Questions

You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition?

"I will inform my dentist about my history of endocarditis prior to any invasive procedures."

what are true statements regarding education for a patient with heart failure?

1. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. 2. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. 3. Heart failure patients should limit sodium intake to 2-3 grams per day.

Which of the following is a late sign of heart failure?

Frothy-blood tinged sputum is a late sign.

should you use a heating pad to warm a pts extremties with PAD?

NO -with layers

anyone with an infection or risk of infection is at risk for what?

Endocarditis

DVT is a type of VTE that is a blood clot that starts where?

in the vein

You're assessing a patient's health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease?

"I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." and It hurts to elevate my legs." and Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away." -Peripheral arterial disease occurs when there is impediment of blood flow to the lower extremities (hence the lower extremities are being deprived of blood flow and this causes pain). The pain most commonly occurs at night and can wake up the patient. It is known as "rest pain". This occurs because when the legs are horizontal the blood flow is compromised and it causes pain...therefore the patient will report they dangle the leg off the bed to help ease the pain (the dependent position (dangling) will help blood flow down to the extremity). In addition, it hurts to elevate the legs (again because this further compromises blood flow).

You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?

"I will limit my consumption of frozen meals." -Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

Which of the following tests/procedures are used to diagnose heart failure?

- ecocardiogram -brain natriuretic peptide blood test -nuclear stress test

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?

Echocardiogram shows an ejection fraction of 38%. & Patient has frequent episodes of nocturnal paroxysmal dyspnea.

what peripheral disease is indicated by a pts legs feeling heavy and aching if they sit or stand to long

PVD

True or False: Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well.

TRUE

Which of the following is a early sign of heart failure?

-Shortness of breath -orthopnea, -edema

What are some signs and symptoms of pericarditis?

-fever -pericardial friction rub -radiating substernal pain felt in left shoulder

What are the typical signs and symptoms of infective endocarditis?

-hypethermia -enlarged spleen -heart failure -cardiac murmur

Which of the following are typical signs and symptoms of right-sided heart failure?

-jugular vein distention -weight gain -nocturia

Which of the following are typical signs and symptoms of left-sided heart failure?

-persitant cough -crackles -orthopenea

You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication?

Ibuprofen should be taken with a full glass of water to prevent GI problems, such as ulcers or bleeding.

A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses _______ and this result means?

fibrin degradation fragment; negative for a blood clot

Stroke volume

the amount of blood pumped by the left ventricle with each beat.

Select all the factors regarding a deep vein thrombosis that are included in Virchow's Triad:

1. Stasis of venous blood 2. Hypocoagulability 3. Endothelial damage -Think SHE

Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks:

1. pallor 2. rubor -In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels).

A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?

1.5 to 2.5 times the normal range

Which of the following patients are MOST at risk for developing endocarditis?

A 25 year old male who reports using intravenous drugs on a daily basis. & A 55 year old male who is post-opt from aortic valve replacement. & A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:

A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction & A 30 year old male with a history of endocarditis and has severe mitral stenosis. & A 58 year old female with uncontrolled hypertension and is being treated for influenza. -

Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?

A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. -Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?

ACE inhibitors (Angiotensin-converting-enzyme inhibitors)

Select below all the characteristics that can present with an arterial ulcer:

Arterial ulcers have very little blood flow to them so they will be pale (little granulation) and have little (if any) drainage. They will be deep, round, and have a "punched out" appearance. They are most commonly found on the lateral malleolus, dorsum of foot, or end of toes.

Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to?

Assess and grade lower extremity pulses bilaterally

You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?

Assist the patient up slowing and gradually. -Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?

BNP=820

A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis?

Constrictive pericarditis

A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will?

Decrease the patient's blood pressure and decrease cardiac afterload

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?

Digibind -The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?

Digoxin -Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the?

Elevated position above heart level -Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient's lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.

True or False: Patients with left-sided systolic dysfunction heart failure usually have a normal ejection fraction.

False

What two factors are used to calculate cardiac output?

Heart rate and Stroke volume -Cardiac output is calculated by taking the heart rate and multiplying it by stroke volume. CO = HR x SV

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?

High Fowler's position -Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier.

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history?

High cholesterol, diabetes mellitus, uncontrolled hypertension, and smoking are risk factors for peripheral arterial disease (PAD)

The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?

Hold the dose and notify the physician about the potassium level -Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient

Which of the following is a common side effect of Spironolactone?

Hyperkalemia -Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).

Select the statement below that best describes cardiac afterload:

It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.

A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?

Ive gained 6lbs in one week & When i sleep i have to prop myself up with pillows to breathe

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?

K+ of 8 -Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

Which treatments below would decrease cardiac preload? Select all that apply:

Nitrogylcerin (vasodilator) and Furosemide (Diuretic)

Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV Heparin. Select all the nursing interventions that are appropriate for this patient:

Nursing interventions for this patient include: measuring leg circumference, elevating affected extremity above heart level, and monitoring aPTT level (for Heparin therapy).

A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as?

Osler's Nodes

Based on Virchow's Triad, select which patients below are at RISK for the development of a deep vein thrombosis?

Patients who experience sepsis are at risk for hypercoagulability of the blood. Patients who use IV drugs damage the endothelial lining of the veins and this can lead to blood clot formation. Patients who've had joint replacement surgery are at risk for blood clots due to stasis of venous circulation etc.

On physical assessment of a patient with pericarditis, you may hear what type of heart sound?

Pericardial friction rub

what are risk factors for PVD?

Pregnancy, being female, varicose veins

Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume:

Preload, afterload, and contractility all have a role with influencing stroke volume.

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition?

Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. It can be prevented by keeping the toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as well that help prevent vasospasm.

The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein thrombosis is present?

Signs and symptoms of a DVT include: redness, swelling, warm extremity, pain, positive Homan's Sign, and swelling (which can be unilateral...meaning there is more swelling in one extremity compared to the other).

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities?

THICK tough brown pigmented

Your patient has severe peripheral arterial disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities?

THIN scaly hairless

TRUE or FALSE: The pericardium layer consists of a fibrous layer and SEROUS layer that is made up of two layers called that parietal and visceral layers.

TRUE

True or False: Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue.

TRUE

True or False: Peripheral venous disease can occur due to overstretched valves of the veins in the lower extremities. In addition, it can occur when the veins become damaged.

TRUE

True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload.

TRUE

Which statement below best describes the term cardiac preload?

The amount the ventricles stretch at the end of diastole. -Cardiac preload is the amount the ventricles stretch at the end of diastole (the filling or relaxation phase of the heart).

what is the best postion for a pt with pericadritis?

The high Fowler's position or leaning forward is the best position for a patient with pericarditis.

Which option below is considered a positive Homan's Sign for the assessment of a deep vein thrombosis (DVT)?

The patient reports pain when the foot is manually dorsiflexed.

A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease?

The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.

A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition?

The physician will probably order a pericardiocentesis. This is a procedure to remove excessive fluid from the pericardial sac.

A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis?

Transesophageal echocardiogram (TEE) is an ultrasound performed to look at the back side of the heart and assesses the valve structure. It is a test used to diagnose vegetations found on the valves.

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.

True

What conditions below can result in an increased cardiac afterload?

Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart....all of this increase cardiac afterload.

A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed?

acute infective endocarditis

what type of arrythimas puts you at an increased risk for HF

artiral fibrilation

The MOST common cause of peripheral arterial disease is?

atherosclerosis -fatty plaque on artery walls

a pt who is taking colchicine for pericaritis should avoid what?

grapefruit juice -increases absorption of drug and risk of toxcity

A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by:

it will increase cardiac output by increasing preload

This type of heart failure is where the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.

left sided

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.

left ventricular diastolic dysfunction

where do DVTs commonly occur?

lower extremties

This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema:

right sided heart failure

Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing?

smoking cessation -the most common cause of buerger's disease is smoking

A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding?

splenic embolic event

when should a pt at risk of DVT where SCDs?

the nurse would apply SCDs per MD order to help prevent DVTs, BUT they are to be applied and worn by the patient anytime they are in bed or sitting. The only time a patient should not wear the SCDs is when they're ambulating.

what veins are susceptible to a DVT?

the peroneal, posterior tibial, popliteal and superficial femoral

A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description?

venous ulcer