remediation 1
A client is admitted to the hospital with multiple signs and symptoms associated with a cardiac problem. What clinical finding alerts the nurse that the primary healthcare provider probably will insert a pacemaker?
1.Angina 2.Chest pain 3.Heart block 4.Tachycardia Heart block is the primary indication for a pacemaker because there is an interference with the electrical conduction of impulses from the atria to the ventricles of the heart. The primary treatment for angina is medication. The primary treatment for chest pain is medication. The primary treatment for tachycardia is medication; tachycardia is not an indication for a pacemaker.
A client is admitted to the hospital for a total hip replacement. Included in the primary healthcare provider's prescriptions is a prescription for digoxin 2.5 mg by mouth daily. The nurse knows that digoxin is supplied in 0.125 mg tablets. What should the nurse do?
1.Give half a tablet. 2Administer two tablets. 3Ask the client what dose was taken at home. 4. Verify the prescription with the primary healthcare provider Ask the client what dose was taken at home. The usual dose of digoxin is 0.125 mg to 0.25 mg daily. A dose of 2.5 mg is excessive, and the prescription should be questioned. Half a tablet and two tablets are not the prescribed dose; the prescribed dose is excessive and must be questioned. Asking the client what dose was taken at home might be done, although it is not as important as verifying the prescription. The nurse should not administer medication that is outside therapeutic parameters.
A client has a right upper lobectomy to remove a cancerous lesion. After the surgery, the nurse monitors the client for the most life-threatening complication, which is what?
1.Hemothorax caused by decreased thoracic drainage 2.Dyspnea caused by increased intrathoracic pressure 3Decreased cardiac output because of mediastinal shift 4Pneumothorax caused by increased abdominal pressure If a closed chest drainage tube becomes obstructed, there is increased intrathoracic pressure that pushes the heart to the opposite side, thereby reducing venous return and cardiac output. Although a hemothorax is serious, it is not as life threatening as a mediastinal shift, which compromises cardiac output. Dyspnea may develop but is not life threatening. A pneumothorax is unrelated to abdominal pressure and is not as life threatening as a mediastinal shift.
A client with a dysrhythmia is admitted to telemetry for observation. In the morning the client asks for a cup of coffee. What is the nurse's best response?
1"Hot drinks such as coffee are not good for your heart." 2"Coffee is not permitted on the diet that was prescribed for you." 3"You cannot have coffee. I can bring you a cup of tea if you like." 4."Coffee has caffeine that can affect your heart. It should be avoided Caffeine is a stimulant that causes vasoconstriction and is contraindicated for a client with a dysrhythmia. Although "Hot drinks such as coffee are not good for your heart" is a true statement, it does not provide information as to why it is not good for the heart. Adherence to a medical regimen increases when the client understands the rationale for recommendations. Tea contains caffeine and should be avoided by a client with a dysrhythmia.
A client reports foot pain and is diagnosed with arterial insufficiency. The nurse provides teaching about what the client can do to increase arterial dilation and to decrease foot pain. Which client statement indicates to the nurse that further teaching is needed?
1"I will wear socks." 2."I will elevate my foot." 3."I will increase fluid intake." 4.I will drink a moderate amount of alcohol." Elevating the leg decreases the flow of blood to the lower extremity because it must flow without the assistance of gravity. Wearing socks should be encouraged because it keeps the feet warm, increasing arterial dilation and perfusion. Increasing fluid intake decreases the viscosity of blood, possibly preventing thrombus formation, and should be encouraged. Alcohol in moderation is useful as a drug to stimulate the dilation of blood vessels.
A client with heart disease asks about cholesterol intake. When teaching the client, the nurse will explain what about cholesterol?
1. Found in both plant and animal sources 2.Causes an increase in serum high-density lipoprotein (HDL) 3.Should be eliminated because it causes the disease process 4. Contributes to high levels of low-density lipoprotein (LDL Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats and can be decreased with unsaturated fat. Exercise, increases HDL levels and helps decrease the risk of heart disease. Cholesterol contributes to heart disease but is not the cause.
The treatment regimen for a female diagnosed with Hodgkin disease, stage III, will start with nodal irradiation. Because the client and her husband have been trying to conceive a child, the client becomes visibly anxious when she learns that the radiation therapy includes the pelvic nodal area. The nurse refers the client to the primary healthcare provider when the client starts to question the treatment. What is the rationale for the nurse's actions?
1. Radiation used is not radical enough to destroy ovarian function. 2. Intermittent radiation to the area does not cause permanent sterilization. 3.Reproductive ability may be preserved through a variety of interventions. 4 Ovarian function will be destroyed temporarily but will return in about six months. Reproductive ability may be preserved through shielding the ovaries or harvesting ova. Radiation can influence or destroy ovarian functioning. Sterilization can occur. Women in the childbearing years should be informed of all options available to preserve ovarian function. Once ova are destroyed, they cannot regenerate.
A client who had a myocardial infarction develops cardiogenic shock despite treatment in the emergency department. Which client responses are related to cardiogenic shock? Select all that apply.
1. Tachycardia 2. Restlessness 3.Warm, moist skin 4.Decreased urinary output 5.Bradypnea The heart rate increases and the respiratory rate increases in an attempt to meet the oxygen demands of the body. Restlessness occurs because of cerebral hypoxia. The urine output drops to less than 30 mL/hr because of decreased arterial perfusion to the kidneys and the compensatory mechanism of reabsorbing fluid to increase the circulating blood volume. The skin becomes cool and pale as blood shunts from the peripheral blood vessels to the vital organs.
When assessing an 85-year-old client's vital signs, the nurse anticipates a number of changes in cardiac output that result from the aging process. Which finding is consistent with a pathologic condition rather than the aging process?
1.A pulse rate irregularity 2.Equal apical and radial pulse rates 3.A pulse rate of 60 beats per minute 4.An apical rate obtainable at the fifth intercostal space and midclavicular line Dysrhythmias are abnormal and are associated with acute or chronic pathologic conditions. An equal apical and radial pulse is expected; the radial pulse reflects ventricular contractions. The expected range in adults is 60 to 100 beats per minute. An apical rate obtainable at the fifth intercostal space and midclavicular line are the anatomical landmarks for locating the apex of the heart; they are unaffected by aging.
A client has left ventricular heart failure. For which clinical indicators should the nurse assess the client? Select all that apply.
1.Ascites 2.Crackles 3.Peripheral edema 4.Dyspnea on exertion 5.Jugular vein distention Pressure in the pulmonic circulation increases when the left ventricle fails; fluid moves from the intravascular compartment into the alveoli, causing crackles. Pressure in the pulmonic circulation increases when the left ventricle fails; fluid in the alveoli impairs gas exchange, which causes dyspnea on exertion. Ascites, a sign of right ventricular failure, results from an increased hydrostatic pressure in the systemic circulation; fluid moves out of the intravascular compartment into the abdominal cavity. Peripheral edema, a sign of right ventricular failure, results from an increased hydrostatic pressure in the systemic circulation. Fluid moves out of the intravascular compartment into the interstitial compartment. Jugular vein distention, a sign of right ventricular failure, results from hypervolemia.
A client is admitted to the hospital for surgical replacement of the mitral valve with a mechanical valve. Which risk factor would be the primary reason that the nurse must frequently check pulses in the client's legs after surgery?
1.Atrial fibrillation 2. Postsurgical bleeding 3.Arteriovenous shunting 4. Peripheral thromboembolism Depending on the type of replacement mitral valve used during surgery, thrombus formation on the valve surface with subsequent emboli has the highest risk of occurring with mechanical valves, which require long-term anticoagulation therapy. Atrial fibrillation is assessed by cardiac monitoring and comparing peripheral and apical pulses for deficit. Bleeding is detected by checking the wound dressing and observing for signs of shock (e.g., lowered blood pressure, tachycardia, restlessness).
When assessing the client with peripheral arterial disease, the nurse anticipates the presence of which clinical manifestations? Select all that apply.
1.Dependent rubor 2.Warm extremities 3.Ulcers on the toes 4.Thick, hardened skin 5.Delayed capillary refill Peripheral arterial disease affects arterial circulation and results in delayed and impaired circulation to the extremities. As a result, the extremities exhibit rubor while in the dependent position and pallor while elevated, ulcers on the feet and toes, cool skin, and capillary refill longer than three seconds. Warm extremities and thick, hardened skin occur in the presence of venous disease.