CH12-15 NUR2120
Prehypertension BP
120-139/80-89
Hypertension
140/90
hypertensive crisis
180/120
sodium in dash diet
2,300
dairy in dash diet
2-3
Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation? (CH13) A) Prazosin B) Reserpine C) Propranolol D) Clonidine
A) Prazosin
Which diuretic medication conserves potassium? (CH13) A) Furosemide B) Spironolactone C) Chlorothiazide D) Chlorthalidone
B) Spironolactone
The nurse understands that an overall goal of hypertension management is that (CH13) A) the client maintains a normal blood pressure reading. B) there is no indication of target organ damage. C) there is no report of postural hypotension. D) there are no reports of sexual dysfunction.
B) There is no indication of target organ damage
Stroke volume (Ch12)
Blood ejected with each heartbeat
The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? (Ch12) A) Count the radial pulse for 20 to 25 seconds. B) Calculate the palpated volume. C) Count the heart rate at the apex. D) Calculate the pauses between pulsations.
C) Count the heart rate at the apex
A diastolic blood pressure of 90 mm Hg is classified as (CH13) A) normal. B) prehypertension. C) stage 1 hypertension. D) stage 2 hypertension.
C) stage 1 hypertension
An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? (Ch13) A) C-reactive protein (CRP) levels B) Sodium, chloride, and potassium levels C) Arterial blood gas (ABG) results D) Blood urea nitrogen (BUN) and creatinine levels
D) BUN and creatinine levels
Pericardium
Membrane surrounding the heart
preload
Pressure generated in the ventricles at the end of diastole and the resultant stretching of the muscle fibers.
Contractility
The force generated by the contracting myocardium under any given condition.
Afterload (Ch12)
The pressure the ventricles must work against to open semi-lunar valves to pump blood out of the heart. Amount of resistance to ejection of blood from ventricle.
Diastolic heart failure
stiff and non compliant heart muscle
S4 heart sound
stiffness of the left ventricle due to scar tissue formation
S3 heart sound
ventricular gallop -abnormally high LV filling pressures -low cardiac output -dilated, poorly contractile LV (congestive heart failure)
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? A) 3 minutes B) 15 minutes C) 30 minutes D) 60 minutes
A) 3 minutes Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch) and ideally alleviates the pain of ischemia within 3 minutes.
A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing? (Ch13) A) Isolated systolic hypertension B) Secondary hypertension C) Primary hypertension D) Hypertensive urgency
A) Isolated systolic hypertension As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).
You are the clinic nurse doing assessments on your clients before they have outpatient diagnostic testing done. What would you document when assessing the client's pulse? (Ch12) A) Rate, quality, and rhythm B) Pressure, rate, and rhythm C) Rate, rhythm, and volume D) Quality, volume, and rate
A) Rate, quality, and rhythm
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? (CH13) A) Renal dysfunction resulting from atherosclerosis B) Anemia resulting from bone marrow suppression C) Hyperglycemia resulting from insulin receptor resistance D) Emphysema related to poor gas exchange
A) Renal dysfunction resulting from atherosclerosis
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? (Ch15) a) Pulmonary congestion b) Pedal edema c) Nausea d) Jugular venous distention
A) pulmonary congestion
hypertensive emergency
BP >180/120 and must be lowered immediately to prevent damage to target organs
Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? (Ch12) A) .25 to .75 B) .75 to 1.5 C) 2.0 to 2.5 D) 2.5 to 3.0
C) 2.0-2.5
A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? (Ch14) A) Predictable and consistent pain that occurs on exertion and is relieved by rest B) Pain that may occur at rest, but the threshold for pain is lower than expected C) Severe, incapacitating chest pain D) Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina
C) Severe, incapacitating chest pain
A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: (Ch14) A) Blocking sympathetic stimulation of the heart and reducing oxygen demand B) Increasing contractility and consequent cardiac output C) Blocking the a-delta pain fibers in the myocardium D) Dilating the blood vessels and reducing preload
D) Dilating the blood vessels and reducing preload. Nitroglycerin is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain. Nitroglycerin dilates primarily the veins and, in higher doses, also the arteries. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitrates do not block sympathetic stimulation or pain transmission. As well, nitrates do not have the ability to increase cardiac contractility.
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? (Ch12) A) Thallium B) Ativan C) Diazepam D) Dobutamine
D) Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.
A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor? A) fluid intake and output. B) urine specific gravity. C) vital signs. D) weight.
D) weight Heart failure typically causes fluid overload, resulting in weight gain. Therefore, weight is the best indicator of this client's status. One pound gained or lost is equivalent to 500 ml. Fluid intake and output and vital signs are less accurate indicators than weight. Urine specific gravity reflects urine concentration, indicating overhydration or dehydration. Numerous factors can influence urine specific gravity, so it isn't the most accurate indicator of the client's status.
Primary hypertension
High blood pressure, the cause of which is unknown; also known as essential hypertension
ejaction fraction
a measurement of the percentage of blood leaving your heart each time it contracts. 55%-70%
Secondary hypertension
high blood pressure caused by the effects of another disease
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? (CH14) A) Clopidogrel B) Isosorbide mononitrate C) Metoprolol D) Diltiazem
A) Clopidogrel Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? A) Decreases resting heart rate B) Decreases cholesterol level C) Increases cardiac output D) Decreases platelet aggregation
A) Decrease resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.
The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse tritrate to improve blood flow to vital organs? (Ch15) A) dopamine B) enalapril C) furosemide D) metoprolol
A) dopamine Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.
A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures? (Ch15) A) A further reduction in his dietary sodium intake B) An increase in the dose of his prescribed diuretic C) A decrease in his daily activity level D) Thoracentesis
B) an increase in the dose of his prescribed diuretic If a patient with HF experiences a significant change in weight (ie, 2- to 3-lb increase in a day or 5-lb increase in a week), the patient is instructed to notify his or her provider or to adjust the medications (eg, increase the diuretic dose) per provider's directions. Thoracentesis is not relevant, and decreased activity may exacerbate the patient's condition. Decreased sodium intake may be of some benefit, but diuretics will have a greater effect.
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? (Ch14) A) Prepare to administer intravenous fluids. B) Suction the airway. C) Check blood pressure. D) Assess pupils for reactiveness.
C) Check blood pressure During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
The nurse is performing health education-related lifestyle modifications for a patient who has been newly diagnosed with hypertension. As a component of these modifications, the DASH (Dietary Approaches to Stop Hypertension) eating plan has been recommended to the patient. Which of the nurse's recommendations is most congruent with this eating plan? (Ch13) A) "Try to buy and consume as many organic and natural foods as you can." B) "Try to replace the complex carbohydrates in your diet with protein-rich foods." C) "Try to reduce the overall amount of fat that is in your diet." D) "If you eat four of five small meals each day, you'll find that you're able to reduce your calorie intake."
C) Try to reduce the overall amount of fat that is in your diet. The DASH eating plan emphasizes fruits, vegetables, fiber, potassium, and low-fat dairy products, and a reduction in animal protein, fat, and saturated fat. Organic foods and small, frequent meals are not components of the DASH eating plan.
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain? (CH15) A) hypertension B) high urine output C) dry mucous membranes D) pulmonary crackles
D) Pulmonary crackles High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures.
Afterload
The amount of resistance of ejection of blood from the ventricle
nuts in dash diet
4-5
veggies and fruits in dash diet
4-5
Meat in dash diet
6 or less
Grains in dash diet
6-8
The nurse is conducting patient teaching about cholesterol levels in the body. When discussing the patient's elevated low-density lipoprotein (LDL) and lowered high-density lipoprotein (HDL) levels, the patient shows an understanding of the significance of these levels by stating what? (Ch12) A) "Increased LDL and decreased HDL increase my risk of coronary artery disease." B) "Increased LDL and decreased HDL decrease my risk of coronary artery disease." C) "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls." D) "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."
A) "Increased LDL and decreased HDL increase my risk of coronary artery disease."
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? (Ch13) A) 160-190 mg/dL B) 210-240 mg/dL C) 250-275 mg/dL D) 280-300 mg/dL
A) 160-190 mg/dL
The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day? (ch13) A) 2 or fewer B) 2 or 3 C) 4 or 5 D) 7 or 8
A) 2 or fewer
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? (CH13) A) Assess the client's level of pain and administer prescribed analgesics. B) Assess the client's level of anxiety and provide emotional support. C) Prepare the client for pulmonary artery catheterization. D) Ensure that the client's family is kept informed of the client's status.
A) Assess the client's level of pain and administer prescribed analgesics
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client? (ch13) A) Change positions (lying or sitting to standing) slowly. B) Check blood pressure every day for signs of rebound hypertension. C) Do not become dependent on canes, walkers, or handrails. D) Eat plenty of salty food to prevent hypotension.
A) Change positions (lying or sitting to standing) slowly.
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? (Ch13) A) Clopidogrel B) Isosorbide mononitrate C) Metoprolol D) Diltiazem
A) Clopridogrel
A patient with cardiovascular disease is being treated with Norvasc, a calcium channel blocking agent. The nurse is aware that calcium channel blockers have a variety of effects. What is one of the therapeutic effects? (CH14) A) Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart B) Prevent platelet aggregation and subsequent thrombosis C) Reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart D) Reduce myocardial oxygen consumption thus decreasing ischemia and relieving pain
A) Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart. Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. They are also used to prevent and treat vasospasm. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis that impede blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and in higher doses, the arteries.
The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmias. Which of the following assessment considerations is essential when caring for this age-group? (Ch12) A) Digoxin level B) Cardiac output C) Activity level D) Dyspnea
A) Digoxin level The action of Digoxin slows and strengthens the heart rate. Assessment of the pulse rate is essential prior to administration in all clients. Due to decreased perfusion common in geriatric clients, toxicity may occur more often. The nurse must monitor Digoxin levels in the body. Monitoring symptoms reflecting cardiac output, activity level, and dyspnea are also important assessment considerations for all clients.
The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? (Ch13) A) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. B) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. C) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. D) Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.
A) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next? (CH13) A) "Have you taken your prescribed clonidine today?" B) "Do you have a dry mouth or nasal congestion?" C) "Are you having chest pain or shortness of breath?" D) "Did you take any medication for your headache?"
A) Have you taken your prescribed clonidine today
The nurse is assessing an older adult client's electrocardiogram (ECG). What age related change to the conduction system may the nurse observe? (Ch12) A) Heart block B) Murmur C) Thrills D) Tachycardia
A) Heart block
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: (CH13) A) high LDL level. B) low LDL level. C) normal LDL level. D) fasting LDL level.
A) High LDL level LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.
The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 8 mm Hg and recognizes that this finding indicates the client is experiencing which condition? (Ch12) A) hypervolemia B) excessive blood loss C) overdiuresis D) left-sided heart failure
A) Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right-ventricular preload, which is most often from hypovolemia.
When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? (Ch13) A) Inadequate fluid volume B) Normal glomerular filtration C) Overhydration D) Anuria
A) Inadequate fluid volume Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric client does not produce urine.
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs? (Ch12) A) left atrium B) left ventricle C) right atrium D) right ventricle
A) Left atrium
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body?(CH12) A) left ventricle B) left atrium C) right ventricle D) right atrium
A) Left ventricle
A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include? (CH13) A) nonpharmacological interventions B) pharmacological interventions C) procedural interventions D) observation only
A) Nonpharmcological interventions
A nursing class is practicing the measurement of blood pressure and finds a client with a blood pressure of 130/88. What lifestyle factors will the nurse discuss with the client? (CH13) A) physical activity, dietary sodium, and the DASH diet B) physical activity, needed medication, and the DASH diet C) weight reduction, the DASH diet, and physical activity D) the DASH diet, sexual dysfunction related to required medications, and physical activity
A) Physical activity, dietary sodium, DASH diet
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to the lungs to be oxygenated? (CH12) A) right ventricle B) left ventricle C) right atrium D) left atrium
A) Right ventricle
A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what? (Ch13) A) Secondary hypertension has a specific cause. B) Secondary hypertension has a more gradual onset than primary hypertension. C) Secondary hypertension does not cause target organ damage. D) Secondary hypertension does not respond to antihypertensive drug therapy.
A) Secondary hypertension has a specific cause
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? (Ch13) A) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less B) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less C) To stop smoking and increase physical activity to 30 minutes/day most days of the week D) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables
A) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? (Ch13) A) Within 6 hours B) Within 12 hours C) Within 24 to 48 hours D) Within 5 to 7 days
A) Within 6 hours
The cardiologist has scheduled a client for drug-induced stress testing. What instructions should the nurse provide to prepare the client for this test? (Ch12) A) You will receive medication via IV administration. B) You will need to wear comfortable shoes to the test. C) You will begin exercising at a slow speed. D) You may experience an onset of dizziness during the test.
A) You will receive medication via IV administration
The nurse is providing care for a patient newly diagnosed with systolic heart failure (HF). What medications should the nurse anticipate administering? (CH15) A) Beta-blockers B) Calcium channel blockers C) Alpha agonists D) Angiotensin prohibiters
A) beta-blockers Several medications are routinely prescribed for systolic HF, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, diuretics, and digitalis. Calcium channel blockers and alpha agonists are not routinely ordered for systolic HF. Angiotensin prohibiters are a distracter for this question.
The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? (CH12) A) Pulse pressure B) Auscultatory gap C) Pulse deficit D) Korotkoff sound
A) pulse pressure The difference between the systolic and the diastolic pressures is called the pulse pressure.
The nurse is assessing a client taking an anticoagulant. What nursing intervention is most appropriate for a client at risk for injury related to side effects of medication enoxaparin? (CH12) A) Report any incident of bloody urine, stools, or both. B) Administer calcium supplements. C) Assess for hypokalemia. D) Assess for clubbing of the fingers.
A) report any incident of bloody urine, stools, or both The client who takes an anticoagulant, such as a low-molecular-weight heparin, is routinely screened for bloody urine, stools, or both. Clients taking enoxaparin will not need to take caclium supplements or have potassium imbalances related to the medication. The clubbing of fingers may occur with chronic pulmonary diseases.
A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? (CH13) A) Sensory B) Musculoskeletal C) Gastrointestinal D) Integumentary
A) sensory
angina pectoris
Almost always associated with a significant obstruction of a major coronary artery Pain varies from mild indigestion to impending death. Pain can be in chest, shoulder, jaw, back or arm.
Preload (Ch12)
Amount ventricles stretch during diastole "filling phase" Pressure generated in ventricles at end of diastole
Atherosclerosis
Atheromas or plaque protrude the lumen of the vessel. Most common cause of cardiovascular disease
The nurse assesses the patient and records the data collected. What would lead the nurse to anticipate that the patient will experience a decrease in cardiac output? (CH12) A) An order for the patient to receive digoxin B) A heart rate of 54 beats per minute C) A pulse oximetry reading of 98% D) An increase in preload related to ambulation in the hall
B) A heart rate of 54 beats per min Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 beats per minute. An increase in preload will lead to an increase in stroke volume. Digoxin will increase contractility of the heart and ultimately increase stroke volume. A pulse oximetry reading of 98% does not indicate hypoxemia, as hypoxia can decrease contractility.
The nurse is caring for a client on a monitored telemetry unit. During morning assessment, the nurse notes abnormal ECG waves on the telemetry monitor. Which action would the nurse do first? (Ch12) A) Call the physician with a report. B) Assess the client. C) Assess for mechanical dysfunction. D) Reposition the client.
B) Assess the client When a nurse notes an abnormal rhythm on a telemetry monitor, the first action is to assess the client. After client assessment, the nurse is able to make an informed decision on the next nursing action.
A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? (CH12) A) Potassium B) B-type natriuretic peptide (BNP) C) C-reactive protein (CRP) D) Platelet count
B) BNP The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP. There is no indication that the client is experiencing bleeding abnormalities, such as those seen with an abnormal platelet count.
The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition? (Ch12) A) hemorrhage B) catheter-related bloodstream infections C) air embolism D) pneumothorax
B) Catheter- related bloodstream infections Catheter-related bloodstream infections (CRBSIs) are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air.
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? (Ch13) A) Alkaline phosphatase B) Creatine kinase MB C) Myoglobin D) Troponin
B) Creatine Kinase MB There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.
The nurse is performing an assessment for an older adult client and auscultates an S3 heart sound. What condition does the nurse determine may correlate with this finding? (Ch12) A) congenital heart disease B) heart failure C) aortic stenosis D) coronary artery disease
B) Heart failure The S3 heart sound is heard immediately after the S2 sound, early in diastole, as blood flows from the atrium into a noncompliant ventricle. The S3 heart sound is normal in children and young adults, but it is a significant finding suggestive of heart failure in older adults. A client with aortic stenosis commonly may have a murmur. A client with congenital heart disease may have more that one abnormal heart sound. Clients with coronary artery disease do not have S3 heart sounds.
A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? (CH13) A) Magnesium level B) Potassium level C) Calcium level D) Sodium level
B) Potassium level
A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? (Ch13) A) Smoking directly causes high blood pressure. B) Smoking increases the risk of heart disease. C) Smoking causes obesity, which exacerbates hypertension. D) Smoking increases cardiac output.
B) Smoking increases the risk of heart disease
A 40-year-old man with overall good health has implemented many of the lifestyle modifications that his care provider recommended when he was diagnosed with hypertension. While these have resulted in reductions in his blood pressure readings over the past several months, the man remains borderline hypertensive. As a result, his care provider has proposed pharmacologic therapy. What medication should the nurse anticipate being prescribed for this patient? (Ch13) A) An angiotensin-converting enzyme (ACE) inhibitor B) thiazide diuretic C) A beta blocker D) An angiotensin receptor blocker (ARB)
B) Thiazide diuretic
A patient with angina is beginning nitroglycerin. Before administering the drug, the nurse informs the patient that, immediately after administration, the patient may experience what? (Ch13) A) Nervousness or paresthesia B) Throbbing headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia
B) Throbbing headache or dizziness Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy. However, the patient usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia don't occur as a result of nitroglycerin therapy.
Which term refers to preinfarction angina? (cH14) A) Stable angina B) Unstable angina C) Variant angina D) Silent ischemia
B) Unstable angina Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is (CH13) A) low. B) high. C) normal. D) extremely high.
B) high
hypertensive urgency
BP severely elevated but there is no evidence of target organ damage.
According to the DASH diet, how many servings of vegetables should a person consume each day? (Ch13) A) 2 or fewer B) 2 or 3 C) 4 or 5 D) 7 or 8
C) 4 or 5
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? (Ch13) A) aspirin or acetaminophen. B) pentoxifylline or acetaminophen. C) aspirin or clopidogrel. D) penicillin V or erythromycin.
C) Aspirin or clopidogrel After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? (Ch12) A) Chemoreceptors B) Sympathetic nerve fiber C) Baroreceptors D) Vagus nerve
C) Baroreceptors
Your client is being prepared for echocardiography when they ask you why they need to have this test. What would be your best response? (Ch12) A) "This test will find any congenital heart defects." B) "This test can tell us a lot about your heart." C) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." D) "Echocardiography will tell your doctor if you have cancer of the heart."
C) Echocardiography is a way of determining the functioning of the left ventricle of you heart
The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? (Ch13) A) Cholesterol, 280 mg/dL B) Low density lipoprotein (LDL), 160 mg/dL C) High-density lipoprotein (HDL), 80 mg/dL D) A ratio of LDL to HDL, 4.5 to 1.0
C) HDL 80 mg/dL
In preparation for transesophageal echocardiography (TEE), the nurse must: (CH12) A) Instruct the patient to drink 1 L of water before the test B) Heavily sedate the patient C) Inform the patient that blood pressure (BP) and electrocardiogram (ECG) monitoring will occur throughout the test D) Inform the patient that an access line will be initiated in the femoral artery
C) Inform the patient that blood pressure (BP) and electrocardiogram (ECG) monitoring will occur throughout the test
A 72-year-old woman with a diagnosis of angina pectoris has presented to her nurse practitioner because her chest pain on exertion has become more frequent and longer lasting in recent days. The nurse should understand that this woman's chest pain is directly attributable to which of the following pathophysiological processes? (CH14) A) Inflammation and physical irritation of the lumens of coronary arteries B) Accumulation of cellular debris in the myocardium after the rupture of atheromas C) Ischemia of cardiac muscle cells D) Accumulation of lactic acid in cardiac muscle
C) Ischemia of cardiac muscle cells The impediment to blood flow that is characteristic of angina is usually progressive, causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen needed for their survival. The condition is known as ischemia. Angina pectoris refers to chest pain that is brought about by myocardial ischemia. The pain associated with this condition is not a direct result of inflammation or the accumulation of debris or lactic acid.
After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When ausculatating a murmur, what does the nurse expect to hear? (CH12) A) Easily heard with no palpable thrill. B) Quiet but readily heard. C) Loud and may be associated with a thrill sound similar to (a purring cat). D) Very loud; can be heard with the stethoscope half-way off the chest.
C) Loud and may be associated with a thrill sound similar to a purring cat
The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? (CH14) A) Creatinine kinase-myocardial band (CK-MB) B) Total creatinine kinase (CK) C) Myoglobin D) Troponin I and T
C) Myoglobin Myoglobin is a heme protein that transports oxygen. Its levels can increase as early as 1 hour after an MI. Negative results are an excellent parameter for ruling out an acute MI. The other biomarker choices start to increase in 2 to 4 hours.
An older African American client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? (CH13) A) Consider this to be a normal finding for the client's age and race. B) Recommend the client have blood pressure rechecked in 1 year. C) Recommend the client have blood pressure rechecked within 2 weeks. D) Recommend the client see a health care provider immediately for further evaluation.
C) Recommend the client have blood pressure rechecked within 2 weeks
It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: (CH12) A) The atrioventricular valves must open. B) The pulmonic valve must be closed. C) Right ventricular pressure must be higher than pulmonary arterial pressure. D) Right ventricular pressure must decrease with systole.
C) Right ventricular pressure must be higher than pulmonary arterial pressure
It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: (Ch12) A) The atrioventricular valves must open. B) The pulmonic valve must be closed. C) Right ventricular pressure must be higher than pulmonary arterial pressure. D) Right ventricular pressure must decrease with systole.
C) Right ventricular pressure must be higher than pulmonary arterial pressure
A 56-year-old man has been brought to the emergency department by emergency medical services (EMS) and has been diagnosed with a myocardial infarction (MI) based on his presentation and electrocardiogram (ECG). The patient has been identified as a candidate for percutaneous transluminal coronary angioplasty (PTCA). The nurse who is providing care for this patient should recognize that the extent of cardiac damage will primarily depend on: (CH14) A) The patient's previous use of antiplatelets and anticoagulants B) The particular risk factors that contributed to the patient's MI C) The duration of oxygen deprivation to the patient's cardiac cells D) The patient's high- and low-density lipoprotein (LDL, HDL) levels prior to MI
C) The duration of oxygen deprivation to the patient's cardiac cells The duration of oxygen deprivation is directly related to the number of cells that die, therefore the time from the patient's arrival in the emergency department to the time percutaneous coronary intervention (PCI) is performed is critical and should be less than 60 minutes. The extent of cardiac damage is not a direct reflection of previous medication use or risk factors such as cholesterol levels.
The nurse is caring for a patient admitted with unstable angina. The laboratory results reveal that the initial troponin I level is elevated in this patient. What conclusion should the nurse draw from this fact? (Ch12) A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B) Because the entry diagnosis is unstable angina, this is a poor indicator of myocardial injury. C) This is an accurate indicator of myocardial injury. D) It is only an accurate indicator of skeletal muscle injury.
C) This is an accurate indicator of myocardial injury Troponin I is specific to cardiac muscle and is elevated within 3 to 4 hours after myocardial injury. Options A, B, and D are incorrect. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.
A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? (Ch12) A) Bounding pulse B) Weak pulse C) Thready pulse D) A pulse deficit
C) Thready pulse
The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance? (ch13) A) A low diastolic reading B) A high systolic pressure reading C) A normal reading D) A high diastolic or low systolic reading
D) A high diastolic or low systolic reading
A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? (Ch13) A) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. B) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. C) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. D) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
D) Administer oxygen, attach a cardiac monitor, take vitals signs, and administer sublingual nitroglycerin Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? (CH13) A) Secondary B) Pathologic C) Malignant D) Essential (primary)
D) Essential (Primary)
The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? (Ch12) A) Pulmonary embolism B) Myocardial infarction C) Pericarditis D) Heart failure
D) Heart failure An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.
The nurse is explaining vasovagal syncope to a client. What does the nurse associate the temporary loss of consciousness with for the client? (Ch12) A) vertigo B) increase fluid intake C) blood pressure 190/50 standing D) heart rate 48
D) Heart rate 48 Parasympathetic hyperactivity leading to sudden hypotension secondary to bradyrhythmia causes vasovagal syncope; bradyrhythmia leads to cerebral ischemia, which in turn leads to syncope. Vasovagal syncope isn't caused by vestibular dysfunction such as vertigo, hypertension, or vascular fluid shifting.
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate? (CH15) A) Furosemide B) Nitroglycerin C) Dopamine D) Morphine sulfate
D) Morphine sulfate Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing. Furosemide is a loop diuretic and will decrease fluid accumulation but will not reduce anxiety. Nitroglycerin will promote smooth muscle relaxation in the vessel walls and will relieve pain but not reduce anxiety. Dopamine is an inotrope that will increase the force of ventricular contraction but will not alleviate anxiety.
The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension? (Ch13) A) Cataracts B) Glaucoma C) Retinal detachment D) Papilledema
D) Papilledema
A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography (EBCT). The nurse understands that the primary advantage of this radiologic test is which of the following? (Ch14) A) Less exposure to radiation B) Clear images C) Less invasive procedure D) Quantifies calcified plaque
D) Quantifies calcified plaque The primary advantage of EBCT is to detect and quantify calcified plaque in the coronary arteries even before symptoms arise. EBCT is noninvasive and provides clearer images with less exposure to radiation than a CT scan but not the primary reason for use.
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? (CH13) A) Postural hypertension and resulting injury B) Rebound hypertension C) Sexual dysfunction D) Postural hypotension and resulting injury
D) postural hypotension and resulting injury
Ejection fraction (Ch12)
Measurement of blood leaving the heart when the heart contracts it ejects blood from two pumping chambers.
SA node (Ch12)
Natural pace maker
A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? (ch15_) visual disturbances. taste and smell alterations. dry mouth and urine retention. nocturia and sleep disturbances.
Visual disturbances
endocardium
inner lining of the heart
myocardium
muscular, middle layer of the heart
epicardium
outer layer of the heart
SA node
pacemaker of the heart
Systolic heart failure
weakened heart muscle
