Combo with cardio and 2 others

Digoxin: FACTS

Inotropic Agent(Increase Contractility),thus increasing CO. Extract of Purpuria/Fox gloves

What are the EKG findings for atrial fibrilation?

Irregularly irregular Rate - any P - none. Fib waves QRS - random T - not defined

What is ventricular fibrilation?

Irregularly irregular Rate - fast P - none QRS - none T - none

percent of kids abused

30-40%

Average 6-yr-old

46 pounds/46 inches

Artistic expression

5 yr old - care, planning, examination of work

What is nirmal ICP?

5-15 mmHg

A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to A) Reduce preload. B) Decrease afterload. C) Increase contractility. D) Promote vasodilation.

A

The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin (Lanoxin) 0.125 mg IV push. An ampule containing 0.25 mg/ml is available. How many milliliters should the nurse draw up to administer the dose? A) 0.5 ml B) 0.6 ml C) 1.2 ml D) 1.4 ml

A

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? A) a. "It is important not to suddenly stop taking the atenolol." B) b. "Atenolol will increase the strength of my heart muscle." C) c. "I can expect to feel short of breath when taking atenolol." D) d. "Atenolol will improve the blood flow to my coronary arteries."

A "It is important not to suddenly stop taking the atenolol."

Review the grading system for CHF

A - No objective evidence of cardiovascular disease B - Objective evidence of minimal cardiovascular disease C - Objective evidence of moderately severe cardiovascular disease D - Objective evidence of severe cardiovascular disease

The nurse is evaluating the response to treatment for a patient has recently started taking furosemide (Lasix) to treat stage 2 hypertension. The information that will require the nurse to act most rapidly is a(n) a. blood potassium level of 3.0 mEq/L. b. blood glucose level of 180 mg/dl. c. BP reading of 164/96. d. orthostatic decrease of 12 mm Hg.

Correct Answer: A Rationale: Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic. Cognitive Level: Application Text Reference: pp. 772-773 Nursing Process: Evaluation NCLEX: Physiological Integrity

When reviewing the 12-lead electrocardiograph (ECG) for a healthy 86-year-old patient who is having an annual physical examination, which of the following will be of most concern to the nurse? A) a. The heart rate (HR) is 43 beats/minute. B) b. The PR interval is 0.21 seconds. C) c. There is a right bundle-branch block. D) d. The QRS duration is 0.13 seconds.

A The heart rate (HR) is 43 beats/minute.

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the A) a. bell of the stethoscope with the patient in the left lateral position. B) b. bell of the stethoscope with the patient sitting and leaning forward. C) c. diaphragm of the stethoscope with the patient in a reclining position. D) d. diaphragm of the stethoscope with the patient lying flat on the left side.

A bell of the stethoscope with the patient in the left lateral position.

A patient admitted with HF appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this patients anxiety (select all that apply)?

A) Position patient in a semi-Fowlers position. B) Administrate ordered morphine sulfate. D) Instruct patient on the use of relaxation techniques. E) Use a calm, reassuring approach while talking to patient.

preoperative patient in the holding area asks the nurse, "Will the doctor put me to sleep with a mask over my face?" The most appropriate response by the nurse is, A) a. "A drug will be given to you through your IV line, which will cause you to go to sleep almost immediately." B) b. "Only your surgeon can tell you for sure what method of anesthesia will be used. Should I ask your surgeon?" C) c. "General anesthesia is now given by injecting medication into your veins, so you will not need a mask over your face." D) d. "Masks are not used anymore for anesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep."

A) a. "A drug will be given to you through your IV line, which will cause you to go to sleep almost immediately"

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective? A) a. "I will call for help when I need to get up to use the bathroom." B) b. "I will be sure to take the medication after eating something." C) c. "I will need to include more high-potassium foods in my diet." D) d. "I will expect to feel more short of breath for the next few days."

A) a. "I will call for help when I need to get up to use the bathroom."

During the preoperative interview, a patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate? A) a. "Tell me more about what happened to your mother." B) b. "You will receive medications to reduce your anxiety." C) c. "You should talk to the doctor again about the surgery." D) d. "Surgical techniques have improved a lot in recent years."

A) a. "Tell me more about what happened to your mother."

A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate? A) a. Allow the student to participate on the swim team. B) b. Refer the student to a cardiologist for further assessment. C) c. Obtain more detailed information about the student's health history. D) d. Tell the student to stop swimming immediately if any dyspnea occurs.

A) a. Allow the student to participate on the swim team.

On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which action is most important at this time? A) a. Auscultate for adventitious breath sounds. B) b. Ask whether the patient has smoked recently. C) c. Remind the patient about harmful effects of smoking. D) d. Calculate the cigarette smoking history in pack-years.

A) a. Auscultate for adventitious breath sounds.

A patient who is just waking up after having a general anesthetic is agitated and confused. Which action should the nurse take first? A) a. Check the O2 saturation. B) b. Administer the ordered opioid. C) c. Take the blood pressure and pulse. D) d. Notify the anesthesia care provider.

A) a. Check the O2 saturation.

. A patient's cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? A) a. Defibrillate at 360 joules. B) b. Give O2 per bag-valve-mask. C) c. Give epinephrine (Adrenalin) IV. D) d. Prepare for endotracheal intubation.

A) a. Defibrillate at 360 joules.

Which action should the postanesthesia care unit (PACU) nurse delegate to nursing assistive personnel (NAP) who help with the transfer of a patient to the surgical unit? A) a. Help with the transfer of the patient onto a stretcher. B) b. Give a verbal report to the surgical unit charge nurse. C) c. Document the appearance of the patient's incision in the chart. D) d. Ensure that the receiving nurse understands the postoperative orders.

A) a. Help with the transfer of the patient onto a stretcher.

After the nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? A) a. Increase in the patient's heart rate B) b. Decrease in premature contractions C) c. Increase in peripheral pulse volume D) d. Decrease in ventricular ectopic beats

A) a. Increase in the patient's heart rate

Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily activities, saying, "I am too nervous to take care of myself." Based on this information, which nursing diagnosis is appropriate? A) a. Ineffective coping related to anxiety B) b. Activity intolerance related to weakness C) c. Denial related to lack of acceptance of the MI D) d. Social isolation related to lack of support system

A) a. Ineffective coping related to anxiety

Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? A) a. Monitor blood pressure frequently. B) b. Encourage patient to ambulate in room. C) c. Titrate nesiritide rate slowly before discontinuing. D) d. Teach patient about safe home use of the medication.

A) a. Monitor blood pressure frequently.

The clinic nurse reviews the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC) 10.2 ´ 103/µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 ´ 103/µL. Which action should the nurse take? A) a. Send the CBC results to the surgery facility. B) b. Call the surgeon and anesthesiologist immediately. C) c. Ask the patient about any symptoms of a recent infection. D) d. Discuss the possibility of blood transfusion with the patient

A) a. Send the CBC results to the surgery facility.

Which action by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? A) a. The nurse assists the patient to do active range of motion exercises for all extremities. B) b. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet. C) c. The nurse gives atenolol (Tenormin) to the patient without consulting first with the health care provider. D) d. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.

A) a. The nurse assists the patient to do active range of motion exercises for all extremities.

During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these data, the best nursing diagnosis for the patient is A) a. activity intolerance related to fatigue. B) b. disturbed body image related to leg swelling. C) c. impaired skin integrity related to peripheral edema. D) d. impaired gas exchange related to chronic heart failure.

A) a. activity intolerance related to fatigue.

A patient's family history reveals that the patient may be at risk for malignant hyperthermia (MH) during anesthesia. The nurse explains to the patient that A) a. anesthesia can be administered with minimal risks with the use of appropriate precautions and medications. B) b. as long as succinylcholine (Anectine) is not administered as a muscle relaxant, the reaction should not occur. C) c. surgery must be performed under local anesthetic to prevent development of a sudden, extreme increase in body temperature. D) d. surgery will be delayed until the patient is genetically tested to determine whether he or she is susceptible to malignant hyperthermia.

A) a. anesthesia can be administered with minimal risks with the use of appropriate precautions and medications.

Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about A) a. angiotensin-converting enzyme (ACE) inhibitors. B) b. digitalis preparations. C) c. b-adrenergic agonists. D) d. calcium channel blockers.

A) a. angiotensin-converting enzyme (ACE) inhibitors.

Any patient guilt about having a therapeutic abortion may be identified when the nurse assesses the functional health pattern of A) a. value-belief. B) b. cognitive-perceptual. C) c. sexuality-reproductive. D) d. coping-stress tolerance.

A) a. value-belief.

A patient admitted with HF appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this patients anxiety (select all that apply)? A) Position patient in a semi-Fowlers position. B) Administrate ordered morphine sulfate. C) Position patient on left side with head of bed flat. D) Instruct patient on the use of relaxation techniques. E) Use a calm, reassuring approach while talking to patient.

A, B, D, E

9) How does a nurse assess for dysrhythmias? A. 12 lead EKG B. Listen to lung sounds C. blood test D. Urine sample

A. 12 lead EKG

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of A) a. asthma. B) b. peptic ulcer disease. C) c. alcohol dependency. D) d. myocardial infarction (MI).

A. asthma.

Which drugs target the renin-angiotensin system ?

ACE Inhibitors

What is first line treatment for HF patients?

ACEI are 1st line (BB) have been shown to decrease mortality; make heart work less

Slow AV Conduction

Mechanisms leading to slow AV node: Increase in vagatonic excitability(direct action)

What is the major cause of death in HF patients?

Most commonly death is a result of ventricular arrhythmias

Digoxin: Side Effects

N&V, Yellow-green blur vision, neurological anxiety, depression, delirium

List nursing interventions for patients w/ CHF

O2 therapy Allow rest and treat anxiety. Gradually increase ADLs Titrate vasoactive drugs Monitor and treat arrhythmias Monitor lab results - watch for dig toxicity Small bland meals, low sodium

What are the symptoms of A fib?

Palpitations SOB fatigue dizziness

Regardless of etiology ADHF always presents with what?

Pulmonary edema

A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to

Reduce preload

What is a sinus rythm?

Regular Rate 60-100bpm [brady <60bpm / tachy > 100bpm] Every beat has the same P / QRS / T PR interval 0.12 - 0.2 seconds QRS <0.12 seconds

What nursing care is provided for a patient recieving cardioversion?

Sedation Oxygenation Recovery

What do the sinus and AV nodes do?

Sinus Node - pacemaker AV Node - slows and filters

What is it called when heart can't contract properly?

Systolic heart failure

Secure

preference for mother over stranger

Accommodation

requires an adjustment of previous schemas upon new information

What type of diet should patinets with chronic heart failure be on?

restrict sodium intake to 2,000 mg/day and to restrict fluids to 64 oz/day

Combining words

start of grammar

Secondary prevention

support for families

Metoprolol

Toprol XL B1

What is stage 1 hypertension?

up to 159/99

Holophrases

words symbolize several things

Jean Piaget

(born 1896) was a pioneer in studying cognitive development in humans.

Stranger wariness

about 6 mo; full-blown 10 - 14 mo

Experimentation

active exploration (12 - 18 mo)

Severely decompensated patients may present with what type of hemodynamic profile?

both congestion and low perfusion (cold and wet - pulmonary edema)

Hybrid theory

combination of the different perspectives

Most patients presenting with ADHF have what type of hemodynamic profile?

congestion without low perfusion (warm and wet).

Representation

create mental images even when things are not present

Synchrony

dance between observant & eager to interact infant

Pretending

deferred imitation

which hypertensive drugs work on the renal system?

diuretics and ACE inhibitors - increase salt and water excretion

Overgeneralization

every male = Dad; every round object = ball

What is stage 2 hypertension?

greater than 160/100

Digoxin: Acute Toxicity

half life of 36hrs

By age two they are?

half their adulthood height

Structural view

infants teach themselves (LAD)

Substantiated maltreatment

means a reported case was investigated and verified

How does aldosterone affect BP?

Aldosterone is a powerful vasoconstrictor that causes large increases in BP Also acts on renal epithelial cells in the distal tubule and collecting duct to promote sodium reabsorption and potassium excretion, ultimately increasing water retention and this raising BP

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which of the following symptoms?

Anorexia and nausea

signs of digitalis toxicity

Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the prescriber if the patient exhibited any of these symptoms.

What are the clinical manifestations of pulmonary edema?

Anxiety pale/cyanotic Clammy and cold Dyspnea >30 breaths per m. wheezing, coughing frothy sputum

What is cardioversion ussually used for?

Atrial fib in a stable patient with a pulse

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid A) High-potassium foods. B) Drugs to treat erectile dysfunction. C) Over-the-counter H2-receptor blockers. D) Nonsteroidal antiinflammatory drugs.

B

The nurse is preparing to administer digoxin to a patient with HF. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dl. The nurse should do which of the following at this time? A) Withhold the daily dose until the following day. B) Withhold the dose and report the potassium level. C) Give the digoxin with a salty snack, such as crackers. D) Give the digoxin with extra fluids to dilute the sodium level.

B

The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include A) Acute anxiety. B) Hypotension and tachycardia. C) Peripheral edema and weight gain. D) Paroxysmal nocturnal dyspnea (PND).

B

A patient with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy? A) a. "Do you take aspirin on a daily basis?" B) b. "What time did your chest pain begin?" C) c. "Is there any family history of heart disease?" D) d. "Can you describe the quality of your chest pain?"

B "What time did your chest pain begin?"

Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? A) a. The pain increases with deep breathing. B) b. The pain has persisted longer than 30 minutes. C) c. The pain worsens when the patient raises the arms. D) d. The pain is relieved after the patient takes nitroglycerin.

B The pain has persisted longer than 30 minutes.

Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will A) a. reduce the "fight or flight" response. B) b. decrease spasm of the coronary arteries. C) c. increase the force of myocardial contraction. D) d. help prevent clotting in the coronary arteries.

B decrease spasm of the coronary arteries.

A 55-year-old with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is appropriate? A) a. "Since you are diabetic, you would not be a candidate for a heart transplant." B) b. "The choice of a patient for a heart transplant depends on many different factors." C) c. "Your heart failure has not reached the stage in which heart transplants are considered." D) d. "People who have heart transplants are at risk for multiple complications after surgery."

B) b. "The choice of a patient for a heart transplant depends on many different factors."

. A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take? A) a. Notify the dietitian about the food allergies. B) b. Alert the surgery center about the latex allergy. C) c. Reassure the patient that all allergies are noted on the medical record. D) d. Ask whether the patient uses antihistamines to reduce allergic reactions.

B) b. Alert the surgery center about the latex allergy.

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? A) a. Continue to monitor the rhythm and BP. B) b. Apply the transcutaneous pacemaker (TCP). C) c. Have the patient perform the Valsalva maneuver. D) d. Give the scheduled dose of diltiazem (Cardizem).

B) b. Apply the transcutaneous pacemaker (TCP).

During recovery from anesthesia in the postanesthesia care unit (PACU), a patient's vital signs are blood pressure 118/72, pulse 76, respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take at this time? A) a. Place the patient in a side-lying position. B) b. Encourage the patient to take deep breaths. C) c. Prepare to transfer the patient from the PACU. D) d. Increase the rate of the postoperative IV fluids.

B) b. Encourage the patient to take deep breaths.

A patient has ST segment changes that indicate an acute inferior wall myocardial infarction. Which lead will be best for monitoring the patient? A) a. I B) b. II C) c. V6 D) d. MCL1

B) b. II

Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? A) a. Provide an explanation of the planned surgical procedure. B) b. Notify the surgeon that the informed consent process is not complete. C) c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. D) d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

B) b. Notify the surgeon that the informed consent process is not complete.

A postoperative patient has not voided for 7 hours after return to the postsurgical unit. Which action should the nurse take first? A) a. Notify the surgeon. B) b. Perform a bladder scan. C) c. Assist the patient to ambulate to the bathroom. D) d. Insert a straight catheter as indicated on the PRN order.

B) b. Perform a bladder scan.

A patient arrives at the ambulatory surgery center for a scheduled outpatient surgery. Which information is of most concern to the nurse? A) a. The patient has not had outpatient surgery before. B) b. The patient is planning to drive home after surgery. C) c. The patient's insurance does not cover outpatient surgery. D) d. The patient had a glass of water a few hours before arriving.

B) b. The patient is planning to drive home after surgery.

. A 36-year-old woman is admitted for an outpatient surgery. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? A) a. The patient's lack of knowledge about postoperative pain control measures B) b. The patient's statement that her last menstrual period was 8 weeks previously C) c. The patient's history of a postoperative infection following a prior cholecystectomy D) d. The patient's concern that she will be unable to care for her children postoperatively

B) b. The patient's statement that her last menstrual period was 8 weeks previously

The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How will the nurse document the rhythm? A) a. Ventricular couplets B) b. Ventricular bigeminy C) c. Ventricular R-on-T phenomenon D) d. Ventricular multifocal contractions

B) b. Ventricular bigeminy

Data that were obtained during the perioperative nurse's assessment of a patient in the preoperative holding area that would indicate a need for special protection techniques during surgery include A) a. a stated allergy to cats and dogs. B) b. a history of spinal and hip arthritis. C) c. verbalization of anxiety by the patient. D) d. having a sip of water 2 hours previously.

B) b. a history of spinal and hip arthritis.

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient A) a. that sudden cardiac death events rarely reoccur. B) b. about the purpose of outpatient Holter monitoring. C) c. how to self-administer low-molecular-weight heparin. D) d. to limit activities after discharge to prevent future events.

B) b. about the purpose of outpatient Holter monitoring.

When the nurse caring for a patient before surgery has a question about a sedative medication to be given before sending the patient to the surgical suite, the nurse will communicate with the A) a. surgeon. B) b. anesthesiologist. C) c. circulating nurse. D) d. registered nurse first assistant (RNFA).

B) b. anesthesiologist.

A 42-year-old patient is recovering from anesthesia in the postanesthesia care unit (PACU). On admission to the PACU, the blood pressure (BP) is 124/70. Thirty minutes after admission, the blood pressure falls to 112/60, with a pulse of 72 and warm, dry skin. The most appropriate action by the nurse at this time is to A) a. increase the rate of the IV fluid replacement. B) b. continue to take vital signs every 15 minutes. C) c. administer oxygen therapy at 100% per mask. D) d. notify the anesthesia care provider (ACP) immediately.

B) b. continue to take vital signs every 15 minutes.

A 75-year-old is to be discharged from the ambulatory surgical unit following left eye surgery. The patient tells the nurse, "I do not know if I can take care of myself with this patch over my eye." The most appropriate nursing action is to A) a. refer the patient for home health care services. B) b. discuss the specific concerns regarding self-care. C) c. give the patient written instructions regarding care. D) d. assess the patient's support system for care at home.

B) b. discuss the specific concerns regarding self-care.

A patient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The patient reports use of echinacea, saw palmetto, and glucosamine/chondroitin. The nurse should A) a. ascertain that there will be no interactions with anesthetic agents. B) b. discuss the supplement use with the patient's health care provider. C) c. teach the patient that these products may be continued preoperatively. D) d. advise the patient to stop the use of all herbs and supplements at this time.

B) b. discuss the supplement use with the patient's health care provider.

A diabetic patient who uses insulin to control blood glucose has been NPO since midnight before having a mastectomy. The nurse will anticipate the need to A) a. withhold the usual scheduled insulin dose because the patient is NPO. B) b. obtain a blood glucose measurement before any insulin administration. C) c. give the patient the usual insulin dose because stress will increase the blood glucose. D) d. administer a lower dose of insulin because there will be no oral intake before surgery.

B) b. obtain a blood glucose measurement before any insulin administration.

Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to A) a. assist the patient to the bathroom and stay with the patient to prevent falls. B) b. offer a urinal or bedpan and position the patient in bed to promote voiding. C) c. allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes. D) d. ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.

B) b. offer a urinal or bedpan and position the patient in bed to promote voiding.

An 83-year-old who had a surgical repair of a hip fracture 2 days previously has restrictions on ambulation. Based on this information, the nurse identifies the priority collaborative problem for the patient as A) a. potential complication: hypovolemic shock. B) b. potential complication: venous thromboembolism. C) c. potential complication: fluid and electrolyte imbalance. D) d. potential complication: impaired surgical wound healing.

B) b. potential complication: venous thromboembolism.

While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate A) a. transfer to a dementia care service. B) b. referral to a home health care agency. C) c. placement in a long-term care facility. D) d. arrangements for around-the-clock care.

B) b. referral to a home health care agency.

When a patient is transferred from the postanesthesia care unit (PACU) to the clinical surgical unit, the first action by the nurse on the surgical unit should be to A) a. assess the patient's pain. B) b. take the patient's vital signs. C) c. read the postoperative orders. D) d. check the rate of the IV infusion.

B) b. take the patient's vital signs.

While caring for a patient with abdominal surgery the first postoperative day, the nurse notices new bright-red drainage about 6 cm in diameter on the dressing. In response to this finding, the nurse should first A) a. reinforce the dressing. B) b. take the patient's vital signs. C) c. recheck the dressing in 1 hour for increased drainage. D) d. notify the patient's surgeon of a potential hemorrhage.

B) b. take the patient's vital signs.

As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." The nurse should A) a. have the patient sign a release and leave the ring on. B) b. tape the wedding ring securely to the patient's finger. C) c. tell the patient that the hospital is not liable for loss of the ring. D) d. suggest that the patient give the ring to a family member to keep.

B) b. tape the wedding ring securely to the patient's finger.

5) Which of the following is not effective nursing management of heart failure? A. High Fowlers position B. Assisting with rigorous exercise 2x a day C. Daily weights, intake & output monitoring D. Continuous EKG monitoring

B. Assisting with rigorous exercise 2x a day

7) Which test is most important for the nurse to carry out if heart failure is suspected in a patient? A.12-lead EKG B. BNP C. ABG D. Exercise treadmill testing

B. BNP

3) What statement by a pre-operative patient indicates the need for further teaching by the nurse? A. Someone will help take care of my home. B. I can drive myself home after surgery. C. My brother will bring his pet gerbil to keep me entertained. D. I'll notify the health care provider if I develop a fever.

B. I can drive myself home after surgery.

4) To improve gas exchange and oxygenation for a patient with heart failure, what nursing management should be implemented? A. Check vital signs B. Place patient in high Fowlers position. C. Place patient in semi-Fowlers position. D. Administer diuretic.

B. Place patient in high Fowlers position.

Bisoprolol

B1

Renin-Angiotensin cycle

BP drops, cells in the kidney detect the change and release renin into the blood stream. Renin converts angiotensin into angiotensin I -> angiotensin II, a much more powerful hormone that causes blood vessels to constrict, and drives BP up.

What benefits do BB have?

Beta blockers decrease mortality (decrease conduction of the AV node) have less chance of going to atrial arrhythmia to ventricular arrhythmia

How are beta blockers used in chronic HF?

Bisoprolol, carvedilol, or sustained-release metoprolol succinate, help decrease mortality in HF patients - reduce HR and myocardial contractility - can cause edema, bradycardia, hypotension etc.

Digoxin: MOA

Blocks Na/K exchange in myocytes. High concentration of Na prevents loss of Ca through the Na/Ca exchange. Excess Ca stroed in SaRe is used for contraction during subsequent depolarization.

Maintain oxygen supply

Breathing, sneezing, hiccups, spit-ups

The priority nursing assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be A) Urine output. B) Lung sounds. C) Blood pressure. D) Respiratory rate.

C

After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? A) a. "I can expect indigestion as a side effect of nitroglycerin." B) b. "I can only take the nitroglycerin if I start to have chest pain." C) c. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." D) d. "I will help slow down the progress of the plaque formation by taking nitroglycerin."

C "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin."

Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? A) a. "I will switch from whole milk to 1% or nonfat milk." B) b. "I like fresh salmon and I will plan to eat it more often." C) c. "I will miss being able to eat peanut butter sandwiches." D) d. "I can have a cup of coffee with breakfast if I want one."

C "I will miss being able to eat peanut butter sandwiches."

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? A) a. Encourage oral fluids to prevent dry mouth or dehydration. B) b. Instruct the patient to ask for help if heart palpitations occur. C) c. Ask the patient to request assistance when getting out of bed. D) d. Teach the patient that headaches may occur with this medication.

C Ask the patient to request assistance when getting out of bed.

To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of these nursing interventions will be most effective? A) a. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary. B) b. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes. C) c. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. D) d. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.

C Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible.

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? A) a. Homocysteine B) b. C-reactive protein C) c. Cardiac-specific troponin I and troponin T D) d. High-density lipoprotein (HDL) cholesterol

C Cardiac-specific troponin I and troponin T

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? A) a. Obtain a BP reading in each arm and average the results. B) b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. C) c. Have the patient sit in a chair with the feet flat on the floor. D) d. Assist the patient to the supine position for BP measurements.

C Have the patient sit in a chair with the feet flat on the floor.

While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next? A) a. Use a ruler to measure the level of the JVD. B) b. Document this finding in the patient's record. C) c. Observe for JVD with the head at 30 degrees. D) d. Have the patient perform the Valsalva maneuver.

C Observe for JVD with the head at 30 degrees.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? A) a. The patient's most recent BP reading is 156/94 mm Hg. B) b. The patient's pulse has dropped from 64 to 58 beats/minute. C) c. The patient has developed wheezes throughout the lung fields. D) d. The patient complains that the fingers and toes feel quite cold

C The patient has developed wheezes throughout the lung fields.

A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that A) a. electrocardiographic (ECG) monitoring will be required for 24 hours after the test. B) b. it will be important to lie completely still during the procedure. C) c. a warm feeling may be noted when the contrast dye is injected. D) d. monitored anesthesia care will be provided during the procedure.

C a warm feeling may be noted when the contrast dye is injected

The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to A) a. exercise more than usual while the monitor is in place. B) b. remove the electrodes when taking a shower or tub bath. C) c. keep a diary of daily activities while the monitor is worn. D) d. connect the recorder to a telephone transmitter once daily.

C keep a diary of daily activities while the monitor is worn.

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, A) a. "It will be 6 weeks before I can take a bath or return to my usual activities." B) b. "I will notify the airlines when I make a reservation that I have a pacemaker." C) c. "I won't lift the arm on the pacemaker side up very high until I see the doctor." D) d. "I must avoid cooking with a microwave oven or being near a microwave in use."

C) c. "I won't lift the arm on the pacemaker side up very high until I see the doctor."

In intervening to promote ambulation, coughing, deep breathing, and turning by a postoperative patient on the first postoperative day, which action by the nurse is most helpful? A) a. Discuss the complications of immobility and poor cough effort. B) b. Teach the patient the purpose of respiratory care and ambulation. C) c. Administer ordered analgesic medications before these activities. D) d. Give the patient positive reinforcement for accomplishing these activities.

C) c. Administer ordered analgesic medications before these activities

A patient who was admitted with a myocardial infarction experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which action should the nurse take next? A) a. Notify the health care provider. B) b. Perform synchronized cardioversion. C) c. Administer the PRN IV lidocaine (Xylocaine). D) d. Document the rhythm and monitor the patient.

C) c. Administer the PRN IV lidocaine (Xylocaine).

After removal of the nasogastric (NG) tube on the second postoperative day, the patient is placed on a clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. Which action should the nurse take? A) a. Reinsert the NG tube. B) b. Give the PRN IV opioid. C) c. Assist the patient to ambulate. D) d. Place the patient on NPO status.

C) c. Assist the patient to ambulate.

Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? A) a. Palpate the radial pulses bilaterally. B) b. Assess the feet for peripheral edema. C) c. Auscultate for a pericardial friction rub. D) d. Check the cardiac monitor for dysrhythmias.

C) c. Auscultate for a pericardial friction rub.

. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? A) a. Serum creatine kinase (CK) B) b. Arterial blood gases (ABGs) C) c. B-type natriuretic peptide (BNP) D) d. 12-lead electrocardiogram (ECG)

C) c. B-type natriuretic peptide (BNP)

Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection? A) a. Care for the surgical incision B) b. Medications used during surgery C) c. Deep breathing and coughing techniques D) d. Oral antibiotic therapy after discharge home

C) c. Deep breathing and coughing techniques

Following gallbladder surgery, a patient's T-tube is draining dark green fluid. Which action should the nurse take? A) a. Place the patient on bed rest. B) b. Notify the patient's surgeon. C) c. Document the color and amount of drainage. D) d. Irrigate the T-tube with sterile normal saline.

C) c. Document the color and amount of drainage.

Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response, which of these assessment data would indicate that the exercise level should be decreased? A) a. BP changes from 118/60 to 126/68 mm Hg. B) b. Oxygen saturation drops from 100% to 98%. C) c. Heart rate increases from 66 to 90 beats/minute. D) d. Respiratory rate goes from 14 to 22 breaths/minute.

C) c. Heart rate increases from 66 to 90 beats/minute.

Which action will the nurse include in the plan of care immediately after surgery for a patient who received ketamine (Ketalar) as an anesthetic agent? A) a. Administer larger doses of analgesic agents. B) b. Monitor for severe slowing of the heart rate. C) c. Provide a quiet environment in the postanesthesia care unit. D) d. Avoid the use of benzodiazepines in the postoperative period.

C) c. Provide a quiet environment in the postanesthesia care unit.

An alert 82-year-old who has poor hearing and vision is receiving preoperative teaching from the nurse. His wife answers most questions directed to the patient. Which action should the nurse take when doing the teaching? A) a. Use printed materials for instruction so that the patient will have more time to review the material. B) b. Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. C) c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. D) d. Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.

C) c. Provide additional time for the patient to understand preoperative instructions and carry out procedures.

The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? A) a. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. B) b. Count the number of large squares in the R-R interval and divide by 300. C) c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. D) d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.

C) c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.

Which action by an inexperienced member of the surgical team requires rapid intervention by the charge nurse? A) a. Wearing street clothes into the nursing station B) b. Wearing a surgical mask into the holding room C) c. Walking into the hallway outside an operating room without the hair covered D) d. Putting on a surgical mask, cap, and scrubs before entering the operating room

C) c. Walking into the hallway outside an operating room without the hair covered

During the administration of the fibrinolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences A) a. bleeding from the gums. B) b. surface bleeding from the IV site. C) c. a decrease in level of consciousness. D) d. a nonsustained episode of ventricular tachycardia.

C) c. a decrease in level of consciousness.

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops A) a. a dry, hacking cough. B) b. any ventricular ectopy. C) c. a systolic BP <90 mm Hg. D) d. a heart rate <50 beats/minute.

C) c. a systolic BP <90 mm Hg.

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about A) a. electrical cardioversion. B) b. IV adenosine (Adenocard). C) c. anticoagulant therapy with warfarin (Coumadin). D) d. insertion of an implantable cardioverter-defibrillator (ICD).

C) c. anticoagulant therapy with warfarin (Coumadin).

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient A) a. uses an additional pillow to sleep when feeling short of breath at night. B) b. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. C) c. calls the clinic when the weight increases from 124 to 130 pounds in a week. D) d. says that the nitroglycerin patch will be used for any chest pain that develops.

C) c. calls the clinic when the weight increases from 124 to 130 pounds in a week.

During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates A) a. decreased fluid volume. B) b. jugular vein atherosclerosis. C) c. elevated right atrial pressure. D) d. incompetent jugular vein valves.

C) c. elevated right atrial pressure.

After orienting a new staff member to the scrub nurse role, the nurse preceptor will know that the teaching was effective if the new staff member A) a. documents all patient care accurately. B) b. labels all specimens to send to the lab. C) c. keeps both hands above the operating table level. D) d. takes the patient to the postanesthesia recovery area.

C) c. keeps both hands above the operating table level.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include A) a. avoid dietary sources of potassium. B) b. take the hydrochlorothiazide before bedtime. C) c. notify the health care provider about any nausea. D) d. never take digoxin if the pulse is below 60 beats/minute

C) c. notify the health care provider about any nausea.

The nurse from the general surgical unit is asked to bring the patient's hearing aid to the surgical suite. The nurse will take the hearing aid to the A) a. clean core. B) b. scrub sink areas. C) c. nursing station or information desk. D) d. corridors of the operating room area.

C) c. nursing station or information desk.

The nurse evaluates that the interventions for the nursing diagnosis of ineffective airway clearance in a postoperative patient have been successful when the A) a. patient drinks 2 to 3 L of fluid in 24 hours. B) b. patient uses the spirometer 10 times every hour. C) c. patient's breath sounds are clear to auscultation. D) d. patient's temperature is less than 100.4° F orally.

C) c. patient's breath sounds are clear to auscultation.

During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. John's wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may A) a. experience increased pain. B) b. have hypertensive episodes. C) c. take longer to recover from the anesthesia. D) d. have more postoperative bleeding than expected.

C) c. take longer to recover from the anesthesia.

After a new nurse has been oriented to the postanesthesia care unit (PACU), the charge nurse will evaluate that the orientation has been successful when the new nurse A) a. places a patient in the Trendelenburg position when the blood pressure (BP) drops. B) b. assists a patient to the prone position when the patient is nauseated. C) c. turns an unconscious patient to the side when the patient arrives in the PACU. D) d. positions a newly admitted unconscious patient supine with the head elevated.

C) c. turns an unconscious patient to the side when the patient arrives in the PACU.

6) Which of the following is not a correct nursing and collaborative management action for heart failure? A. High Fowlers position B. Improve gas exchange and oxygenation C. Increase fluid intake D. ECG monitoring

C. Increase fluid intake

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? A) a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. B) b. Assist the patient up in the chair for meals to avoid complications associated with immobility. C) c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. D) d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

C. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.

What nursing care is associated with defibrilation?

CPR ALL CLEAR! Pain relief

Which hypertensive drugs work directly on the heart?

Calcium channel blockers - block Ca+ from moving into cells = vasodialtion, decreased HR, Contractility

What is CRT?

Cardiac resynchronization therapy (CRT) - Prolonged QRS complexes (more than 120 ms), - LVEF of 35% or lower, and - Advanced signs and symptoms (NYHA class III or IV) while on optimal drug therapy.

What affects Cardiac Output?

Cardiac: HR, Inotropic State, Neaural Humoral Renal Fluid Volume Control: Aldosterone, Renin-angiotensin, natriuretic peptides

How do you treat ventricular tachycardia?

Cardiovert or defibrillate Meds - Mg, Amio, Lidocaine CPR Ablation and/or ICD

Long Term Use of BetaBlockers

Causes myoctye toxicity. Deleterious to myocardium

What are the causes and symptoms of ventricular fib?

Causes: MI, electrocution, cardiomyopathy, trauma Symptoms: Collapse, unconscious, pulseless

What are the causes and symptoms of ventricular tachycardia?

Causes:Cardiomyopathy, myocarditis, valvular disease, heart failure, electrolytes. meds Symptoms:Angina, syncope, lightheadedness, SOB, palpitations, low BP, weak/absent pulse

male patient with a long-standing history of HF has recently qualified for hospice care. Which of the following measures should the nurse now prioritize when providing care for this patient?

Choosing interventions to promote comfort and prevent suffering

List the perameters of Class 1 CHF

Class 1 mild -No limitation of physical activity - Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).

List the perameters of Class 2 CHF

Class II (Mild) - Slight limitation of physical activity. -Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.

The nurse has received the laboratory results for a patient who developed chest pain 2 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be a. troponins T and I. b. creatine kinase-MB. c. LDL cholesterol. d. C-reactive protein.

Correct Answer: A Rationale: Cardiac troponins start to elevate 1 hour after myocardial injury and are specific to myocardium. Creatine kinase (CK-MB) is specific to myocardial injury and infarction, but it does not increase until 4 to 6 hours after the infarction occurs. LDL cholesterol and C-reactive protein are useful in assessing cardiovascular risk but are not helpful in determining whether a patient is having an acute myocardial infarction. Cognitive Level: Application Text Reference: pp. 751-752 Nursing Process: Assessment NCLEX: Physiological Integrity

A patient is diagnosed with hypertension, and first-line drug therapy with a β-adrenergic blocking agent is planned. After reviewing the patient's history, the nurse consults with the health care provider about the use of this drug upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

Correct Answer: A Rationale: Cardioselective β-adrenergic blocking agents block β1-adrenergic receptors. Nonselective agents block β1- and β2-adrenergic receptors. Nonselective agents may cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. The use of a β-blocker for a hypertensive patient who has had an MI is appropriate because β-blocker therapy is recommended after MI. Cognitive Level: Application Text Reference: p. 774 Nursing Process: Assessment NCLEX: Physiological Integrity

List the goasl of therapy for ADHF

- Improve CO - Reduce pulmonary and systemic congestion - Prevent complications - Educate patient and family

List collaborative care for increased ICP

- Maintain PaO2 >100 - maintain sytstolic BP 100-160 - O2 monitoring - PaCO2 30-35 mm Hg - nutrition

What are the tx goals for those w. Chronic HF?

- Relieve symptoms - Increase exercise tolerance - Maintain heart function - Maximize CO - Prolong life

What nursing care can be provided to reduce pulmonary congestion?

- bed in high fowlers - O2 - diuretics

What are clinical manifestations of increased ICP?

- change in LOC - Cushings Triad ( wide pulse pressure, brady, irregular breathing) - ipsilateral pupil issues - headache - vomitting - Decoticate and decerebrate posturing

How do you treat TBI?

- ensure airway -stabalize spine - O2 via nonrebreather - 2 large bore IV cathaters - admnister fluids cautiously to avoid raising IP - neuro assessments

Brain = 75% adult weight at age 2yr; 90 at age 5 yr

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Freud - mothers primarily; fathers secondarily

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Information we are being tested on starts here

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chapter 6

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An average newborn weighs?

7 1/2 lbs

Which description best defines the role of the nurse anesthetist as a member of the surgical team? A) a. Functions independently in the administration of anesthetics B) b. Has the same credentials and responsibilities as an anesthesiologist C) c. Is responsible for intraoperative administration of anesthetics ordered by the anesthesiologist D) d. Requires supervision by the anesthesiologist or surgeon while administering anesthesia to a patient

A) a. Functions independently in the administration of anesthetics

A patient with a dislocated shoulder is prepared for a closed, manual reduction of the dislocation with monitored anesthesia care (MAC). The nurse anticipates the administration of A) a. IV midazolam (Versed). B) b. inhaled desflurane (Suprane). C) c. epidural lidocaine (Xylocaine). D) d. eutectic mixture of local anesthetics (EMLA).

A) a. IV midazolam (Versed).

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patient's A) a. P wave. B) b. PR interval. C) c. QT interval. D) d. QRS complex.

A) a. P wave.

Attachment

Affectional tie that binds one person to another in space and over time

What does the P wave represent?

Atrial depolarization

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? A) a. Low dietary fiber intake B) b. No regular aerobic exercise C) c. Weight 5 pounds above ideal weight D) d. Drinks wine with dinner once a week

B No regular aerobic exercise

When auscultating over the patient's abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a A) a. thrill. B) b. bruit. C) c. heave. D) d. murmur.

B bruit.

Neurological markers

Babinski, palmer grasp, swimming, Moro, stepping

The priority nursing assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be

Blood Pressure

What determines blood pressure

Blood Pressure = Cradiac output x Systemic vascular resistence

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? A) a. 15 to 20 B) b. 20 to 40 C) c. 40 to 60 D) d. 60 to 100

C) c. 40 to 60

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include A) a. canned and frozen fruits. B) b. fresh or frozen vegetables. C) c. milk, yogurt, and other milk products. D) d. eggs and other high-cholesterol foods.

C) c. milk, yogurt, and other milk products.

List the perameters of Class 3 CHF

Class III (Moderate) Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.

List the perameters of Class 4 CHF

Class IV (Severe) Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

Carvedilol

Coreg (A1, B1, B2 blocker)

What questions to ask a patient to determine if they have HF or CHF?

1. Do they have SOB when at rest? 2. How many times did they have to rest when walking a short distance due to SOB? 3. How many pillows do they use to prop themselves up at night due to congestion in lungs while sleeping? 4. Need to find out if patient has systolic or diastolic heart failure?

List the 3 collaborative care steps for ADHF

1. Identify and treat reversible exacerbating factors 2. Evaulate symptoms related to congestion and / or low perfusion, BNP, Hemodynamic profile 3. Determine appropriate treatment strategies

First spoken words

12 months

Lateralization

Cross hemisphere control of body

Regulate body temperature

Cry, shiver, tuck legs close to body (fetal position)

Which action will the scrub nurse use to maintain aseptic technique during surgery? A) a. Use waterproof shoe covers. B) b. Wear personal protective equipment. C) c. Insist that all operating room (OR) staff perform a surgical scrub. D) d. Change gloves after touching the upper arm of the surgeon's gown.

D) d. Change gloves after touching the upper arm of the surgeon's gown.

A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. At completion of the surgery, it is most important that the nurse monitor the patient for A) a. nausea. B) b. confusion. C) c. bronchospasm. D) d. weak chest-wall movement.

D) d. weak chest-wall movement.

List the pulmonary manifestations of volume overload

DOE, PND, orthopnea, crackles, wheezes, pleural effusions, pulmonary edema

Where do infants sleep?

Depends on culture, co-sleeping common bad if drunk

List the systemic manifestations of volume overload

Edema, weight gain, abdominal symptoms

What are complications of increased ICP?

Herniation

What is an ICD?

Implantable cardiac defibrillators (ICDs) LVEF of 30% or lower and NYHA class II through IV signs and symptoms.

Cardiac Excitability

Increase Cardiac Excitability in Atria caused by a less negative resting potential

Diuresis

Increase urinary output (improve hemodynamic conditions)

Disorganized Attachment

Infant demonstrates bizarre, inconsistent behavior toward the parent

Behavioral Theory

Infant's emotions and personality are molded as parents reinforce or punish child's spontaneous behavior.

activity level higest injuries + death

2-3yrs

A patient with hypertension asks the nurse why lifestyle changes are needed when the patient has no symptoms from the high BP. The response by the nurse that is most likely to improve patient compliance with therapy is that hypertension a. damages the blood vessels leading to risk for heart attack, stroke, and kidney failure. b. increases blood flow to the kidneys leading to increased workload for the renal system. c. may not cause any problems for some people but does cause symptoms in many others. d. is probably causing symptoms but the patient does not recognize that they are occurring.

Correct Answer: A Rationale: Teaching the patient that hypertension can damage blood vessels and eventually cause severe health problems is most likely to improve patient compliance with needed lifestyle changes. The increased renal blood flow caused by hypertension does not damage the kidneys. Teaching the patient that hypertension may cause symptoms in some people or that the patient has unrecognized symptoms is unlikely to provide the motivation for behavior changes.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. increase the dietary intake of high potassium foods. b. move slowly when moving from lying to standing. c. check the BP with a home BP monitor every day. d. make an appointment with the dietitian for teaching about a low-sodium diet.

Correct Answer: A Rationale: The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril. Cognitive Level: Application Text Reference: p. 772 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented to manage BP. Which diet choice indicates that the teaching has been effective? a. The patient has a glass of low-fat milk with each meal. b. The patient has only one cup of coffee in the morning. c. The patient restricts intake of dietary protein. d. The patient has tomato juice and bacon for breakfast.

Correct Answer: A Rationale: The DASH recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Tomato juice is very high in sodium and bacon is very high in sodium and fat, both of which should be restricted in patients with hypertension. Cognitive Level: Application Text Reference: p. 770 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

The nurse hears a murmur between the S1 and S2 heart sounds at the patient's left 5th intercostal space and midclavicular line. The best way to record this information is a. "systolic murmur heard at mitral area." b. "diastolic murmur heard at aortic area." c. "systolic murmur heard at Erb's point." d. "diastolic murmur heard at tricuspid area."

Correct Answer: A Rationale: The S1 sound is created by closure of the mitral and tricuspid valves and signifies the onset of ventricular systole. S2 is caused by the closure of the aortic and pulmonic valves and signifies the onset of diastole. A murmur occurring between these two sounds is a systolic murmur. The mitral area is the intersection of the left 5th intercostal space and the midclavicular line. The aortic area is located at the 2nd intercostal space along the right sternal border. Erb's point is located at the 3rd intercostal space along the left sternal border. The tricuspid area is located at the 5th intercostal space along the left sternal border.

The nurse obtains the following information about hypertension risk factors from a patient with prehypertension. The risk factor that will be most important to address with the patient is that the patient a. gets no regular aerobic exercise. b. is 5 pounds over the ideal weight. c. has a low dietary fiber intake. d. drinks wine with dinner once a week.

Correct Answer: A Rationale: The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The DASH diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The dietary recommendation for alcohol is for no more than one drink a day for women and small adults or two drinks a day for men. Cognitive Level: Application Text Reference: pp. 768, 770, 779 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

A new patient is seen at an outpatient clinic for a routine health examination. To determine the patient's baseline blood pressure (BP) accurately, the nurse will a. have the patient sit with the arm supported at the level of the heart and measure the BP in each arm. b. obtain the BP readings in both arms and average the results. c. measure the BP in both the supine and upright positions. d. take additional measurements if there is a 10 mm Hg difference between BP readings taken 5 minutes apart.

Correct Answer: A Rationale: To obtain the baseline BP, the patient's arm should be at the level of the heart. The BP is obtained in both arms; if there is a difference, the arm with the higher pressure should be used to monitor BP. The BP can be obtained with the patient in the supine position, but the arm should be positioned at heart level. A 10 mm Hg difference between BP taken 5 minutes apart is within the range of normal and would not require additional measurements. Cognitive Level: Comprehension Text Reference: pp. 778-779 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

uring physical examination of a thin 72-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area just below the xiphoid process. The nurse teaches the patient that this is a. a normal assessment finding for a thin individual. b. likely to be caused by age-related sclerosis and inelasticity of the aorta. c. an indication that an abdominal aortic aneurysm has probably developed. d. evidence of elevated systemic arterial pressure.

Correct Answer: A Rationale: Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. More data would be needed to support a diagnosis of aortic sclerosis, aortic aneurysm, or hypertension. Cognitive Level: Application Text Reference: p. 750 Nursing Process: Assessment NCLEX: Physiological Integrity

A patient with stage 1 hypertension who received a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. BP is unchanged from the previous clinic visit. The nurse's first action will be to a. ask the patient about whether the medication is actually being taken. b. teach the patient about the reasons for an increase in the medication dose. c. provide information about the use of multiple drugs to treat hypertension. d. remind the patient that lifestyle changes are also important in BP control.

Correct Answer: A Rationale: β-adrenergic blockers cause adverse effects (such as erectile dysfunction, fatigue, and depression) in some patients, leading to noncompliance. It is important to determine whether the patient has stopped taking the medication before initiating any changes in therapy, such as increasing the atenolol dose or adding a second medication. Whereas reinforcement of the continued need for lifestyle changes is appropriate, a decrease in BP would be expected after initiation of medication therapy even if lifestyle changes had not occurred.

When auscultating over the patient's abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a a. thrill. b. bruit. c. heave. d. murmur.

Correct Answer: B Rationale: A bruit is the sound created by turbulent blood flow in an artery. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. Heaves are sustained lifts over the precordium that can be observed or palpated. A murmur is the sound caused by turbulent blood flow through the heart. Cognitive Level: Comprehension Text Reference: pp. 748, 750 Nursing Process: Assessment NCLEX: Physiological Integrity

The RN has developed a care plan for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions should not be delegated to an LPN/LVN who is working in the ICU? a. Reposition the patient every 2 hours. b. Titrate nitroprusside to maintain BP 160/100 mm Hg. c. Check and document urine output hourly. d. Monitor oxygen saturation every 2 hours.

Correct Answer: B Rationale: LPN/LVN education and scope of practice include nursing tasks such as repositioning patients, monitoring and documenting urine output and oxygen saturation, and administration of oral medications. Titration of vasoactive medications requires RN-level education and scope of practice. Cognitive Level: Application Text Reference: pp. 781-782 Nursing Process: Evaluation NCLEX: Physiological Integrity

A 62-year-old patient who has just arrived in the emergency department complaining of a sudden-onset severe headache and nausea has a BP of 240/118 mm Hg. The patient gives a history of taking clonidine (Catapres) and hydrochlorothiazide (HydroDIURIL) for 10 years for hypertension. The most appropriate question by the nurse at this time is a. Have you recently taken any antihistamine medications? b. Have you been taking the Catapres and HydroDIURIL lately? c. Do you have any recent stressful events in your life? d. Did you take any acetaminophen (Tylenol) yet today?

Correct Answer: B Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP, but not usually to the level in this patient. Cognitive Level: Analysis Text Reference: p. 779 Nursing Process: Assessment NCLEX: Physiological Integrity

During a physical examination of a patient, the nurse palpates the PMI in the sixth intercostal space lateral to the midclavicular line. The most appropriate action for the nurse to take next will be to a. document that the PMI is in the normal location. b. assess the patient for symptoms of left ventricular hypertrophy. c. ask the patient about risk factors for coronary artery disease. d. auscultate both the carotid arteries for a bruit.

Correct Answer: B Rationale: The PMI should be felt at the intersection of the 5th intercostal space and the midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with coronary or carotid artery disease. Cognitive Level: Application Text Reference: pp. 750-751 Nursing Process: Assessment NCLEX: Physiological Integrity

The RN is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse a. presses on the skin over the tibia for 10 seconds to check for edema. b. palpates both carotid arteries simultaneously to compare pulse quality. c. places the patient in the left lateral position to check for the PMI. d. uses the palm of the hand to assess extremity skin temperature.

Correct Answer: B Rationale: The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow. The other assessment techniques also need to be corrected; however, they are not dangerous to the patient. Cognitive Level: Application Text Reference: p. 748 Nursing Process: Assessment NCLEX: Physiological Integrity

An 86-year-old patient lives alone and is on a fixed income. The patient is taking once-daily doses of metoprolol (Lopressor) and furosemide (Lasix) to control BP. The patient is able to tell the nurse the names of the medications and when they are to be taken but does not always take the medications regularly, so BP is not well controlled. The most appropriate action by the nurse will be to a. discuss the patient's possible confusion with a family member. b. ask the patient about whether the cost of the medications is too high. c. offer the patient teaching about long-term effects of hypertension. d. assist the patient with an easier dosing schedule to improve compliance.

Correct Answer: B Rationale: The cost of medications is a common cause of lack of medication compliance in older patients with fixed incomes. The patient is well-oriented and well-informed about the medications, and there is no indication that further education about the possible effects of chronic hypertension is needed. The once-daily dosing schedule is already in place and is optimal for assuring compliance with the medications. Cognitive Level: Application Text Reference: pp. 778, 780 Nursing Process: Implementation NCLEX: Physiological Integrity

During change-of-shift report, the nurse obtains all of this information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. The information that will be of most concern to the nurse is that a. the patient's heart rate has dropped from 64 to 58 beats/min. b. the patient has developed wheezes throughout the lung fields. c. the patient complains that the fingers and toes feel quite cold. d. the patient's most recent BP is 156/94 mm Hg.

Correct Answer: B Rationale: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with the β-receptor blockage caused by the nadolol but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm. Cognitive Level: Application Text Reference: p. 774 Nursing Process: Evaluation NCLEX: Physiological Integrity

A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that a. a catheter will be inserted into a vein in the arm or leg and advanced to the heart. b. ECG monitoring will be required for 24 hours following the test to detect any dysrhythmias. c. a feeling of warmth may be experienced as the contrast material is injected into the catheter. d. it will be important to lie completely still during the coronary angiography procedure.

Correct Answer: C Rationale: A sensation of warmth or flushing is common when the iodine-based contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient. The catheter is inserted in an artery (typically the femoral artery) and advanced to the openings for the coronary arteries at the aortic root. Dysrhythmias may occur during the procedure, but most patients are discharged a few hours after the coronary arteriogram or angiogram is completed. The patient is not required to be completely immobile during the procedure. Cognitive Level: Application Text Reference: pp. 755, 759 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse measures the BP of a 78-year-old patient and finds it to be 168/86 mm Hg in both arms. The nurse will plan to teach the patient that a. increased BP is a normal finding in older adults. b. prehypertension indicates the need for lifestyle changes. c. it is important to address the increased BP. d. there is a high probability of kidney and heart disease.

Correct Answer: C Rationale: Although an increase in systolic BP (SBP) is a common finding in older adults, the recommendations for treating elevated BP are unchanged. An SBP of >140 mm Hg is a more important cardiovascular risk factor than diastolic BP (DBP) in individuals older than 50. The diagnosis of prehypertension indicates a systolic BP between 120 and 139 and a DBP between 80 and 89. Kidney and heart disease are common complications of hypertension, but there are no data to support these as diagnoses for this patient. Cognitive Level: Application Text Reference: p. 779 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

The nurse is has just finished medication teaching for a hypertensive patient who has a new prescription for quinapril (Accupril). The patient statement that indicates that more teaching is needed is a. "I will call the doctor if I notice that I have a frequent cough." b. "The medication may not work as well if I take any aspirin." c. "I won't worry if I have a little swelling around my lips and face." d. "The doctor may order a blood potassium level occasionally."

Correct Answer: C Rationale: Angioedema occurring with angiotension-converting enzyme (ACE)-inhibitor therapy is an indication that the ACE-inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE-inhibitor therapy. Cognitive Level: Application Text Reference: p. 776 Nursing Process: Evaluation NCLEX: Physiological Integrity

Laboratory testing is ordered for a patient during a clinic visit for routine assessment of hypertension. When monitoring for target organ damage, the nurse will be most concerned about a. blood urea nitrogen (BUN) of 15 mg/dl (5.4 mmol/L). b. serum hemoglobin of 14.7 g/dl (135 g/L). c. serum creatinine of 2.6 mg/dl (230 mmol/L). d. serum potassium of 3.8 mEq/L (3.2 mmol/L).

Correct Answer: C Rationale: BUN and creatinine are useful in determining whether renal failure is developing as a result of hypertension. The BUN level is normal. The serum creatinine is elevated and will require further investigation. The serum potassium level and hemoglobin level are normal. Cognitive Level: Application Text Reference: pp. 767, 768 Nursing Process: Assessment NCLEX: Physiological Integrity

When performing an assessment of a newly admitted patient, the nurse notes a thrill along the left sternal border. To obtain more information about the cause of the thrill, which action will the nurse take next? a. Palpate the quality of the peripheral pulses. b. Compare the apical and radial pulse rates. c. Assess for murmurs. d. Locate the PMI.

Correct Answer: C Rationale: Both thrills and murmurs are caused by turbulent blood flow, such as occurs when blood flows through a damaged valve. Relevant information includes the quality of the murmur, where in the cardiac cycle the murmur is heard, and where on the thorax the murmur is heard best. The other information is also important in the cardiac assessment but will not provide information that is relevant to the thrill. Cognitive Level: Application Text Reference: pp. 748-749, 751 Nursing Process: Assessment NCLEX: Physiological Integrity

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. diaphragm of the stethoscope with the patient in a reclining position. b. diaphragm of the stethoscope with the patient lying flat on the left side. c. bell of the stethoscope with the patient in the left lateral position. d. bell of the stethoscope with the patient sitting and leaning forward.

Correct Answer: C Rationale: Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher-pitched sounds such as S1 and S2. Cognitive Level: Application Text Reference: pp. 750-751 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

The nurse teaches a patient who is taking labetalol (Normodyne) for treatment of hypertension to change position slowly because this drug a. blocks the renin-angiotensin-aldosterone system (RAAS). b. paralyzes the smooth muscle of blood vessels. c. decreases sympathetic nervous system activity. d. prevents the movement of calcium into the cardiac cells.

Correct Answer: C Rationale: Labetalol decreases sympathetic nervous system activity by blocking both α- and β-receptors, leading to vasodilation and a decrease in heart rate, which lower BP. The angiotensin-converting enzyme (ACE)-inhibitors and angiotensin II blocking medications block the RAAS. Direct vasodilator medications inhibit the ability of vascular smooth muscle to contract and cause vasoconstriction. Calcium-channel blockers block the movement of calcium into cardiac muscle cells and lead to a decrease in heart rate and contractility, which will result in lower cardiac output.

While assessing a patient who has just arrived in the emergency department, the nurse notes a pulse deficit. The nurse will anticipate that the patient may require a. hourly blood pressure (BP) checks. b. a coronary arteriogram. c. electrocardiographic (ECG) monitoring. d. a 2-D echocardiogram.

Correct Answer: C Rationale: Pulse deficit is a difference between simultaneously obtained apical and radial pulses and indicates that there may be cardiac dysrhythmias that would be detected with ECG monitoring. Frequent BP monitoring, coronary arteriograms, and echocardiograms are used for diagnosis of other cardiovascular disorders but would not be as helpful in determining the reason for the pulse deficit. Cognitive Level: Application Text Reference: pp. 750-751 Nursing Process: Assessment NCLEX: Physiological Integrity

The nurse is obtaining a health history for a new patient with possible coronary artery disease. Which question would the nurse use when obtaining subjective data related to the patient's health perception-health management functional health pattern? a. "Do you every have any discomfort or indigestion resulting from exercise or activity?" b. "Have you had any recent episodes of sore throat, fever, or streptococcal infections?" c. "How frequently do you have your cholesterol level and blood pressure checked?" d. "Are there any symptoms that seem to occur when you are feeling very stressed?"

Correct Answer: C Rationale: The health perception-health management functional pattern includes information related to what the patient knows about coronary heart disease risk factors and actions the patient is taking to decrease risk. Any patient history of streptococcal infections or sore throat would also be included in this functional pattern, but this patient has possible coronary artery disease, not rheumatic heart disease. Information about discomfort caused by activity would be included in the activity-exercise pattern. The data about symptoms in response to stress would be documented in the coping-stress tolerance functional pattern. Cognitive Level: Application Text Reference: pp. 745-746 Nursing Process: Assessment NCLEX: Health Promotion and Maintenanc

During assessment of a patient with newly diagnosed stage 1 hypertension, the nurse finds that the patient uses a lot of salt on foods and is 30 pounds overweight. The patient states, "I thought high blood pressure was caused by stress, but I do not feel stressed at all." An appropriate nursing diagnosis for this patient is a. noncompliance related to lack of motivation and poor coping skills. b. situational low self-esteem related to new diagnosis of hypertension. c. ineffective health maintenance related to lack of knowledge about risk factors for hypertension d. ineffective denial related to complexity of management regimen and the associated lifestyle changes.

Correct Answer: C Rationale: This patient's subjective and objective assessment data indicate that lack of knowledge about hypertension will need to be addressed to allow the patient to improve the BP. There is no evidence for noncompliance, lack of motivation, or poor coping skills. The patient's statements do not indicate low self-esteem or denial. Cognitive Level: Application Text Reference: p. 778 Nursing Process: Diagnosis NCLEX: Health Promotion and Maintenance

While caring for a patient admitted with a hypertensive emergency and receiving sodium nitroprusside (Nipride), it will be essential for the nurse to a. insert an arterial line to obtain BP to ensure accurate BP measurements. b. assist the patient up in the chair for meals to avoid complications associated with immobility. c. titrate the rate of IV nitroprusside to avoid too-rapid reduction of BP to normal levels. d. place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

Correct Answer: C Rationale: When initiating treatment with rapidly acting medications such as sodium nitroprusside, the BP should not be decreased more than 25 % in the first 2 hours to prevent a sudden drop in cerebral perfusion. Frequent BP monitoring is required when treating hypertensive emergencies, an arterial line is often used; however, BP can also be monitored by using an automatic noninvasive BP device. Additionally, only a health care provider or an advanced practice nurse would insert an arterial line. When patients are receiving IV vasodilators, the BP is unable to adjust to changes in position, so the patients should remain on bed rest. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is not appropriate. Cognitive Level: Application Text Reference: pp. 781-782 Nursing Process: Implementation NCLEX: Physiological Integrity

1. When assessing a 76-year-old woman, the nurse finds the following results: BP 146/102, resting HR 104, slightly irregular S4 heart sound, and a grade I/VI aortic systolic murmur. The nurse recognizes that common effects of aging may be responsible for the (Select all that apply.) a. HR. b. irregular pulse. c. S4 heart sound. d. systolic BP. e. diastolic BP. f. grade I/VI aortic systolic murmur.

Correct Answer: C, D, F Rationale: An S4 gallop, increased systolic BP, and aortic stenosis are associated with aging, although all these findings require further assessment or intervention. Increases in HR, irregular heart rhythms, and diastolic BP increases are not associated with increased age. Cognitive Level: Comprehension Text Reference: p. 744 Nursing Process: Assessment NCLEX: Physiological Integrity

A 52-year-old patient has no history of hypertension and no risk factors related to hypertension. During an annual physical examination, the BP is 188/106. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in 2 months. b. there is an imminent danger of a stroke and immediate hospitalization is indicated. c. the dietary sodium and fat content should be decreased. d. more diagnostic testing may be needed to determine the cause of the hypertension

Correct Answer: D Rationale: A sudden increase in BP in a patient with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will require more frequent monitoring than every 2 months. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level. Cognitive Level: Application Text Reference: p. 765 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

The nurse is monitoring a patient with possible coronary artery disease who is undergoing exercise (stress) testing on a treadmill. The symptom that has the most immediate implications for the patient's care during the exercise testing is a. the BP rising from 134/68 to 150/80 mm Hg. b. the heart rate (HR) increasing from 80 to 96 beats/min. c. the patient complaining of feeling short of breath. d. the ECG indicating the presence of coronary ischemia.

Correct Answer: D Rationale: ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be immediately terminated. Increases in BP and HR are normal responses to aerobic exercise. Shortness of breath is also normal as the intensity of exercise increases during the stress testing. Cognitive Level: Application Text Reference: pp. 753, 757 Nursing Process: Assessment NCLEX: Physiological Integrity

During assessment of a patient who has stage 2 hypertension, the nurse recognizes that it is common for the patient to experience a. frequent nose bleeds. b. blurred vision. c. dyspnea on exertion. d. no symptoms.

Correct Answer: D Rationale: Hypertension is largely asymptomatic until damage to target organs has occurred. Frequent nosebleeds are not a common symptom of hypertension. Blurred vision and dyspnea on exertion indicate complications associated with damage to the retina and heart failure caused by chronic hypertension, but they are not common symptoms of hypertension. Cognitive Level: Comprehension Text Reference: pp. 766, 779 Nursing Process: Assessment NCLEX: Physiological Integrity

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has a history of coronary artery disease. b. The patient took all the prescribed cardiac medications today. c. The patient has an allergy to shellfish and iodine. d. The patient has a permanent ventricular pacemaker in place.

Correct Answer: D Rationale: MRI is contraindicated for patients with implanted metallic devices such as pacemakers. The other information will also be reported to the health care provider but does not impact on whether or not the patient can have an MRI. Cognitive Level: Application Text Reference: p. 755 Nursing Process: Implementation NCLEX: Physiological Integrity

When reading the medical history on a patient's chart, the nurse notes that the patient has pseudohypertension. When assessing the patient, the nurse will anticipate a. an elevated SBP with a normal DBP. b. an increase in BP when the patient is stressed. c. that the patient may also be diabetic or have insulin resistance. d. that the patient may have few symptoms of target-organ damage.

Correct Answer: D Rationale: Pseudohypertension is caused by sclerosis of the larger arteries, resulting in BP readings that are falsely elevated. One indication of pseudohypertension is a high BP without any of the target-organ damage that would be expected. An elevated SBP with a normal DBP is common in older adults but does not define pseudohypertension. A BP increase with stress or associated with diabetes or insulin resistance may occur but is not defined as pseudohypertension. Cognitive Level: Application Text Reference: p. 765 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

The nurse is planning patient teaching for a patient who has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. To increase fluid intake if dryness of the mouth is a problem b. To check BP daily before taking the medication c. To include high-potassium foods such as citrus fruits in the diet d. To change position slowly to help prevent dizziness and falls

Correct Answer: D Rationale: The ACE inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

A patient with no history of health problems and a BP of 210/142 is admitted to the ICU with a diagnosis of hypertensive crisis. The clinical manifestation that will require the most immediate action by the nurse is that a. the patient complains of a severe headache with pain at level 9/10 (0-10 scale). b. tremors are present in the fingers when the arms are extended. c. the urine output is 90 ml over the first 2 hours after the patient is admitted. d. the patient is unable to move the left leg when asked to do so.

Correct Answer: D Rationale: The patient's inability to more the left leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also are likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes. Cognitive Level: Analysis Text Reference: pp. 767, 778 Nursing Process: Assessment NCLEX: Physiological Integrity

While assessing a patient with heart failure, the nurse notes that the patient has jugular venous distension (JVD) when lying flat in bed. The nurse's next action will be to a. have the patient perform the Valsalva maneuver and observe the jugular veins. b. palpate the jugular veins and compare the volume and pressure on the both sides. c. use a centimeter ruler to measure and document accurately the level of the JVD. d. elevate the patient gradually to an upright position and examine for continued JVD.

Correct Answer: D Rationale: When assessing for and documenting JVD, the nurse should document the angle at which the patient is positioned. When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not clinically significant) finding. JVD that persists when the patient is sitting at a 30- to 45-degree angle or greater is significant. The nurse may use a ruler to determine the level of JVD above the heart if the JVD persists when the patient is at 30 to 45 degree angle or more. JVD is an expected finding when a patient performs the Valsalva maneuver because right atrial pressure increases. Comparison of the volume and pressure of the jugular veins is not included in jugular vein assessment. Cognitive Level: Application Text Reference: pp. 748-749 Nursing Process: Assessment NCLEX: Physiological Integrity

What medications are used for HF?

Current pharmacologic recommendations for HF patients include beta blockers, ACE inhibitors, or angiotensin II receptor blockers (ARBs) and/or an aldosterone antagonist before discharge.

A male patient with a long-standing history of HF has recently qualified for hospice care. Which of the following measures should the nurse now prioritize when providing care for this patient? A) Tapering the patient off his current medications B) Continuing education for the patient and his family C) Pursuing experimental therapies or surgical options D) Choosing interventions to promote comfort and prevent suffering

D

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which of the following symptoms? A) Muscle aches B) Constipation C) Pounding headache D) Anorexia and nausea

D

. When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? A) a. Check blood pressure. B) b. Monitor apical pulse rate. C) c. Monitor for dysrhythmias. D) d. Ask about chest discomfort.

D Ask about chest discomfort.

To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? A) a. Myoglobin B) b. Homocysteine (Hcy) C) c. Low-density lipoprotein (LDL) D) d. B-type natriuretic peptide (BNP)

D B-type natriuretic peptide (BNP)

While doing the admission assessment for a thin 72-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? A) a. Notify the hospital rapid response team. B) b. Instruct the patient to remain on bed rest. C) c. Teach the patient about aortic aneurysms. D) d. Document the finding in the patient chart.

D Document the finding in the patient chart.

A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? A) a. Platelet aggregation is enhanced by IV heparin infusion. B) b. Heparin will dissolve the clot that is blocking blood flow to the heart. C) c. Coronary artery plaque size and adherence are decreased with heparin. D) d. Heparin will prevent the development of new clots in the coronary arteries.

D Heparin will prevent the development of new clots in the coronary arteries.

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? A) a. The patient rates the pain at a level 3 to 5 (0 to 10 scale). B) b. The patient states that the pain "wakes me up at night." C) c. The patient says that the frequency of the pain has increased over the last few weeks. D) d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

D The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to A) a. document that the PMI is in the normal anatomic location. B) b. ask the patient about risk factors for coronary artery disease. C) c. auscultate both the carotid arteries for the presence of a bruit. D) d. assess the patient for symptoms of left ventricular hypertrophy.

D assess the patient for symptoms of left ventricular hypertrophy.

After noting a pulse deficit when assessing a patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require A) a. a 2-D echocardiogram. B) b. a cardiac catheterization. C) c. hourly blood pressure (BP) checks. D) d. electrocardiographic (ECG) monitoring.

D electrocardiographic (ECG) monitoring.

When developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the A) a. family history of coronary artery disease. B) b. increased risk associated with the patient's gender. C) c. high incidence of cardiovascular disease in older people. D) d. elevation of the patient's serum low density lipoprotein (LDL) level.

D elevation of the patient's serum low density lipoprotein (LDL) level.

Nadolol (Corgard) is prescribed for a patient with angina. To determine whether the drug is effective, the nurse will monitor for A) a. decreased blood pressure and apical pulse rate. B) b. fewer complaints of having cold hands and feet. C) c. improvement in the quality of the peripheral pulses. D) d. the ability to do daily activities without chest discomfort.

D the ability to do daily activities without chest discomfort.

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if A) a. the patient is restless and agitated. B) b. the blood pressure is 190/110 mm Hg. C) c. the patient complains about feeling anxious. D) d. the cardiac monitor shows a heart rate of 45.

D the cardiac monitor shows a heart rate of 45.

After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates, which statement by the patient indicates that the teaching has been effective? A) a. "I will put on the nitroglycerin patch as soon as I develop any chest pain." B) b. "I will check the pulse rate in my wrist just before I take any nitroglycerin." C) c. "I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin." D) d. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."

D) d. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."

Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? A) a. Turn the synchronizer switch to the "off" position. B) b. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position. C) c. Set the defibrillator/cardioverter energy to 300 joules. D) d. Administer a sedative before cardioversion is implemented.

D) d. Administer a sedative before cardioversion is implemented.

. A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. The patient's oxygen saturation is 99%, and recent lab results are all normal. Which action by the nurse is most appropriate? A) a. Insert an oral or nasal airway. B) b. Notify the anesthesia care provider. C) c. Orient the patient to time, place, and person. D) d. Be sure that the patient's IV lines are secure.

D) d. Be sure that the patient's IV lines are secure.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? A) a. Need to participate in an aerobic exercise program several times weekly B) b. Use of salt substitutes to replace table salt when cooking and at the table C) c. Importance of making a yearly appointment with the primary care provider D) d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

D) d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

A patient's cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? A) a. Prepare for possible temporary pacemaker insertion. B) b. Administer atropine sulfate 1 mg IV per agency protocol. C) c. Document the patient's rhythm and assess the patient's response to the rhythm. D) d. Call the health care provider before giving the prescribed metoprolol (Lopressor).

D) d. Call the health care provider before giving the prescribed metoprolol (Lopressor).

Which outcome measure will be best for the operating room (OR) nurse manager to use in determining the effectiveness of the physical environment and traffic control measures in the operating room? A) a. Smooth functioning of the OR team B) b. Effective protection of patient privacy C) c. Rapid completion of surgical procedure D) d. Low incidence of perioperative infection

D) d. Low incidence of perioperative infection

When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a A) a. T wave of 0.16 second. B) b. P-R interval of 0.18 second. C) c. Q-T interval of 0.34 second. D) d. QRS interval of 0.14 second.

D) d. QRS interval of 0.14 second.

Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? A) a. Blood glucose 228 mg/dL B) b. Serum chloride 90 mEq/L C) c. Serum sodium 133 mEq/L D) d. Serum potassium 2.8 mEq/L

D) d. Serum potassium 2.8 mEq/L

Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? A) a. The pacemaker prevents or minimizes ventricular irritability. B) b. The pacemaker paces the atria at rates up to 500 impulses/minute. C) c. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. D) d. The pacemaker stimulates a heart beat if the patient's heart rate drops too low.

D) d. The pacemaker stimulates a heart beat if the patient's heart rate drops too low.

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is A) a. weight loss of 2 pounds overnight. B) b. hourly urine output greater than 60 mL. C) c. reduction in patient complaints of chest pain. D) d. decreased dyspnea with the head of bed at 30 degrees.

D) d. decreased dyspnea with the head of bed at 30 degrees.

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the PR interval is 0.24 seconds. The appropriate intervention by the nurse is to A) a. notify the patient's health care provider immediately. B) b. administer atropine per agency bradycardia protocol. C) c. prepare the patient for temporary pacemaker insertion. D) d. document the finding and continue to monitor the patient.

D) d. document the finding and continue to monitor the patient.

The perioperative nurse encourages a family member or a friend to remain with a patient in the preoperative holding area until the patient is taken into the operating room primarily to A) a. ensure the proper identification of the patient before surgery. B) b. protect the patient from cross-contamination with other patients. C) c. assist the perioperative nurse to obtain a complete patient history. D) d. help relieve the stress of separation for the patient and significant others.

D) d. help relieve the stress of separation for the patient and significant others.

A surgical patient received a volatile liquid as an inhalation anesthetic during surgery. Postoperatively the nurse should monitor the patient for A) a. tachypnea. B) b. myoclonia. C) c. hypertension. D) d. incisional pain.

D) d. incisional pain.

A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as A) a. pulsus alternans. B) b. two-pillow orthopnea. C) c. acute bilateral pleural effusion. D) d. paroxysmal nocturnal dyspnea.

D) d. paroxysmal nocturnal dyspnea.

The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as A) a. atrial fibrillation. B) b. sinus tachycardia. C) c. ventricular fibrillation. D) d. ventricular tachycardia.

D) d. ventricular tachycardia.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? A) a. "The medication may not work as well if I take any aspirin." B) b. "The doctor may order a blood potassium level occasionally." C) c. "I will call the doctor if I notice that I have a frequent cough." D) d. "I won't worry if I have a little swelling around my lips and face."

D. "I won't worry if I have a little swelling around my lips and face."

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? A) a. Check BP daily before taking the medication. B) b. Increase fluid intake if dryness of the mouth is a problem. C) c. Include high-potassium foods such as bananas in the diet. D) d. Change position slowly to help prevent dizziness and falls.

D. Change position slowly to help prevent dizziness and falls.

2) Which patient should the nurse attend to first? A. Diabetic patient experiencing an increased blood sugar at 8am in the morning. B. Influenza patient experiencing a fever spike of 100.0 F C. Pneumonia patient experiencing productive cough with green sputum. D. Heart failure patient experiencing abnormal (symptomatic) Bradycardia at rest.

D. Heart failure patient experiencing abnormal (symptomatic) Bradycardia at rest.

8) A nurse is assessing the client with left sided heart failure. The client states that he needs to use 3 pillows under the head and chest at night to be able to breathe comfortably while sleeping. The documents that the client is experience: A. ORTHOPNEA B. DYSPNEA at rest C. DYSPNEA on exertion D. Paroxysmal nocturnal dyspnea

D. Paroxysmal nocturnal dyspnea

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? A) a. The patient avoids eating nuts or nut butters. B) b. The patient restricts intake of dietary protein. C) c. The patient has only one cup of coffee in the morning. D) d. The patient has a glass of low-fat milk with each meal.

D. The patient has a glass of low-fat milk with each meal.

1) Which of the following is not found in acute decompensated heart failure? A. ORTHOPNEA B. TACHYCARDIA C. DYSPNEA D. UNPRODUCTIVE COUGH

D. UNPRODUCTIVE COUGH

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that A) a. a BP recheck should be scheduled in a few weeks. B) b. the dietary sodium and fat content should be decreased. C) c. there is an immediate danger of a stroke and hospitalization will be required. D) d. more diagnostic testing may be needed to determine the cause of the hypertension.

D. more diagnostic testing may be needed to determine the cause of the hypertension.

10) A patient with potential heart failure enters the emergency room. What symptom should the nurse not consider for heart failure? A. cyanosis, cold and clammy skin B. lung sounds-- crackling and wheezing C. orthopnea, shortness of breath D. tightness & burning from the chest

D. tightness & burning from the chest

Therapeutically what do you want to do with HF patients?

Decrease afterload (heart works less to pressure to pump against) to improve ejection fraction and help heart rest. This can increase mortality and quality of life

What is the pathophys of systolic heart failure?

Decreased contractility -> Increased LV volume -> Increased LV EDP -> Increased LA volume -> Fluid build up in the pulmonary vasculature

List the clinical manifestations of CHF

Decreased exercise tolerance Unexplained fatigue Unexplained mental confusion Decreased urine output Loss of appetite Arrhythmias Peripheral vasoconstriction

Child Abuse

Deliberate harm

What are common causes of Diastolic Heart Failure?

Diabetes Sex ( women) Cardiac ischemia Hypertension Aging (older than 75) Obesity Aortic stenosis

What is it called when heart can't relax properly?

Diastolic heart failure (loss of flexibility)

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid

Drugs used to treat erectile dysfunction NSAIDs, H2-receptor blockers, and high-potassium foods do not pose a risk in combination with nitrates

What are characteristic features for CHF?

Dyspnea Impaired functional capacity Pulmonary or systemic venous congestion

What is defibrilation used for?

Emergency Pt unstable Usually used for ventricular dysrhythmias

Quality infant care

Encouragement of sensorimotor exploration & language development

Insecure avoidant

Engage in no interaction with mothers

Beta-Blockers

Epi and NE- Sympathic stimulation. Decreases myocardial centractility.

Classify and grade a patient with dyspnoea at rest who has only mild aortic stenosis

Functional Classification IV and Objective Assessment B.

What is difference between CHF and HF?

HF-Can either be hyperperfusing the organs (DRY) or CHF- Hyperperfusing the organs while congested (WET)

Digoxin: CV Toxicity

Heart block, atrial tachycardia, Premature Ventricular contraction, Ventricular tachycardia→Ventricular Fibrillation, Paroxysmal Atrial Tachycardia.

What is diastolic heart failure?

Heart can contract normally but can't relax ->Backup into the lungs and CHF symptoms. *Ejection fraction normal.

What assessments should be done for HF pt.s?

Heart sounds, rhythm, BP, UOP, lung sounds, LOC, PAP

What does high blood pressure do to the heart muscle?

High BP = the heart must works harder to push blood into the arteries -> hypertrophy The thickened muscle can't relax properly, and the arteries supplying blood to the heart muscle can't deliver enough oxygen to meet its needs = ischemia and chest pain. Prolonged ischemia -> heart attack - portion of the heart muscle dies.

Accident rates

Highest death rates by drowning

What are the causes of A fib?

Htn CAD cardiomyopathy age postop

What effects Systemic Vascular Resistance?

Humoral Local Regulation Sympathetic Nervous System

What mechanisms changes blood pressure the most quickly in the body?

Humoral (hormonal)

Digoxin: Electrolyte Imblance Toxcitiy

Hypokalemia, Hypomagnesimia, Hypercalemia(hypocalcemia reduces digoxin activity)

Treatment of Toxicity

Hypokalemia: with KCL. Phenytoin IV to enhance conduction of AV node). Atropine for Bradycardia. Lidocaine control of the perkinje fibers. Digibind for sever toxcitiy (digoxin antibodies)

The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include

Hypotension and tachycardia

Severely decompensated pt.s (cold and wet) should be treated how?

Improve perfusion first then deal with congestion Vasodilators / inotropes

What is the difference between congestion in lungs vs periphery, and what eventually happens?

In lungs: when left ventricle is failing In periphery: when right ventricle is failing As the disease progresses eventually left failure can lead to right failure and vice versa leading to complete failure of the heart can lead to death

Child Neglect

Inaction that leads to harm

Ventricular Automaticity

Increase in purkinje fiber automaticity → premature ventricular contraction → Ventricular tachycardia →Ventricular fibrillation

Preterm

Long periods of silence

What drugs are used for increased ICP?

Mannitol - osmotic diuretic Phenytoin - antiseizure h2 antagonists or proton pump inhibitors - prvent GI ulvers/bleeding

How is systolic failure measured?

Measured by ejection fraction (EF) Normal ejection fraction is greater than 50%. Systolic heart failure has a decreased ejection fraction of less than 50%.

Which groups are salt sensative and thus retain more water and are at risk for HTN?

Obesity Increasing age (>55 for men, >65 for women) African American ethnicity People with diabetes, renal disease

How can you tell if patient has systolic or diastolic CHF?

Preserved or Normal EF: If EF above 50 w/HF most likely is diastolic Decreased EF: If EF below 40 w/HF most likely is systolic Look at JVD (ears wiggle)- Dependent on how much distention there is determines level of volume overload

What is the primary determinent of cardiac output in healthy individuals?

Primary determinant of cardiac output in normal individuals is volume status (sodium content)

Contrast Primary and Secondary hypertension

Primary/Essential HTN does not have an apparent cause. Genetics or lifestyle. Most people with high blood pressure have essential HTN. Onset is usually in the 40s - 50's Secondary is caused by medical disorders or drugs

What is systolic heart failure?

Pumping action of the heart reduced or weakened.

How is a-fib treated?

Rate control with anticoagulation Antiarrhythmics Cardioversion Ablation Afib surgery

List the cardiac manifestations of volume overload

S3 systolic murmur, Sinus tachycardia, atrial arrhythmias, displaced PMI

What are the EKG findings for ACS?

ST elevation or depression Q Waves T wave abnormalities Lack of R wave progression

How are ACE inhibitors/ARBs used to treat chronic HF?

Should begin once congestion resolves or should be started gradually at low dosages and titrated after inotropic therapy has been tapered. *Use ARBs if ACE inhibitors are not toleratedshould be attempted instead. - These drugs reduce systemic vascular resistance

What care should you provide for patients with artificial devices?

Site care Activity restrictions EKG monitoring and troubleshooting Failure to capture Failure to sense PEA Patient education Psychosocial adjustment

Beta-Blockers-CHF Therapeutics

Start with low intital dose. Used to improve survival

What can exacerbate increased ICP?

Straining coughing sneazing hypoxemia being touched, awoken

HTN is the most powerful risk factor for?

Stroke Kidney Dz Eye damage

Ensure adequate nourishment

Sucking, swallowing, rooting, crying

What does the QT interval represent?

The ventricular cycle

What does the PR interval represent?

Time from SA to AV node

What is a primary nursing goal with increased ICP?

To prevent secondary injury

By 1 year infants gain how much compared to their birthweight?

Triple

What conditions may precipitates acute deconstructive heart failure?

Uncontrolled hypertension Renal insufficiency Arrhythmias Acute MI or ischemia Medication triggers Infections Hyperthyroidism Untreated anemia Alcohol Noncompliance

How do you classify the severity of TBI?

Using the Glasgow Coma Scale 13-15 minor 9-12 moderate <9 severe

What are the EKG findings for ventricular tachycardia?

Usually regular Rate: fast P - none QRS - wide T - hidden

What are the humoral effects on systemic vascular resistance

Vasoconstrictors: angiotensin and NE

What beta blocker sand other HTN do?

Vasodialate

What are the Local Regulations of systemic vascular resistance?

Vasodialtors:EDRF, prostaglandins - beta receptors Vasoconstrictors: Endothelin - alpha receptors

How does Vasopressin affect BP?

Vasopressin is a hormone released from the pituitary gland in response to decreases in blood volume and BP. - - Causes vasoconstriction, increasing BP in the short-term. *Also called the antidiuretic hormone and works on kidneys to inhibit fluid release and thus promot fluid retention in the body.

What does teh QRS segment represent?

Ventricular depolarization

What does the T wave represent?

Ventricular repolarization

Gow should you treat ventricular fib?

Vfib - Defib! AED CPR - remember: mostly dead! 911

What is Heart Failure?

When heart can't keep up with workload, can't meet the metabolic demands of the body Syndrome that results from any (hemodynamic or neuronal) structural or functional cardiac disorder that impairs the ventricle to fill or eject blood

The nurse is preparing to administer digoxin to a patient with HF. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dl. The nurse should do which of the following at this time?

Withhold the dose and report the potassium level

Separation anxiety

about 8 - 9; peaks at 14 mo

How is Spironolactone used to treat chronic HF?

an aldosterone inhibitor, is a class I recommendation shown to help reduce mortality. If your patient is receiving it, watch closely for hyperkalemia from the drug's potassium-sparing properties.

The realization that one is a unique person separate from others

around 15-18 months

What is temperament

be able to recognize definition, categories, and examples of temperament

Babbling

consonants + vowels

First communications

cry, noises, gestures

Digoxin: Renal excretion toxcitiy

cumulative toxicity (because of decreased renal function)

Primary prevention

deal with cultural attitudes, economics, social base

Prefrontal cortex

developing & being myelinated during preschool years

Transient exuberance

expansion of neurons, dendrites, synapses

Myelination

fatty coating of neurons improves message delivery

Child maltreatment

harm or neglect of children under age 18 years

Epigenetic theory

holds that child-rearing practices shape inborn predispositions

Can sense without perceiving

humming lights example

ADULTOMOPHISM

i.e., while we talk about emotions in infants, we can only conjecture that they feel sadness, anger, happiness

Pathophys of diastolic heart failure

impairment in ventricular relaxation ->resistance to filling of the ventricle ->elevated diastolic filling pressures The contractility of the myocardium may be normal, resulting in a near-normal LVEF. The stiffened left ventricle impedes normal ventricular filling, which can result in a reduction of cardiac output

Myelination

improves neural transmission

Learning theory

infants are taught

Over time/experience

infants can start to lead

Permanency planning

involves setting goals and a timetable for long-term care of a child.

Kinship care

is care by relatives.

Psychosocial development

is the combination of emotional and social development.

Expectant

language; adults care for babies; etc

Piaget's first stage

learning through senses and motor actions.

Basic structure

making sounds > communicate

Severe deprivation

may hamper genetic potential

Cooing

mostly vowel sounds

What causes sytolic heart failure?

myocardial ischemia/infarction CAD (65%) Valvular disease, Idiopathic, Alcoholic / toxin-induced Viral, Familial dilated cardiomyopathy Peripartum cardiomyopathy, Stress-induced cardiomyopathy, Tachycardia mediated cardiomyopathy

Corpus callosum

nerves between brain hemispheres

What is the biggest cause of resistent HTN?

non-compliance with meds due to side effects

Early emotional responses

not stable first 3 mo

Average North American

o At Birth - 20 inches (51 centimeters) & 7 pounds o At one year - 30 inches (75 centimeters) & 22 pounds (10 kg) o At two years - 32 - 36 inches (81 - 91 centimeters) & 30 pounds • Cephalo-caudal growth pattern o At birth - head = one-fourth of total body length o At one year - head = one-fifth of body length o At adulthood - head = one-eight of body length • Proximal-distal growth pattern o Legs at birth = one-quarter of total body length o Legs at adulthood = one-half of total body length

Affordances

opportunities for perception and interaction that environment offers (depend on):

Temperamental traits

originate in one's genes, but are influenced by experience.

Tertiary Circular Reaction

outside of body, but now tries variations.

Surface structure

particular language/grammar learned

Meaningful sounds

phonemic contraction to use sounds from parents' language

Fine motor

pour, use knife & fork, tie, write

Social

pragmatic view: social impulses foster infant language

Smell

prefer cloth from mother's vs other nursing mother's breast

Taste

preference for sweet

Erikson

quality of care in the first year shapes the infant's view of predictability of the world

Sleep states

quiet; active; alert awake; crying

Comprehension

receptive language precedes productive

Tertiary

reduce damage after impact

Cognition

refers to thinking, including language, learning, memory, and intelligence.

Growth

slowest rate of first 17 yrs is from 2 - 3

Cognitive Theory

states that infants form a concept of what to expect from people

Gross motor

swim, throw, run, kick balls

Assimilation

taking new information in by incorporating it into previous "schemas"

Angiotensin II also stimulates?

the release of aldosterone

What is good nutrition for a person with increased ICP?

they are in a hyper meta/catbolic state which increases the need for glucose malnutrition promotes cerebral edema so starting supplaments right away is crucial

Touch

transitory reaction

Tertiary prevention

treat maltreatment after it occurs

What is prehypertension?

up to 139/89

List lifestyle modifations that reduce HTN in the order of which ones help the most

weight Reduction DASH Diet Sodium Restriction Aerobic physical activity stop drinking

Dependent

which language; how to care for babies

Learning theories

whichever persons in the infants environment present reinforcement (and sometimes punishment) - usually parents for the most part.