Chapter 26 27 28

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction? A. Enhances myocardial oxygenation b. Lyses the blood clot C. Promotes platelet aggregation d. Inhibits clotting mechanisms

B

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest? A. Assess peripheral pulses. b. Encourage passive leg exercises. C. Limit fluid intake. d. Position pillows behind the knees.

B

Which drug is used to obtain vasodilation in the treatment of chronic heart failure? A. ACTH B. ACE inhibitors C. ARBs D. ANB agents

B

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? a. Bolus the patient with an additional 5000 units of heparin. b. Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic. C.Administer protamine sulfate stat. D. Continue with the prescribed rate.

D

What would the nurse anticipate if a patient with a history of type 2 diabetes is prescribed a thiazide diuretic? a. No change in the antidiabetic regimen b. Decreased need for antidiabetic medication C. Increased blood sugar levels d.Less frequent monitoring of blood sugar level

C

When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte? a. Calcium B. Sodium C. Potassium d.Magnesium

C

Which condition warrants the use of acetazolamide (Diamox) as a diuretic? A. Increased intracranial pressure b. Increased extravascular fluid pressure C.Increased intraocular pressure D. Periorbital edemas.

C

Which drug will be administered to a patient being admitted with severe digoxin intoxication? A. Amiodarone (Cordarone) B. Spironolactone(Aldactone) C.Digoxin immune Fab (Digibind) d. Digitalis glycoside

C

Which foods will the nurse recommend for a patient taking loop diuretics? A. Protein-rich foods such as poultry, whole grains, and fish B. Fiber-rich foods such as yellow vegetables, nuts, and lentils C. Potassium-rich foods such as raisins, figs, and bananas D. Sodium-rich foods such as canned vegetables and processed foods

C

Which is the initial manifestation of digoxin toxicity in children? a. Hallucinations B. Weakness C. Atrial dysrhythmia d. Diuresis

C

Which patient assessment would alert the nurse to withhold a loop diuretic? a. Crackles in the lung bases B. +2 pitting peripheral edema C. Serum potassium of 2.6 mEg/L D. Weight gain of 2 pounds in 2 days

C

Which action of ACE inhibitors results in effective treatment of heart failure? A. Increased afterload b. Increased aldosterone C. Increased preload d. Increased cardiac output

D

The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take? a. Administer the medication. b. Contact the pediatric cardiologist for further orders. C. Hold the digoxin. d. Request that another unit nurse assess the child

A

The nurse is reviewing lab work received on a patient admitted with the diagnosis of dehydration. The nurse will notify the physician of which lab value? A. Serum sodium level: 115 mEg/L B. Serum potassium level: 5.0 mEq/L C. Serum sodium level: 140 mEg/L d. Serum potassium level: 3.5 mEg/L

A

The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive hear failure. The nurse will schedule this medication A. in the morning b. after lunch. C. with dinner. D. a bedtime.

A

The nurse would expect to assess which serum potassium level in a patient who has severe vomiting and diarrhea? a. Less than 3.5 mEg/L b. Between 3.5 and 4.5 mEg/L C. Between 4.6 and 5 mEg/L d. Higher than 5.5 mEq/L

A

Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output? a. Inotropic b. Chronotropic C. Isotonic d. Isopropyl

A

Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure? A. "Report nausea and vomiting to your health care provider." B. "Decrease the amount of high potassium foods you eat." C. "Omit your dose of digoxin if your pulse is 60 beats/min. D. -Visual disturbances are common adverse effects.

A

The nurse transcribes a new order for ethacrynic acid (Edecrin) on a patient with edema resulting from cirrhosis of the liver. Which currently prescribed medication(s) should the nurse report to the ordering health care provider? (Select all that apply.) a. Digoxin b. Prednisone C. Tobramvcin D. Lipitor E. Zofran

ABC

The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.) A. Prevent platelet aggregation. b. Prevent the extension of existing clots. C. Inhibit steps in the fibrin clot formation cascade. d. Prolong bleeding time. E. Lower serum triglycerides.

ABCD

Which medication condition(s) may contribute to fluid volume excess? (Select all that apply) A. Hypertension B. Liver disease C. Pregnancy D. Use of corticosteroids E. Skin disorders

ABCD

Anticoagulant therapy may be used for which situation(s)? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction C. Following total hip or knee joint replacement surgery d. With DVT E. To prevent thrombosis in immobilized patients f. Peptic ulcer disease

ABCDE

Individuals with which disorder(s) are particularly susceptible to the development of electrolyte disturbances during diuretic therapy? (Select all that apply.) A. History of cardiac disease b. History of renal disease C. History of hormonal disorders d. History of psychiatric illness E. Massive trauma f. Serious burns g. Overhydration

ABCEF

Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.) A. Hypertension b. Addiction to smoking C. Genetic history d. Exercise tolerance E. Age

ABD

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.) A. "Do not make any major changes to your diet without discussing it with your health care provider." B. "Keep outpatient laboratory appointments for monitoring of therapy." C. Take the medication after meals. D. "Report signs of bleeding to your health care provider, including observing skin for bruising; petechia; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." E. "Avoid aspirin products.

ABDE

Which nursing intervention(s) would be performed for a patient who is on diuretic therapy? (Select all that apply.) A. Auscultation of lung sounds b. Assessment of skin turgor C. Initiation of electrolyte supplements D. Positioning techniques E. Monitoring of intake and output

ABDE

A patient who has heart failure and difficulty breathing is being admitted. Which physical assessment(s) indicate(s) fluid volume excess? (Select all that apply.) A. Rapid, bounding, irregular pulse rate b. Clear lung sounds C. 3+ pitting ankle edema d. Neck vein engorgement e. Shortness of breath

ACDE

Which statement (s) about vasodilators is/are true? (Select all that apply.) A. They reduce systemic vascular resistance. b. They increase afterload. C. They reduce preload. d. They decrease pulmonary congestion. E. They increase tissue perfusion to muscles and organs. f. They increase the volume of blood returning to the heart.

ACDE

Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.) a. Review of the digoxin blood level b. Administration of the medication with pulse less than 60 beats/min C. Review of serum electrolytes, liver, and kidney function studies D. Administration of the medication with a pulse of 110 beats/min E. Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

ACE

The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed? A. Potassium supplements B. Furosemide (Lasix) C. Acety|salicylic acid (aspirin) D. Antibiotics

B

Which are common signs and symptoms of dehydration? (Select all that apply.) a. Furrowed tongue b. Decreased intake and output levels C. Bounding pulse rate d. Mental confusion e. Elastic skin turgor

Abd

Which premedication assessment(s) would the nurse obtain prior to the initiation of humetanide (Bumex)? (Select all that applv.) A. Serum potassium b. Bowel sounds C. Lung sounds d. Orientation level e. Blood pressure

Acde

A 37-year-old male presents at the emergency department reporting severe vomiting for the past 48 hours. When assessing skin turgor, the nurse will a. exert pressure against the shin. b. gently pinch the skin together over the sternum. C. assess for vein distention. d. inspect oral mucous membranes.

B

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? a. "It takes at least 3 days for the symptoms to resolve once the clot dissolves." b. "Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body." C. "I will report this to your health care provider because there may be a need to look at alternative treatments." d "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge

B

How soon will diuresis be expected to occur after the nurse has administered 20 mg of furosemide (Lasix) intravenously (IV) to a patient with heart failure? A. As soon as injected B. Within 10 minutes C. After 2 hours d. After 4 hours

B

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product? A. Expel the air bubble from the prefilled syringe. B. Leave the needle in place for 10 seconds after injection. C. Administer the medication into the deltoid muscle. d. Massage the site after injection to increase absorption.

B

Which medication is a potassium sparing diuretic? A. Acetazolamide (Diamox) b. Spironolactone (Aldactone) C. Furosemide (Lasix) d. Bumetanide (Bumex)

B

Which medication, if administered with spironolactone (Aldactone), will alert the nurse to assess the patient for signs and symptoms of hyperkalemia? a. Propranolol (Inderal) b. Captopril (Capoten) C. Furosemide (Lasix) d. Ibuprofen (Motrin)

B

Which nursing assessment is most important to determine fluid status for a patient with heart failure? a Auscultation of lungs b. Daily weights C. Intake and output d. Measurement of abdominal girth

B

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? A. Bradycardia b. Petechiae C. Increased urinary output d. Dry skin

B

A patient with heart failure has been prescribed nesiritide (Natrecor). Which statement(s) is/are true regarding this medication? (Select all that apply.) a. It increases preload. B. Cardiac ventricles secrete this hormone in response to fluid overload. C. It suppresses aldosterone. d It promotes norepinephrine secretion. e. It causes vasodilation.

BCE

Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.) a. Administer diuretics at bedtime. b. Assess electrolyte levels. C. Report daily weight fluctuations. d. Encourage sodium intake. E. Maintain skin hygiene.

BCE

The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will (Select all that apply.) A. administer intramuscularly. b. inject slowly. C. remove needle immediately after injection d. rub injection site following administration. e. alternate injection sites every 24 hours.

BE

Which sign(s) and/or symptom(s) of dehydration may occur as a result of a diuretic? (Select all that apply.) a. Decreased urine specific gravity b. Skin remains peaked on turgor assessment C. Bounding peripheral pulses d. Neck vein engorgement e. Soft, sunken eyeballs

BE

(Xarelto) is ordered on a pt following knee replacement surgery. When providing education in this medication to the pt, the nurse conveys that treatment will continue A. Only while hospitalized B. For 35 days post-surgically C. For 12 days post surgically D. As long as creatinine clearance is less than 30

C

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? A. Document in the nursing notes that these results are within therapeutic range. B. Note the BC count and wait for the health care provider to make the next round to discuss all laboratory values. C. Stop the heparin drip. d. Assess the patient for signs and symptoms of decreased sensorium

C

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? a. Warfarin sodium (Coumadin) b. Enoxaparin (Lovenox) C. Protamine sulfate d. Vitamin K

C

An older adult male patient with long-term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John's wort. What results with the use of this herbal supplement? A. Digoxin toxicity b. Altered potassium electrolyte balance C. Reduced therapeutic benefits of digoxin D. Enhanced digoxin effectiveness without producing toxicity

C

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event? A. Myocardial infarction b. Transient ischemic attack C. Cardiac valve replacement d. Heart transplant

C

The nurse is to administer digoxin to an 18-month-old patient who weighs 16.5 lb. Guidelines for administration read as follows: 0.0075 to 0.010 mg/kg/day. Which is a safe medication dosage? a. 0.05 mg b. 0.12 mg C. 0.074 mg d. 0.75 mg

C

The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.) A. Reports of recent weight loss b. Complaints of peripheral edema C. Diminished exercise tolerance D. Shortness of breath with activity E. Blood pressure elevation

CD

The nurse is providing education to a patient with altered cardiac function. When instructing this patient the nurse will encourage (Select all that apply.) a. alcohol consumed in moderation. b. use of salt substitute. C. regular, mild exercise. D. good skin care. e. stress reduction.

CDE

A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a—-position. a. prone b. supine C. Sims d. Fowler's

D

On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the health care provider will prescribe? a. Allopurinol (Zyloprim) B. Diphenhydramine (Benadryl) C. Mannitol d. Furosemide (Lasix)

D

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching? a. "I will always wear a medical alert bracelet." b."I will check with my health care provider before I take any OTC medications." C. "I will be careful when I use a knife or other sharp objects." D. "I will rinse my mouth with mouthwash instead of brushing my teeth."

D

The nurse has provided patient teaching about potassium sparing diuretic therapy. Which statement by the patient indicates a need for further teaching? A. will take my medication in the morning." B. "I will report a weight gain of 2 pounds in 2 days." C. "I will rise slowly when I get up from a sitting position." D. "I will use a salt substitute because I limit my salt intake."

D

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will A. position the patient with knees flexed. b initiate use of fitted thromboembolic disease deterrent (TED) stockings. C. maintain complete bed rest. d. implement deep breathing and coughing exercises.

D

The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate? A. "This medication dilates your coronary arteries." b. "This medication will help your kidneys get rid of fluid." C. "This medication reduces volume returning to your heart so it doesn't overstretch." d. "This medication reduces the resistance your heart has to pump against."

D

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K? a. Fruit b. Pasta C. Potato d.Spinach

D

What is the mechanism of action of drugs used to treat thromboembolic disease? A. Dissolving clots and preventing formation of new clots b. Making platelets more flexible and preventing formation of new clots C. Causing vasodilation and increased blood flow d.Preventing platelet aggregation and inhibiting clot formation

D

Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.) A. Assessment of recent aPT levels b.Massaging the site after injection of medication C. Aspirating after needle insertion d. Documenting ecchymotic areas e. Monitoring of vital signs

DE