprotein (LDL) level Increased risk of cardiovascular disease with aging Family history of myocardial infarction Greater risk associated with the patient's gender

Elevated low-density lipoprotein (LDL) level

The nurse is caring for a client who is on strict bed rest and creates a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing? Placing a pillow under the knees Encouraging active range-of-motion exercises Restricting fluids Applying a heating pad to the lower extremities

Encouraging active range-of-motion exercises

True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation.* True False

False

True or False: Assessment of Homan's Sign is the most reliable indicator of a deep vein thrombosis.* True False

False

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension causes direct pressure on organs, resulting in necrosis and scar tissue. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. Hypertension increases blood viscosity, which causes intravascular coagulation and tissue necrosis distal to occlusions.

Hypertension promotes atherosclerosis and damage to the walls of the arteries. Rationale: Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, when atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply. Hypokalemia Hypouricemia Hyperglycemia Sulfa allergy Osteoporosis Hypercalcemia

Hypokalemia Hyperglycemia Sulfa allergy Hypercalcemia

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND)

Hypotension and tachycardia Rationale: Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia. I understand a dry cough is a common side effect with this medication. I will only take this medication if my blood pressure is high. I will make sure I consume foods high in potassium.

I will make sure I consume foods high in potassium.

On an EKG, the lateral view of the heart is represented with leads?* A. V1, V2, V3 B. II, II, AVF C. I, AVL, V5, V6 D. V1, V2, V6

I, AVL, V5, V6

What is the purpose of including exercise and activity in a cardiac rehabilitation program? (Select all that apply.) Select all that apply. Increase blood pressure Increase flexibility Increase cardiac output Increase muscle mass Increase serum lipids Increase blood flow through the arteries

Increase flexibility Increase cardiac output Increase muscle mass Increase blood flow through the arteries A cardiac rehabilitation program seeks to increase cardiac output, blood flow through the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? Blocks β-adrenergic effects. Relaxes arterial and venous smooth muscle. Inhibits conversion of angiotensin I to angiotensin II. Reduces sympathetic outflow from central nervous system.

Inhibits conversion of angiotensin I to angiotensin II. Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-Blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the central nervous system to produce vasodilation and decreased systemic vascular resistance and blood pressure.

A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. The nurse anticipates which action is needed next? Leaving the rate of the heparin infusion as is Discontinuing the heparin infusion Decreasing the rate of the heparin infusion Increasing the rate of the heparin infusion

Leaving the rate of the heparin infusion as is

Which coronary artery provides blood to the left atrium and left ventricle:* A. Right marginal artery B. Posterior descending artery C. Left circumflex artery D. Right coronary artery

Left circumflex artery

You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage?* A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.

Left coronary artery blockages can cause anterior wall death which affects the left ventricle.

Which is the correct pathway for blood through the heart for systemic circulation to occur? Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs. Lungs, pulmonary vein, left atrium, left atrioventricular valve, left ventricle, aortic valve, aorta, body. Lungs, pulmonary artery, pulmonary valve, right ventricle, right atrioventricular valve, right atrium. Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs.

Lungs, pulmonary vein, left atrium, left atrioventricular valve, left ventricle, aortic valve, aorta, body.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient? (Select all that apply.) Left ventricular function is documented Controlling dysrhythmias will eliminate HF Prescription for digoxin (Lanoxin) at discharge Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

Left ventricular function is documented Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen Rationale: The Joint Commission has identified these 3 core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.

The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.) Lose weight. Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days.

Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days. Rationale: Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Beef includes saturated fats, which should be limited. Weight loss may or may not be necessary, depending on the person.

A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect?* A. Losartan B. Lisinopril C. Cardizem D. Lipitor

Lisinopril

A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem?Losartan Lisinopril Labetalol Hydrochlorothiazide

Lisinopril

A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level?* A. Losartan B. Norvasc C. Aspirin D. Cardizem

Losartan

The nurse is administering a dose of Digitalis (digoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? Muscle aches Constipation Loss of appetite Pounding headache

Loss of appetite Rationale: Anorexia, nausea, vomiting, blurred or yellow vision, and dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this?* A. Coreg B. Cardizem C. Lovenox D. Lipitor

Lovenox

Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV Heparin. Select all the nursing interventions that are appropriate for this patient:* A. Apply cool compresses to affected extremity B. Measure leg circumference C. Massage affected extremity D. Elevate affected extremity above heart level E. Encourage frequent ambulation F. Monitor the patient's INR level G. Monitor the patient's aPTT level H. Apply sequential compression device (SCD) to the affected extremity

Measure leg circumference Monitor the patient's INR level Monitor the patient's aPTT level

Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques? Limiting caffeine Smoking cessation Dietary changes Multivitamins

Multivitamins

The nurse is assessing a female patient at the neighborhood clinic. The patient reports "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? Pneumonia Peptic ulcer disease Myocardial infarction Ischemia

Myocardial infarction Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.

24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase.* A. Neutrophils B. Eosinophils C. Platelets D. Macrophages

Neutrophils

Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? Redness on both sides of the sternal incision Pallor and weakness of the right hand Fine crackles heard at both lung bases Complaints of incisional chest pain

Pallor and weakness of the right hand

A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?* A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis

Pericarditis

A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention?* A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000

Platelets 135,000

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration? O2 saturation 93% Pulse 48 beats/min Respirations 24 breaths/min Blood pressure 118/74 mm Hg

Pulse 48 beats/min Rationale: Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

A patient taking Lovenox is having a severe reaction. What is the antidote for this medication?* A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate

Protamine sulfate

A pregnant client diagnosed with DVT 1 day ago suddenly complains of chest pain and shortness of breath and is visibly anxious. Which complication should the nurse immediately assess the client for? Pneumonia Pulmonary edema Myocardial Infarction Pulmonary Embolism

Pulmonary Embolism

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix). What outcome would demonstrate medication effectiveness? Promote vasodilation. Reduction of preload. Decrease in afterload. Increase in contractility.

Reduction of preload. Rationale: Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

The nurse is reviewing the laboratory test results for a client with a diagnosis of DIC who is receiving a transfusion. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? Remove the fresh flowers from the client's room. Instruct family members to wear a mask when entering the client's room. Call the dietary department to report that the client will be on a low-bacteria diet. Remove the rectal thermometer from the client's room.

Remove the rectal thermometer from the client's room

When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate? Increase water intake. Restrict sodium intake. Increase protein intake. Use calcium supplements.

Restrict sodium intake. Rationale: The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Protein intake does not affect hypertension. Calcium supplements are not recommended to lower blood pressure.

Which is the correct pathway for blood through the heart for pulmonary circulation? Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs,

Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs,

After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? Chronic HF Left-sided HF Right-sided HF Acute decompensated HF

Right-sided HF Rationale: An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

Lisinopril has been recently prescribed for an anemic patient newly diagnosed with hypertension. What should the nurse instruct the client about this medication? Rise slowly from a reclining to a sitting position. Discontinue the medication if nausea occurs. Expect to note a full therapeutic effect immediately. Take the medication with food only.

Rise slowly from a reclining to a sitting position.

When providing dietary teaching to a patient with hypertension, the nurse would teach the patient to restrict intake of which meat? Broiled fish Roasted duck Roasted turkey Baked chicken breast

Roasted duck Rationale: Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall cardiovascular disease risk. The other meats are lower in fat and are therefore acceptable in the diet.

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? Serum uric acid of 3.8 mg/dL Serum creatinine of 2.6 mg/dL Serum potassium of 3.5 mEq/L Blood urea nitrogen of 15 mg/dL

Serum creatinine of 2.6 mg/dL Rationale: The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other laboratory results are within normal limits.

The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? Prothrombin time Urine specific gravity Serum potassium level Hemoglobin and hematocrit

Serum potassium level Rationale: Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.

The home care nurse visits a patient with chronic heart failure. Which assessment findings would indicate acute decompensated heart failure (pulmonary edema)? Fatigue, orthopnea, and dependent edema Severe dyspnea and blood-streaked, frothy sputum Temperature is 100.4° F and pulse is 102 beats/min Respirations 26 breaths/min despite oxygen by nasal cannula

Severe dyspnea and blood-streaked, frothy sputum Rationale: Manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

Which is the correct sequence of events for the electrical impulses that travel through the heart to facilitate a ventricular contraction? Atrioventricular node, atrial contraction, sinoatrial node, bundle of His, purkinje fibers,ventricular contraction. Sinoatrial node, atrial contraction, atrioventricular node, purkinje fibers, bundle of His, ventricular contraction. Atrioventricular node, atrial contraction, sinoatrial node, bundle of His, ventricular contraction,purkinje fibers. Sinoatrial node, atrial contraction, atrioventricular node, bundle of His, purkinje fibers, ventricular contraction.

Sinoatrial node, atrial contraction, atrioventricular node, bundle of His, purkinje fibers, ventricular contraction.

The nurse is caring for a client who has +3 pitting edema in the legs and a potassium level of 2.3 mEq/L. The nurse expects which of the following diuretics to be ordered? Spironolactone (Aldactone) Furosemide (Lasix) Lisinopril Hydrochorithiazide

Spironolactone (Aldactone)

A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? Start an infusion of 0.9% normal saline at 100 mL/hr. Maintain the current administration rate of the nitroprusside. Request insertion of an arterial line for accurate blood pressure monitoring. Stop the nitroprusside infusion and assess the patient for potential complications.

Stop the nitroprusside infusion and assess the patient for potential complications. Rationale: Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal is to decrease MAP by no more than 25% within minutes to 1 hour. For this patient, the goal MAP would be around 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside infusion and then use fluids only if necessary to support restoration of MAP.

Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Older patients require higher doses of antihypertensive medications.

Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Rationale: Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.

The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next? Repeat BP and HR in this position. Record the BP and HR measurements. Take BP and HR with patient standing. Return the patient to the supine position.

Take BP and HR with patient standing. Rationale: The vital signs taken do not reflect orthostatic changes, so the UAP will continue with the measurements while the patient is standing. There is no need to repeat or delay the readings. The patient does not need to return to the supine position. When assessing for orthostatic changes, the UAP will take the BP and pulse in the supine position, then place the patient in a sitting position for 1 to 2 minutes and repeat the readings, and then reposition to the standing position for 1 to 2 minutes and repeat the readings. Results consistent with orthostatic changes would have a decrease of 20 mm Hg or more in systolic BP, a decrease of 10 mm Hg or more in diastolic BP, and/or an increase in HR of greater than or equal to 20 beats/min with position changes.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? Take medications as prescribed. Use oxygen when feeling short of breath. Direct questions only to the health care provider. Encourage most activity in the morning when rested.

Take medications as prescribed. Rationale: The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them?* A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.

The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension.

An ER patient who has had chest pain for several hours is admitted with a rule-out acute myocardial infarction (AMI) diagnosis. Which laboratory test is most appropriate for the nurse to monitor in determining whether the patient has had an AMI? Creatinine Kinase Troponin C-reactive protein Myoglobin

Troponin

You're developing a plan of care for a patient who is at risk for the development of a deep vein thrombosis after surgery. What nursing intervention below would the nurse NOT include in the patient's plan of care to prevent DVT formation?* A. The patient will eat all meals out of the bed daily by sitting in the bedside chair. B. The nurse will apply sequential compression devices (SCDs) per physician's order to the patient's lower extremities every night at bedtime. C. The nurse will administer per physician's order Enoxaparin in the subcutaneous tissue of the abdomen. D. The patient will ambulate daily.

The nurse will apply sequential compression devices (SCDs) per physician's order to the patient's lower extremities every night at bedtime.

Which option below is considered a positive Homan's Sign for the assessment of a deep vein thrombosis (DVT)?* A. The patient reports pain when the foot is manually dorsiflexed. B. The patient reports pain when the foot is manually plantarflexed. C. The patient experiences pain when the leg is extended. D. the patient experiences pain when the leg is flexed.

The patient reports pain when the foot is manually dorsiflexed.

A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers.* A. Myoglobin B. CK-MB C. CK D. Troponin

Troponin

A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?* A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected

Troponin result and when the next troponin level is due to be collected

True or False: Most patients with hypertension are asymptomatic. True False

True

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.* True False

True

The nurse is assessing the sleep patterns of a patient when the patient reports he has trouble sleeping when lying flat. Which is the best response by the nurse? Use pillows to prop yourself up while sleeping. Use nasal strips to assist with breathing. Sleep in a side-lying position. Open a window to let fresh air into the room.

Use pillows to prop yourself up while sleeping. Using pillows to prop himself up during sleep allows the patient to breathe more easily and comfortably. Nasal strips will help with breathing, but they do not always bring relief when one is lying flat. Sleeping in a side position or opening a window does not help one to breathe more easily when one is lying flat.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse? Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with a salty snack, such as crackers. Give the digoxin with extra fluids to dilute the sodium level.

Withhold the dose and report the potassium level. Rationale: The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and wait for the potassium level to normalize. The provider may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

Which pulse is monitored by listening to the client's heart with a stethoscope? radial apical carotid femoral

apical

Which term is synonymous with the mitral valve? aortic valve bicuspid valve tricuspid valve pulmonic valve

bicuspid valve

Which is an example of a cardiac arrhythmia that can occur when there are issues with the electrical impulses that stimulate each heart beat? angina pectoris myocardial infarction complete heart block coronary artery disease

complete heart block

Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient's symptoms? Select-all-that-apply:* A. EKG B. Stress test C. Heart catheterization D. Balloon angioplasty

ekg stress test

Which is the conduit for the pumping action of the heart? the lungs blood flow electrical impulses skeletal muscle movement

electrical impulses

Which test does the nurse anticipate for the client who requires monitoring for both the electrical and mechanical functions of the heart? echocardiogram cardiac stress test electrocardiogram coronary catherization

electrocardiogram

A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent?* A. Lateral B. Septal C. Anterior D. Inferior

inferior

Which structure receives oxygen-poor blood from the lower body? aorta pulmonary artery inferior vena cava superior vena cava

inferior vena cava

Which valve allows oxygenated blood to flow from the left atrium to the left ventricle? aortic mitral tricuspid pulmonic

mitral

Which structure sends blood to the lungs for oxygenation to occur? pulmonary artery pulmonary vein aorta atria

pulmonary artery

Which is the only vein within the circulatory system that carries freshly oxygenated blood to the heart? jugular vein pulmonary vein inferior vena cava superior vena cava

pulmonary vein

Which structure receives blood from the lungs that is oxygen rich? atria aort pulmonary vein pulmonary artery

pulmonary vein

Which valve allows oxygen-poor blood to leave the right ventricle to enter the lungs for oxygenation? aortic mitral tricuspid pulmonic

pulmonic

Which vital sign allows the nurse to monitor the client's heart rate? pulse respirations blood pressure temp

pulse

A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?* A. absent Q wave B. QRS widening C. absent P-wave D. ST segment elevation

st segment elevation

Which structure of the heart receives oxygen-poor blood from the upper body? aorta pulmonary artery inferior vena cava superior vena cava

superior vena cava

Which is the location where ventricular systole begins? the QRS the p wave the t wave the ST segment

the QRS

Which statement is correct regarding the heart, or cardiac cycle? the heart cycle consists of one phase the heart cycle consists of two phases the heart cycle consists of three phases the heart cycle consists of four phases

the heart cycle consists of two phases