NUR 222 - Ch 14-18 & 54 - Test 3 PrepU Super Set

The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump?

Echocardiogram

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?

The development of left-sided heart failure

A class of beginning nursing students is learning about heart failure in their pathophysiology class. What should the students be taught is the reason for heart failure?

The heart cannot pump sufficient blood to meet the body's metabolic needs (p. 424)

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur?

Worsening angina (p. 403)

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as:

a third heart sound - S3 (p. 428)

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation?

"Rehabilitation will help me function as well as I physically can." (p. 421)

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse?

"Removing the patch at night prevents drug tolerance while keeping the benefits."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

"The pain occurred while I was mowing the lawn." (p. 401)

The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following?

Pitting edema (p. 430, Box 15-1)

Left-sided heart failure results in several symptoms as a result of reduced cardiac output. A client is diagnosed with heart failure. Which of the following symptoms would NOT have contributed to this diagnosis?

Polydipsia (p. 427-428)

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having?

Potassium

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?

Potassium level of 3.1

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?

Preload (p. 425)

Which medication is an antidote to heparin?

Protamine sulfate (p. 409)

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

Rheumatic fever (p. 442)

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection (p. 455)

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders?

Older adults are at increased risk for toxicity.

The seasoned nurse is instructing the new graduate on information obtained from central venous pressure and pulmonary artery pressure. Which statement, made by the seasoned nurse, reflects the most pertinent information regarding circulation?

"A pulmonary artery pressure provides information about pressure on the left side of the heart."

A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following?

"A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required." (p. 447)

The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information?

"Are you only able to breathe when you are sitting upright?"

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?

"I'll keep a log of each time my ICD discharges." (p. 486-487)

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment?

5 (p. 505)

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?

Increased abdominal and back pain (p. 499)

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures?

"I have my wife look at the soles of my feet each day." (p. 511)

A client with shock brought on by hemorrhage has a temperature of 97.6° F (36.4° C), a heart rate of 140 beats/minute, a respiratory rate of 28 breaths/minute, and a blood pressure of 60/30 mm Hg. For this client, the nurse should question which physician order?

"Infuse I.V. fluids at 83 ml/hour." (p. 1399)

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following?

"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." (p. 466)

The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following?

"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." (p. 487)

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

"Spike" on the rhythm strip

The nurse is caring for a motor vehicle accident client who is unresponsive on arrival to the emergency department. The client has numerous fractures, internal abdominal injuries, and large lacerations on the head and torso. The family arrives and seeks update on the client's condition. A family member asks, "What causes the body to go into shock?"Given the client's condition, which statement is most correct?

"The client is in shock because the blood volume has decreased in the system."

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following?

"The only difference is the rate, which will be below 60 bpm in sinus bradycardia." (p. 468)

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation?

"Walk to the point of pain, rest until the pain subsides, then resume ambulation." (p. 495)

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?

"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." (p. 486)

The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?

"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." (p. 472)

After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of:

0.12 and 0.2 seconds. (p. 466)

Nursing management of a patient receiving heparin includes monitoring for heparin-induced thrombocytopenia. Choose the result that indicates the potential for spontaneous intracranial hemorrhage, which is life-threatening. A platelet count of:

10,000 to 14,500 mm3 (p. 505)

When vasoactive medications are administered, the nurse must monitor vital signs at least how often?

15 minutes (p. 1398)

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be?

2.0-3.0 (p. 504)

The nurse taking care of a patient evidencing signs of shock empties the urinary catheter drainage bag after her 12-hour shift. The nurse notes an indicator of renal hypoperfusion. What is the relevant urinary output for this condition?

300 mL (p. 1404)

The nurse receives an order to administer a colloidal solution for a patient experiencing hypovolemic shock. What common colloidal solution will the nurse most likely administer?

5% albumin (p. 1397)

The nurse knows when the cardiovascular system becomes ineffective in maintaining an adequate mean arterial pressure (MAP). Select the reading below that indicates tissue hypoperfusion.

60 mm Hg (p. 1404)

The nurse is using continuous central venous oximetry (ScvO2) to monitor the blood oxygen saturation of a patient in shock. What value would the nurse document as normal for the patient?

70%

A nurse practitioner visits a patient in a cardiac care unit. She assesses the patient for shock, knowing that the primary cause of cardiogenic shock is:

A myocardial infarction. (p. 1400)

You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages?

A rapid, bounding pulse (p. 1404)

A patient is being discharged to home. The nurse must emphasize the importance of being weighed daily. Which significant weight change would need to be reported to the patient's health care provider?

A weight gain of 2½ pounds in a day (p. 433)

A client presents to the community health office experiencing rapidly increasing symptoms of anaphylactic shock. Which nursing action would be completed first?

Administer an epinephrine injection as ordered by the health care provider.

A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per minute, and respirations of 30 breaths per minute. The client's skin is cold and clammy. The nurse next

Administers oxygen by nasal cannula at 2 liters per minute (p. 1394)

The nurse is caring for a client in shock who is deteriorating. The nurse is infusing IV fluids and giving medications as ordered. What type of medications is the nurse most likely giving to this client?

Adrenergic drugs (p. 1398)

Which colloid is expensive but rapidly expands plasma volume?

Albumin (p. 1397)

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?

Altered patterns frequently affect the heart's ability to pump blood effectively.

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment?

An automatic external defibrillator

A nurse educator is teaching a group of nurses about assessing critically ill clients for multiple organ dysfunction syndrome (MODS). The nurse educator evaluates understanding by asking the nurses to identify which client would be at highest risk for MODS. It would be the client who is experiencing septic shock and is

An older adult man with end-stage renal disease and an infected dialysis access site (p. 1409)

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the:

Anterior surface of the foot near the ankle joint. (p. 493)

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?

Anticoagulant

You are assessing a client recently admitted to your unit for hypotension. While assessing this client, you find a pulsatile mass near the umbilicus. What would you suspect?

Aortic aneurysm (p. 499)

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?

Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.

A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease?

Assess chest pain and administer prescribed drugs and oxygen (p. 406)

You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult?

Atherosclerosis (p. 490)

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?

Atrial depolarization (p. 465)

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

Atrial flutter

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

Atrial flutter (p. 470)

Which medication is the drug of choice for sinus bradycardia?

Atropine (p. 469)

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack?

Avoid situations that contribute to ischemic episodes. (p. 498)

The nurse is working with a client who has just been diagnosed with an aneurysm. What advice should the nurse provide to this client?

Avoid straining during bowel movements and coughing. (p. 501)

After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker?

Avoid undergoing magnetic resonance imaging (MRI). (p. 486)

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?

Bibasilar crackles (p. 428)

A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring?

Blood pressure 80/46 mm Hg

Shock occurs when tissue perfusion is inadequate to deliver oxygen and nutrients to support cellular function. When caring for patients who may develop indicators of shock, the nurse is aware that the most important measurement of shock is:

Blood pressure. (p. 1392)

Which of the following is a clinical characteristic of neurogenic shock?

Bradycardia (p. 1406)

During preshock, the compensatory stage of shock, the body, through sympathetic nervous system stimulation, will release catecholamines to shunt blood from one organ to another. Which of the following organs will always be protected?

Brain (p. 1394)

Which is a diagnostic marker for inflammation of vascular endothelium?

C-reactive protein (CRP) (p. 398)

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea?

Call for a chest x-ray.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

Cardiac tamponade (p. 458)

A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for?

Catheter ablation therapy (p. 487)

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is:

Cigarette smoking. (p. 490)

You are caring for a client who is in neurogenic shock. You know that this is a subcategory of what kind of shock?

Circulatory {distributive} (p. 1406)

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

Clients with recurrent life-threatening tachydysrhythmias (pp. 481-482)

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin?

Clopidogrel (p. 404)

The nurse assesses a patient who experienced a reaction to a bee sting. The patient's clinical findings indicate a pre-shock condition, which is evidenced by:

Cold, clammy skin and tachycardia. (pp. 1393-4)

A pacemaker is the treatment of choice for what cardiac dysrhythmia?

Complete heart block (p. 473)

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?

Constant chest pain (p. 458)

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?

Constant, intense back pain and falling blood pressure (p. 499)

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?

Decreased cardiac output and decreased systolic and diastolic blood pressure (p. 471)

After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following?

Defibrillation (p. 481)

Which is a characteristic of arterial insufficiency?

Diminished or absent pulses (p. 508)

Which aneurysm results in bleeding into the layers of the arterial wall?

Dissecting (p. 501)

The nurse is monitoring the patient in shock. The patient begins bleeding from previous venipuncture sites, in the indwelling catheter, and rectum, and the nurse observes multiple areas of ecchymosis. What does the nurse suspect has developed in this patient?

Disseminated intravascular coagulation (DIC)

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?

Dorsiflex the foot while the leg is elevated to check for calf pain. (p. 503)

cardiotonics

Drugs that have beneficial action on the heart are classed as cardiotonics. Usually intended to indicate increased force of contraction.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?

Dyspnea on exertion

A 65-year-old client has come to the emergency department reporting lightheadedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms?

Electrocardiogram (p. 461)

The community health nurse finds the client collapsed outdoors. The nurse assesses that the client is shallow breathing and has a weak pulse. A neighbor calls 911. Which nursing action is helpful while waiting for the ambulance?

Elevate the legs higher than the heart.

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency?

Elevate the legs periodically for at least 15 to 20 minutes. (p. 506)

A patient visits a health clinic because of urticaria and shortness of breath after being stung by several wasps. The nurse practitioner immediately administers which medication to reduce bronchospasm?

Epinephrine (p. 1407)

Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes?

Head injury (p. 1399)

The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do?

Give an IV bolus of atropine. (p. 469)

A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?

Group A, beta-hemolytic streptococcus (p. 454)

A patient experiences a faster-than-normal heart rate when she drinks more than two cups of coffee in the morning. The nurse knows that an indicator of sinus tachycardia on an ECG would be which of the following?

Heart rate of 118 bpm (p. 469)

Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a:

Heart rate of 42 beats per minute (bpm). (p. 468.)

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of:

Hemorrhage (p. 495)

Which of the following is NOT a category of shock?

Hepatic (p. 1393)

Which is the most common type of shock?

Hypovolemic (p. 1398)

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?

Homans' (p. 503)

Which of the following is a potential cause of premature ventricular complexes {PVCs}?

Hypokalemia (p. 473)

While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following?

Hypovolemia and fever (p. 469)

The nurse enters the client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate defibrillation

You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate defibrillation (pp. 481-482)

The nurse is administering a medication to the client with a positive inotropic effect. Which action of the medication does the nurse anticipate?

Increase the force of myocardial contraction

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time?

Ineffective peripheral tissue perfusion related to venous congestion (p. 503)

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity?

Intermittent claudication (p. 492)

A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with?

Intubation and mechanical ventilation

The central venous pressure (CVP) reading in hypovolemic shock is typically which of the following?

Low (p. 1400)

On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard?

Low-pitched, rumbling diastolic murmur at the apex of the heart (p. 442)

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest?

Lowering the limb so that it is dependent (p. 492)

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities?

Participate in a regular walking program. (p. 495)

Which positioning strategy should be used for the client diagnosed with hypovolemic shock?

Modified Trendelenburg (p. 1399)

The nurse determines that a patient in shock is experiencing a decrease in stroke volume when what clinical manifestation is observed?

Narrowed pulse pressure

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment?

Numbness, cool skin temperature, and pallor (p. 492)

When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating

Orthopnea (p. 433)

A client experiences an acute myocardial infarction. Current blood pressure is 90/58, pulse is 118 beats/minute, and respirations are 30 breaths/minute. The nurse intervenes first by administering the following prescribed treatment:

Oxygen at 2 L/min by nasal cannula (p. 1400)

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

Pacer rate (p. 486)

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?

Pericardial friction rub (p. 415)

Which of the following is a late clinical manifestation of mitral stenosis?

Peripheral edema (p. 442)

The client with cardiac failure is taught to report which symptom to the physician or clinic immediately?

Persistent cough (p. 430)

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?

Prepare to administer protamine sulfate. (p. 504)

The nurse takes a preoperative ECG on a 48-year-old patient. She notices that there is a longer than normal distance between right ventricular depolarization and repolarization. She documents the strip finding and notifies the surgeon. Her conclusion was based on an abnormality in which of the following?

QT interval (p. 466)

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms?

Raynaud's disease (p. 498)

Morphine sulfate has which of the following effects on the body?

Reduces preload (p. 1401)

Which terms describes the backward flow of blood through a heart valve?

Regurgitation (p. 440)

The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm?

Severe back pain

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?

Right side of sternum, fourth intercostal space (p. 464.)

It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the:

Right ventricle to the right atrium. (p. 441)

Which of the following is the most effective intervention for preventing progression of vascular disease?

Risk factor modification (p. 497)

A patient is being treated for septic shock. On assessment, the nurse notes an abnormal finding that is reported to the health care provider. Which of the following is most likely that finding?

SVO2 of 55% (p. 1405)

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?

Shortness of breath (p. 442)

A patient comes to the emergency department with complaints of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

Sinus tachycardia (p. 469)

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions?

Stabilizing heart rate and blood pressure and easing anxiety (p. 501)

A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client?

Stop smoking (p. 490)

The nurse is caring for a client who is status post operative from a vein stripping. What would the nurse monitor for?

Swelling in the operative leg (p. 506)

When a client is in the compensatory stage of shock, which symptom occurs?

Tachycardia (p. 1394)

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend?

Taking daily walks (p. 495)

What should the nurse do to manage the persistent swelling in a client with severe lymphangitis and lymphadenitis?

Teach the client how to apply an elastic sleeve (p. 511)

The LPN is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The LPN is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The LPN confirms the monitor reading. When consulting with the RN, which of the following is anticipated?

The RN administering atropine sulfate intravenously

A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details?

The client can walk about 50 feet before getting pain in the right lower leg (p. 492)

Which of the following is the most common site for a dissecting aneurysm?

Thoracic area (p. 500)

Medication used to treat a-fib

Treatment consists of blood thinners and beta blockers. Other treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation).

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks?

Troponin (p. 419)

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for?

Ulceration (p. 508)

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue?

Ulcers and infection in the edematous area (p. 511)

When a patient in shock is receiving fluid replacement, what should the nurse monitor frequently? (Select all that apply.)

Urinary output; Mental status; Vital signs (p. 1397)

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect?

Venous insufficiency (p. 507-508)

Which of the following clinical manifestations would the nurse expect to find in the patient diagnosed with aortic regurgitation?

Visible neck vein pulsations (p. 446)

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of:

acute pulmonary edema (p. 434)

Atropine Sulfate

an antimuscarinic agent used to treat bradycardia

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:

aspirin or clopidogrel {Plavix}. (p. 405)

The PR interval

begins at the onset of the P wave and ends at the onset of the QRS complex. This interval represents the time the impulse takes to reach the ventricles from the sinus node. It is termed the PR interval because the Q wave is frequently absent. Normal values lie between 0.12 and 0.20 seconds.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:

forcing blood into the deep venous system. (p. 505)

A nurse knows that the major clinical use of dobutamine (Dobutrex) is to:

increase cardiac output. (p. 1401)

Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:

occur at a rate of more than six per minute (pp. 473-474)

A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac:

troponin. (p. 419)

Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?

Heterograft (p. 447)

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following?

Administration of a vasodilating drug {as ordered by a qualified provider} (p. 431)

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?

Check regularly for dependent edema (p. 449)

Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis?

Maintain the client on bed rest (p. 449)

Which s the analgesic of choice for acute myocardial infarction (MI)?

Morphine (p. 420)

The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis?

Addressing obesity

A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate?

Morphine sulfate

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.

3.8 (pp. 448)

The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following?

Obtaining a throat culture

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. (p. 419)

A nurse assesses a patient who is being evaluated for myocarditis. Which of the following clinical manifestations are consistent with this diagnosis? Select all that apply.

An S3 gallop; Jugular venous distention; Orthopnea; Palpitations (p. 457)

A patient has been experiencing increasing shortness of breath and fatigue. The physician has ordered a diagnostic test in order to determine what type of heart failure the patient is having. What diagnostic test does the nurse anticipate being ordered?

An echocardiogram (p. 429)

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse?

An extra heart sound (p. 443)

Which would the nurse stress as a lifelong necessity for a client managing infective endocarditis?

Antibiotic therapy

Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent?

Antiplatelets (p. 404)

A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next?

Check the client's potassium level (p. 431)

When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom?

Chest pain (p. 458)

The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following?

Count the respiratory rate for bradypnea. (p. 420)

The nurse is caring for a patient who is having chest pain associated with a myocardial infarction (MI). What medication should the nurse administer intravenously to reduce pain and anxiety?

Morphine sulfate (p. 420)

During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?

Decreased cardiac output (p. 448)

Which of the following medications is a human brain natriuretic peptide (BNP) preparation?

Natrecor (p. 431)

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate?

Decreased cardiac output (p. 450)

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?

Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction (p. 410)

What is the primary underlying disorder of pulmonary edema?

Decreased left ventricular pumping (p. 434)

Frequently, what is the earliest symptom of left-sided heart failure?

Dyspnea on exertion (p. 430)

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following?

Heart transplantation (p. 449)

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern?

Hematocrit of 30% (p. 404)

The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?

Echocardiogram (p. 425)

The diagnosis of heart failure is usually confirmed by which of the following?

Echocardiogram (p. 429)

Which diagnostic study is usually performed to confirm the diagnosis of heart failure?

Echocardiogram (p. 435)

The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?

Echocardiography (p. 446)

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

Elevated ST segment (p. 416)

A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display?

Fatty deposits in the lumen of arteries

Which signs and symptoms accompany a diagnosis of pericarditis?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate {ESR} (p. 458)

Which medication is categorized as a loop diuretic?

Furosemide {Lasix} (p. 431)

A 63-year-old accountant was admitted to the cardiac ICU with full-blown pulmonary edema. After he was revived, the nurse discusses his symptoms with the client and his wife. What is a typical, subtle symptom that communicates right-sided heart failure?

Gradual, unexplained weight gain (p. 430)

Which of the following therapies are for patients who have advanced heart failure (HF) after all other therapies have failed?

Heart transplant (p. 432)

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement (p. 455)

The nurse is preparing to administer hydralazine and isosorbide dinitrate (Dilatrate). When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?

Hold the medication and call the physician.

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.

Hyperlipidemia, Obesity, Tobacco use (p. 398)

Which type of cardiomyopathy is associated with syncope?

Hypertrophic

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?

Hypertrophic (p. 450)

Which of the following is inconsistent as a condition related to metabolic syndrome?

Hypotension (p. 398)

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document?

Hypotension (p. 416)

A patient diagnosed with a pericarditis and pericardial effusion. Based on the physiologic mechanisms of increased pericardial fluid and its effect on the heart, which of the following effects would be expected?

Inability of the ventricles to distend and fill adequately (p. 435)

Which of the following is the primary cause of pulmonary or peripheral congestion?

Inadequate cardiac output (p. 424)

A nurse is discussing pharmacologic therapy used in the treatment of coronary vascular disease with a nursing student. The nurse would be correct in identifying the use of a positive inotrope as having which of the following functions?

Increase in myocardial contractility (p. 403)

A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect?

Increased liver enzymes (p. 401, Table 14-1)

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?

Increased pulmonary artery diastolic pressure (p. 429)

A client in the hospital informs the nurse he "feels like his heart is racing and can't catch his breath." What does the nurse understand occurs as a result of a tachydysrhythmia?

It reduces ventricular ejection volume.

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?

Left ventricular dysfunction (p. 445)

The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply.

Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed; Renew the supply every 6 months; Take the tablet in anticipation of any activity that can produce pain; Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. (p. 403, Box 14-3).

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

Lie down or sit in a chair for 5 to 10 minutes after taking the drug. (p. 403)

As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid.

Low-density lipoproteins (LDL) (p. 399)

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?

Low-sodium diet

A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client?

The high risk for complications if she becomes pregnant while taking warfarin (p. 447)

A nurse caring for a patient with mitral stenosis understands that the initial cause of disruption to the normal flow of blood through the heart is due to:

The increased resistance of a narrowed orifice between the left atrium and the left ventricle. (pp. 441-2)

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)?

The patient has at least a 70% occlusion of a major coronary artery. (p. 408)

The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery?

Warfarin (p. 448)

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:

assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. (p. 448)