MS2- Cardio Questions (Lewis)

A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. What does the nurse need to do to prevent complications of this drug combination? Select all that apply. A. Monitor serum potassium levels. B. Teach the patient how to take a pulse rate. C. Withhold digitalis if pulse rhythm is irregular. D. Keep an accurate measure of intake and output. E. Teach the patient about dietary potassium restrictions.

ANS: A, B (Lewis textbook questions- Ch. 34)

The nurse is concerned that a patient recovering from surgery to repair an abdominal aneurysm is developing bowel ischemia. What assessment findings did the nurse use to come to this conclusion? Select all that apply. A. diarrhea B. obvious bloody stool C. abdominal distention D. onset of abdominal pain E. hyperactive bowel sounds

ANS: A, B, C, D Rationale: Manifestations of bowel ischemia include diarrhea, occult or fresh blood in stools, abdominal distention, and abdominal pain. A change in bowel sounds is not a manifestation of bowel ischemia.

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? Select all that apply. A. Uncontrolled hypertension is the primary cause. B. Left ventricular ejection fraction may be within normal limits. C. The pathophysiology involves ventricular relaxation and filling. D. Multiple evidence-based therapies have been shown to decrease mortality. E. Therapies focus on symptom control and treatment of underlying conditions.

ANS: A, B, C, E (Lewis textbook question- CH. 34)

A patient is diagnosed with an aortic dissection. Which medications should the nurse expect to be prescribed for this patient? Select all that apply. A. verapamil (Isoptin) B. esmolol (Brevibloc) C. diltiazem (Cardizem) D. hydralazine (Apresoline) E. sodium nitroprusside (Nipride)

ANS: A, B, C, E Rationale: Patients with aortic dissection are initially treated with intravenous beta-blockers such as esmolol (Brevibloc) to reduce the heart rate to about 60 bpm. Sodium nitroprusside (Nipride) infusion is started concurrently to reduce the systolic pressure to 120 mmHg or less. Calcium channel blockers such as verapamil (Isoptin) or diltiazem (Cardizem) also may be used. Direct vasodilators such as hydralazine (Apresoline) are avoided because they may actually worsen the dissection.

A patient is undergoing diagnostic tests for aortic regurgitation. Which findings should the nurse expect to assess in this patient? A. dizziness B. head bobbing C. peripheral edema D. throbbing neck pulse E. palpitations in the supine position

ANS: A, B, D, E Rationale: Dizziness, head bobbing, throbbing neck pulse, and palpitations are common manifestations of aortic regurgitation. Peripheral edema is not a manifestation of aortic regurgitation.

A patient is admitted to the ICU with a diagnosis of NSTEMI. Which drug(s) would the nurse expect the patient to receive? Select all that apply. A. Oral statin therapy B. Antiplatelet therapy C. Thrombolytic therapy D. Prophylactic antibiotics E. Intravenous nitroglycerin

ANS: A, B, E (Lewis textbook questions- Ch. 33)

A male patient of African-American descent is prescribed hydralazine and isosorbide (BiDil) as treatment for heart failure. What should the nurse instruct the patient about this medication? Select all that apply. A. "Change positions slowly." B. "Dizziness and fainting are expected adverse effects of this medication." C. "You may have a headache when starting this medication, but it will subside." D. "Notify the healthcare provider if you have chest pain while taking this medication." E. "Do not take medications to treat erectile dysfunction while taking this medication."

ANS: A, C, D, E Rationale: This drug can cause a drop in blood pressure, particularly when changing positions from lying to sitting or sitting to standing. The patient should change positions slowly and use caution to prevent falls. Headache is a common adverse effect of this drug, particularly when first starting therapy. Headaches tend to subside with continued treatment. The doctor should be notified if chest pain develops while taking this medication. Drugs such as sildenafil (Viagra, Revatio), vardenafil (Levitra), or tadalafil (Cialis) are not to be taken while taking this medication because the combination may cause an extreme drop in blood pressure, leading to fainting, chest pain, or a heart attack. Dizziness and fainting should be reported to the healthcare provider as they may indicate a significant drop in blood pressure.

The nurse is caring for an older patient. The nurse recognizes that which factors place older adults at higher risk for development of heart failure? Select all that apply. A. impaired diastolic filling B. increased cardiac reserve C. increased maximal heart rate D. reduced ventricular compliance E. high responsiveness to sympathetic nervous system stimulation

ANS: A, D Rationale: Diastolic filling is impaired because of reduced ventricular compliance. With aging, cardiac function is less responsive to increased stress because cardiac reserve decreases, maximal heart rate is reduced, and the heart becomes less responsive to sympathetic nervous system stimulation.

During a home visit the nurse suspects that a patient with heart failure needs additional teaching. What did the nurse observe to make this decision? Select all that apply. A. The patient lifted an 18-month-old child off the floor. B. The patient's lunch was a small salad and half a sandwich. C. The patient drank from a pitcher of water on the coffee table. D. The patient documented the frequency and amount of walking completed. E. Working in the kitchen, the patient was obviously sweating and short of breath.

ANS: A, E Rationale: Home activity guidelines for the patient with heart failure include no heavy lifting. An 18-month-old child would be considered heavy. The patient should also stop any activity that causes sweating or shortness of breath. Other guidelines include eating up to six small meals per day, drinking water to prevent constipation, and participating in a graded exercise program.

The nurse is caring for a patient who is 2 days post MI. The patient reports that she is experiencing chest pain when she takes a deep breath. Which action would be a PRIORITY? A. Notify the provider STAT and obtain a 12-lead ECG. B. Obtain vital signs and auscultate for a pericardial friction rub. C. Apply high-flow O2 by face mask and auscultate breath sounds. D. Medicate the patient with as-needed analgesic and reevaluate in 30 minutes.

ANS: B (Lewis textbook question- Ch. 33)

A 50-year-old woman who weighs 95 kg has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. Which is the MOST IMPORTANT risk factor for peripheral artery disease (PAD) to address in the nursing plan of care? A. Salt intake B. Tobacco use C. Excess weight D. Sedentary lifestyle

ANS: B (Lewis textbook questions- Ch. 37)

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that the aneurysm has ruptured? A. Rapid onset of shortness of breath and hemoptysis B. Sudden, severe, low back pain and bruising along his flank C. Gradually increasing substernal chest pain and diaphoresis D. Sudden, patchy blue mottling on feet and toes and rest pain

ANS: B (Lewis textbook questions- Ch. 37)

When teaching a patient about rest pain with PAD, what should the nurse explain as the cause of the pain? A. Vasospasm of cutaneous arteries in the feet. B. Decrease in blood flow to the nerves of the feet. C. Increase in retrograde venous perfusion to the lower legs. D. Constriction in blood flow to leg muscles during exercise.

ANS: B (Lewis textbook questions- Ch. 37)

A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest? A. O2 saturation drops from 99% to 95%. B. Heart rate increases from 66 to 98 beats/min. C. Respiratory rate goes from 14 to 20 breaths/min. D. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

ANS: B Rationale: A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in O2 saturation, are normal responses to exercise.

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? A. Record hourly chest tube drainage. B. Monitor fluid intake and urine output. C. Assess the abdominal incision for redness. D. Counsel the patient to plan for a long recovery time.

ANS: B Rationale: Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound.

The nurse is admitting a patient newly diagnosed with peripheral artery disease who takes clopidogrel. Which admission order should the nurse question? A. Cilostazol drug therapy B. Omeprazole drug therapy C. Use of treadmill for exercise D. Exercise to the point of discomfort

ANS: B Rationale: Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this order with the health care provider. The other interventions are appropriate for a patient with peripheral artery disease.

An older patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? A. Draw blood for laboratory testing. B. Check the patient's blood pressure. C. Assess the patient for an abdominal bruit. D. Determine any family history of heart disease.

ANS: B Rationale: Because the patient appears to be experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure. The other actions may also be done, but they will not provide information to determine what interventions are needed immediately.

The nurse is evaluating the discharge teaching outcomes for a patient with chronic peripheral artery disease (PAD). Which patient statement indicates a need for further instruction? A. "I will buy loose clothes that do not bind across my legs or waist." B. "I will use a heating pad on my feet at night to increase the circulation." C. "I will walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week." D. "I will change my position every hour and avoid long periods of sitting with my legs crossed."

ANS: B Rationale: Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.

Which patient statement supports a history of intermittent claudication? A. "When I stand too long, my feet start to swell." B. "My legs cramp when I walk more than a block." C. "I get short of breath when I climb a lot of stairs." D. "My fingers hurt when I go outside in cold weather."

ANS: B Rationale: Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Shortness of breath that occurs with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

Which finding on a patient's nursing admission assessment is congruent with the initial medical diagnosis of a 6-cm thoracic aortic aneurysm? A. Low back pain B. Trouble swallowing C. Abdominal tenderness D. Changes in bowel habits

ANS: B Rationale: Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms.

A patient is exhibiting dyspnea, orthopnea, cyanosis, clammy skin, crackles, and a productive cough with pink, frothy sputum. Which health problem should the nurse suspect is occurring in this patient? A. chronic heart failure B. pulmonary edema C. endocarditis D. angina

ANS: B Rationale: Dyspnea, orthopnea, cyanosis, clammy skin, crackles, and productive cough with pink frothy sputum are signs and symptoms of pulmonary edema, which is considered a medical emergency. Not all patients with chronic heart failure have pink, frothy sputum. The presence of this symptom differentiates pulmonary edema from chronic heart failure. Endocarditis would manifest with pain and potentially fever. Angina is chest pain.

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? A. "Taking both blood thinners greatly reduces the risk for another clot to form." B. "Enoxaparin will work right away, but warfarin takes several days to begin preventing clots." C. "Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from forming." D. "Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."

ANS: B Rationale: Low-molecular-weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE. Anticoagulants do not thin the blood.

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? A. Wrap both legs in a warming blanket. B. Notify the surgeon and anesthesiologist. C. Document the findings and recheck in 15 minutes. D. Compare findings to the preoperative assessment of the pulses.

ANS: B Rationale: Lower extremity pulses may be absent for a short time after surgery because of vasospasm and hypothermia. Decreased or absent pulses together with a cool and mottled extremity may indicate embolization or graft occlusion. These findings should be reported to the surgeon immediately because this is an emergency situation. Because pulses are marked before surgery, the nurse would know whether pulses were present before surgery before notifying the health care providers about the absent pulses. Because the patient's symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 15 minutes before taking action. A warming blanket will not improve the circulation to the patient's legs.

Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective? A. "Carvedilol will help my heart muscle work harder." B. "It is important not to suddenly stop taking the carvedilol." C. "I can expect to feel short of breath when taking carvedilol." D. "Carvedilol will increase the blood flow to my heart muscle."

ANS: B Rationale: Patients who have been taking -adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases myocardial contractility. Shortness of breath that occurs when taking -adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider. Carvedilol works by decreasing myocardial O2 demand, not by increasing blood flow to the coronary arteries.

Which instructions should the nurse include in a teaching plan for an older adult patient newly diagnosed with peripheral artery disease (PAD)? A. "Exercise only if you do not experience any pain." B. "It is very important that you stop smoking cigarettes." C. "Try to keep your legs elevated whenever you are sitting." D. "Put elastic compression stockings on early in the morning."

ANS: B Rationale: Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) after hospitalization for venous thromboembolism (VTE). Which patient statement indicates a need for additional teaching? A. "I should get a Medic Alert device stating that I take warfarin." B. "I should reduce the amount of green, leafy vegetables that I eat." C. "I will need routine blood tests to monitor the effects of the warfarin." D. "I will check with my health care provider before I begin any new drugs."

ANS: B Rationale: Teach patients taking warfarin to follow a consistent diet regarding foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. What is the nurse's priority action? A. Teach the patient about restricting dietary sodium. B. Assess the patient for manifestations of acute heart failure. C. Ask the patient about the use of the prescribed medications. D. Have the patient recall the dietary intake for the past 3 days.

ANS: B Rationale: The 5-lb weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.

The nurse is caring for a patient with heart failure. What should the nurse expect when assessing this patient? A. S1, S2, and flat neck veins B. S3 and distended neck veins C. S2 heard the loudest and followed by S1 D. S4 and flat neck veins

ANS: B Rationale: The abnormal S3 sound is reflective of the heart's attempts to fill an already distended ventricle, and the neck veins distend because of the increased venous pressure. Most patients have elements of both right- and left-sided heart failure. Incorrect: A- S1 and S2 are normal heart sounds; flat neck veins are considered a normal finding. C- S1 and S2 sounds may be diminished in the heart failure patient and do not vary in intensity. D- S4 (gallop) may be present, but neck veins would be distended.

Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)? A. Need to begin an aerobic exercise program several times weekly B. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors C. Use of salt substitutes to replace table salt when cooking and at the table D. Importance of making an annual appointment with the health care provider

ANS: B Rationale: The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction below 40% should receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure. Salt substitutes are not usually recommended because of the risk of hyperkalemia. The patient will need to see the primary care provider more often than annually.

Several hours after a patient had an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 45 mL. What should the nurse anticipate will be prescribed? A. Hemoglobin count B. Increased IV fluids C. Additional antibiotics D. Serum creatinine level

ANS: B Rationale: The decreased urine output suggests decreased renal perfusion and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient's decreased urinary output.

Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)? A. Monitor heart rate. B. Ask about chest pain. C. Check blood pressure. D. Observe for dysrhythmias.

ANS: B Rationale: The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse will also monitor heart rate and blood pressure and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? A. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL. B. Patient with stable angina whose chest pain has recently increased in frequency. C. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL. D. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.

ANS: B Rationale: The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are more stable.

A patient is seen for increasing edema in his left lower extremity and pain in the limb with ambulation. What should the nurse suspect is occurring in this patient? A. arterial occlusion B. deep vein thrombosis C. superficial vein thrombosis D. varicose veins

ANS: B Rationale: The manifestations of deep vein thrombosis (DVT) are primarily due to the inflammatory process that accompanies the thrombus. Calf pain is the most common symptom, and it may be described as tightness or a dull, aching pain in the affected extremity, particularly upon walking. A DVT is not an arterial or a primary superficial vein problem. Varicose veins are tortuous veins with valve insufficiency.

After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first? A. A patient who reported dizziness after receiving the first dose of captopril. B. A patient who has new-onset confusion and restlessness and cool, clammy skin. C. A patient who is receiving oxygen and has crackles bilaterally in the lung bases. D. A patient who is receiving IV nesiritide (Natrecor), with a blood pressure of 100/62.

ANS: B Rationale: The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion.

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? A. Patient who is taking carvedilol (Coreg) and has a heart rate of 58. B. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L. C. Patient who is taking captopril and has a frequent nonproductive cough. D. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache.

ANS: B Rationale: The patient's low potassium level increases the risk for digoxin toxicity and potentially life-threatening dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their drugs, but their symptoms do not indicate potentially life-threatening complications.

After receiving change-of-shift report, which patient admitted to the emergency department should the nurse assess first? A. A 67-yr-old patient who has a gangrenous foot ulcer with a weak pedal pulse B. A 50-yr-old patient who is reporting sudden sharp and severe upper back pain C. A 39-yr-old patient who has right calf tenderness and swelling after a plane ride D. A 58-yr-old patient taking anticoagulants for atrial fibrillation who has black stools

ANS: B Rationale: The patient's presentation of sudden sharp and severe upper back pain is consistent with dissecting thoracic aneurysm, which will require the most rapid intervention. The other patients also require rapid intervention but not before the patient with severe pain.

Which clinical manifestations can the nurse expect to see in both patients with Buerger's disease and patients with Raynaud's phenomenon? Select all that apply. A. Intermittent low-grade fevers B. Sensitivity to cold temperatures C. Gangrenous ulcers on fingertips D. Color changes of fingers and toes E. Episodes of superficial vein thrombosis

ANS: B, C, D (Lewis textbook questions- Ch. 37)

Patients are at risk for which complications in the first year after heart transplantation? Select all that apply. A. Cancer B. Infection C. Rejection D. Vasculopathy E. Sudden cardiac death

ANS: B, C, E (Lewis textbook questions- Ch. 34)

The nurse suspects a patient recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. What findings did the nurse use to make this clinical decision? Select all that apply. A. urine output 45 mL/hr B. complaint of groin pain C. abdominal dressing dry and intact D. respiratory rate 16 and regular E. complaint of back discomfort

ANS: B, E Rationale: The nurse should monitor for and report any back, or groin pain. The urine output needs to be below 30 mL/hr before reporting. A dry abdominal dressing and respiratory rate of 16 and regular are expected findings.

The most common finding in people at risk for sudden cardiac death is A. aortic valve disease. B. mitral valve disease. C. left ventricular dysfunction. D. atherosclerotic heart disease.

ANS: C (Lewis textbook question- Ch. 33)

A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan? A. Refrain from sexual activity for a minimum of 3 weeks. B. Plan a diet program that aims for a 1- to 2-lb weight loss per week. C. Begin an exercise program that aims for at least five 30 minute sessions per week. D. Consider the use of erectile agents and prophylactic NTG before engaging in sexual activity.

ANS: C (Lewis textbook questions- Ch. 33)

What are the priority nursing interventions 8 hours after an abdominal aortic aneurysm repair? A. Assessing nutritional status and dietary preferences B. Initiating IV heparin and monitoring anticoagulation C. Administering IV fluids and watching kidney function D. Elevating the legs and applying compression stockings

ANS: C (Lewis textbook questions- Ch. 37)

What is the FIRST priority of interprofessional care for a patient with a suspected acute aortic dissection? A. Reduce anxiety B. Monitor chest pain C. Control blood pressure D. Increase myocardial contractility

ANS: C (Lewis textbook questions- Ch. 37)

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" How should the nurse document this finding? A. Orthopnea B. Pulsus alternans C. Paroxysmal nocturnal dyspnea D. Acute bilateral pleural effusion

ANS: C Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alteration of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.

A patient is being started on enalapril (Vasotec). Which common adverse effect should the nurse review with the patient? A. increased thirst B. reduced urine output C. persistent cough D. loss of appetite

ANS: C Rationale: A primary adverse effect of an ACE inhibitor is a persistent cough. Thirst, reduced urine output, and loss of appetite are not primary adverse effects of this medication.

A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Teach the patient the reasons for remaining on bed rest. B. Change the peripheral IV site according to agency policy. C. Monitor the patient's blood pressure and heart rate every hour. D. Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg.

ANS: C Rationale: An experienced LPN/VN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, adjusting the drip rate for vasoactive drugs, and inserting a new peripheral IV catheter require RN level education and scope of practice.

Which diagnostic test will be MOST useful to the nurse in determining whether a patent admitted with acute shortness of breath has heart failure? A. Serum troponin B. Arterial blood gases C. B-type natriuretic peptide D. 12-lead electrocardiogram

ANS: C Rationale: B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a probable or very probable diagnosis of heart failure. A 12-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.

Blood tests are ordered for a patient with suspected heart failure (HF). Which test result should the nurse review to support this medical diagnosis? A. liver function B. urinalysis and blood urea nitrogen (BUN) C. brain natriuretic peptide (BNF) D. serum electrolytes

ANS: C Rationale: BNP tests have been shown to positively correlate with pressures in the left ventricle and pulmonary vascular system. As the severity of left ventricular failure increases, BNP levels increase. Incorrect: A- Liver function tests are drawn but do not specifically identify problems in cardiac function. B- Urinalysis and blood urea nitrogen (BUN) may be performed but do not specifically identify problems in cardiac function. D- Serum electrolytes may be drawn but do not specifically identify problems in cardiac function.

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? A. Weight loss of 2 lb in 24 hours B. Hourly urine output greater than 60 mL C. Reduced dyspnea with the head of bed at 30 degrees D. Patient denies experiencing chest pain or chest pressure

ANS: C Rationale: Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data may also indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patient's response.

A patient has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe. What should the nurse expect to find on assessment? A. Dilated superficial veins. B. Swollen, dry, scaly ankles C. Prolonged capillary refill in all the toes. D. Serosanguineous drainage from the ulcer.

ANS: C Rationale: Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

A patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? A. "I plan to take the medication with food." B. "I should eat more potassium-rich foods." C. "I will call for help when I need to get up to use the bathroom." D. "I can expect to feel more short of breath for the next few days."

ANS: C Rationale: Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of -adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating.

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? A. An increase in troponin levels from baseline B. A large bruise at the patient's IV insertion site C. No change in the patient's reported level of chest pain D. A decrease in ST-segment elevation on the electrocardiogram

ANS: C Rationale: Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring, and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened.

A 46-yr-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge? A. Sitting at the work counter, rather than standing, is recommended. B. Exercise, such as walking or jogging, can cause recurrence of varicosities. C. Elastic compression stockings should be applied before getting out of bed. D. Taking an aspirin daily will help prevent clots from forming around venous valves.

ANS: C Rationale: Elastic compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended for a patient who had just had sclerotherapy.

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient? A. "Heparin enhances platelet aggregation at the plaque site." B. "Heparin decreases the size of the coronary artery plaque." C. "Heparin prevents the development of new clots in the coronary arteries." D. "Heparin dissolves clots that are blocking blood flow in the coronary arteries."

ANS: C Rationale: Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.

A patient who has heart failure has recently started taking digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider? A. Presence of 1+ to 2+ edema in the feet and ankles B. Palpable liver edge 2 cm below the ribs on the right side C. Serum potassium level 3.0 mEq/L after 1 week of therapy D. Weight increase from 120 pounds to 122 pounds over 3 days

ANS: C Rationale: Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions) and potentiate the actions of digoxin. Hypokalemia also increases the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level.

A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate? A. "Your heart failure has not reached the end stage yet." B. "You could not manage the multiple complications of that surgery." C. "The suitability of a heart transplant for you depends on many factors." D. "Because you have diabetes, you would not be a heart transplant candidate."

ANS: C Rationale: Indications for a heart transplant include end-stage heart failure (stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Patients with diabetes who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, there are no data to suggest that the patient could not manage the care.

The health care provider prescribes an infusion of heparin and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). Which action should the nurse include in the plan of care? A. Obtain a Doppler for monitoring bilateral pedal pulses. B. Decrease the infusion when the PTT value is 65 seconds. C. Avoid giving IM medications to prevent localized bleeding. D. Have vitamin K available in case reversal of the heparin is needed.

ANS: C Rationale: Intramuscular injections are avoided in patients receiving anticoagulation to prevent hematoma formation and bleeding from the site. A PTT of 65 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.

The nurse who works in the vascular clinic has several patients with venous insufficiency. Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/VN)? A. Patient who has a history of venous thromboembolism and reports dyspnea. B. Patient who has been reporting increased edema and skin changes in the legs. C. Patient who needs wound care for a chronic venous stasis ulcer on the lower leg. D. Patient who needs teaching about compression stockings for venous insufficiency.

ANS: C Rationale: LPN education and scope of practice includes wound care. The other patients, which require more complex assessments or education, should be managed by the RN.

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the health care provider? A. Presence of flatus B. Hypoactive bowel sounds C. Maroon-colored liquid stool D. Abdominal pain with palpation

ANS: C Rationale: Loose, bloody (maroon-colored) stools at this time may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Which instruction should the nurse include? A. Limit dietary sources of potassium. B. Take the hydrochlorothiazide at bedtime. C. Notify the health care provider if nausea develops. D. Take the digoxin if the pulse is below 60 beats/min.

ANS: C Rationale: Nausea is a symptom of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60 beats/min, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.

The nurse is obtaining the health history of a patient who is being assessed for possible heart failure (HF). Which patient statement should the nurse identify as being associated with this condition? A. "I break out in a cold sweat when I eat a large meal." B. "I am sleepy after I eat lunch every day." C. "I have to prop myself up on three pillows to sleep at night. Otherwise I can't breathe." D. "I feel better with my legs down when I sit in my favorite chair."

ANS: C Rationale: Needing to prop oneself up with pillows at night to breathe describes orthopnea, which is consistent with heart failure (HF). HF produces a volume excess, congestion in the lungs, and dyspnea when the patient attempts to lie down. Incorrect: A- Diaphoresis is not related to a diagnosis of HF. B- Sleepiness after meals is not related to a diagnosis of HF. D- The effects of leg position are not related to a diagnosis of HF.

A young adult patient tells the health care provider about experiencing cold, numb fingers and Raynaud's phenomenon is suspected. What type of testing should the nurse anticipate explaining to the patient? A. Hyperglycemia B. Hyperlipidemia C. Autoimmune disorders D. Coronary artery disease

ANS: C Rationale: Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis. Patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hyperglycemia, or coronary artery disease.

IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. Which reassessment finding during the first hours of administration indicates that the nurse should decrease the rate of nitroprusside infusion? A. Ventricular ectopy B. Dry, hacking cough C. Systolic BP below 90 mm Hg D. Heart rate below 50 beats/min

ANS: C Rationale: Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.

Which action by a nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg venous thromboembolism (VTE) indicates that the nurse needs further education about the drug? A. The nurse avoids rubbing the site after giving the injection. B. The nurse injects the drug into the abdominal subcutaneous tissue. C. The nurse ejects the air bubble from the syringe before giving the drug. D. The nurse does not check partial thromboplastin time (PTT) before giving the drug.

ANS: C Rationale: The air bubble is not ejected before giving fondaparinux to avoid loss of drug. The other actions by the nurse are appropriate for subcutaneous administration of a low-molecular-weight heparin (LMWH). LMWHs typically do not require ongoing PTT monitoring and dose adjustment.

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication? A. Administer the medication at the patient's usual bedtime. B. Have the patient take the colesevelam 1 hour before breakfast. C. Give the patient's other medications 2 hours after colesevelam. D. Have the patient take the dose at the same time as the prescribed aspirin.

ANS: C Rationale: The bile acid sequestrants interfere with the absorption of many other drugs and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For maximum effect, colesevelam should be administered with meals.

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider? A. Weak pedal pulses B. Absent bowel sounds C. Blood pressure of 138/88 mm Hg D. 25 mL of urine output over the past hour

ANS: C Rationale: The blood pressure is typically kept at less than 120 mm Hg systolic to minimize extension of the dissection. The nurse will need to notify the health care provider so that beta-blockers or other antihypertensive drugs can be prescribed. The other findings are typical with aortic dissection and should also be reported but do not require immediate action.

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? A. The troponin level is elevated. B. The patient denies having a heart attack. C. Bilateral crackles in the mid-lower lobes. D. Occasional premature atrial contractions (PACs).

ANS: C Rationale: The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI.

While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." What should the nurse include in the discharge plan? A. Consult with a psychologist. B. Transfer to a long-term care facility. C. Referral to a home health care agency. D. Arrangements for around-the-clock care.

ANS: C Rationale: The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care.

A patient is prescribed digoxin (Lanoxin). What is the nurse's priority instruction to the patient about this medication? A. how to manage itchy skin B. foods that should be eaten while taking this drug C. the importance of not taking the medication if the pulse is under 60 beats per minute D. the need to check the pulse once a week and record the result on a notepad

ANS: C Rationale: The highest priority is for the patient to know that it may not be safe to take the drug when the pulse is under 60 beats per minute (bpm) and to contact the physician if that occurs. Incorrect: A- Itchy skin is not an adverse effect of this medication. B- The patient should be instructed to eat foods high in potassium; however, this is not the priority instruction concerning this medication. D- The pulse should be assessed daily to determine if the medication can be taken.

While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate? A. Decreased fluid volume B. Jugular vein atherosclerosis C. Increased right atrial pressure D. Incompetent jugular vein valves

ANS: C Rationale: The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis.

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first? A. Chest x-ray B. Troponin level C. Electrocardiogram (ECG) D. Insertion of a peripheral IV

ANS: C Rationale: The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that the appropriate therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion, and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction. Peripheral access will be needed but not before the ECG.

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? A. Auscultate the abdomen. B. Check the capillary refill. C. Auscultate the breath sounds. D. Ask about the patient's allergies.

ANS: C Rationale: This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) may be occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority.

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? A. "Do you have any allergies?" B. "Do you take aspirin daily?" C. What time did your pain begin?" D. "Can you rate the pain on a 0 to 10 scale?

ANS: C Rationale: Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information is not a factor in the decision about thrombolytic therapy.

Which actions for a patient at risk for venous thromboembolism could the nurse delegate to unlicensed assistive personnel (UAP)? A. Monitor for any bleeding after anticoagulation therapy is started. B. Tell the patient to call immediately if any shortness of breath occurs. C. Apply sequential compression devices whenever the patient is in bed. D. Ask the patient about use of any herbal medicines or dietary supplements.

ANS: C Rationale: UAP training includes the use of equipment that requires minimal nursing judgment, such as sequential compression devices. Patient assessment and teaching require more education and critical thinking and should be done by the registered nurse (RN).

When teaching a patient with heart failure on a 2000-mg sodium diet, which foods should the nurse recommend limiting? A. Chicken and eggs B. Canned and frozen fruits C. Yogurt and milk products D. Fresh or frozen vegetables

ANS: C Rationale: Yogurt and milk products (e.g., cheese) naturally contain a significant amount of sodium, and the intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. The other foods listed have minimal levels of sodium and can be eaten without restriction.

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Why would this drug be prescribed? Select all that apply. A. It dilates renal blood vessels. B. It will increase the heart rate. C. Heart contractility will improve. D. Dobutamine is a selective beta-agonist. E. It increases systemic vascular resistance.

ANS: C, D (Lewis textbook question- Ch. 34)

The nurse suspects that a patient is experiencing a neuroendocrine response from low cardiac output in heart failure. What manifestations did the nurse assess to make this clinical decision? Select all that apply. A. irregular heart rhythm B. gastrointestinal bleeding C. blood pressure 188/94 mmHg D. nausea, vomiting, and diarrhea E. heart rate 112 beats per minute

ANS: C, E Rationale: A neuroendocrine response to low cardiac output is stimulation of the sympathetic nervous system and catecholamine release, leading to an increase in heart rate or tachycardia. A neuroendocrine response to low cardiac output and decreased renal perfusion is the stimulation of the renin-angiotensin system, which leads to vasoconstriction and increased blood pressure. Dysrhythmias, gastrointestinal bleeding, nausea, vomiting, and diarrhea are not neuroendocrine responses to low cardiac output.

What compensatory mechanism involved in both chronic heart failure and acute decompensated heart failure leads to fluid retention and edema? A. Ventricular dilation B. Ventricular hypertrophy C. Increased systemic blood pressure D. Renin-angiotensin-aldosterone activation

ANS: D (Lewis textbook question- CH. 34)

A barrier to hospice referrals for patients with stage D heart failure is A. family member refusal. B. scarcity of hospice facilities. C. history of pacemaker placement. D. difficulty in estimating prognosis.

ANS: D (Lewis textbook questions- Ch. 34)

Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. What medication topic should the nurse anticipate including in discharge teaching? A. Beta-Adrenergic blockers B. Calcium channel blockers C. Digitalis and potassium therapy regimen d. Angiotensin-converting enzyme (ACE) inhibitors

ANS: D Rationale: ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other drugs such as ACE-inhibitors, diuretics, and beta-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The beta-adrenergic blockers are not used as initial therapy for new onset heart failure.

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? A. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. B. A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). C. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. D. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

ANS: D Rationale: After PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient's blood pressure, pulses, and the access site immediately. The other patients should also be assessed as quickly as possible, but assessment of this patient has the highest priority.

Which risk factor should the nurse focus on when teaching a patient who has a 5-cm abdominal aortic aneurysm? A. Male gender B. Turner syndrome C. Abdominal trauma history D. Uncontrolled hypertension

ANS: D Rationale: All the factors contribute to the patient's risk, but only hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm.

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? A. captopril (Capoten) 25 mg B. furosemide (Lasix) 60 mg C. digoxin (Lanoxin) 0.125 mg D. carvedilol (Coreg) 3.125 mg

ANS: D Rationale: Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other drugs are appropriate for the patient with ADHF.

Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Monitor the quality and presence of the pedal pulses. B. Teach the patient the signs of possible wound infection. C. Check the lower extremities for strength and movement. D. Help the patient to use a pillow to splint while coughing.

ANS: D Rationale: Assisting a patient who has already been taught how to cough is part of routine postoperative care and within the education and scope of practice for UAP. Patient teaching and assessment of essential postoperative functions such as circulation and movement should be done by RNs.

A patient is being evaluated for postthrombotic syndrome. Which assessment will the nurse perform? A. Ask about leg pain with exercise. B. Determine the ankle-brachial index. C. Assess capillary refill in the patient's toes. D. Inspect for presence of lipodermatosclerosis.

ANS: D Rationale: Clinical signs of postthrombotic syndrome include lipodermatosclerosis. In this situation, the skin on the lower leg becomes scarred, and the leg becomes tapered like an "inverted bottle." The other assessments would be done for patients with peripheral arterial disease.

Which topic should the nurse include in teaching for a patient with a venous stasis ulcer on the lower leg? A. Need to increase carbohydrate intake B. Methods of keeping the wound area dry C. Purpose of prophylactic antibiotic therapy D. Application of elastic compression stockings

ANS: D Rationale: Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist dressings are used to hasten wound healing.

The nurse is assessing a patient with chronic heart failure. Which abnormal chest sound should the nurse expect to auscultate? A. expiratory wheezes B. friction rub C. harsh vesicular sounds D. crackles

ANS: D Rationale: Fluid accumulates in the alveolar spaces in left-sided heart failure. This fluid causes the sound of crackles at the end of inspiration. Incorrect: A- Expiratory wheezes are not associated with chronic heart failure. B- Friction rub is not associate with chronic heart failure. C- Harsh vesicular sounds are not associated with chronic heart failure.

A patient is diagnosed with pulmonary edema. What is a priority for this patient? A. inserting a peripheral intravenous catheter B. requesting a prescription to medicate the patient for comfort C. monitoring the blood glucose level D. placing a pulse oximeter and administering oxygen

ANS: D Rationale: Pulmonary edema is a medical emergency. Priority nursing actions focus on maintaining the airway and improving oxygenation, then breathing and circulation. Inserting an IV catheter would follow, although often, if more than one caregiver is present, this action can be done simultaneously. Medication would not be given until the ABCs have been addressed. The blood glucose level is not related to pulmonary edema.

A patient newly diagnosed with heart failure is prescribed 40 mg of furosemide (Lasix) to be given IV push. Knowing that the patient is also prescribed digoxin (Lanoxin), the nurse should review which laboratory result? A. sodium level B. digoxin level C. creatinine level D. potassium level

ANS: D Rationale: Serum potassium level is measured in the patient receiving digoxin and furosemide. Heightened digoxin effect can occur in the patient with hypokalemia. Hypokalemia also predisposes the patient to ventricular dysrhythmias. There is no data indicating renal insufficiency; therefore creatinine level is not relevant. Furosemide can cause hyponatremia, but the risk of hypokalemia has more severe consequences in this situation.

Which statement by a patient with newly diagnosed heart failure indicates to the nurse that teaching was effective? A. "I will take furosemide (Lasix) every day just before bedtime." B. "I will use the nitroglycerin patch whenever I have chest pain." C. "I will use an additional pillow if I am short of breath at night." D. "I will call the clinic if my weight goes up 3 pounds in a week."

ANS: D Rationale: Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 lb in 2 days or 3 to 5 lb in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an "as needed" basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops rather than just compensating by further elevating the head of the bed.

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? A. Anxiety B. Acute pain C. Stress management D. Decreased cardiac output

ANS: D Rationale: The hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority.

An older patient was recently discharged to home after treatment for chronic heart failure. The patient experiences an increase in pulse rate from 80 beats per minute (bpm) to 102 bpm when walking from the kitchen to the utility room to do laundry. What should the home care nurse encourage the patient to do? A. complete tasks such as laundry early in the morning before fatigue is an issue B. ignore the pulse rate and become more active to build stamina C. rest for 30 minutes between loads of laundry D. rest on a chair in the utility room, and sit and rest when the patient feels the pulse rate increase

ANS: D Rationale: The increase in pulse rate indicates that activity is not being tolerated. Rest should help to bring the heart rate down to the pre-exercise level. Incorrect: A- Completing household tasks in the morning is not a practical strategy for an older patient with compromised heart function. B- Ignoring the pulse rate and becoming more active is not a practical strategy for an older patient with compromised heart function. C- All home activities should be performed at a pace that is comfortable for the patient.

A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." What focused assessment should the nurse make? A. Look for the presence of tortuous veins bilaterally on the legs. B. Ask about any skin color changes that occur in response to cold. C. Assess for unilateral swelling, redness, and tenderness of either leg. D. Palpate for the presence of dorsalis pedis and posterior tibial pulses.

ANS: D Rationale: The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism.

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? A. 2+ bilateral pedal edema B. Heart rate of 52 beats/min C. Report of increased fatigue D. Blood pressure (BP) of 88/42 mm Hg

ANS: D Rationale: The patient's BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of -adrenergic blockade, though it may need to be monitored. -Adrenergic blockade initially will worsen symptoms of heart failure in many patients and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs.

An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. After the nurse notifies the health care provider, what should the nurse do next? A. Apply a compression stocking to the leg. B. Elevate the leg above the level of the heart. C. Assist the patient in gently exercising the leg. D. Keep the patient in bed in the supine position.

ANS: D Rationale: The patient's history and clinical manifestations are consistent with acute arterial occlusion. Resting the leg will decrease the O2 demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism of the left lower leg. Which action by the nurse is best? A. The patient's bed is placed in the Trendelenburg position. B. Two pillows are positioned under the calf of the affected leg. C. The bed is elevated at the knee and pillows are placed under both feet. D. One pillow is placed under the thighs and 2 pillows are under the lower legs.

ANS: D Rationale: The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing 2 pillows under the feet and another under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the calf level.

A patient is admitted with acute heart failure. The nurse recognizes that this condition is associated with an abrupt onset of which health problems? Select all that apply. A. cardiomyopathy B. heart valve disease C. coronary heart disease (CHD) D. massive infarction (MI) E. myocardial injury

ANS: D, E Rationale: Acute failure is the abrupt onset of a myocardial injury (such as a massive MI) resulting in suddenly reduced cardiac function and signs of reduced cardiac output. Incorrect: A- Cardiomyopathy is associated with chronic heart failure. B- Valve disease is associated with chronic heart failure. C- Coronary heart disease (CHD) is associated with chronic heart failure.

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial blood pressure (BP) of 147/82 mm Hg and an ankle pressure of 112/74 mm Hg. The nurse calculates the patient's ankle-brachial index (ABI) as ________ (round up to the nearest hundredth).

ANS: 0.76 Rationale: The ABI is calculated by dividing the ankle systolic BP by the brachial systolic BP.

The nurse is reviewing data collected on a group of patients. Which patient should the nurse realize is at risk for high-output heart failure? A. a patient with chronic anemia B. a person with untreated hypertension C. an individual with untreated hypothyroidism D. someone who abuses sedatives and analgesics

ANS: A High-output heart failure occurs in patients in hypermetabolic states such as anemia or hyperthyroidism. Hypertension is typically associated with low-output heart failure. Sedatives and analgesics slow metabolic function.

The nurse should recognize which finding as a sign of decreased cardiac output and tissue perfusion in a patient with heart failuer? A. reduced mental alertness B. increased urine output C. abdominal distention D. strong peripheral pulses

ANS: A Rationale: A change in mentation is a common sign of decreased cardiac output and tissue perfusion. Incorrect: B- Urine output would decrease in this patient. C- Abdominal distention is a sign of right-sided failure, which is a problem with venous return, not cardiac output or tissue perfusion. D- Pulses would weaken in this patient.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? A. O2 saturation of 88% B. Weight gain of 1 kg (2.2 lb) C. Heart rate of 106 beats/min D. Urine output of 50 mL over 2 hours

ANS: A Rationale: A decrease in O2 saturation to less than 92% indicates hypoxemia, and the nurse should start supplemental O2 immediately. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output may also indicate worsening heart failure and require nursing actions, but the low O2 saturation rate requires the most immediate nursing action.

The nurse is developing a discharge teaching plan for a patient diagnosed with thromboangiitis obliterans (Buerger's disease). Which expected outcome has the highest priority for this patient? A. Cessation of all tobacco use B. Control of serum lipid levels C. Maintenance of appropriate weight D. Demonstration of meticulous foot care

ANS: A Rationale: Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.

The nurse is caring for a chronic heart failure patient with left-sided failure. Which documentation should the nurse expect to see in the medical record after this patient has a cardiac catheterization? A. "Pressures in the left ventricle and atrium are increased." B. "Pressures in the left ventricle and atrium are decreased." C. "Pressures in the right ventricle and atrium match the ventricle pressures." D. "Pressures in the right ventricle reflect functioning of all heart chambers."

ANS: A Rationale: As the heart loses its ability to eject blood effectively from the left ventricle upon contraction, blood is retained in the left ventricle after systole and the chamber pressure rises due to the added blood volume. incorrect: B- As the heart loses its ability to eject blood effectively from the left ventricle upon contraction, blood is retained in the left ventricle after systole and the chamber pressure rises due to the added blood volume C,D- This patient is in left-sided heart failure, so pressure is higher in the left side of the heart, not the right side.

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? A. Attach the heart monitor. B. Obtain the blood pressure. C. Assess the peripheral pulses. D. Auscultate the breath sounds.

ANS: A Rationale: Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible.

Which patient statement to the nurse is most consistent with the diagnosis of venous insufficiency? A. "I can't get my shoes on at the end of the day." B. "I can't ever seem to get my feet warm enough." C. "I have burning leg pain after I walk two blocks." D. "I wake up during the night because my legs hurt."

ANS: A Rationale: Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease.

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first? A. Obtain vital signs. B. Teach wound care. C. Assess pedal pulses. D. Check the wound site.

ANS: A Rationale: Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but can be done after determining that bleeding is not occurring.

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Reinforcement of teaching about the prescribed medications B. Evaluation of the patient's response to walking in the hallway C. Completion of the referral form for a home health nurse follow-up D. Education of the patient about the pathophysiology of heart disease

ANS: A Rationale: LPN/VN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient's response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning and referral are skills that require RN education and scope of practice.

A patient is being discharged from the healthcare facility following surgical replacement of a mitral valve with a mechanical valve. The patient asks the nurse how much longer he will need to take warfarin (Coumadin). What is the nurse's best response? A. "You will be on it for the rest of your life because you have a mechanical valve." B. "That will depend on your surgeon. Ask her when you go to your office visit." C. "You will be on it for the rest of your life because you have a biologic tissue valve." D. "You will be told when to stop, usually when your mechanical prosthetic valve is healed and there is a minimal risk of clots."

ANS: A Rationale: Long-term anticoagulation is necessary with a mechanical prosthetic valve, due to the risk of development of clots on the valve. Biologic tissue valves have a low risk of thrombus formation and long-term anticoagulation is rarely necessary. The nurse should address the patient's question.

A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action should the nurse take first? A. Give PRN IV morphine sulfate 4 mg. B. Give PRN IV diazepam (Valium) 2.5 mg. C. Increase nitroglycerin infusion by 5 mcg/min. D. Increase dopamine infusion by 2 mcg/kg/min.

ANS: A Rationale: Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is MOST important to communicate to the health care provider? A. Generalized muscle aches and pains B. Dizziness with rapid position changes C. Nausea when taking the drugs before meals D. Flushing and pruritus after taking the drugs

ANS: A Rationale: Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed.

Which action should the nurse include in the plan of care for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? A. Monitor blood pressure frequently. B. Encourage patient to ambulate in room. C. Teach patient to drink at least 3 liters of fluid daily. D. Titrate nesiritide dose down slowly before stopping.

ANS: A Rationale: Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Because the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration. Excessive hydration could exacerbate ADHF.

Which action by the patient with newly diagnosed Raynaud's phenomenon best demonstrates that the nurse's teaching about managing the condition has been effective? A. The patient exercises indoors during the winter months. B. The patient immerses hands in hot water when they turn pale. C. The patient takes pseudoephedrine (Sudafed) for cold symptoms. D. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).

ANS: A Rationale: Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm rather than hot water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking NSAIDs with Raynaud's phenomenon.

Which group of drugs will the nurse plan to include when teaching a patient who has a new diagnosis of peripheral artery disease (PAD)? a. Statins b. Antibiotics c. Thrombolytics d. Anticoagulants

ANS: A Rationale: Research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other drug categories in PAD.

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? A. Tadalafil (Cialas) B. Furosemide (Lasix) C. Warfarin (Coumadin) D. Diltiazem (Cardizem)

ANS: A Rationale: The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using tadalafil because of the risk of severe hypotension caused by vasodilation. The other home medications should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.

A patient who is 2 days post femoral popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/VN) caring for the patient requires the registered nurse (RN) to intervene? A. The LPN/VN tells the patient sit in a chair for 2 hours. B. The LPN/VN gives the prescribed aspirin after breakfast. C. The LPN/VN assists the patient to walk 40 ft in the hallway. D. The LPN/VN places the patient in Fowler's position for meals.

ANS: A Rationale: The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.