Med Surge III finals

The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI)? (Select all that apply.)

Ashen skin, Diaphoresis, Nausea and vomiting, S3 or S4 heart sounds

3 primary causes of Peritonitis? (CBG)

a. Cirrhosis with ascites b. Blood-borne organisms c. Genital tract organisms

While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information?

"My legs cramp whenever I walk more than a block."

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient states

"I can take up to five tablets every three minutes for relief of my chest pain."

A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is most supportive of the diagnosis?

"I can't get my shoes on at the end of the day."

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?

"I should reduce the amount of green, leafy vegetables that I eat."

When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions should the nurse include?

"It is very important that you stop smoking

Hypertension is related to which one of the following?

Abdominal aortic aneurysm

Which statement best describes the difference between the pain of angina and the pain of myocardial infarction?

Pain associated with angina is relieved by nitro

Which diagnostics might the nurse anticipate the HCP would order for acromegaly? Select All

insulin-like growth factor (IGF-1) oral glucose tolerance test (OGTT) GH

A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately

keep the patient in bed in the supine position.

A 40 years old client has recently developed Hypertension and Angina. Further assessment shows Depressed reflexes with Psychomotor retardation and an Abnormal Gait. Which condition might the nurse suspect?

Hyperparathyroidism

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are:

Hypertension and cigarette smoking

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are

Hypertension and cigarette smoking.

A 40 years old client has recently developed Hyportension and Edema. Further assessment shows hyperreflexia with muscle cramps and paresthesias of lips, hands, feet. Which condition might the nurse suspect?

Hypoparathyroidism

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is most appropriate?

"Lovenox will work right away, but Coumadin takes several days to have an effect on preventing clots."

A client recently diagnosed with hyperparathyroidism will be starting drug therapy. Which drug might the HPC order?

.cinacalcet (Sensipar) b. pamidronate (Aredia) c. alendronate (Fosamax)

A condition characterized by an overproduction of growth hormone (GH)?

Acromegaly

A client is seen in the ED what is described as polyuria, polydipsia and polyphagia. What condition might the nurse suspect?

DKA

Long-acting Nitrates

Used to PREVENT anginal episodes

Myocardial Ischemia

deficiency of blood supply to the myocardium

The main difference between HHS and DKA is that the patient with HHS usually has enough circulating insulin so that ________ does not occur?

ketoacidosis

The nurse is caring for a patient who survived a sudden cardiac death. What should the nurse include in the discharge instructions?

"Your family members should learn how to perform CPR and practice these skills regularly.

FACTORS THAT INCREASE DEMAND OR O2 CONSUMPTION

-Increased systolic blood pressure (hypertension)-Increased ventricular volume (fluid overload)-Increased myocardial thickness (left ventricular hypertrophy)-Increased heart rate (stress, exercise)-Increased myocardial contractility (medications)

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 147/82 and an ankle pressure of 112/74. The nurse calculates the patient's ankle-brachial index (ABI) as ________ (round up to the nearest hundredth).

0.76

Diagnostic Tests to evaluate chest pain/cardiac function

12-lead ECGSerum biomarkers (troponin, CK-MB) Blood chemistry and CBCC-reactive protein Echocardiogram Stress testing

The triglyceride lab results must report _____ to be considered a risk factor for metabolic syndrome?

>150 mg/dL

After receiving report, which patient admitted to the emergency department should the nurse assess first?

50-year-old who is complaining of sudden "sharp" and "worst ever" upper back pain

The High-density lipoprotein (HDL) cholesterol lab results must report _____ in men to be considered a risk factor for metabolic syndrome?

<40 mg/dL (0.9mmol/L)ORDrug treatment for elevated cholesterol

The High-density lipoprotein (HDL) cholesterol lab results must report _____ in woman to be considered a risk factor for metabolic syndrome?

<50 mg/dL (1.7mmol/L)ORDrug treatment for elevated cholesterol

C-Reactive Protein

A nonspecific protein, produced in the liver, that becomes elevated during episodes of acute inflammation or infection.

Which one of the following individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)?

A 45-year-old depressed male with a high-stress job

Which patient is most at risk for developing coronary artery disease?

A hypertensive patient who smokes cigarettes

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the health care provider?

Loose, bloody stools

The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI)? (select all that apply)

Ashen skin, Diaphoresis, Nausea and vomiting, S3 or S4 heart sounds

The nurse is caring for a client who is 24 hours post-pacemaker insertion. Which of the following nursing interventions is most appropriate at this time?

Assessing the incision for any redness, swelling or discharge

For which of the following antilipemic medications would the nurse question an order in a patient with cirrhosis of the liver?

Atorvastatin (Lipitor)

For which of the following is percutaneous coronary intervention (PCI) most clearly indicated?

Acute myocardial infarction

A resting heart rate of 55 beats/minute is a normal finding in which type of client?

An athletic client

Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?

Application of elastic compression stockings

Which actions could the nurse delegate to unlicensed assistive personnel (UAP) who are providing care for a patient who is at risk for venous thromboembolism?

Apply sequential compression device whenever the patient is in bed.

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which of the following common complications?

Atrial dysrhythmias

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?

Blood pressure 137/88 mm Hg

A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is developing a discharge teaching plan for the patient, which outcome has the highest priority for this patient?

Cessation of all tobacco use

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which of the following food choices?

Canned chicken noodle soup

A patient was admitted to the emergency department 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). Which of the following complications of MI should the nurse anticipate?

Cardiac dysrhythmias

A patient is being evaluated for post-thrombotic syndrome. Which assessment will the nurse perform?

Check for presence of lipodermatosclerosis.

Fibrinolytic: Inclusion Criteria

Chest pain or sx of AMI for at least 30 min, but less than 6 hours-<75 y/o-ECG changes consistent with AMI-Chest pain and ECG changes that persist after administration of sl NTG

The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question?

Combined clopidogrel and omeprazole therapy

A profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration.

DKA

The following risk factors include illness and infection, inadequate insulin dosage, undiagnosed type 1 diabetes, poor self-management, and neglect?

DKA

A nurse is assessing a patient and notes they are lethargic, anorexic and the breath is sweet, fruity odor. Lab results show blood glucose is over 250 mg/dL, pH less than 7.30 and (Bicarb) HCO3 less than 16 mEq/L.

DKA Low pH and low CO3 indicate metabolic acidosis = Kussmal Breathing

Nitroglycerin

DO NOT TAKE if taking sexual dysfunction meds Increases collateral blood flow, dilates coronary arteries, peripheral vasodilation, decreases preload and after load

The most common clinical manifestations of DKA are?Select All

Dehydration Poor skin turgor Dry mouth. Tachycardia. Orthostatic hypotension

Clinical Manifestations of CAD

Down left armPain in jawSense of impending DOOMRate painCrushing feel on chestSweatingCool, clammy, sticky skinAnxietyElevated BP changes INITIALLY, but decrease in pump, patient may have lower BPInitially tachycardia, then over a period of time develop bradycardiaConfusionExtra heart sounds

A 46-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?

Elastic compression stockings should be applied before getting out of bed.

Which action by a nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg venous thromboembolism (VTE) indicates that more education about the drug is needed?

The nurse ejects the air bubble in the syringe before giving the drug.

Place below in the order in which the ED nurse should treat a patient with sever DKA or HHS?

Ensure patent airway. Administer O2 via nasal cannula or non-rebreather mask. Establish IV access with large-bore catheter. Begin IV with 0.9% NaCl solution 1 L/hr until BP stabilized and urine output 30-60 mL/hr. Begin continuous regular insulin drip 0.1 U/kg/hr.

The Blood Pressure results are _____ in a client to be considered a risk factor for metabolic syndrome?

Greater than or equal to 130/85 mm Hg OR Drug treatment for hypertension

The female waist must measure over _____ to be considered a risk factor for metabolic syndrome?

Greater than or equal to > 35 inch (89 cm)

Male waist must measure over _____ to be considered a risk factor for metabolic syndrome?

Greater than or equal to > 40 inch (102 cm)

Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

Help the patient to use a pillow to splint while coughing.

Fibrinolytic: Exclusion Criteria

Hx of intracranial bleed or CVAUlcer or GI bleedPG or post partumUncontrolled HTNAneurysmCPRTraumaSevere bleeding hazardTerminal condition

A life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion?

Hyperosmolar hyperglycemic syndrome (HHS)

Tetany, a condition of neuromuscular hyperexcitability associated with sudden decrease in calcium levels, and tingling of the lips and stiffness in the extremities?

Hypoparathyroidism

After teaching a patient with chronic angina about nitoglycerin, the nurse recognizes the need for further teaching when the patient states:

I can take up to five tablets every three minutes for relief of my chest pain

Which of the following is not a desired action of beta blockers?

Increased myocardial oxygen consumption

A client was recently diagnosed with metabolic syndrome. The nurse understands this to be?

Insulin resistance

A client describes non radiating substernal chest pain precipitated by climbing three flights of stairs. The client has taken one sublingual nitroglycerin tablet and asks what to do next if the pain is unrelieved. What would be the nurse's best response?

Lie down and take another nitro tab 5 minutes after the first tablet.

A group of 3 or more metabolic risk factors that increase an individual's chance of developing cardiovascular disease, stroke, and diabetes mellitus. which condition might the nurse suspect?

Metabolic Syndrome

Patient's lab results come back for fasting blood glucose and show a reading of 120 mg/dL. Which condition might the nurse expect to educate the client about?

Metabolic syndrome

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?

Monitor fluid intake and urine output.

When planning emergent care for a client with a suspected MI, the nurse will anticipate administration of which of the following?

Morphine, oxygen, nitroglycerin and aspirin

CAD Pathophysiology

Most common cause is atherosclerosis Atheromas Vessel lining damage platelets, immune factors, swelling Lumens of coronary vessels become narrowed Decreased vessel elasticity Decrease blood flow & O2 delivery to myocardium

Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse?

New onset shortness of breath

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?

Notify the surgeon and anesthesiologist.

An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first?

Obtain the blood pressure.

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?

Obtain vital signs.

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient's feet is best?

One pillow is placed under the thighs and two pillows are placed under the lower legs.

The nurse would determine that a postop client is not receiving the beneficial effects of enoxaparin (Lovenox) after noting which of the following during a routine shift assessment?

Pain and swelling in lower extremities

A client newly admitted to the hospital begins to have chest pain. Before calling the physician, the nurse should gather what additional information? (select all that apply)

Pain intensity, Location of the pain, Character of the pain, Radiation of the pain

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which of the following ECG changes is most indicative of prolonged or complete coronary occlusion?

Pathologic Q wave

The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)?

Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg

A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aneurysm is:

Pulsations in the periumbilical area

The most significant factor in long-term survival of a patient with sudden cardiac death is:

Rapid institution of emergency services and procedures

Diagnostic Indicators of MI: ECG

ST elevation or depression-Q waves-T wave abnormalities

These conditions include vitamin D deficiencies, malabsorption, chronic kidney disease, and hyperphosphatemia.

Secondary hyperparathyroidism is a compensatory response to conditions that induce or cause hypocalcemia,

Diagnostic Indicators of MI: Serum Cardiac Markers

Serum Cardiac Markers:-Troponin-CK-MB

Modifiable risk factors for CAD

Smoking, HTN, DM, obesity, diet, activity level, hyperlipidemia

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of medications will the nurse plan to include when providing patient teaching about PAD management?

Statins

Fibrinolytics

Streptokinase, Tenecteplase (TNKase)

short acting nitrates

Sublingual Tab or Spray

This condition is seen in patients who have had a kidney transplant or after a long period of dialysis treatment for chronic kidney disease?

Tertiary hyperparathyroidism

A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene?

The LPN/LVN has the patient sit in a chair for 90 minutes.

The nurse is admitting a patient who is complaining of chest pain to the emergency department. Which information collected by the nurse suggests that the pain is caused by an acute MI?

The pain has persisted longer than 30 minutes

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective?

The patient exercises indoors during the winter months.

What is the primary mechanism of action of medications that relieve the pain of stable angina?

They decrease cardiac oxygen demand

Which of the following assessment findings would the nurse expect in a patient with DKA? Select All

Thirst Flushed, dry skin Breath odor or ketones Kussmaul respiration's Urinary Frequency Other known findings:Serum glucose >250 mg/dL (13.9 mmol/L)Glucosuria and ketonuria

When providing nutritional counselling for patients at risk for coronary artery disease (CAD), which of the following foods would the nurse encourage patients to include in their diet?(Select all that apply.

Tuna fish, tofu, and walnuts

When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?

Uncontrolled hypertension

Which of the following below are risk factors for Metabolic Syndrome?Select All

Waist circumference Triglycerides High-density lipoprotein (HDL) cholesterol, Fasting blood glucose

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which of the following ethnic groups would the nurse select as the highest priority for this intervention?

White male

Before administering a client's morning dose of Lanoxin (digoxin), the nurse checks the apical pulse rate and finds a rate of 54. The appropriate nursing intervention is to:

Withhold the medications and notify the doctor

Which of the following instructions given to a client who is about to undergo Holter monitoring is most appropriate?

You will need to keep a diary of all your activities and symptoms

8 causes of Secondary Peritonitis? Secondary are most common.

a. Perforated peptic/duodenal ulcer b. Perforated Intestine c. Postoperative (breakage of anastomosis) d. Peritoneal dialysis e. Blunt or penetrating trauma to abdominal organs(Knife/Gun) f. Appendicitis with rupture g. Diverticulitis with rupture e. Ischemic bowel disorders

A client suspected of having hyperparathyroidism is under going diagnostic testing which might the nurse predict?

a. Serum calcium levels exceed 10 mg/dL b. Serum phosphorus level less than 3 mg/dL Normal Ca = 8.6 to 10.5 Normal Phosphate = 2.7 to 4.5

The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to

avoid giving any IM medications to prevent localized bleeding.

Homocysteine

an amino acid normally found in the blood and used by the body to build and maintain tissues

A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should

assess for the presence of the dorsalis pedis and posterior tibial pulses.

P wave

atrial depolarization

A 23-year-old patient tells the health care provider about experiencing cold, numb fingers when running during the winter and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for

autoimmune disorders.

S-T segment

entire ventricular myocardium depolarized

Flu Vaccine

flu prompts an inflammatory response Preload

Primary hyperparathyroidism is due to an increased secretion of PTH leading to disorders of calcium, phosphate, and bone metabolism. The most common cause is a?

benign tumor (adenoma)

Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 40 mL. The nurse notifies the health care provider and anticipates an order for a(n)

blood urea nitrogen (BUN) level.

Atherosclerosis

hardening of the arteries

Angina

chest pain

Chronic Stable Angina

chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms

STEMI

complete occlusion of artery

The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). Discussion regarding resumption of sexual activity should be

discussed along with other physical activities.

A client recently diagnosed with acromegaly will be starting drug therapy. Which drug might the HPC order?

octreotide (Sandostatin) cabergoline bromocriptine pegvisomant (Somavert)

When planning emergent care for a patient with a suspected myocardial infarction (MI), the nurse will anticipate administration of

oxygen, nitroglycerin, acetylsalisylic acid (aspirin), and morphine sulphate.

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find

prolonged capillary refill in all the toes.

Afterload

resistance to left ventricular ejection

It is suspected that a client may have HHS when the blood glucose reading is over 600 mg/dL. Which neurological manifestations might the nurse see? Select All

somnolence coma seizures aphasia Since these manifestations resemble a stroke, immediate determination of the glucose level is critical.

The most common cause of hypoparathyroidism is?

thyroidectomy hypomagnesemia tumors heavy metal poisoning

A patient has a 6-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining an admission history from the patient, it will be most important for the nurse to ask about

trouble swallowing.

When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will

use a heating pad on my feet at night to increase the circulation and warmth in my feet."

QRS Complex

ventricular depolarization

Mr. Simpson, 55 years old, is diagnosed with atrial fibrillation. The physician orders warfarin sodium (Coumadin) for Mr. Simpson. While implementing this order, the nurse makes certain that which of the following medications is available as the antidote for Coumadin?

vitamin K

Preload

volume of blood in ventricles at end of diastole