Test 3 perfusion

A nurse is caring for a pt with hypomagnesemia who asks the nurse what foods are rich in Mg. Which of the following foods will the nurse recommend? 1. Apples 2. Almonds 3. Quinoa 4. Cornflakes 5. Olives

b, c

The nurse is developing a discharge teaching plan for the client diagnosed with CHF. Which intervention should be included in the plan? Select all that apply. A. Notify the HCP of a weight gain of more than 1 pound a week B. Teach the client how to count the radial pulse when taking digoxin C. Instruct the client to remove the salt shaker from the dinner table D. Encourage the client to monitor urine output for changing color to become dark E. Discuss the importance of taking the loop diuretic furosemide made a bedtime

b, c

The client diagnosed with a DVT's place on a medical unit. Which nursing intervention should be implemented? Select all that apply. A. Place sequential compression devices on both legs B. Instruct the client to stay in bed and not ambulate C. Encourage fluids and diet high in roughage D. Monitor IV site every four hours and PRN E. Assess Homans sign every 24 hours

b, c, d

The client diagnosed with CHF is complaining of leg cramps. Which nursing intervention should be implemented? A. Check the client for peripheral edema and make sure the client takes a diuretic early in the day B. Monitor the clients potassium level and assess the clients and take a bananas and orange juice C. Determine if the client has gained weight and instruct the client to keep legs elevated D. Instruct the client to ambulate frequently and perform calf muscle stretching exercises daily

b

The elderly client diagnosed with DVT is complaining of chest pain during inhalation. Which intervention should be implemented first? A. Ask the HCP to order a stat lung screen B. Placed oxygen on the client via nasal cannula C. Prepare to administer IV heparin D. Tell the client not to ambulate and remain in bed

b

The healthcare provider ordered an ace inhibitor for the client diagnosed with CHF. Which discharge instruction should the nurse include? A. Instruct the client to take her cough suppressant if a cough develops B. Teach the client how to prevent orthostatic hypotension C. Encourage the client to eat bananas to increase potassium D. Explain the importance of taking the medication with food

b

The nurse is administering medication on cardiac unit. Which medication should the nurse question administering? A. Warfarin an anticoagulant to a client with a PT of 14 and INR of 1.6 B. Digoxin a cardiac glycoside to a client with a potassium level of 3.3 C. Atenolol a beta blocker for the client with an AST of 18 D. Lisinopril and ace inhibitor for the client with a serum creatinine level of 0.8

b

The nurse is discharging the female client diagnosed with deep vein thrombosis (DVT) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client needs more teaching concerning this medication? A. "I should wear a MedicAlert bracelet in case of an emergency." B. "If I get cut, I will apply pressure for at least 5 minutes." C. "I will increase the amount of green, leafy vegetables I eat." D. "I will have to see my HCP regularly while taking this medication."

C

The nurse is reviewing the lab results for a client with an elevated cholesterol level he was taking atorvastatin. Which result is most important to discuss with the healthcare provider? A. Potassium is 3.4 B. Blood urea nitrogen is 9 C. Aspartate aminotransferase (AST)is 30 D. Low density lipoprotein cholesterol is 170

D

A client is taking digoxin and furosemide for heart failure. the nurse approves of which of the following client selections that is the best commands choice for this client a. chicken with baked potato and cantaloupe b. ham and cheese omelet with low cholesterol egg substitute c. Grilled cheese sandwich and canned brown potatoes d. pizza with low fat mozzarella cheese and pepperoni

a

A client with coronary artery disease ask the nurse, "why do I get chest pain?" Which statement by the nurse would be the most appropriate response? A. Chest pain is caused by decreased oxygen to the heart muscle B. There is ischema to the myocardium as a result of hypoxemia the heart muscle C. the heart muscle is unable to pump effectively to perfuse the body D. Chest pain occurs when the lungs cannot adequately oxygenated blood

a

The client diagnosed with arterial hypertension is receiving furosemide (Lasix), a loop diuretic. Which data indicates the medication is effective? A. The client's 8-hour intake is 1800 mL and the output is 2300 mL. B. The client's blood pressure went from 144/88 to 154/96. C. The client's has had a weight loss of 1.3 kg in 7 days. D. The client reports occasional lightheadedness and dizziness.

a

The client diagnosed with high blood pressure is ordered the angiotensin-converting enzyme inhibitor captopril (Capoten). Which statement by the client indicates to the nurse that the discharge teaching has been effective? A. "I should get up slowly when I am getting out of my bed." B. "I should check and record my blood pressure once a week." C. "If I get leg cramps, I should increase my potassium supplements." D. "If I forget to take my medication, I will take two doses the next day."

a

The client with coronary artery disease is prescribed cholestyramine, a bile-acid sequestrant. Which intervention should the nurse implement when administering the medication? A. Administer the medication with fruit juice. B. Explain to decrease fiber when taking the medication. C. Monitor the cholesterol level before giving medication. D. Assess the client for upper-abdominal discomfort.

a

The health-care provider prescribed a beta blocker for the client diagnosed with arte- rial hypertension. Which is the scientific rationale for administering this medication? A. This medication decreases the sympathetic stimulation to the heart, thereby decreasing the client's heart rate and blood pressure. B. This medication prevents the calcium from entering the cell, which helps decrease the client's blood pressure. C. This medication prevents the release of aldosterone, which deceases absorption of sodium and water, which, in turn, decreases blood pressure. D. This medication will cause an increased excretion of water from the vascular system, which will decrease the blood pressure.

a

The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) who has been prescribed the cardiac glycoside digoxin (Lanoxin) and the loop diuretic furosemide (Lasix). Which statement by the client indicates the medications are effective? A. "I am able to walk next door now without being short of breath." B. "I keep my feet propped up as much as I can during the day." C. "I have gained 3 pounds since my last visit here." D. "I am staying on my diet, and I don't salt my foods anymore."

a

The nurse is caring for a client/surgical floor which client should be assessed first? A. The client who is four days postop abdominal surgery and is complaining of left calf pain when ambulating B. The client who is one day postop hernia repair who has been able to avoid 550 mL of clear amber urine C. The client was five days postop open cholecystectomy who has a T tube and is being discharged D. The client who is 16 hours post of Domino hysterectomy and is complaining of abdominal pain and is expelling flatus

a

Which medication should the nurse question administering to a client diagnosed with stage C congestive heart failure (CHF)? A. Ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID). B. Amlodipine (Norvasc), a calcium channel blocker. C. Spironolactone (Aldactone), a potassium-sparing diuretic. D. Atenolol (Tenormin), a beta blocker.

a

Which intervention should the nurse discuss with the client diagnosed with atherosclerosis? select all that apply. A. Include the significant other in the discussion B. Stop smoking or using any type of tobacco products C. Maintain a sedentary lifestyle as much as possible D. Avoid stressful situations E. Daily isometric exercises are important

a, b

The nurse is administering the combination medication Tenoretic (clorthalidone and atenolol), a thiazide diuretic and beta blocker, to a client diagnosed with chronic hypertension. Which interventions should the nurse implement? Select all that apply. A. Do not administer if the client's B/P is less than 90/60. B. Do not administer if the client's apical pulse is less than 60. C. Teach the client how to prevent orthostatic hypotension. D. Encourage the client to eat potassium-rich foods. E. Monitor the client's oral intake and urinary output.

a, b, c, d, e

The home health nurse is assigned a client diagnosed with heart failure. Which should the nurse implement? Select all that apply. A. Request a dietary consult for sodium restricted diet B. Instruct the client to elevate the feet during the day C. Teach the client tp weigh every morning wearing the same type of clothing D. Assessed for edema independent areas of the body E. Encourage the client to drink at least 3000 mL of fluid per day F. Encourage the client repeat back instructions to the nurse

a, b, c, e, f

Which client teaching sure the nurse implement for the client diagnosed with coronary artery disease? A.. Encourage low fat low cholesterol diet B. Instruct the client walk 30 minutes a day C. Decrease the salt intake to 2g a day D. Refer to a counselor for stress reduction techniques E. Teach the client to increase fiber in the diet

a, b, d, e

A care plan was made for a client diagnosed with CHF. A nursing diagnosis of decreased cardiac output related to inability of the heart to pump effectively as written. Which short term goal would be the best for the client? A. The client will be able to ambulate in the hall by the date of discharge B. The client will have an audible S1 and S2 with no S3 heard by end of shift C. The client will turn, cough, and deep breathe every two hours D. The client will have an essay O2 rating of 98% by day two of care

b

A client who has just arrived in the ED report sub sternal and left arm discomfort that has been going on for about three hours. Which laboratory test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol? A. Creatinine kinase MB level B. Troponin 1 level C. Myoglobin level D. C-reactive protein level

b

The 66 year old male has his blood pressure checked at a health fair. The BP is 168/98. Which action should the nurse implement first A. Recommend the client had his blood pressure checked in one month B. Instruct client to see his healthcare provider as soon as possible C. Discussed the importance of eating a low salt, low-fat, low cholesterol diet D. Explain that this BP is within normal range for an elderly person

b

The HCP prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with congestive heart failure (CHF). Which instruction should the nurse provide? A. Eat a banana or drink orange juice at least twice a day. B. Notify the HCP if you develop localized edematous areas that itch. C. A dry cough is expected early in the morning on arising. D. The symptoms of CHF should improve rapidly.

b

The HCP prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with CAD. Which should the nurse teach about this medication? A. take this medication on empty stomach B. this medication should be taken in the evening C. do not be concerned if muscle pain occurs. D. Check your cholesterol level daily.

b

The client diagnosed with congestive heart failure (CHF) is prescribed the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec). Which statement explains the scientific rationale for administering this medication? A. ACE inhibitors increase the levels of angiotensin II in the blood vessels. B. ACE inhibitors dilate arteries, which reduces the workload of the heart. C. ACE inhibitors decrease the effects of bradykinin in the body. D. ACE inhibitors block the action of antidiuretic hormone in the kidney.

b

The client diagnosed with coronary artery disease is prescribed atorvastatin (Lipitor), an HMG-CoA reductase inhibitor. Which statement by the client would warrant the nurse notifying the health-care provider? A. "I really haven't changed my diet, but I am taking my medication every day." B. "I am feeling pretty good except I am having muscle pain all over my body." C. "I am swimming at the local pool about three times a week for 30 minutes." D. "I am taking this medication first thing in the morning with a bowl of oatmeal."

b

The client tells the nurse that his cholesterol level is 240. Which action should the nurse implement? A. praise the client for having a normal cholesterol level B. Explain that the client needs to lower the cholesterol level. C. Discuss dietary changes that could help increase the level. D. Allow the client to ventilate feelings about the blood test result

b

The client with a serum cholesterol level of 320 mg/dL is taking the antihyperlipi- demic medication ezetimibe (Zetia). Which statement by the client indicates the client needs more teaching concerning this medication? A. "This medication helps decrease the absorption of cholesterol in my intestines." B. "I cannot take this medication with any other cholesterol-lowering medication." C. "I need to eat a low-fat, low-cholesterol diet even when taking the medication." D. "It will take a few months for my cholesterol level to get down to normal levels."

b

The client with essential hypertension is prescribed the beta blocker metoprolol (Lopressor). Which assessment data would make the nurse question administering this medication? A. The client's blood pressure is 112/90. B. The client's apical pulse is 56. C. The client has an occipital headache. D. The client is complaining of a yellow haze.

b

The nurse is discussing the thiazide diuretic chlorothiazide (Diuril) with the client diagnosed with essential hypertension. Which discharge instruction should the nurse discuss with the client? A. Encourage the intake of sodium-rich foods. B. Instruct the client to drink adequate fluids. C. Teach the client to keep strict intake and output. D. Explain to take the medication at night only.

b

The nurse is preparing to administer a calcium channel blocker, a loop diuretic, and a beta blocker to a client diagnosed with arterial hypertension. Which action should the nurse implement? A. Hold the medication and notify the HCP on rounds. B. Check the client's blood pressure. C. Contact the pharmacist to discuss the medication. D. Double-check the health-care provider's orders.

b

The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT38 PTT 39 Control 12.9 Control 36 INR 5.9 Which action should the nurse implement? A. Discontinue the intravenous bag immediately. B. Prepare to administer AquaMEPHYTON (vitamin K). C. Notify the health-care provider to increase the dose. D. Administer the medication as ordered.

b

Which data would indicate to the nurse that simvastatin (Zocor), an HMG-CoA reductase inhibitor, is effective? A. The client's blood pressure is 132/80. B. The client's cholesterol level is 180 mg/dL. C. The client's LDL is 180 mg/dL. D. The client's HDL is 35 mg/dL.

b

Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning the diet? A. I will not eat more than six eggs a week B. I should bake or grill any meat I eat C. I will drink 8 ounces of whole milk a day D. I should not eat any type of work products

b

Which of the following clients is at high risk for developing coronary heart disease that may not be responsive to diet and exercise alone? SATA a. a client who has diabetes b. a client who has a strong family history of cardiovascular disease c. a client who is overweight d. a client who is a hemorrhagic stroke at age 40 e. a client who is 73 years old

b, e

The nurse is administering digoxin (Lanoxin), a cardiac glycoside, to a client diag- nosed with congestive heart failure (CHF). Which interventions should the nurse implement? Select all that apply. A. Assess the client's carotid pulse for 1 full minute. B. Check the client's current potassium level. C. Ask the client if he or she is seeing a yellow haze around objects. D. Have the client squeeze the nurse's fingers. E. Teach the client to get up slowly from a sitting position.

b,c

A client who has endocarditis with agitation on the mitral valve suddenly reports severe left foot pain. The nurse notes that no pulses palpable in the left foot and that the foot is cold and pale. Which action should the nurse take next? A. Lower the clients foot below heart level B. Administer oxygen at 4 L per minute to the client C. Notify the healthcare provider about the change in status D. Reassure the client the embolization is common in endocarditis

c

A coin is being admitted with Coumadin toxicity. Which lab data should the nurse monitor? A. BUN levels B. Bilirubin levels C. INR D. PTT

c

A pt with with essential hypertension asked the nurse, why do I have high blood pressure? Which response by the nurse would be most appropriate? A. You probably have some type of kidney disease that causes the high BP B. More than likely you have a high die or insult, fat, and cholesterol C. There is no specific cause for hypertension, but there are many known risk factors D. You were concerned that you have high blood pressure. Looks down and talk

c

The client diagnosed with coronary artery disease is instructed to take 81 mg of aspirin ("children's aspirin" or "adult low-dose aspirin") daily. Which statement best describes the scientific rationale for prescribing this medication? A. This medication will help thin the client's blood. B. Daily aspirin will decrease the incidence of angina. C. This medication will prevent platelet aggregation. D. Baby aspirin will not cause gastric distress.

c

The client diagnosed with stage D congestive heart failure (CHF) has a brain natri- uretic peptide (BNP) level greater than 1500. Which medication would the nurse anticipate the HCP prescribing? A. Captopril (Capoten), an angiotensin-converting enzyme inhibitor, orally. B. Digoxin (Lanoxin), a cardiac glycoside, IVP. C. Dobutamine (Dobutrex), a synthetic catecholamine, IV. D. Metoprolol (Lopressor), a beta blocker, orally.

c

The client on strict bed rest is prescribed subcutaneous heparin. Which data indi- cates the medication is effective? A. The client's current PT is 22, the INR is 2.4, and the PTT is 70. B. The client's calves are normal size, are normal skin color, and are nontender. C. The client performs active range-of-motion exercises every 4 hours. D. The client's varicose veins have reduced in size and appearance.

c

The healthcare provider prescribes an ace inhibitor her for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? A. ace inhibitors prevent beta receptors stimulation in the heart B. This medication blocks the alpha receptors in the vascular smooth muscle C. Ace inhibiters prevent vasoconstriction and sodium and water retention D. ace inhibitors decrease blood pressure by relaxing vascular smooth muscle

c

The male client diagnosed with essential hypertension tells the nurse, "I am not able to make love to my wife since I started my blood pressure medications." Which statement by the nurse would be most appropriate? A. "You are concerned that you cannot make love to your wife." B. "I will refer you to a psychologist so that you can talk about it." C. "You need to discuss this with your health-care provider." D. "Ask your wife to come in and we can discuss it together."

c

The nurse in the HCP's office is completing an assessment on a client who has been prescribed the cardiac glycoside digoxin (Lanoxin) for congestive heart failure (CHF). Which data indicates the medication has been effective? A. The client's sputum is pink and frothy. B. The client has 2" pitting edema of the sacrum. C. The client has clear breath sounds bilaterally. D. The client's heart rate is 78 beats per minute.

c

The nurse is assessing a client diagnosed with CHF. Which signs/symptoms would indicate that the medical treatment has been effective? A. The clients peripheral pitting Adema has gone from 3+ to 4+ B. The client is able to take the radial pulse accurately C. The client is able to perform ADLs without dyspnea D. The client has minimal jugular vein distention

c

The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge instruction should be provided for the client? A. Have the PTT levels checked weekly until therapeutic range is achieved B. Staying at home is best, but if traveling, airplanes are better than automobiles C. Avoid green, leafy vegetables and notify the HCP of red or brown urine D. Where knee stockings with an elastic band around the top

c

The nurse is preparing to administer clopidogrel bisulfate (Plavix), an antiplatelet medication, to the client with coronary artery disease. The client asks the nurse, "Why am I getting this medication?" Which statement by the nurse would be most appropriate? A. "It will help decrease your chance of developing deep vein thrombosis." B. "Plavix will help decrease your LDL cholesterol levels in about 1 month." C. "This medication will help prevent your blood from clotting in the arteries." D. "The medication will help decrease your blood pressure if you take it daily."

c

The nurse is providing discharge instructions for a client prescribed the thiazide diuretic hydrochlorothiazide (Diuril). Which instruction should the nurse include? A. Drink at least 8 to 10 glasses of water a day. B. Weigh monthly and report the weight to the HCP. C. Eat bananas or oranges regularly. D. Try to sleep in an upright position.

c

The nurse knows the client understands the teaching concerning a low-fat, low cholesterol diet when the client selects which meal? A. Fried fish, garlic mashed potatoes, and Iced tea B. Ham and cheese on white bread and whole milk C. Baked chicken, baked potato, and skim milk D. A hamburger, french fries, carbonated beverage

c

Essential hypertension has been prescribed an alpha androgenic blocker. Which intervention should the nurse discuss with the client? A. Eat at least one banana do to help increase potassium B. Explain the importance is an expected side effect of this medication C. Take the medication on an empty stomach to increase absorption D. Change position slowly when going from lying to sitting position

d

The client diagnosed with essential hypertension is taking the loop diuretic bumetanide (Bumex). Which statement by the client would warrant notifying the client's health-care provider? A. "I really wish my mouth would not be so dry." B. "I get a little dizzy when I get up too fast." C. "I usually have one or two glasses of wine a day." D. "I have been experiencing really bad leg cramps."

d

The client diagnosed with peripheral vascular disease is overweight, spoke to packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest of atherosclerotic lesions? A. Being overweight B. Sedentary lifestyle C. high fat, high cholesterol diet D. Smoking cigarettes

d

The client has had a total right hip replacement. Which medication should the nurse anticipate the HCP prescribing? A. The oral anticoagulant warfarin (Coumadin). B. The intravenous anticoagulant heparin. C. The thrombolytic alteplase (Activase). D. The low molecular weight heparin enoxaparin (Lovenox).

d

The client newly diagnosed with coronary artery disease is being prescribed a daily aspirin. The client tells the nurse, "I had a bad case of gastritis last year." Which action should the nurse implement first? A. Ask the client if he or she informed the HCP of the gastritis. B. Explain that regular aspirin could cause gastric upset. C. Instruct the client to take an enteric-coated aspirin. D. Determine if the client is taking any antiulcer medication.

d

The client with coronary artery disease is prescribed nicotinic acid (Niacin). The client complains of flushing of the face, neck, and ears. Which priority action should the nurse implement? A. Instruct the client to stop taking the medication immediately. B. Encourage the client to take the medication with meals only. C. Discuss that this is a normal side effect and will decrease with time. D. Tell the client to take 325 mg of aspirin 30 minutes before taking medication.

d

The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data would warrant notifying the health-care provider? A. The client has lost 5 pounds in the last month. B. The client has trouble hearing low tones. C. The client reports having a funny taste in the mouth. D. The client has hard, dark, tarry stools.

d

The female client diagnosed with congestive heart failure (CHF) tells the nurse that she has been taking hawthorn extract, an over-the-counter medication, since the HCP told her that she had heart problems. Which statement by the nurse would be appropriate? A. "You need to take garlic supplements with hawthorn for it to be effective." B. "You should stop taking this herb immediately because it can cause more prob- lems." C. "This herb can cause bleeding if you take it with your other medications." D. "Some clients find this is helpful, but make sure your HCP is aware of the medication."

d

The nurse is preparing to administer the following medications. Which medication would the nurse question administering? A. The vasodilator hydralazine (Apresoline) to the client with a blood pressure of 168/94. B. The alpha blocker prazosin (Minipress) to the client with a serum sodium level of 137 mEq/L. C. The calcium channel blocker diltiazem (Cardizem) to the client with a glucose level of 280 mg/dL. D. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 3.1 mEq/L.

d

Which medication would the nurse question administering? A. Lisinopril (Zestril), an ACE inhibitor, to a client with a BP of 118/84. B. Carvedilol (Coreg), a beta blocker, to a client with an apical pulse of 62. C. Verapamil (Calan), a calcium channel blocker, to a client with angina. D. Furosemide (Lasix), a loop diuretic, to a client complaining of leg cramps.

d

A patient diagnosed with alcoholic dilated cardiomyopathy is admitted to the hospital. his initial treatment is intravenous digoxin. if you are as later the patient dies as a result of ventricular tachyarrhythmia. which of the following ejection fraction values did the patient most likely have on admission 1. 90% 2. 85% 3. 65% 4. 55% 5. 35%

e

The clinic nurse is evaluating a client who had coronary artery stenting through the right for moral artery a week previously and is taking metoprolol, clopidogrel, and aspirin. Which information report about a client is most important to report to the healthcare provider? A. Stools that have been black in color B. Bruising is present at the right right groin C. Home blood pressure today was 104/52 D. Home radial pulse has been 55-60bpm

1

The client complains of chest pain on deep inspiration. Which intervention should the nurse implement first? A. place the client on oxygen B. Assess the clients lungs C. Notify the respiratory therapist D. Assess the clients pulse ox reading

a

The clinic nurse is assessing a client who is complaining of right leg calf pain. The right Ieg is edematous and warm to the touch. Which intervention should the nurse implement first? A. Notify the clinic HCP immediately B. Ask the client how long the lake has been hurting C. Complete a neurovascular assessment on the leg D. Please place the client right leg on two pillows

a

The health care provider prescribed captopril for a client diagnosed with hypertension. before administering the first dose it is most important for the nurse to make which statement a. remain in bed for the first three hours after taking the first dose of medication b. you may experience a loss of taste c. you may experience some hair loss d. you should increase your intake of fresh vegetables fruit and whole grains

a

During the initial post office assessment of a client who has just been transferred from the PACU after repair of an abdominal aortic aneurysm, the nurse obtained these data. Which finding has the most immediate implications for the clients care? A. Arterial line indicates a blood pressure of 190/112 B. Cardiac monitor shows frequent premature atrial contractions C. There is no response to verbal stimulation D. Urine output is 40 mL of amber urine

a

A nurse in a pediatric clinic is caring for an infant who has heart failure and is taking digoxin. which of the following parent statements indicates a therapeutic response to the medication 1. my baby is breathing easier than before 2. my baby is taking longer naps 3. my baby is having fewer wet diapers and starting this medication 4. my baby's heart rate is faster than it was before the medication

a

A nurse is caring for a client with chronic obstructive pulmonary disease. which of the following clinical findings support the nurses suspicion that the client is developing core pulmonale? 1. peripheral edema 2. productive cough 3. twitching of the extremities 4. lethargy progressing to coma

a

A nurse is reviewing a drug handbook for information prior to teaching a client who is to start taking atorvastatin. which of the following baseline exams should the nurse include information about in the teaching 1. liver function tests 2. hearing function 3. urinalysis 4. dental exam

a

A nurse is teaching a client poison new prescription for daily aspirin. which of the following statements should the nurse make 1. aspirin reduces the formation of blood clots that could cause a heart attack 2. aspirin or leaves pain during a myocardial infarction 3. aspirin dissolves clots that are forming in your coronary arteries 4. aspirin can lower total cholesterol

a

The nurse has received the shift report which client should the nurse assess first? A. The client with a DVT who is complaining of dyspnea and coughing B. The client diagnosed with Berger's disease who has intermediate claudication C. The client diagnosed with aortic aneurysm who has an audible bruit D. The client with an acute arterial ischemia who has bilateral palpable pedal pulses

a

The nurse is administering medication's to clients in the cardiac critical care area. Which client with the nurse question administering this medication? A. The client receiving a calcium channel blocker he was drinking a glass of grapefruit juice B. The client receiving a beta adrenergic blockers who has an apical heart rate of 62 BPM C. The client receiving and said to just finished eating breakfast D. The client receiving an oral anticoagulant with an INR of 2.8

a

The nurse is initiating discharge teaching to a 68-year-old male client who has quadruple coronary bypass surgery. Which priority question should the nurse asked the client? A. Are you sexually active B. Can you still drive your car C. Do you know if you have pain medication at home D. Do you know when to call your HCP?

a

The nurse is caring for a client admitted with new onset atrial fibrillation. Which intervention should be included in the plan of​ care? (Select all that​ apply.) a. Elevate the foot of the bed with knees slightly flexed b. Monitor for tenderness & warmth of bilateral lower extremities c. Teach the pt to report, sharp, stabbing pain in calm d. Monitor for bilateral edema e. Assess extremities for cyanosis

a, b, d, e

A nurse is admitting a client at 12 weeks gestation for treatment of a deep vein thrombosis. which of the following medications is contraindicated in pregnancy? 1. Prasugrel 2. Warfarin 3. Enoxaparin 4. unfractionated heparin

b

The nurse is performing an initial assessment on a client in hypertensive crisis. What is the nurses priority assessment based on the following data: BP 210-120, HR 109, Resp 20 O2 sat 96% a. Heart sounds b. LOC c. Lung sounds d. visual fields and acuity

b

The nurse reviews information about the relationship of psychological risk factors in persons with coronary artery disease. which risk factor does the nurse identify a. Schizophrenia b. Depression c. sleep disturbances d. phobias

c

A resident in a long term care facility who has been as stasis as ulcers is treated with an Unna boot. which nursing activity included in the residence care is best for the nurse to delegate to the UAP? a. teaching family members as signs of infection b. monitoring caps refill once every eight hours c. evaluated for sensation and movement each shift d. assisting the client in cleaning around it unna boot

d

The client diagnosed with atrial hypertension has been taking a calcium channel blocker, a loop diuretic, and an ace inhibitor for three years. Which statement made by the client would warrant intervention by the nurse? A. I have to go to the bathroom a lot during the morning B. I get up very slowly when I have been sitting for a while C. I do not salt my food when I'm cooking it but I added the table D. I drink grapefruit juice every morning with my breakfast

d

A nurse is caring for the hospitalized client after hip replacement. when monitoring the client for post op complications which of the following does the nurse understand is a sign of pulmonary embolism 1. Anxiety 2. Brady cardia 3. pleuritic chest pain 4. hypoventilation 5. hypertension

a, c

A nurse is reviewing the lab data of four clients. The nurse should identify that which of the following results indicates the client is at risk for heart disease? SATA 1. Total cholesterol 245 2. HDL 90 3. LDL 140 4. Triglycerides 125 5. C reactive protein 0.5

a, c

A nurse is preparing a teaching plan for a client who requires assistance in lowering LDL cholesterol levels. which of the following foods should the nurse recommend is having high fiber content? SATA 1. Beans 2. Cheese 3. whole grain 4. oats 5. yogurt

a, c, d

The clinic nurse obtained this information about a client who is taking warfarin after having a DVT. Which finding is most indicative of a need for a change in therapy? A. Blood pressure is 106/54 B. International normalized ratio is 1.2 C. Bruises are noted at sides were blood has been drawn D. Client reports eating a green salad for lunch every day

b

The nurse is preparing to hang the next bag of heparin to a client diagnosed with deep vein thrombosis. The client's current laboratory values are as follows: PT 12.7 PTT 62 Control 12.9 Control 36 INR 1 Which intervention should the nurse implement? A. Hang the intravenous bag at the same rate. B. Order a STAT PT/INR/PTT. C. Notify the health-care provider. D. Assess the client for abnormal bleeding.

a

The nurse is teaching a class about atherosclerosis. Which modifiable risk factor should the nurse discussed teaching about atherosclorosis? A. Stress B. Gender C. Age D. Family history

a

The nurse is teaching the dash diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the dash diet? A. I should eat at least 4 to 5 servings of vegetables a day B. I should eat meat that has a lot of white streaks in it C. I should drink no more than two glasses of whole milk per day D. I should decrease my grain intake to no more than twice a week

a

The nurse is working in an outpatient clinic or money back for the diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to the UAP? A. Measuring ankle and brachial pressures in the client for whom the ankle brachial index is to be calculated B. Checking blood pressure and pulse every 10 minutes for a client who is undergoing exercise testing C. Obtaining information about how do use from a client who is scheduled for a left leg contrast venography D. Provide a brief client teaching for a client who will undergo a right subclavian vein doppler study

a

The nurse is working with an experienced unlicensed assistive personnel and LPN on the Telementry unit. A client who had an acute myocardial infarction three days ago has been reporting fatigue and chest discomfort when ambulating. Which nursing activity included in the care plan is best assigned to the LPN? A. Administer nitroglycerin 0.4 mg sublingual leave chest is comfort occurs during client activities B. Monitoring pulse, blood pressure and oxygen saturation before and after client ambulation C. Teaching the client energy conservation techniques to decrease myocardial oxygen demand D. Explaining the rationale for alternating rest periods with exercise for client and family

a

The nurse just received the a.m. shift report which client should the nurse assessed first? A. The client who is six hours post-op vein ligation who has absent pedal pulses B. The client diagnosed with DVT who is complaining of calf pain C. The client with Raynauds disease who has throbbing and tingling in the extremities D. The client with Buerger's disease who has intermediate codification of the feet and arms

a

The nurse preparing to administer two units of packed red blood cells to a client diagnosed with CHF. Which HCP orders should the nurse question? A. Administer each unit over two hours B. Administer the loop diuretic furosemide IV push once C. Restrict the clients fluids to 1000 mL per 24 hours D. Have a complete complete blood count done the following morning

a

The nurse provides care for a client receiving both digoxin and hydrochlorothiazide. the nurse understands a major adverse effect of hydrochlorothiazide include which finding a. Hypokalemia b. Hyperkalemia c. Hyponatremia d. Oliguria

a

The nurse receives handoff report on assigned clients. which client should the nurse assess first a. client one day post femoral-popliteal bypass surgery who now has non palpable pedal pulse present only with Doppler b. client with chronic venous insufficiency who has edema and brown discoloration in the lower extremities c. pt with peripheral artery disease and gangrene of the foot who has a cool to the touch hairless extremity d. pt with peripheral arterial disease who reports severe cramping pain in the calf with activities such as walking

a

Where does the nurse place the stethoscope to auscultate heart sounds in the aortic area a. to the right of the sternum near the manubrium b. two the left of the sternum at the angle of Louis c. directly over Erb point d. slightly below the point of maximal impulse

a

The nurse should recommend the following activities to a patient with heart failure 1. Walking 2. Increase fiber 3. Stool softener 4. Drink extra water

a, b, c

The nurse should assess which client for possible deep venous​ thrombosis? (Select all that​ apply.) a. Client with bilateral lower extremity edema but slightly greater in the left lower extremity b. a client who recently had surgery but has no reports of pain or swelling in lower extremity c. the client with cyanosis on the right lower extremity d. client was sharp stabbing pain in the right lower extremity only when walking e. The client would cap the refill less than three seconds in one lower extremity in four seconds in the other

a, b, c, e

The cardiac nurse is teaching a client diagnosed with CHF. Which teaching intervention should the nurse discuss with the client? Select all that apply. A. Notify the healthcare provider if the client gains more than 2 pounds in one day B. Keep the head of the bed elevated when sleeping C. Take the loop diuretic once a day before going to sleep D. Teach the client which foods are high in sodium and should be avoided E. Perform isotonic exercises at least once a day

a, b, d, e

A nurse is collecting data from a client who has peripheral artery disease and is scheduled for a right lower extremity amputation. which of the following findings should the nurse expect in the affected extremity? SATA 1. Skin cool to touch from mid calk to toes 2. Develop rubor when extremity is in a dependent position 3. Palpable pounding pedal pulse 4. Excess hair growth on lower leg 5. Blackened areas on several toes

a, b, e

A nurse is instructing a client with low potassium about foods that may help boost potassium levels. which of the following foods that are high in potassium should the nurse recommend. SATA 1. Avocado 2. Banana 3. Lettuce 4. Cucumber 5. Apple 6. Orange

a, b, f

The nurse on a cardiac unit is caring for a client admitted with an acute exacerbation of heart failure. the nurse concludes that the client's condition is worsening after noting which client data during assessment? SATA a. normal sinus rhythm that becomes sinus tachycardia b. urine drainage is increased in amount c. onset of a cough with pink frothy sputum d. presence of dyspnea at rest e. falls asleep when not disturbed

a, c, d

While ambulating in the hallway with the nurse the client diagnosed with myocardial infarction complains of chest pain. Which intervention should the nurse implement? A. Administer nitroglycerin 0.4 mg sublingual stat B. Have a client walk back to the room C. Take the clients vital signs D. Place the client on supplemental oxygen E. Ask the word secretary to call the healthcare provider for orders

a, c, d

Which topics will the nurse plan to include in discharge teaching for a client with been admitted with heart failure? select all that apply a. How to monitor and record daily weight b. importance of stopping exercise and heart rate increases c. symptoms of worsening heart failure d. purpose of chronic antibiotic therapy e. how to read food labels for sodium content f. date and time for follow up appointments

a, c, e, f

A client who has a strong family history of coronary artery disease asks the​ nurse, "How can I decrease my chances of developing problems with my​ arteries?" Which response by the nurse is​ appropriate? (Select all that​ apply.) a. You can reduce your risk by making some changes in your lifestyle such as moderate exercise b. there is little you can do except take medication to prevent coronary artery disease c. as long as your cholesterol is normally arteries will remain clear d. keeping your blood pressure within normal levels will decrease the risk of injury to your arteries e. a diet high in fruit vegetables and unsaturated fatty acids may help protect your arteries

a, d, e

The healthcare provider prescribes these actions for a client who was admitted with acute sub sternal chest pain. Which actions are appropriate to assign to an experienced LPN who is working in the emergency department? Select all that apply. A. Attaching cardiac monitor leads B. Giving heparin 5000 units IV push C. Administering morphine sulfate 4 mg IV D. Obtain a 12 lead electrocardiogram E. Having the the client chew and swallow aspirin 162mg

a, d, e

The nurse is administering medications to treat heart failure. Which of the following belong to this general classification of drugs? SATA 1. Digoxin 2. Paroxetine 3. Cisplatin 4. Fosinopril 5. Triamterene 6. Furosemide

a, d, e, f

A client has been diagnosed with borderline hypertension and is given a blood pressure monitor to take daily BP readings. What instructions would be appropriate for the nurse to give the client for taking home blood​ pressure? a. "Blood pressure readings will be erroneously high if the arm is above the level of the​ heart." b. ​"Rest for at least 5 minutes before taking blood pressure and at least 30 minutes after drinking caffeinated​ beverages." c. ​"Blood pressure should be taken before getting up in the​ morning, with the arm elevated over the level of the​ heart." d. ​"Take blood pressure at different times every day to be sure it is not elevated at different times of the​ day."

b

A clinic nurse is caring for a client who has hypertension in its prescribed hydrochlorothiazide, lisinopril and clonidine. the current blood pressure reading is 190/102 in the client reports a headache that has lasted several days. which question is most important for the nurse to ask a. have you notice any abnormal swelling in your legs b. how are you currently taking your blood pressure medication c. how is your stress level been the past few weeks d. what over the counter medications have you taken today

b

A nurse is caring for a client who has a new prescription for heparin. The nurse should identify that which of the following statements by the client is a priority to report 1. I'm allergic to morphine 2. I take antacids several times a day 3. I had a blood clot in my leg several years ago 4. I've been taking antibiotics for urinary track and back home

b

A nurse is caring for a client with a nursing diagnosis of fluid volume excess related to heart failure. which of the following lab values would the nurse expect to see in a client with this diagnosis 1. decrease be type natriuretic peptide BNP 2. Decrease serum sodium 3. increase hemoglobin 4. increase albumin

b

A nurse is caring for a client with heart failure who has signs of reduced cardiac output. which best describes cardiac output 1. the stroke volume compared to body surface area 2. the volume of blood ejected from the ventricle in one minute 3. the volume of blood ejected from the ventricle with each heartbeat 4. the amount of blood returning to the heart before contraction

b

A nurse is planning to administer IV alteplase (Activase) to a client who is demonstrating manifestations of an acute pulmonary embolism. which of the following actions should the nurse plan to take 1. administer enoxaparin along with the alteplase dose 2. hold direct pressure on puncture sites for up to 30 minutes 3. administer aminocaproic acid IV prior to the alteplase infusion 4. administer the alteplase over 2 hours

b

A nurse is teaching a client who has a new prescription for atorvastatin. the nurse should tell the client to notify the health care provider for which of the following symptoms 1. headache 2. muscle pain 3. cough 4. frequent urination

b

A nurse receives lab data for 4 clients. which of the following requires immediate intervention 1. A pt with acute leukemia who has a white blood cell count of 4000 2. a client with a deep vein thrombosis who has a PT of 50 3. a client with hypertension and diabetes who has triglycerides of 320 4. a client with peptic ulcer disease and GI bleed who has a hemoglobin of 10 & hct of 30%

b

A pt is taking verapamil in the sustained release form that was prescribed one month ago. The pt reports having a mild headache since starting this medication. which information did the nurse provides the client a. this is an unrelated symptom and should be reported b. this medication often causes headache which may improve with time c. this medication should be stopped until the headaches disappear d. the client should go immediately to the emergency department

b

Client seen in the clinic with shortness of breath and fatigue is being evaluated for possible diagnosis of heart failure. Which laboratory result will be the most useful to monitor? A. Serum potassium B. B type natriuretic peptide C. Blood urea nitrogen D. Hematocrit

b

The healthcare provider telephones the nurse with new prescriptions for a client with angina it was already taking aspirin. Which medication is most important to clarify further with the healthcare provider? A. Clopidogrel 75 mg per day B. Ibuprofen 200 mg every four hours PRN C. Metoprolol 50 mg per day D. Nitroglycerin patch 0.4 mg/h

b

The nurse in the cardiovascular clinic receives telephone calls from four clients. Which client should the nurse schedule to be seen most urgently? A. Client with peripheral artery disease who complains of leg cramps when walking B. Client with atrial fibrillation who reports episodes of lightheadedness and syncope C. Client with a new permanent pacemaker who has severe itching us at the wound site D. Client with angina who took nitroglycerin twice in the last week while exercising

b

The nurse is caring for a client who has heart failure and has a new prescription for Zach use the trail valsartan. Which client information is most important to discuss with the healthcare provider before administration of this medication? A. The clients oxygen saturation is 92% B. The client receives the lisinopril 10 mg per day C. The clients blood pressure is 150/90 D. The clients potassium is 3.3

b

The nurse is just received change of shift report about these clients on the corner a step down unit which one should be assessed first? A. A 26-year-old with heart failure caused by congenital mitral stenosis who is scheduled for balloon valvuloplasty later today B. 45-year-old client with constructive cardiomyopathy who developed acute dyspnea and agitation about one hour before shift change C. A 56-year-old who underwent coronary angioplasty and stent placement yesterday and is reported occasional chest pain since procedure D. 77-year-old client who is transferred from the ICU after coronary artery bypass graft in who has a temperature of 100.6°F

b

Which one is best for the coronary care charge nurse to assign to afloat RN who is come home for the day from a general medical surgical unit? A. Client requiring discharge teaching about coronary artery stenting before going home today B. Client receiving IV furosemide to treat acute left ventricle failure C. Client who just transferred in from radiology department after a coronary angioplasty D. Client admitted with unstable angina who has orders for heparin infusion and aspirin

b

The nurse provides discharge instructions to a client who was hospitalized for deep venous thrombosis that is now resolved. which of the following instructions to the nurse include to prevent recurrence of DVT? SATA a. do not take car rides longer than four hours for at least three to four weeks b. drink plenty of fluids every day and limit caffeine and alcohol c. elevate legs on a footstool when sitting and dorsiflex the feet often d. resume your walking program as soon as possible after getting home e. sitting across legged position for five to 10 minutes to improve circulation

b, c, d

The nurse is planning care for a client with a deep venous thrombosis of the right calf. Which should the nurse include in this​ client's plan of​ care? (Select all that​ apply.) a. Assisting to a sitting position with the legs dependent q 4 h b. Measuring the calf & thigh diameter of the right leg q shift c. Applying war, moist heat to the affected area q 6 h d. Coaching to perform deep breathing & coughing q 2 h e. Encouraging ROM exercises q 2-4 h

b, c, d, e

1. A female client is undergoing diagnostic testing for coronary heart disease. The nurse should assess for which symptoms that are indicative of heart​ disease? (Select all that​ apply.) a. HA b. Indigestion c. Abdominal fullness d. Insomnia e. Chronic fatigue

b, c, e

A nurse is teaching a class in a Wellness clinic about low sodium diets and how they are used in the treatment of hypertension. which of the following statements by the attendee indicates an understanding of the teaching? SATA 1. I should select organic canned vegetables 2. I need to read food labels when grocery shopping 3. I will eat frozen dinners for lunch at work 4. I know that deli meats are usually high in sodium 5. I can season foods with herbs lemons or spices

b, d, e

A nurse is caring for a client with a new prescription of warfarin. which of the following about this medication 1. partial thromboplastin time values determine the warfarin dosage 2. protamine is used to reverse warfarin effects 3. international normalized ratio INR is used to assess effectiveness 4. warfarin will facilitate blood clotting

c

A nurse is evaluating a client with hypertension and benign essential tremor who just started Propranolol 3 hours ago for treatment. which of the following findings is most concerning and should be prioritized for reporting to the HCP 1. the client has a blood pressure of 150/90 2. the client has a heart rate of 68 down from 80 3. the client has wheezing on auscultation 4. the client has a headache

c

A nurse is instructing a client about a new prescription for digoxin. in addition to instructing that the prescribed dose of digoxin should be withheld and the presence of a decreased pulse rate, the nurse will also teach the client to withhold the medication with the client experiences which of the following 1. decreased urinary output 2. chest pain 3. blurred vision 4. Singultus

c

A nurse is presenting a community education program about lifestyle changes to reduce the risk for CAD. Which of the following changes should the nurse recommend? 1. Limit sodium intake to 2,000 mg/day 2. Perform moderate exercise for 75 min/wk 3. Increase dietary fiber to 20 g/day 4. Take 900 mg of st john's wort each day

c

A pt diagnosed with iron deficiency anemia receives heparin after a venous thrombus embolism is diagnosed in the left leg. which observation most concerns centers a. the client passes a black stool b. the client is pale c. the client has a Nosebleed d. the client is confused

c

After receiving a report from the day nurse which client should the oncoming night shift nurse assess first 1. a client who is 2 days post op open cholecystectomy who reports a fever, shortness of breath and productive cough 2. a client who is 1 day post op prostatectomy with an indwelling catheter a fever & cloudy urine 3. A client who is 2 days post op reduction and internal fixation of a femur fracture with a new onset of shortness of breath and chest pain 4. A client who has gallstones pancreatitis and request pain medications for severe epigastric pain

c

During the home visit to an 88-year-old client who is taking digoxin 0.25 mg per day to treat heart failure and atrial fibrillation the nurse obtained this assessment information. Which finding is most important to communicate to the healthcare provider? A. Apical pulse 68 bpm and the regular B. Digoxin taken with meals C. Vision that is becoming fuzzy D. Long crackles that clear after coughing

c

Her client to systolic blood pressure is always higher than 140 in the clinic told the nurse my blood pressure at home is always fine which action should the nurse take next? A. Instruct the client about effects of untreated high blood pressure on the cardiovascular and cerebral vascular systems B. Educate client about lifestyle changes such as low sodium diet, daily exercise, and restricting alcohol used to know more than two beers per day C. Ask the client to obtain blood pressure twice a day with an automatic by blodpressure cuff at home and bring the results back to the clinic in a week D. Provide the client with a handout describing the various types of antihypertensive medication's with the medication affects and adverse effects

c

Nurse is participating as a team member in the resuscitation of a client who has a cardiac arrest. The healthcare provider who is directing the resuscitation asked the nurse to administer of an effort and 1 mg IV. After giving the medication, which action should the nurse take notes? A. Prepare to defibrillate the client B. Offer to take over chest compressions C. State epinephrine 1 mg IV has been given B. Continue to monitor the client responsiveness

c

The cardiac nurse received lab results on the following clients. Which client wants immediate intervention from the nurse? A. The client who has an INR of 2.8 B. With a client who has a serum potassium level of 3.8 C. The client who has a serum digoxin level of 2.6 D. The client who has a glycosylated hemoglobin of 6%

c

The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction. Which action will the nurse take first A. Insert an IV catheter B. Auscultate heart sounds C. Administer sublingual nitroglycerin D. Draw for troponins one measurement

c

The nurse in the CC cardiac unit is in ministering medication's to a client. Which intervention should the nurse implement first? A. Check the radio pulse before administering digoxin a cardiac glycoside B. Monitor the amiodarone and level up for the client receiving amiodarone C. Obtain the latest PTT results on a client with a heparin drip. D. Check the liver function panel for the phone receiving at opening up

c

The nurse in the cardiac unit is preparing to administer medications after receiving morning change of shift report. Which medication should the nurse administer first? A. The cardiac glycoside to the client has an apical pulse of 58 B. The loop diuretic to a client with a serum potassium level of 3.2 C. The anti-dysrhythmic to the client in ventricular fibrillation D. The calcium channel blocker who has a blood pressure of 110/68

c

The nurse instructed client diagnosed with atrial fibrillation receiving lisinopril. which statement if made by the client to the nurse indicates the need for further teaching a. I had to limit the amount of canned soup, lunch meat and cheese I eat b. I will decrease the number of oranges bananas and apricots in my diet c. I have switched to a salt substitute instead of iodized salt d. I do not include as much broccoli, potatoes, and weepy green vegetables in my diet

c

The nurse is administering medication to clients on a cardiac unit. Which medication should the nurse question administering? A. The loop diuretic furosemide on a client who had a 320 ML output in four hours B. The anticoagulant a Knox apparent to a client who had open heart surgery C. The anti-platelet ticlodipine to a client being prepared for surgery. D. The ACE inhibitor captopril to a client with who a BP of 100/68

c

The nurse makes a home visit to evaluate a hypertensive client who has been taking an article. Which finding is most important to report to the healthcare provider? A. Client reports frequent urination B. Client reports blood pressure is 138/86 C. Client complains about a frequent dry cough D. Client says I get dizzy sometimes if I stand up fast

c

A client with newly diagnosed chronic heart failure is being discharged home. which statement by the client indicates a need for further teaching by the nurse? SATA a. I do not plan on eating anymore frozen meals b. I plan to take my diuretic pill in the morning c. I will weigh myself at least every other day d. I'm going to look into joining a cardiac rehab program e. ibuprofen works best for me when I have pain

c, e

A nurse is caring for a client who has a family history of heart disease. which of the following laboratory test should the nurse recognize as the greatest risk factor for atherosclerotic coronary vascular disease? 1. high density lipoprotein cholesterol 75 milligrams 2. high density lipoprotein cholesterol 80 milligrams 3. low density lipoprotein cholesterol 75 milligrams 4. low density lipoprotein cholesterol 190 milligrams

d

A nurse is reviewing the DASH diet for hypertension with a client during discharge teaching. which of the following statements by the client indicates an understanding of the teaching 1. my daily sodium consumption should be 3000 milligrams 2. I should consume foods that are low in potassium 3. I need to lose at least 25 pounds to see a decrease in my blood pressure 4. I should consume low fat dairy products

d

At 9 PM the nurse and it's a 63-year-old client with a diagnosis of acute myocardial infarction. Which finding is most important to communicate to the healthcare provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator (alteplase) for the client? A. The client was treated with alteplase about eight months ago B. The client takes famotidine for gastroesophageal reflux disease C. The client has ST segment elevation on the electrocardiogram D. The client reports having continuous chest pain since 8 AM

d

The nurse has given morphine sulfate 4 mg IV to a client who is having an acute myocardial infarction. When evaluating the clients response five minutes after giving the medication, which finding indicates a need for immediate further action? A. BP decreased from 114/65 to 106/58 B. Respiratory rate drops from 18 to 12 breaths per minute C cardiac monitor indicating sinus rhythm at a rate of 96 BPM D. Persisting chest pain at a level of one

d

The nurse in the cardiac rehab unit knows the maintenance dose of oral digoxin for adults is in which range? a. 1.0 to 3.0 mg b. 0.5-1.0 mg c. 3.5-5.0 mg d. 0.125-0.5 mg

d

The nurse in the cardiac unit is discussing case management with a client who asked why do I need a case manager for my heart disease? Which statements are most appropriate for the nurse to respond? Select all that apply. A. Case management helps contain the cost of your healthcare B. It will help enhance her quality of life with a chronic illness C. It decreases the fragmentation of care across many healthcare settings D. Case management is a form of health insurance for clients with chronic illness E. We try to provide quality care along the health care continum

d

The nurse is caring for client recently diagnosed with a deep vein thrombosis. which action by the client would require immediate intervention by the nurse a. the client has a temperature of 100 F b. the client is ambulating up and down the hallways c. the client is breathing at a rate of 16 d. the client is massaging the leg at the site of inflammation

d

The nurse is preparing to administer the following medication's to a client with multiple health problems has been hospitalized with DVT. Which medication is most important to double check with another licensed nurse? A. Famotidine 20 mg IV B. For us my 40 mg IV C. Digoxin 0.25 mg PO D. Warfarin 2.5 mg PO

d

The nurse is preparing to administer the following medications with client with multiple health problems who has been hospitalized with DVT. which medication is most important to double check with another licensed nurse a. famotidine b. furosemide c. dioxin d. warfarin

d

When the nurse is monitoring a 53-year-old client who is undergoing treadmill stress test, which finding will require the most immediate action? A. Blood pressure of 152/88 B. Heart rate of 134 C. Oxygen saturation of 91% D. Chest pain level of three on a scale of 0 to 10

d

Which action by the UAP indicates to the nurse the UAP understands the correct procedure for applying compression stockings to the client recovering from a pulmonary embolus? A. The UAP instruct the client to sit in the chair when applying the stockings B. The UAP cannot insert one finger under the proximal end of the stocking C. The UAP ensured the toe opening is placed on the top side of the feet D. The UAP checked to make sure the clients toes were warm after putting the stockings on

d

Which client should I telementry nurse assess first after receiving a.m. shift report? A. The client diagnosed with DVT who has edematous right calf B. The client with mitral valve stenosis who has heart palpitations C. The client diagnosed with atrial occlusive disease who has intermediate claduation D. The client diagnosed with CHF who has pink frothy the sputum

d

Which client warrants immediate intervention by the nurse? A. The client diagnosed with pericarditis who has chest pain with inspiration B. The client with mitral valve regurgitation who has three peripheral pulses C. The client diagnosed with Marfan syndrome who has pectus excavatum D. The client diagnosed with atherosclerosis who has blurred speech and drooling

d