25, 26, & 27

The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed? a. Potassium supplements b. Furosemide (Lasix) c. Acetylsalicylic acid (aspirin) d. Antibiotics

b. Furosemide (Lasix)

Which assessment verifies increased blood perfusion to the lower extremities? a. Toes cool to the touch b. Decreased sensation below the knees c. Increased amplitude of pedal pulses d. Paleness of the foot

c. Increased amplitude of pedal pulses

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.) a. "Do not make any major changes to your diet without discussing it with your health care provider." b. "Keep outpatient laboratory appointments for monitoring of therapy." c. "Take the medication after meals." d. "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." e. "Avoid aspirin products."

a. "Do not make any major changes to your diet without discussing it with your health care provider." b. "Keep outpatient laboratory appointments for monitoring of therapy." d. "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." e. "Avoid aspirin products."

A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective? a. "I have less leg cramping when I walk." b. "My pulse rate is more regular." c. "I have had fewer episodes of angina." d. "My blood pressure has decreased."

a. "I have less leg cramping when I walk."

Which is the initial manifestation of digoxin toxicity in children? a. Hallucinations b. Weakness c. Atrial dysrhythmia d. Diuresis

a. Hallucinations

Which are included in the baseline assessment of PVD? (Select all that apply.) a. History of heart disease b. Smoking and dietary habits c. Current medications d. Weight e. Limb pain f. Mental status

a. History of heart disease b. Smoking and dietary habits c. Current medications d. Weight e. Limb pain

Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.) a. Hypertension b. Addiction to smoking c. Genetic history d. Exercise tolerance e. Age

a. Hypertension b. Addiction to smoking d. Exercise tolerance

Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure? a. "Report nausea and vomiting to your health care provider." b. "Decrease the amount of high potassium foods you eat." c. "Omit your dose of digoxin if your pulse is 60 beats/min." d. "Visual disturbances are common adverse effects."

a. "Report nausea and vomiting to your health care provider."

The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take? a. Administer the medication. b. Contact the pediatric cardiologist for further orders. c. Hold the digoxin. d. Request that another unit nurse assess the child.

a. Administer the medication.

The nurse is preparing a teaching plan for a patient with Raynaud's disease who is soon to be discharged. What information will be included to improve circulation and prevent complications of this disease? (Select all that apply.) a. Begin a daily exercise program. b. Keep hands and feet warm. c. Surgery is often the most effective treatment. d. Elevate the lower extremities when reclining. e. Smoking cessation will improve outcomes.

a. Begin a daily exercise program. b. Keep hands and feet warm. e. Smoking cessation will improve outcomes

Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)? (Select all that apply.) a. Check for intolerance to caffeine. b. Obtain baseline data on pain that may be present. c. Obtain test results for PT and aPTT. d. Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia. e. Ask specifically if the patient has any cardiac symptoms or dizziness. f. Schedule the patient for an exercise stress test.

a. Check for intolerance to caffeine. b. Obtain baseline data on pain that may be present. d. Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia. e. Ask specifically if the patient has any cardiac symptoms or dizziness.

The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.) a. Prevent platelet aggregation. b. Prevent the extension of existing clots. c. Inhibit steps in the fibrin clot formation cascade. d. Prolong bleeding time. e. Lower serum triglycerides.

a. Prevent platelet aggregation. b. Prevent the extension of existing clots. c. Inhibit steps in the fibrin clot formation cascade. d. Prolong bleeding time.

Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.) a. Review of the digoxin blood level b. Administration of the medication with pulse less than 60 beats/min c. Review of serum electrolytes, liver, and kidney function studies d. Administration of the medication with a pulse of 110 beats/min e. Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

a. Review of the digoxin blood level c. Review of serum electrolytes, liver, and kidney function studies e. Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

Which statement(s) about vasodilators is/are true? (Select all that apply.) a. They reduce systemic vascular resistance. b. They increase afterload. c. They reduce preload. d. They decrease pulmonary congestion. e. They increase tissue perfusion to muscles and organs. f. They increase the volume of blood returning to the heart.

a. They reduce systemic vascular resistance. c. They reduce preload. d. They decrease pulmonary congestion. e. They increase tissue perfusion to muscles and organs.

Anticoagulant therapy may be used for which situation(s)? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients f. Peptic ulcer disease

a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients

The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive heart failure. The nurse will schedule this medication a. in the morning. b. after lunch. c. with dinner. d. at bedtime.

a. in the morning.

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest? a. Assess peripheral pulses. b. Encourage passive leg exercises. c. Limit fluid intake. d. Position pillows behind the knees.

b. Encourage passive leg exercises.

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? a. "It takes at least 3 days for the symptoms to resolve once the clot dissolves." b. "Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body." c. "I will report this to your health care provider because there may be a need to look at alternative treatments." d. "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge."

b. "Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."

Which drug is used to obtain vasodilation in the treatment of chronic heart failure? a. ACTH b. ACE inhibitors c. ARBs d. ANB agents

b. ACE inhibitors

When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects? a. Antilipemic b. Antihypertensive c. Antibiotic d. Antipsychotic

b. Antihypertensive

Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.) a. Administer diuretics at bedtime. b. Assess electrolyte levels. c. Report daily weight fluctuations. d. Encourage sodium intake. e. Maintain skin hygiene.

b. Assess electrolyte levels. c. Report daily weight fluctuations. e. Maintain skin hygiene.

A patient with heart failure has been prescribed nesiritide (Natrecor). Which statement(s) is/are true regarding this medication? (Select all that apply.) a. It increases preload. b. Cardiac ventricles secrete this hormone in response to fluid overload. c. It suppresses aldosterone. d. It promotes norepinephrine secretion. e. It causes vasodilation.

b. Cardiac ventricles secrete this hormone in response to fluid overload. c. It suppresses aldosterone. e. It causes vasodilation.

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product? a. Expel the air bubble from the prefilled syringe. b. Leave the needle in place for 10 seconds after injection. c. Administer the medication into the deltoid muscle. d. Massage the site after injection to increase absorption.

b. Leave the needle in place for 10 seconds after injection.

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction? a. Enhances myocardial oxygenation b. Lyses the blood clot c. Promotes platelet aggregation d. Inhibits clotting mechanisms

b. Lyses the blood clot

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? a. Bradycardia b. Petechiae c. Increased urinary output d. Dry skin

b. Petechiae

The nurse has admitted a resident with the diagnosis of PVD to a long-term care facility. When providing care to this patient, the nurse will (Select all that apply.) a. initiate elevation of lower extremities. b. implement pain management as ordered. c. assess skin temperature. d. vigorously dry feet after washing. e. palpate pedal pulses.

b. implement pain management as ordered. c. assess skin temperature. e. palpate pedal pulses

The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will (Select all that apply.) a. administer intramuscularly. b. inject slowly. c. remove needle immediately after injection. d. rub injection site following administration. e. alternate injection sites every 24 hours.

b. inject slowly. d. rub injection site following administration

The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching? a. "I will sit down if I feel lightheaded or faint." b. "Because this medication helps my circulation, I will try to quit smoking." c. "Grapefruit juice will increase the effects of this medication." d. "Diarrhea may occur but likely will stop with continued therapy."

c. "Grapefruit juice will increase the effects of this medication."

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event? a. Myocardial infarction b. Transient ischemic attack c. Cardiac valve replacement d. Heart transplant

c. Cardiac valve replacement

Which drug will be administered to a patient being admitted with severe digoxin intoxication? a. Amiodarone (Cordarone) b. Spironolactone (Aldactone) c. Digoxin immune Fab (Digibind) d. Digitalis glycoside

c. Digoxin immune Fab (Digibind)

The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.) a. Reports of recent weight loss b. Complaints of peripheral edema c. Diminished exercise tolerance d. Shortness of breath with activity e. Blood pressure elevation

c. Diminished exercise tolerance d. Shortness of breath with activity

1. A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? a. Warfarin sodium (Coumadin) b. Enoxaparin (Lovenox) c. Protamine sulfate d. Vitamin K

c. Protamine sulfate

An older adult male patient with long-term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John's wort. What results with the use of this herbal supplement? a. Digoxin toxicity b. Altered potassium electrolyte balance c. Reduced therapeutic benefits of digoxin d. Enhanced digoxin effectiveness without producing toxicity

c. Reduced therapeutic benefits of digoxin

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? a. Document in the nursing notes that these results are within therapeutic range. b. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. c. Stop the heparin drip. d. Assess the patient for signs and symptoms of decreased sensorium.

c. Stop the heparin drip.

What will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.) a. Intermittent cold applications to the extremities b. Heat therapy c. Stress reduction techniques d. An exercise program e. Bed positioning techniques

c. Stress reduction techniques d. An exercise program e. Bed positioning techniques

Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue a. only while hospitalized. b. for 35 days postsurgically. c. for 12 days postsurgically. d. as long as creatinine clearance is less than 30.

c. for 12 days postsurgically.

The nurse is providing education to a patient with altered cardiac function. When instructing this patient the nurse will encourage (Select all that apply.) a. alcohol consumed in moderation. b. use of salt substitute. c. regular, mild exercise. d. good skin care. e. stress reduction.

c. regular, mild exercise. d. good skin care. e. stress reduction.

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching? a. "I will always wear a medical alert bracelet." b. "I will check with my health care provider before I take any OTC medications." c. "I will be careful when I use a knife or other sharp objects." d. "I will rinse my mouth with mouthwash instead of brushing my teeth."

d. "I will rinse my mouth with mouthwash instead of brushing my teeth."

The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate? a. "This medication dilates your coronary arteries." b. "This medication will help your kidneys get rid of fluid." c. "This medication reduces volume returning to your heart so it doesn't overstretch." d. "This medication reduces the resistance your heart has to pump against."

d. "This medication reduces the resistance your heart has to pump against."

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? a. Bolus the patient with an additional 5000 units of heparin. b. Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic. c. Administer protamine sulfate stat. d. Continue with the prescribed rate.

d. Continue with the prescribed rate.

Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.) a. Assessment of recent aPTT levels b. Massaging the site after injection of medication c. Aspirating after needle insertion d. Documenting ecchymotic areas e. Monitoring of vital signs

d. Documenting ecchymotic areas e. Monitoring of vital signs

A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a _____ position. a. prone b. supine c. Sims d. Fowler's

d. Fowler's

Which action of ACE inhibitors results in effective treatment of heart failure? a. Increased afterload b. Increased aldosterone c. Increased preload d. Increased cardiac output

d. Increased cardiac output

The nurse is assessing the patient's leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first? a. Contact the health care provider for further orders. b. Request x-ray studies of the lower extremities. c. Request that the patient lie flat. d. Obtain a Doppler ultrasound device for auscultation.

d. Obtain a Doppler ultrasound device for auscultation.

What is the mechanism of action of drugs used to treat thromboembolic disease? a. Dissolving clots and preventing formation of new clots b. Making platelets more flexible and preventing formation of new clots c. Causing vasodilation and increased blood flow d. Preventing platelet aggregation and inhibiting clot formation

d. Preventing platelet aggregation and inhibiting clot formation

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K? a. Fruit b. Pasta c. Potato d. Spinach

d. Spinach

The nurse is preparing to provide personal care to a patient with peripheral vascular disease. When providing foot care, the nurse will a. assist the patient to a supine position. b. keep feet moistened with lotion. c. trim toenails daily. d. change socks daily.

d. change socks daily.

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will a. position the patient with knees flexed. b. initiate use of fitted thromboembolic disease deterrent (TED) stockings. c. maintain complete bed rest. d. implement deep breathing and coughing exercises.

d. implement deep breathing and coughing exercises.

Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output? a. Inotropic b. Chronotropic c. Isotonic d. Isopropyl

a. Inotropic

What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease? a. Vasodilates the peripheral arteries b. Potentiates the blood-clotting mechanism c. Increases erythrocyte flexibility d. Increases blood viscosity

c. Increases erythrocyte flexibility

Which nursing assessment is most important to determine fluid status for a patient with heart failure? a. Auscultation of lungs b. Daily weights c. Intake and output d. Measurement of abdominal girth

c. Intake and output