THE ADULT CLIENT WITH HEMATOLOGIC AND CARDIOVASCULAR DISORDERS

The nurse is developing a care plan with an older adult and is instructing the client that hypertension can be a silent killer. The nurse should instruct the client to be aware of signs and symptoms of other system failures and encourage the client to report signs of which of the following diseases that are often a result of undetected high blood pressure? a. Cerebrovascular accidents (CVAs). b. Liver disease. c. Myocardial infarction. d. Pulmonary disease.

a. Cerebrovascular accidents (CVAs).

The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is: a. Decreased blood flow. b. Increased blood flow. c. Slow blood flow. d. Thrombus formation.

a. Decreased blood flow.

Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? a. 5 to 10 minutes. b. 30 to 60 minutes. c. 2 to 4 hours. d. 6 to 8 hours.

a 5 to 10 minutes.

Which of the following nursing diagnoses would be appropriate for a client with systolic heart failure? Select all that apply- 1. Ineffective peripheral tissue perfusion related to a decreased stroke volume. 2. Activity intolerance related to impaired gas exchange and perfusion. 3. Dyspnea related to pulmonary congestion and impaired gas exchange. 4. Decreased cardiac output related to impaired cardiac filling. 5. Impaired renal perfusion related to a decreased cardiac output. a. 1, 2, 3, and 5 b. 1, 2, 4 and 5 c. 2, 3, and 4 d. 1, 3, 4 and 5

a. 1, 2, 3, and 5 1. Ineffective peripheral tissue perfusion related to a decreased stroke volume. 2. Activity intolerance related to impaired gas exchange and perfusion. 3. Dyspnea related to pulmonary congestion and impaired gas exchange. 5. Impaired renal perfusion related to a decreased cardiac output.

Which of the following clients is at greatest risk for Buerger's disease? a. A 29-year-old male with a 14-year history of cigarette smoking. b. A 38-year-old female who is taking birth control pills. c. A 54-year-old female with adult onset diabetes. d. A 65-year-old male with atherosclerosis.

a. A 29-year-old male with a 14-year history of cigarette smoking.

The nurse is planning care for a client who has returned to the medical-surgical unit following repair of an aortic aneurysm. The nurse first should assess the client for: a. Alteration in renal perfusion. b. Electrolyte imbalance. c. Ineffective coping. d. Wound infection.

a. Alteration in renal perfusion.

An industrial health nurse at a large printing plant finds a male employee's blood pressure to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25lb overweight and has smoked a pack of cigarettes daily for more than 20 years. The client's physician prescribes atenolol (Tenormin) for the hypertension. The nurse should instruct the client to: a. Avoid sudden discontinuation of the drug. b. Monitor the blood pressure annually. c. Follow a 2-g sodium diet d. Discontinue the medication if severe headaches

a. Avoid sudden discontinuation of the drug.

When a client is diagnosed with aplastic anemia the nurse should assess the client for changes in which of the following physiologic functions? a. Bleeding tendencies b. Intake and output c. Peripheral sensation d. Bowel function

a. Bleeding tendencies

A 69-year-old female has a history of heart failure. She is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first? a. Blood pressure. b. Skin breakdown c. Serum potassium level. d. Urine output.

a. Blood pressure.

A client has sudden, severe pain in his back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The physician suspects the client is experiencing a dissecting aortic aneurysm. The code cart is brought into the room because one complication of a dissecting aneurysm is: a. Cardiac tamponade. b. Stroke. c. Pulmonary edema. d. Myocardial infarction

a. Cardiac tamponade.

The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD) and has a history of heart failure. The nurse should develop a plan of care that is based on the fact that the client may have a low tolerance for exercise related to: a. Decreased blood flow. b. Increased blood flow. c. Decreased pain. d. Increased blood viscosity

a. Decreased blood flow.

When giving discharge instructions to the client with vasospastic disorder, Raynaud's phenomenon, the nurse should explain that the expected outcome of taking a beta adrenergic blocking medication is to control the symptoms by a. Decreasing the influence of sympathetic nervous system on the tissues in the hands and feet. b. Decreasing the pain by producing analgesia. c. Increasing the blood supply to the affected area. d. Increasing monoamine oxidase.

a. Decreasing the influence of sympathetic nervous system on the tissues in the hands and feet.

The major goal of therapy for a client with heart failure and pulmonary edema should be to: a. Increase cardiac output b. Improve respiratory status. c. Decrease peripheral edema. d. Enhance comfort.

a. Increase cardiac output

Before surgery for a known aortic aneurysm, the client's pulse pressure begins to widen, suggesting Encreased aortic valvular insufficiency. If the branches of the aortic arch are involved, the nurse should assess the client for. a. Loss of consciousness b. Anxiety. c. Headache. d. Disorientation.

a. Loss of consciousness

The nurse is planning care for a client with a history of peripheral vascular disease who has symptoms of claudication. Nursing care should be directed to avoiding which of the following situations? a. Oxygen demand by muscle exceeds the supply. b. Oxygen demand and supply of the working muscle are in balance. c. Oxygen supply exceeds the demand of the working muscle. d. Oxygen is absent

a. Oxygen demand by muscle exceeds the supply.

The client has had hypertension for 20 years. The nurse should assess the client for? a. Renal insufficiency and failure. b. Valvular heart disease c. Endocarditis. d. Peptic ulcer disease.

a. Renal insufficiency and failure.

In which of the following positions should the nurse place a client with suspected heart failure? a. Semi-sitting (low Fowler's position) b. Lying on the right side (Sims' position) c. siting almost upright (High Fowler's position d. Lying on the back with the head lowered (Trendelenburg's position)

a. Semi-sitting (low Fowler's position)

A nurse is assessing a group of clients. Which clients are at risk for vasospastic disorder (Raynaud's phenomenon)? a. Young women b. Old women c. Old men d. Young men

a. Young women

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse's best response? a. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." c. " The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." d. "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."

The nurse devises a teaching plan for the client with aplastic anemia. Which of the following is the most important concept to teach for health promotion and maintenance? a. Eat animal protein and dark green, leafy vegetables every day. b. Avoid exposure to others with acute infections. c. Practice yoga and meditation to decrease stress and anxiety. d. Get 8 hours of sleep at night and take naps during the day.

b. Avoid exposure to others with acute infections. Aplastic anemia is a rare but serious blood condition that occurs when your bone marrow cannot make enough new blood cells for your body to work normally.

The nurse is assessing a client with Buerger's disease. The nurse should determine if the client is experiencing: a Thickening of the intima and media of the artery. b. Inflammation and fibrosis of arteries, veins, and nerves. c. Vasospasm lasting several minutes. d. Pain, pallor, and pulselessness.

b. Inflammation and fibrosis of arteries, veins, and nerves.

A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess first? a. IV fluid solution b. Pedal pulses c. Nasal cannula flow rate d. Capillary refill

b. Pedal pulses

During an initial assessment of a client diagnosed with vasospastic disorder (Raynaud's phenomenon,, the nurse notes a sudden color change to white in the fingers. The nurse should first assess: a. Appearance of cyanosis. b. Radial pulse. c. Sp02 of the affected fingers. d. Blood pressure.

b. Radial pulse.

Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? a. Apples. b. Tomato juice. c. Whole wheat bread. d. Beef tenderloin.

b. Tomato juice.

A client with heart failure is receiving digoxin intravenously . The nurse should determine the effectiveness of the drug by assessing which of the following? a. dilated coronary arteries b. increased myocardial contractility c. decreased cardiac arrhythmias d. decreased electrical conductivity in the heart.

b. increased myocardial contractility

An overweight client taking warfarin (Coumadin) has a nursing diagnosis of ineffective tissue perfusion related to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply. 1. Apply lanolin or petroleum jelly to intact skin, 2. Encourage a reduced calorie, reduced-fat diet. 3. Inspect the involved areas daily for new ulcerations. 4. Instruct the client to limit activities of daily living (ADLs). 5. Use an electric razor to shave. a. 2, 3 and 4 b. 2, 3, and 5 c. 1, 2, 3, and 5 d. 1, 3, 4 and 5

c. 1, 2, 3, and 5 1. Apply lanolin or petroleum jelly to intact skin, 2. Encourage a reduced calorie, reduced-fat diet. 3. Inspect the involved areas daily for new ulcerations. 5. Use an electric razor to shave.

A health care provider orders 0.5 mg of protamine sulfate for a client who is showing signs of bleeding after receiving a 100-unit dose of heparin. The nurse should expect the effects of the protamine sulfate to be noted in which of the following time frames? a. 5 minutes b. 10 minutes c. 20 minutes d. 30 minutes

c. 20 minutes

The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? a. Mixed green salad with blue cheese dressing, crackers, and cold cuts. b. Ham sandwich on rye bread and an orange. c. Baked chicken, an apple, and a slice of white bread. d. Hot dogs, baked beans, and celery and carrot sticks.

c. Baked chicken, an apple, and a slice of white bread.

Which of the following sets of conditions is an indication that a client with a history of left- sided heart failure is developing pulmonary edema? a. Distended jugular veins and wheezing. b. Dependent edema and anorexia. c. Coarse crackles and tachycardia d. Hypotension and tachycardia.

c. Coarse crackles and tachycardia

A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly Which of the following should be the primary focus of nursing care for this client? a. Providing activities of daily living on the time schedule of the client's homeland. b. Offering foods that the client enjoys in order to increase the intake of calories. c. Decreasing cardiac demands by promoting rest. d. Listening to concerns about the hospitalization.

c. Decreasing cardiac demands by promoting rest.

The client realizes the importance of quitting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? a. Review the negative effects of smoking on the body. b. Discuss the effects of passive smoking on environmental pollution. c. Establish the client's daily smoking pattern. d. Explain how smoking worsens high blood pressure

c. Establish the client's daily smoking pattern.

Which of the following increases the risk of having a large abdominal aortic aneurysm rupture? a. Anemia. b. Dehydration. c. High blood pressure d. Hyperglycemia.

c. High blood pressure

A client is discharged after an aortic aneurysm repair with a synthetic graft to replace part of the aorta. The nurse should instruct the client to notify the physician before having: a. Blood drawn. b. An I.V. line inserted. c. Major dental work. d. An X-ray examination.

c. Major dental work.

The client with vasospastic disorder (Raynaud's phenomenon) complains of cold and numbness in her fingers. The nurse assesses the client for effects of vasoconstriction. Which of the following is an early sign of vasoconstriction? a. Cyanosis b. Gangrene. c. Pallor. d. Rubor.

c. Pallor.

A client with Buerger's disease smokes two packs of cigarettes a day. Smoking cessation is critical or the client may lose the affected extremity. When helping a client change behavior, it is important to know the client's: a. Ability to attend support groups. b. Goals of the treatment. c. Perception of the negative behavior. d. Motivation.

c. Perception of the negative behavior.

A client is admitted to the emergency department complaining of severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. The primary goal at this time is to: a. Maintain circulation. b. Manage pain. c. Prepare the client for emergency surgery. d Teach postoperative breathing exercises.

c. Prepare the client for emergency surgery.

Which of the following is a late symptom of polycythemia vera? a. Headache. b. Dizziness. c. Pruritus d. Shortness of breath.

c. Pruritus

The primary goal for the client with Buerger's disease is to prevent: a. Embolus formation. b. Fat embolus formation. c. Thrombus formation. d. Thrombophlebitis.

c. Thrombus formation.

The nurse should teach the client that signs of digoxin toxicity include which of the following? a. Rash over the chest and back. b. Increased appetite. c. Visual disturbances such as seeing yellow spots. d. Elevated blood pressure

c. Visual disturbances such as seeing yellow spots.

The nurse should instruct a client who has been diagnosed with vasospastic disorder (Raynaud's phenomenon) to: a. Immerse her hands in cold water during an episode. b. Wear light garments when the temperature gets below 50° F (10° C). c. Wear gloves when handling ice or frozen foods. d. Live in a cold climate.

c. Wear gloves when handling ice or frozen foods.

In order to prevent recurrent vasospastic episodes with Raynaud's phenomenon, the nurse should instruct the client for a. Keep the hands and feet elevated as much as possible. b. Use a vibrating massage device on the hands. c. Wear gloves when obtaining food from the refrigerator d. Increase coffee and take to 2 cups per day.

c. Wear gloves when obtaining food from the refrigerator

The nurse should instruct a young female adult with sickle cell anemia to do which of the following? Select all that apply. 1. Drink plenty of fluids when outside in hot weather. 2. Avoid travel to cities where the oxygen level is lower 3. Be aware that since she is homozygous for HbS, she carries the sickle cell trait. 4. Know that pregnancy with sickle cell disease increases the risk of a crisis. 5. Avoid flying on commercial airlines. a. 1, 3 and 4 b. 1, 2, 3 and 4 c. 2, 4 and 5 d. 1, 2 and 4

d. 1, 2 and 4 Be aware that since she is heterozygous for HbS, she carries the sickle cell trait.

The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings requires further evaluation? a. Heart rate 57 bpm b. Sp02 of 94% on room air c. Blood pressure 134/82 d. Ankle brachial index of 0.65

d. Ankle brachial index of 0.65

When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse notes bilateral ankle edema The edema is related to: a. Competent venous valves. b. Decreased blood volume. c. Increase in muscular activity. d. Increased venous pressure.

d. Increased venous pressure.

A client's job involves working in a warm, dry room, frequently bending and crouching to check the underside of a high-speed press, and wearing eye guards. Given this information, the nurse should assess the client for which of the following? a. Muscle aches b. Thirst. c. Lethargy. d. Orthostatic hypotension

d. Orthostatic hypotension

Peripheral blood flow is dependent on which of the following variables? a. Blood viscosity and diameter of vessels. b. Diameter and resistance of vessels. c. Force of contraction of the heart and resistance of vessels. d. Pressure differences in the arterial and venous systems and resistance.

d. Pressure differences in the arterial and venous systems and resistance.

The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help: a. Prevent electrolyte imbalances. b. Retard rapid drug absorption. c. Excrete excessive fluids accumulated during the d. Prevent sleep disturbances during the night.

d. Prevent sleep disturbances during the night.

An exercise program is prescribed for the client with hypertension. Which intervention would be the most likely to assist the client in maintaining an exercise program? a. Giving the client a written exercise program. b. Explaining the exercise program to the clients spouse. c. Reassuring the client that he or she can do the exercise program. d. Tailoring a program to the client's needs and abilities.

d. Tailoring a program to the client's needs and abilities.

A client states that she is afraid of receiving vitamin B12 injections because of potential toxic reactions. fears? Which is the nurse's best response to relieve these a. "Vitamin B12 will cause ringing in the ears before a toxic level is reached." b. "Vitamin B12 may cause a very mild rash initially" c. "Vitamin B12 cause mild nausea but nothing toxic. d. Vitamin B12 is generally free of toxicity because it is water-soluble."

d. Vitamin B12 is generally free of toxicity because it is water-soluble."

A client had a repair of a thoracoabdominal aneurysm 2 days ago. Which of the following findings should the nurse consider unexpected and report to the physician immediately? The client has: a. Abdominal pain at 5 on a scale of 0 to 10 for the last 2 days. b. Heart rate of 100 beats per minute after ambulating 200 feet. c. Urine output of 2,000 mL in 24 ours. d. Weakness and numbness in the lower extremities.

d. Weakness and numbness in the lower extremities.