EXAM3: CARDIAC 1215
A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? A. "Practice meticulous foot care." B. "Consider cutting down on your smoking." C. "Reduce your level of exercise." D. "See the physician if complications occur."
A
A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A. Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours B. Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours C. A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling D. A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling
A
A nurse is providing education about maintaining tissue integrity to a client with peripheral arterial disease. Which of the following statements by the client indicates a need for clarification? a. "Shoes made of synthetic material are best for my feet." b. "It is important to apply sunscreen to the top of my feet when wearing sandals." c. "I should apply powder daily because my feet perspire." d. "I can use lamb's wool between my toes if necessary."
A
Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: a. Cigarette smoking. b. Lack of exercise. c. Obesity. d. Stress.
A
The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks several blocks. The client has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what instruction about long-term care to the client? A. "Be sure to practice meticulous foot care." B. "Consider cutting down on your smoking." C. "Reduce your activity level to accommodate your limitations." D. "Try to make sure you eat enough protein."
A
The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? A. lisinopril B. diltiazem C. bumetanide D. cholestyramine
A
The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? A. ACE inhibitor B. Calcium channel blocker C. Diuretic D. Bile acid sequestrants
A
The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure? A. fatigue B. pedal edema C. nocturia D. irregular pulse
A
The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. What medication should the nurse anticipate administering to this client? A. A beta-adrenergic blocker B An antiplatelet aggregator C. A calcium channel blocker D. A nonsteroidal anti-inflammatory drug (NSAID)
A
The nurse is teaching a client about lifestyle modifications after a heart failure diagnosis. What will be included in the teaching? A. Engage in exercise daily. B. Restrict dietary potassium. C. Avoid any alcohol. D. Drink 3 liters of fluid per day.
A
Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: A. keep the client warm. B. maintain room temperature at 78° F (25.6° C). C. keep the client uncovered. D. match the room temperature to the client's body temperature.
A
What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? A. The level of physical activity each allows B. Duration of symptoms C. There is a marked limitation of physical activity. D. The client is unable to carry out any physical activity.
A
Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease? A. Acute Pain B. Disturbed Sensory Perception C. Self-Care Deficit D. Activity Intolerance
A
Which observation regarding ulcer formation on the client's lower extremity indicates that the ulcer is a result of venous insufficiency? A. Border of the ulcer is irregular B. Though superficial, it is very painful C. Base is pale to black D. Is deep, involving the joint space
A
Which observation regarding ulcer formation on the client's lower extremity indicates to the nurse that the ulcer is a result of venous insufficiency? A. Large and superficial B. Though superficial, is very painful C. Base is pale to black D. Is deep, involving the joint space
A
Which of the following is a characteristic of an arterial ulcer? A. Border regular and well demarcated B. Brawny edema C. -brachial index (ABI) > 0.90 D. Edema may be severe
A
Which of the following is a characteristic of an arterial ulcer? a. Border regular and well demarcated b. Brawny edema c. Ankle-brachial index (ABI) > 0.90 d. Edema may be severe
A
The nurse has performed a thorough nursing assessment of the care of a client with chronic leg ulcers. The nurse's assessment should include which of the following components? Select all that apply. a. Location and type of pain b. Apical heart rate c. Bilateral comparison of peripheral pulses d. Comparison of temperature in the client's legs e. Identification of mobility limitations
A ,C, D, E
A client has been diagnosed with right-sided heart failure based on symptomology. The cardiologist will confirm this suspicion through diagnostics. Which diagnostics are used to reveal right ventricular enlargement? Select all that apply. A. electrocardiogram B. chest radiograph C. echocardiography D. pulmonary arteriography
A, B, C
Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. A. Causes vasospasm B. Reduces circulation to the extremities C. Impairs transport and cellular use of oxygen D. Increases blood viscosity E. Decreases blood viscosity
A, B, C, D
The nurse is caring for a client with heart failure. What are the management goals for the client with heart failure? Select all that apply. A. Promoting a healthy lifestyle. B. Increasing cardiac output by strengthening muscle contractions. C. Reducing the amount of circulating blood volume. D. Lowering the risk for hospitalization. E. Increasing preload and afterload.
A, B, D
The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) A. Avoid constricting garments. B. Elevate the legs above the heart level for 30 minutes every 2 hours. C. Sit as much as possible to rest the valves in the legs. D. Sleep with the foot of the bed elevated about 6 inches. E. Sit on the side of the bed and dangle the feet.
A, B, D
The nurse is evaluating a client's diagnosis of arterial insufficiency with reference to the adequacy of the client's blood flow. On what physiologic variables does adequate blood flow depend? Select all that apply. a. Efficiency of heart as a pump b. Adequacy of circulating blood volume c. Ratio of platelets to red blood cells d. Size of red blood cells e. Patency and responsiveness of the blood vessels
A, B, E
The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) A. Cool and cyanotic skin B. Initial absence of edema C. Sharp pain that may be relieved by the elevation of the extremity D. Full superficial veins E. Brisk capillary refill of the toes
A, C, D
The nurse is planning the care of a client with heart failure. The nurse should identify what overall goals of this client's care? Select all that apply. A. Improve functional status B. Prevent endocarditis. C. Extend survival. D. Limit physical activity. E. Relieve client symptoms.
A, C, E
A client is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in client teaching before discharge? A. Adequate carbohydrate intake B. Application of graduated compression stockings C. Prophylactic antibiotic therapy D. Methods of keeping the wound area dry
B
A nurse is assessing a client with heart failure. What breath sound is commonly auscultated in clients with heart failure? A. tracheal. B. fine crackles. C. coarse crackles. D. friction rubs.
B
A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? A. Ineffective right ventricular contraction B. Myocardial ischemia C. Pulmonary embolus D. Cystic fibrosis
B
The nurse explains to a patient that the primary cause of a varicose vein is: a. Phlebothrombosis. b. An incompetent venous valve. c. Venospasm. d. Venous occlusion.
B
The nurse is caring for a client who is admitted to the medical unit for the treatment of a venous ulcer in the area of her lateral malleolus that has been unresponsive to treatment. What is the nurse most likely to find during an assessment of this client's wound? A. Hemorrhage B. Heavy exudate C. Deep wound bed D. Pale-colored wound bed
B
The nurse is caring for a client who is receiving a loop diuretic for the treatment of heart failure. What assessment should the nurse prioritize? A. Monitoring liver function studies B. Blood pressure C. Vitamin D intake D. Monitoring potassium levels
B
The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? a. Elevating the limb above heart level b. Lowering the limb so that it is dependent c. Massaging the limb after application of cold compresses d. Placing the limb in a plane horizontal to the body
B
The nurse is providing care for a client who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? A. Numbness and tingling in the distal extremities B. Unequal peripheral pulses between extremities C. Visible clubbing of the fingers and toes D. Reddened extremities with muscle atrophy
B
The nurse knows which diagnostic test is used to document the anatomic site of reflux and provides a quantitative measure of the severity of valvular reflux? A. Contrast phlebography B. Duplex ultrasound scan C. Lymphangiography D. Lymphoscintigraphy
B
While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? A. Decrease the heparin infusion rate. B. Prepare to administer protamine sulfate. C. Monitor the partial thromboplastin time (PTT). D. Start an I.V. infusion of dextrose 5% in water (D5W).
B
The client asked the nurse to describe Stage C heart failure. What is the best explanation by the nurse? A. a client who reports no symptoms of heart failure at rest but has risk factors of heart disease B. a client who reports no symptoms of heart failure at rest but has a cardiac history and is taking medications C. a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity D. a client who reports symptoms of heart failure at rest and is a candidate for a heart transplant
C
The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication? A. Furosemide blocks reabsorption of potassium on the collecting tubule. B. Furosemide promotes sodium secretion into the distal tubule. C. The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels. D. The medication promotes potassium secretion into the distal tubule and constrict renal vessels.
C
The nurse is assessing a client with left-sided heart failure. What assessment finding is expected? A. ascites B. jugular vein distention C. air hunger D. pitting edema of the legs
C
The nurse is caring for a client with heart failure who has been prescribed digoxin. What laboratory value for the client can precipitate digoxin toxicity? A. Sodium 128 milliequivalents per liter B. Sodium 155 milliequivalents per liter C. Potassium 3.0 milliequivalents per liter D. Potassium 5.6 milliequivalents per liter
C
The nurse is caring for an acutely ill client who is on anticoagulant therapy. The client has a comorbidity of renal insufficiency. How will this client's renal status affect heparin therapy? A. Heparin is contraindicated in the treatment of this client. B. Heparin may be given subcutaneously, but not IV. C. Lower doses of heparin are required for this client. D. Warfarin will be substituted for heparin.
C
The nurse is caring for an acutely ill client who is on anticoagulant therapy. The client has a comorbidity of renal insufficiency. How will this client's renal status affect heparin therapy? a. Heparin is contraindicated in the treatment of this client. b. Heparin may be given subcutaneously, but not IV. c. Lower doses of heparin are required for this client. d. Warfarin will be substituted for heparin.
C
The triage nurse in the ED is assessing a client who reports pain and swelling in her right lower leg. The client's pain became much worse last night and appeared along with fever, chills, and sweating. The client states, "I hit my leg on the car door 4 or 5 days ago and it has been sore ever since." The client has a history of chronic venous insufficiency. What intervention should the nurse anticipate for this client? A. Platelet transfusion to treat thrombocytopenia B. Warfarin to treat arterial insufficiency C. Antibiotics to treat cellulitis D. Heparin IV to treat VTE
C
The triage nurse in the Emergency Department (ED) is admitting a client with a history of Class III heart failure. What symptoms would the nurse expect the client to exhibit? A. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea. The client does not experience any limitation of activity. B. Ordinary physical activity results in fatigue, heart palpitation, or dyspnea. C. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. D. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
C
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? A. Assess for reduced urine output. B. Assess for reduced blood sodium levels. C. Assess for elevated blood potassium levels. D. Assess for elevated blood urea nitrogen levels.
D
A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? A. Application of ace wraps from the toe to below the knees B. Use of antiembolic stockings C. Elevation of the legs above the heart D. Keeping the legs in a neutral or dependent position
D
An older adult client has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? a. Use of supplementary oxygen to aid tissue oxygenation b. Daily use of normal saline compresses on the lower limbs c. Daily administration of prophylactic antibiotics d. A high-protein diet that is rich in vitamins
D