medsurg final chapters 29-31
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?
"Practice meticulous foot care."
Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment?
5
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition?
Acute pulmonary edema
A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following?
Arterial insufficiency
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?
Assess for elevated blood urea nitrogen levels.
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
Heart failure
Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply.
Impairing the synthesis of norepinephrine. Modifying the rate of myocardial contraction. Decreasing renal absorption of sodium.
A client informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement?
It takes 2 to 3 months for the taste buds to adapt to changes in salt intake.
A patient with impaired renal function is scheduled for a multidetector computer tomography (MDCT) scan. What preprocedure medication may the nurse administer to this patient?
Oral N-acetylcysteine
An older African American client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?
Recommend the client have blood pressure rechecked within 2 weeks.
Which finding indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage
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.)
Sharp pain that may be relieved by the elevation of the extremity Cool and cyanotic skin Full superficial veins
A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering?
Valsartan
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?
fatigue
The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as
stage 1 hypertension.
