Med Sure
nadolol is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for:
the ability to do daily activities without chest pain
A few days after experiencing a myocardial infarction (MI), the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which response should the nurse make?
"What do you think caused your chest pain episode?"
Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure?
128/76 mm Hg
When the nurse is screening patients for possible peripheral arterial disease, indicate where the posterior tibial artery will be palpated.
3
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
43-year-old with a BP of 160/92 who is complaining of chest pain
after receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
59 year old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)
When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication?
Ask about chest pain.
Propranolol is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of:
Asthma
To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review?
B-type natriuretic peptide (BNP)
The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril. Which patient statement indicates that more teaching is needed?
a little swelling around my lips and face is okay.
a patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute MI, which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?
Cardiac-specific troponin
a pt who has chest pain is admitted to the ED and all of the following are ordered. Which one should the nurse arrange to be completed first?
ECG
a patient with a history of hypertension treated with a diuretic and an ACE inhibitor arrives in the ER complaining of severe headache and nausea and has a BP of 238/118. Which question should the nurse ask first?
Have you been consistently taking your meds?
Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response, which of these assessment data would indicate that the exercise level should be decreased?
Heart rate increases from 66 to 92 beats/minute.
Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin?
Heparin prevents the development of new clots in the coronary arteries.
after the nurse has finished teaching a patient about the use of sublingual nitroglycerin, which patient statement indicates that the teaching has been effective?
I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart
when evaluating the effectiveness of preoperative teaching with a patient scheduled for a CABG surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says what:
I will have small incisions in my leg where they will remove the vein.
which statement made by a patient with CAD after the nurse has completed teaching about therapeutic lifestyle changes diet indicates that further teaching is needed?
I will miss being able to eat peanut butter sandwiches
in preparation for discharge, the nurse teaches a pt with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?
I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.
the nurse is reviewing the laboratory results for newly admitted patient on the cardiovascular unit. Which patient laboratory result is most important to communicate asap to the HCP?
Patient with increase in troponin T and I levels
a trans esophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which action included in the standard TEE orders will the nurse need to accomplish first?
Place the patient on NPO status.
the nurse and UAP on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP?
Placing electrodes in the correct position for a patient who is to receive ECG monitoring.
Which electrocardiographic (ECG) change is most important for the nurse to communicate to the health care provider when caring for a patient with chest pain?
ST-segment elevation
the RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside. Which nursing action can the nurse delegate to an experienced LPN/LVN?
Set up the automatic blood pressure machine to take BP every 15 mins
a patient who is being admitted to the ED with intermittent chest pain gives the following list of meds to the nurse. which medication has the most immediate implications for the patients care?
Sildenafil (viagra)
When reviewing the 12-lead ECG for a healthy 79-year-old patient who is having an annual physical exam, what will be of most concern to the nurse?
The heart rate (HR) is 42 BPM
which information obtained by the nurse who is admitting the patient for MRI will be the most important to report to the health care provider before the MRI?
The patient has a permanent ventricular pacemaker.
When admitting a patient for a cardiac catheterization and coronary angiogram, which information about the patient is the most important for the nurse to communicate to the health care provider?
The patient is allergic to shellfish
a patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that:
a flushed feeling may be noted when the contrast dye is injected.
during the administration of the thrombolytic agent to a patient with an acute MI, the nurse should stop the drug infusion if the patient experiences:
a decrease in level of consciousness
when caring for a patient who is recovering from a sudden cardiac death event and has no evidence of an acute MI, the nurse will anticipate teaching the patient that:
additional diagnostic testing will be required.
which action should the nurse take when administering the initial dose of oral labetalol to a patient with hypertension?
ask the patient to request assistance when getting out of bed.
During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to:
assess the patient for symptoms of left ventricular hypertrophy
when admitting a patient with a nonST-segment elevation MI (NSTEMI) to the ICU which action should the nurse perform first?
attach the cardiac monitor
a patient is recovering from a MI and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?
auscultate for a pericardial friction rub
To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the:
bell of the stethoscope with the patient in the left lateral position.
the nurse obtains the following data when assessing a pt who experienced a STEMI 2 days previously. which information is most important to report the HCP?
bilateral crackles are auscultated in the mid-lower lobes
Which assessment finding for a patient who is receiving IV furosemide to treat stage 2 hypertension is most important to report to the HCP?
blood potassium level of 3.0 mEq/L
The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the:
blood pressure is 90/54 mm Hg
When auscultating over the patients abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a:
bruit
an older patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next?
tell the patient how to self-monitor and record BP at home.
a patient has just been diagnosed with hypertension and has been started on captopril. Which information is important to include when teaching the patient about this medication?
change positions slowly to help prevent dizziness and falls.
when Caring for a pt with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?
chest pain level 7 out of 10.
which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?
collect a detailed diet history
to improve the physical activity level for a mildly obese 71 year old patient, which action should the nurse plan to take?
determine what kind of physical activity the patient usually enjoys
a 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 198/110. After reconfirming the BP, it is appropriate for the nurse to tell the patient that :
diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.
diltiazem is ordered for a patient with newly diagnosed prinzmetals angina. When teaching the patient, the nurse will include the information that diltiazem will:
decrease spasm of the coronary arteries
When assessing a newly admitted patient, the nurse notes a murmur along the left sternal border. To document more information about the murmur, which action will the nurse take next?
determine the timing of the murmur.
after reviewing information shown in the accompanying figure from the medical records of a 43 year old, which risk factor modification for CAD should the nurse include in pt teaching?
dietary changes to improve lipid levels
While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take?
document the finding in the patient chart.
After noting a pulse deficit when assessing a 74-year-old patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require what?
electrocardiographic (ECG) monitoring.
When developing a teaching plan for a 61-year-old man with the following risk factors for CAD, the nurse should focus on the:
elevation of the patients LDL level.
a patient who has recently started taking pravastatin and niacin reports the following symptoms to the nurse, which is most important to communicate to the health care provider?
generalized muscle aches and pains
a patient with hyperlipidemia has a new order for colesevelam. Which nursing action is most appropriate when giving the medication?
give the patients other meds 2 hours before the colesevelam
when caring for a pt who has just arrived on the med surg unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a LPN/LVN?
give the scheduled aspirin and lipid-lowering medication
Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline BP for a new patient?
have the patient sit in a chair with the feet flat on the floor.
which nursing intervention will be most effective when assisting the patient with CAD to make appropriate dietary changes?
help the patient modify favorite high-fat recipes by using monounsaturated oils when possible
which information should the nurse include when teaching a patient with newly diagnosed hypertension?
hypertension is usually asymptomatic until target organ damage occurs
the charge nurse observes a new RN doing discharge teaching for a patient with hypertension who has a new prescription for enalapril. The charge nurse will need to intervene if the new RN tells the patient to:
increase the dietary intake of high-potassium foods.
three days after experiencing a MI, a patient who is scheduled for discharge asks for assistance with hygiene, saying I am too nervous to take care of myself. Based on this information, which nursing diagnosis is appropriate?
ineffective coping related to axiety
after the nurse teaches the patient about the use of carvedilol in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?
it is important not to suddenly stop taking the carvedilol
The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to:
keep a diary of daily activities while the monitor is worn.
When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse?
newly inverted T waves on the electrocardiogram
which information about a patient who has been receiving thrombolytic therapy for an acute MI is most important for the nurse to communicate to the health care provider?
no change in the patients chest pain
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient?
no regular aerobic exercise.
While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next?
observe for JVD with the patient upright at 45 degrees.
which assessment finding by the nurse caring for a pt who has had CABG using a right radial artery graft is most important to communicate to the health care provider?
pallor and weakness of the right hand
a registered nurse (RN) is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse:
palpates both carotid arteries simultaneously to compare pulse quality.
The nurse is caring for a 70-year-old who uses hydrochlorothiazide and enalapril, but whose self-monitored BP continues to be elevated. Which patient information may indicate a need for a change?
patient uses ibuprofen daily to treat osteoarthritis
which patient at the cardiovascular clinic requires the most immediate action by the nurse?
patient with stable angina whose chest pain has recently increased in frequency.
The standard policy on the cardiac unit states, notify the health care provider for MAP less than 70 mmHg. The nurse will need to call the health care provider about the:
postoperative patient with a BP of 116/42.
a pt with diabetes mellitus and chronic stable angina has a new order for captopril. The nurse should teach the pt that the primary purpose of captopril is to:
prevent changes in the heart muscle.
a patient with hypertension who has just started taking atenolol returns to the health clinic after 2 weeks for a follow-up visit. The BP is unchanged from the previous visit. Which action should the nurse take first?
question the patient about whether the meds are actually being taken.
a pt had a NSTEMI 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the RN to delegate to an experienced LPN/LVN?
reinforcement of teaching about the purpose of prescribed medications.
the nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
serum creatinine of 2.8 mg/dL
a patient who is recovering from an acute MI asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best?
sexual activity uses about as much energy as climbing two flights of stairs.
a pt admitted to the CCU with an ST-segment elevation MI (STEMI) is restless and anxious. The BP is 86/40 and HR is 123. Based on this information, which nursing diagnosis is a priority for the patient?
stress overload r/t acute change in health
The nurse hears a murmur between the S1 and S2 heart sounds at the patient's left fifth intercostal space and midclavicular line. How will the nurse record this information?
systolic murmur heard at the mitral area.
after reviewing the pts history, vitals, physical assessment and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the HCP?
tachypnea and crackles in lungs
Which action will the nurse implement for a patient who arrives for a calcium-scoring CT scan?
teach the patient about the procedure
which assessment data collected by the nurse who is admitting a patient with chest pain suggest that pain is caused by an acute MI?
the pain has lasted longer than 30 mins
the nurse is assessing a patient who has been admitted to the intensive care unit with a hypertensive emergency. Which finding is most important to report the HCP?
the patient cannot move the left arm and leg when asked to do so.
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?
the patient has a glass of low fat milk with each meal.
during change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol during the previous shift. Which information indicates the patient needs immediate intervention?
the patient has developed wheezes throughout the lung fields.
which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?
the patient states the pain goes away with one sublingual nitroglycerin tablet
the nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be:
troponin T and I
which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine to treat a hypertensive emergency?
use an automated noninvasive BP machine to obtain frequent BP measurements.
A patient with ST-segment elevation in three contiguous ECG leads is admitted to the ED and diagnosed as having an ST-segment elevation MI, which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?
what time did your chest pain begin?
the nurse is caring for a patient who was admitted to the coronary care unit following an AMI and percutaneous coronary intervention the previous day. Teaching for this patient would include:
when cardiac rehabilitation will begin.