NSG 121 UNIT 4 Cardiac

Very low levels of sodium may result in?

Seizures, coma, death

Actual Sodium Excess and Examples?

too concentrated in a dehydrated environment Examples: Hyperaldosteronism Kidney failure Corticosteroids Cushing's syndrome Excess oral Na ingestion Excessive administration of sodium containing IV fluids

•A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect? •A. Frothy sputum •B. Dependent edema •C. Nocturnal polyuria •D. Jugular distention

•A. Frothy sputum

Hyper: Nervous Changes caused by Fluid Overload s/sx?

lethargic, drowsy, stuporous, or comatose

Hyponatremia: What two problems occur?

1. Reduced excitable membrane depolarization 2. Cellular swelling- water moves into the cell (water follows sodium)

A patient is prescribed Metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly? A. "After I stop taking this medication I will let my physician know." B. "I take this medication with my breakfast every morning." C. "I will change positions slowly while I'm taking this medication." D. "While I'm taking this medication I will monitor my heart rate."

A. "After I stop taking this medication I will let my physician know." (NEVER just stop taking a medication)

•A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication? A. Bradycardia B. Tremor C. Cough D. Constipation

A. Bradycardia (beta blockers slow the heart rate)

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."

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

The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of which medication because it raises an index of suspicion as to the worsening of the client's HF? A. Ibuprofen (Motrin) B. Hydrochlorothiazide C. NPH Insulin D. Levothyroxine (Synthroid)

A. Ibuprofen (Motrin) (Long-term use of NSAID drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client's HF.)

•A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease? •A. Intermittent claudication •B. Dependent rubor •C. Rest pain •D. Foot ulcers

A. Intermittent claudication

A nurse is providing instructions to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? A. Spironolactone B. Lasix C. Furosemide D. HCTZ

A. Spironolactone

Hypernatremia: Nervous system S/sx

Altered cerebral function Mental status changes

A nurse is teaching a middle-age client about hypertension. Which of the following information should the nurse include in the teaching? •A. "Reaching your goal blood pressure will occur within 2 months." •B. "Diuretics are the first type of medication to control hypertension." •C. "Limit your alcohol consumption to three drinks a day." •D. "Plan to lower saturated fats to 10 percent of your daily calorie intake."

B. "Diuretics are the first type of medication to control hypertension."

•A nurse is reviewing discharge instructions with a client who has Raynaud's disease. Which of the following client statements indicates an understanding of the teaching? •A. "I plan to use nicotine gum to help me quit smoking." •B. "I am going to take a stress management class." •C. "I will limit myself to only two cups of coffee in the morning." •D. "I should not drive in the winter months."

B. "I am going to take a stress management class." (stress can elicit attacks)

A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect? A. Thin, pliable toe nails B. Leg pain at rest C. Hairy legs D. Flushed, warm legs

B. Leg pain at rest

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? A. Decrease the patient's blood pressure and increase cardiac afterload B. Decrease the patient's blood pressure and decrease cardiac afterload C. Decrease the patient's blood pressure and increase cardiac preload D. Increase the patient's blood pressure but decrease cardiac output.

B. Decrease the patient's blood pressure and decrease cardiac afterload

A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is? A. Tell the patient to immediately stop taking the medication and seek medical treatment. B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication. C. Recommend the patient start taking the medication at night to decrease the coughing. D. Reassure the patient that the cough will disappear within 6 months of taking the medication.

B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication.

Hypo: What do you assess as far as cerebral changes?

Behavior confusion

For hyponatremia; what would you assess as far as cerebral changes?

Behavior, acute confusion, increased confusion

What is cardiac output?

Blood flow from the heart to systemic arterial circulation, amount of blood pumped by each ventricle in L/min

What is the central blood flow principle?

Blood naturally flows from an area of higher pressure to an area of low pressure.

Hyper: Cardiac Changes in Hypervolemia

Bounding peripheral pulses Distended neck veins Increased BP

How are sodium levels regulated?

By the kidneys under influence of aldosterone, ADH, and NP. (RAAS System)

A nurse in a clinic is caring for a client who has a prescription for digoxin. Which of the following statements indicates the client is experiencing digoxin toxicity? A. "I am gaining weight." B. "I am constipated." C. "My vision seems yellow." D. "My tongue is red and beefy."

C. "My vision seems yellow."

The nurse is assessing a client's understanding of his hypertension therapy. What client statement indicates a need for further teaching? A. "If my blood pressure stays under control, I will reduce my risk for a heart attack." B. "If I lose weight, I might be able to reduce my blood pressure medication." C. "When my blood pressure is normal, I will no longer need to take medication." D. "When getting out of bed in the morning, I will sit for a few moments then stand."

C. "When my blood pressure is normal, I will no longer need to take medication."

During RAAS activation, what gland releases aldosterone? A. Hypothalamus B. Thymus C. Adrenal cortex D. Pituitary

C. Adrenal cortex

Your patient is taking an ACE Inhibitor to manage blood pressure. Which finding below requires immediate nursing action? A. Urinary output is 190 mL within the past 4 hours. B. Patient has a persistent, dry cough. C. EKG shows tall, peaked t-waves. D. Patient has a negative Chvostek's sign.

C. EKG shows tall, peaked t-waves.

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 prescribed a beta blocker for a cardiac condition. You know this medication blocks the beta receptors in the body so ____________ and __________ cannot bind to the receptor site and elicit a _______ ________ _________ response. A. angiotensin II and angiotensin I; sympathetic nervous system B. dopamine and norepinephrine; parasympathetic nervous system C. norepinephrine and epinephrine; sympathetic nervous system D. dopamine and acetylcholine; parasympathetic nervous system

C. norepinephrine and epinephrine; sympathetic nervous system

Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________. A. vasodilation; anti-diuretic hormone (ADH) B. vasodilation; aldosterone C. vasoconstriction; aldosterone D. vasoconstriction; anti-diuretic hormone (ADH)

C. vasoconstriction; aldosterone

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? A. "I can walk a mile a day." B. "I've had a backache for several days." C. "I am urinating more frequently." D. "I feel nauseated and have no appetite."

D. "I feel nauseated and have no appetite"

Which patient below is at risk for experiencing Hypovolemic Hyponatremia? A. Patient with congestive heart failure B. Patient with cirrhosis of the liver C. Patient on IV saline at 250 cc/hr D. Patient with nasogastric tube suction experiencing diarrhea

D. Patient with nasogastric tube suction experiencing diarrhea

Hyponatremia: Drug therapy

DISCONTINUE diuretics or any drugs that produce Na loss.

Relative Sodium Deficits

Excessive ingestion of hypotonic fluids Kidney failure

What does ADH do?

Facilitates reabsorption of water in nephron of kidney

Hyponatremia: Cardiovascular Changes with Hypervolemia

Full or bounding pulse with normal or high BP

High serum sodium levels move water from...

ICF to ECF

What are cardiac biomarkers?

Myoglobin Troponin T and I Creatine kinase (CK)/Ck-MB

Relative Sodium Excess Examples?

NPO, increased rate of metabolism, fever, hyperventilation, infection, excessive diaphoresis, watery diarrhea, dehydration*

A health care professional is caring for a patient who is taking spironolactone (Aldactone) to treat hypertension. Which of the following laboratory values should alert the health care professional to take further action?

Potassium level of 5.2 mEq/L

Hyponatremia; WHY do we cautiously assess the _____?

Respiratory effectiveness such as RR and chest expansion We are worried because the diaphragm muscle may be damaged or weak

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

TRUE

True or False: Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue.

TRUE

True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload.

TRUE

The bottom of the heart is also called?

The apex of the heart

The top of the heart is also called?

The base of the heart

Characteristics of a vein?

Thin walled Returning deoxygenated blood to the heart after exchange of oxygen at the cellular level Distend easily allowing large volumes of blood to accumulate under LOW pressure (this makes them less effective)

According to the JNC 8 guidelines for the management of hypertension, the nurse anticipates the first medication choice for a client in the general population with uncomplicated hypertension, might be: A. Statins B. Anti-platelets C. Beta blockers D. Thyazide diuretics

Thyazide diuretics

1. The nursing is caring for a client suspected of having heart failure. Diagnostic evaluation for a client in heart failure may include which of the following? SATA a. BNP >300 b. Decreased CO c. Altered ventricular filling d. Decreased myocardial contractility e. Increased ejection fraction

a. BNP >300 b. Decreased CO c. Altered ventricular filling d. Decreased myocardial contractility

1. A nurse performs a head to toe physical assessment on a client who is admitted for the treatment of heart failure, which of the following assessment findings should signal to the nurse a possible exacerbation of the client's condition? a. Crackles b. BP 144/99 c. 600 mL of urine over 8 hours d. Glucose level of 159.

a. Crackles

1. A client in heart failure is prescribed a 2g sodium diet what is the important of the 2g Na diet? a. Decrease circulatory volume b. Improve coronary _____ c. Assist in weight loss d. Decrease incidence of arrythmias

a. Decrease circulatory volume

1. The nurse knows that the overall goal of managing clients with heart failure are: SATA a. Extend survival b. Improve functional status c. Relieve the client's symptoms d. Decrease the incidence of Vircho's triad e. Extend clotting times 1.5-2.5 times the baseline

a. Extend survival b. Improve functional status c. Relieve the client's symptoms

1. A client newly diagnosed with HTN asks the nurse what happens when uncontrolled HTN is prolonged. The nurse explains that a client with prolonged uncontrolled HTN is at risk for what health problem? a. Renal failure b. DVT c. OSA d. Right ventricular hypertrophy

a. Renal failure

Hyponatremia: Fluid Excess

administer medications that promote the excretion of water such as Conivaptan or Tolvaptan

1. A nurse is preforming a PA on a client suspected of being in HF, during auscultation HF would be suggested by what? SATA a. Thrill b. Crackles c. Ascites d. S3 e. Bilateral pedal edema

b. Crackles d. S3

1. A client with heart failure is at risk for poor CO related to inadequate perfusion to the kidneys, what will the kidneys do? (not worded correctly) a. Hyperkalemia b. Increased renin release c. Release of BNP d. Increase K+

b. Increased renin release

Hyponatremia: Nutrition Therapy

can help in mild cases of hyponatremia, increase oral Na and restrict oral fluid, work with registered dietician

What does NP do?

causing a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion.

Water follows sodium which results in... (think HYPER)

cellular dehydration and cellular shrinkage, eventually dehydrated cells may no longer respond to stimuli at all

1. A patient states, "the front of my foot aches at night", the nurse can suspect that the client is experiencing what? a. Diabetic neuropathy b. Raynaud's disease c. DVT d. Severe arterial insufficiency

d. Severe arterial insufficiency

What is cardiac hemodynamics?

describes the pumping forces or pressures required by the heart to maintain blood flow through the cardiovascular system

Hyper: Drug Therapy for Poor Kidneys

diuretic that promotes sodium loss such as furosemide or bumetanide

Hyper: Nutrition Therapy

ensure adequate intake of water and dietary sodium restriction

Actual Sodium Deficits

excessive sweating diuretics wound drainage ((GI) Decreased secretion of aldosterone kidney disease NPO

What is the #1 leading cause of death in the US?

heart disease

Hypernatremia makes excitable tissues...

more easily excitable also known as irritability

Hypernatremia causes an..

over response to stimuli

A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of following statements by the nurse indicates an understanding of the teaching? A. "I should increase my intake of potassium-rich foods." B. "I should expect to have facial swelling when taking this medication." C. "I should take this medication with food." D. "I should report a cough to my provider."

D. "I should report a cough to my provider." (ACE inhibitor)

A nurse is instructing a client who has a new diagnosis of Raynaud's disease about preventing the onset of manifestations. Which of the following client statements should indicate to the nurse the need for additional teaching? •A. "I will wear gloves when removing food from the freezer." •B. "I will try to anticipate and avoid stressful situations when possible." •C. "I will complete the smoking cessation program I started." •D. "I will take my medications at the first sign of an attack."

D. "I will take my medications at the first sign of an attack."

Which of the following terms describes the force against which the ventricle must expel blood? A. Afterload B. Cardiac Output C. Overload D. Preload

A. Afterload

Preventing thrombus formation is a major nursing responsibility. Which of the following are appropriate teaching topics for clients who are at risk for peripheral thrombus formation? SELECT ALL THAT APPLY A. Passive leg exercises B. Decreasing potassium intake C. Lie still in bed for prolonged periods of time D. Don't cross legs E. Don't wear constrictive clothing

A. Passive leg exercises D. Don't cross legs E. Don't wear constrictive clothing

Hyper: Nervous Changes caused by Normal or Decreased Fluid Volumes s/sx?

short attention span, agitated or confused

You're providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply: A. "If I feel unwell, it is okay that I miss a dose." B. "I will avoid using salt substitutes that contain potassium." C. "I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication". D. "I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor."

B. "I will avoid using salt substitutes that contain potassium." D. "I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor."

A patient with hypovolemic hyponatremia is started on IV fluids. Which of the following fluids do you expect the patient to be started on? A. 0.45% Saline B. 3% Saline C. D5W D. 0.33% Saline

B. 3% Saline

When a nurse assesses for an arterial or venous ulcer on a client, which of the following characteristics are consistent with an arterial ulcer? SELECT ALL THAT APPLY A. Edges are sloping and gradual B. Edges are punched out and well defined C. Painful D. Located in the medial gaiter region E. Located on the toes, foot, or ankle

B. Edges are punched out and well defined C. Painful E. Located on the toes, foot or ankle

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

A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? A. The client's ability to understand medication teaching B. The risk for hypotension C. The potential for bradycardia D. Liver function tests

B. The risk for hypotension (Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are associated with first-dose hypotension and orthostatic hypotension)

The nurse knows that which factors effect peripheral vascular resistance? A. The viscosity of the blood and cardiac output B. The viscosity of the blood and diameter of the blood vessel C. The diameter of the blood vessel and cardiac output D. Cardiac output and blood pressure

B. The viscosity of the blood and diameter of the blood vessel

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: A. Moderate doses of two different types of diuretics are more effective than a large dose of one type B. This combination promotes diuresis but decreases the risk of hypokalemia C. This combination prevents dehydration and hypovolemia D. Using two drugs increases osmolality of plasma and the glomerular filtration rate.

B. This combination promotes diuresis but decreases the risk of hypokalemia

A patient is taking an ACE Inhibitor and Spironolactone. It is priority the nurse teaches the patient? A. To avoid consuming alcoholic beverages B. To limit foods high in potassium C. To limit salt intake D. To take the medications with food

B. To limit foods high in potassium

Select all the roles of angiotensin II when it is activated in the renin-angiotensin-aldosterone system: A. Activates bradykinin B. Triggers the release of aldosterone C. Increases the blood volume D. Causes vasodilation E. Increases systemic vascular resistance F. Causes the release of ADH (antidiuretic hormone)

B. Triggers the release of aldosterone C. Increases the blood volume E. Increases systemic vascular resistance F. Causes the release of ADH (antidiuretic hormone)

A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include? A. "You should expect brown-colored urine." B. "You should avoid grapefruit juice." C. "You should monitor for ringing in the ears." D. "You should take the medication in the morning."

B. avoid grapefruit juice

A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility

B. increase, increasing preload

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."

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

•A nurse is providing discharge instructions for a client who has congestive heart failure. Which of the following client statements indicates to the nurse that the teaching was effective? •A. "I will read food labels and limit my sodium to 4 grams per day." •B. "I should use naproxen to manage discomfort." •C. "I plan to slow down if I am tired the day after exercising." •D. "I will take my diuretic before sleep and drink fluids during the day."

C. "I plan to slow down if I am tired the day after exercising."

A nurse is preparing educational material for a client who has a thrombocytopenic disorder. Which of the following information should the nurse include? •A. "Use a rectal suppository if constipated." •B. "Swish with a commercial mouthwash after brushing the teeth." •C. "Notify the dentist of your condition prior to invasive procedures." •D. "Take aspirin for headaches."

C. "Notify the dentist of your condition prior to invasive procedures."

Which statement best reflects correct client education for a client with a blood pressure (BP) of 136/86 mm Hg? A. This blood pressure is good because it is a normal reading. B. This blood pressure indicates that the client has hypertension or high blood pressure. C. This blood pressure increases the workload of the heart; the client must consider modifying his or her lifestyle. D. This blood pressure seems a little low; the client must be further assessed for orthostatic hypotension.

C. This blood pressure increases the workload of the heart; the client must consider modifying his or her lifestyle.

When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? A. Auscultation of crackles B. Pedal edema C. Weight loss of 6 pounds since the last visit D. Reports sucking on ice chips all day for dry mouth.

C. Weight loss of 6 pounds since the last visit

A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication? A. analgesic B. anti-inflammatory C. antiplatelet aggregate D. antipyretic

C. antiplatelet aggregate

A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching? •A. "A weight loss program can decrease my LDL cholesterol level." •B. "Exercising regularly will increase HDL cholesterol levels." •C. "Adding foods containing omega-3 fatty acids to my diet can lower my risk." •D. "Increasing my intake of foods containing trans-fatty acids can lower my risk."

D. "Increasing my intake of foods containing trans-fatty acids can lower my risk." (trans-fatty acids can increase LDL)

A client is scheduled for an echocardiography today and asks why this test is being performed. What is the nurse's best response? A. "This procedure assesses for blockages within the coronary arteries." B. "This procedure will evaluate the oxygen saturation in your blood." C. "This procedure assesses for abnormal electrical impulses within the heart." D. "This procedure is a noninvasive way to assess the structure of the heart."

D. "This procedure is a noninvasive way to assess the structure of the heart."

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

D. 1 hour before a meal

When obtaining a client's vital signs, the nurse assesses a blood pressure of 124/78 mmHg. What is the nurse's most anticipated intervention? A. Teach lifestyle modification to decrease blood pressure and add two blood pressure-lowering medications from two different classes. B. Teach the client lifestyle modifications to decrease blood pressure and evaluate yearly. C. Teach lifestyle modification to decrease blood pressure and add one blood pressure-lowering medication. D. Teach the client lifestyle modifications to decrease blood pressure and reassess in 3 - 6 months

D. Teach the client lifestyle modifications to decrease blood pressure and reassess in 3 - 6 months.

Which of the following types of pain is most characteristic of angina? A. Knifelike B. Sharp C. Shooting D. Tightness

D. Tightness

A client has been admitted to the hospital with chest pain radiating down the left arm. The pain has been unrelieved by rest and antacids. Which test result best confirms that the client sustained a myocardial infarction (MI)? A. C-reactive protein of 1 mg/dL B. Homocysteine level of 13 mcmol/L C. Creatine kinase of 125 units/L D. Troponin of 5.2 ng/mL

D. Troponin of 5.2 ng/mL (The presence of elevated troponin indicates myocardial damage.)

•A nurse is assessing a client who is postoperative following a vaginal hysterectomy. Which of the following findings is a manifestation of deep-vein thrombosis (DVT)? •A. Coolness of the leg or legs •B. Decreased pedal pulses •C. Pain in the ankle and foot •D. Unilateral leg edema

D. Unilateral leg edema

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? A. Auscultate the client's precordium for murmurs B. Teach the client about the reason for the TEE. C. Reassure the client that the test is painless D. Validate that the client has remained NPO.

D. Validate that the client has remained NPO. (R/f aspiration)

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus those in women. Which information would be included? A. Men do not tend to report chest pain B. Men are more likely than women to die after MI. C. Men more than women tend to deny the importance of symptoms. D. Women may experience extreme fatigue and dizziness as sole symptoms.

D. Women may experience extreme fatigue and dizziness as sole symptoms.

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.

Hyponatremia: Fluid Volume Deficit

IV saline 3% saline (severe hyponatremia) 5% saline (extreme hyponatremia)

What does aldosterone do?

Increases reabsorption of sodium and increases secretion of potassium

If a someone is hyponatremic, how does the body work to correct it?

Inhibits the secretion of ADH and NP, triggers aldosterone secretion

If someone is hypernatremic, how does the body work to correct it?

Inhibits the secretion of aldosterone, triggering ADH and NP secretions

Hyper: Drug Therapy for Fluid Loss (dehydrated)

Isotonic saline 0.9%, D5 1/2 NS

There is a reduced excitable membrane depolarization because...

It needs a high ECF Na

Hyper: Monitor the response to...

therapy and ensure patient safety by preventing hyponatremia or dehydration

Characteristics of an artery?

Thick walled Carry oxygen rich blood AWAY from the heart to capillaries Pressure is HIGHER Not as flexible

Why is the Left anterior descending artery called the "widow maker"?

a lot of men die of blockage in the LAD

Hyponatremia: Intestinal Changes

increased motility with nausea, diarrhea, abdominal cramping, frequent watery bowel movements, hyperactive bowel sounds

Hyper: Cardiac Changes in Hypovolemia

increased pulse rate, difficult to palpate peripheral pulses, hypotension, orthostatic hypotension, decreased pulse pressure

thus, decreasing sodium levels by increasing...

kidney excretion of sodium and kidneys reabsorb water

Hyponatremia: Neuromuscular changes?

muscle weakness especially in legs and arms, diminished deep tendon reflexes

Which is a sign and symptom noted during a focused skin assessment with a client who has peripheral vascular disease (PVD)?

pulselessness pallor paresthesia pain poikilothermia paralysis

Hyponatremia: Cardiovascular Changes with Hypovolemia

rapid, weak, thready pulse, decreased BP, orthostatic hypotension, dizziness

•A nurse is reviewing a client's CBC findings and discovers that the client's platelet count is 9,000/mm3. The nurse should monitor the client for which of the following conditions? •A. Spontaneous bleeding •B. Oliguria •C. Hyperactive deep tendon reflexes •D. Infection

A. Spontaneous bleeding

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? A. Cancer B. HTN C. Liver disease D. MI

D. MI

Which patient below would MOST benefit from an ACE Inhibitor? A. A 50-year-old female with systolic dysfunction heart failure. B. A 48-year-old male with severe renal failure. C. A 35-year-old female with chronic hepatitis. D. A 54-year-old male with hypovolemic shock.

A. A 50-year-old female with systolic dysfunction heart failure.

A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description? A. venous ulcer B. arterial ulcer C. diabetic ulcer

A. venous ulcer

A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: A. Decreased arterial blood flow secondary to vasoconstriction B. Decreased arterial blood flow leading to hyperemia C. Atherosclerotic obstruction of the arteries D. Trauma to the lower extremities

A. Decreased arterial blood flow secondary to vasoconstriction

The client is scheduled for electrocardiography (EKG/ECG). After teaching by the nurse, which statement by the client indicates a good understanding of the pre-procedure teaching? A. "I must lie as still as possible during the procedure." B. I can not eat or drink before the electrocardiography." C. "I am likely to feel the warmth as the dye enters my heart." D. "I will increase my fluid intake on the day of the procedure."

A. "I must lie as still as possible during the procedure."

The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? A. "I will call the provider if I have a cough lasting 3 or more days." B. "I will report to the provider weight loss of 2 to 3 pounds in a day." C. "I will try walking for 1 hour each day." D. "I should expect occasional chest pain."

A. "I will call the provider if I have a cough lasting 3 or more days."

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.

You are caring for a post-operative client who had a graft surgically placed to repair an abdominal aneurysm. Which interventions should the nurse include in the plan of care? SELECT ALL THAT APPLY A. Administer blood pressure medication as prescribed B. Administer prescribed anti platelet agent C. Assess pedal pulses D. Report a RR of 20 bpm E. Maintain high fowlers position

A. Administer blood pressure medication as prescribed B. Administer prescribed anti platelet agent C. Assess pedal pulses

•A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan? •A. Apply pressure to needlestick sites for 10 min. •B. Assess core temperatures using a rectal thermometer. •C. Measure abdominal girth twice weekly. •D. Monitor for the presence of WBCs in the urine.

A. Apply pressure to needlestick sites for 10 min.

When checking a client's capillary refill, the nurse finds that the color returns in 10 seconds. The nurse should understand that this finding indicates which of the following? A. Arterial insufficiency B. Venous insufficiency C. Within the expected range D. Thrombus formation in the vein

A. Arterial insufficiency

Which statement reflects correct cardiac physical assessment technique? A. Auscultate the aortic valve in the second intercostal space at the right sternal border B. Evaluate for orthostatic hypotension by moving the client from a standing to a reclining position. C. Palpate the apical pulse over the third intercostal space in the midclavicular line. D. Assess for carotid bruit by auscultating over the anterior neck.

A. Auscultate the aortic valve in the second intercostal space at the right sternal border

A nurse is reviewing cardiac biomarker lab values on a client experiencing angina. Which lab test is not considered a cardiac biomarker? A. BNP B. Myoglobin C. Troponin T and I D. Creatine Kinase (CK)/Ck-MB

A. BNP (brain natriuretic peptide)

The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? SATA A. Blurred Vision B. Tachycardia C. Fatigue D. Serum digoxin level of 1.5 ng/ml E. Anorexia

A. Blurred Vision C. Fatigue E. Anorexia

A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function

A. Decreased blood pressure

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

A. Cardiovascular, brain, kidney, eyes

What is the role of the antidiuretic hormone during RAAS? A. Causes the kidneys to keep water B. Leads to vasoconstriction of vessels C. Activates the release of angiotensin I D. Prevents the activation of the parasympathetic nervous system

A. Causes the kidneys to keep water

•A nurse is caring for a client who just had a cardiac catheterization. Which of the following nursing interventions should the nurse include in the client's plan of care? (Select all that apply.) •A. Check peripheral pulses in the affected extremity. •B. Place the client in high-Fowler's position. •C. Measure the client's vital signs every 4 hr. •D. Keep the client's hip and leg extended. •E. Have the client remain in bed up to 6 hr.

A. Check peripheral pulses in the affected extremity. D. Keep the client's hip and leg extended. E. Have the client remain in bed up to 6 hr.

The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? SATA A. Chest discomfort or pain B. Tachycardia C. Expectorating thick, yellow sputum D. Sleeping on back without a pillow E. Fatigue

A. Chest discomfort or pain B. Tachycardia E. Fatigue

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

A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply: A. Decreases SVR (systemic vascular resistance) and blood pressure B. Constriction of the vessels C. Kidneys will excrete water and sodium D. Kidneys will retain potassium. E. Increases SVR (systemic vascular resistance) and blood pressure

A. Decreases SVR (systemic vascular resistance) and blood pressure C. Kidneys will excrete water and sodium D. Kidneys will retain potassium.

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. B. Take the medication with food. C. Count your pulse rate before taking the medication. D. Expect to gain weight while taking this medication.

A. Do not use salt substitutes while taking this medication.

•A nurse is providing discharge teaching to a client who has a new diagnosis of heart failure. Which of the following instructions should the nurse include in the teaching? •A. Exercise at least three times per week. •B. Take diuretics early in the morning and before bedtime. •C. Notify the provider of a weight gain of 0.5 kg (1 lb) in a week. •D. Take naproxen for generalized discomfort.

A. Exercise at least three times per week.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments B. Flumazenil C. Acetylcysteine D. Naloxone

A. Fab antibody fragments (blocks the action of digoxin)

A client who is suffering from dyspnea on exertion and congestive heart failure (CHF) will most likely report which symptom during the health history? A. Fatigue B. Swelling of one leg C. Bradycardia D. Brown discoloration of lower extremities

A. Fatigue

•A nurse is caring for a client 4 hr following a cardiac catheterization. Which of the following actions should the nurse take? •A. Have the client lie flat in bed. •B. Keep the affected leg slightly flexed. •C. Elevate the head of the bed 45°. •D. Keep the client NPO for 4 hr.

A. Have the client lie flat in bed.

A client with heart failure has also been diagnosed with peripheral arterial disease. The nurse knows that what clinical manifestation would be inconsistent with an acute arterial occlusion? A. Hyperthermia B. Paresthesia C. Pallor D. Poikilothermia

A. Hyperthermia

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? A. I will make sure I consume foods high in potassium. B. I will only take this medication if my blood pressure is high. C. I understand a dry cough is a common side effect with this medication. D. I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia.

A. I will make sure I consume foods high in potassium.

•A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.) •A. Increased heart rate •B. Increased blood pressure •C. Increased respiratory rate •D. Increase hematocrit •E. Increased temperature

A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate

•A nurse is planning care for a client who has deep vein thrombosis of the lower leg. Which of the following interventions should the nurse include in the plan of care? •A. Keep the client's affected leg elevated while in bed. •B. Have the client ambulate prior to applying antiembolic stockings. •C. Apply ice packs to affected leg. •D. Massage the client's affected leg twice a day.

A. Keep the client's affected leg elevated while in bed.

Which client has the highest risk for cardiovascular disease? A. Man who smokes and whose father died at 49 of myocardial infarction (MI) B. Woman with abdominal obesity who exercises three times per week C. Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L) D. Man who is sedentary and reports four episodes of strep throat

A. Man who smokes and whose father died at 49 of myocardial infarction (MI)

A nurse is planning a presentation about hypertension for a community women's group. Which of the following lifestyle modifications should the nurse include?SELECT ALL THAT APPLY A. Smoking cessation B. Reduce Potassium intake C. Regular exercise program D. Decreased magnesium intake E. Limit alcohol intake

A. Smoking cessation C. Regular exercise program E. Limit alcohol intake

A nurse is teaching a client who has a new prescription for captopril. Which of the following instructions should the nurse include in the teaching? A. Monitor for a cough. B. Hold medication for heart rate less than 60/min. C. Take this medication with food. D. Avoid grapefruit juice.

A. Monitor for a cough (This is an ACE inhibitor used to treat HTN)

A nurse is caring for a client who has peripheral vascular disease and reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse take to promote the client's comfort? A. Obtain a pair of slipper-socks for the client. B. Rub the client's feet briskly for several minutes. C. Increase the client's oral fluid intake. D. Place a moist heating pad under the client's feet.

A. Obtain a pair of slipper-socks for the client.

•A nurse is caring for a client who reports an area of redness, warmth, tenderness and pain in the right calf. The nurse anticipates which of the following orders when notifying the provider of this finding? •A. Obtain a venous duplex ultrasound. •B. Obtain impedance plethysmography. •C. Monitor Homan's sign. •D. Apply cold therapy to the affected leg.

A. Obtain a venous duplex ultrasound.

During the renin-angiotensin-aldosterone system activation, what gland releases antidiuretic hormone (ADH)? A. Pituitary B. Thyroid C. Hypothalamus D. Adrenal cortex

A. Pituitary

A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication? A. Potassium B. Hemoglobin C. Creatinine D. Blood urea nitrogen

A. Potassium

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply: A. Raynaud's Disease is triggered by cold temperatures or stress. B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. D. Raynaud's Disease is prevented by glucose control.

A. Raynaud's Disease is triggered by cold temperatures or stress. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose.

The nurse is caring for a client with heart failure. Which of the following are characteristics of systolic heart failure?SELECT ALL THAT APPLY A. Reduced ejection fraction B. Normal ejection fraction C. Stiff heart muscle D. Change in contraction of ventricles E. Weak heart muscle

A. Reduced ejection fraction D. Change in contraction of ventricles E. Weak heart muscle

•A nurse is caring for a male client who has peripheral vascular disease (PVD), is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the warfarin? (Select all that apply.) • •A. Saw palmetto •B. Flaxseed oil •C. Glucosamine •D. Black cohosh •E. Gingko biloba

A. Saw palmetto C. Glucosamine E. Gingko biloba (these increase bleeding/may suppress coagulation)

•A nurse is monitoring the cardiac output of a client who has left-sided heart failure using pulse pressure analysis. Which of the following findings can compromise the readings? •A. The client is experiencing premature atrial contractions. •B. The client has a decreased oxygen saturation level. •C. The client has bilateral wheezes. •D. The client has lower leg edema.

A. The client is experiencing premature atrial contractions.

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.

A. The patient reports pain when the foot is manually dorsiflexed.

A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply: A. The patient reports seeing yellow-greenish halos and is vomiting. B. The patient reports flushing and has enlargement of the gums. C. The patient's heart rate is regular and 80 beats per minute. D. The patient's Digoxin level is 3 ng/mL

A. The patient reports seeing yellow-greenish halos and is vomiting. D. The patient's Digoxin level is 3 ng/mL

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply: A. Thick, tough B. Thin, scaly C. Hairless D. Brown pigmented

A. Thick, tough D. Brown pigmented

Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply: A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II. C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I. D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart.

A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II.

Which laboratory finding is consistent with acute coronary syndrome (ACS)? A. Troponin 3.2 ng/mL B. C-reactive protein 13 mg/dL C. Triglycerides 400 mg/dL D. Lipoprotein- a 18 mg/dL

A. Troponin 3.2 ng/mL (Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).)

The nurse knows that characteristics of acute coronary syndrome in clients include: SELECT ALL THAT APPLY A. Unusual fatigue B. High sodium C. Sleep disturbances D. SOB E. Chest discomfort

A. Unusual fatigue C. Sleep disturbances D. SOB E. Chest discomfort

What conditions below can result in an increased cardiac afterload? Select all that apply: A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension

A. Vasoconstriction B. Aortic stenosis E. Pulmonary Hypertension

A nurse is caring for a client who has a new diagnosis of essential hypertension. The nurse should monitor the client for which of the following findings that is consistent with this diagnosis? •A. Vertigo •B. Uremia •C. Blurred vision •D. Dyspnea

A. Vertigo (as well as headache, facial flushing and fainting)

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.

A. Vital signs

•A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect? •A. Decreased brain natriuretic peptide (BNP). •B. Elevated central venous pressure (CVP). •C. Increased pulmonary artery wedge pressure (PAWP). •E. Decreased specific gravity

B. Elevated central venous pressure (CVP).

A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypokalemic? A. Pitting edema B. Fatigue C. Dyspnea D. Oliguria

B. Fatigue (fatigue due to muscle weakness with hypokalemia)

The nurse is providing teaching to a group of clients at a local community center. The nurse teaches that modifiable risk factors for cardiovascular disease include which of the following? SELECT ALL THAT APPLY A. Male Gender B. HTN C. Overweight/Obesity D. Sedentary Lifestyle E. Older age

B. HTN C. Overweight/Obesity D. Sedentary Lifestyle (AGE AND GENDER ARE NOT MODIFIABLE)

A nurse is assessing a client who has right ventricular failure. Which of the following findings should the nurse expect? •A. Dry, hacking cough •B. Hepatomegaly •C. Dizziness •D. Crackles in the lungs

B. Hepatomegaly

Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are? A. Low in calcium B. High in fiber C. Low in potassium D. High in sodium

B. High in fiber (Verapamil can cause constipation)

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.

You're providing discharge instructions to a patient who will be taking a calcium channel blocker at home. Which statement by the patient demonstrates they did NOT understand the teaching instructions and needs re-education? A. "I will follow a low-fat and high-fiber diet." B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice." C. "This medication can enlarge my gums so I will maintain good oral hygiene." D. "I will monitor my blood pressure regularly because this medication can cause low blood pressure."

B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice."

A client is newly diagnosed with a heart murmur and asks the nurse to explain what this means. What is the nurse's best response? A. "It is a term health care providers use to describe the efficiency of blood circulation." B. "It is a rushing sound that blood makes moving across narrowed places or defects." C. "It is the sound of the heart muscle stretching in an area of weakness." D. "It is the sound the heart makes when it has an increased workload."

B. "It is a rushing sound that blood makes moving across narrowed places or defects."

You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A. "It is important I quit smoking." B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. C. "A walking program would be beneficial in treatment of my PAD." C. "I will avoid wearing tight socks or shoes."

B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad.

•A nurse is teaching a client who has a new diagnosis of venous insufficiency. Which of the following instructions should the nurse include? •A. "Apply ice packs to your legs." •B. "Use elastic stockings." •C. "Remain on bed rest." •D. "Place your legs in a dependent position while in bed."

B. "Use elastic stockings."

A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? A. "Now I will not have to diet to lose weight." B. "With the new medication, I should experience fewer side effects." C. "I will not have to do anything different because it is the same medication." D. "The extra letters after the name of medication means it is a stronger dose."

B. "With the new medication, I should experience fewer side effects."

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. (Remember risk factors for developing CAD include: smoking, family history, diabetes, being overweight or obese, and high cholesterol.)

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.

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. ("SHE": Stasis of Venous Blood, Hypercoagulability (means excessive coagulability), Endothelial damage)

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. (Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.)

A nurse is reviewing the serum laboratory findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report to the provider? A. Sodium 136 mEq/L B. Potassium 2.3 mEq/L C. Chloride 99 mEq/L D. Calcium 10 mg/dL

B. Potassium 2.3 mEq/L

A nurse is providing discharge teaching to a client who has peripheral arterial disease (PAD). Which of the following instructions should the nurse include in the teaching? •A. Apply a heating pad on a low setting to help relieve leg pain. •B. Adjust the thermostat so that the environment is warm. •D. Wear antiembolic stockings during the day. •E. Rest with the legs above heart level.

B. Adjust the thermostat so that the environment is warm. (Keep environment warm to prevent vasoconstriction- Wearing gloves, warm clothes, and socks will help prevent vasoconstriction)

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. (These meds cause orthostatic hypotension)

The home health nurse visits a client with heart failure who has gained 5 pounds (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? A. Assess the client for peripheral edema B. Auscultate the client's posterior breath sounds. C. Notify the health care provider about the client's weight gain. D. Remind the client about dietary sodium restrictions

B. Auscultate the client's posterior breath sounds. (the client is at risk for pulmonary edema and hypoxemia, the breath sounds must be assessed)

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

The nurse is assessing the lower extremities of a patient with a possible DVT. Which of the following are possible indicators of a DVT? SELECT ALL THAT APPLY A. Ejection fraction of 35% B. Calf tenderness C. Increased circumference of the affected extremity D. ABI of 0.79 E. Edema in the extremity

B. Calf tenderness C. Increased circumference of the affected extremity E. Edema in the extremity

•A nurse in an outpatient clinic is assessing a middle adult client as part of a routine physical examination. The client's BP is 142/88 mm Hg, his body mass index (BMI) is 31, and he is a current smoker. The nurse should identify that this client has multiple risk factors for which of the following disorders? •A. Testicular cancer •B. Cardiovascular disease •C. Depression •D. Thyroid disease

B. Cardiovascular disease

Which medication, when given in heart failure, may improve morbidity and mortality? A. Dobutamine (Dobutrex) B. Carvedilol (Coreg) C. Digoxin (Lanoxin) D. Bumetanide (Bumex)

B. Carvedilol (Coreg) (Beta-adrenergic blocking agents such as carvedilol reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure.)

A nurse is reviewing a client's laboratory results and finds the hemoglobin is 10 g/dL and the hematocrit is 30%. The nurse recognizes that the client is at risk for which of the following? A. Prolonged bleeding B. Cellular hypoxia C. Impaired immunity D. Fluid retention

B. Cellular hypoxia (these lab values indicate anemia, which puts the client at risk for cellular hypoxia)

How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? A. Ejection fraction is 25% B. Client states that she is able to sleep on one pillow C. Client was hospitalized five times last year with PE D. Client reports that she experiences palpitations

B. Client states that she is able to sleep on one pillow (Improvement in activity tolerance, less orthopnea, and improved symptoms represents a positive response to beta blockers such as metoprolol.)

Which client has pain most consistent with myocardial infarction (MI) requiring notification of the health care provider? A. Client with abdominal pain and belching B. Client with pressure in the mid-abdomen and profound diaphoresis C. Client with dyspnea on exertion and inability to sleep flat who sleeps on four pillows D. Client with claudication and fatigue

B. Client with pressure in the mid-abdomen and profound diaphoresis (Typical symptoms of MI include chest pain or pressure, ashen skin color, diaphoresis, and anxiety)

The nurse in a coronary care unit interprets information from hemodynamic monitoring. The client has a cardiac output of 2.4 L/min. Which action would be taken by he nurse? A. No intervention is needed; this is a normal reading. B. Collaborate with the primary health care provider to administer a positive inotropic agent. C. Administer a STAT dose of metoprolol (Lopressor). D. Ask the client to perform the Valsalva maneuver.

B. Collaborate with the primary health care provider to administer a positive inotropic agent. (A positive inotropic agent will increase the force of contraction (stroke volume [SV]), thus increasing cardiac output (CO). Recall that SV × HR = CO (heart rate [HR]). Normal cardiac output is 4 to 7 L/min.)

Which medication is known to increase the strength and efficiency of heart contractions as well as slow the electrical conduction between the atria and ventricles? A. Diuretics B. Digoxin C. Beta blockers D. ACE inhibitors

B. Digoxin

•A nurse is assessing a client who has chronic venous insufficiency. Which of the following findings should the nurse expect? •A. Dependent rubor •B. Edema •C. Hair loss •D. Thick, deformed toenails

B. Edema (an increase in venous hydrostatic pressure develops when fluid accumulates in the veins causing fluid to leak out into the tissues resulting in edema)

Which of these factors contribute to the risk for cardiovascular disease? SATA A. Consuming a diet rich in fiber B. Elevated C-reactive protein levels C. Hypotension D. Elevated HDL cholesterol level E. Smoking

B. Elevated C-reactive protein levels E. Smoking (Elevation in C-reactive protein, suggestive of inflammation, is a risk factor for atherosclerosis and cardiac disease.)

The nurse should expect which of the following symptoms in a client with right ventricular heart failure? A. Pulmonary edema B. PND (Paroxysmal nocturnal dyspnea) C. JVD (jugular vein distention) D. Crackles upon auscultation

C. JVD

•A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.) •A. Genetic predisposition •B. Hypercholesterolemia •C. Hypertension •D. Obesity •E. Smoking

B. Hypercholesterolemia •C. Hypertension •D. Obesity •E. Smoking

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

B. Hyperkalemia

What is the role of aldosterone? A. It causes constriction of vessels. B. It causes the kidneys to keep sodium and water. C. It causes the kidneys to keep potassium and water. D. It causes the kidneys to only keep water.

B. It causes the kidneys to keep sodium and water.

•A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions? •A. Elevating her feet •B. Massaging her legs •C. Flexing her ankles •D. Ambulating soon after surgery

B. Massaging her legs

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

B. Measure leg circumference D. Elevate affected extremity above heart level G. Monitor the patient's aPTT level

You're developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient's plan of care? Select all that apply: A. Encourage the patient to limit the consumption of bananas, avocadoes, spinach, strawberries, and potatoes. B. Measure the patient's intake and output daily. C. Weigh the patient daily using a bedside scale. D. Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia.

B. Measure the patient's intake and output daily. C. Weigh the patient daily using a bedside scale.

•A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury? •A. Atorvastatin •B. Metformin •C. Nitroglycerin •D. Carvedilol

B. Metformin (metformin interacts with contrast dye and can cause acute kidney damage)

A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include? A. "Take this medication before bedtime." B. "Monitor for leg cramps." C. "Avoid grapefruit juice." D. "Reduce intake of potassium-rich foods."

B. Monitor for leg cramps. (HCTZ can cause hypokalemia)

The nurse is caring for a client with heart failure who is prescribed digoxin and a diuretic. What is a priority nursing action for this client? A. Ensure ejection fraction remains above 55% B. Monitor serum potassium levels C. Monitor daily weights D. Monitor serum sodium levels

B. Monitor serum potassium levels

A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? A. Urinary retention B. Muscle weakness C. Orthostatic hypotension D. Blurred vision

B. Muscle weakness (Myopathy is an adverse effect of this med)

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take? A. Suggest that the client use a salt substitute. B. Obtain a 12-lead ECG. C. Advise the client to add citrus juices and bananas to her diet. D. Obtain a blood sample for a serum sodium level.

B. Obtain a 12-lead ECG. (High potassium puts client at risk for dysrhythmias as well as cardiac arrest)

•A nurse is giving a presentation about preventing deep-vein thrombosis (DVT). Which of the following should the nurse include as a risk factor for this disorder? (Select all that apply.) •A. BMI of 20 •B. Oral contraceptive use •C. Hypertension •D. High calcium intake •E. Immobility

B. Oral contraceptive use E. Immobility

The nurse is caring for a client with heart failure. The nurse knows that right sided heart failure includes all of the following EXCEPT: A. Dependent edema B. Paroxysmal nocturnal dyspnea (PND) C. Increased central venous pressure (CVP) D. Ascites

B. Paroxysmal nocturnal dyspnea (PND)

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.

•A nurse is teaching a client's partner about how to obtain a blood pressure reading. Which of the following actions by the partner indicates a need for further instruction? •A. Wraps the blood pressure cuff snugly around the client's arm •B. Places the client's arm above the level of the client's heart •C. Checks the instrument gauge to ensure the reading starts at zero •D. Centers the cuff bladder over the client's brachial artery

B. Places the client's arm above the level of the client's heart

A patient is currently taking a potassium-sparing diuretic. The patient is experiencing EKG changes with tall-peaked T-waves, nausea, diarrhea, and paresthesia. The patient's morning lab results are back and the nurse makes it priority to check what lab result? A. Calcium B. Potassium C. Magnesium D. Sodium

B. Potassium

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? A. Calcium 8.5 mEq/L B. Potassium 3.0 mEq/L C. Magnesium 2.1 mEq/L D. INR of 1.0

B. Potassium 3.0 mEq/L (Hypokalemia may predispose to the client to dysrhythmia, especially if the client is taking digitalis preparations.)

•A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/84 mm Hg places him in which of the following categories? • •A. Within the expected reference range •B. Prehypertension •C. Stage 1 hypertension •D. Stage 2 hypertension

B. Prehypertension

Select below the CORRECT sequence in how the renin-angiotensin-aldosterone system works: A. Angiotensin I -> Angiotensin II -> ACE -> Renin -> Angiotensinogen B. Renin-> Angiotensinogen -> Angiotensin I -> ACE -> Angiotensin II C. Renin -> Angiotensin I -> Angiotensinogen -> ACE -> Angiotensin II D. Angiotensinogen -> Renin -> ACE -> Angiotensin I -> Angiotensin II

B. Renin-> Angiotensinogen -> Angiotensin I -> ACE -> Angiotensin II

A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription? A. Serum sodium level of 135 mEq/L B. Serum potassium level of 2.8 mEq/L C. Serum creatinine of 1.0 mg/dL D. Serum magnesium level of 1.9 mEq/L

B. Serum potassium level of 2.8 mEq/L

Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.

B. The amount the ventricles stretch at the end of diastole

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? A. The client follows a low-fat diet to reduce cholesterol. B. The client drinks a glass of grapefruit juice every day. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. D. The client uses garlic to lower cholesterol levels.

B. The client uses garlic to lower cholesterol levels. (garlic can increase the action of warfarin)

After a cardiac catheterization, the client needs to increase his or her fluid intake for which reason? A. NPO status will cause the client to be thirsty. B. The dye causes an osmotic diuresis. C. The dye contains a heavy sodium load. D. The pedal pulses will be more easily palpable.

B. The dye causes an osmotic diuresis.

A nurse is performing an ECG on a client who is experiencing chest pain. Which of the following statements should the nurse make? A. "You might feel a slight tingling while the test is being done." B. "The test will be complete in 30 to 60 minutes." C. "I will need to apply electrodes to your chest and extremities." D. "The radioactivity from the dye lasts only a few hours."

C. "I will need to apply electrodes to your chest and extremities."

A patient with diabetes and hypertension is being discharged home. The patient will be taking Sotalol and insulin per sliding scale. Which statement by the patient demonstrates they did NOT understand your discharge instructions about the side effects of Sotalol? A. "This medication can affect my blood glucose levels." B. "I will monitor my heart rate and blood pressure everyday while taking this medication." C. "While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low." D. "I will report to my physician if I develop shortness of breath, weight gain, or swelling in my feet."

C. "While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low."

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

C. 1.5-2.5 times the normal value range

A nurse in the emergency department is caring for a client who is suspected to have a ruptured abdominal aortic aneurysm. Which of the following is the priority nursing intervention? A. Get a 12 lead EKG B. Keep the client warm C. Administer IV fluids as ordered D. Administer pain medication as ordered

C. Administer IV fluids as ordered

According to the updated 2017 Hypertension Clinical Guidelines, which population is more likely to have hypertension than other groups and which medication(s) are more effective for the population? A. Asian Americans; calcium channel blockers and ace inhibitors B. Hispanic American; thiazide diuretics and calcium channel blockers C. African American; calcium channel blockers and thiazide diuretics D. African American; ace inhibitors and angiotensin II receptor blockers

C. African American; calcium channel blockers and thiazide diuretics

What component of the RAAS (renin-angiotensin-aldosterone system) is created and found in the liver that is activated by renin? A. Aldosterone B. Angiotensin I C. Angiotensinogen D. Angiotensin II

C. Angiotensinogen

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.

The MOST common cause of peripheral arterial disease is? A. Diabetes B. Deep vein thrombosis C. Atherosclerosis D. Pregnancy

C. Atherosclerosis

Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? A. Serum potassium level of 3.2 mEq/L B. Ejection fraction of 60% C. BNP of 760 pg/mL D. Chest x-ray report showing right middle lobe consolidation

C. BNP of 760 pg/mL

A nurse is teaching a client about diagnostic tests. A diagnostic test that could indicate target organ damage from prolonged uncontrolled hypertension includes: A. Intra-arterial line B. Palpation for apical thrill C. BUN/Creatinine D. Orthostatic vital signs

C. BUN/Creatinine

A client consistently reports feeling dizzy and lightheaded when moving from a supine position to a sitting position. What nursing assessment takes priority at this time? A. Respiratory rate B. Neurovascular evaluation C. Blood pressure D. Pulse oximetry

C. Blood pressure

Which of these vital signs is most important for a nurse to monitor in a patient with a known stable aneurysm? A. Pain B. Heart Rate C. Blood pressure D. Respirations

C. Blood pressure

A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition? •A. Anorexia •B. Weight gain •C. Breathlessness •D. Distended abdomen

C. Breathlessness

A client with heart failure reports a 7.6-pound (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? A. Dietary consult B. Sodium restriction C. Daily weight monitoring D. Restricted activity

C. Daily weight monitoring (A sudden weight increase of 2.2 pounds (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight.)

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 No medication because this is a normal Digoxin level.

C. Digibind

•A nurse is caring for a client who is postoperative following vascular surgery. Which of the following signs should indicate to the nurse that the client has developed a thrombus? •A. Positive Kernig's sign •B. Positive Homan's sign •C. Dull, aching calf pain •D. Soft, pliable calf muscle

C. Dull, aching calf pain

•A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. Which of the following instructions should the nurse include? •A. Applying cool compresses to her legs •B. Wearing loose, non-constricting stockings •C. Flexing her knees and feet frequently •D. Taking an NSAID tablet daily

C. Flexing her knees and feet frequently

A nurse in a provider's office is assessing a client who reports dyspnea and fatigue. Physical assessment reveals tachycardia and weak peripheral pulses. The nurse should recognize these findings as manifestations of which of the following conditions? •A. Asthma •B. Aortic valve regurgitation •C. Heart failure •D. Aortic stenosis

C. Heart failure

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply: A. Pregnancy B. Being Female C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension F. Varicose veins G. Smoking

C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension G. Smoking

•A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis? • •A. Myringotomy •B. Laparoscopic appendectomy •C. Hip arthroplasty •D. Cataract extraction

C. Hip arthroplasty

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 normal Digoxin level is <2)

•A nurse is caring for a client 1 day postoperative who has developed atelectasis. Which of the following manifestations is an expected finding for this condition? A. Apnea B. Dysphagia C. Hypoxemia D. Pleural effusion

C. Hypoxemia

A patient has a sodium level of 119. Which of the following is NOT related to this finding? A. Over secretion of ADH (antidiuretic hormone) B. Low salt diet C. Inadequate water intake D. Hypotonic fluid infusion (overload)

C. Inadequate water intake

What is the goal of the renin-angiotensin-aldosterone system (RAAS)? A. Decrease blood pressure B. Increase the heart rate C. Increase the blood pressure D. Decrease the heart rate

C. Increase the blood pressure

•A nurse is reviewing the laboratory results of a male adult client who is at risk for peripheral arterial disease from atherosclerosis. The nurse should identify that which of the following results places the client at risk? •A. Triglycerides 130 mg/dL •B. Blood glucose 92 mg/dL •C. LDL 172 mg/dL •D. HDL 84 mg/dL

C. LDL 172 mg/dL

A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? A. Monitoring VS B. Completing a physical assessment C. Maintaining cardiac monitoring D. Maintaining at least one IV access site

C. Maintaining cardiac monitoring

Which treatments below would decrease cardiac preload? Select all that apply: A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide

C. Nitroglycerin D. Furosemide (Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys.)

•A nurse is reviewing blood pressure classifications with a group of nurses at an in-service meeting. Which of the following should the nurse include as a risk factor for the development of hypertension? •A. High-density lipoprotein (HDL) level of 70 mg/dL •B. A diet high in potassium •C. Obstructive sleep apnea (OSA) •D. Taking benazepril

C. Obstructive sleep apnea (OSA)

A client recovering from cardiac angiography develops slurred speech. What does the nurse do first? A. Maintains NPO until it resolves B. Calls in another nurse for a second opinion C. Performs a complete neurologic assessment and notifies the primary care provider D. Explains to the client and family that this is expected after sedation.

C. Performs a complete neurologic assessment and notifies the primary care provider

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about the adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following? A. Tendon Pain B. Constipation C. Persistent cough D. Frequent urination

C. Persistant Cough

Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? A. Monitor pulse oximetry and cardiac rate and rhythm B. Reassure the client that his distress can be relieved with proper intervention C. Place the client in high-fowler's position with legs down. D. Ask a family member to remain with the client

C. Place the client in high-fowler's position with legs down.

What is the direct role of Angiotensin II in the Renin-Angiotensin-Aldosterone system (RAAS)? A. Release BNP B. Stimulate baroreceptors C. Potent Vasoconstrictor D. Sodium and fluid retention

C. Potent vasoconstrictor

The nurse recognizes the difference between a hypertensive emergency and a hypertensive urgency is: A. Decreased cardiac output B. Uncomplicated pulse pressure C. Potential damage to target organs D. Hyperglycemia

C. Potential damage to target organs

The nurse is caring for a client with an upper extremity arterial occlusive disease that includes vasospasm and vasodilation. What condition might the client have? A. Arterial hemostatis B. Intermittent claudication C. Raynauds phenomenon D. Atherosclerosis

C. Raynauds phenomenon

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

The nurse assesses the apical pulse of a client. Which extra heart sound is usually indicative of heart failure? A. S1 B. S1, S2 C. S3 D. S2

C. S3

A 72-year-old client admitted with fatigue and dyspnea has elevated levels of all of these laboratory results. Which finding is consistent with acute coronary syndrome (ACS) and must be communicated immediately to the primary health care provider? A. White blood cell count B. LDL C. Serum troponin I level D. C-reactive protein

C. Serum troponin I level (Elevation in serum troponin levels is associated with acute myocardial injury and indicates a need for immediate interventions such as angioplasty, anticoagulant administration, or administration of fibrinolytic medications.)

A patient with Cushing's Syndrome has been experiencing an infection and has a fever of 102'F. On assessment, you find the patient to be confused, restless, has dry mucous membranes, and flushed skin. Which finding below correlates with the presentation of this patient? A. Sodium level of 144 B. Sodium level of 115 C. Sodium level of 170 D. Sodium level of 135

C. Sodium level of 170

Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply: A. Hyperkalemia B. Persistent, dry cough C. Swelling in the face D. Thin and shiny skin in the lower extremities E. Difficulty breathing

C. Swelling in the face E. Difficulty breathing

A nurse is preparing to administer warfarin to a client. Which of the following information should the nurse recognize prior to administering the medication? A. Warfarin is compatible with heparin. B. The client's aPTT should be monitored. C. The client should be observed for manifestations of hemorrhage. D. Warfarin can be administered along with NSAIDS.

C. The client should be observed for manifestations of hemorrhage.

The physician prescribes the patient a potassium-sparing diuretic. Which statement below best describes how this medication works to cause diuresis? A. These medications work to inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. B. These medications work to inhibit the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle. C. These medications work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct. D. These medications work to inhibit the sodium channels within the proximal convoluted tubule by decreasing sodium reabsorption.

C. These medications work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct.

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."

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 is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.)

While conducting medication teaching on ace inhibitors for a newly diagnosed client with hypertension, the nurse emphasizes what possible side effect to report? A. Angioedema and seizures B. Frequent urination and nagging cough C. High sodium levels and nausea D. Angioedema and nagging dry cough

D. Angioedema and nagging dry cough

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

The nurse instructs a client with hypertension to avoid all of the following medications except: A. Birth control pills B. OTC cold medication with pseudoephedrine C. Guaifenesin D. Calcium Channel Blockers

D. Calcium Channel Blockers

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

D. Digoxin

•A nurse is planning care for a client who has deep-vein thrombosis (DVT) and is receiving anticoagulation therapy. Which of the following interventions should the nurse include in the plan of care? •A. Apply cold compresses to the affected extremity. •B. Massage the affected extremity gently. •C. Apply compression stockings at bedtime. •D. Encourage the client to walk.

D. Encourage the client to walk.

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

A patient with a sodium level of 178 is ordered to be started on 0.45% Saline. What is the most IMPORTANT nursing intervention for this patient? A. Maintain patent IV B. Give rapidly to ensure fluids levels are shifted properly C. Clarify doctor's order because 0.45% saline is contraindicated in hypernatremia D. Give slowly and watch for signs and symptoms of cerebral edema

D. Give slowly and watch for signs and symptoms of cerebral edema

A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? A. Milk B. Orange juice C. Coffee D. Grapefruit juice

D. Grapefruit juice (Can increase blood levels)

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect? •A. Jugular venous distention •B. Abdominal distension •C. Dependent edema •D. Hacking cough

D. Hacking cough

The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F (37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the nurse take? A. Give the digoxin; reassess the heart rate in 30 minutes. B. Give the digoxin; document assessment findings in the medical record. C. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. D. Hold the digoxin, and obtain a prescription for a potassium supplement.

D. Hold the digoxin, and obtain a prescription for a potassium supplement.

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

Which of the following clinical manifestations are indications for a nurse to performing an ankle-brachial index (ABI) on a client? A. Hypertensive crisis B. Irregular, superficial ulcer along the medial malleolus C. 4+ pitting edema to lower extremities D. Intermittent claudication

D. Intermittent claudication

Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

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 client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect: A. Normal vs. Abnormal tissue B. Damage in areas of the heart C. Ventricular function D. Myocardial scarring and perfusion

D. Myocardial scarring and perfusion

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 nurse is reviewing the laboratory findings for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following findings should the nurse expect to be decreased? •A. WBC •B. RBC •C. Granulocytes •D. Platelets

D. Platelets

The nurse is caring for a client with heart failure in the coronary care unit. The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? A. Determines the client's physical limitations B. Encourages alternate rest and activity periods C. Monitors and documents heart rate, rhythm, and pulses D. Positions the client to alleviate dyspnea

D. Positions the client to alleviate dyspnea

A patient has a dose of Spironolactone due at 1000. Which finding below would require the nurse to hold the dose and notify the physician for further orders? A. Magnesium 1.5 mg/dL B. BUN 18 C. Sodium 140 mEq/L D. Potassium 7 mEq/L

D. Potassium 7 mEq/L

Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? A. Afterload B. Cardiac index C. Cardiac output D. Preload

D. Preload

A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? A. Furosemide B. Hydrochlorothiazide C. Metolazone D. Spironolactone

D. Spironolactone

___________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume

D. Stroke volume

The nurse knows that which type of heart failure is characterized by a severely reduced ejection fraction in clients? A. Right sided B. Central C. Diastolic D. Systolic

D. Systolic

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

•A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur. A. is a high-pitched sound due to a narrow valve. B. is an extra sound due to blood entering an inflexible chamber. C. means that there is some inflammation around the heart. D. indicates turbulent blood flow through a valve.

D. indicates turbulent blood flow through a valve

•A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur •A. is a high-pitched sound due to a narrow valve. •B. is an extra sound due to blood entering an inflexible chamber. •C. means that there is some inflammation around the heart. •D. indicates turbulent blood flow through a valve.

D. indicates turbulent blood flow through a valve.

When the RAAS is activated due to a change in body hemodynamics, the __________________ stimulates the ___________________ cells in the kidneys to release _______________. A. parasympathetic nervous system; mesangial; aldosterone B. sympathetic nervous system; podocytes; renin C. parasympathetic nervous system; juxtaglomerular; aldosterone D. sympathetic nervous system; juxtaglomerular; renin

D. sympathetic nervous system; juxtaglomerular; renin

Thus, increasing serum sodium levels by increasing....

Kidney reabsorption of sodium and enhancing kidney loss of water

•A nurse is creating a teaching plan for a client who has thrombocytopenia. Which of the following instructions should the nurse include? (Select all that apply.) •A. Lubricate lips with water-soluble ointment. •B. Brush teeth with a soft toothbrush. •C. Blow nose gently. •D. Limit fruit consumption. •E. Use a straight edge razor to shave.

•A. Lubricate lips with water-soluble ointment. •B. Brush teeth with a soft toothbrush. •C. Blow nose gently.