EAQ study set

A primary healthcare provider prescribes atenolol 20 mg by mouth four times a day for a client who has had double coronary artery bypass surgery. What information is most important for the nurse to include in the discharge teaching plan for this client?

Avoid abruptly discontinuing the medication An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a healthcare provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.

A client is to receive conscious sedation during a cardiac catheterization. Which route of administration should the nurse explain will be used to deliver the conscious sedation?

Through an intravenous catheter Conscious sedation is administered by direct intravenous (IV) injection or IV push to dull or reduce the intensity of pain or awareness of pain during a procedure without loss of defensive reflexes. General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized. An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. A nerve block, a type of regional anesthesia, is achieved by injection of the anesthetic agent into or around the nerves supplying the area; it interrupts sensory, motor, and sympathetic transmission

A client with coronary artery disease is scheduled for a cardiac catheterization. What should the client be able to describe if the nurse's preoperative teaching is considered effective?

What will be experienced during the procedure Knowing what to expect reduces fear of the unknown. Knowing what will occur in an emergency may increase fear associated with the experience. Discussing the risks of the procedure is the primary healthcare provider's responsibility. The nurse does not give the risks associated with this invasive procedure; the nurse determines the client's knowledge regarding the procedure and documents the client's signature on the consent form. Exercise is not immediate; bed rest is prescribed with operative site immobilization for several hours

Which is the priority nursing action when admitting a client to the emergency department during cardiac arrest from ventricular fibrillation?

Initiating defibrillation The priority nursing action for a client who is admitted to the emergency department during cardiac arrest caused by ventricular fibrillation is initiating defibrillation. Treating pain, assessing respirations, and monitoring blood pressure will not occur until this action has been initiated.

A client is admitted to the cardiac intensive care unit with intense chest pain. What pain relief medication does the nurse expect to find on the plan of care for this client?

Morphine Morphine is the drug of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

A client with a history of cardiac dysrhythmias is admitted to the hospital due to a fluid volume deficit caused by a pulmonary infection. The registered nurse is assessing the vital signs recorded by the student nurse. Which vital sign assessments require reassessment based on the data given by the student nurse? Select all that apply.

Respiratory rate of 14 breaths/minute Blood pressure of 120/80 mmHg Oxygen saturation of 95% In pulmonary infections, the respiratory rate may increase and oxygen saturation may decrease. In fluid volume deficit, the blood pressure may be decreased. A respiratory rate of 14 breaths/minute, a blood pressure of 120/80 mmHg, and an oxygen saturation of 95% are normal readings. Therefore, the registered

The spouse of a patient who had emergency coronary artery bypass surgery asks why there is a dressing on the patient's left leg. How should the nurse explain the dressing?

"A vein in the leg was used to bypass the coronary artery." The response that a vein in the leg was used to bypass the coronary artery provides information and reduces anxiety. The nurse understands that the greater saphenous vein of the leg is used to bypass the diseased coronary artery, and one surgical team obtains the vein while another team performs the chest surgery; this shortens the surgical time and decreases the risks of surgery. The internal mammary arteries are the grafts of choice, but the surgery is usually longer because of the necessity of dissecting the arteries from the chest wall. In addition, the internal mammary arteries may have been used in a previous bypass surgery. Cardiopulmonary bypass (extracorporeal circulation) is accomplished by placement of a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body; blood is returned to the body via a cannula in the aorta or the femoral artery. Off-pump surgery is used for minimally invasive surgical techniques. A filter is not inserted in the leg to prevent embolization during a coronary artery bypass graft (CABG). The arteries in the extremities are not examined during a CABG.

A client is scheduled to have a coronary artery bypass graft (CABG). The client's spouse asks what the benefit of the surgery is. How should the nurse respond?

"This surgery significantly decreases symptoms in most clients." The majority of those who have this surgery have marked relief from their symptoms because the flow of blood to myocardial cells is increased. Whether the procedure will enable the client to return to work depends on the client's presurgical condition and occupation, not the surgery itself. So far, studies have failed to show that coronary artery bypass surgery affects life span. The surgery itself does not affect the disease process; clients must reduce risk factors (obesity, smoking, and high-fat/high-cholesterol diet) as well.

The nurse providing postprocedure care to a client who had a cardiac catheterization through the femoral artery discovers a large amount of blood under the client's buttocks. After donning gloves, which action should the nurse take first?

Assess the catheterization site. Observing standard precautions is the first priority when dealing with any body fluid, followed by assessment of the catheterization site as the second priority. This action establishes the source of the blood and determines how much blood has been lost. Once the source of the bleeding is determined, the priority goal for this client is to stop the bleeding and ensure stability of the client by monitoring the vital signs. Changing the client's gown and bed linens is not necessary until the bleeding is controlled and the client is stabilized

A nurse is caring for a client who has had multiple myocardial infarctions and has now developed cardiogenic shock. Which clinical manifestation supports this diagnosis?

Cold, clammy skin The action of the sympathetic nervous system causes vasoconstriction, and as cellular and peripheral hypoperfusion progresses, the skin becomes cold, clammy, cyanotic, or mottled. The heart rate increases in an attempt to meet the body's oxygen demands and circulate blood to vital organs; it has a low volume (weak, thready) because of peripheral vasoconstriction. The blood pressure decreases because of continued hypoperfusion and multiorgan failure. Bowel sounds are hypoactive or absent, not hyperactive.

The nurse is providing care to a client who presents in the emergency department (ED) in cardiac arrest. Which are the priority nursing actions when providing care to this client? Select all that apply.

Determining the need for rapid defibrillation Performing adequate chest compressions The priority nursing actions for a client who presents with cardiac arrest include determining need for rapid defibrillation and performing adequate chest compressions. Documenting care, notifying family members, and administering pain medications are all appropriate nursing actions but these to not address the patient' immediate life-threatening condition.

A client who has been admitted to the hospital with chest pain complains of shortness of breath, weakness, and vomiting. The nurse suspects cardiac arrest. Which site is the most appropriate place to check the client's pulse rate?

Femoral A client with chest pain, shortness of breath, weakness, and vomiting may be experiencing cardiac arrest. In a client with cardiac arrest, the most appropriate place to check the pulse rate is the femoral site, because other pulses may not be palpable at this time. The ulnar site is used to assess the status of circulation to the hand and also used to perform the Allen test. The radial site is commonly used to assess the character of the pulse peripherally and to assess the status of the circulation to the hand. The brachial site is used to assess the status of the circulation to the client's lower arm or the blood pressure is being auscultated.

While instructing a community group regarding risk factors for coronary artery disease, the nurse provides a list of risk factors that cannot be modified. What should be included on the list?

Heredity Heredity refers to genetic makeup and cannot be changed. Cigarette smoking is a lifestyle habit that involves behavior modification. Hypertension and diabetes mellitus are risk factors of coronary artery disease that can be controlled with diet, medication, and exercise.

Findings on a client's cardiac monitor indicate a need for an intravenous infusion that contains potassium for a client with hypokalemia. The nurse concludes that what finding on the monitor indicated a need for potassium replacement?

Lowering of the T wave Hypokalemia causes a flattening of the T wave on an electrocardiogram, as observed on the monitor, because of its effect on muscle function. Hypokalemia causes a depression of the ST segment. Hypokalemia causes a widening of the QRS complex. Hypokalemia does not cause a deflection of the Q wave

A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect?

Metabolic acidosis Decreased oxygen promotes the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Arterial blood gases do not assess serum potassium levels. Hyperkalemia will occur with shock because of renal shutdown. Respiratory alkalosis may occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The carbon dioxide level will be increased in profound shock.

The nurse is caring for a client who had a massive myocardial infarction and developed cardiogenic shock. Which clinical manifestations support these diagnoses? Select all that apply.

Rapid pulse Decreased urinary output The heart rate increases (tachycardia) in an attempt to meet the body's oxygen demands and circulate blood to vital organs; the pulse is weak and thready because of peripheral vasoconstriction. The urinary output decreases because increased catecholamines and activation of the renin-angiotensin-aldosterone system increase fluid reabsorption in the kidneys. The respirations are rapid and shallow, not deep. The skin is cold and clammy because of vasoconstriction caused by the shunting of blood to vital organs. The blood pressure is decreased, not increased, because of continued hypoperfusion and multiorgan failure.

Which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client?

Serum potassium of 7.2 mEq/L (7.2 mmol/L) Hyperkalemia causes dysrhythmias and cardiac arrest. The normal serum potassium concentration ranges between 3.5 and 5.0 mEq/L (3.5-5.0 mmol/L). A concentration of 7.2 mEq/L (7.2 mmol/L) indicates hyperkalemia. The normal concentration of sodium in the serum ranges between 135 and 145 mEq/L (135-145 mmol/L). The normal chloride concentration ranges between 96 and 106 mEq/L (96-106 mmol/L). The normal serum calcium level ranges between 9 and 10.5 mg/dL (2.25-2.625 mmol/L).

A health care provider prescribes bisacodyl for a client with cardiac disease. The nurse explains to the client that this drug acts by what mechanism?

Stimulating peristalsis Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid, form soft, pliant bulk that promotes physiologic peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil, lubricate the feces and decrease absorption of water from the intestinal tract.

A client is admitted with full-blown anaphylactic shock that developed due to a type 1 latex allergic reaction. Which findings will the nurse observe upon assessment? Select all that apply

Stridor Hypotension Dyspnea Full-blown anaphylactic shock produces stridor, hypotension, and dyspnea. Fissuring and cracking of the skin occurs in individuals with a type IV contact dermatitis.

To prevent septic shock in the hospitalized client, what should the nurse do?

Use aseptic technique during all invasive procedures. Septic shock occurs as a result of an uncontrolled infection, which may be prevented by using correct infection control practices. These include aseptic technique during all invasive procedures. Maintaining the client in a normothermic state, administering blood products, and keeping the critically ill client immobilized are not directly related to the prevention of septic shock.