NRSG T4 Part 1

The nurse is caring for a patient with infective endocarditis. For which reason would a referral to social services be needed?

Uses intravenous drugs

During a home visit the nurse determines that teaching provided to a patient recovering from infective endocarditis has been effective. What did the nurse observe to make this clinical determination?

Using a soft toothbrush

An older patient is being evaluated for a cardiac click audible upon auscultation. Which age-related change should the nurse realize might be causing this heart sound?

Valve stenosis

A patient is scheduled for an exercise stress test. For which cardiac health problems is this patient being tested? Select all that apply.

Valvular disease Coronary artery disease

After palpating a patient's radial pulses the nurse proceeds to palpate the brachial, carotid, femoral, popliteal, and posterior tibial pulses. What condition caused the nurse to make this more thorough physical assessment?,

Various skin temperatures

The nurse explains about the development of tissue clumps within the innermost layer of the heart to a patient with infective endocarditis. What aspect of the disease process is the nurse describing?

Vegetation

The nurse notes that a patient has bilateral lower extremity edema. For which health problem should the nurse assess further?

Venous insufficiency

A patient's QRS complex is becoming increasingly wider. What is occurring within the heart muscle that is reflected on this tracing?

Ventricular depolarization is prolonged.

The nurse is visiting the home of a patient with peripheral arterial disease. For which observation should the nurse immediately intervene?

Walks around the house barefoot

The nurse is reviewing the anatomy of the heart with a patient scheduled for cardiac surgery. Which patient statement indicates additional teaching is required?

"Blood leaves the right ventricle and travels through the pulmonary artery to the lungs."

A patient with infective endocarditis is being started on intravenous antibiotics. What should the nurse include when teaching about this medication?

"Expect to continue this medication for four to six weeks at home."

The nurse is evaluating teaching provided to a patient with coronary artery disease. Which patient statement indicates that additional teaching is required?

"I can take up to three doses of nitroglycerin 15 minutes apart."

A patient with peripheral arterial disease is instructed on the medication pentoxifylline (Trental). Which patient statement indicates that teaching has been effective?

"I might not feel the effect of this medication for up to two months."

A client with type 2 diabetes mellitus is newly diagnosed with carotid artery disease. What should the nurse emphasize when discussing blood glucose control with this patient?

"Maintain blood glucose levels within normal limits."

A patient with atherosclerosis asks why smoking cessation is important. What should the nurse respond to this patient?

"Tobacco smoke speeds the growth of atherosclerosis in coronary arteries, aorta, and the legs."

The nurse suspects that a patient is experiencing a complication from a pulmonary artery catheter. What findings did the nurse use to make this clinical determination? Select all that apply.

1) Bleeding 3) Elevated body temperature 4) Acute onset of shortness of breath 5) Development of a cardiac dysrhythmia

The nurse is preparing to determine a patient's left heart afterload. What measurements are needed to make this calculation? Select all that apply.

1) Cardiac output 2) Mean arterial pressure 3) Central venous pressure

. The nurse is preparing material about peripheral artery disease (PAD) for a community fair. What should the nurse include about modifiable risk factors for the disease? Select all that apply.

1) Diabetes 2) Smoking 3) Hypertension 5) Sedentary lifestyle

The health-care provider wants an SvO2 level on a patient with a pulmonary artery catheter. From where should this sample be taken?

1) Distal lumen

A patient with a blood pressure over 160/90 mm Hg for two office visits is being started on antihypertensive medication for the first time. For which medication classifications should the nurse prepare teaching? Select all that apply.

1) Diuretics 2) Vasodilators 3) ACE Inhibitors 4) Calcium channel blockers

The nurse is preparing a tool to instruct patients on the manifestations of carotid artery disease. What should the nurse include with this information? Select all that apply.

1) Dizziness 2) Difficulty talking 3) Sudden vision changes 5) Sudden weakness on one side of the body

The nurse is reviewing the manifestations of an acute myocardial infarction with a patient diagnosed with type 2 diabetes mellitus. What should the nurse emphasize as being an atypical manifestation of this cardiac disorder?

1) Fatigue

A patient who comes to the community clinic for a wellness visit has a blood pressure of 164/92 mm Hg. What additional information should the nurse assess from this patient? Select all that apply.

1) Heart rate 3) Lower extremities 4) Neurological system 5) BMI and waist circumference

The nurse is preparing to obtain a pulmonary artery wedge pressure (PAWP) on a patient. What action should be taken to ensure for the patient's safety?

1) Inflate the balloon 1.5 mL

The nurse is assigned to a patient with a newly inserted central line. What actions should be taken to prevent the patient from developing an infection? Select all that apply.

1) Perform line care 2) Use aseptic technique 4) Use normal saline to flush the line 5) Ensure an occlusive dressing is applied

A patient with atypical chest pain is prescribed a 12-lead electrocardiogram. What findings would support this patient experiencing an acute myocardial infarction? Select all that apply.

1) Q waves 3) ST segment elevation

The nurse notes that a patient with cardiomyopathy has been prescribed an angiotensin-converting enzyme inhibitor. What is the purpose of this medication?

1) Reduce afterload

A patient with cardiomyopathy comes into the emergency department with chest pain and dyspnea after running a 5K race. What should the nurse explain to this patient?

1) Signs of overexertion

A patient's ankle systolic blood pressure is 148 mm Hg and brachial systolic pressure is 118 mm Hg. What is this patient's ankle-brachial index? Record your answer as a whole number.

1.25

A patient with cardiomyopathy is scheduled for a biventricular implantable cardioverter defibrillator. What should the nurse include when teaching the patient about this device? Select all that apply.

2) A pacer wire is placed in the right and left ventricles 4) The automatic defibrillator will deliver a shock if necessary 5) The automatic defibrillator monitors the heart for dysrhythmias

A patient with a deep vein thrombosis (DVT) is disappointed to learn that tissue plasminogen activator (tPA) is not an option. What information was used to make this treatment decision? Select all that apply.

2) Being treated for hemophilia 4) Symptoms of a DVT present for a week 5) Diagnosis of DVT made upon symptoms

The nurse wants to evaluate a patient's right heart preload. Which approach should be used to obtain this measurement?

2) Measure the central venous pressure

The nurse is preparing a teaching tool about the cardiac electrical conduction system. In which order should the nurse explain the route of the action potential?

265143 2) Sinoatrial node fires in the right atrium 6) Impulse spreads through atrial myocardium 5) Impulse travels to the atrioventricular node 1) Impulse travels to the bundle of His 4) Impulse travels through bundle branches 3) Impulse extends through Purkinje fibers

The nurse instructs a patient recovering from an acute myocardial infarction on the Life's Simple 7 actions. Which patient statement indicates that additional teaching is required?

3) "I will walk for at least 30 minutes three times a week."

A patient with cardiomyopathy asks for salt when the breakfast tray arrives. What should the nurse respond to this request?

3) "Restricting salt helps prevent the development of other health problems."

A patient with cardiogenic shock has an intra-aortic balloon pump (IABP). What should the nurse include when caring for this patient?

3) Keep the affected leg straight at all times

The health-care provider wants to determine a patient's cardiac contractility. What should be used to make this determination?

3) Pulmonary artery measurement

The nurse is preparing to measure a patient's central venous pressure. In which order should the nurse perform the steps to ensure an accurate reading

3,2,1,4 3) Secure the transducer at the phlebostatic axis 2) Ensure tubing is less than 120 cm long 1) Zero the transducer 4) Ensure transducer and tubing are free from blood and air

During a home visit the nurse notes that a patient recovering from an acute myocardial infarction has not had medication prescriptions filled at the pharmacy. What should the nurse say in response to this observation?

4) "The medications will help treat the effects of your current health problem and prevent any future events."

A patient recovering from cardiogenic shock is observed walking to the patient lounge. What should the nurse recommend to this patient?,

4) Important to obtain as much rest as possible

The clinical trainer is reviewing the renin-angiotensin-aldosterone system with graduate nurses during orientation to the telemetry unit. In which order should the trainer discuss this system?

42351 4) Kidneys release renin in response to a drop in blood pressure 2) Renin reacts with angiotensin to create angiotensin 1 3) Angiotensin I is converted to angiotensin II in the lungs 5) Angiotensin II influences adrenal glands to release aldosterone 1) Sodium and water reabsorbed in the kidneys

A patient is prescribed a 12-lead electrocardiogram. In which order should the nurse apply the V leads?

542361 5) 4th intercostal space right of the sternum 4) 4th intercostal space left of the sternum 2) Between V2 and V4 3) Midclavicular line 5th intercostal space 6) Between V4 and V6 anterior axillary line 1) Midaxillary line

The nurse is concerned that a patient is at risk for developing infective endocarditis. What information in the patient's history caused the nurse to have this concern?

70 years of age

The nurse is evaluating teaching provided to a patient with hypertension. Which observation indicates that additional instruction would be required?

Adds salt when cooking eggs in a frying pan

A patient's blood pressure is 174/98 mm Hg. Which aspect of cardiac output is most affected by this elevated reading?

Afterload

The nurse is preparing content for a community health fair on risk factors for heart disease. What should the nurse include as nonmodifiable risk factors? Select all that apply.

Age Ethnic background Parents' health history

A patient with hypertension has a low serum potassium level. Which mechanism should the nurse consider as being the cause for the elevated blood pressure?

Aldosterone

A patient is recovering from mechanical valve replacement surgery for valvular disease. What medication teaching should medication teaching should the nurse prepare for this patient?

Anticoagulant therapy for life

A patient is demonstrating manifestations of valvular disease. Which valve should the nurse expect to be affected with this disorder?

Aortic

The nurse is providing care to a patient who is prescribed furosemide as part of the treatment for congestive heart failure (CHF). The patient's serum potassium level is 3.4 mEq/L. Which food should the nurse encourage the patient to eat based on this data?

Bananas

A patient is experiencing manifestations of infective endocarditis. Which diagnostic tests should the nurse expect to be prescribed for this client? Select all that apply.

Blood cultures Electrocardiogram Transthoracic echocardiogram (TTE) Transesophageal echocardiogram (TEE)

The nurse is reviewing data collected during the assessment of an older patient. Which finding should the nurse consider as being an age-related change of the cardiovascular system?

Blood pressure 168/96 mm Hg

While planning care the nurse identified interventions to reduce a patient's risk for developing heart failure. Which assessment findings did the nurse use to make this clinical determination? Select all that apply.

Body mass index 31.3 Smokes 1/2 pack of cigarettes Blood pressure 168/90 mm Hg Fasting blood glucose 146 mg/dL

A patient is suspected of having an abdominal aortic aneurysm. For which gold standard diagnostic test should the nurse prepare teaching for this client?

CT scan with IV contrast

The nurse auscultates a bruit over a patient's carotid artery. Which noninvasive diagnostic test should the nurse expect to be prescribed for this patient?,

Carotid duplex ultrasound

The nurse is preparing to determine a patient's cardiac output. Which measurement should be used for preload?

Central venous pressure

The nurse is planning care for a patient with peripheral arterial disease. Which nursing diagnosis would be appropriate for this patient?

Chronic pain

The nurse is concerned that a patient with heart failure is decompensating. What assessment finding supports the nurse's clinical decision?

Dyspnea on exertion

The nurse is caring for a patient with pericardial effusion. Which action should the nurse use to relieve shortness of breath and pain?

Elevate the head of the bed

A patient with heart failure is having a B-type natriuretic peptide (BNP) level drawn. What is the purpose of this laboratory test?

Evaluate effectiveness of medication therapy

The nurse is preparing teaching material to help a patient with atherosclerosis manage lifestyle changes. What should the nurse emphasize in this teaching?

Follow a low-fat, low-cholesterol diet

The nurse is preparing a community program on the metrics to improve cardiovascular health. What should be included in this program? Select all that apply.

Healthy diet Physical activity Smoking cessation Lower blood pressure

After completing a physical assessment the nurse anticipates the health-care provider to prescribe diagnostic testing for valvular disease. What did the nurse assess to come to this conclusion?

Heart murmur

The nurse suspects that a patient is experiencing a release of norepinephrine from the adrenal medulla. Which assessment finding did the nurse use to make this clinical decision?

Heart rate 120 beats per minute

A patient is recovering from a cardiac catheterization. For which finding should the nurse notify the health-care provider?

Hematoma formation at puncture site

A patient with pericarditis is being prepared for an emergency pericardiocentesis. What did the nurse most likely assess to support this immediate procedure? Select all that apply.

Hypotension Pulsus paradoxus Muffled heart sounds Jugular vein distention

A patient with pericarditis asks the nurse to explain the health problem. Which phrase should the nurse use when responding to this patient?

Inflammation of the tissue surrounding the heart

The nurse is explaining the development of atherosclerosis to a patient. What should the nurse emphasize as beginning this process?

Injury to the vessel wall

The nurse notes that a patient with heart failure has a normal ejection fraction. What should this information indicate to the nurse? Select all that apply.

It is a common diagnosis It is associated with older patients with obesity It is seen in patients with diabetes mellitus and atrial fibrillation There is less blood in the ventricle to eject because of the impaired filling

A patient is diagnosed with a 7 cm abdominal aortic aneurysm. What should the nurse include in this patient's plan of care?

Keep the bed flat

The nurse notes that an older patient's point of maximum impulse is displaced to the left. What age-related change should the nurse suspect as causing this assessment finding?

Left ventricular atrophy

A patient is being assessed for heart disease. For which laboratory test should the nurse instruct to avoid eating and drinking fluids for 12 hours?

Lipid panel

A patient is being evaluated for medication therapy to treat atherosclerosis. For which health problem would a statin be contraindicated?

Liver cirrhosis

While auscultating a patient's heart rate the nurse hears scratching sounds. What is most likely causing this sound?

Low level of fluid in the pericardial cavity

A patient recovering from a carotid endarterectomy (CEA) has a blood pressure of 90/48 mm Hg. What should the nurse do first?

Lower the head of the bed

The nurse is preparing to auscultate the heart sounds of a patient with mitral valve regurgitation. Which sound should the nurse expect to hear?

Murmur

A patient is admitted for treatment of pericarditis. For which additional health problem should the nurse expect the patient to be evaluated?

Myocardial infarction

The nurse suspects that a patient has atherosclerosis. What finding did the nurse use to make this clinical determination?

Pain when walking

After an assessment the nurse concludes that a patient is experiencing infective endocarditis. What finding caused the nurse to make this decision?

Painless spots on the palms and soles

The nurse is identifying actions to reduce a patient's risk for developing another deep vein thrombosis (DVT). What should the nurse include?

Perform exercises every day

The nurse notes that a newly admitted patient has an elevated sedimentation rate. For which health problem should the nurse plan care for this patient?

Pericarditis

The nurse notes that a patient has a low serum potassium level. Which phase of the cardiac action potential will be most affected by this blood level?

Phase 3

Which information should the nurse include when documenting the findings of a patient's heart sounds? Select all that apply.

Pitch Quality Intensity Location

A patient with a blood pressure of 88/50 mm Hg has a heart rate of 112 beats per minute. Which mechanism should the nurse realize is occurring in this patient?

Positive chronotropic effect

A patient is diagnosed with an abdominal aneurysm measuring 5 cm. Which teaching material should the nurse prepare for this patient?

Preoperative and postoperative care

A patient is scheduled for a transesophageal echocardiogram (TEE). What information should the nurse expect to be provided from this test?

Presence of clots in the atria

A patient with heart failure is prescribed an angiotensin-converting enzyme inhibitor. What should the nurse explain as being the purpose of this medication?

Reduce afterload

The nurse is preparing teaching for a patient being treated for coronary artery disease. What dietary information should the nurse emphasize?

Reduce saturated fat and sodium intake

An older patient seeks emergency care for a sudden onset of severe abdominal pain. Which health problem should the nurse suspect be occurring in this patient?

Rupture of an abdominal aneurysm

A patient's blood pressure is 158/90 mm Hg, however previous measurements have been within normal limits. Which intervention would be appropriate for this patient?,

Schedule an additional measurement in a few weeks

The nurse notes that a patient is scheduled for a brain natriuretic peptide level to be drawn. What patient teaching should the nurse prepare for this patient?

Signs of heart failure

During an assessment a patient describes experiencing chest pain with exercise that disappears with rest. For which health problem should the nurse plan care for this client?

Stable angina

A patient experiencing pain and burning in the legs at rest. Which stage of peripheral arterial disease should the nurse suspect this patient is experiencing?

Stage III

A patient learns of having a 1 cm abdominal aortic aneurysm. What should the nurse emphasize when discussing the health problem with this patient?

Stop smoking

A patient is diagnosed with carotid artery disease. For which potential health problem should the nurse prepare teaching for this patient?

Stroke

The nurse applies oxygen two liters via nasal cannula on a patient with coronary artery disease. What should the nurse explain as being the purpose of the oxygen?

Supports myocardial oxygen demand

A patient with pericarditis is prescribed corticosteroids. What should the nurse emphasize when teaching about this medication?

Take the medication as prescribed

The nurse is preparing teaching about the coronary arteries for a group of patients scheduled for heart surgery. Which information should the nurse include in this teaching?

The coronary arteries originate in the cusps of the aortic valve.

A patient is prescribed to have capillary blood glucose readings every four hours. What should the nurse include when explaining capillaries to the patient?

The real work of the vascular system occurs at the capillary level.

During a physical assessment the nurse suspects that a client is experiencing a femoral thrombosis. What finding did the nurse use to make this clinical determination?

Thigh swelling to the knee