perfusion

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

"You should avoid grapefruit juice." Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. -Potential adverse effects include elevated liver enzymes, and rhabdomyolysis. Brown-colored urine is a manifestation of liver dysfunction, an adverse effect of simvastatin. The client should report this to the provider. -Simvastatin can cause rhabdomyolysis and myopathy. -Take in the evening.

A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

Bradycardia is an adverse effect of digoxin. Expected apical heart rates vary considerably according to age. The nurse should withhold the digoxin dose for heart rate of 60/min or below in an adult, 70/min or below in a child, and 90/min or below in an infant.

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? Anorexia Weight gain Breathlessness Distended abdomen

Breathlessness Manifestations of left-sided heart failure include crackles or wheezes and breathlessness due to pulmonary congestion. A distended abdomen, anorexia, nausea, weight gain frim edema and ascites are all manifestations of right-sided heart failure.

A nurse is providing discharge instructions to a client following a cardiac catheterization. Which of the following information should the nurse include? "You can resume regular exercise as soon as tomorrow." "The dressing should be changed within 12 hours of the procedure." "You will notice a small hematoma at the incision site." "Pain medication will not be necessary."

Bruising and a small hematoma at the incision site are expected. -Drsng change 1 day -Exercise few days

What is a murmur?

Cardiac murmurs are relatively loud, turbulent sounds the nurse can hear between the usual, expected heart sounds. They create a whooshing or a swishing sound. Those between S1 and S2 are systolic murmurs. Those between S2 and the next S1 are diastolic murmurs.

A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the cause of the client's low potassium level? Furosemide Nitroglycerin Metoprolol Spironolactone

Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis, which decreases potassium through excretion in the distal nephrons. Hypokalemia is an adverse effect of furosemide.

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? Potassium Albumin Cortisol Bicarbonate

Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia.

A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication? Weight gain Increased blood pressure Hypoglycemia Leg cramps

Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level. -May cause weight loss with fluid loss.

A nurse is performing a cardiac assessment on a client and auscultates an S3 sound. The nurse should recognize that this sound represents which of the following heart conditions? Atrial gallop Ventricular gallop Closure of the mitral valve Closure of pulmonic valve

Ventricular gallop An S3 represents a ventricular gallop caused by a rush of blood into a ventricle that is stiff or dilated. This can be a finding of heart failure and hypertension. -Closure of the mitral valve is represented by the S1 heart sound. -Closure of the pulmonic valve is represented by the S2 heart sound. -An S4 sound represents an atrial gallop.

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? "I can walk a mile a day." "I've had a backache for several days." "I am urinating more frequently." "I feel nauseated and have no appetite."

"I feel nauseated and have no appetite." Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

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? "I will read food labels and limit my sodium to 4 grams per day." "I should use naproxen to manage discomfort." "I plan to slow down if I am tired the day after exercising." "I will take my diuretic before sleep and drink fluids during the day."

"I plan to slow down if I am tired the day after exercising." Clients who experience chest pain or dyspnea while exercising or experience fatigue the next day are probably advancing the activity too quickly and should slow down. -A client who has heart failure should avoid the use of NSAIDs as these medications can cause sodium retention. The nurse should recommend the use of acetaminophen for the treatment of discomfort. -No pee meds at night

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? Exercise at least three times per week. Take diuretics early in the morning and before bedtime. Notify the provider of a weight gain of 0.5 kg (1 lb) in a week. Take naproxen for generalized discomfort.

-ANSWER: EXERCISE. The nurse encourage the client to stay as active as possible and to develop a regular exercise regimen. Clients who have heart failure who remain active appear to have improved outcomes. The client should try to walk at least three times per week and should slowly increase the amount of time walked over several months. Regular exercise strengthens the heart and cardiovascular system, thereby improving circulation and lowering blood pressure. -A client who is taking diuretics should take them in the early morning and early afternoon. The nurse instruct the client not to take the diuretics near bedtime to avoid sleep pattern disturbance secondary to increased urination. -The nurse should instruct the client to check weight daily at the same time and notify the provider of a weight gain of 1.4 to 2.3 kg (3 to 5 lb) in 1 week, or 0.5 to 1 kg (1 to 2 lb) overnight. The client should be instructed that excessive weight gain indicates fluid volume excess and fluid retention. -The nurse should instruct the client to avoid the use of NSAIDs as these contribute to sodium and fluid retention, worsening the client's condition.

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? Apply a heating pad on a low setting to help relieve leg pain. Adjust the thermostat so that the environment is warm. Wear antiembolic stockings during the day. Rest with the legs above heart level.

Adjust the thermostat so that the environment is warm. The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will help prevent vasoconstriction. -Think Reynaud's Syndrome- cold fingers, bad cold intolerance, an artery issue

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? Anorexia Ataxia Photosensitivity Jaundice

Anorexia, vomiting, confusion, headache, and vision changes (light halos) are manifestations of digoxin toxicity.

A nurse is teaching a client about following a low-cholesterol diet after coronary artery bypass grafting. Which of the following client food choices reflects the client's understanding of these dietary instructions? Liver Milk Beans Eggs

Any food that does not contain animal products does not contain cholesterol. Beans are a good source of protein for a client who follows a low-cholesterol diet. Egg whites, however, are cholesterol-free.

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

Edema -An increase in venous hydrostatic pressure, which develops when fluid accumulates in the veins, causes fluid to leak out into the tissues resulting in edema. -Dependent rubor, hair loss, thick toenails are manifestation of peripheral arterial disease.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include? "Take this medication with food." "You might have to stop taking this medication 5 days before any planned surgeries." "Take this medication three times daily." "Expect to have black-colored stools while taking this medication."

Clopidogrel (Plavix), an anticoagulant, inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding. -Take once daily -Clopidogrel can cause gastrointestinal bleeding. The client should monitor and report any manifestations of bleeding, such as black stools, hematuria, or coffee ground emesis.

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? Decreased brain natriuretic peptide (BNP). Elevated central venous pressure (CVP). Increased pulmonary artery wedge pressure (PAWP). Decreased specific gravity

Elevated central venous pressure (CVP). -CVP is a measurement of the pressure in the right atria or ventricle at the end of diastole. An elevated CVP is indicative of heart failure.

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? Potassium Hemoglobin Creatinine Blood urea nitrogen

Digoxin is a cardiac glycoside medication used to improve myocardial contractility, increasing stroke volume and cardiac output in a client who has heart failure. During therapy, the nurse should closely monitor the client's potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias.

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? Frothy sputum Dependent edema Nocturnal polyuria Jugular distention

Frothy sputum: Left-sided heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations include hacking cough, frothy sputum, wheezing, fatigue, and weakness. Right-sided failure has greater systemic effects because of increased venous pressures and congestion. Manifestations include dependent edema to the extremities and sacrum, enlarged liver and spleen, and ascites, jugular distension, nocturnal polyuria.

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? Asthma Aortic valve regurgitation Heart failure Aortic stenosis

Heart failure: fatigue and tachycardia are early manifestations of heart failure. Other manifestations include dyspnea and weak peripheral pulses. -Manifestations of aortic valve regurgitation include dyspnea, orthopnea, nocturnal angina with diaphoresis. -Manifestations of aortic stenosis include dyspnea, angina and syncope. As the condition progresses the client might have fatigue and peripheral cyanosis.

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

Hepatomegaly, or liver enlargement, is a manifestation of right-sided heart failure.

A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect? Thin, pliable toe nailsThe client who has PAD will have thickened toenails. Leg pain at restMY ANSWERIn the initial stages of PAD, clients might experience intermittent claudication. As the disease progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night. Hairy legsBecause of the decreased perfusion to the lower extremities, the client who has PAD will have shiny, dry skin on the legs with sparse hair growth. Flushed, warm legsThe client who has PAD will have skin that is cool or cold to the touch because of the decreased arterial blood flow to the extremity. When the extremity is in a dependent position, such as when the client is dangling, the extremity develops dependent rubor, a dark red color. When the extremity is elevated above the heart, it will appear pale and cyanotic.

In the initial stages of PAD, clients might experience intermittent claudication. As the disease progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night. ***The client who has PAD will have skin that is cool or cold to the touch because of the decreased arterial blood flow to the extremity. When the extremity is in a dependent position, such as when the client is dangling, the extremity develops dependent rubor, a dark red color. When the extremity is elevated above the heart, it will appear pale and cyanotic.

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? Intermittent claudication Dependent rubor Rest pain Foot ulcers

Intermittent claudication is ischemic pain that is precipitated by exercise, resolves with rest, and is reproducible. The pain associated with claudication arises when cellular oxygen demand exceeds supply. It occurs early in the disease course, and is typically the initial reason clients who have PAD seek medical attention.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? Withholding the medication if the heart rate is above 100/min Instructing the client to eat foods that are low in potassium Measuring apical pulse rate for 30 seconds before administration Evaluating the client for nausea, vomiting, and anorexia

Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse in a provider's office is assessing a client who reports occasional atypical chest pain, palpitations, and exercise intolerance. On auscultation, the nurse notes a systolic click. The nurse should recognize this finding as a manifestation of which of the following conditions? Aortic regurgitation Mitral stenosis Aortic stenosis Mitral valve prolapse

Mitral valve prolapse: Although many clients who have mitral valve prolapse are asymptomatic, others report atypical chest pain, palpitations, exercise intolerance, dizziness, and syncope. Auscultation of a client who has mitral valve prolapse reveals a systolic click that is caused by a valve leaflet prolapsing into the left atrium. -Manifestations of aortic regurgitation include bounding arterial pulse and a widened pulse pressure. -Manifestations of mitral stenosis include a low-pitched, rumbling murmur and a weak, irregular pulse. -A rough, systolic crescendo-decrescendo murmur is a manifestation of aortic stenosis.

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? Urinary retention Muscle weakness Orthostatic hypotension Blurred vision

Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.

A nurse is assessing a toddler who has heart failure. Which of the following findings should the nurse expect? Weight loss Increased urine output Bradycardia Orthopnea

ORTHOPNEA: A toddler who has heart failure has increased venous return to the heart and lungs, which leads to pulmonary congestion. The congestion causes orthopnea, or difficulty breathing, while lying down. Having the toddler sit up decreases venous return, as well as pressure the abdominal organs have on the diaphragm. This decrease in pressure improves breathing and oxygenation. -A toddler who has heart failure is more likely to have weight gain than weight loss due to systemic venous congestion. -A toddler who has heart failure is more likely to have decreased, rather than increased, urine output due to impaired cardiac function and decreased cardiac output. -A toddler who has heart failure is more likely to have tachycardia, rather than bradycardia, as a result of sympathetic stimulation of the heart.

A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take? Instruct the client to perform range-of-motion exercises to his lower extremities. Perform neurovascular checks with vital signs. Ambulate the client 1 hr following the procedure. Restrict the client's fluid intake.

Perform neurovascular checks with vital signs. The nurse should assess color, temperature, and pulse in the affected extremity and monitor the client for neurovascular changes that can indicate a stroke, such as slurred speech and visual disturbances.

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? Furosemide Hydrochlorothiazide Metolazone Spironolactone

Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia. -Furosemide is a high-ceiling (loop) diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. =Hydrochlorothiazide is a thiazide diuretic that increases the risk of hypokalemia, not hyperkalemia. -Metolazone is a thiazide diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia.

A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG strip should the nurse recognize as normal sinus rhythm? The P wave falls before the QRS complex. The T wave is in the inverted position. The P-R interval measures 0.22 seconds. The QRS duration is 0.20 seconds.

The P wave falls before the QRS complex. The nurse should recognize that in normal sinus rhythm the P wave, representing atrial depolarization, falls before the QRS wave. In normal sinus rhythm, the T wave is upright. In normal sinus rhythm, the P-R interval has a constant duration between 0.12 and 0.20 seconds. In normal sinus rhythm, a QRS has a constant duration between 0.04 and 0.10 seconds.

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? The client is experiencing premature atrial contractions. The client has a decreased oxygen saturation level. The client has bilateral wheezes. The client has lower leg edema.

The client is experiencing premature atrial contractions. Pulse pressure devices require the presence of optimal arterial waveforms in order to capture accurate data. Therefore, a dysrhythmia, such as premature atrial contractions, will compromise the readings.

A nurse is teaching about necessary baseline examinations with a female client who is to start taking atorvastatin. Which of the following baseline examinations should the nurse include in the teaching? Liver function tests Hearing test Papanicolaou test Dental examination

The nurse should inform the client that statins such as atorvastatin can cause liver damage and should not be taken by clients who have a history of liver disease. The client should undergo baseline liver function testing before beginning therapy, and every 6 to 12 months thereafter.