Exam 3 Cardiac

A patient began antihypertensive therapy 2 days ago. He calls the clinic today complaining that he is drowsy throughout the day. The nurse's best response is:

"It is normal to feel drowsiness for the first 2 weeks, but let your health care provider know if it continues beyond 2 weeks."

The nurse in a long-term care facility designs a teaching program for the residents to help prevent peripheral vascular disease (PVD) caused by age-related changes, which include:

- loss of elasticity in vessel walls- atherosclerotic vessels- sedentary practices- weakened leg muscles

The nurse outlines behaviors that aid in the prevention of cardiovascular disease, which are:

- regular physical activity at least 30 minutes a day -maintain high -density lipoprotein (HDL) greater than 50 mg/dL -refrain from smoking -maintain healthy weight

The nurse plans to enhance blood flow in the 80-year-old long-term care facility resident by interventions such as:

- using lap throws or light blankets over legs while sitting- encouraging walking- coaching isometric exercises- keeping environment warm

A patient has been diagnosed with mild hypertension. Which intervention(s) will likely be included in his plan of care?

-Developing methods to help with controlling stress -Restricting sodium intake in his diet -Controlling his weight -Incorporating exercise into his daily routine

Of all the assessments the nurse has made on the new patient,those that may indicate heart failure are: (Select all that apply.)

-Jugular vein distention -wearing loose house shoes rather than street shoes -diminished pedal pules -weight gain but eating very little

Immediately following a patient's cardiac catheterization, what are the highest priority interventions when the patient returns to his room? (Select all that apply.)

-Monitoring the ECG (electrocardiogram) -Allowing the patient to rest -Administering oxygen via mask -Assessing the pulses distal to the catheterization site. -Taking the patient's vital signs.

A patient with a 10-year history of angina is admitted to the unit with chest pain. The working medical diagnosis is to rule out myocardial infarction. Definitive diagnosis of MI will be based on what information? (Select all that apply)

-Patient history and physical exam -Cardiac enzyme levels -ECG

The nurse is aware that certain risk factors increase the chance of a person developing cardiomyopathy. Which of the circumstances increase the risk for cardiomyopathy? (Select all that apply.)

-Pregnancy -systemic infection -chronic excessive alcohol consumption -systemic HTN

The patient asks the nurse what might have caused her varicose veins. The nurse is correct with which response?

-Prolonged sitting or standing in one position can contribute to the development of varicose veins. -Having family members with varicose veins can predispose you to the development of varicose veins -A history of deep vein thrombosis can contribute to the development of varicose veins -Pregnancy can contribute to the development of varicose veins

Place the events of arterial obstruction in proper sequence.

-Streaks of fatty material are laid down in arteries. -Deposits of low-density lipoproteins (LDLs) accumulate. -Fibrous plaque is laid down in vessel. -Platelets adhere to plaque. -Platelets clump. -Platelets calcify.

Immediately following a patient's cardiac catheterization, what are the highest priority interventions when the patient returns to his room?

-Taking the patient's vital signs -Monitoring the client's cardiac rhythm -Assessing the pulses distal to the catheterization site

When assessing a patient's cardiovascular system, the nurse should be alert for:

-adventitious lung sounds -patient says, "My shoes started feeling tight a few days ago. patient describes of interrupted sleep patterns

The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium, which is brought on by which factors? (Select all that apply.)

-emotional excitement -eating heavy meals -exposure to cold -exertion

The nurse outlines methods of prevention of peripheral vascular disease (PVD), which include:

-relieving stress -controlling diabetes -maintaining appropriate weight -routinely exercising -stopping smoking

Hypertension is diagnosed by the finding of a blood pressure reading greater than:

140/90 twice, 2 weeks apart.

The nurse has assessed the patient to have a blood pressure of 140/90, an apical pulse of 82, and a radial pulse of 76. The nurse records a pulse pressure of:

50 The pulse pressure is the difference between the systolic and diastolic pressures. Pulse deficit is the difference between the radial and the brachial pulses.

The number of people with hypertension in the United States is estimated to be?

70 million

Which patient is the best candidate to receive nesiritide therapy?

A patient with acutely decompensated HF who has dyspnea at rest

Captopril

ACE inhibitor

What drugs are used to treat HTN?

ACE inhibitors Diuretics Angiotensin II receptor blockers

These agents lower blood pressure by blocking the action of angiotensin II, thereby preventing vasoconstriction.

ARB's

Cozaar (Iosartan)

Antihypertensive, angiotensin II receptor agonist

A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first?

Apply pressure to the site with a gauze pad.

A patient asks how to apply transdermal nitroglycerin. What is the nurse's best response?

Apply the patch to hairless areas of the body

Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy?

Avoid drinking large amounts of green tea.

When administering nitroglycerine, the nurse knows that it is important to monitor the patient's:

BP

The patient asks if it is harmful for him to drink a glass of wine with dinner on a daily basis. Which is the nurse's best response?

"As long as it is okay with your physician, moderate alcohol intake can be beneficial to your cardiovascular health."

What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina?

Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week.

A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next?

Check the IV lock to see if it is functioning properly

A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next?

Continue to monitor the patient.

The nurse is preparing to implement a teaching plan for a patient with mild hypertension. What should be included in the plan for this patient?

Controlling stress Restricting sodium intake Controlling weight Monitoring and keeping cholesterol level normal

Patient education for a patient taking bile acid-sequestering resins should include taking supplemental vitamins, especially the fat-soluble vitamins including:

D, E, A, and K

A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?

Digoxin 1 mg IV push now; then 0.25 mg IV daily

What are the actions of Nitroglycerin?

Dilates arteries and veins Decreases preload on the heart

A patient reports a history of severe mitral valve disorder. What sign or symptom does the nurse expect to find?

Exertional dyspnea

The lipoprotein that is sometimes referred to as the "good" lipoprotein is:

HDL

The nurse points out the characteristics of normal sinus rhythm (NSR), which are: (Select all that apply.)

HR 60-100 one ventricular contraction (QRS complex) one T wave one atrial contraction (p wave)

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time?

He needs to be examined for possible internal bleeding from the fall.

The nurse points out the characteristics of normal sinus rhythm (NSR), which are:

Heart rate 60 to 100 One T wave One ventricular contraction (QRS complex) One atrial contraction (P wave)

Which ethnic group has the highest rate of metabolic syndrome?

Hispanic-American females

A 60-year old patient was told by his doctor that he would need heart transplant. Which conditions would be required before the patient could receive a heart transplant?

History of hospitalization for HF Need for left ventricular assist device (LVAD) Have good renal function Psychologically stable

While performing an assessment of a patient, the nurse discovers that the patient's pain is increased by dorsiflexion of the foot. The nurse should document this as a positive:

Homan's sign

Drugs administered IV to control pain in a patient with acute MI are morphine sulfate or __________.

Hydromorphone (Dilaudid)

A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate?

IV infusion

A patient with a known history of angina was walking his dog and developed chest pain. The patient immediately stops walking and sits down. He continues to experience chest pain when sitting down. When should he call 911?

If one sublingual tablet does not relieve the pain after 5 minutes

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. What is the concern with taking these two drugs together?

Increased risk of bleeding because of the ginkgo

When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug?

Lithium (Eskalith)

The nurse is aware that the patient's cardiac rehabilitation levels of physical activity are designated through......units.

MET metabolic equivalent

The nurse is providing patient teaching to a pregnant patient who works as a cashier in a grocery store. Which suggestion by the nurse will help most in preventing varicose veins?

March in place while standing at the counter

The antilipemic agent that causes a decrease in LDL and triglyceride production by inhibiting VLDL synthesis by liver cells is:

NIACIN

The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication?

Nesiritide (Natrecor)

Which drug groups are most often used to treat patients with angina?

Nitrates and nitrites, the beta blockers, and the CCBs are the drugs most often used to treat patients with angina pectoris

When the nurse uses the PQRST tool for pain assessment, the "R" prompts an inquiry about the ...of the pain.

P=Provocation/Palliation Q=Quality/Quantity R=Region/Radiation S=Severity Scale T=Timing

When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin?

PT/INR

A patient with a 10-year history of angina is admitted to the unit with chest pain. The working medical diagnosis is to rule out myocardial infarction. Definitive diagnosis of MI will be based on what information? (Select all that apply.)

Patient history and physical exam Cardiac enzyme levels ECG

The nurse is obtaining a medication history on a patient presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin?

Phosphodiesterase inhibitors (ED meds)

A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication?

Positive inotrope

A patient is receiving oral quinidine. Which assessment finding is of most concern?

Prolonged QT interval

The primary therapeutic outcome expected from adenosine therapy is conversion of _____________ to normal sinus rhythm. atrial flutter ventricular tachycardia atrial fibrillation supraventricular tachycardia

SVT

The primary therapeutic outcome expected from adenosine therapy is conversion of......to normal sinus rhythm.

SVT

A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern?

Serum potassium level of 2.9 mEq/L

The nurse suspects arterial insufficiency in the 50-year-old patient when the feet and legs exhibit:

Shiny and hairless

A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient?

Slowing of the heart rate

A patient will be taking niacin as part of antilipemic therapy. What is the best way to avoid problems with flushing or pruritus?

Start with a low initial dose and then increase it gradually.

A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be?

Stop mowing and sit or lie down

The nurse is aware that certain risk factors increase the chance of a person developing cardiomyopathy. Which of the circumstances increase the risk for cardiomyopathy?

Systemic HTN Chronic excessive alcohol consumption Pregnancy Systemic infection

A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true?

The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication.

A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct?

The heparin provides anticoagulation until therapeutic levels of warfarin are reached.

The home health nurse is assessing the home-bound patient with heart failure. Which assessment finding is of most concern to the nurse?

The nurse notes a 3-lb weight gain over the course of a week

The nurse is assessing the patient who has been taking digoxin (Lanoxin) for the past 2 months. Which assessment finding would alert the nurse that the patient may be experiencing digitalis toxicity?

The patient reports frequent nausea and diarrhea

An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks so thick. Which is the most accurate response by the nurse?

The valves in the vessels in your legs aren't working as well as they used to, which causes the discoloration and thickening of your skin.

A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order?

This medication has a protective effect on the kidneys for patients with diabetes

A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses' best response?

This time frame correlates better with the natural diurnal rhythm of cholesterol production.

The nurse cautions the patient with uncontrolled hypertension that the consequences of the disease will include:

Threat of a stroke Possible kidney failure Risk for heart attack Probability of CHF

What are the treatment goals for metabolic syndrome?

Triglycerides less than 150 Fasting glucose less than 120 Increased HDL

A patient with a 10-year history of angina is admitted to the unit with chest pain. After the nurse completed the history and physical exam, the physician should order which diagnostic tests to confirm the working medical diagnosis of myocardial infarction:

Troponin I ECG CK-MB

A patient asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). Which response by the nurse is accurate?

We do not know how Ranexa works.

Antidysrhythmic agents are classified according to their effects on the electrical conduction system of the heart. Class I antidysrhythmic agents:

act as myocardial depressants by inhibiting sodium ion movement.

The medication used to reduce the absorption of glucose from the intestine, reducing postprandial hyperglycemia is:

alpha-glycosidase inhibitors

What is a class III antidysrhythmic also called?

amiodarone

The most common form of obstructive arterial disease is:

arteriosclerosis obliterans

The patient is instructed that the most common and effective OTC antiplatelet aggregation agent is:

aspirin

The patient is instructed that the most common and effective over the counter anti-platelet aggregation agent is:

aspirin

Atenolol

beta blocker

Propranolol

beta blocker (antiarrhytmic Class II)

When the nurse assesses an apical pulse of 52, the finding of this arrhythmia is known as...?

bradycardia

A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient?

captopril

The patient in the emergency room with a myocardial infarction(MI) becomes pale, diaphoretic, and hypotensive and complains of feeling cold.The nurse recognizes that these signs are which post-MI complication?

cardiogenic shock

Which statement about ARBs does the nurse identify as being true? A. Hyperkalemia is more likely to occur than when using ACE inhibitors. B.Cough is more likely to occur than when using ACE inhibitors. C.Chest pain is a common adverse effect. D.Overdose is usually manifested by hypertension and bradycardia.

chest pain is the most common adverse

Ranolazine is a new medication that does not affect the blood pressure or heart rate and is used to treat:

chronic stable angina

The 65-year-old patient complains of leg pain that disappears on rest after having walked a short distance. The nurse recognizes the description of the patient's discomfort as being characteristic of:

claudication

A patient diagnosed with intermittent claudication may be prescribed pentoxifylline (Trental). This medication:

decreases the viscosity of blood

.....is the acute symptom most experienced by African Americans when having a myocardial infarction.

dyspnea

The nurse who uses a regular sized adult blood pressure cuff on a large adult will get a blood pressure reading that is falsely.....

elevated

A small fragment of a thrombus that breaks off and circulates until it becomes trapped in a capillary is called a(n):

emobolus

The first steps of treatment for metabolic syndrome are usually:

exercise and weight loss

The nurse expresses concern to the 80-year-old resident in along-term care facility who is attempting to jog on a treadmill. The nurse is aware that the exceptional oxygen and metabolic demands brought on by the exercise might cause hypertension.

false

What are the signs of hypokalemia?

fatigue, muscle weakness, drowsiness, confusion, new onset of bradycardia, or postural hypotension.

What patient history would the nurse recognize as a contraindication for beginning Niacin therapy?

gout

The post-myocardial infarction (MI) patient is placed on a low-fat diet as well as daily simvastatin (Zocor). The nurse instructs that while on this drug, the patient should:

have blood work every 2 months to check for liver damage

The nurse expresses concern to the 80-year-old resident in a long-term care facility who is attempting to jog on a treadmill. The nurse is aware that the exceptional oxygen and metabolic demands brought on by the exercise might cause...?

heart failure

The nurse is administering doxazosin (Cardura) with the patient's morning medications. The patient's current blood pressure is 98/52 mm Hg and heart rate is 50 beats per minute. The nurse's best action is to:

hold the doxazosin (Cardura) and contact the health care provider.

The nurse is aware that some arrhythmias may be the result of:

hyperkalemia, valvular prolapse, defective SA node, excess fluid, infarct damage

When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response?

hypotension

What assessment verifies increased blood perfusion to the lower extremities?

increase of pedal pulses

Nitrates relieve angina pectoris by:

inducing relaxation to the peripheral vascular smooth muscles

The nurse uses a diagram to show how obstruction of an artery has caused an area of necrosis called a(n)

infarction

The 85-year-old patient asks the nurse why he has a heart murmur now after all these years. What is the most likely cause of this patient's heart murmur?

insufficient valves

The nurse adds an intervention to the care plan of a patient who has just been prescribed a thiazide diuretic, which is to increase:

intake of foods containing potassium

The nurse explains that the pain of coronary artery disease (CAD) is related to:

ischemia

Of all the assessments the nurse has made on the new patient,those that may indicate heart failure are:

jugular distention weight gain but eating very little diminished pedal pulses wearing loose house shoes (slippers) rather than street shoes

The nurse encourages a 65-year-old female patient to get a cholesterol study because the best indicator of possible heart disease in women is:

low levels of high-density lipoprotein.

The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. The following questions relate nursing considerations when caring for this patient. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include A.immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. B.overlapping therapy of IV heparin and warfarin are for at least 5 days. C.monitoring the INR and stopping the IV heparin when the INR is 1.0.

overlapping therapy of IV heparin and warfarin are for at least 5 days.

The nurse assessing the heart places the stethoscope between the fifth and sixth ribs at the mid-clavicular line to hear the point of.....?

point of maximal impulse

The nurse explaining blood pressure to a patient instructs that,in a blood pressure of 120/80, the 80 indicates the:

pressure in the relaxed ventricles

The primary purpose of anticoagulants is to:

prevent formation of new clots

Approximately 90% of all clinical cases of high blood pressure are:

primary HTN

Which location is the area where the highest percentage of sodium and water are resorbed back into the bloodstream?

proximal tubule

The patient suffering from ventricular tachydysrhythmia may benefit from.....when medications are not effectively treating the disorder.

radiofrequency ablation

The nurse suggests to the patient with angina that a daily dose of 81 mg of aspirin is an inexpensive therapy to help:

reduce clotting

A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication?

scheduled surgery

The patient who has a history of smoking and alcohol abuse is most likely to develop ..... hypertension.

secondary

The nurse lists modifiable risk factors for a patient at risk for cardiovascular disease, which are:

smoking HTN obesity sedentary lifestyle

Which medication is considered a fibrinolytic agent?

tenecteplase (TNKase)

What primary mechanism of ACE inhibitors will the nurse understand as the therapeutic action?

to inhibit aldosterone secretion

Patient assessment and cholesterol-lowering treatment are based on the level of:

total cholesterol

Nitroprusside (Nitropress)

vasodilator

Dysrhythmias developing below the bundle of His are referred to as:

ventricular dysrhythmias

The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. Which drug can the nurse anticipates administrating?

vitamin K High doses of vitamin K (10 mg) given IV will reverse the anticoagulation of warfarin within 6 hours

A 25 year female patient was diagnosed with Raynaud's disease. The patient asked a nurse what medications the doctor is likely to put her on. The nurse will respond with what drug are used to treat this disease? Diltiazem Captopril Lasix Trental Nitroglycerin

•Nifedipine is the calcium ion agonist with the greatest success in reducing the occurrence of spasms. •Captopril has been extensively studied and successful in reducing frequency and severity of attacks. •Adrenergic antagonists have moderate success and many adverse effects. •Nitroglycerin has adverse effects such as dizziness, headache, and hypotension.