Med Surg - CARDIO

A nurse is caring for a patient following insertion of a permanent pacemaker. which of the following client statements indicates a potential complication of the insertion procedure? A. "I can't get rid of these hiccups." B. "I feel dizzy when I stand." C. "My incision site stings." D. "I have a headache."

A. "I can't get rid of these hiccups." Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

A nurse is providing teaching to a patient who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching? A. "You might no longer be able to feel chest pain." B. "Your level of activity tolerance will not change." C. "After 6 months, you will no longer need to restrict your sodium intake." D. "You will be able to stop taking immunosuppressants after 12 months."

A. "You might no longer be able to feel chest pain." Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart. The client will need to permanently maintain a diet that is restricted in sodium and fat. The client will remain on immunosuppressants for the remainder of their life to help prevent rejection of the heart.

A nurse is assessing a patient who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the clients condition? A. Absence of adventitious breath sounds B. Presence of a nonproductive cough C. Decrease in respiratory rate at rest D. SaO2 86% on room air

A. Absence of adventitious breath sounds Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving.

A nurse is assessing a patient who has dilated cardiomyopathy. Which of the following findings should the nurse expect? A. Dyspnea on exertion B. Tracheal deviation C. Pericardial rub D. Weight loss

A. Dyspnea on exertion The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output. Tracheal deviation is an expected manifestation of a tension pneumothorax. A pericardial rub is an expected manifestation of pericarditis. Weight gain is an expected manifestation of dilated cardiomyopathy. Weight gain is due to ventricular compromise and fluid retention.

A nurse is planning a presentation for a group of patients who have hypertension. Which of the following lifestyle modifications should the nurse include? Select all that apply. A. Limited alcohol intake B. Regular exercise program C. Decreased magnesium intake D. Reduced potassium intake E. Tobacco cessation

A. Limited alcohol intake B. Regular exercise program E. Tobacco cessation

A nurse is providing discharge teaching for a patient who has a heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A. Weight gain of 0.9 kg (2 lb) in 24 hr. B. Increase of 10 mm Hg in systolic blood pressure. C. Dyspnea with exertion. D. Dizziness when rising quickly.

A. Weight gain of 0.9 kg (2 lb) in 24 hr. When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is caring for a patient who is 8 hr postoperative following a coronary artery graft. Which of the following client findings should the nurse report? A. Mediastinal drainage 100 mL/hr B. Blood pressure 160/80 mm Hg C. Temperature 37.1° C (98.8° F) D. Potassium 4.0 mEq/L

B. Blood pressure 160/80 mm Hg The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.

A nurse is providing discharge teaching for a patient who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? A. Apply the new patch to the same site as the previous patch. B. Place the patch on an area of skin away from skin folds and joints. C. Keep the patch on 24 hr per day. D. Replace the patch at the onset of angina.

B. Place the patch on an area of skin away from skin folds and joints. The nurse should instruct the client to rotate the patch site to help prevent skin irritation. The nurse should instruct the client to have a patch-free interval of 10 to 12 hr each day to prevent tolerance to the medication. The nurse should emphasize that nitroglycerin patches offer ongoing prevention of angina attacks. The nurse should instruct the client that patches do not treat angina attacks because they do not take effect immediately.

A nurse is caring for a patient who was admitted for treatment of left-sided HF & is receiving IV loop diuretics & digitalis therapy. The patient is experiencing weakness & an irregular HR. Which of the following actions should the nurse take first? A. Obtain the patient's current weight. B. Review serum electrolyte values. C. Determine the time of the last digoxin dose. D. Check the patient's urine output.

B. Review serum electrolyte values. Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.

A nurse is admitting a patient who has a leg ulcer and a history of diabetes mellitus. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? A. Explore the client's family history of peripheral vascular disease. B. Note the presence or absence of pain at the ulcer site. C. Inquire about the presence or absence of claudication. D. Ask if the client has had a recent infection.

C. Inquire about the presence or absence of claudication. Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.

A nurse is caring for a patient who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? A. "I'm still hungry after the bowl of cereal I ate at 7 a.m." B. "I didn't take my heart pills this morning because the doctor told me not to." C. "I have had chest pain a couple of times since I saw my doctor in the office last week." D. "I smoked a cigarette this morning to calm my nerves about having this procedure."

D. "I smoked a cigarette this morning to calm my nerves about having this procedure." Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.

A nurse in an emergency department is caring for a patient who had an anterior myocardial infarction. The patient's history reveals they are 1 week post-op following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated? A. Administering IV morphine sulfate B. Administering oxygen at 2 L/min via nasal cannula C. Helping the patient to the bedside commode D. Assisting with thrombolytic therapy

D. Assisting with thrombolytic therapy The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

A nurse is caring for patient who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the clients aPTT is 96 seconds? A. Increase the heparin infusion flow rate by 2 mL/hr. B. Continue to monitor the heparin infusion as prescribed. C. Request a prothrombin time (PT). D. Stop the heparin infusion.

D. Stop the heparin infusion. The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse in an emergency room is assessing a patient who has bradydysrhythmia. Which of the following findings should the nurse monitor for? A. Confusion B. Friction rub C. HTN D. Dry skin

A. Confusion Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status. The nurse should expect to hear a friction rub during cardiac auscultation for a client who has pericarditis. The nurse should monitor a client who has a bradydysrhythmia for hypotension. The nurse should monitor a client who has a bradydysrhythmia for diaphoresis.

A nurse is caring for a patient who has heart failure & is experiencing afib. Which of the following findings should the nurse plan to monitor for & report to the provider immediately? A. Slurred speech B. Irregular pulse C. Dependent edema D. Persistent fatigue

A. Slurred speech The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately. An irregular pulse is an expected finding for a client who has atrial fibrillation and indicates the client is at risk for inadequate cardiac output. Dependent edema is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate circulation. Fatigue is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate cardiac output.

A nurse is caring for a patient who is being rated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication? A. SOB B. Lightheadedness C. Dry cough D. Metallic taste

B. Lightheadedness Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness. A dry cough is an adverse effect of ACE inhibitors. Furosemide is used to manage shortness of breath secondary to heart failure. Shortness of breath is not an adverse effect of this medication.

A nurse is assessing a patient who has Left-Sided heart failure. Which of the following manifestations should the nurse expect to find? A. Increased abdominal girth B. Weak peripheral pulses C. Jugular venous neck distention D. Dependent edema

B. Weak peripheral pulses Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure. Increased abdominal girth, JVD, and dependent edema are findings related to systemic congestion resulting from right-sided heart failure.

A nurse is caring for a patient who is scheduled for a coronary artery bypass graft (CABG) in 2 hours. which of the following patient statements indicates a need for further clarification by the nurse? A. "My arthritis is really bothering me because I haven't taken my aspirin in a week." B. "My blood pressure shouldn't be high because I took my blood pressure medication this morning." C. "I took my warfarin last night according to my usual schedule." D. "I will check my blood sugar because I took a reduced dose of insulin this morning."

C. "I took my warfarin last night according to my usual schedule." Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.

A nurse is teaching a patient who has a new prescription for an ACE inhibitor to treat HTN. The nurse should instruct the patient to notify the provider if they experience which of the following adverse effects of this medication? A. Tendon pain B. Persistent cough C. Frequent urination D. Constipation

B. Persistent cough A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication. Tendonitis is an adverse effect of fluoroquinolone antibiotics. Frequent urination is an expected outcome of this medication. Constipation is an adverse effect of ACE inhibitors. However, the client does not need to discontinue use or report this to the provider.

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? A. Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL B. Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL C. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL D. Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL

C. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL The expected reference range for cholesterol is less than 200 mg/dL; for HDL is above 45 mg/dL for males and above 55 mg/dL for females; and for LDL is less than 130 mg/dL.

A nurse is caring for a patient who had an onset of chest pain 24 hr ago. The nurse recognize that an increase in which of the following is diagnostic of myocardial infarction (MI)? A. Myoglobin B. C-reactive protein C. Creatine kinase-MB D. Homocysteine

C. Creatine kinase-MB Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury. Myoglobin is elevated following an MI, and with skeletal muscle injury. However, it is not specific to the cardiac muscle. C-reactive protein increases soon after the beginning of an inflammatory process, such as rheumatoid arthritis, and is not specific to cardiac muscle. Homocysteine is always present in the blood. An increased level might indicate a risk factor for the development of cardiovascular disease.

A nurse in an emergency department is caring for a patient who has a BP of 254/139 mm Hg. The nurse recognizes that the patient is in a hypertensive crisis. Which of the following actions should the nurse take first? A. Initiate seizure precautions. B. Tell the patient to report vision changes. C. Elevate the head of the patient's bed. D. Start a peripheral IV.

C. Elevate the head of the patient's bed. The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse is caring for a postoperative patient 1 hr following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? A. Serosanguineous drainage on dressing B. Severe pain with coughing C. Urine output of 20 mL/hr D. Increase in temperature from 36.8° C (98.2° F) to 37.5° C (99.5° F)

C. Urine output of 20 mL/hr Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.

A nurse is assessing a patient who has a history of DVT and is receiving warfarin. The nurse should identify that which of the following findings indicates the mediation is effective? A. Hemoglobin 14 g/dL B. Minimal bruising of extremities C. Decreased blood pressure D. INR 2.0

D. INR 2.0 The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke. Decreased blood pressure is a manifestation of bleeding, which is an adverse effect of warfarin.

A nurse is preparing a patient for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure? A. Hemoglobin 14.4 g/dL B. History of peripheral arterial disease C. Urine output 200 mL/4 hr D. Previous allergic reaction to iodine

D. Previous allergic reaction to iodine The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to iodine might need a steroid or antihistamine prior to the procedure. This procedure involves access through large arteries or veins into the heart and is not affected by peripheral arterial disease.

A nurse is providing health teaching for a group of patients. Which of the following patients is at risk for developing peripheral arterial disease? A. A patient who has diabetes mellitus. B. A patient who has hypothyroidism. C. A patient who consumes two 12-oz bottles of beer a day. D. A patient whose daily caloric intake consists of 25% fat.

A. A patient who has diabetes mellitus. Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease. Twenty-five percent is within the recommended range for daily fat intake, and diet does not place the client at risk for development of peripheral arterial disease. Two 12-oz bottles of beer a day is considered moderate alcohol intake and does not place the client at risk for development of peripheral arterial disease.

A nurse is monitoring a patient's ECG monitor and notes the clients rhythm has change from normal signs rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A. Initiate chest compressions. B. Vagal stimulation. C. Administration of atropine IV. D. Defibrillation.

B. Vagal stimulation. The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause brady dysrhythmias, ventricular dysrhythmias, or asystole. The nurse should initiate chest compressions for pulseless ventricular tachycardia until a defibrillator is available. Supraventricular tachycardia does not require chest compressions The nurse should identify that atropine is used to treat bradydysrhythmias. Supraventricular tachycardia does not require atropine. The nurse should identify that cardioversion, rather than defibrillation, is used to treat supraventricular tachycardia. Defibrillation is used to treat ventricular fibrillation or pulseless ventricular tachycardia.

A nurse is caring for a patient who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A. Ventricular depolarization. B. Guillain-Barre syndrome. C. Myelodysplastic syndrome. D. Valvular disease.

D. Valvular disease. Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium. Ventricular depolarization occurs during a normal cardiac cycle and is not a potential complication of endocarditis. Guillain-Barré syndrome is associated with certain bacterial and viral infections but is not a potential complication of endocarditis. Myelodysplastic syndrome is a disorder of the bone marrow and is not a potential complication of endocarditis.