Cardiac
The optimal therapeutic range for digoxin is
0.5 to 0.8 ng/mL.
The therapeutic range for prothrombin time is ____________ times the control for clients at risk for thrombus.
1.5 to 2
Nitroglycerin tablets are usually prescribed __________every ______________minutes PRN (as needed) for chest pain for the hospitalized client, up to a total dose of _________-- tablets
1;5; 3
Regarding bleeding secondary to Warfarin therapy: For mild bleeding, vitamin K should be administered orally; a dose of 10 to 20 mg will cause prothrombin levels to normalize within _______________ hours. If bleeding is severe, ________________ vitamin K is indicated.
24; parenteral
In adults, the cardiac output ranges from ___________________ L/min.
4 to 7
Thrombolytics are most effective when started within ________________hours after symptom onset and act to dissolve or lyse existing thrombi that are causing a blockage.
4-6 hours
What medication class if dipyridamole ?
ANTIPLATELET Dipyridamole combined with warfarin sodium is prescribed to protect the client's artificial heart valves. Dipyridamole does not prevent strokes, heart attacks, or hypertension.
____________- is the force against which the ventricle must expel blood.
Afterload
__________________________ is the antidote for thrombolytic therapy.
Aminocaproic acid
___________________ is the individualized measurement of cardiac output, based on the client's body surface area
Cardiac index
_______________ is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy.
Compliance Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance
_____________________is a common early reaction associated with chest discomfort, angina, or MI.
Denial
A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure? 1.The client's digoxin has been withheld for the last 48 hours. 2.The client is wearing a nasal cannula delivering oxygen at 2 L/min. 3.The defibrillator has the synchronizer turned on and is set at 120 joules (J). 4.The client has received an intravenous dose of a conscious sedation medication.
During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular fibrillation. Energy level typically is set at 120 to 200 J for a biphasic machine. The client typically receives a dose of an intravenous sedative or antianxiety agent.
Why is applying pressure to both carotid arteries at the same time contraindicated?
Excess pressure to the baroreceptors in the carotid vessels could cause the heart rate and blood pressure to drop reflexively. In addition, the manual pressure could interfere with the flow of blood to the brain, causing possible dizziness and syncope.
Remember to always assess the client ______________, not the monitoring devices.
FIRST
Which two ACE inhibitors should be taken 1 hour before meals ?
Moexipril Captopril
__________________________ PR intervals indicate first-degree heart block
Prolonged and equal
___________________- has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval.
Sinus dysrhythmia
Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited. TRUE OR FALSE
TRUE
ERP
The effective refractory period (ERP) is the amount of time in which the cell cannot respond to a new conducted stimulus. This period is how the heart stays in rhythm and prevents arrhythmias.
The most significant adverse effect of Epoetin Alfa is
The most significant adverse effect is hypertension, and its use is contraindicated in uncontrolled hypertension.
many medications with names that end in -statin are used to treat high _____________________________
cholesterol levels
The method of action of alteplase is to promote increased blood flow through a _____________ artery and that ______________is of the essence to restore blood flow
closed; time
myocardial ischemia causes cellular __________________________ that alter the processes of _______________________.
derangements; depolarization
Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as ........................
headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting.
Pain of pleuropulmonary origin usually worsens on _____________________
inspiration
Torsemide is a ________________. The medication can produce acute and profound __________ loss, volume and electrolyte depletion, dehydration, _________________blood volume, and circulatory collapse.
loop diuretic; water; decreased
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about _________ hour after a heart attack is experienced and peaks within ________________hours after infarction (Note: less than 90 mg/L is normal).
one; 4-6 hours
____________ is required to meet the metabolic needs of the body. With decreased hemoglobin, such as in iron deficiency anemia, the __________________ capacity of the blood is less than normal. The client feels the effects of this change as ____________.
oxygen; oxygen-carrying; fatigue
An important component of taking digoxin is monitoring the ____________- rate
pulse
Peripheral and sacral edema, jugular vein distention, and organomegaly all are manifestations of problems with ___________________heart function.
right-sided
nitroglycerin patch application instructions
should be applied to a non hairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop.
The kidneys respond to a rise in blood pressure by excreting ________ and excess ____________
sodium; water
Hypertensive clients often have no symptoms until...................................
target organ involvement, which happens with very high blood pressure. This is why it is often noted as the "silent killer."
Dopamine causes vaso______________. The client who is receiving dopamine therapy should be assessed for peripheral vaso__________________related to the action of the medication.
vasoconstriction; vasoconstriction
the heparin sodium dose should be adjusted to maintain a therapeutic level of ___________________ the control value in seconds.
1.5 to 2.5 times The platelet count cannot be used to determine an adequate dosage for the heparin sodium infusion.
The normal PT is ____________________ seconds
11 to 12.5
The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1.120 joules 2.200 joules 3.250 joules 4.350 joules
120 joules For cardioversion procedures, the defibrillator is charged to the energy level prescribed by the HCP. Countershock usually is started at 120 to 200 joules. The number of joules in the remaining options are incorrect.
The recommended INR range for warfarin sodium therapy for atrial fibrillation is ______________________-
2.0 to 3.0
A subcutaneous injection of enoxaparin is performed using the same technique as for a heparin injection. The client should use a ______________-gauge, ⅝-inch (1.5 cm) needle to prevent hematoma formation at the injection site. The client should be taught to _____________ the skin rather than placing it flat. The area should not be ___________ after injection.
25- to 27 gauge; bunch; massaged
Exercise is most effective when done at least ________________ times a week for 20 to 30 minutes to reach a target heart rate.
3
The normal cardiac output for the adult can range from __________ to ___________________ L/min.
4-7
The nurse should encourage regular use of pain medication for the first _______________________ hours after cardiac surgery because analgesia will promote rest, ___________________ myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation.
48-72; decrease
Thrombolytic drugs are administered within the first ____________ hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.
6
Regarding pain, what should the nurse teach the client with unstable angina to report immediately to her physician?
A change in the pattern of her pain
agranulocytosis
A life-threatening drop in white blood cells. Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood. This condition is sometimes produced by the atypical antipsychotic drug clozapine.
characteristics of venous stasis ulcer
A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion.
The nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item? 1.Bananas 2.Broccoli 3.Antacids 4.Cantaloupe
ANTACIDS The sodium level can increase with the use of several types of products, including toothpaste and mouthwash; over-the-counter medications such as analgesics, antacids, laxatives, and sedatives; and softened water and mineral water. Clients are instructed to read labels for sodium content. Water that is bottled, distilled, deionized, or demineralized may be used for drinking and cooking. Fresh fruits and vegetables are low in sodium.
Enalapril is an angiotensin-converting enzyme inhibitor. ________________ is an adverse effect, which can lead to swelling of the tongue and lips, which, can result in airway occlusion. Nausea, insomnia, and a cough can occur as side, not adverse, effects of the medication.
Angioedema
Atenolol hydrochloride is prescribed for a hospitalized client. The nurse should perform which action as a priority before administering this medication?
Atenolol hydrochloride is a beta blocker that is used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is lower than 90 mm Hg or the apical pulse is 60 beats/min or slower, the medication is withheld and the health care provider is notified
Propranolol is a beta blocker. __________________________ could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not _____________________, such as propranolol, may induce this reaction, particularly in clients with ___________________________
Audible expiratory wheezes; cardioselective; chronic obstructive pulmonary disease or asthma
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value comes back elevated? 1.Myoglobin 2.Troponin 3.C-reactive protein 4.Creatine kinase (CK)
Cardiac troponin elevations indicate myocardial injury or infarction. Although the remaining options may also rise, they are not definitive enough to draw a conclusive diagnosis.
Ferrous sulfate is an iron supplement used to treat anemia. __________________ is a frequent and uncomfortable side effect associated with the administration of oral iron supplements.
Constipation Stool softeners often are prescribed to prevent constipation.
A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.
The nurse is caring for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the health care provider will prescribe which medication to treat the iron overload? 1.Terbinafine 2.Granisetron 3.Ketoconazole 4.Deferoxamine
Deferoxamine is a medication used to treat iron overload. Granisetron is an antiemetic. Ketoconazole and terbinafine are antifungal medications.
Enoxaparin sodium is prescribed for a client after hip replacement surgery. Which medication should the nurse anticipate to administer in the event of enoxaparin sodium overdose? 1.Epinephrine 2.Phytonadione 3.Protamine sulfate 4.Diphenhydramine
Enoxaparin sodium is an anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Epinephrine is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms. Phytonadione is the antidote for warfarin sodium. Diphenhydramine is an antihistamine
Direct-acting vasodilators have which of the following effects on the heart rate?
Heart rate increases in response to decreased blood pressure caused by vasodilation.
The nurse is caring for a client after an above-the-knee amputation. The nurse assesses the residual (remaining) limb and expects to note which finding?
Pink color to the skin flap Following above-the-knee amputation, the nurse's primary focus is to monitor for signs indicating that there is sufficient tissue perfusion and no hemorrhage. The skin flap at the end of the residual (remaining) limb should be pink in a light-skinned person and not discolored (lighter or darker than other skin pigmentation) in a dark-skinned person. The area should be warm but not hot. If the area is hot this could indicate inflammation or infection. The incision should be clean and dry with no serous or other fluid leaking from it. There should be a pulse at the closest proximal pulse point. If no pulse is felt, the nurse would assess for a pulse using a Doppler. If no pulse is detected using the Doppler device, this could indicate lack of perfusion and the surgeon would need to be notified.
The nurse should educate the client receiving pravastatin to immediately report which finding? 1.Fatigue 2.Diarrhea 3.Sore throat 4.Muscle pain
Pravastatin is used to treat hyperlipidemia. Muscle pain could indicate rhabdomyolysis, a serious complication of this medication. It must be reported immediately
A client is scheduled for a cardiac catheterization using an iodineagent. Which assessment is most critical before the procedure?
Previous allergy to contrast agents A cardiac catheterization requires an informed consent because it involves injection of an iodine-based contrast agent into the blood vessel. The risk of allergic reaction and possible anaphylaxis is a concern, and the presence of allergies to previous received contrast agents must be assessed before the procedure. An antihistamine or corticosteroid may be given to a client with a positive history or to prevent a reaction. Although the remaining options are accurate, they are not the most critical preprocedure assessments.
The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease? 1.Checking for a rash on the digits 2.Observing for softening of the nails or nail beds 3.Palpating for a rapid or irregular peripheral pulse 4.Palpating for diminished or absent peripheral pulses
Raynaud's disease produces closure of the small arteries in the distal extremities in response to cold, vibration, or external stimuli. Palpation for diminished or absent peripheral pulses checks for interruption of circulation. Skin changes include hair loss, thinning or tightening of the skin, and delayed healing of cuts or injuries. The nails grow slowly, become brittle or deformed, and heal poorly around the nail beds when infected. Although palpation of peripheral pulses is correct, a rapid or irregular pulse would not be noted.
___________________________ sound occurs in the later stage of diastole, during atrial contraction and active filling of the ventricles, and that it is a soft, low-pitched sound that is heard immediately before S1
S4
sustained-release tablets or capsules should never be broken open or mixed with food. TRUE OR FALSE
TRUE
the client should avoid taking over-the-counter medications without checking with the health care provider (HCP) first; they might contain ingredients that could interact with prescribed medication. TRUE OR FALSE
TRUE
The risks to the cardiovascular system from smoking are noncumulative and are not permanent. TRUE OR FALSE .
TRUE Three to 4 years after cessation, a client's cardiovascular risk is similar to that of a person who never smoked In addition, tobacco use and passive smoking from "secondhand smoke" (also called environmental smoke) substantially reduce blood flow in the coronary arteries.
A home health nurse instructs a client about the use of a nitrate patch. The nurse should make which statement to the client to prevent client tolerance to nitrates?
To help prevent tolerance, clients need a 12-hour "no-nitrate" time, sometimes referred to as a pharmacological vacation from the medication.
The nurse is developing a plan of care for a client recovering from pulmonary edema. The nurse establishes a goal to have the client participate in activities that reduce cardiac workload. The nurse should identify which client action as contributing to this goal? 1.Using a bedside commode 2.Sleeping in the supine position 3.Elevating the legs when in bed 4.Using seasonings to improve the taste of food
Using a bedside commode decreases the work of getting to the bathroom or struggling to use the bedpan. The supine position increases respiratory effort and decreases oxygenation. Elevating the client's legs increases venous return to the heart thus increasing cardiac workload. Seasonings may be high in sodium and promote further fluid retention.
Which parameter is the major determinant of diastolic blood pressure?
Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
The nurse is preparing to administer furosemide 40 mg by intravenous (IV) injection (IV push) to a client. The nurse should administer the medication over which time period? 1.10 seconds 2.30 seconds 3.2 minutes 4.5 minutes
When furosemide is administered by IV injection, each 40 mg or fraction thereof should be given over a 1- to 2-minute period. Options of 10 seconds and 30 seconds identify administration times that are too rapid and could cause adverse effects. Five minutes is too slow of a time period for administration and may affect the effectiveness of the IV medication.
Clonidine is an __________________ medication. Side effects of clonidine include ..............
antihypertensive; dry mouth, drowsiness, constipation, and hypotension
Hydralazine is an ___________________ medication used for moderate to severe_____________________. What needs to be monitored ?
antihypertensive; used for moderate to severe hypertension Because the blood pressure and pulse should be monitored frequently after administration, a noninvasive blood pressure cuff should be obtained
Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of _____________________
bleeding.
The client who receives a continuous IV infusion of heparin sodium is at risk for ___________________ The nurse assesses for signs/symptoms of this, which include
bleeding; bleeding from the gums, ecchymosis on the skin, cloudy or pink-tinged urine, tarry stools, and body fluids that test positive for occult blood
Renin, aldosterone, and angiotensin are substances that assist in maintaining ________________________________
blood pressure
Contraindications to the Atenolol include severe ______________cardia, ____________ failure, cardiogenic shock, and heart block greater than _________________degree.
brady; cardiac; first
Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as ____________________________________
broccoli, cabbage, turnip greens, and lettuce.
A client with a diagnosis of MI should not consume __________________ beverages because _________________ products can produce a _____________________ effect, leading to further cardiac ischemia
caffeinated; caffeinated; vasoconstrictive
Verapamil medication class
calcium channel blocker
Prinzmetal's angina results from spasm of the coronary vessels and is treated with __________________________ . ___________________blockers are contraindicated because they may actually worsen the spasm. The risk factors are ____________________, and this type of angina is relatively unresponsive to _____________________ Diet therapy is not specifically indicated.
calcium channel blockers; beta; unknown; nitrates.
Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. It is contraindicated in ____________________________________ It is used with caution in clients with preexisting muscle weakness, asthma, infection with fever, and hepatic or renal insufficiency.
complete AV block, intraventricular conduction defects, and abnormal impulses and rhythms caused by escape mechanisms, and with myasthenia gravis.
Verapamil is a calcium channel blocker. The most common complaint with the use of verapamil is _____________________. Other frequent side effects are _______________________________
constipation; dizziness, facial flushing, headache, and edema of the hands and feet
Exercise after meals can ___________________ the client's tolerance because of shunting of blood to the gastrointestinal tract for digestion.
decrease
The client taking a potassium-losing diuretic such as chlorothiazide should be monitored for _______________ potassium levels. Other possible fluid and electrolyte imbalances that occur with use of this medication include hypercalcemia, hyponatremia, ___________phosphatemia, and ___________magnesemia.
decreased; hypo; hypo
__________________________________ is a complication of Toxic shock syndrome
disseminated intravascular coagulopathy
vasopressor
drug that constricts or narrows the diameter of a blood vessel
An ACE inhibitor is used to treat hypertension or heart failure. An side effect of ACE inhibitors is a characteristic _______________________________ This can be quite bothersome to a client, and the medication may need to be changed. The _________________ is reversible with discontinuation of therapy.
dry, nonproductive cough; cough
medication names that end in the letters -ase are ___________________________
enzymes that break down components of the target system
Clients with chronic kidney disease do not manufacture adequate amounts of _________________________________, which is a glycoprotein needed to synthesize red blood cells
erythropoietin
Sinus tachycardia often is caused by ..........................
fever, physical and emotional stress, heart failure, hypovolemia, certain medications, nicotine, caffeine, and exercise
Atenolol is a beta-adrenergic blocker that is used as an __________________, ___________________, and ________________. It is used to treat conditions such as hypertension and angina pectoris. It is not used to treat the conditions noted in the other options. In addition, its use is contraindicated in the client with heart block greater than _______________- degree
first; antihypertensive, antianginal, and antidysrhythmic
When a client has HF, the goal is to reduce ___________________accumulation One way that this is accomplished is through __________________reduction.
fluid; sodium
Phytonadione-rich foods include _____________________________
green leafy vegetables, fish, liver, coffee, and tea.
The priorities in management of sickle cell crisis are ___________________________ and________________________________
hydration therapy and pain relief. To achieve this, the client is given IV fluids to promote hydration and reverse the agglutination of sickled cells in small blood vessels. Opioid analgesics may be given to relieve the pain that accompanies the crisis
Sodium polystyrene sulfonate is a cation exchange resin used for the treatment of ____________________. The resin passes through the intestine or is retained in the colon. It releases sodium ions primarily in exchange for potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.
hyperkalemia
The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding? Also name 3 other things the nurse should assess for
hypotension The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
Leukocytosis
increase in WBC
Pain of pleuropulmonary origin usually worsens on _____________
inspiration.
Breath sounds are an accurate indicator of _______________________ heart function.
left sided
Warfarin is an anticoagulant that is used for _________term prophylaxis of thrombosis. Clients must receive detailed instructions on the signs of bleeding. Hematuria is a sign of bleeding, which the client should report. _________________ is a common side effect associated with anticoagulant therapy and is almost unavoidable. The client, however, should not stop the medication if bruising occurs. Stiff joints are ___________________ to the use of warfarin, and prevention of a stroke cannot be guaranteed, although risk for thrombotic stroke may be reduced.
long; Bruising; unrelated
The development of Q waves indicates myocardial ______________________
necrosis.
Sickle cell crises are acute exacerbations of the disease. Vaso-occlusive crisis is caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction. Manifestations include ................................................
pallor; fever; painful swelling of hands, feet, and joints; and abdominal pain.
Nursing responsibilities after cardioversion include maintenance first of a _______________ and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection
patent airway
Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially ______________________________Administering furosemide to a client with low electrolyte levels could precipitate ________________________________
potassium, sodium, and chloride; ventricular dysrhythmias.
The volume of blood in the ventricle at the end of diastole determines the ______________-
preload.
What are some actions that stimulate the vagus nerve, and consequently lower the blood pressure and heart rate ?
raising the arms above the head applying pressure over the carotid artery applying pressure over the eyes stimulating a gag reflex when brushing the teeth or putting objects into the mouth bearing down or straining during a bowel movement.
Epoetin alfa stimulates __________ blood cell production. Initial effects should be seen within _________________ weeks, and the hematocrit reaches normal levels in ______________ months.
red; 1-2; 2 to 3 months as the hematocrit rises, blood pressure also may rise transiently
Amiloride is a potassium-_______________ diuretic used to treat edema or hypertension. The daily dose should be taken in the _________________-to avoid nocturia, and the medication should be taken with food to increase bioavailability. Sodium should be restricted or limited as prescribed.
retaining; morning
a serious adverse effect of statins is _____________myolysis, and an early sign of this effect is ________________pain.
rhabdomyolosis; muscle
Liquid iron preparations will _____________ the teeth.
stain
an atrial gallop (S4) is found most commonly in disorders involving increased ______________________of the ventricle.
stiffness
Enoxaparin is an anticoagulant that is administered by the _______________________ route.
subcutaneous
Syringes with a ⅚-inch (1.5 cm) needle are used for ____________________injection. A 1½-inch (3.8cm) needle may be used for ________________________ injection
subcutaneous; intramuscular
Thiazide diuretics, such as hydrochlorothiazide, are _____________-based medications, and a client with a _______________ allergy is at risk for an allergic reaction. A _____________ allergy must be communicated to the pharmacist, health care providers (HCPs), and nurse.
sulfa; sulfa; sulfa
Vasovagal attacks are also known as .................... why do they occur?
syncope Vasovagal attacks or syncope occurs when the client faints because the body overreacts to certain triggers.
The client with anemia is likely to experience shortness of breath and complain of fatigue because of the decreased ability of the blood to carry oxygen to the tissues to meet metabolic demands. The client is likely to have ____________________________cardia, as a result of efforts by the body to compensate for the effects of anemia. Muscle cramps are an unrelated finding. Increased respiratory rate is not an associated finding.
tachycardia
VVI mode pacemaker
the first letter of VVI stands for the chamber paced (in this case, the ventricle) . The second letter of the code stands for the chamber sensed, and the third letter indicates the response to sensing. When a pacemaker is operating in the VVI mode, pacemaker spikes will be observed before the QRS complex if the client does not have his or her own intrinsic beat
Found in the peripheral arteries and veins, alpha-adrenergic receptors cause a powerful ___________________ when stimulated.
vasoconstriction
Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. It is a ________________medication that decreases ______________load. The blood pressure needs to be monitored.
vasodilator; afterload
Digoxin can be used to treat supraventricular dysrhythmias, but is inactive against ____________________ dysrhythmias.
ventricular
phytonadione is also known as
vitamin K
Classic signs of pernicious anemia include
weakness, mild diarrhea, and a smooth red tongue that is sore. The client also may have nervous system signs and symptoms such as paresthesias, difficulty with balance, and occasional confusion.
Clients with heart failure should immediately report these symptoms _____________________________________
weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia.
heart failure is exacerbated by factors that increase the _______________ of the heart
workload
antihypertensives can cause orthostatic____________________.
hypotension
A cardiac catheterization requires an informed consent because it involves ________________________________
injection of an iodine-based contrast agent into the blood vessel.
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by .........................
intake greater than output and by a sudden increase in weight.
Diuretics should be given in the _____________________ whenever possible to avoid____________________
morning; nocturia
Cardiac troponin T or cardiac troponin I have been found to be a protein marker in the detection of _______________________ and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction
myocardial infarction,
The _________________________layer of the heart is damaged when a client experiences an MI.
myocardial This is the middle layer that contains the striated muscle fibers responsible for the contractile force of the heart. The obstruction, which causes the interruption in blood flow and ensuing hypoxia, affects the myocardial layer
The primary effect of a decrease in blood pressure is reduced blood flow to the ____________________.
myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time.
In the first several hours after insertion of a permanent or temporary pacemaker, the most common complication is _____________________________ How does the nurse help prevent this complication ?
pacing electrode dislodgement. The nurse helps prevent this complication by limiting the client's activities of the arm on the side of the insertion site.
Alteplase converts
plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist.
Epoetin alfa should be ____________________ at all times. The bottle should not be _____________________, and the medication should not be frozen because this will affect the chemical composition.
refridgerated; shaken
For the client taking benazepril, what kind of foods should be avoided because they increase the risk for hyper_______________
salt substitutes and high-potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia.
The client with coronary artery disease should avoid foods high in _______________________ and _______________________ such as eggs, whole milk, and red meat because these foods contribute to increases in low-density lipoproteins. The use of ___________________oils is recommended to control hypercholesterolemia. It is not necessary to eliminate all cholesterol and fat from the diet.
saturated fat and cholesterol; polyunsaturated
Sclerotherapy is the injection of a ________________- agent into a varicosity. What does that do ?
sclerosing The agent damages the vessel and causes aseptic thrombosis, which results in vein closure. With no blood flow through the vessel, distention will not occur.
Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of _____________________________________________-
slowing the heart rate, decreasing cardiac output, decreasing myocardial oxygen demand, and decreasing blood pressure.
If a client complains of chest pain, the initial assessment question is to ask the client about _________________________________
the pain intensity, location, duration, and quality.
Alteplase is a __________________medication that is used to manage acute myocardial infarction.
thrombolytic. It lyses thrombi that are obstructing the coronary arteries, decreases infarct size, improves ventricular function, decreases the risk of heart failure, and limits the risk of death associated with myocardial infarction
Nitroglycerin causes ____________________. The major side effect of nitroglycerin is a ______________ that can be alleviated by an analgesic
vasodilation; headache
Nitroglycerin produces peripheral _________________, which _______________myocardial oxygen consumption and demand.
vasodilation; reduces
Morphine sulfate reduces anxiety and dyspnea in the client with pulmonary edema. It also promotes peripheral ____________________and causes blood to pool in the periphery. It decreases pulmonary capillary pressure, which reduces fluid migration into the alveoli. The client receiving morphine sulfate is monitored for signs and symptoms of __________________________ and extreme drops in blood pressure, especially when it is administered _______________________.
vasodilation; respiratory depression; intravenously
Amiodarone is an antidysrhythmic that may be used to treat _______________-- dysrhythmias.
ventricular
Advanced cardiac life support recommends that at least one or two _________________ be inserted in one or both of the antecubital spaces
intravenous lines
Epoetin alfa is administered parenterally by the ______________ or ______________ route. It cannot be given ______________because it is a glycoprotein and would be degraded in the gastrointestinal trac
intravenous or subcutaneous; orally
Milk and eggs inhibit absorption of _______________.
iron
The client should call the health care provider (HCP) if the pulse rate is ______________________ than what the pacemaker is set at because this could be a sign of pacemaker or battery failure
less
Ventricular fibrillation is characterized by the _____________________The rhythm is instantly recognizable by the presence of coarse or fine ______________________ on the cardiac monitoring screen
absence of P waves and QRS complexes; fibrillatory waves
____________________ is the amount of blood the heart is expelling per minute.
Cardiac output is the amount of blood the heart is expelling per minute.
To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse:
Distal to the catheter insertion Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.
Comment on the pain of Myocardial infarctions
pain is not relieved by rest or nitroglycerin tablets. It can radiate. Usually begins spontaneously. Lasts longer than 30 minutes. Accompanied usually by nausea, vomiting, dyspnea, diaphoresis, or anxiety The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. The pain of angina may radiate to the left shoulder, arm, neck, or jaw. It often is precipitated by exertion or stress, is accompanied by few associated symptoms, and is relieved by rest and nitroglycerin. The pain of MI also may radiate to the left arm, shoulder, jaw, and neck. It typically begins spontaneously, lasts longer than 30 minutes, and frequently is accompanied by associated symptoms (such as nausea, vomiting, dyspnea, diaphoresis, or anxiety).
The principal side and adverse effects of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, are _____________________________________
persistent cough, first-dose hypotension, and hyperkalemia The medication is used to treat hypertension. A persistent dry cough is a harmless side effect, although it can be disturbing. If this side effect occurs and is troublesome, the health care provider should be notified so that the medication can be changed to a different one. A rapid pulse and metallic taste in the mouth
A frequent side effect of therapy with any angiotensin-converting enzyme (ACE) inhibitor, including quinapril, is a _______________________. In general, this does not resolve during the course of medication therapy, so clients should be advised to notify the health care provider if it becomes very troublesome.
persistent, dry cough
A home health care nurse is visiting an older client at home. Furosemide is prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates the need for further teaching 1."I will sit up slowly before standing each morning. " 2."I will take my medication every morning with breakfast. " 3."I need to drink lots of coffee and tea to keep myself healthy. " 4."I will call my health care provider if my ankles swell or my rings get tight."
"I need to drink lots of coffee and tea to keep myself healthy." Tea and coffee are stimulants and mild diuretics. These are a poor choice for hydration. Sitting up slowly prevents postural hypotension. Taking the medication at the same time each day improves compliance. Because furosemide is a diuretic, the morning is the best time to take the medication so as not to interrupt sleep. Notification of the health care provider is appropriate if edema is noticed in the hands, feet, or face or if the client is short of breath.
The therapeutic digoxin level is ____________________-ng/dL Note, though, that it is best for digoxin levels to be kept as low as possible (_________________ ng/mL)
0.5 to 2.0; 0.5 to 0.8
The normal value for INR is ____________________). The target INR or therapeutic level for a client receiving warfarin sodium is ____________________-
0.81 to 1.2; 2.5 to 3.
Moexipril is an angiotensin-converting enzyme (ACE) inhibitor. The client should be instructed to take the medication at least The other ACE inhibitor that should be taken___________________ is captopril.
1 hour before meals
The left anterior descending artery is the primary source of blood flow for the ________________wall of the heart. the right coronary artery supplies the ______________ wall of the heart. The circumflex artery supplies the ____________ wall of the heart
anterior; inferior ; lateral
Nitroglycerin is a coronary vasodilator used for coronary artery disease. The client should apply a new patch each morning and leave it in place for________________ hours in accordance with health care provider directions. This prevents the client from developing _______________________ (as happens with 24-hour use). The client does not need to wait to apply a new patch if it falls off because the medication is released continuously in small amounts through the skin. The client should avoid placing the patch in skin folds or excoriated areas.
12-14; tolerance
Mechanical valves require long-term ____________________ to prevent clots from forming on the "foreign" object implanted in the client's body.
anticoagulation
clonidine hydrochloride is an ______________________ medication
antihypertensive
Prazosin hydrochloride is an ___________________medication
antihypertensive medication used to treat high blood pressure.
Hydralazine is an _______________medication used in the management of moderate to severe hypertension. The ________________ and _______________ should be monitored frequently after administration, so a blood pressure cuff is one item to have in place.
antihypertensive; blood pressure and pulse
The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority?
Status of airway Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection.
Fenofibrate is a fibric acid derivative that is used to treat ____________________________. Contraindications to the use of fibrates include known medication allergy, severe______________ or ________________ disease, cirrhosis, and gallbladder disease.
hyperlipidemia; kidney; liver
Epoetin alfa is generally well tolerated, although ______________________ can occur and is the most significant adverse effect. Occasionally, tachycardia may also occur. It may also cause an improved sense of well-being
hypertension
Atorvastatin is a (HMG-CoA) reductase inhibitor that is used to treat hypercholesterolemia and hypertriglyceridemia. Contraindications to the medication include active _______________ disease, unexplained elevated _______________ function tests, pregnancy, and lactation.
liver; liver
Betaxolol is a beta-adrenergic blocking agent used to _________________ blood pressure, relieve angina, or decrease the occurrence of dysrhythmias. Side and adverse effects include _____________ and signs and symptoms of heart failure, such as increased edema and weight gain.
lower; bradycardia
The sickle cell client should avoid infections, which can increase _____________________ demands and cause dehydration, precipitating a ______________________________.
metabolic; sickle cell crisis Fluids are important to prevent dehydration, which could lead to sickle cell crisis.
The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu? 1.Tea 2.Cola 3.Coffee 4.Raspberry juice
A client with a diagnosis of MI should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect, leading to further cardiac ischemia. Coffee, tea, and cola all contain caffeine and need to be avoided in the client with MI.
Nitroglycerin may be self-administered sublingually ________________ minutes before an activity that could trigger chest pain. Tablets should be discarded ______________ months after opening the bottle (expiration date on the bottle should always be checked), and a new bottle of pills should be obtained from the pharmacy. Nitroglycerin is very unstable and is affected by heat and cold, so it should not be kept close to the body (warmth) in a shirt pocket; rather, it should be kept in a jacket pocket or purse. Headache often occurs with early use and diminishes in time. __________________, rather than acetylsalicylic acid (aspirin), may be used to treat headache.
5-10 minutes ; 6-9 months; Acetaminophen
A client has been prescribed pindolol for hypertension. The nurse provides anticipatory guidance, knowing that which common side effect of this medication may decrease client compliance? 1.Impotence 2.Mood swings 3.Increased appetite 4.Difficulty swallowing
A common side effect of beta-adrenergic blocking agents such as pindolol is impotence. Other common side effects include fatigue and weakness. Central nervous system side effects are rarer and include mental status changes, nervousness, depression, and insomnia. Mood swings, increased appetite, and difficulty swallowing are not side effects of this medication.
A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1. Anterior chest pain 2. Pericardial friction rub 3. Weakness and irritability 4. Chest pain that worsens on inspiration
A pericardial friction rub is heard when inflammation of the pericardial sac is present during the inflammatory phase of pericarditis. Anterior chest pain may be experienced with angina pectoris and myocardial infarction. Weakness and irritability are nonspecific complaints and could accompany a variety of disorders. Chest pain that worsens on inspiration is characteristic of both pericarditis and pleurisy.
The home care nurse visits a client with a diagnosis of unstable angina. The client is taking acetylsalicylic acid (aspirin) on a daily basis to reduce the risk of myocardial infarction (MI). Which medication dose would the nurse expect the client to be taking? 1.300 to 325 mg daily 2.650 to 700 mg daily 3.1.3 g daily 4.3 g daily
Acetylsalicylic acid (aspirin) may be used to reduce the risk of recurrent transient ischemic attacks (TIAs) or stroke or reduce the risk of MI in clients with unstable angina or a history of previous MI. The normal dose for clients being treated with acetylsalicylic acid to decrease thrombosis and MI is 300 to 325 mg daily, and some health care providers may prescribe an even lower dose. Clients taking aspirin to prevent TIAs usually are prescribed 1.3 g daily in 2 to 4 divided doses. Clients with rheumatoid arthritis may be treated with 3.2 to 6 g daily in divided doses.
A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The health care provider (HCP) prescribes the administration of alteplase. The registered nurse (RN) preceptor is orienting a new RN in the use of this medication. Which statement by the new RN indicates that teaching has been effective? 1. "Administer the medication within 4 to 6 hours after onset of chest pain." 2. "Administer the medication concurrently with the administration of heparin." 3. "Administer the medication with the administration solution set protected from light." 4. "Administer the medication after the results of all laboratory tests have been received."
Alteplase is a fibrinolytic medication. In a client with an acute coronary artery thrombosis that evolves into a transmural MI, fibrinolytic therapy is most effective when started within 4 to 6 hours after onset of symptoms. The solution does not need to be protected from light. Heparin may be administered after the administration of alteplase but not concurrently, and it is not appropriate to wait for all laboratory tests to administer the medication.
A client is scheduled to have alteplase. Which item should the nurse obtain to monitor side/adverse effects of the medication therapy? 1.Flashlight 2.Pulse oximeter 3.Suction equipment 4.Occult blood test strips
Alteplase is a thrombolytic medication that dissolves thrombi or emboli. Bleeding is a frequent and potentially severe adverse effect of therapy. The nurse assesses for signs of bleeding in clients receiving this therapy using occult blood test strips to test urine, stool, or nasogastric drainage. A flashlight is used for pupil assessment as part of the neurological examination in the client who is neurologically impaired. Pulse oximeter and suction equipment would be needed if the client had evidence of oxygenation or respiratory problems.
Risk factors for CAD
Hypertension, cigarette smoking, and hyperlipidemia are modifiable risk factors that are predictors of CAD. Glucose intolerance, obesity, and response to stress are contributing modifiable risk factors for CAD. Age is a nonmodifiable risk factor.
The nurse employed in a cardiac unit determines that which client is the least likely to have an implanted cardioverter-defibrillator (ICD) inserted? 1. A client with syncopal episodes related to ventricular tachycardia 2.A client with ventricular dysrhythmias despite medication therapy 3.A client with an episode of cardiac arrest related to myocardial infarction 4.A client with 3 episodes of cardiac arrest unrelated to myocardial infarction
An ICD detects and delivers an electrical shock to terminate life-threatening episodes of ventricular tachycardia and ventricular fibrillation. This device is implanted in clients who are considered high risk, including those who have syncopal episodes related to ventricular tachycardia, those who are refractive to medication therapy, and those who have survived sudden cardiac death unrelated to myocardial infarction.
The nurse has a prescription to administer a dose of iron by the intramuscular route to the client. What are the most appropriate nursing actions? Select all that apply. 1.Use a Z-track method. 2.Administer the medication only in the deltoid. 3.Aspirate for blood after the needle is inserted. 4.Use an air lock when drawing up the medication. 5.Change the needle after drawing up the dose and before injection. 6.Massage the injection site well after injection to hasten absorption.
An air lock and a Z-track method should both be used when administering iron by the intramuscular route. Proper technique includes changing the needle after drawing up the medication but before giving it to prevent staining of skin. Only the dorsogluteal site should be used, and proper identification of appropriate landmarks is essential. The site should not be massaged after injection because massaging could cause staining of the skin.
The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which statement, if made by the parent, indicates an understanding of the administration of this medication? 1. "I should give the iron with food." 2. "I can mix the iron with cereal to give it." 3. "I should add the iron to the formula in the baby's bottle." 4. "I should use a medicine dropper and place the iron near the back of the throat."
An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Medication should not be added to food or formula. Iron requires an acidic environment to facilitate its absorption in the duodenum.
Characteristics of Arterial ulcers
Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients.
A client is scheduled to have heparin sodium 5000 units subcutaneously. What is the most appropriate nursing intervention? 1. Inject via an infusion device. 2. Inject ½ inch (1.25 cm) from the umbilicus. 3. Massage the injection site after administration. 4. Avoid aspirating prior to injecting the medication.
Aspiration should be avoided before injecting the heparin because it can cause hematoma at the administration site. Heparin sodium administered subcutaneously does not require an infusion device and is injected at least 2 inches (5 cm) from the umbilicus or any scar tissue. The needle is withdrawn rapidly, and the site is not massaged (although pressure is applied).
Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg?
Assess peripheral pulses with an ultrasonic Doppler device. Acute arterial insufficiency is associated with interruption of arterial blood flow to an organ, tissue, or extremity. It is associated with an acutely painful pasty-colored leg. The priority is for the nurse to perform a comprehensive assessment of peripheral circulation. When pulses are difficult to palpate, the Doppler device is useful to determine the presence of blood flow to the area. The Doppler directs sound waves toward the artery being examined, which emits an audible sound. The nurse must document that the pulse was present via Doppler and not palpation. Although the remaining options may be components of the assessment, they are not the priority.
Atorvastatin has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication?
Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. Because the medication is metabolized in the liver, baseline and periodic liver function tests, as well as cholesterol and triglyceride level determinations, should be done periodically.
The nurse has given the client with atrial fibrillation instructions to take one 1 aspirin daily. The client says to the nurse, "Why do I need to take this? I don't get any pain with my heart rhythm."Which response by the nurse is the most appropriate? 1."This will keep you from experiencing chest pain." 2."This will most likely keep you from ever having a heart attack." 3."This will prevent any inflammation from occurring on the walls of your heart." 4."This will help prevent clot formation in your heart as a result of your heart's rhythm."
Atrial fibrillation puts the client at risk for mural thrombi because of the sluggish blood flow through the atria that occurs as a result of loss of the atrial kick. In atrial fibrillation, the health care provider may prescribe a daily aspirin. This will prevent clot formation along the walls of the atria and resultant embolus. Aspirin will not prevent chest pain or keep a client from ever having a heart attack. Although aspirin does have antiinflammatory properties, it cannot prevent any inflammation from occurring, as stated in option 3.
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. What electrolyte imbalance should the nurse suspect?
hypokalemia Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.
Correct procedure for taking blood pressure
BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.
What is radiofrequency ablation ?
Basically, a heating element is used to occlude the vein. Radiofrequency ablation (RFA) is a treatment for varicose veins that uses a radiofrequency heat element to ablate (occlude) the affected vessel. This procedure is less invasive than a ligation and removal of veins procedure. Using ultrasound guidance, the clinician advances a catheter into a vein and injects an anesthetic agent around it. Then the vessel is ablated while the catheter is slowly removed. This causes collapse and sclerosis of the vein causing the occlusion.
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? A"Eat foods high in potassium." B"Take daily potassium supplements." C. "Discontinue sodium restrictions." D. "Avoid salt substitutes."
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.
What is Buerger's Disease and what specific activity should definitely be stopped?
Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's Disease; stopping smoking completely is recommended. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops.
A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the health care provider? 1.Bumetanide 2.Amiodarone 3.Propranolol 4.Streptokinase
Bumetanide is a diuretic. The paroxysmal nocturnal dyspnea may be caused by increased venous return when the client is lying in bed, and the client needs diuresis. Amiodarone is an antidysrhythmic, Propranolol is a beta blocker, and streptokinase is a thrombolytic.
cardiac tamponade - what it is and assessment findings
acute compression of the heart caused by fluid accumulation in the pericardial cavity cardiac tamponade is the accumulation of fluid in the pericardial cavity and that tamponade restricts ventricular filling, causing cardiac output to drop. Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention with clear lung sounds, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg).
A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure?
CHEST PAIN The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.
What is the main reason for having a cardiac catheterization ?
Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.
A client with rapid-rate atrial fibrillation asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective? 1."The vagus nerve slows the heart rate." 2."The diaphragmatic nerve slows the heart rate." 3."The diaphragmatic nerve overdrives the rhythm." 4."The vagus nerve increases the heart rate, overdriving the rhythm."
Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. Others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm.
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action?
Check the client's status and lead placement Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention
Pulmonary edema causes the client to be extremely ______________________ and __________________
agitated and anxious. The client may complain of a sense of drowning, suffocation, or smothering. Therefore, the client will experience extreme anxiety.
The nurse is caring for a client with hyperlipidemia who is taking cholestyramine. Which nursing assessment is most significant for this client relative to the medication therapy? 1. Observe for joint pain. 2. Auscultate bowel sounds. 3. Assess deep tendon reflexes. 4. Monitor cardiac rate and rhythm.
Cholestyramine is used to treat hyperlipidemia. The site of action of the medication is the bowel Remember that the medication's site of action is the bowel and that it can result in constipation.
The home care nurse has given instructions to a client who is beginning therapy with digoxin. The nurse determines a need for further teaching if the client makes which statement? 1. "If I miss a dose, I should just take 2 the next day." 2. "I shouldn't change brands without asking the health care provider first." 3. "I should call the health care provider if my daily pulse rate is under 60 or over 100." 4. "The pills should be kept in their original container so they don't get mixed up with my other medicines."
Client teaching should include taking the dose exactly as prescribed each day. If the client misses a dose and more than 12 hours goes by, that dose should be omitted, and only the next scheduled dose should be taken; the client should not double-dose. The health care provider (HCP) should be consulted before changing brands because the bioavailability of another preparation of the medication may be different. A daily pulse check is necessary, and the client should know the parameters for which the HCP should be called. Clients are advised not to mix digoxin in pill boxes with other medications.
The home health nurse makes a home visit to a client who has an implanted cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary? 1."If I feel an internal defibrillator shock, I should sit down." 2."I won't be able to have a magnetic resonance imaging test (MRI)." 3."My wife knows how to call the emergency medical services (EMS) if I need it." 4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker."
Clients with an ICD usually continue to receive antidysrhythmic medications after discharge from the hospital. The nurse should stress the importance of continuing to take these medications as prescribed. The nurse should provide clear instructions about the purposes of the medications, dosage schedule, and side effects or adverse effects to report. Clients should sit down if they feel an internal defibrillator shock. They cannot have an MRI because of the possible magnetic properties of the device. Also, knowledge of how to reach EMS is important.
The nurse is concerned about the adequacy of peripheral tissue perfusion in the post-cardiac surgery client. Which action should the nurse include within the plan of care for this client?
Covering the legs with a light blanket during sitting promotes warmth and vasodilation of the leg vessels. The nurse plans postoperative measures to prevent venous stasis. These include applying elastic stockings or leg wraps, use of pneumatic compression boots, and discouraging crossing of the legs. Clients should be encouraged to perform passive and active range-of-motion exercises. The knee gatch on the bed and pillows under the knees should be avoided because they place pressure on the blood vessels in the popliteal area, impeding venous return.
Signs of Digoxin Toxicity
Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL.
The ______________ is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction.
ECG
The nurse is assessing a client's legs for the presence of edema. The nurse notes that the client has mild pitting with slight indentation and no perceptible swelling of the leg. How should the nurse define and document this finding?
Edema is accumulation of fluid in the intercellular spaces and is not normally present. To check for edema, the nurse would imprint his or her thumbs firmly against the ankle malleolus or the tibia. Normally, the skin surface stays smooth. If the pressure leaves a dent in the skin, pitting edema is present. Its presence is graded on the following 4-point scale: 1+, mild pitting, slight indentation, no perceptible swelling of the leg; 2+, moderate pitting, indentation subsides rapidly; 3+, deep pitting, indentation remains for a short time, leg looks swollen; 4+, very deep pitting, indentation lasts a long time, leg is very swollen.
Endovenous laser treatment (EVLT) is done on a client with varicose veins. Which interventions should the nurse include in the postprocedure plan of care? 1.Inform the client that the EVLT procedure ensures closure of the treated vein. 2.Assess color and temperature of the affected limb to determine vascular status. 3.Teach the client the importance of using graduated compression stockings (GCSs) during the day. 4.Inform the client that circulation impairment and nerve damage is expected to occur following the procedure.
Endovenous laser treatment (EVLT) is a treatment for varicose veins that uses laser heat to ablate (occlude) the affected vessel. This procedure is less invasive than a ligation and removal of veins procedure. Using ultrasound guidance, the clinician advances a catheter into a vein (most commonly the saphenous vein) and injects an anesthetic agent around it. Then the vessel is ablated while the catheter is slowly removed. After the procedure, the client is taught the importance of using a GSC or other form of compression such as elastic compression bandages as prescribed for 24 hours a day (not just during the day), except for showers for at least the first week. A follow-up ultrasonography is done to ensure closure, so it is not appropriate to tell the client that the EVLT ensures closure; this need to be verified. Circulation impairment is not expected. Nerve damage is not expected but can occur; if it does occur it is usually temporary and minimal and resolves within a few months. The nurse needs to assess the vascular status of the affected limb and check for changes in color or temperature of the limb. The nurse would also monitor for pain, edema, and paresthesias that could indicate complications such as deep vein thrombosis or nerve damage.
Echocardiography is an invasive, risky and painful test. TRUE OR FALSE.
FALSE! Echocardiography is a noninvasive, risk-free, pain-free test that involves no special preparation. It commonly is done at the bedside or on an outpatient basis. The client must lie quietly for 30 to 60 minutes while the procedure is being performed.
Obesity and sodium intake are nonmodifiable risk factors for hypertension. These are of the utmost importance because they can be changed or modified by the individual through a regular exercise program and careful monitoring of sodium intake. Protein intake also has a relationship to hypertension. TRUE OR FALSE
FALSE. Obesity and sodium intake are modifiable risk factors for hypertension. These are of the utmost importance because they can be changed or modified by the individual through a regular exercise program and careful monitoring of sodium intake. Protein intake has NO relationship to hypertension.
A client is diagnosed with iron deficiency anemia, and ferrous sulfate is prescribed. The nurse should tell the client that it would be best to take the medication with which food? 1.Milk 2.Boiled egg 3.Tomato juice 4.Pineapple juice
Ferrous sulfate is an iron preparation, and the client is instructed to take the medication with orange juice or another vitamin C-containing product or a product high in ascorbic acid to increase the absorption of the iron. Among the options presented, tomato juice is highest in vitamin C and ascorbic acid. Milk and eggs inhibit absorption of iron.
A client with hypertension has a new prescription for a medication called moexipril. The nurse plans to provide written directions that tell the client to take the medication at which time? 1.At bedtime 2.With meals 3.1 hour before meals 4.With a snack in late afternoon
First, eliminate options 2 and 4 because they are comparable or alike and indicate administering the medication with a food item. Next, remember that there are several medications in the ACE inhibitor classification. If you can remember that moexipril and captopril are the ones that are taken 1 hour before meals, you will easily be able to answer questions similar to this one.
A client is prescribed nicotinic acid for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1."It is not necessary to avoid the use of alcohol." 2."The medication should be taken with meals to decrease flushing." 3."Clay-colored stools are a common side effect and should not be of concern." 4."Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing."
Flushing is an adverse effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the health care provider (HCP) immediately.
The nurse is preparing to administer heparin sodium subcutaneously. Which nursing action is the most appropriate? 1.Apply heat after the injection. 2.Use a 21- to 23-gauge, 1-inch (2.5 cm) needle. 3.Use a 25- to 26-gauge, ⅝-inch (1.5 cm) needle. 4.Aspirate before injection of the medication.
For subcutaneous heparin sodium injection, a 25- to 26-gauge, ⅝-inch (1.5 cm) needle is used to prevent tissue trauma and inadvertent intramuscular injection. The application of heat may affect the absorption of the heparin sodium and cause bleeding. A 1-inch (2.5 cm) needle would inject the heparin sodium into the muscle. Aspiration before injection is an incorrect technique with heparin sodium administration beca
___________________ is a frequent side effect of nitroglycerin, resulting from its vasodilator action. It often subsides as the client becomes accustomed to the medication and is effectively treated with acetaminophen.
Headache
The nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply. 1. Emotional stress 2.Atrial fibrillation 3.Nutritional anemia 4.Peptic ulcer disease 5.Recent upper respiratory infection
Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hypervolemia. Peptic ulcer disease is not an exacerbating factor.
________________________should be suspected whenever platelet counts fall below normal in the client on heparin sodium.
Heparin induced thrombocytopenia If severe thrombocytopenia develops (platelet count less than 100,000 mm3 [100 × 109/L]), heparin sodium should be discontinued
A client is having a follow-up health care provider (HCP) office visit after vein ligation and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which would be an appropriate action by the nurse based on evaluation of the client's comment? 1. Report the complaint to the HCP. 2. Instruct the client to apply warm packs. 3. Reassure the client that this is only temporary. 4. Advise the client to take acetaminophen until it is gone.
Hypersensitivity or a sensation of pins and needles in the surgical limb may indicate temporary or permanent nerve injury following surgery. The saphenous vein and saphenous nerve run close together in the distal third of the leg. Although complications from this surgery can occur, they are relatively rare so this symptom should be reported. The actions in the remaining options are incorrect and could be harmful; in addition, they delay the possible need for intervention about the client's complaint. Although nerve damage can occur and is usually temporary and minimal and resolves within a few months, it is not appropriate to tell the client that this occurrence is only temporary. The complaint needs to be further assessed
A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms?
Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the chambers that are primarily responsible for this disease process, although these chambers may be affected as the disease becomes more chronic.
A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client? 1.Increased heart rate and increased blood pressure 2.Increased heart rate and decreased blood pressure 3.Decreased heart rate and increased blood pressure 4.Decreased heart rate and decreased blood pressure
Hypothermia decreases the heart rate and the blood pressure because the metabolic needs of the body are reduced in this condition. With fewer metabolic needs, the workload of the heart decreases, resulting in decreased heart rate and blood pressure.
A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point?
If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted.
A client receiving heparin sodium by continuous intravenous (IV) infusion removes the tubing from the pump to change his hospital gown. The nurse is concerned that the client received a bolus of medication. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse should check for the availability of which medication in the medication cart? 1.Enoxaparin 2.Phytonadione 3.Protamine sulfate 4.Aminocaproic acid
If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin sodium is at risk for bleeding. If the results of the next PTT are extremely high, a dose of protamine sulfate, the antidote for heparin sodium, may be prescribed. Enoxaparin is an anticoagulant. Phytonadione is the antidote for warfarin sodium. Aminocaproic acid is an antifibrinolytic agent (inhibits clot breakdown).
The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention?
In the client with a venous disorder, the legs are elevated above the level of the heart to assist with the return of venous blood to the heart.
A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? 1.Bilateral edema 2.Increased calf circumference 3.Diminished distal peripheral pulses 4.Coolness and pallor of the affected limb
Increased Calf Circumference The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a complication.
The nurse has provided medication instructions to a client with an iron deficiency anemia who will be taking iron supplements. What kind of instructions are needed?
Iron preparations can be very irritating to the stomach and are best taken between meals. Because iron supplements may be associated with constipation, the client should increase fluids and fiber in the diet to counteract this side effect of therapy. Iron preparations should be taken with a substance that is high in vitamin C to increase its absorption. The tablet is swallowed whole and not chewed.
What is Idiopathic autoimmune hemolytic anemia ?
It is a decrease in the number of red blood cells due to increased destruction by the body's defense (immune) system. It is an acquired disease that occurs when antibodies form against a person's own red blood cells. In the idiopathic form of this disease, the cause is unknown. Idiopathic autoimmune hemolytic anemia is treated with corticosteroids. Other treatments that may be prescribed as necessary include transfusions, splenectomy, and, occasionally, immunosuppressive medications.
The nurse has conducted medication instructions with a client receiving lovastatin. Which periodic blood study will be necessary and included in the client's instructions? 1. Bleeding time 2. Blood glucose levels 3. Liver function studies 4. Complete blood cell count
Lovastatin is a reductase inhibitor. It results in an increase in high-density lipoprotein cholesterol and a decrease in triglycerides and low-density lipoprotein cholesterol. This medication is converted by the liver to active metabolites and therefore is not used in clients with active hepatic disease or elevated transaminase levels. Because it is metabolized by the liver, clients are recommended to have periodic liver function studies. Periodic cholesterol levels also are needed to monitor the effectiveness of therapy.
A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions? 1."It will really hurt when the catheter is first put in." 2."I will receive general anesthesia for the procedure." 3."I will have to go to the operating room for this procedure." 4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
It is common for the client to feel fatigued after the cardiac catheterization procedure. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. Other preprocedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection.
Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. It decreases _________________ cholesterol and plasma triglycerides and increases _______________ cholesterol
LDL; HDL
Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication? 1. A decreased dosage of warfarin 2. An increased dosage of warfarin 3. A decreased dosage of levothyroxine 4. An increased dosage of levothyroxine
Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. Therefore, if thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.
Lisinopril has been prescribed for a client. What should the nurse instruct the client about this medication? 1.Take the medication with food only. 2.Discontinue the medication if nausea occurs. 3.Rise slowly from a reclining to a sitting position. 4.Expect to note a full therapeutic effect immediately.
Lisinopril is an angiotensin-converting enzyme inhibitor used in the treatment of hypertension. The client should be instructed to rise slowly from a reclining to a sitting position and to dangle the legs from the bed for a few moments before standing to reduce the hypotensive effect. It is not necessary to take the medication with food. If nausea occurs, the client should drink a noncola carbonated beverage and eat salted crackers or dry toast. A full therapeutic effect may be achieved in 1 to 2 weeks.
The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1.Soak the feet in hot water daily. 2.Be careful not to injure the legs or feet. 3.Use a heating pad on the legs to aid vasodilation. 4.Walk each day to increase circulation to the legs. 5.Cut down on the amount of fats consumed in the diet.
Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity are contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further.
A client is receiving scheduled doses of lovastatin. The nurse determines that the medication is having the intended effect if which is noted? 1.Weight loss 2.Increased pulse rate 3.Lowered blood pressure 4.Decreased cholesterol level
Lovastatin is an HMG-CoA reductase inhibitor used to lower blood cholesterol levels. It does not induce weight loss, does not stimulate heart rate, and is not an antihypertensive.
Dyspnea in the cardiac client often is accompanied by ___________________. This can be detected by an _______________________ monitor, especially if it is used continuously.
hypoxemia; oxygen saturation
The post-myocardial infarction client is scheduled for a technetium-99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure? 1.A urinary catheter 2.Signed informed consent 3.A central venous pressure (CVP) line 4.Notation of allergies to iodine or shellfish
MUGA is a radionuclide study used to detect myocardial infarction and decreased myocardial blood flow and to determine left ventricular function. A radioisotope is injected intravenously; therefore, a signed informed consent is necessary. A urinary catheter and CVP line are not required. The procedure does not use radiopaque dye; therefore, allergies to iodine and shellfish are not a concern.
The nurse is caring for a child with heart failure (HF). The nurse provides instructions to the mother regarding the procedure for administration of the prescribed digoxin. Which statement by the mother indicates a need for further teaching? 1."I will make sure to mix the medication with food." 2."I need to take my child's pulse before administering the medication." 3."If more than 1 dose is missed, I need to call the health care provider." 4."If my child vomits after being given the medication, I should not repeat the dose."
Medication should not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 or more hours later, the dose should not be administered. If more than 1 dose is missed, the health care provider needs to be notified.
A client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:
Myocardial scarring and perfusion
infarct
Necrotic area of tissue following cessation of the blood supply area of dead tissue after a lack of blood supply
What is Nesiritide ?
Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output.
What is the most serious adverse effect associated with the use of ticlopidine?
Neutropenia A baseline complete blood cell (CBC) count with differential will be performed for the client. Neutropenia occurs most often within the first 3 months of therapy; therefore, a CBC with differential is recommended every 2 weeks during the first 3 months. If a diagnosis of neutropenia is determined, the client will be withdrawn from therapy. This medication is used to prevent a stroke and is not contraindicated in hypertension. Gastrointestinal disturbances can occur as a result of taking the medication, and the client is instructed to take the medication with food to minimize these side effects.
The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time? 1. Evaluate pupil response. 2. Place the client on the left side. 3. Administer the prescribed analgesic. 4. Notify the health care provider (HCP) immediately.
Nitroglycerin causes vasodilation. The major side effect of nitroglycerin is a headache that can be alleviated by an analgesic. It is an expected response to the medication, and the HCP does not need to be notified. Placing the client on the left side will not alleviate the headache. There is no indication for the need to evaluate pupil response.
A hospitalized client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin, gr 1/4 sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure remains stable, the nurse should take which action next? 1.Administer another nitroglycerin tablet. 2.Administer 10 L of oxygen via nasal cannula. 3.Call for a 12-lead electrocardiogram (ECG) to be performed. 4.Wait an additional 5 minutes, and then give a second nitroglycerin tablet.
Nitroglycerin tablets are usually prescribed 1 every 5 minutes PRN (as needed) for chest pain for the hospitalized client, up to a total dose of 3 tablets. The nurse should administer the second tablet. The client with known angina pectoris should have low-flow oxygen at a rate of 1 to 3 L/min via nasal cannula. A 12-lead ECG would be done if prescribed by standing protocol or by individual health care provider prescription.
Symptoms of abdominal aneurysm
Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.
The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1. Assessing pain 2. Administering vasodilators 3. Avoiding over-the-counter (OTC) medications 4. Moving slowly from a sitting to a standing position
Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls. Vasodilators normally are not prescribed for the client with cardiomyopathy. Although important, pain assessment and avoiding OTC medications are not directly related to the issue of safety.
The ___________________represents the time it takes for the cardiac impulse to spread from the atria to the ventricles.
PR interval The normal range for the PR interval is 0.12 to 0.20 second.
When are PVCs considered dangerous ?
PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave.
A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if which finding is noted with regard to the PVCs? 1.They occur in pairs. 2.They appear to be multifocal. 3.They fall on the second half of the T wave. 4.They decrease to a frequency of less than 6 per minute.
PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias.
The nurse is preparing to administer phytonadione to the client. Which laboratory value should the nurse monitor in order to evaluate the effectiveness of the medication? 1.Prothrombin time 2.Blood ammonia level 3.Direct serum bilirubin 4.Serum potassium level
Phytonadione is needed for adequate blood clotting. Therefore, checking the prothrombin time is necessary 24 hours after injection of this medication. Blood ammonia levels are assessed to determine the conversion of ammonia to urea that normally occurs in the liver. Bilirubin is a measurement of the ability of the liver to conjugate and excrete bilirubin. Serum potassium is an electrolyte and is not affected by the injection of phytonadione.
The nurse monitors the client for which condition as a complication of polycythemia vera? 1.Thrombosis 2.Hypotension 3.Cardiomyopathy 4.Pulmonary edema
Polycythemia vera is a disorder of the bone marrow. It results in excessive production of white blood cells, red blood cells, and platelets. Clients with polycythemia vera are also more likely to form blood clots that can cause thrombi, strokes, myocardial infarctions, and abnormal bleeding. Clients with polycythemia vera are hypertensive
A client is scheduled to receive a daily morning dose of furosemide. Which client laboratory result warrants a call to the health care provider (HCP) prior to the medication administration? 1.Serum sodium of 135 mEq/L (135 mmol/L) 2.Serum calcium of 10.4 mg/dL (2.6 mmol/L) 3.Serum potassium of 2.8 mEq/L (2.8 mmol/L) 4.Fasting blood glucose of 110 mg/dL (6 mmol/L)
Potassium is lost through increased secretion in the distal nephron from the effects of furosemide. If serum potassium falls below 3.5 mEq/L (3.5 mmol/L), fatal dysrhythmias may result. The HCP should be notified of the results so that the value can be corrected before administration of an additional dose of furosemide. The values in the remaining options would not warrant an immediate call to the HCP.
A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA) by infusion. Which parameter should the nurse determine requires the least frequent assessment to detect complications of therapy with tPA? 1.Neurological signs 2.Blood pressure and pulse 3.Presence of bowel sounds 4.Complaints of abdominal and back pain
Presence of bowel sounds Thrombolytic agents dissolve existing clots, and bleeding can occur anywhere in the body. The nurse monitors for any obvious signs of bleeding and also for occult signs of bleeding, which would include hemoglobin and hematocrit values, blood pressure and pulse, neurological signs, assessment of abdominal and back pain, and the presence of blood in the urine or stool. Remember that bleeding is the primary complication of thrombolytic therapy; therefore, look for the option that is not related to bleeding. A change in neurological signs could indicate cerebral bleeding, abdominal and back pain could indicate abdominal bleeding, and change in blood pressure and pulse could be general indicators of hemorrhage. The presence of bowel sounds is unrelated to this medication.
A client has recently begun medication therapy with propranolol. The long-term care nurse should plan to notify the health care provider (HCP) if which assessment finding is noted? 1.Complaints of insomnia 2.Audible expiratory wheezes 3.Decrease in heart rate from 86 to 78 beats/min 4.Decrease in blood pressure from 162/90 to 136/84 mm Hg
Propranolol is a beta blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective, such as propranolol, may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Insomnia is a frequent mild side effect and should continue to be monitored. A normal decrease in heart rate and blood pressure is expected.
A client with cardiac disease has begun taking propranolol, and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop? 1. Insomnia and headache 2. Nausea and constipation 3. Night cough and dyspnea 4. Drowsiness and nightmares
Propranolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, antidysrhythmic, and antimigraine medication. It may precipitate heart failure or myocardial infarction in clients with cardiac disease. Signs of heart failure include dyspnea (particularly on exertion or lying down), night cough, peripheral edema, and distended neck veins. If signs of heart failure occur, the HCP should be notified. The symptoms noted in the remaining options identify effects of this medication that do not warrant HCP notification if they occur. Focus on the subject, symptoms that warrant the need to contact the HCP. Use the ABCs-airway, breathing, and circulation. This will direct you to the correct option.
A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted? 1.Rhonchi 2.Wheezes 3.Crackles in the bases 4.Crackles throughout the lung fields
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs reveals crackles throughout the lung fields.
The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider (HCP) will most likely prescribe which option? 1.Maintain activity level as prescribed. 2.Maintain the affected leg in a dependent position. 3.Administer an opioid analgesic every 4 hours around the clock. 4.Apply cool packs to the affected leg for 20 minutes every 4 hours.
Rationale:Standard management for the client with DVT includes maintaining the activity level as prescribed by the health care provider; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Recent research is showing that ambulation, as previously thought, does not cause pulmonary embolism and does not cause the existing DVT to worsen. Therefore, the nurse should maintain the prescribed activity level, which could be bed rest or ambulation. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen
paroxysmal nocturnal dyspnea.
Refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening.
The client who undergoes cardiac surgery is at risk for ___renal injury_____________ from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. What signals renal injury ?
Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. The client may need medications to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
A client enters the hospital emergency department with a nosebleed. On assessment the client tells the nurse that the nosebleed just suddenly began. The nurse notes no obvious facial injury. Which is the initial nursing action?
Sit the client down, ask the client to lean forward slightly, and apply pressure to the nose for 5 to 10 minutes. The initial nursing action for a client with a nosebleed is to sit the client down, ask the client to lean forward slightly, and apply pressure to the nose for 5 to 10 minutes. Inserting nasal packing or preparing a nasal balloon is not an appropriate initial intervention. These interventions are used when conservative measures fail. Placing the client in a semi Fowler's position would promote swallowing blood, which is not helpful because of the risk of vomiting and resultant aspiration.
The nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris. The client is receiving sotalol orally daily. Which assessment finding indicates to the nurse that the client is experiencing a side or adverse effect related to the medication? 1.Dry mouth 2.Diaphoresis 3.Palpitations 4.Difficulty swallowing
Sotalol is a beta-adrenergic blocking agent. Side and adverse effects include bradycardia, palpitations, difficulty breathing, irregular heartbeat, signs of heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness also can occur. PALPITATIONS Focus on the subject, a side or adverse effect related to sotalol. Note that the question describes a client with chronic angina pectoris, a cardiac disorder. Recall that medications ending with -lol (sotalol) are beta-adrenergic blockers, which commonly are used for cardiac disorders. Note that the correct option is the only one that is directly cardiac related.
_______________ nitroglycerin should be used to treat chest pain.
Sublingual
Which of the following types of pain is most characteristic of angina?
TIGHTNESS The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.
Alcohol is very irritating and drying to tissues and should not be used in areas of skin breakdown. TRUE OR FALSE
TRUE
An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. TRUE OR FALSE
TRUE
Clients need to notify all health care providers (HCPs) that they are on warfarin sodium therapy. TRUE OR FALSE
TRUE
In general, over-the-counter medications should be avoided when a client is taking a prescription medication. TRUE OR FALSE
TRUE
NCLEX Test strategy: Always focus on the client's feeling first. TRUE OR FALSE
TRUE
NCLEX Test strategy: initial treatment is always directed at a conservative measure first. TRUE OR FALSE
TRUE
NCLEX strategy: Remember that options that are comparable or alike are not likely to be correct. TRUE OR FALSE
TRUE
NCLEX strategy: Regarding therapeutic communication questions, The correct option is the only one that is therapeutic and addresses the family member's feelings. TRUE OR FALSE
TRUE
NCLEX strategy: in general, medications should not be discontinued without first consulting the HCP. TRUE or FALSE
TRUE
NCLEX strategy: the client should not stop taking a medication without a prescription to do so from the health care provider. TRUE OR FALSE
TRUE
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma. TRUE OR FALSE
TRUE
Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. TRUE OR FALSE
TRUE
Unstable angina occurs at lower levels of activity than those that previously precipitated the angina. Unstable angina also occurs at rest, is less predictable, and is often a precursor of myocardial infarction. TRUE OR FALSE
TRUE
Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, usually in the morning. TRUE OR FALSE
TRUE
Warfarin sodium is an anticoagulant that prevents further extension of formed existing clots and also prevents new clot formation and secondary thromboembolic complications. Because the medication places the client at risk for bleeding, the client is instructed to avoid salicylates (acetylsalicylic acid, or aspirin) and alcohol. The medication should be taken exactly as prescribed and at the same time daily. The client needs to avoid all over-the-counter medications and needs to consult with the HCP before taking any other medications because of the risk for medication interactions TRUE OR FALSE
TRUE
NCLEX strategy: the client should not stop taking the medication unless this has been prescribed by the HCP. TRUE OR FALSE
TRUE, client should not stop taking the medication unless prescribed too by the healthcare provider
The new registered nurse (RN) is orienting on the cardiac unit. Which statement by the new RN indicates an understanding of an early indication of fluid volume deficit due to blood loss? 1. "Pulse rate will increase." 2. "Blood pressure will decrease." 3. "Edema will be present in the legs." 4. "Crackles in the lungs will be present."
The cardiac output is determined by the volume of the circulating blood, the pumping action of the heart, and the tone of the vascular bed. Early decreases in fluid volume are compensated for by an increase in the pulse rate. Although the blood pressure will decrease, it is not the earliest indicator. Edema and crackles in the lungs indicate an increase in fluid overload.
Aminocaproic acid is
an antifibrinolytic agent that prevents clot breakdown or dissolution It is commonly prescribed after subarachnoid hemorrhage if surgery is delayed or contraindicated, to prevent further hemorrhage.
hyperemia
an excess of blood in the vessels supplying an organ or other part of the body.
The home health nurse visits a client recovering after an episode of cardiogenic shock secondary to an anterior myocardial infarction (MI) and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? 1."I exercise every day after breakfast." 2."I've gained 8 pounds (3.6 kg) since discharge." 3."I take an antacid when I experience epigastric pain." 4."I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily."
The client recovering from an episode of cardiogenic shock secondary to an MI will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated MI. The complication of cardiogenic shock increases the recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing. It is best to allow the meal to settle prior to activity in order to improve circulation to the heart during exercise. Epigastric pain or a weight gain of 8 pounds (3.6 kg) is significant and should be reported to the health care provider, at which point follow-up should occur.
A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction? 1.Take acetaminophen if the chest pain worsens. 2.Take antibiotics until the chest pain is fully resolved. 3.Use a firm-bristle toothbrush and floss vigorously to prevent cavities. 4.Notify all health care providers (HCPs) of the history of infective endocarditis before any invasive procedures.
The client should alert any HCP about the history of infective endocarditis before invasive dental, oral, or upper respiratory procedures. The HCP should place the client on prophylactic antibiotics if one of these procedures is needed. Antibiotics should be taken for the full course of therapy. The client should notify the HCP if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a portal of entry for bacterial infection
A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instructions should the nurse plan to provide to the client about this procedure?
The client should wear loose, comfortable clothing for the procedure. Electrocardiogram (ECG) lead placement is enhanced if the client wears a shirt that buttons in the front. The client should receive nothing by mouth after bedtime or for a minimum of 2 hours before the test. The client should wear rubber-soled, supportive shoes, such as athletic training shoes. The client should avoid smoking, alcohol, and caffeine on the day of the test. Inadequate or incorrect preparation can interfere with the test, with the potential for a false-positive result.
The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do? 1.Walk for as long as possible each day. 2.Cross the legs at the ankle only, not at the knee. 3.Sit in a chair 3 times a day for 3 hours at a time. 4.Lie down with the legs elevated and avoid sitting.
The client who has had vein ligation and stripping should avoid standing or sitting for prolonged periods. The client should remain lying down unless performing a specific activity for the first few days after the procedure. Prolonged standing or sitting increases the risk of edema in the legs by decreasing blood return to the heart. The client should avoid crossing the legs at any level for the same reason.
The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective? 1."Oxygen has a calming effect." 2."Oxygen will prevent the development of any thrombus." 3."The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." 4."Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle."
The pain associated with angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more oxygen demand on heart muscle. Supplemental oxygen will help meet the added demands on the heart muscle. Oxygen does not dilate blood vessels or prevent thrombus formation and does not directly calm the client.
The most common early manifestations of digoxin toxicity are gastrointestinal disturbances such as ______________________and neurological disturbances such as ________________. Visual disturbances such as photophobia, light flashes, halos around bright objects, and yellow or green color perception also may occur.
anorexia, nausea, and vomiting; fatigue, headache, weakness, drowsiness, confusion, and nightmares
The health care provider (HCP) prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply. 1.Encourage coughing with deep breathing. 2.Place in high Fowler's position for eating. 3.Encourage increased oral intake of water daily. 4.Place thigh-length elastic stockings on the client. 5.Place sequential compression boots on the client. 6.Encourage the intake of dark green, leafy vegetables.
The client with DVT may require bed rest to prevent embolization of the thrombus resulting from skeletal muscle action, anticoagulation to prevent thrombus extension and allow for thrombus autodigestion, fluids for hemodilution and to decrease blood viscosity, and elastic stockings to reduce peripheral edema and promote venous return. While the client is on bed rest, the nurse prevents complications of immobility by encouraging coughing and deep breathing. Venous return is important to maintain because it is a contributing factor in DVT, so the nurse maintains venous return from the lower extremities by avoiding hip flexion, which occurs with high Fowler's position. The nurse avoids providing foods rich in vitamin K, such as dark green, leafy vegetables, because this vitamin can interfere with anticoagulation, thereby increasing the risk of additional thrombi and emboli. The nurse also would not include use of sequential compression boots for an existing thrombus. They are used only to prevent DVT, because they mimic skeletal muscle action and can disrupt an existing thrombus, leading to pulmonary embolism.
What is the correct protocol for taking nitroglycerin tablets ?
The correct protocol for nitroglycerin use involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.
The nurse is caring for a client who suddenly starts complaining of palpitations, restlessness, and anxiety. The nurse obtains a stat electrocardiogram (ECG) which shows Atrial Fibrillation with rapid and irregular ventricular rate. The nurse should perform which actions, in anticipation of appropriate medication therapy with amiodarone? 1.Obtain an infusion pump and prepare to administer 150 mg over 1 hour followed by a maintenance dose. 2.Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a maintenance dose. 3.Obtain a syringe and administer 150 mg over 1 minute via intravenous push followed by a maintenance dose. 4.Obtain a syringe and administer 360 mg over 2 minutes via intravenous push followed by a maintenance dose.
The dysrhythmia shown in the figure is atrial fibrillation with a rapid and irregular ventricular rate. This dysrhythmia is left threatening due to the risk for clot formation and inadequate cardiac output. Amiodarone is a class III antidysrhythmic medication that is highly effective against both atrial and ventricular dysrhythmias. When used in emergent situations for life-threatening dysrhythmias, this medication should be given using an infusion pump so an accurate dose can be administered. An initial loading dose of 150 mg over 10 minutes should be infused as a bolus using the pump. Next, maintenance doses of 360 mg over 6 hours, then 540 mg over 18 hours, followed by 720 mg over 24 hours are infused. The infusion is titrated based on blood pressure.
A new registered nurse (RN) is assisting the RN in admitting a client who has a diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs in the client with hypothermia. Which statement by the new RN indicates that the teaching has been effective? 1."The client will likely exhibit increased heart rate and increased blood pressure." 2."The client will likely exhibit increased heart rate and decreased blood pressure." 3."The client will likely exhibit decreased heart rate and increased blood pressure." 4."The client will likely exhibit decreased heart rate and decreased blood pressure."
The heart rate and blood pressure are decreased because the metabolic needs of the body are reduced with hypothermia. With fewer metabolic needs, the workload of the heart decreases.
Atenolol has been prescribed for a hospitalized client. The nurse should check which item before administering this medication? 1.Pedal pulses 2.Apical heart rate 3.Most recent potassium level 4.Most recent electrolyte levels
The nurse should check the client's apical heart rate and blood pressure immediately before administering the medication. If the heart rate is 60 beats/min or lower or if the systolic blood pressure is less than 90 mm Hg, the medication is withheld and the health care provider is contacted. The client should not abruptly stop the medication. Abrupt withdrawal may result in sweating, palpitations, headache, and tremulousness and may precipitate heart failure or myocardial infarction in a client with cardiac disease. Abrupt withdrawal can also cause rebound hypertension. A pulse of 60 or below should be reported to the health care provider.
The right coronary artery supplies the ______________ventricle, or the inferior portion of the heart.
The right coronary artery supplies the right ventricle, or the inferior portion of the heart.
What are the usual guidelines for administering nitroglycerin tablets ?
The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering 1 tablet every 5 minutes PRN (as needed) for chest pain, for a total dose of 3 tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the HCP is notified. . The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose.
Premature Ventricular Contractions are characterized by
They are characterized by an absence of P waves, the presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy. PVCs are abnormal ectopic beats originating in the ventricles
A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1.Check the blood pressure. 2.Call the health care provider (HCP). 3.Check the client and the chest leads. 4.Initiate cardiopulmonary resuscitation (CPR)
This type of pattern on the cardiac monitor indicates either ventricular fibrillation or lead displacement. The first action of the nurse is always to check the client and the chest leads. If the client is nonresponsive and the leads are not the problem, CPR would be the next choice, along with designating another person to contact the HCP.
Nitroglycerin patch tolerance can be prevented by
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
Which blood test is most indicative of cardiac damage?
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.
The nurse is instructing the post-cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions? 1.Driving is permitted as long as the lap and shoulder seat belts are worn. 2.Lifting should be restricted to objects that do not weigh more than 25 pounds (11.3 kg) . 3.Use the arms for balance, not weight support, when getting out of bed or a chair. 4.Activities that involve straining may be resumed as long as they do not cause pain.
Use the arms for balance, not weight support, when getting out of bed or a chair. The client is taught to use the arms for balance, but not weight support, to avoid the effects of straining on the sternum. Typical discharge activity instructions for the first 6 weeks include instructing the client to lift nothing heavier than 5 pounds (2.2 kg), to not drive, and to avoid any activities that cause straining. These limitations allow for sternal healing, which takes approximately 6 weeks.
The correct location for the .______________lead is the fourth intercostal space right sternal border.
V1
A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept?
Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility. Bearing down as if straining to have a bowel movement can stimulate a vagal reflex. Stimulation of the vagus nerve causes a decrease in heart rate and cardiac contractility. Stimulation of the sympathetic nervous system has the opposite effect. These two branches of the autonomic nervous system oppose each other to maintain homeostasis.
A client is at risk for vasovagal attacks that cause bradydysrhythmias. The nurse would tell the client to avoid which actions to prevent this occurrence? Select all that apply. 1.Applying pressure on the eyes 2.Raising the arms above the head 3.Taking stool softeners on a daily basis 4.Bearing down during a bowel movement 5.Simulating a gag reflex when brushing the teeth
Vasovagal attacks or syncope occurs when the client faints because the body overreacts to certain triggers. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to the brain, causing the client to briefly lose consciousness. The client at risk should be taught to avoid actions that stimulate the vagus nerve. Actions to avoid include raising the arms above the head, applying pressure over the carotid artery, applying pressure over the eyes, stimulating a gag reflex when brushing the teeth or putting objects into the mouth, and bearing down or straining during a bowel movement. Taking stool softeners is an important measure to prevent the bearing down and straining during a bowel movement.
Raynaud's disease is peripheral vascular disease characterized by ____________________________________________
abnormal vasoconstriction in the extremities. Smoking cessation is one of the most important lifestyle changes that the client must make.
A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? 1.Oxygen saturation decreased from 96% to 91%. 2.Pulse rate increased from 80 to 104 beats per minute. 3.Blood pressure decreased from 140/86 to 112/72 mm Hg. 4.Respiratory rate increased from 16 to 19 breaths per minute.
Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.
A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? 1.Weigh self on a daily basis. 2.Sleep with the head of the bed flat. 3.Take a double dose of the diuretic if peripheral edema is noted. 4.Withhold prescribed digoxin if slight respiratory distress occurs.
Weigh self on a daily basis. The client can best determine fluid status at home by weighing himself or herself on a daily basis. Increases of 2 to 3 lb (0.9 to 1.4 kg) in a short period are reported to the health care provider (HCP). The client should sleep with the head of the bed elevated. During recumbent sleep, fluid (which has seeped into the interstitium with the assistance of the effects of gravity) is rapidly reabsorbed into the systemic circulation. Sleeping with the head of the bed flat is therefore avoided. The client does not modify medication dosages without consulting the HCP.
A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?
When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed
A client's electrocardiogram shows that the ventricular rhythm is irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? 1.Atrial flutter 2.Atrial fibrillation 3.Third-degree atrioventricular (AV) block 4.First-degree AV block
With atrial fibrillation, the ventricular rhythm is irregular and there are usually no discernible P waves. Therefore, an atrial rhythm cannot be determined. In atrial flutter, the QRS complexes may be either regular or irregular, and the P waves occur as flutter waves. A client in third-degree AV block (also known as complete heart block) has regular atrial and ventricular rhythms, but there is no connection between the P waves and the QRS complexes. In other words, the PR interval is variable and the QRS complexes are normal or widened, with no relationship with the P waves. With first-degree AV block, the PR interval is longer than normal, and there is a connection between the occurrence of P waves and that of QRS complexes..
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by __________________________ and ___________________
intake greater than output and by a sudden increase in weight.
Ticlopidine medication class Monitor baseline _________________ before implementation of therapy
antiplatelet Ticlopidine is an antiplatelet agent that is used for the prevention of thrombotic stroke. Ticlopidine's effects last for the life of the platelets, 7 to 10 days. Ticlopidine also can cause neutropenia, which is an abnormally small number of mature white blood cells (WBCs). Baseline data from a CBC count are necessary before implementation of therapy, and the nurse should monitor for neutropenia during this medication therapy. If this adverse effect does occur, the health care provider is notified and therapy should be stopped. The effects of neutropenia are reversible within 1 to 3 weeks. Ticlopidine is best tolerated when taken with meals
Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Other signs of digoxin toxicity include _____________________________
bradycardia, visual alterations (such as green and yellow vision, or seeing spots or halos), confusion, vomiting, diarrhea, decreased libido, and impotence.
The cardiac output is determined
by the volume of the circulating blood, the pumping action of the heart, and the tone of the vascular bed. An increase in the pulse rate compensates for decreases in fluid volume.
Diltiazem is a calcium channel blocker that inhibits _____________ movement across cell membranes of cardiac and smooth muscle. It ______________- coronary arteries and peripheral arteries and arterioles. Diltiazem _______________ the heart rate and slows sinoatrial and atrioventricular conduction.
calcium; dilates; decreases
Nimodipine is a calcium channel-blocking agent that has an affinity for _______________________ blood vessels. It is used to prevent or control vasospasm in _______________________l blood vessels, thereby reducing the chance for rebleeding. It is typically prescribed for 3 weeks' duration
cerebral; cerebral
Baroreceptors in the carotid artery walls and aorta respond to _________________
changes in blood pressure
oral iron can cause _________________
constipation
Calcium is needed by the heart for _______________________
contraction; calcium ions move across cell membranes into cardiac cells during depolarization and move back during repolarization. Depolarization is responsible for cardiac contraction
Myocardial infarction is generally related to __________________ disease.
coronary artery CVA's can be related to long-term hypertension.
Stable angina is triggered by a predictable amount of effort or emotion and is a chronic condition. Variant angina is triggered by ________________; the attacks are of ________________ duration than in classic angina and tend to occur early in the day and at rest. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in ___________________, ___________ and ________________over time. Intractable angina is chronic and incapacitating and is refractory to medical therapy.
coronary artery spasm; longer; number, duration, and severity
The best advice for the client who needs liquid iron is to ______________ the iron in juice or water, drink it through a _____________, and _______________ the mouth well afterward.
dilute; straw; rinse
Thrombolytic medications are used to treat acute thrombolytic disorders. These medications ________________. Because these medications alter the hemostatic capability of the client, any _________________ that does occur can be difficult to control.
dissolve; bleeding
Filgrastim is a ___________________________ produced by human recombinant DNA. It is administered to clients with __________________ to promote the growth of neutrophils and enhance the function of mature neutrophils. How is it administered ? Is it diluted with anything ? Treatment is continued until ..........
granulocyte colony-stimulating factor; agranulocytosis It is given by subcutaneous injection or continuous intravenous infusion. It is diluted only with D5W when administered by the IV route. The solution should not be shaken. It should be stored in a refrigerator and should be discarded if it has been exposed to room temperature for more than 6 hours. Treatment is continued until the absolute neutrophil count reaches 10,000 cells/mm3.
_____________________is a frequent side effect of atorvastatin.
headache Occasional side effects include myalgia, rash or pruritus (signs of an allergic reaction), flatulence, and dyspepsia. Adverse effects include photosensitivity and the potential for developing cataracts
An increased risk of digoxin toxicity exists in clients with ...................
hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function.
Gemfibrozil is used to treat _______________________. One adverse effect is __________________________
hypercholesterolemia; hepatotoxicity. Remember that this medication is used to treat hypercholesterolemia and that cholesterol is manufactured in the liver
_______________can cause tall, peaked, or tented T waves on the ECG
hyperkalemia
