PCC4 Exam 1

A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A) "I will notify the airport screeners about my pacemaker" B) "I will expect to have occasional hiccups" C) "I will have to disconnect my garage door opener D) "I will take my pulse every 2-3 days"

A) "I will notify the airport screeners about my pacemaker"

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says A) "I would like to add weight lifting to my exercise program" B) "I can only keep my blood pressure normal with medication." C) "I can change my diet to decrease my intake of saturated fats" D) "I will change my lifestyle to reduce activities that increase stress."

A) "I would like to add weight lifting to my exercise program"

A nurse on a cardiac unit is caring for a group of clients. the nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? select all that apply. A) A client who has metabolic alkalosis B) A client with a serum potassium level of 4.3 mEq/L C) A client who has an SaO2 of 96% D) A client who has COPD E) A client who underwent stent placement in a coronary artery

A) A client who has metabolic alkalosis D) A client who has COPD E) A client who underwent stent placement in a coronary artery

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? Select all that apply A) Cool and clammy foot with cap refill of 5 seconds B) Observed pacing spike followed by QRS complex C) Persistent hiccups D) HR 84/min E) BP 104/62

A) Cool and clammy foot with cap refill of 5 seconds C) Persistent hiccups

A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following nursing actions should the nurse use to promote client safety? Select all that apply A) Wear gloves when handling pacemaker leads B) ensure electronic equipment has three-pronged grounding plugs C) Minimize client's shoulder movements D) Hold lead wires taut when turning client E) Keep extra pacemaker batteries at least 300 ft away from the client

A) Wear gloves when handling pacemaker leads C) Minimize client's shoulder movements

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? select all that apply A) follow-up ECG B) energy settings used C) IVF intake D) Urinary output E) Skin condition under electrodes

A) follow-up ECG B) energy settings used E) Skin condition under electrodes

A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should the nurse recommend for the client? (Select all that apply.) A. 1 slice cheddar cheese B. 1 medium beef hot dog C. 3 oz Atlantic salmon D. 3 oz roasted chicken breast E. 2 oz lean baked ham

A. 1 slice cheddar cheese C. 3 oz Atlantic salmon D. 3 oz roasted chicken breast

A nurse is caring for a client who asks why her provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C." Aspirin dissolves clots that are forming in your coronary arteries." D." Aspirin relieves headaches that are caused by other medications."

A. "Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluids he is allowed. Which of the following statements is an appropriate response by the nurse? A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink." B. "Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day." C. "This is the same as 2 quarts, or about the same as two pots of coffee." D. "Take sips of water or ice chips so you will not take in too much fluid."

A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink."

A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for coronary artery bypass grafting with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply.) A. "The client's demand for oxygen is lowered." B. "Motion of the heart ceases." C."Rewarming of the client takes place." D."The client's metabolic rate is increased." E. "Blood flow to the heart is stopped."

A. "The client's demand for oxygen is lowered." B. "Motion of the heart ceases." C."Rewarming of the client takes place."

A nurse is admitting a client who has a suspected myocardial infarction(MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolves in less than 15 min. C. The type of activity that causes an MI can be identified D. Angina can occur for longer than 30 min.

A. Angina can be relieved with rest and nitroglycerin.

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestations are expected findings? (Select all that apply.) A. Tachypnea B. Persistent cough C. Increased urinary output D. Thick, yellow sputum E. Orthopnea

A. Tachypnea B. Persistent cough E. Orthopnea

A nurse planning care for a client who has a PICC line in the right arm.Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Use a 10 mL syringe to flush the PICC line. B. Apply gentle force if resistance is met during injection. C. Cleanse ports with alcohol for 15 seconds prior to use. D. Maintain a transparent dressing over the insertion site. E. Flush with 10 mL heparin before and after medication administration.

A. Use a 10 mL syringe to flush the PICC line. C. Cleanse ports with alcohol for 15 seconds prior to use. D. Maintain a transparent dressing over the insertion site.

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) A) diffuse involvement of plaque formation in coronary veins B) abnormal levels of cholesterol, especially low-density lipoproteins C) accumulation of lipid and fibrous tissue within the coronary arteries D) development of angina due to a decreased blood supply to the heart muscle E) chronic vasoconstriction of coronary arteries leading to permanent vasospasm

B) abnormal levels of cholesterol, especially low-density lipoproteins C) accumulation of lipid and fibrous tissue within the coronary arteries D) development of angina due to a decreased blood supply to the heart muscle

Which patient teaching should the nurse include when providing d/c instructions to a pt with a new permanent pacemaker and the caregiver? select all that apply A) avoid or limit air travel B) take and record a daily pulse rate C) obtain and wear a Medic Alert ID device at all times D) avoid lifting arm on the side of the pacemaker above the shoulder E) avoid microwave ovens because they interfere with pacemaker function

B) take and record a daily pulse rate C) obtain and wear a Medic Alert ID device at all times D) avoid lifting arm on the side of the pacemaker above the shoulder

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia A) Will always progress to myocardial infarction B) will be relieved by rest, nitroglycerin, or both C) indicates that irreversible myocardial damage is occurring D) is frequently associated with vomiting and extreme fatigue

B) will be relieved by rest, nitroglycerin, or both

A nurse is caring for a client who is 4 hr postoperative following coronary artery bypass grafting (CABG) surgery. He is able to inspire 200 mL with the incentive spirometer, then refuses to cough because he is tired and it hurts too much. Which of the following actions should the nurse take? A. Allow the client to rest and return in 1 hr. B. Administer IV bolus analgesic, and return in 15 min. C. Document the 200 mL as an appropriate inspired volume. D. Tell the client that he must try to cough if he does not want to get pneumonia.

B. Administer IV bolus analgesic, and return in 15 min.

A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following actions should the nurse take first? A. Obtain the client's weight. B. Assist the client into high-Fowler's position. C. Auscultate lungs sounds. D. Check oxygen saturation with pulse oximeter.

B. Assist the client into high-Fowler's position.

A nurse is assessing a client who is undergoing hemodynamic monitoring. The client has a CVP of 7 mm Hg and a PAWP of 17 mm Hg. Which of the following findings should the nurse expect? (Select all that apply) A. Poor skin turgor B. Bilateral crackles in the lungs C. Jugular vein distension D. Dry mucous membranes E. Hepatomegaly

B. Bilateral crackles in the lungs C. Jugular vein distension E. Hepatomegaly

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? (Select all that apply.) A. Trace of bloody drainage on dressing B. Capillary refill of affected limb of 6 seconds C. Mottled appearance of the limb D. Throbbing pain of affected limb that is decreased following IV bolus analgesic E. Pulse of 2+ in the affected limb

B. Capillary refill of affected limb of 6 seconds C. Mottled appearance of the limb

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client? A. Defibrillation B. Pacemaker insertion C. Synchronized cardioversion D. Administration of IV lidocaine

B. Pacemaker insertion

Patient admitted with ACS has continuous ECG monitoring. an examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats per minute and regular; ventricular rate 62 beats per minute and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to: A) perform synchronized cardioversion B) administer epinephrine 1mg IVP C) observe for sx of hypotension or angina D) apply transcutaneous pacemaker pads on the pt

C) observe for sx of hypotension or angina

The nurse is monitoring the ECG of a pt admitted with ACS. Which ECG characteristics would be most suggestive of myocardial ischemia? A) sinus rhythm with pathologic Q wave B) sinus rhythm with elevated ST segment C) sinus rhythm with depressed ST segment D) sinus rhythm with premature atrial contractions

C) sinus rhythm with depressed ST segment

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A. Diet modification B. Relaxation exercises C. Smoking cessation D. Taking omega-3 capsules

C. Smoking cessation

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect? A. Retroperitoneal bleeding B. Cardiac tamponade C. Bleeding from the incisional site D. Heart failure

C. Bleeding from the incisional site

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin

C. Troponin T

A student nurse is observing a cardioversion procedure and hears the team leader call out "Stand clear." The student should recognize the purpose of this action to alert personnel that A. The cardioverter is being charged to the appropriate setting B. they should initiate CPR d/t PEA C. they cannot be in contact with equipment connected to the client D. a time-out is being called to verify correct protocols

C. they cannot be in contact with equipment connected to the client

A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's HR is 34/min and BP is 83/48. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A) Transport client to cardiovascular laboratory B) Prepare client for insertion of permanent pacemaker C) Obtain signed informed consent form for a pacemaker D) Apply transcutaneous pacemaker pads

D) Apply transcutaneous pacemaker pads

The ECG monitor of a pt in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50bpm. the nurse would anticipate A) performing a defibrillation B) treating with IV amiodarone C) inserting a temporary transvenous pacemaker D) assessing the pt's response to the dysrhythmia

D) assessing the pt's response to the dysrhythmia

The nurse prepares a pt for synchronized cardioversion knowing that cardioversion differs from defibrillation in that A) defibillation requires a lower dose of electrical energy B) cardioversion is indicated to treat atrial bradydysrhythmias C) defibrillation is synchronized to deliver a shock during the QRS complex D) pts should be sedated if cardioversion is done on a non-emergency basis

D) pts should be sedated if cardioversion is done on a non-emergency basis

A Nurse is orienting a newly licensed nurse on the care of a client who is to have a line placed for hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates effectiveness of the teaching? A. "Air should be instilled into the monitoring system prior to the procedure." B. "The client should be positioned on the left side during the procedure." C. "The transducer should be level with the second intercostal space after the line is placed." D. "A chest x-ray is needed to verify placement after the procedure."

D. "A chest x-ray is needed to verify placement after the procedure."

A nurse is completing the admission assessment of a client who will undergo peripheral bypass graft surgery on the left leg. Which of the following findings should the nurse expect? A. Rubor of the affected leg when elevated B. 3+ dorsal pedal pulse in left foot C. Thin, peeling toenails of left foot D. Report of intermittent claudication in the affected leg

D. Report of intermittent claudication in the affected leg

A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? A. "I should place the tablet under my tongue." B. "I should have my clotting time checked weekly." C."I will report any ringing in my ears." D."I will call my doctor if my pulse rate is less than 60."

D."I will call my doctor if my pulse rate is less than 60."

A nurse is teaching a client who is scheduled for an angiography. Which of the following statements should the nurse include in the teaching? A. "You should have nothing to eat or drink for 4 hours prior to the procedure." B. "You will be given general anesthesia during the procedure." C."You should not have this procedure done if you are allergic to eggs. D."You will need to keep your affected leg straight following the procedure."

D."You will need to keep your affected leg straight following the procedure."

A nurse is completing discharge teaching with a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following food selections should the nurse include as having the highest source of potassium? A. 1 medium apple B. 1 medium baked potato C. 1 slice toast with 1 tbsp peanut butter D. 1 large scrambled egg

E. Orthopnea

Exercise and activity are included in a cardiac rehabilitation program for which purposes? (select all that apply) a. Increase cardiac output b. Increase serum lipids c. Increase blood pressure d. Increase blood flow to the arteries e. Increase muscle mass f. Increase flexibility

a. Increase cardiac output d. Increase blood flow to the arteries e. Increase muscle mass f. Increase flexibility A cardiac rehabilitation program seeks to increase cardiac output, blood flow to the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure.

a cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. which of the following statements by a newly hired nurse indicates understanding of the review? a. "this means the pacemaker fires in an asynchronous pattern." b. "this means the pacemaker fires only when the heart rate is below a certain rate." c. "the pacemaker can automatically adjust to a client's increased activity level. d. "the pacemaker activity is triggered by heart muscle activity."

a. "this means the pacemaker fires in an asynchronous pattern."

Which individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)? a. A 45-yr-old depressed man with a high-stress job b. A 60-yr-old man with below normal homocysteine levels c. A 54-yr-old woman vegetarian with elevated high-density lipoprotein (HDL) levels d. A 62-yr-old woman who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

a. A 45-yr-old depressed man with a high-stress job The 45-yr-old depressed man with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.

A patient is admitted to the ICU with a diagnosis of unstable angina. Which drugs(s) would the nurse expect the patient to receive (select all that apply)? a. ACE inhibitor b. Antiplatelet therapy c. Thrombolytic therapy d. Prophylactic antibiotics e. Intravenous nitroglycerin

a. ACE inhibitor b. Antiplatelet therapy e. Intravenous nitroglycerin

Which factor should be considered when caring for a woman with suspected coronary artery disease? a. Fatigue may be the first symptom. b. Classic signs and symptoms are expected. c. Increased risk is present before menopause. d. Women are more likely to develop collateral circulation.

a. Fatigue may be the first symptom. Fatigue, rather than pain or shortness of breath, may be the first symptom of impaired cardiac circulation. Women may not exhibit the classic signs and symptoms of ischemia such as chest pain which radiates down the left arm. Neck, throat, or back pain may be symptoms experienced by women. Risk for coronary artery disease increases four times after menopause. Men are more likely to develop collateral circulation.

The patient has a potassium level of 2.9 mEq/L, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm, the P wave is 0.06 seconds (sec) and normal shape, the PR interval is 0.24 sec, and the QRS is 0.09 sec. How should the nurse document this rhythm? a. First-degree AV block b. Second-degree AV block c. Premature atrial contraction (PAC) d. Premature ventricular contraction (PVC)

a. First-degree AV block In first-degree atrioventricular (AV) block, there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 sec. In type I second-degree AV block, the PR interval continues to increase in duration until a QRS complex is blocked. In type II, the PR interval may be normal or prolonged, the ventricular rhythm may be irregular, and the QRS is usually greater than 0.12 sec. PACs cause an irregular rhythm with a different-shaped P wave than the rest of the beats, and the PR interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS complex is wide and distorted in shape.

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? a. Oxygen, nitroglycerin, aspirin, and morphine b. Aspirin, nitroprusside, dopamine, and oxygen c. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine d. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)

a. Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. The other medications may be used later in the patient's treatment.

A patient informs the nurse of experiencing syncope. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? a. Preparing to assist with a head-up tilt-test b. Preparing an IV dose of a β-adrenergic blocker c. Assessing the patient's knowledge of pacemakers d. Teaching the patient about the role of antiplatelet aggregators

a. Preparing to assist with a head-up tilt-test In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup after episodes of syncope. IV β-blockers are not indicated, although an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response if the head-up tilt-test did not have a response. Addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient teaching surrounding antiplatelet aggregators is not directly relevant to the patient's syncope at this time.

A 52-yr-old male patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of the medication? a. Presence of chest pain b. Blood in the urine or stool c. Tachycardia with hypotension d. Decreased level of consciousness

a. Presence of chest pain Alteplase is a fibrinolytic agent that is administered to patients who have had an STEMI. If the medication is effective, the patient's chest pain will resolve because the medication dissolves the thrombus in the coronary artery and results in reperfusion of the myocardium. Bleeding is a major complication of fibrinolytic therapy. Signs of major bleeding include decreased level of consciousness, blood in the urine or stool, and increased heart rate with decreased blood pressure.

When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which foods would the nurse encourage patients to include in their diet (select all that apply.)? a. Tofu b. Walnuts c. Tuna fish d. Whole milk e. Orange juice

a. Tofu b. Walnuts c. Tuna fish Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.

The nurse prepares to defibrillate a patient. For which dysrhythmia has the nurse observed in this patient? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse

a. Ventricular fibrillation Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? a. "I will replace my nitroglycerin supply every 6 months." b. "I can take up to five tablets every 3 minutes for relief of my chest pain." c. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." d. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

b. "I can take up to five tablets every 3 minutes for relief of my chest pain." The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every 5 minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely.

The nurse is doing discharge teaching with the patient who received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that further teaching is required? a. "I will call the cardiologist if my ICD fires." b. "I cannot fly because it will damage the ICD." c. "I cannot move my left arm until it is approved." d. "I cannot drive until my cardiologist says it is okay."

b. "I cannot fly because it will damage the ICD." The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught that informing TSA security screening agents at the airport about the ICD should be done because it may set off the metal detector and if a hand-held screening wand is used, it should not be placed directly over the ICD. The other options indicate the patient understands the teaching.

Which patient is at greatest risk for sudden cardiac death (SCD)? a. A 42-yr-old white woman with hypertension and dyslipidemia b. A 52-yr-old African American man with left ventricular failure c. A 62-yr-old obese man with diabetes mellitus and high cholesterol d. A 72-yr-old Native American woman with a family history of heart disease

b. A 52-yr-old African American man with left ventricular failure Patients with left ventricular dysfunction (ejection fraction <30%) and ventricular dysrhythmias after myocardial infarction are at greatest risk for SCD. Other risk factors for SCD include (1) male gender (especially African American men), (2) family history of premature atherosclerosis, (3) tobacco use, (4) diabetes mellitus, (5) hypercholesterolemia, (6) hypertension, and (7) cardiomyopathy.

A patient reports dizziness and shortness of breath and is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? a. Digoxin b. Adenosine c. Metoprolol d. Atropine sulfate

b. Adenosine IV adenosine is the first drug of choice to convert supraventricular tachycardia to a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds) followed by a rapid, normal saline flush. The nurse should monitor the patient's electrocardiogram continuously because a brief period of asystole after adenosine administration is common and expected. Atropine sulfate increases heart rate, whereas lanoxin and metoprolol slow the heart rate.

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply.)? a. Flushing b. Ashen skin c. Diaphoresis d. Nausea and vomiting e. S3 or S4 heart sounds

b. Ashen skin c. Diaphoresis d. Nausea and vomiting e. S3 or S4 heart sounds During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.

The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

b. Atrial fibrillation Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating. Sinus tachycardia is a sinus rate above 100 beats/min with normal P waves. Ventricular fibrillation is seen on the ECG without a visible P wave; an unmeasurable heart rate, PR or QRS; and the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature ventricular contractions that have distorted QRS complexes with regular or irregular rhythm, and the P wave is usually buried in the QRS complex without a measurable PR interval.

A patient returns after cardiac catheterization. Which nursing care would the registered nurse delegate to the licensed practical nurse? a. Monitor the electrocardiogram for dysrhythmias b. Check for bleeding at the catheter insertion site c. Prepare discharge teaching related to complications d. Take vital signs and report abnormal values

b. Check for bleeding at the catheter insertion site The licensed practical nurse can check for bleeding at the puncture sites. If bleeding is identified, it should be reported to the registered nurse. Vital signs should be delegated to the unlicensed assistive personnel. Preparation of discharge teaching and monitoring for dysrhythmias such as S-T elevation would be registered nurse scope of practice.

The nurse is providing teaching to a patient recovering from a myocardial infarction. How should resumption of sexual activity be discussed? a. Delegated to the primary care provider b. Discussed along with other physical activities c. Avoided because it is embarrassing to the patient d. Accomplished by providing the patient with written material

b. Discussed along with other physical activities Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex as a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.

The nurse prepares a discharge teaching plan for a 44-yr-old male patient who has recently been diagnosed with coronary artery disease (CAD). Which risk factor should the nurse plan to focus on during the teaching session? a. Type A personality b. Elevated serum lipids c. Family cardiac history d. Hyperhomocysteinemia

b. Elevated serum lipids Dyslipidemia is one of the four major modifiable risk factors for CAD. The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? a. Myocardial injury b. Myocardial ischemia c. Myocardial infarction d. A pacemaker is present.

b. Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from inadequate supply of blood and oxygen to the heart. Myocardial injury is identified with ST-segment elevation. Myocardial infarction is identified with ST-segment elevation and a widened and deep Q wave. A pacemaker's presence is evident on the ECG by a spike leading to depolarization and contraction.

The nurse is caring for a patient who is 2 days post MI. The patient reports that she is experiencing chest pain. She states, "It hurts when I take a deep breath." Which action would be a priority? a. Notify the physician 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 PRN analgesic and reevaluate in 30minutes.

b. Obtain vital signs and auscultate for a pericardial friction rub.

The nurse is examining the electrocardiogram (ECG) of a patient just admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? a. Sinus tachycardia b. Pathologic Q wave c. Fibrillatory P waves d. Prolonged PR interval

b. Pathologic Q wave The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.

A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response? a. Perfusion assists the body by preventing clots and increasing stamina. b. Perfusion assists the cell by delivering oxygen and removing waste products. c. Perfusion assists the heart by increasing the cardiac output. d. Perfusion assists the brain by increasing mental alertness.

b. Perfusion assists the cell by delivering oxygen and removing waste products. Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.

The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for? a. Defibrillation b. Synchronized cardioversion c. Automatic external defibrillator (AED) d. Implantable cardioverter-defibrillator (ICD)

b. Synchronized cardioversion Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death, have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias.

The nurse obtains a 6-second rhythm strip and charts the following analysis: Atrial data: Rate 70, regular, variable PRI, independent beats Ventricular data: Rate 40, regular, isolated escape beats Additional data: QRS: 0.04 sec, P wave and QRS complexes unrelated What is the correct interpretation of this rhythm strip? a. Sinus dysrhythmia b. Third-degree heart block c. Wenckebach phenomenon d. Premature ventricular contractions

b. Third-degree heart block Third-degree heart block represents a loss of communication between the atrium and ventricles from atrioventricular node dissociation. This is depicted on the rhythm strip as no relationship between the P waves (representing atrial contraction) and QRS complexes (representing ventricular contraction). Whereas the atria are beating totally on their own at 70 beats/min, the ventricles are pacing themselves at 40 beats/min. Sinus dysrhythmia is seen with a slower heart rate with exhalation and an increased heart rate with inhalation. In Wenckebach heart block, there is a gradual lengthening of the PR interval until an atrial impulse is nonconducted and a QRS complex is blocked or missing. Premature ventricular contractions are the early occurrence of a wide, distorted QRS complex.

In caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient? a. "What precipitated the pain?" b. "Has the pain changed this time?" c. "In what areas did you feel this pain?" d. "What is your pain level on a 0 to 10 scale?"

c. "In what areas did you feel this pain?" Using PQRST, the assessment data not volunteered by the patient is the radiation of pain, the area the patient felt the pain, and if it radiated. The precipitating event was going to the bathroom and having a bowel movement. The quality of the pain was "like before I was admitted," although a more specific description may be helpful. Severity of the pain was the "worst chest pain ever," although an actual number may be needed. Timing is supplied by the patient describing when the pain occurred and that he had previously had this pain.

When computing a heart rate from the electrocardiography (ECG) tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. What does the nurse calculate the patient's heart rate to be? a. 60 beats/min b. 75 beats/min c. 100 beats/min d. 150 beats/min

c. 100 beats/min Because each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15, in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).

The nurse is monitoring the electrocardiograms of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all of the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? a. A 62-yr-old man with a fever and sinus tachycardia with a rate of 110 beats/min b. A 72-yr-old woman with atrial fibrillation with 60 to 80 QRS complexes per minute c. A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute d. A 42-yr-old woman with first-degree AV block and sinus bradycardia at a rate of 56 beats/min

c. A 52-yr-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute Frequent premature ventricular contractions (PVCs) (>1 every 10 beats) may reduce the cardiac output and precipitate angina and heart failure, depending on their frequency. Because PVCs in CAD or acute myocardial infarction indicate ventricular irritability, the patient's physiologic response to PVCs must be monitored. Frequent PVCs most likely must be treated with oxygen therapy, electrolyte replacement, or antidysrhythmic agents.

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? a. Reinforcing the pressure dressing as needed b. Encouraging range-of-motion exercises of the involved arm c. Assessing the incision for any redness, swelling, or discharge d. Applying wet-to-dry dressings every 4 hours to the insertion site

c. Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement.

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication? a. Dehydration b. Paralytic ileus c. Atrial dysrhythmias d. Acute respiratory distress syndrome

c. Atrial dysrhythmias Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days after CABG surgery. Although the other complications could occur, they are not common complications.

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-pound 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

c. Begin an exercise program that aims for at least five 30-minute sessions per week

The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer? a. Lidocaine and amiodarone b. Digoxin and procainamide c. Epinephrine and/or vasopressin d. β-adrenergic blockers and dopamine

c. Epinephrine and/or vasopressin Normally, the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine or vasopressin may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for ventricular tachycardia or ventricular fibrillation. Digoxin and procainamide are used for ventricular rate control. β-adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.

Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply.)? a. Niacin b. Cholestyramine c. Ezetimibe (Zetia) d. Gemfibrozil (Lopid) e. Atorvastatin (Lipitor)

c. Ezetimibe (Zetia) d. Gemfibrozil (Lopid) e. Atorvastatin (Lipitor) - Ezetimibe (Zetia) should not be used by patients with liver impairment. - Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently and the medication stopped if these enzymes increase. - Niacin's side effects subside with time, although decreased liver function may occur with high doses. - Cholestyramine is safe for long-term use.

The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? a. Palpate the insertion site for induration. b. Assess peripheral pulses in the right leg. c. Inspect the patient's right side and back. d. Compare the color of the left and right legs.

c. Inspect the patient's right side and back. The best method to determine that the right femoral artery is intact after inspection of the insertion site is to logroll the patient to inspect the right side and back for retroperitoneal bleeding. The artery can be leaking and blood is drawn into the tissues by gravity. The peripheral pulses, color, and sensation of the right leg will be assessed per agency protocol.

The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? a. Ischemia b. Pneumonia c. Myocardial infarction d. Peptic ulcer disease

c. Myocardial infarction Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.

A 74-yr-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? a. Administer morphine sulfate IV. b. Auscultate heart and lung sounds. c. Obtain a 12-lead electrocardiogram (ECG). d. Assess for coronary artery disease risk factors.

c. Obtain a 12-lead electrocardiogram (ECG). If a patient has chest pain, the nurse should institute the following measures: (1) administer supplemental oxygen and position the patient in upright position unless contraindicated, (2) assess vital signs, (3) obtain a 12-lead ECG, (4) provide prompt pain relief first with a nitrate followed by an opioid analgesic if needed, and (5) auscultate heart sounds. Obtaining a 12-lead ECG during chest pain aids in the diagnosis.

The nurse observes ventricular tachycardia (VT) on the patient's monitor. What evaluation made by the nurse led to this interpretation? a. Unmeasurable rate and rhythm b. Rate 150 beats/min; inverted P wave c. Rate 200 beats/min; P wave not visible d. Rate 125 beats/min; normal QRS complex

c. Rate 200 beats/min; P wave not visible VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion and a normal QRS complex are not associated with VT.

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the electrocardiogram (ECG)? a. The length of time it takes to depolarize the atrium b. The length of time it takes for the atria to depolarize and repolarize c. The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers d. The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node

c. The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.

The nurse determines there is artifact on the patient's telemetry monitor. Which factor should the nurse assess for that could correct this issue? a. Disabled automaticity b. Electrodes in the wrong lead c. Too much hair under the electrodes d. Stimulation of the vagus nerve fibers

c. Too much hair under the electrodes Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair. Disabled automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.

Cardioversion is attempted for a patient with atrial flutter and a rapid ventricular response. After the delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately? a. Administer 250 mL of 0.9% saline solution IV by rapid bolus. b. Assess the apical pulse, blood pressure, and bilateral neck vein distention. c. Turn the synchronizer switch to the "off" position and recharge the device. d. Tell the patient to report any chest pain or discomfort and administer morphine sulfate.

c. Turn the synchronizer switch to the "off" position and recharge the device. Ventricular fibrillation produces no effective cardiac contractions or cardiac output. If during synchronized cardioversion the patient becomes pulseless or the rhythm deteriorates to ventricular fibrillation, the nurse should turn the synchronizer switch off and initiate defibrillation. Fluids, additional assessment, or treatment of pain alone will not restore an effective heart rhythm.

The most common finding in individuals at risk for sudden cardiac death is a. aortic valve disease b. mitral valve disease. c. left ventricular dysfunction d. atherosclerotic heart disease.

c. left ventricular dysfunction

Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double catheter use c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences.

c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms

The nurse performs discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD). Which statement by the patient indicates to the nurse that further teaching is needed? a. "The device may set off the metal detectors in an airport." b. "My family needs to keep up to date on how to perform CPR." c. "I should not stand next to antitheft devices at the exit of stores." d. "I can expect redness and swelling of the incision site for a few days."

d. "I can expect redness and swelling of the incision site for a few days." Patients should be taught to report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to their primary care providers immediately. Teach patients to inform TSA airport security of presence of ICD because it may set off metal detectors. If a handheld screening wand is used, it should not be placed directly over the ICD. Teach patients to avoid standing near antitheft devices in doorways of stores and public buildings and to walk through them at a normal pace. Caregivers should learn cardiopulmonary resuscitation.

The nurse instructs a 68-yr-old woman with hypercholesterolemia about natural lipid-lowering therapies. The nurse determines further teaching is necessary if the patient makes which statement? a. "Omega-3 fatty acids are helpful in reducing triglyceride levels." b. "I should check with my physician before I start taking any herbal products." c. "Herbal products do not go through as extensive testing as prescription drugs do." d. "I will take garlic instead of my prescription medication to reduce my cholesterol."

d. "I will take garlic instead of my prescription medication to reduce my cholesterol." Current evidence does not support using garlic in the treatment of elevated cholesterol. Strong evidence supports the use of omega-3 fatty acids for reduction of triglyceride levels. Many herbal products are not standardized and effects are not predictable. Patients should consult with their health care provider before starting herbal or natural therapies.

A patient develops third-degree heart block and reports feeling chest pressure and shortness of breath. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing? a. "The device will convert your heart rate and rhythm back to normal." b. "The device uses overdrive pacing to slow the heart to a normal rate." c. "The device is inserted through a large vein and threaded into your heart." d. "The device delivers a current through your skin that can be uncomfortable."

d. "The device delivers a current through your skin that can be uncomfortable." Before initiating transcutaneous pacing therapy, it is important to tell the patient what to expect. The nurse should explain that the muscle contractions created by the pacemaker when the current passes through the chest wall are uncomfortable. Pacing for complete heart block will not convert the heart rhythm to normal. Overdrive pacing is used for very fast heart rates. Transcutaneous pacing is delivered through pacing pads adhered to the skin.

The patient is being dismissed from the hospital after acute coronary syndrome and will be attending rehabilitation. What information would be taught in the early recovery phase of rehabilitation? a. Therapeutic lifestyle changes should become lifelong habits. b. Physical activity is always started in the hospital and continued at home. c. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. d. Activity level is gradually increased under cardiac rehabilitation team supervision and with electrocardiographic (ECG) monitoring.

d. Activity level is gradually increased under cardiac rehabilitation team supervision and with electrocardiographic (ECG) monitoring. In the early recovery phase after the patient is dismissed from the hospital, the activity level is gradually increased under supervision and with ECG monitoring. The late recovery phase includes therapeutic lifestyle changes that become lifelong habits. In the first phase of recovery, activity is dependent on the severity of the angina or myocardial infarction, and attention is focused on the management of chest pain, anxiety, dysrhythmias, and other complications. With early recovery phase, the cardiac rehabilitation team may suggest that physical activity be initiated at home, but this is not always done.

For which problem is percutaneous coronary intervention (PCI) most clearly indicated? a. Chronic stable angina b. Left-sided heart failure c. Coronary artery disease d. Acute myocardial infarction

d. Acute myocardial infarction PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and coronary artery disease are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure.

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food? a. Baked flounder b. Angel food cake c. Baked potato with margarine d. Canned chicken noodle soup

d. Canned chicken noodle soup Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content.

A patient admitted to the emergency department 24 hours ago with complaints of chest pain was diagnosed with a ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate? a. Unstable angina b. Cardiac tamponade c. Sudden cardiac death d. Cardiac dysrhythmias

d. Cardiac dysrhythmias Dysrhythmias are present in 80% to 90% of patients after myocardial infarction (MI). Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.

A patient experienced sudden cardiac death (SCD) and survived. Which preventive treatment should the nurse expect to be implemented? a. External pacemaker b. An electrophysiologic study (EPS) c. Medications to prevent dysrhythmias d. Implantable cardioverter-defibrillator (ICD)

d. Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used but are not the best prevention of SCD.

A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? a. Exercise almost every day. b. Avoid saturated fat intake. c. Limit calories to daily limit. d. Keep Hgb A1C (A1C) less than 7%.

d. Keep Hgb A1C (A1C) less than 7%. If the Hgb A1C (A1C) is kept below 7%, this means that the patient has had good control of her blood glucose over the past 3 months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.

A male patient who has coronary artery disease (CAD) has serum lipid values of low-density lipoprotein (LDL) cholesterol of 98 mg/dL and high-density lipoprotein (HDL) cholesterol of 47 mg/dL. What should the nurse include in patient teaching? a. Consume a diet low in fats. b. Reduce total caloric intake. c. Increase intake of olive oil. d. The lipid levels are normal.

d. The lipid levels are normal. For men, the recommended LDL is less than 100 mg/dL, and the recommended level for HDL is greater than 40mg/dL. His normal lipid levels should be included in the patient teaching and encourage him to continue taking care of himself. Assessing his need for teaching related to diet should also be done.