NUR415 Remediation Qs (Session 1- Bleeding & Cardiovascular)
A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client EKG show the nurse interpret as a sign of hypokalemia? A. Abnormally prominent U wave B. Elevated ST segment C. Wide QRS D. Inverted P wave
A. Abnormally prominent U wave Although U waves are rare, their presence can be associated with hypokalemia, hypertension and heart disease. For a client who has hypokalemia, the nurse should monitor the EKG strip for a flattened T wave, prolonged PR interval, prominent U wave, or ST depression.
A nurse in the clinic is caring for a client who has recently begun taking warfarin. The nurse is reviewing potential drug and food and traction risks and should instruct the client to do which of the following? A. Cabbage B. Cantaloupe C. Green beans D. White beans
A. Cabbage Cabbage should be limited in the diet when taking warfarin, because it is rich in vitamin K.
A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? A. "I can walk a mile a day." B. "I've had a backache for several days." C. "I am urinating more frequently." D. "I feel nauseated and have no appetite."
D. "I feel nauseated and have no appetite." Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.
A nurse is caring for a client who has heart failure in a prescription for the Jackson 125 µg PO daily. Available is the Jackson PL .25 mg per tablet. How many tablets to the nurse administer per dose?
0.5 tabs/dose
A nurse is caring for a client who has deep vein thrombosis and is prescribed heparin by continuous IV at 1200 units per hour available is heparin 25,000 units in 500 mL D5W. The nurse should set the IV pump to deliver how many milliliters per hour?
24 mL/hr
A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) without the reason blood was drawn from a client which of the following statements should the nurse make regarding cardiac enzyme studies? A. "These tests help determine the degree of damage to the heart tissues." B. "Cardiac enzymes will identify the location of the MI." C. "These tests will enable the provider to determine the heart structure and mobility of the heart valves." D. "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion."
A. "These tests help determine the degree of damage to the heart tissues." Cardiac enzyme studies are obtained because the degree of enzyme elevation reflects the degree of damage to the myocardium. The enzymes most commonly measured are CPK and troponin. These enzymes have a characteristic rise and fall pattern after an MI. It may take 4 hr or more after the onset of manifestations for the test to become abnormal and up to 24 hr for the level to peak. Eventually, the levels in the blood fall back to normal. Consequently, serial blood tests must be taken from the client to document and evaluate enzyme levels
A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing a client? Or, the nurse notes swelling of the clients arm above the (PICC) insertion site. Which of the following actions should the nurse take first? A. Measure the circumference of both upper arms. B. Notify the provider who inserted the PICC line. C. Remove the PICC line. D. Apply a cold pack to the client's upper arm.
A. Measure the circumference of both upper arms The first action the nurse should take using the nursing process is to assess the client. The nurse should measure the arm and compare the result with the circumference of the other arm. If the arm is swollen, the nurse should notify the provider who inserted the PICC line. Swelling could indicate formation of a clot above the site or even catheter rupture.
A nurse is preparing an in-service about the various supplements clients might use which of the following herbal supplements should the nurse include as potentially increasing the anticoagulant effects of aspirin and other oral anticoagulants? A. Valerian B. Feverfew C. Mile thistle D. Saw palmetto
B. Feverfew Feverfew can increase the risk of bleeding due to the suppression of platelet aggregation.
A nurse is providing discharge instructions to a parent of a 10-year-old child following a cardiac catheterization. Which of the following instruction should the nurse include? A. Keep the child home for 1 week. B. Give the child acetaminophen for discomfort. C. Offer the child clear liquids for the first 24 hr. D. Assist the child to take a tub bath for the first 3 days.
B. Give the child acetaminophen for discomfort. The child might have minor discomfort at the puncture site. The parent should offer either acetaminophen or ibuprofen due the risk of Reye syndrome associated with taking aspirin.
Nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A. Hyperthermia B. Hypotension C. Ototoxicity D. Muscle pain
B. Hypotension Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.
A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions? A. Elevating her feet B. Massaging her legs C. Flexing her ankles D. Ambulating soon after surgery
B. Massaging her legs Massaging an extremity that has a blood clot can cause it to detach and become an embolus. The use of sequential compression devices and antiembolic stockings and therapeutic anticoagulation can help prevent this postoperative complication.
A nurse is caring for a client who is prescribed warfarin therapy at for an artificial heart valve. Which of the following laboratory results for the nurse monitor for therapeutic effect of warfarin? A. Hemoglobin (Hgb) B. Prothrombin time (PT) C. Bleeding time D. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.
A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asked the nurse how long it will take for the Heparin Can you dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." B. "A pharmacist is the person to answer that question." C. "Heparin does not dissolve clots. It stops new clots from forming." D. "The oral medication you will take after this IV will dissolve the clot."
C. "Heparin does not dissolve clots. It stops new clots from forming."
A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asked the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." B. "A pharmacist is the person to answer that question." C. "Heparin does not dissolve clots. It stops new clots from forming." D. "The oral medication you will take after this IV will dissolve the clot."
C. "Heparin does not dissolve clots. It stops new clots from forming." This statement accurately answers the client's question.
A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to water the following actions of the medication? A. analgesic B. anti-inflammatory C. antiplatelet aggregate D. antipyretic
C. Antiplatelet aggregate Aspirin is used to decrease the likelihood of blood clotting. It also is used to reduce the risk of a second heart attack or stroke by inhibiting platelet aggregation and reducing thrombus formation in an artery, a vein, or the heart.
A nurse is reviewing data for for children. Which of the following children should the nurse assess first? A. A 10-year-old child who has sickle cell anemia who reports severe chest pain B. A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 C. A 1-year-old toddler who has roseola and a temperature of 39° C (102.2° F) D. A 4-year-old child who has asthma and a PCO2 of 37 mm Hg
A. A 10-year-old child who has sickle cell anemia who reports severe chest pain When using the urgent vs. nonurgent approach to client care, the nurse should determine that the 10-year-old child who has sickle cell anemia and reports severe chest pain should be assessed first. This finding is a medical emergency because it is a manifestation of acute chest syndrome.
The nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the clients EKG should the nurse interpret as a sign of hypokalemia?
A. Abnormally prominent U wave Although U waves are rare, their presence can be associated with hypokalemia, hypertension and heart disease. For a client who has hypokalemia, the nurse should monitor the EKG strip for a flattened T wave, prolonged PR interval, prominent U wave, or ST depression.
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. TheClient refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.
A. Check pt's vitals It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.
Nurse is assessing a real child who has aortic stenosis following findings should the nurse expect? Select all that apply A. Hypotension B. Bradycardia C. Clubbing of the nail beds D. Weak pulses E. Murmur
A. Hypotension D. Weak pulses E. Murmur Hypotension with aortic stenosis is a result of decreased cardiac output. Weak pulses with aortic stenosis are a result of decreased cardiac output. A narrowing of the aortic valve cause a characteristic murmur in children who have aortic stenosis.
The nurse is assessing a client who has fluid overload. which of the following findings should the nurse expect? Select all that apply. A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate D. Increase hematocrit
A. Increased heart rate B. Increased blood pressure C. Increased respiratory rate Increased heart rate is correct. The nurse should expect the client who has fluid volume excess to have tachycardia and increased cardiac contractility in response to the excess fluid.Increased blood pressure is correct. The nurse should expect the client who has fluid volume excess to have increased blood pressure and bounding pulse in response to the excess fluid.Increased respiratory rate is correct. The nurse should expect the client who has fluid volume excess to have increase in respiratory rate and moist crackles heard in lungs.
A nurse is caring for a client who has peripheral vascular disease and reports difficulty sleeping because of cold feet. Which of the following nursing action should the nurse take to promote the clients comfort? A.
A. Obtain a pair of slipper socks for the client. In cold weather or when the client's feet are cold, he should wear extra socks or slipper socks to help provide warmth and increase his level of comfort.
A nurse is auscultating a clients heart sounds in here is an extra heart sound before what should be considered the first sound S1. The nurse should document this finding as which of the following heart sounds? A. The fourth heart sound (S4) B. A friction rub C. The third heart sound (S3) D. A split second heart sound S2
A. The fourth heart sound (S4) S4 is an extra sound that is heard late in diastole just before S1. It occurs due to resistance to blood flow in an enlarged ventricle.
A nurse in a providers clinic is assessing a client who has cancer in a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums? A. Explain to the client that this is an expected adverse effect. B. Check the value of the client's current platelet count. C. Instruct the client to use an electric toothbrush. D. Have the client make an appointment to see the dentist.
C. Check the value of the client's current platelet count. The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy.
A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. which of the following instruction should the nurse include? A. Applying cool compresses to her legs B. Wearing loose, non-constricting stockings C. Flexing her knees and feet frequently D. Taking an NSAID tablet daily
C. Flexing her knees and feet frequently. Leg, ankle, and foot exercises can help improve circulation and prevent venous stasis while the client is resting.
A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22-gauge needle to inject the medication. B. Use a 1-inch needle to inject the medication. C. Inject the medication into the abdomen above the level of the iliac crest. D. Massage the injection site after administration of the medication.
C. Inject the medication into the abdomen above the level of the iliac crest. The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.
A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching? A. "I will have my child rest." B. "I will elevate the affected part." C. "I will compress the site." D. "I will apply heat."
D. "I will apply heat" Supportive measures to control a minor bleeding episode include applying cool compresses.
A nurse is instructing a client who has a new diagnosis of Reynauds disease about preventing the onset of manifestations. Which of the following client statements should indicate to the nurse the mood for additional teaching? A. "I will wear gloves when removing food from freezer" B. "I will try to anticipate and avoid stressful situations when possible" C. "I will complete the smoking cessation program i started" D. "I will take my medications at the first sign of an attack"
D. "I will take my meds at the first sign of an attack" Taking medications at the onset of an episode of Raynaud's disease may help to reduce the severity of the manifestations, but it will not prevent the onset of vasoconstriction.
A nurse is providing teaching to a client who is taking warfarin about monitoring it's therapeutic effects. Which of the following explanations should the nurse provide about the internal national normalized ratio INR test? A. "The INR also monitors heparin therapy if the provider switches the medication prescription." B. "The INR is the only test available for anticoagulant therapy monitoring." C. "You will only need the test twice per month." D. "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times."
D. "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.
A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function
A. Decreased blood pressure Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.
A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Feverfew B. Black cohosh C. Echinacea D. Flaxseed
A. Feverfew The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect.
A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. for which of the following results should be a nurse notify the provider? A. PT 45 seconds B. Hgb 16 g/dL C. Hct 44% D. Platelets 190,000/mm^3
A. PT 45 seconds The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.
A nurse is caring for a mail client who has peripheral vascular disease (PVD, is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting warfarin? Select all that apply A. Saw palmetto B. Flaxseed oil C. Glucosamine D. Black cohosh E. Ginko biloba
A. Saw palmetto C. Glucosamine E. Ginko biloba (Saw palmetto is used to relieve symptoms associated with benign prostatic hypertrophy and has an antiplatelet effect. It should not be taken with warfarin.) (Glucosamine is used to prevent osteoarthritis and may increase the risk of bleeding. It should not be taken with warfarin) (Gingko biloba is used to increase pain-free walking in clients with PVD and may suppress coagulation. It should not be taken with warfarin.)
A nurse is assessing a client who is receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain and the clients blood pressure is 80/60 4 mmHg. Which of the following actions should the nurse take first? A.
A. Stop the infusion of blood This client is experiencing an acute intravascular hemolytic transfusion reaction. The greatest risk to this client is injury from receiving additional blood; therefore, the first action the nurse should take is to stop the infusion of blood.
A nurse on a medical surgical unit is caring for four clients who are 24 to 36 hours postoperative. Which of the following surgical procedures places the client at risk for deep vein thrombosis? A. Myringotomy B. Laparoscopic appendectomy C. Hip arthroplasty D. Cataract extraction
C. Hip Arthroplasty Clients who are postoperative following orthopedic procedures of the lower extremities and clients who were placed in the lithotomy position for a procedure, such as for gynecological or urological surgeries, are at a higher risk of developing deep-vein thrombosis postoperatively.
A nurse is caring for a client in premature labor and is receiving terbutaline. The nurse should monitor the client go to the following adverse effects that should be reported to the provider? A. Headaches B. Nervousness C. Tremors D. Dyspnea
D. Dyspnea The presence of dyspnea is a manifestation of pulmonary edema, which is a potentially life-threatening complication of terbutaline. This finding should be reported to the provider immediately.
A nurse is assessing a client perforated circulation. In which of the following locations for the nurse palpate to assess the posterior tibial pulse?
Dorsal pedis artery
Call performing an admission assessment for a client, the nurse know that the client has varicose vein's with alterations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses as being a priority and clients care? A. Impaired tissue perfusion B. Alteration in body image C. Alteration in activity tolerance D. Impaired skin integrity
A Impaired tissue perfusion When using the airway, breathing, and circulation (ABC) priority-setting framework, the nurse should identify impaired perfusion of tissues as the priority finding.
A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribed warfarin PO without discontinuing heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." B. "I will call the provider to get a prescription for discontinuing the IV heparin today." C. "Both heparin and warfarin work together to dissolve the clots." D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."
A. Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level."
Nurse is teaching a client who is to start taking warfarin about herbal supplements. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Valerian B. Black cohosh C. Echinacea D. St. John's wort
D. St. John's wort The nurse should instruct the client that St. John's wort can decrease anticoagulation when taking warfarin.
A nurse is preparing to administer warfarin to a client. Which of the following information should the nurse recognize prior to administering the medication? A. Warfarin is compatible with heparin. B. The client's aPTT should be monitored. C. The client should be observed for manifestations of hemorrhage. D. Warfarin can be administered along with NSAIDS.
C. A client should be observed for manifestations of hemorrhage. The nurse should observe for manifestations of hemorrhage because it is an adverse side effect of warfarin, which has anticoagulant and anti-inflammatory actions.
A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medication is incompatible with warfarin? A. Furosemide B. Alprazolam C. Vitamin K D. Vitamin A
C. Vitamin K These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.