Perfusion
A nurse is providing teaching about a heart healthy diet to a group of clients with hypertension. Which of the following statements by one of the clients indicates a need for further teaching? -"I may eat 10 ounces of lean protein each day." -"Fresh fruits make a good snack option." -"I will replace table salt with dried herbs." -"I may thicken gravies with cornstarch as I cook."
-"I may eat 10 ounces of lean protein each day." (Lean meats should be limited to 5 to 6 oz per day.) !!! -"Fresh fruits make a good snack option." -"I will replace table salt with dried herbs." (Salt should be replaced with dried or fresh herbs.) -"I may thicken gravies with cornstarch as I cook."
A nurse is planning a diet for client who is iron deficient. Which of the following foods high in iron should the nurse include in the plan? -Oranges -Cashews -Red meat -Yogurt
-Oranges (low in iron, but high in Vitamin C.) -Cashews (low in iron, but high in protein.) -Red meat (Good source of iron. If vegetarian, kidney beans with a high iron content are a good substitute.) !!! -Yogurt (low in iron, but good source of calcium.)
A nurse is reinforcing teaching with a client regarding reduction of risk factors for coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply) -"I must stop smoking." -"I should limit my exercise." -"I will stop consuming alcohol." -"I need to monitor my weight." -"I am limiting my intake of fast foods."
-"I must stop smoking." (Nicotine in tobacco causes peripheral vasoconstriction, which increases BP, cardiac afterload, and oxygen consumption. Alterations in blood vessels contribute to atherosclerosis and the formation of clots. Smoking cessations can decrease the risk of coronary artery disease by as much as 80%. Clients also should avoid secondhand smoke.) !!! -"I should limit my exercise." (A sedentary lifestyle or lack of exercise can lead to obesity, which is a significant contributing factor to the development of hypertension and heart disease. Less active individuals have a 30-50% increased incidence of developing hypertension. Regular physical activity helps to maintain body weight, decrease the risk of hypertension, and optimize lipid levels. Physical activity and dietary modification have been positively associated with decreased lipid and cholesterol levels.) -"I will stop consuming alcohol." (The client does not have to stop consuming alcohol. Consuming less than 3 oz per day can assist in decreasing the risk of coronary artery disease. However, consuming more than 3 oz per day has been associated with an increased risk of cardiac disease.) -"I need to monitor my weight." (Obesity or an increase in weight is a significant factor in developing coronary artery disease. Weight management is vital to decreasing the risk of coronary artery disease.) !!! -"I am limiting my intake of fast foods." (Fast foods typically are prepared with high sodium and high fat, which increase the risk of atherosclerosis and coronary artery disease. An elevated cholesterol and serum lipid level predisposes a client to coronary artery disease. To promote cardiovascular health, clients should select healthier food options, such as fruits and vegetables, or foods prepared by baking or broiling.) !!!
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? -Atorvastatin -Metformin -Nitroglycerin -Carvedilol
-Atorvastatin (This is contraindicated for a client who has active hepatic disease, but it does not interact with contrast material) -Metformin (This interacts with contrast dye and can cause acute kidney damage.) !!! -Nitroglycerin (This is contraindicated for a number of conditions including increased intracranial pressure, but it does not interact with contrast material). -Carvedilol (This is contraindicated for a number of conditions including 2nd and 3rd degree heart block, but it does not interact with contrast material.)
A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? -Decreased blood pressure -Increase of HDL cholesterol -Prevention of bipolar manic episodes -Improved sexual function
-Decreased blood pressure (Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in BP.) !!! -Increase of HDL cholesterol (This is not an intended effect of lisinopril.) -Prevention of bipolar manic episodes (This is not an intended effect of lisinopril.) -Improved sexual function (This is not an intended effect of lisinopril. Lisinopril may in fact cause sexual dysfunction and impotence.)
A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a contributing factor to the development of the anemia? -Dietary iron restrictions -Intestinal malabsorption syndrome -Chronic blood loss -Intestinal parasites
-Dietary iron restrictions (Dietary approaches to ulcerative colitis do not restrict iron; in fact, they often include supplemental iron in an attempt to prevent anemia.) -Intestinal malabsorption syndrome (Ulcerative colitis is an inflammatory bowel disease affecting primarily the sigmoid colon and rectum, although the entire colon may be affected. A malabsorption syndrome is more likely to be caused by a condition affecting the small intestine.) -Chronic blood loss (A client with long-standing ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occurs over time, although the colitis may result in erosion of the intestine and hemorrhage. These clients often report bloody stools and are therefore at increased risk for developing anemia.) !!! -Intestinal parasites (This is not a manifestation of ulcerative colitis. This inflammatory bowel disease can cause dehydration, fever, weight loss and anorexia.)
A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.) -Dyspnea -Gastrointestinal bloating -Jugular vein distention -Confusion -Hypotension
-Dyspnea !!! -Gastrointestinal bloating -Jugular vein distention !!! -Confusion !!! -Hypotension (Actually hypertension. Hypotension is a manifestation of a hemolytic transfusion reaction.)
A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect? -Fatigue -Hypertension -Bradycardia -Diarrhea
-Fatigue (The nurse should identify that the client who has anemia due to blood loss following surgery will experience fatigue. This is due to the body's decreased ability carry oxygen to vital tissues and organs). !!! -Hypertension (actually hypotension) -Bradycardia (actually tachycardia) -Diarrhea (actually constipation)
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? -High-density lipoprotein (HDL) level of 70 mg/dL -A diet high in potassium -Obstructive sleep apnea (OSA) -Taking benazepril
-High-density lipoprotein (HDL) level of 70 mg/dL (HDL is an important factor in the role of cardiovascular health and the development of hypertension. HDLs collect cholesterol from tissues and the vascular epithelium, decreasing the incidence of atherosclerosis, one of the contributing factors for the development of hypertension. The nurse should identify a low HDL level as a risk factor in the development of hypertension. However, an HDL level of 70 mg/dL places the client at a low risk for the development of hypertension and heart disease. The expected reference range for HDL is >45 mg/dL in men and >55 mg/dL in women.) -A diet high in potassium (The nurse should include diet as a factor in the development or prevention of hypertension. Low dietary potassium intake has been associated with an elevation in BP and an increased risk of stroke, while a diet high in potassium has been found to decrease blood pressure. Other electrolytes impacting blood pressure include calcium and magnesium, both of which can result in hypertension if dietary consumption is low.) -Obstructive sleep apnea (OSA) (OSA is a condition in which the client's airway becomes blocked by the relaxation of the tongue and muscles of the oropharynx, effectively obstructing the airway. The obstructed airway results in surges in the both the systolic and diastolic pressure during sleep and, in some clients, through the waking hours even when breathing is normal.) !!! -Taking benazepril (The nurse should include medications that can cause secondary hypertension such as glucocorticoids, mineralocorticoids, and sympathomimetics. Benazepril is an angiotensin-converting-enzyme (ACE) inhibitor that is used in the treatment of hypertension.)
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
-Liver (Liver and other organ meats are from animal sources and are therefore high in cholesterol content.) -Milk (Dairy products, including whole milk and butter, are from animal sources and therefore contain cholesterol.) -Beans (Any food that does not contain animal products does not contain cholesterol. Beans are a good source of protein for a client who follow a low-cholesterol diet.) !!! -Eggs (Egg yolks contain cholesterol. Egg whites, however, are cholesterol-free.)
A nurse on a medical-surgical unit is caring for a client who reports pain in the jaw, back, and shoulder, and shortness of breath and nausea. Which of the following actions should the nurse take? -Obtain an EKG. -Administer enteric-coated acetaminophen. -Administer ibuprofen. -Maintain oxygen saturations greater than or equal to 92%.
-Obtain an EKG. (The nurse should obtain an EKG to detect heart rhythm abnormalities within 10 min of the client's reported discomfort.) !!! -Administer enteric-coated acetaminophen. (The nurse should administer a non-enteric coated aspirin to allow for more rapid absorption of the antiplatelet medication. Acetaminophen does not have antiplatelet properties.) -Administer ibuprofen. (The nurse should administer morphine IV to provide rapid pain relief. Decreasing the client's pain level will increase oxygen supply and decrease myocardial demands for oxygen.) -Maintain oxygen saturations greater than or equal to 92%. (The nurse should administer oxygen therapy as needed to maintain oxygen saturations greater than or equal to 95% to increase myocardial oxygen supply.)
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? -Prolonged bleeding -Cellular hypoxia -Impaired immunity -Fluid retention
-Prolonged bleeding (The client's laboratory results indicate anemia. Thrombocytopenia, rather than anemia, places the client at risk for prolonged bleeding.) -Cellular hypoxia (The client's laboratory results indicate anemia, which places the client at risk for cellular hypoxia.) !!! -Impaired immunity (The client's laboratory results indicate anemia. Leukopenia, rather than anemia, places the clients at risk for impaired immunity.) -Fluid retention (Increased serum sodium, rather than anemia, places the client at risk for fluid retention.)
