Chapter 47: Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder

The life support system that uses special techniques, ventilation equipment, and therapies for emergency situations is ________.

advanced cardiac life support (ACLS)

What should a person with unstable angina avoid?

shoveling snow

The nurse caring for a patient recovering from a myocardial infarction (MI) teaches which method to avoid the Valsalva maneuver during a bowel movement?

Mouth breathing

The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot?

Pain, which would be a positive Homans sign

What do dark or "cold" spots on a thallium scan indicate?

Tissue that has inadequate perfusion

The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for:

cessation of smoking.

The nurse takes into consideration that age-related changes can affect the peripheral circulation because of:

sclerosed blood vessels.

The cardiac marker ___________ rises 3 hours after a myocardial infarct and measures myocardial contractile protein.

troponin I

The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says:

"I always take off the telemetry device when I shower."

During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure?

"I have to sleep in my recliner and I have this hacking cough."

Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)?

"I try to eat more green leafy vegetables, especially broccoli, spinach, and kale."

The elderly patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse's most helpful response would be:

"If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals, call your physician and come to the hospital."

The nurse assesses pitting edema that can be depressed approximately inch and refills in 15 seconds. The nurse would document this assessment as:

+2 edema.

The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between:

2 and 3.

The patient with congestive heart failure who is on a diuretic drug shows a weight loss of 6.6 lb. The nurse is aware that the patient has lost ______ L of fluid.

3

The nurse reminds the patient that the National Heart, Lung, and Blood Institute recommends a lipid study every _________ years.

5

The patient has been hospitalized for hypertensive episodes three times in the last months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse's immediate course of action would be to:

collect more information to identify his reasons for noncompliance.

The nurse identifies the "LUBB" sound of the "LUBB/DUBB" of the cardiac cycle as the sound of the:

AV valves closing.

A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?

CK-MB

The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)?

Cocaine use

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?

Edematous, red scaly skin on medial surface of the leg

The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask?

Have you contacted your physician about your dental appointment?"

The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times?

In the morning

The nurse is treating a patient who has had a pacemaker inserted for the correction of atrial fibrillation. Which diagnostic test is no longer available to the patient because of the implanted device?

MRI

The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention?

Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema.

What is the major cause of cardiac valve disease?

Rheumatic fever

What is the difference between primary and secondary hypertension?

Secondary hypertension is caused by another disorder like renal disease.

How should the nurse advise a patient with an international normalized ratio (INR) of 5.8?

Stop taking the anticoagulant and notify health care provider

What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient?

Walk 2 miles in less than 60 minutes after 12 weeks.

What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.)

a. Detect thrombi before a cardioversion c. Visualize vegetation on the heart valves e. Visualize abscesses on the heart valves

The nurse points out which of the following as modifiable risks for coronary artery disease (CAD)? (Select all that apply.)

a. Diabetes mellitus c. Smoking d. Hypertension e. Hyperlipidemia

The nurse outlines which of the following as conditions that would disqualify a candidate for a heart transplant? (Select all that apply.)

a. Recent malignancy c. Peptic ulcer disease e. Severe obesity

Following an angiogram with the insertion site of the left groin, the nurse will include in the plan of care provisions for (select all that apply):

a. checking pedal pulses. c. checking color and warmth of left leg frequently. d. sandbagging over insertion site.

The nurse encourages the patient who is recovering from a myocardial infarct (MI) to ask the health care provider to prescribe a cardiac rehabilitation series in order to learn to (select all that apply):

a. improve stamina. b. strengthen muscles. e. reduce risk of further problems. f. understand heart condition.

Trace the impulse pattern of conduction in sequence through the heart. (Separate letters by a comma and space as follows: A, B, C, D)

a. Atrial wall b. Atrial-ventricular (AV) node c. Purkinje fibers d. Sinoatrial (SA) node e. Bundle branches f. Bundle of His ANS: B, A, D, F, E, C

Arrange in sequence the path of the blood through the coronary circulation. (Separate letters by a comma and space as follows: A, B, C, D)

a. Right atrium b. Pulmonary artery c. Tricuspid valve d. Right ventricle e. Superior and inferior vena cava f. Pulmonary vein g. Left atrium h. Mitral valve i. Left ventricle j. Lungs ANS: E, A, C, D, B, J, F, G, H, I

The nurse explains that the heart has the ability to contract in a rhythmic pattern that is called ____________.

automaticity

Which patient teaching would help to prevent venous stasis? (Select all that apply.)

b. Avoid crossing legs at the knee c. Elevate legs when lying in bed or sitting e. Wear elastic stockings when ambulating

Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.)

b. Bradycardia c. Headache d. Visual disturbance f. Gastrointestinal complaints

When assessing a patient with a possible MI, what should the nurse assess for? (Select all that apply.)

b. Hypertension c. Pallor d. Diaphoresis e. Erratic behavior f. Cardiac rhythm changes

Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.)

b. Take medication at the same time each day. c. Report to physician cuts that do not stop bleeding with direct pressure.

The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply.)

b. Using mittens in cold weather c. Practicing stress-reducing techniques d. Complete smoking cessation e. Using caution when cleaning the refrigerator or freezer

The nurse would assess closely for signs of right-sided heart failure which include (select all that apply):

b. increasing abdominal girth. d. edema of feet and ankles. e. distended jugular veins.

The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause:

heart failure.

The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can:

increase the action of the Coumadin.

The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having:

indigestion.

After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of:

infective endocarditis.

.The pain that a person with arterial insufficiency feels on exertion, which is relieved by rest, is ______________ _____________.

intermittent claudication

The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of:

moderate heart failure.

The nurse is aware that the muscle layer of the heart, which is responsible for the heart's contraction, is the:

myocardium.

The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse's reaction is one of:

satisfaction. This is good cholesterol control.

A patient is admitted from the emergency department. The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patient's condition as:

severe heart failure.

The process by which a heart is shocked from a persistent arrhythmia back into sinus rhythm is called a ____________.

cardioversion

The nurse clarifies that the master pacemaker of the heart is the:

sinoatrial (SA) node.

The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as:

sinus tachycardia.

The nurse assesses that the home health patient has no signs or symptoms of heart failure, but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA) staging, this patient would be a:

stage A.

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include:

substernal pain that radiates down the left arm.

The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into:

ventricular tachycardia and death.