patho final test bank combined set

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Which finding should the nurse expect when assessing a patient with symmetrical distal polyneuropathy due to diabetes? A. Distal pain in lower legs that worsens at night B. Sharp, shooting pain in the distal legs C. Distal sensory loss in one limb D. Leg pain that progresses from proximal to distal

Which laboratory values should the nurse expect in a patient with diabetic ketoacidosis? A. Serum bicarbonate > 18 mEq/L B. Arterial pH > 7.3 C. Ketonuria D. Plasma glucose level of 200 mg/dL

Which data indicates a diagnosis of diabetes in a patient being assessed for unexplained weight loss? A. Symptoms of diabetes plus casual plasma glucose concentration ≥ 150mg/dL B. 2-hour plasma glucose > 150 mg/dL C. Fasting plasma glucose ≤ 126 mg/dL D. A1C ≥ 6.5%

when is An oral glucose tolerance test used to check for gestational diabetes

the 24th week of pregnancy

When teaching a patient newly diagnosed with type 1 diabetes about autonomic nervous system symptoms of hypoglycemia, which would the nurse include? A. Irritability and confusion B. Visual disturbances and drowsiness C. Sweating and tremors D. Incoordination and difficulty speaking

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct? a. Insulin is not used to control blood glucose in patients with type 2 diabetes. b. Complications of type 2 diabetes are less serious than those of type 1 diabetes. c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. d. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.

Which statement by the parent of a child with an eating disorder indicates that more teaching is needed? A. "My child may experience uncontrolled diabetes." B. "If my child develops diabetes, the rate of complications may be higher than usual." C. "Diabetes is not connected to eating disorders in children." D. "Diabetic complications can be accelerated in children with eating disorders."

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about a. self-monitoring of blood glucose. b. using low doses of regular insulin. c. lifestyle changes to lower blood glucose. d. effects of oral hypoglycemic medications.

C The patient's impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

The nurse is assessing a patient with hyperglycemic hyperosmolar syndrome (HHS). Which finding would differentiate HHS from diabetic ketoacidosis (DKA)? A. Fluid volume deficit B. Electrolyte imbalances C. Hyperglycemia D. Lack of ketonuria

The public health nurse is conducting a community screening for diabetes. Which of the following people does the nurse identify as being at highest risk for type 1 diabetes? A. A person with an affected father B. A person with an affected sibling C. A person with an affected mother D. A person with multiple affected first-degree relatives

during RAAS system, what gland releases antidiuretic hormone (ADH)

pituitary gland

Which metabolic state is characterized by the oxidation of free fatty acids by muscles?

postabsorptive state

When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?

"I will notify my health care provider if my blood glucose level is consistently greater than 250 mg/dL."

When conducting community screening for diabetes, which population should the community health nurse recognize as being at highest risk? A. Caucasians B. Hispanics/Latinos C. African Americans D. Asian Americans

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? a. The patient uses oral contraceptives. b. The patient runs several days a week. c. The patient has been pregnant three times. d. The patient has a family history of diabetes.

ANS: A Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT. History of previous pregnancies may provide informational about gestational glucose tolerance but will not lead to misleading information from the OGTT.

A 30-yr-old patient has a new diagnosis of type 2 diabetes. The nurse will discuss the need to schedule a dilated eye examination a. every 2 years. c. when the patient is 39 years old. b. as soon as possible. d. within the first year after diagnosis.

ANS: B Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and annually thereafter. Patients with type 1 diabetes should have dilated eye examinations starting 5 years after they are diagnosed and then annually.

After change-of-shift report, which patient should the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% b. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL c. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL d. A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute abdominal pain

ANS: B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other patients also have symptoms that require assessments or interventions, but they are not at immediate risk for life-threatening complications.

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. "I will need a bedtime snack because I take an evening dose of NPH insulin." b. "I can choose any foods, as long as I use enough insulin to cover the calories." c. "I can have an occasional beverage with alcohol if I include it in my meal plan." d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: B Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

The nurse identifies a need for additional teaching when the patient who is self-monitoring blood glucose a. washes the puncture site using warm water and soap. b. chooses a puncture site in the center of the finger pad. c. hangs the arm down for a minute before puncturing the site. d. says the result of 120 mg indicates good blood sugar control.

ANS: B The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve endings along the side of the finger pad. The other patient actions indicate that teaching has been effective.

The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?

Apply a moisturizing lotion to dry feet, but not between the toes

The nurse administers a chewable aspirin to a patient who reports worsening chest pain at rest. The patient asks the nurse why the aspirin is needed. Which explanation by the nurse is accurate? "Aspirin is used to help alleviate the pain associated with acute coronary syndrome." "Aspirin is used to vasodilate the coronary arteries to increase blood flow to the heart muscle." "Aspirin is used to slow the heart rate to prevent the heart from working too hard." "Aspirin is used with acute coronary syndrome because of its antiplatelet function, which helps prevent thrombosis."

"Aspirin is used with acute coronary syndrome because of its antiplatelet function, which helps prevent thrombosis." Non-enteric-coated chewable aspirin should be given at presentation of symptoms and continued throughout the patient's life because of its antiplatelet function in preventing future thrombosis and coronary artery occlusion. Morphine sulfate may be administered intravenously in the presence of persistent ischemic chest pain, unless there are contraindications such as hypotension. Short-acting sublingual nitroglycerin should be administered under the patient's tongue every 5 minutes for up to 3 doses for vasodilation. Beta blockers are used to slow the heart rate.

A patient undergoing an electrocardiogram (ECG) asks the nurse the purpose of the test. Which explanation by the nurse is accurate? "ECG is a test used to assess the pumping ability of the heart." "ECG is a test used to assess the electrical activity of the heart." "ECG is a test used to determine cardiac output of the heart." "ECG is a test used to measure the preload and afterload in the heart."

"ECG is a test used to assess the electrical activity of the heart." The electrocardiogram (ECG) is used to assess and record the heart's electrical activity and show the presence of dysrhythmias related to cardiovascular disease. It cannot determine preload, afterload, cardiac output, or the pumping ability of the hear

A patient with systolic heart failure (HF) asks why medications are prescribed to help with the pumping action of the heart. Which response by the nurse is correct? "Decreased systemic vascular resistance is making it harder for the heart to pump blood to the body." "Increased blood pressure and fluid volume make it difficult for the heart to pump blood to the body." "Increased preload and perfusion to the body's organs are causing too much fluid to build up in the body." "Increased blood flow through the lungs is making it harder for the heart to pump blood."

"Increased blood pressure and fluid volume make it difficult for the heart to pump blood to the body." Increased blood pressure, afterload, fluid volume, and preload make it difficult for the heart to pump blood to the body. Increasing perfusion is not associated with heart failure (HF). Increased systemic vascular resistance (SVR) increases afterload and makes it harder for the heart to pump. Decreased blood flow through the lungs occurs in HF due to congestion. SVR is increased in heart failure.

The nurse is teaching a colleague about cardiac output. Which statement by the nurse is accurate? "Decreased preload will increase cardiac output." "Decreased stroke volume will increase the cardiac output." "Increased stroke volume and heart rate will increase cardiac output." "Increased stroke volume and bradycardia will increase cardiac output."

"Increased stroke volume and heart rate will increase cardiac output." Cardiac output (CO) is the amount of blood pumped from the left or right ventricle. It is determined by stroke volume (SV) and heart rate (HR) as represented by the equation: CO = SV x HR. Decreased HR or SV will decrease CO. Decreased preload will decrease stroke volume.

A patient is diagnosed with periodontal disease. The nurse explains to the patient how periodontal disease is associated with coronary artery disease (CAD). Which statement by the nurse is accurate? Periodontal disease is a disease that has no association to CAD." "Periodontal disease is a nonmodifiable risk factor that is associated with a decreased risk of development of CAD." "Periodontal disease is an inflammatory process that may be associated with increased risk of CAD." "Periodontal disease is a nonmodifiable risk factor that may be associated with increased risk of CAD."

"Periodontal disease is an inflammatory process that may be associated with increased risk of CAD." Periodontal disease is an inflammatory process that may be associated with increased risk of coronary artery disease. Infections have been associated with CAD as well as periodontal disease, which makes the diseases possibly related due to shared risk factors and inflammatory processes. Peridontal disease is a modifiable risk factor.

A patient with a history of cocaine use is scheduled for cardiac function tests. Which should the nurse include when explaining the purpose of these tests to the patient? "Cocaine is an idiopathic cause of heart failure." "Cocaine causes bradycardia and decreases cardiac output, so heart function needs to be monitored." "Systolic heart failure can be caused by cocaine increasing pressure in the lungs." "Systolic heart failure can be caused by toxins affecting the function of the heart."

"Systolic heart failure can be caused by toxins affecting the function of the heart." Systolic heart failure may be due to the effect of toxins such as cocaine on the heart, which results in tachycardia. Cocaine does not increase pressure in the lungs to cause heart failure. Since cocaine is an identifiable cause, it is not idiopathic.

A patient with a history of myocardial infarction (MI) asks why breathing becomes difficult at night. Which response by the nurse is accurate? "The MI has caused the heart to have a compromised pumping ability and cannot oxygenate the body, making breathing difficult." "The MI caused cardiac output to increase and is putting too much workload on the heart, making it difficult to breath." "Due to the MI, the heart is unable to pump blood to the lungs, so it has become difficult to breath." "The MI caused the heart to lose some ability to pump blood out of the heart, and blood is backing up into the lungs making it difficult to breath."

"The MI caused the heart to lose some ability to pump blood out of the heart, and blood is backing up into the lungs making it difficult to breath." The myocardial infarction (MI) caused damage to the heart resulting in the loss of some ability to pump blood, so the blood is backing up into the lungs and making it difficult to breathe. Left-sided heart failure (HF) occurs when the left side of the heart is unable to pump blood sufficient to meet the needs of the body. In this type of heart failure there is a lack of forward flow of blood to the aorta and the systemic circulation causing a decrease in cardiac output. There is also increased venous congestion in the lungs as blood begins to back up into the pulmonary vessels. Oxygenation is an issue in HF, but the assessment finding relates to left-sided HF. The difficulty breathing is due to pulmonary congestion. The right side delivers blood to the lungs and does not cause pulmonary congestion.

A patient with hypertension (HTN) asks why medication is needed. Which response by the nurse is acurate? "Hypertension decreases with age, decreasing the risk factor for heart failure." "Uncontrolled hypertension increases the risk of development of heart failure." "Mild hypertension does not have a relationship as a risk factor for heart failure." "Hypertension results in a myocardial infarction, which is the greatest risk factor for heart failure."

"Uncontrolled hypertension increases the risk of development of heart failure." Of the risks for developing heart failure (HF), studies have identified that HTN has the greatest impact. Risk for heart failure with myocardial infarction is also high, but not high as with hypertension. HTN increases with age. Decreasing HTN, even mild HTN, is the best prevention of HF.

Which finding would the nurse expect when assessing a patient with diastolic heart failure? A. Normal ejection fraction B. Dyspnea at rest C. Lack of peripheral edema D. Increased urinary output

Which information should the nurse include in a teaching care plan for a patient with systolic heart failure? A. Restrict salt intake. B. Monitor weight once a week. C. Ensure sufficient bedrest. D. Drink plenty of fluids with meals.

The coronary angiogram of a client with acute myocardial infarction reveals that the client has two significantly blocked coronary arteries. Which procedure should the nurse anticipate? A. Coronary angioplasty B. Echocardiogram C. Electrocardiogram D. Pacemaker placement

A. Coronary angioplasty

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? a. Choose flat-soled leather shoes. b. Set heating pads on a low temperature. c. Use callus remover for corns or calluses. d. Soak feet in warm water for an hour each day.

ANS: A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? a. 10:00 AM c. 2:00 PM b. 12:00 AM d. 4:0 PM

ANS: A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin? a. thigh. c. abdomen. b. buttock. d. upper arm.

ANS: C Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle

The nurse is assessing a patient for risk factors of coronary artery disease. Which factor is considered nonmodifiable? Sedentary lifestyle Age 62 years Stress level Elevated lipid levels

Age 62 years As age increases, so does the risk of coronary artery disease. The patient cannot change their age, so it is classified as a nonmodifiable risk factor. Patients can learn methods to minimize or manage stress; therefore, it is considered a modifiable risk factor. Elevated lipid levels increase the risk of fatty deposits inside blood vessels. Lipid levels can be controlled through diet, exercise, and medications and are considered a modifiable risk factor. A lack of activity increases the risk of the formation of plaque seen in coronary artery disease. A patient can change their activity level and therefore it is classified as a modifiable risk factor.

The nurse is teaching a patient about strategies to decrease the risk for coronary artery disease. Which diet choice demonstrates that the patient accurately understands the nurse's instruction? Liver Coconut milk Almonds Egg yolks

Almonds Nuts contain unsaturated fats, providing essential nutrients without cholesterol. Coconut products are high in saturated fats and increase the risk for coronary artery disease. Egg yolks are high in saturated fat and cholesterol, increasing the risk for coronary artery disease. Egg whites are low in fat. Liver has animal fats that contribute to elevated levels of low-density lipoproteins and increase the risk for coronary artery disease.

To effectively care for patients with heart disease, the staff development nurse is teaching new nurses hired for the intensive care unit about the Frank-Starling law. Which concept will the instructor teach? A. Increasing afterload causes an increase in left ventricular contractility. B. Increasing preload causes an increase in left ventricular contractility. C. Increasing preload causes a decrease in left ventricular contractility. D. Increasing afterload causes a decrease in left ventricular contractility.

To obtain information about a patient's major modifiable risk factors for coronary artery disease, which question should the nurse ask? A. "Do you suffer from depression?" B. "Do you smoke cigarettes?" C. "How much alcohol do you drink?" D. "Do you have sleep apnea?"

When auscultating the heart of a patient with mitral stenosis, the nurse is most likely to hear which sounds? A. Holosystolic murmur B. Diastolic murmur and opening snap. C. Systolic click murmur D. Loud, harsh holosystolic murmur

A nurse is teaching a client who has diabetes mellitus and a new prescription for prednisone for a rash. Which of the following statements by the client indicates the need for further teaching? A. "I might need to decrease my regular insulin during this time." B. "I will gradually stop the prednisone when my rash goes away." C. "I might feel a little emotional when I am on this medicine." D. "I might have a hard time falling asleep while taking prednisone."

B. "I will gradually stop the prednisone when my rash goes away." The pt should discontinue glucocorticoids gradually to reduce risk for adrenal insufficiency. Manifestations of adrenal insufficiency include nausea, vomiting, confusion, & hypotension. Glucocorticoids can cause hyperglycemia, pts might req. reduced calories and increased hypoglycemic meds, mood changes, irritability, and insomnia are adverse rxns, pt should report severe psychological disturbances, like hallucinations or depression.

A client who has type 2 diabetes mellitus asks the nurse, "Why did I develop diabetes?" Which of the following responses should the nurse make? A. "Your body is destroying the cells that secrete insulin." B. "Your body has insulin resistance and decreased insulin secretion." C. "An infection in your pancreas destroyed the cells that make insulin." D. "Your kidneys are not able to reabsorb water which leads to type 2 diabetes mellitus."

B. "Your body has insulin resistance and decreased insulin secretion."

Which ethnic group has the highest percentage of individuals with hypertension? A. Asian American B. African American C. Hispanic D. Caucasian

B. African American The fact that ethnic groups differ in their susceptibility to hypertension (HTN) also suggests a genetic component to the disease. African Americans have the highest rate of HTN among ethnic groups. Caucasians (non-Hispanic White) are less likely to have high blood pressure than are non-Hispanic Blacks. Asians are less likely to have HTN than are non-Hispanic Blacks and non-Hispanic Whites. Non-Hispanic Black men tend to have higher blood pressure than do non-Hispanic Black women.

A patient with Raynaud disease experiences numbness, tingling, and an ashy white appearance of the hands. Which medication should the nurse anticipate being prescribed as the primary pharmacologic treatment for this patient? A. Anti-inflammatory medication B. Calcium channel blocker C. Antimigraine medication D. Beta blocker

B. Calcium channel blocker - The primary pharmacologic treatment for Raynaud disease is a calcium channel blocker, such as nifedipine, which dilates arterioles that spasm. - Beta blockers will be of no benefit for treatment of Raynaud disease. - Antimigraine medications are a trigger for Raynaud disease. - Anti-inflammatory medications are used to treat secondary Raynaud disease.

A patient has a blood pressure of 110/70 mmHg. Which category of blood pressure should the nurse document? A. Stage 1 hypertension B. Normal blood pressure C. Elevated blood pressure D. Stage 2 hypertension

B. Normal blood pressure - Normal blood pressure is classified as a systolic pressure <120 mmHg and a diastolic pressure <80 mmHg. - Elevated blood pressure is classified as a systolic pressure between 121-129 mmHg and a diastolic pressure >80 mmHg. - Stage 1 hypertension is classified as a systolic pressure from 130-139 mmHg and a diastolic pressure 80-89 mmHg. - Stage 2 hypertension is classified as a systolic pressure of at least 140 mmHg and a diastolic pressure of at least 90 mmHg.

While performing a physical exam on a patient, the nurse notices that both the diastolic and systolic blood pressures are elevated at 170/110 mmHg. Which lifestyle modification should the nurse suggest to the patient that could lower both diastolic and systolic blood pressures? A. Exercise frequently B. Reduce alcohol consumption C. Decrease stress D. Lose weight

B. Reduce alcohol consumption - The sympathetic nervous system (SNS) is activated after the consumption of alcohol, causing the fight-or-flight response and elevated blood pressure. Reducing alcohol consumption can lower both systolic and diastolic pressure. Other mechanisms are likely involved in the pathogenesis of alcohol-related hypertension. - Decreasing stress, losing weight, and frequent exercise will have a positive effect on hypertension; however, they are only effective at lowering the systolic pressures.

Which explanation of cardiac risk assessment should the nurse give to a patient asking about his risk for heart disease? A. "If you reduce your risk for heart disease, you will prevent heart disease." B. "Risk assessment will tell us if you will have a heart attack." C. "Risk assessment can guide us in helping you reduce your risk for heart disease." D. "Risk assessment takes into consideration accumulated long-term exposure to risk factors."

Which laboratory finding is expected in the patient experiencing unstable angina? A. Elevated creatine kinase B. Elevated creatine kinase MB C. Normal cardiac troponin levels D. Elevated myoglobin

The nurse is caring for a patient with unstable angina. Which symptom indicates that the patient may be experiencing a myocardial infarction? Chest pain Tachycardia Cool mottled skin Dyspnea

Cool mottled skin Cool mottled skin indicates a decrease in supply of oxygenated blood to the body and possible heart failure. This manifestation is not present with unstable angina and indicates the possible occurrence of a myocardial infarction. Chest pain, tachycardia, and dyspnea are present with unstable angina and do not indicate a progression to myocardial infarction.

A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? A. "Have an eye examination once per year." B. "Examine your feet carefully every day." C. "Wear compression stockings daily." D. "Maintain stable blood glucose levels."

D. "Maintain stable blood glucose levels." Keeping blood glucose under control is pt's best protection against long-term complications of DM, increased BG contributes to neuropathic disease, & microvascular complications (like retinopathy & neuropathy), as well as to macrovascular complications. Annual eye exams & daily feet exams are important, but not preventative. Constant use of compression stockings can impair circulation and increase risk of complications. Pts with DM should NOT wear them routinely.

A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe? A. 14 units B. 28 units C. 32 units D. 42 units

D. 42 units Each order for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.

A patient is experiencing swelling of the lower leg and leg pain while standing. Which medical condition should the nurse consider this patient is experiencing? A. Raynaud disease B. Thoracic outlet syndrome C. Hypertension D. Chronic venous insufficiency (CVI)

D. Chronic venous insufficiency (CVI) General symptoms occurring with chronic venous insufficiency (CVI) include leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. Three conditions closely associated with CVI are chronic leg ulcers, varicose veins, and deep vein thrombosis.

The nurse is reviewing laboratory values of a client at risk for coronary disease. Which lab value increases risk for this client? A. Below normal serum sodium (Na) B. Low low-density lipoprotein (LDL) C. Elevated high-density lipoprotein (HDL) D. Elevated C-reactive protein (CRP)

D. Elevated C-reactive protein (CRP)

The nurse is discussing coronary artery disease (CAD) with a colleague. Which statement by the nurse is accurate? "Atherosclerosis begins with small particles of high-density lipoproteins in the tunica intima." "Coronary artery disease decreases quality of life but does not increase risk of death." "Decreased levels of high-density lipoproteins (HDLs) decrease the risk of CAD." "Atherosclerosis causes narrowed arteries and decreased blood flow."

"Atherosclerosis causes narrowed arteries and decreased blood flow." The development of atherosclerotic plaque protruding into the vessel lumen leads to a narrowed artery, which disrupts laminar blood flow. thereby reducing blood delivery to distal tissue. Progressive narrowing of the coronary artery occurs as the atherosclerotic plaque builds up and decreased blood flow results in insufficient supply to distal tissues such as the myocardium. The first steps of atherosclerosis involve the accumulation of small particles of low-density lipoprotein (LDL), not HDL, cholesterol in the tunica intima. Increased, not decreased, levels of high-density lipoproteins (HDLs) decrease the risk of atherosclerosis. Decreases in oxygenated blood supply to the coronary arteries both decrease a patient's ability to function and increase the risk of death.

A patient's laboratory test results demonstrate an elevated C-reactive protein (CRP). The patient asks the nurse, "What does this mean?" Which response by the nurse is accurate? "Increased C-reactive protein levels show that inflammation has caused angina that will lead to a myocardial infarction (MI)." "Decreased C-reactive protein levels interfere with the heart's electrical activity." "C-reactive protein (CRP) level is strongly associated with atherosclerosis and coronary artery disease (CAD)." "C-reactive protein levels indicate that damage to the heart muscle has impacted the heart's pumping ability."

"C-reactive protein (CRP) level is strongly associated with atherosclerosis and coronary artery disease (CAD)." An elevated plasma or serum C-reactive protein level is strongly associated with atherosclerosis and CAD, and is predictive of cardiovascular events such as MI, stroke, peripheral artery disease, and sudden cardiac death. CRP does not impact the electrical activity or pumping activity of the heart. Increased levels do indicate inflammation, but that alone does not lead to angina or MI, because those are caused by the narrowing of the lumen of the artery.

The nurse is teaching a patient with coronary artery disease about nonmodifiable risk factors. Which statement by the patient shows that teaching has been effective? "Elevated lipid levels are genetic and I cannot change the levels." "Family history is something I cannot change." "Depression is a disease that I cannot change." "Obesity is a disease and cannot be changed."

"Family history is something I cannot change." A patient cannot change family history, so it is classified as a nonmodifiable risk factor. Patients can learn methods to minimize or manage depression; therefore, it is considered a modifiable risk factor. Elevated lipid levels increase the risk of fatty deposits inside blood vessels. Lipid levels can be controlled through diet, exercise, and medications, and are considered a modifiable risk factor. A patient can change obesity and therefore it is classified as a modifiable risk factor.

The nurse manager is determining the appropriate nursing staff ratio for patients with heart failure. Which statement should the nurse consider? "Lower nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure." "Nurse staffing ratios have not been shown to affect the 30-day readmission rates for patients with heart failure." "Higher nurse staffing ratios are associated with increased 30-day readmission rates for patients with heart failure." "Higher nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure."

"Higher nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure." With heart failure, higher nurse staffing is associated with decreased 30-day readmission rates. Although this study did not examine the specific reasons for the lower readmission rates, it is possible that increased nurse staffing ratios enable nurses to facilitate better discharge planning, provide more discharge education, and/or better involve family and significant others in the education, provide more complete patient assessments, and contribute more overall to the team management of heart failure.

A patient with hypertension (HTN) states, "I feel fine. Why do I continually need follow-up?" Which explanation by the nurse is accurate? "Hypertension causes increased cardiac output and puts more work on the heart." "Hypertension should be screened so that blood pressure can be managed, but it will not impact your heart." "Hypertension can cause organ damage to the heart, brain, kidneys, and eyes without symptoms." "Hypertension causes decreased afterload on the left ventricle and makes it harder for the heart to pump."

"Hypertension can cause organ damage to the heart, brain, kidneys, and eyes without symptoms." While some of the most common symptoms that hypertensive patients report are headaches and nocturia, many patients have no symptoms of HTN. HTN has an impact on the heart and its functions. HTN causes increased afterload, which decreases cardiac output.

A patient at high risk for sudden cardiac arrest asks about treatment options to prevent it.Which statement by the nurse is accurate? "A wearable cardioverter-defibrillator vest is a permanent treatment option that requires no surgical operation." "Pacemaker insertion is needed to help decrease mortality for patients at high risk for sudden cardiac arrest." "Implantable cardioverter-defibrillators (ICDs) are the best option to decrease mortality for patients at high risk for sudden cardiac arrest." "It is best to get an automated external defibrillators (AED) to keep at home to decrease mortality for patients at high risk for sudden cardiac arrest."

"Implantable cardioverter-defibrillators (ICDs) are the best option to decrease mortality for patients at high risk for sudden cardiac arrest." Implantable cardioverter-defibrillator implantation has been associated with reduced mortality in patients who are at high risk for sudden cardiac death. Pacemakers are indicated mainly for symptomatic bradydysrhythmias or for patients with asymptomatic bradydysrhythmia if development of serious or symptomatic dysrhythmia is likely. A wearable cardioverter-defibrillator vest is a temporary option until an ICD can be implanted. An AED is not the best option, because it requires a second person to operate.

The nurse is assessing a patient with diabetes for clinical manifestations of coronary artery disease. The patient states, "Since I've had no chest pain, why are you concerned about cardiac disease?" Which statement by the nurse is accurate? "Diabetes causes more severe symptoms of heart problems so you would feel more chest pain if you had any heart problems." "It is common for people with diabetes to not experience the classic signs of heart problems such as chest pain." "People with diabetes have a better prognosis for decreasing heart problems." "Diabetes decreases the risk of heart disease, but everyone should be screened for heart disease."

"It is common for people with diabetes to not experience the classic signs of heart problems such as chest pain." Diabetes increases the risk of coronary artery disease, due to high blood sugar causing damage to vessel walls. Many people may live with widespread coronary artery obstruction but never experience the typical symptoms of angina pectoris. Episodes of silent ischemia are estimated to be present in one-third of patients who are treated for angina, a higher prevalence being likely for patients with diabetes. The pathogenesis for silent ischemia is unclear, but is thought to be related to a defective anginal warning system as a result of problems in peripheral and central neural processing of pain which decreases pain felt.

The nurse is teaching a patient about the effects of hypertension on the heart. Which patient statement indicates that the teaching has been effective? "It is important to maintain my blood pressure because it will slow the signs of aging." "It is important to maintain my blood pressure to maintain a good urinary output." "It is important to maintain my blood pressure in order to keep my heartbeat strong." "It is important for me to maintain my blood pressure in order to prevent damage to my heart."

"It is important for me to maintain my blood pressure in order to prevent damage to my heart." Hypertension is a risk factor for development of coronary artery diease and can affect the left ventricle of the heart critically. Over time, this leads to left-sided heart failure. Hypertension does not affect signs of aging, strength of heartbeat, or urinary output as critically.

A patient with hypertension (HTN) has not been able to decrease blood pressure with diet and exercise over the past 6 months. The patient asks about the next step in managing the hypertension. Which statement by he nurse is appropriate? "Since lifestyle modifications have not been effective alone, medications may be added to get the blood pressure in the healthy range." "Lifestyle modifications are the best way to lower blood pressure, so continue to stick with the diet and exercise for now." "Medications will only need to be started if the blood pressure worsens." "Medications will be started so lifestyle modifications are no longer needed."

"Since lifestyle modifications have not been effective alone, medications may be added to get the blood pressure in the healthy range." Since lifestyle modifications have not been effective alone, medications need to be added to get the blood pressure in the heatlhy range to help prevent target organ damage. Once a diagnosis of HTN has been made, every treatment needs to be considered to lower the blood pressure. Even if medications are started, lifestyle modifications should be continued.

A patient with systolic heart failure (HF) is prescribed new medications to help control the symptoms. Which statement by the nurse explains the goal of treatment for this patient? "The goal of these medications is to reduce blood flow through the lungs." "The goal of these medications is to increase systemic vascular resistance and make it easier for the heart to pump blood to the body." "The goal of these medications is to increase preload and perfusion to the body's organs." "The goal of these medications is to make it easier for your heart to pump blood to the body."

"The goal of these medications is to make it easier for your heart to pump blood to the body." Targeted medication therapies such as increasing diuresis or afterload reduction may be advised to help the symptoms of heart failure (HF) and make it easier for the heart to pump blood to the body. Increasing preload can overwhelm the heart with too much fluid. Increased systemic vascular resistance (SVR) increases afterload and makes it harder for the heart to pump. The goal is not to reduce blood flow through the lungs, but to make it easier for the heart to pump blood forward.

The nurse notes that a patient who developed left-sided heart failure after a myocardial infarction has jugular vein distention. Which statement represents what the nurse should conclude about this finding? "The patient developed right-sided heart failure (HF) due to decreased afterload in the pulmonary system." "The patient is now experiencing decreased right-sided preload." "The left side of the heart is pumping too much blood into the body." "The left-sided heart failure (HF) increased pulmonary pressure and caused right-sided heart failure."

"The left-sided heart failure (HF) increased pulmonary pressure and caused right-sided heart failure." Right-sided heart failure (HF) can be caused by many conditions, but is most typically caused by left-sided HF. Jugular vein distention (JVD) is sign of right-sided HF as fluid backs up into the body. JVD is not a forward effect of left-sided HF. Right-sided afterload and preload is increased in HF. JVD is not from too much blood being pumped to the body by the left side of the heart.

A patient recovering from an acute myocardial infarction (MI) develops heart failure (HF). Which statement should the nurse include when explaining the development of HF in this patient? "The myocardial infarction resulted in disruption in the electrical system of the heart, which led to disorganized contractions." "The myocardial infarction resulted in the heart's decreased ability to pump blood." "The myocardial infarction lead to your heart beating faster because of the systems that control your blood pressure." "The myocardial infarction caused the nervous system to increase the fluid volume in the vascular space."

"The myocardial infarction resulted in the heart's decreased ability to pump blood." Heart failure (HF) is a progressive disorder that begins after an initial injury, such as a myocardial infarction, that damages the myocardium and decreases the pumping ability of the heart muscle. HF is not related to the electrical system being disrupted. The renin-angiotensin-aldosterone system (RAAS) affects vasoconstriction and fluid retention in the body. The sympathetic nervous system (SNS) influences heart rate and vasoconstriction.

A patient with multiple myeloma is demonstrating signs of heart failure, but has a normal ejection fraction. Which statement supports what the nurse should conclude about this patient? "The patient may have systolic heart failure that has not yet affected the ejection fraction (EF)." "The patient has right-sided systolic heart failure (HF)." "The patient may have diastolic heart failure that is related to a preserved or normal ejection fraction (EF)." "The patient does not have heart failure because the ejection fraction (EF) is normal."

"The patient may have diastolic heart failure that is related to a preserved or normal ejection fraction (EF)." A form of heart failure (HF) commonly known as diastolic heart failure is seen in patients with normal contractility of the heart but abnormal relaxation of the heart. This type of HF is called heart failure with preserved ejection fraction (EF), because these patients have HF in the presence of a normal ejection fraction. Obesity, hypertension, metabolic syndrome, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, multiple myeloma, and amyloid heart disease have been linked to diastolic HF. The normal ejection fraction rules out systolic HF.

A patient asks why a transthoracic echocardiogram (TTE) has been scheduled. Which response by the nurse is correct? "This is a test that shows pulmonary congestion in the lung fields." "This is an x-ray procedure that gives a view of the cardiac shadow." "This is an ultrasound of the heart and gives information about the ejection fraction of the heart." "This is a test that allows us to measure blood flow through the lungs."

"This is an ultrasound of the heart and gives information about the ejection fraction of the heart." A transthoracic echocardiogram (TTE) is an ultrasound that typically reveals an ejection fraction (EF) less than 40% with or without ventricular enlargement in heart failure. A chest x-ray may show an enlarged cardiac shadow or evidence of pulmonary vascular congestion. Pulmonary artery catheterization may be helpful in measuring blood flow through the lungs.

A patient with heart failure (HF) asks why daily weight needs to be measured at home. Which response should the nurse make to this patient? "Heart failure patients often lose too much weight due to fluid volume issues, and so it must be monitored." "Weight is a good indicator of oxygenation and needs to be monitored." "Weight is used to guide the amount of medications that need to be taken daily. Medications may only be needed if weight gain is noticed." "Weight gain can be a sign of worsening heart failure and should be monitored and reported to your healthcare provider."

"Weight gain can be a sign of worsening heart failure and should be monitored and reported to your healthcare provider." Weight gain can be a sign of worsening heart failure (HF) and should be monitored frequently. Weight changes should be reported to the healthcare provider. HF patients tend to have issues with fluid retention that cause weight gain. Weight gain is not a good indicator of oxygenation. Medications may be adjusted based on weight gain or loss, but they should be taken daily as prescribed, not just with weight changes.

A patient with heart failure (HF) asks why urine output has increased since starting on a new medication. Which response should the nurse make to this patient? "You are prescribed a beta blocker that works to increase cardiac output and better perfuse the kidneys." "You are prescribed a nitrate that helps to lower fluid volume in the body." "You are prescribed a diuretic that works to encourage the kidneys to excrete sodium and water out of the body." "You are prescribed a vasodilator that works to increase preload returning to the heart to better perfuse the kidneys."

"You are prescribed a diuretic that works to encourage the kidneys to excrete sodium and water out of the body." Diuretics work to reduce sodium resorption in the kidneys, promoting diuresis and relieving symptoms related to congestion in the body. Vasodilators, such as nitrates, directly relax vascular smooth muscle, leading to vasodilation. Nitrates affect the venous system, reducing preload. Beta blockers work to reduce vasoconstriction and heart rates, reducing blood pressure and allowing more time for ventricular filling, but do not work on the kidneys.

The nurse is teaching a patient about heart failure. Which statement should the nurse use to explain the body's compensatory responses to decreased cardiac output (CO)? "Your heart rate will decrease so your body can conserve energy." "Your body will work to release more sodium in your urine." "You will urinate less so your body can retain more water." "Your veins will open up to decrease the amount of blood coming back to the heart."

"You will urinate less so your body can retain more water." In response to decreased cardiac output (CO), the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS) are activated. The RAAS system decreases urine output by increasing sodium and water retention. The SNS causes peripheral vasoconstriction and increases the heart rate. Activation of the neurohormonal system in heart failure: The sympathetic nervous system (SNS) influences the activation of the renin-angiotensin-aldosterone system (RAAS). Kidneys release renin when blood flow to the kidney is reduced. Renin causes the conversion of angiotensinogen to angiotensin I in the liver. Angiotensin-converting enzyme helps convert angiotensin I to angiotensin II in the lungs. Angtiotensinogen II causes peripheral vasoconstriction and causes the release of aldosterone and antidiuretic hormone. Aldosterone from the adrenal glands causes sodium to be reabsorbed leading to increased sodium level and fluid retention. Antidiuretic hormone (vasopressin) released by the pituitary gland causes additional vasoconstriction and water retention.

A baby is born with tetralogy of Fallot. The parents ask the nurse what this diagnosis means for their child. Which explanation by the nurse is accurate? "Your child has a simple ventricular septal defect, which is usually asymptomatic and has an excellent long-term prognosis." "Your child has an enlarged heart and will require monitoring during the first year of life." "Your child has pulmonary valve stenosis and a transesophageal echocardiography (TEE) will be performed to fix the valve defect." "Your child will require open heart surgery in the first year of life to correct congenital heart defects."

"Your child will require open heart surgery in the first year of life to correct congenital heart defects.".. Tetralogy of Fallot is a complex heart defect that involves pulmonary valve stenosis, a large ventricular septal defect, an overriding aorta causing deoxygenated blood from the right ventricle to flow directly into the aorta instead of the pulmonary artery, and right ventricular hypertrophy, in which the right ventricle is thicker and must work harder to contract. Infants and children with simple ventricular septal defects are usually asymptomatic and have an excellent long-term prognosis. A ventricular septal defect as part of the complex disease process of tetralogy of Fallot requires open heart surgery, typically during the first year of life. TEE is just a test and does not fix any malformations. Monitoring alone will not be treatment for Tetralogy of Fallot.

Which is the 5-year survival rate for patients with heart failure (HF)? 38% 50% 13% 63%

50% Mortality for heart failure is high, with 50% of individuals succumbing to this condition within 5 years of diagnosis, so 50% survive for at least 5 years. Statistics about heart failure: Lifetime risk of developing heart failure in a 40-year-old individual is 20%. Risk increases with age. Annual rate per 1,000 population of new heart failure events for a Caucasian man is 15.2%. Rate of heart failure increases to 31.7% for ages 75-84. Rate of heart failure increases to 65.2% for people age 85 and older.

A patient with heart failure reports some shortness of breathing with activity, such as cleaning the house or grocery shopping, but no shortness of breath at rest. According to the American College of Cardiology (ACC)/American Heart Association (AHA) staging, the nurse would classify this patient as: A. Stage C B. Stage B C. Stage D D. Stage A

When assessing the patient with high-output heart failure, the nurse is most likely to find: A. vasodilation and hypotension. B. vasodilation and hypertension. C. vasoconstriction and hypertension. D. vasoconstriction and hypotension.

When caring for a patient who has advanced from stage C to stage D of the American College of Cardiology (ACC)/American Heart Association (AHA) heart failure classification system, the nurse instructs the patient and family that this stage includes the addition of: A. interventional therapy with left ventricular assist device or heart transplantation. B. lifestyle modification and management of underlying disorder. C. ACE inhibitors, angiotensin receptor blockers (ARBs), blood pressure control, or beta blockers. D. diuretics, aldosterone blockers, or vasodilators.

When performing cardiopulmonary resuscitation, in which order should the nurse perform the steps? A. compressions, airway, breathing B. Breathing, airway, compressions C. Compressions, breathing, airway, D. Airway, breathing, compressions

When preparing a nursing care plan for an adolescent with diabetes, which concept should the nurse keep in mind? A. More insulin is needed as more growth hormone is released during adolescence. B. More insulin is needed as adolescents begin to engage in sports. C. More insulin is needed as the adolescents ingests less calories. D. More insulin is needed during sleep in adolescents.

Which electrocardiographic change would the emergency department nurse expect to observe in a patient experiencing subendocardial cardiac injury? A. ST-segment depression B. Shortened PR interval C. ST-segment elevation D. Prolonged PR interval

Which manifestation would the nurse expect in a patient with stable angina? A. Pain that is relieved with short-acting nitroglycerin B. Pain that is relieved by a long-acting nitrate C. Pain that persists with rest D. Pain that is relieved with oxygen administration

Which of the following teaching points about atherosclerosis would the school nurse include when speaking to parents of middle school-aged children? A. A healthy blood pressure in childhood reduces the risk of heart disease as adults. B. A healthy lifestyle should be started by age 40 years old to reduce risk of atherosclerosis as adults. C. Early eating habits do not affect adult risk of atherosclerosis. D. Atherosclerotic buildup begins in middle adulthood.

Which physical assessment findings would the nurse expect in a patient with a left ventricular aneurysm? A. S3 B. Apical impulse displaced to right C. Opening snap D. Diastolic murmur

The nurse prepares teaching material for a patient with heart failure (HF). Which information should the nurse include? Decrease alcohol consumption to avoid adverse reactions with medications. Increased fluid intake will help maintain cardiac output. Avoid exercise to reduce increased stress on the heart. A low-sodium diet will lessen fluid retention in the body.

A low-sodium diet will lessen fluid retention in the body. Patients with heart failure (HF) are expected to follow a low-sodium diet, avoid all alcohol, and limit their fluid intake to avoid fluid overload. Exercise is also advised for HF patients.

A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching? A. " I will feel shaky." B. "I will be more thirsty than usual." C. "My skin will be warm and moist." D. "My appetite will be decreased."

A. "I will feel shaky." Hypoglycemia: shaky, nervous, cool, clammy skin. Hyperglycemia: increased thirst, dehydration, warm, moist skin, hunger, weakness.

The nurse is providing care for a client with Dressler syndrome post myocardial infarction. Which medication should the nurse anticipate being ordered for this client? A. Aspirin B. Diuretic C. Antibiotic D. Chemotherapy

A. Aspirin

The nurse providing care for clients on a coronary care unit suspects which client as experiencing unstable angina? A. Chest pain that is increasing in frequency B. Chest pain occurring when using cardiac rehabilitation equipment C. Chest pain controlled by nitrate D. Chest pain relieved by rest

A. Chest pain that is increasing in frequency

The nurse is providing care for a client admitted with chest pain and a possible myocardial infarction. Which clinical manifestation should the nurse recognize as being consistent with this diagnosis? (Select all that apply.) A. Diaphoresis B. Indigestion C. Fatigue D. ST segment depression E. Dyspnea

A. Diaphoresis B. Indigestion C. Fatigue E. Dyspnea

The nurse assessing a female client recognizes which factor as a risk for coronary artery disease (CAD)? (Select all that apply.) A. Dyslipidemia B. Social isolation C. Premenopausal D. Cigarette use E. Sleep apnea

A. Dyslipidemia B. Social isolation D. Cigarette use E. Sleep apnea

A patient presents with dizziness, nosebleeds, and a headache. Which medical condition should the nurse suspect? A. Hypertension B. Thrombosis C. Thoracic outlet syndrome D. Chronic venous insufficiency (CVI)

A. Hypertension - A majority of the time an individual with hypertension will have no overt symptoms of the disorder. Hypertension usually goes undetected until identified by a healthcare provider, often during a routine physical exam. Symptoms such as dizziness, nosebleeds, headaches, facial flushing, and blood spots in the eyes are rare until blood pressure is extremely high. - Thrombosis manifests as swelling and pain. - Chronic venous insufficiency (CVI) is generally associated with leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. - With thoracic outlet syndrome, symptoms are related to poor blood flow or decreased nerve function. Not only will there be symptoms distal from the outlet, there will be ramifications in the neck and shoulder area.

The nurse is teaching a client about a heart healthy diet. Which food should the nurse include? A. Mediterranean diet B. Western diet C. Atherogenic diet D. Gluten-free diet

A. Mediterranean diet

The nurse is caring for a client with symptomatic cardiac tamponade. Which procedure should the nurse anticipate for the client? A. Pericardiocentesis B. Placement of an intra-aortic balloon pump C. Implantation of a defibrillator D. Coronary artery bypass grafting

A. Pericardiocentesis

The nurse is providing care for a client with a myocardial infarction (MI). Which clinical manifestation indicates that the client may be experiencing the complication of cardiac tamponade? (Select all that apply.) A. Peripheral edema B. High urine output C. Tachypnea D. Dyspnea E. Tachycardia

A. Peripheral edema C. Tachypnea D. Dyspnea E. Tachycardia

A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.) A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. D. Sustain hyperglycemia to reduce deterioration of nerve cells. E. Maintain optimal blood pressure to prevent kidney damage.

A. Reduce cholesterol and saturated fat intake. B. Increase physical activity and daily exercise. C. Enroll in a smoking-cessation program. E. Maintain optimal blood pressure to prevent kidney damage. Hyperglycemia leads to neuropathy through blood vessels changes that cause nerve hypoxia.

The nurse providing care for a client with acute coronary syndrome (ACS) recognizes that which process most likely triggered the formation of a blood clot that caused the condition? A. Rupture of the fibrous cap B. Deposition of LDL in the intima C. Monocytes differentiating into macrophages D. Development of a fatty streak

A. Rupture of the fibrous cap

A client tells the nurse that he experienced chest pain while mowing the lawn, but it was relieved with rest. He states he has never had chest pain occur at rest. Which type of angina does the nurse suspect for this client? A. Stable angina B. Variant angina C. Unstable angina D. Prinzmetal angina

A. Stable angina

Which body system helps develop hypertension in response to increased stress and high salt intake? A. Sympathetic nervous system (SNS) B. Renin-angiotensin-aldosterone system (RAAS) C. Enteric nervous system D. Parasympathetic nervous system

A. Sympathetic nervous system (SNS) - The sympathetic nervous system (SNS) has a role in the development of HTN. Lifestyle factors, such as increased stress and high salt intake, also contribute to higher sympathetic nervous system (SNS) activity. - The enteric nervous system controls gastrointestinal activity. - The parasympathetic nervous system is not associated with high blood pressure. - Alcohol consumption appears to activate the RAAS and cause a prolonged elevation of plasma renin and angiotensin II.

A 57-year-old man presents to the emergency department reporting persistent chest pain for the last 48 hours that radiates up the neck. What lab value is important for the nurse to monitor? A. Troponin B. BMP C. Complete blood count (CBC) D. PTT

A. Troponin

Which client is at highest risk for developing coronary artery disease (CAD)? A. Woman with a brother and a sister diagnosed with CAD B. A 40-year-old man C. A 50-year-old woman D. Man with a grandfather diagnosed with CAD

A. Woman with a brother and a sister diagnosed with CAD

A 58-year-old client with a strong family history of coronary artery disease asks the nurse, "How can I decrease my chances of developing problems with my arteries?" Which response is appropriate? (Select all that apply.) A. "A diet high in fruits, vegetables, and unsaturated fatty acids appears to have a protective effect on the arteries." B. "The exact causes of atherosclerosis are not known, but you can reduce your risk by making some changes in your lifestyle." C. "Keeping your blood pressure within normal levels will decrease the risk of injury to your arteries." D. "With your age and family history, there is little you can do besides take medication to prevent coronary artery disease." E. "As long as your cholesterol is normal, your arteries will remain clear."

A. "A diet high in fruits, vegetables, and unsaturated fatty acids appears to have a protective effect on the arteries." B. "The exact causes of atherosclerosis are not known, but you can reduce your risk by making some changes in your lifestyle." C. "Keeping your blood pressure within normal levels will decrease the risk of injury to your arteries."

The nurse is providing care for a client with history of hypertension and recent history of a myocardial infarction and renal insufficiency. Which medication is contraindicated in the treatment of this client? A. Angiotensin-converting enzyme (ACE) inhibitor B. Asprin C. Beta blocker D. Statin

A. Angiotensin-converting enzyme (ACE) inhibitor

A patient is diagnosed with acute coronary syndrome (ACS). The patient asks the nurse to explain the diagnosis. Which information should the nurse include? ACS is a diagnosis used when a myocardial infarction has occurred. ACS is a diagnosis used when the patient has had a ST-segment elevation myocardial infarction. ACS means that the patient has a stable plaque lesion that is decreasing blood flow to the heart muscle. ACS is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found.

ACS is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found. Acute coronary syndrome (ACS) is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found. ACS diagnosis alone does not confirm a myocardial infarction has occurred. A stable plaque lesion is associated with stable angina. ACS can mean unstable angina or a non-ST-segment elevation ACS.

To assist an older patient with diabetes to engage in moderate daily exercise, which action is most important for the nurse to take? a. Determine what types of activities the patient enjoys. b. Remind the patient that exercise improves self-esteem. c. Teach the patient about the effects of exercise on glucose level. d. Give the patient a list of activities that are moderate in intensity.

ANS: A Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions may be helpful but are not the most important in improving compliance.

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.

ANS: A Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure. The other assessments require more education and critical thinking and should be done by the registered nurse (RN).

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.

ANS: A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Which patient action indicates a good understanding of the nurse's teaching about the use of an insulin pump? a. The patient programs the pump for an insulin bolus after eating. b. The patient changes the location of the insertion site every week. c. The patient takes the pump off at bedtime and starts it again each morning. d. The patient plans a diet with more calories than usual when using the pump.

ANS: A In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver a basal insulin rate 24 hours a day.

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? a. Give the patient 4 to 6 oz more orange juice. b. Administer the PRN glucagon (Glucagon) 1 mg IM. c. Have the patient eat some peanut butter with crackers. d. Notify the health care provider about the hypoglycemia.

ANS: A The "rule of 15" indicates that administration of quickly acting carbohydrates should be done two or three times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care provider. More complex carbohydrates and fats may be used after the glucose has stabilized. Glucagon should be used if the patient's level of consciousness decreases so that oral carbohydrates can no longer be given.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.

ANS: A The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? a. Infuse 1 L of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/

ANS: A The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? a. Ask the patient's family to participate in the diabetes education program. b. Assess the patient's perception of what it means to have diabetes mellitus. c. Demonstrate how to check glucose using capillary blood glucose monitoring. d. Discuss the need for the patient to actively participate in diabetes management.

ANS: B Before planning teaching, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.

Which patient action indicates good understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? a. The patient avoids injecting the insulin into the upper abdominal area. b. The patient cleans the skin with soap and water before insulin administration. c. The patient stores the insulin in the freezer after administering the prescribed dose. d. The patient pushes the plunger down while removing the syringe from the injection site.

ANS: B Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give 50% dextrose. c. initiate O2 by nasal cannula. b. insert an IV catheter. d. administer glargine (Lantus) insulin.

ANS: B HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires O2. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

The nurse is taking a health history from a 29-yr-old pregnant patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? a. Teach the patient about administering regular insulin. b. Schedule the patient for a fasting blood glucose level. c. Teach about an increased risk for fetal problems with gestational diabetes. d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.

ANS: B Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. Teaching plans would depend on the outcome of a fasting blood glucose test and other tests.

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? a. Assess the patient for symptoms of hyperglycemia. b. Give the patient a snack of peanut butter and crackers. c. Have the patient drink a glass of orange juice or nonfat milk. d. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider? a. Hemoglobin A1C level of 6.2% b. Blood pressure of 140/88 mmHg c. Heart rate at rest of 58 beats/minute d. High density lipoprotein (HDL) level of 65 mg/dL

ANS: B To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the goal blood pressure is usually 130/80 mm Hg. An A1C less than 6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient with diabetes presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.

ANS: C Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.

A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a. use only the lispro insulin until the symptoms are resolved. b. limit intake of calories until the glucose is less than 120 mg/dL. c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

ANS: C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? a. Hemoglobin A1C level is 7.9%. b. Last eye examination was 18 months ago. c. Glomerular filtration rate is decreased. d. Patient has questions about the prescribed diet.

ANS: C The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication. In older patients, the goal for A1C may be higher in order to avoid complications associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye examination and addressing the questions about diet, but the area for prompt intervention is the patient's decreased renal function.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

ANS: C The patient's clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

After change-of-shift report, which patient will the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who was admitted with possible dawn phenomenon b. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

ANS: C The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? a. The patient's blood glucose level is 174 mg/dL. b. The patient is scheduled for a chest x-ray in an hour. c. The patient has gained 2 lb (0.9 kg) in the past 24 hours. d. The patient's blood urea nitrogen (BUN) level is 52 mg/dL.

ANS: D The BUN indicates possible renal failure, and metformin should not be used in patients with renal failure. The other findings are not contraindications to the use of metformin.

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? a. "If I overeat at a meal, I will still take the usual dose of medication." b. "Other medications besides the Glucotrol may affect my blood sugar." c. "When I am ill, I may have to take insulin to control my blood sugar." d. "My diabetes won't cause complications because I don't need insulin."

ANS: D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? a. The patient always carries hard candies when engaging in exercise. b. The patient goes for a vigorous walk when his glucose is 200 mg/dL. c. The patient has a peanut butter sandwich before going for a bicycle ride. d. The patient increases daily exercise when ketones are present in the urine.

ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients with type 1 diabetes should be taught to avoid exercise when ketosis is present.

The nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). Which is the priority nursing action for this client who is in the acute phase?

Administer intravenous (IV) regular insulin.

The nurse reviews medications prescribed for a patient with heart failure (HF). Which classes of medications should the nurse identify that are used to block the renin-angiotensin-aldosterone system (RAAS)? Nitrates and diuretics Nitrates and beta blockers Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers Angiotensin-converting-enzyme (ACE) inhibitors and vasodilators

Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers To block the renin-angiotensin-aldosterone system (RAAS), angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers are used. ACE inhibitors block the conversion of angiotensin I to angiotensin II, decreasing vasoconstriction and reducing afterload. ACE inhibitors also block release of aldosterone to promote sodium and water excretion from the body. Nitrates, beta blockers, diuretics, and vasodilators do not interact with the RAAS system.

The nurse notes that a patient with heart failure (HF) has had a gradual reduction in daily urine output. Which mechanism describes the reason for the decrease in urine output? As perfusion falls to the tissues, the sympathetic nervous system decreases afterload and decreases perfusion to the kidneys. As tissue perfusion falls due to decreased cardiac output, the kidneys initiate the renin-angiotensin-aldosterone system (RAAS) to help increase perfusion pressure. As oxygenation decreases, the kidneys respond by retaining sodium and water in the vascular space. The kidney responds to fluid volume overload by increasing kidney activity and initiates the renin-angiotensin-aldosterone system (RAAS) to help decrease circulatory volume.

As tissue perfusion falls due to decreased cardiac output, the kidneys initiate the renin-angiotensin-aldosterone system (RAAS) to help increase perfusion pressure. As left ventricular output decreases, blood pressure typically falls. The cardiac muscle initially enlarges or hypertrophies, and the heart rate increases in response to stimulation of the sympathetic nervous system (SNS) due to the decreased cardiac output (CO). The renin-angiotensin-aldosterone system (RAAS) is activated, leading to increasing preload and afterload. The RAAS tells the kidneys to retain sodium and water, increasing fluid retention and decreasing urine output. The RAAS system increases circulatory volume. It is perfusion pressure that triggers the RAAS, not oxygenation. The SNS increases afterload with vasoconstriction.

A patient with heart failure reports some shortness of breathing with activity, such as cleaning the house or grocery shopping, but no shortness of breath at rest. According to the New York Heart Association staging system, the nurse would classify this patient as: A. Class I. B. Class II. C. Class IV. D. Class III.

The nurse is caring for a patient with cardiac tamponade who underwent pericardiocentesis to remove fluid. What findings would indicate to the nurse that the procedure has been effective? A. Pulsus paradoxus of 14 mm Hg B. Hear rate 92 bpm C. Respiratory rate 34 breaths/minute D. Jugular venous distention

The plan of care for a patient in diabetic ketoacidosis, with a blood glucose level of 450 mg/dL, should include strategies for: A. administration of long-acting subcutaneous insulin. B. administration of intravenous short-acting insulin. C. administration of short-acting subcutaneous insulin. D. administration of oral hypoglycemic agents.

The plan of care for a patient with a STEMI, treated in a non-percutaneous coronary intervention capable (PCI) hospital, includes: A. stabilizing patient for 24 hours, then transferring to a PCI-capable hospital. B. fibrinolytic therapy if transfer causes a delay of more than 120 minutes for door to balloon. C. evaluation in the cardiac catheterization lab within 90 minutes of non-PCI hospital arrival. D. transfer to a PCI-capable hospital within 3 hours.

When developing a care plan for a patient with type 1 diabetes, the nurse should consider which pathophysiological concept? A. In type 1 diabetes, there is an over secretion of insulin. B. In type 1 diabetes, there is a complete lack of insulin secretion. C. In type 1 diabetes, there is insulin resistance. D. In type 1 diabetes, there is a relative deficiency in insulin.

When planning care for a patient with heart failure, which concept should the nurse keep in mind? A. Heart muscle demonstrates excessive contractility. B. The sympathetic nervous system is activated when cardiac output drops. C. The renin-angiotensin-aldosterone system is inhibited when cardiac output drops. D. Inflammatory mediators inhibit heart muscle repair and remodeling.

Which medications should the nurse anticipate administering in the patient with an initial diagnosis of stable angina? A. Antiplatelet, long-acting nitrate B. Antiplatelet, beta blocker C. Beta blocker, ACE inhibitor D. ACE inhibitor, long-acting nitrate

Which patient statement indicates to the nurse that the patient needs more teaching about type 2 diabetes? A. "From time-to-time, I may need insulin to control my blood glucose levels." B. "Type 2 diabetes is also call juvenile-onset diabetes." C. "I am not dependent on insulin to control my blood glucose levels." D. "Most people with diabetes have type 2 diabetes."

Which statement made by a patient with a biventricular pacemaker indicates that more teaching is needed? A. "My right ventricle contracts at the same time as the left ventricle." B. "This pacemaker can deliver a shock if I develop a life-threatening heart rhythm." C. "Biventricular pacing decreases regurgitation of my mitral valve." D. "This type of pacemaker mimics normal cardiac function."

Which first-line medication would the nurse anticipate being in the plan of care for a patient with systolic heart failure to reduce vasoconstriction and afterload? A. Diuretics B. ACE inhibitor C. Beta blocker D. Nitrates

A nurse is reviewing guidelines to prevent DKA during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching? A. "Test your blood glucose levels every 8 hours." B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." C. "Withhold your usual daily dose of insulin." D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours."

B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL." This indicates DKA, pt should contact provider if he has moderate/large amounts of ketones in his urine. Pt should check BG level at least every 4-6 hr when he is also experiencing anorexia, nausea, and vomiting. During illness pt is at risk for hyperglycemia, so pt should take usual dose of insulin to keep BG levels w/in expected reference range. To prevent dehydration pt should drink 240-360 mL (8-12 oz) of calorie-free liquids every hour, if BG level is low he should drink fluids containing sugar.

The nurse is teaching a patient diagnosed with stage I hypertension about lifestyle changes that may help lower blood pressure. Which patient statement indicates the need for further teaching? A. "I will have an alcohol beverage on the weekends." B. "I will use salt only in the preparation of food." C. "I will remove the skin from chicken before I cook it." D. "I will increase my walking to a mile daily."

B. "I will use salt only in the preparation of food." - The first step in treating chronic hypertension (HTN) is to implement therapeutic lifestyle changes, such as restricting sodium intake. The patient should be instructed to eliminate all added salt to foods and to consume foods that are low in sodium content. The therapeutic lifestyle changes are the same as those for other cardiovascular disorders. - Increasing physical activity, and decreasing consumption of saturated fat and cholesterol, and limiting alcohol intake will help decrease blood pressure.

Which substance is deposited on arterial walls when low-density lipoprotein (LDL) levels are elevated that promotes the development of atherosclerosis? A. Plaque B. Cholesterol C. Calcium D. Triglycerides

B. Cholesterol - Low-density lipoproteins (LDLs) are the primary carriers of cholesterol. Elevated levels of LDL promote atherosclerosis, because LDL deposits cholesterol on the arterial walls. (LDL can also be considered a mnemonic for "less desirable lipoproteins"). Plaque begins to form when white blood cells attack the LDL on the damaged endothelium. - Calcium is a component of atheroma along with macrophages, lipids, and fibrous connective tissue. - Triglycerides are transported to adipose tissue for storage by very low-density lipoproteins. - Steps in formation of atherosclerosis: The process begins when endothelial cells are damaged. When LDL cholesterol reaches the damaged endothelium, white blood cells attack the LDL, and plaque begins to form.

A nurse is assessing a client who has diabetes mellitus. Which of the following findings is a manifestation of hypoglycemia? A. Bradycardia B. Cool, clammy skin C. Vomiting D. Fruity odor on the client's breath

B. Cool, clammy skin Cool, clammy skin and tachycardia are manifestations of hypoglycemia. Nausea and vomiting and fruity odor on pt's breath = hyperglycemia.

The nurse learns that a 28-year-old woman currently takes oral contraceptives. Which medical condition should the nurse identify that this patient is at risk of developing? A. Raynaud disease B. Deep venous thrombosis C. Coarctation of the aorta D. Thoracic outlet syndrome

B. Deep venous thrombosis - Chronic venous insufficiency (CVI) is a long-term disorder that most commonly occurs as a result of blood clots in the deep veins of the legs. Oral contraceptives increase the risk for the development of blood clots in the legs. - Cigarette smoking has a direct effect on the blood vessels, which increases the risk of Raynaud disease. - Coarctation of the aorta is normally a congenital defect of a narrow aorta. - Thoracic outlet syndrome is precipitated by heavy lifting or working as a laborer.

The nurse learns that a patient has a body mass index (BMI) of 31 and has a sedentary lifestyle. Which health problem should the nurse identify that this patient is at most risk for developing? A. Thrombosis B. Hypertension C. Thoracic outlet syndrome D. Chronic venous insufficiency (CVI)

B. Hypertension Obesity is a contributing factor for hypertension (THN). Disruption of the RAAS mechanism may contribute to the close link between HTN and obesity. Obesity leads to increased expression of angiotensin II in adipocytes, especially in visceral fat, and a reduced level of plasma adiponectin. It appears that adiponectin may be a key molecule linking obesity to HTN as well as to the metabolic syndrome. Lifestyle factors, such as a lack of physical exercise, and obesity contribute to a higher sympathetic nervous system (SNS) activity, which has a role in the development of hypertension. While obesity and/or sedentary lifestyle could be risk factors for the other conditions, the patient is at greatest risk for hypertension.

A patient presents with chest pain, dyspnea, and a blood pressure of 220/140 mmHg after using cocaine. Which medical condition is most likely associated with this patient's symptoms? A. Thoracic outlet syndrome B. Hypertensive emergency C. Chronic venous insufficiency (CVI) D. Thrombosis

B. Hypertensive emergency - A hypertensive emergency is a relatively rare condition that occurs when diastolic pressure exceeds 120 mmHg, and there is evidence of target organ damage. This can be a result of cocaine ingestion, which causes an increase in sympathetic nervous system (SNS) activity. The most common symptoms of hypertensive emergency are chest pain and dyspnea. - Thrombosis generally manifests as swelling and pain. - Chronic venous insufficiency (CVI) is generally associated with leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. - With thoracic outlet syndrome, symptoms are related to poor blood flow or decreased nerve function. Not only will there be symptoms distal from the outlet, there will also be manifestations in the neck and shoulder area.

Which characteristic is commonly seen in individuals with a family history of hypertension? A. Alcoholism B. Increases in epinephrine and norepinephrine C. African American ethnicity D. Obesity

B. Increases in epinephrine and norepinephrine - An increase in norepinephrine and epinephrine are frequently seen in individuals with a family history of hypertension (HTN). - Obesity and alcoholism are considered modifiable risk factors and do not have a genetic component. - African Americans have the highest rate of HTN among ethnic groups, but other ethnic groups are also at a higher risk of developing HTN.

Which medical condition is usually prevented by angioplasty with stent placement? A. Infection B. Infarction C. Ischemia D. Inflammation

B. Infarction If severe plaque is identified in a critical artery, such as one serving a major artery, the vessel must be reopened to prevent infarction. Angioplasty with stent placement is the minimally invasive procedure usually employed for this purpose. Angioplasty is performed in the presence of ischemia to prevent infarction. Some stents, used during angioplasty, are medically coated with anti-inflammatory medications to reduce the risk of inflammation. Angioplasty is not used to prevent infection.

A nurse is preparing to administer lispro insulin to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take? A. Assess for hypoglycemia 4 hr after the insulin injection. B. Inject the insulin 15 min before a meal. C. Monitor for polyuria. D. Administer with short-acting insulin.

B. Inject the insulin 15 min before a meal. The nurse should administer lispro insulin 15 min before a meal, bc lispro insulin is rapid-acting insulin that has an onset w/in 15-30 min. Pt may develop hypoglycemia quickly if they don't eat. Nurse should assess for hypoglycemia for 1-3 hr (when lispro peaks). Polyuria = hyperglycemia. The nurse may administer by mixing lispro insulin (longer-acting) in the same syringe.

The nurse is concerned that a patient is at risk for rupture of atherosclerotic plaque in their legs. For which health problem should the nurse plan care for this patient? A. Claudication B. Thrombosis C. Aneurysm D. Arterial dissection

B. Thrombosis - Plaque rupture is usually followed by thrombosis (blood clot) and possibly infarction, which is complete obstruction of a vessel. - Claudication occurs when blood flow in the skeletal muscle is insufficient. - Aneurysm is due to a bulging of a weak arterial wall, in which the combination of plaque and hypertension make up the primary cause. - Arterial dissection is caused by a tear in the tunica intima, in which the blood vessel splits, and blood goes between the inner and outer layers.

Atherosclerosis begins when endothelial cells are damaged. When low-density lipoprotein (LDL) cholesterol reaches the damaged endothelium, which type of cell attacks the LDL causing plaque to form? A. Stem cells B. White blood cells C. Red blood cells D. Platelets

B. White blood cells - When low-density lipoprotein (LDL) cholesterol reaches the damaged endothelium, white blood cells attack the LDL and plaque begins to form. - The region of plaque, called an atheroma, consists of calcium, macrophages, lipids, and fibrous connective tissue.

A client asks the nurse, "Why does it matter if my coronary arteries are narrowed, can't the heart just get oxygen from some of the blood that pumps through it?" Which response is appropriate? A. "Blood moves too quickly through the inside of the heart for the heart muscle to obtain oxygen." B. "The vessels necessary to deliver oxygenated blood to the heart muscle are not located in the heart chambers." C. "The pericardial lining inside of the heart prevents oxygen from moving from the chambers to the heart muscle." D. "That works on the left side of the heart because the blood is oxygenated blood but on the right side the blood is unoxygenated."

B. "The vessels necessary to deliver oxygenated blood to the heart muscle are not located in the heart chambers."

A patient with heart failure (HF) is placing a lunch order. Which lunch choice is the best option for this patient? Prime rib, mashed potatoes Bacon, lettuce, and tomato sandwich Baked chicken, steamed broccoli Tomato soup and grilled cheese sandwich

Baked chicken, steamed broccoli Patients with heart failure (HF) are expected to follow a low-sodium diet, and they may be instructed to limit their fluid intake. Baked chicken and steamed broccoli is a good choice for the patient. Prime rib, mashed potatoes, bacon, tomato soup, and a grilled cheese sandwich are not low sodium or a healthy choice for a HF patient.

The nurse reviews the dinner menu selected by a patient with heart failure (HF). Which dinner choice should the nurse question? Baked chicken and bell peppers Baked potato with sour cream and butter Spinach salad with no dressing Baked salmon with lemon

Baked potato with sour cream and butter Patients with heart failure (HF) are expected to follow a low-sodium diet, and they may be instructed to limit their fluid intake. Baked chicken, salmon, and spinach are good choices for the patient. Baked potatoes with sour cream and butter are not low in sodium, and are not healthy choices for a patient with HF.

How should the nurse interpret the electrocardiogram (ECG) of a patient which shows an atrial rate of 300-600 bpm, ventricular rate of 100-180 bpm, irregularly irregular rhythm, variable P:QRS, and PR interval that cannot be measured? A. Paroxysmal supraventricular tachycardia B. Atrial flutter C. Atrial fibrillation D. Sinus tachycardia

How should the nurse respond when a patient with coronary artery disease asks why C-reactive protein (CRP) levels are being drawn for laboratory analysis? A. "CRP is released from atherosclerotic plaques." B. "CRP is released from the heart during a heart attack." C. "An elevated CRP level is a predictor of coronary artery disease." D. "An elevated CRP level means you will have a heart attack."

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? a. "Are you anorexic?" c. "Have you lost weight lately?" b. "Is your urine dark colored?" d. "Do you crave sugary drinks?"

What response should the nurse give when a patient with heart failure asks what the physician meant by saying his left ventricular assist device (LVAD) was destination therapy? A. "Your LVAD will support your heart until a heart is available for transplant." B. "Your LVAD will allow your heart to rest and recover." C. "Your LVAD will support your heart because you are not a candidate for heart transplant." D. "Your LVAD takes the place of your heart."

When assessing a patient with heart failure affecting only the left ventricle, the nurse would expect which of the following conditions? A. Peripheral edema B. Elevated jugular venous pressure C. Pulmonary venous congestion D. Systemic venous congestion

When assessing a patient, which finding by the nurse would support a diagnosis of left-sided heart failure? A. Nausea and vomiting B. Elevated jugular venous pressure C. Paroxysmal nocturnal dyspnea D. Hepatic engorgement

When caring for a patient with heart failure, which concept about cardiac output should the nurse keep in mind? A. Preload is the volume of blood in the ventricle after contraction. B. A slower heart rate increases cardiac output. C. A faster heart rate increases the cardiac output. D. Afterload is the pressure of the heart during ventricular filling.

Which action would the intensive care nurse take to measure the preload of a patient with heart failure? A. Calculate the mean arterial pressure. B. Calculate the systemic vascular resistance. C. Measure the pulmonary artery pressure. D. Take the patient's blood pressure.

Which data in a patient undergoing pulmonary heart catheterization confirms a diagnosis of systolic heart failure? A. Decreased right atrial pressure B. Increased cardiac index C. Elevated pulmonary artery wedge pressure D. Decreased pulmonary artery pressure

Which of the following is the best response given to a patient by the nurse when a patient with heart failure asks for an explanation of his ejection fraction? A. "It is the amount of blood the heart pumps each minute." B. "It is the amount of blood pumped from the heart with each beat." C. "It is the percentage of blood pumped by the heart with each beat." D. "It is the amount of blood the heart pumps each minute divided by the body surface area."

Which patient statement indicates that more teaching about the Zio Patch arrhythmia monitor is needed? A. "There are no wires to for me to worry about coming loose." B. "This will record my heart rhythm over two weeks." C. "My doctor will call me if I have an arrhythmia while I am wearing this monitor." D. "It is very convenient that I don't have a bulky monitor to carry around."

Which statement by a patient with chronic heart failure indicates to the nurse that more teaching is needed? A. "Any type of stress can cause a worsening of the disease." B. "The disease will be marked by periods of exacerbations." C. "If I follow strict self-care, I can cure the disease." D. "I will need to make lifestyle modifications to control the disease."

A patient has an elevated blood pressure. Which hormone should the nurse consider as a cause for this condition? A. Norepinephrine B. Cortisol C. Aldosterone D. Adrenaline

C. Aldosterone - Angiotensin II is a potent vasoconstrictor that returns blood pressure back to normal. Angiotensin II also causes the release of aldosterone from the adrenal glands. Aldosterone helps the body retain sodium, which increases blood volume and raises blood pressure. - Cortisol, adrenaline, and norepinephrine are also excreted by the adrenal glands but are not associated with the renin-angiotensin-aldosterone system (RAAS).

The nurse notes that a patient with a slightly low blood pressure has a normal pressure several hours later. Which hormone helped return this patient's blood pressure back to normal? A. Renin B. Angiotensin I C. Angiotensin II D. Adiponectin

C. Angiotensin II - Angiotensin II is a potent vasoconstrictor that returns blood pressure back to normal. - Renin converts angiotensinogen to angiotensin I. - Adiponectin is released from adipocytes and has anti-inflammatory and anti-plaque properties.

Plaque formation can occur in any of the blood vessels throughout the body. Which location affected with plaque formation can lead to stroke? A. Vessels in the extremities B. Kidneys C. Carotid arteries D. Heart

C. Carotid arteries If plaque is found in the carotid arteries, it is referred to as carotid artery disease, which can lead to stroke. Plaque found in the heart, kidneys, or vessels of the extremities will most likely lead to medical conditions other than stroke.

The nurse is caring for a patient whose leg veins are unable to return adequate blood to the heart. The nurse should recognize that the patient has which condition? A. Coarctation of the aorta B. Hypertension C. Chronic venous insufficiency (CVI) D. Thoracic outlet syndrome

C. Chronic venous insufficiency (CVI) - Chronic venous insufficiency (CVI) is a disorder in which the veins are unable to return adequate blood to the heart. It is a long-term disorder that most commonly occurs as a result of blood clots in the deep veins of the leg or deep vein thrombosis (DVT). - Hypertension occurs when atherosclerosis progressively blocks blood flow in major arteries. - Coarctation of the aorta is characterized by a narrow aorta and is usually identified at birth. - Thoracic outlet syndrome occurs by the upper body meeting resistance on a frequent basis.

The nurse prepares to assess a patient with atherosclerosis. For which reason should the nurse use a stethoscope when assessing this patient? A. Detect unequal blood flow B. Rule out cardiac involvement C. Detect the presence of a bruit D. Rule out renal involvement

C. Detect the presence of a bruit - Diagnosis of peripheral artery disease and atherosclerosis is accomplished by a thorough physical examination and several diagnostic tests. Listening with a stethoscope over specific arteries may help detect a bruit, a whooshing sound that occurs as blood tumbles over and around areas of plaque buildup. - Checking pulses in the extremities is used to detect unequal blood flow. - A treadmill test with echocardiography may be prescribed to detect cardiac involvement. - If renal involvement is suspected, kidney function tests may be prescribed.

A nurse is developing a teaching a plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? A. Establish short-term, realistic goals for the client. B. Give the client access to a video about diabetes. C. Determine what the client who knows about managing diabetes. D. Evaluate the effectiveness of the client's admission teaching plan.

C. Determine what the client knows about managing diabetes. The first action a nurse should take using the nursing process is to assess/collect data from pt. Nurse should find out what the pt knows before proceeding w/ the plan. All the other choices are correct, but not the first action that needs to be taken.

A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. To focus on effective learning with this client, which of the following interventions should the nurse use? A. Ask the client to perform a return demonstration of insulin injection. B. Review the action of insulin therapy. C. Explore the client's feelings about dietary modifications. D. Have the client practice blood-glucose monitoring using a glucometer.

C. Explore the client's feelings about dietary modifications. The teaching intervention allows pt to express his acceptance of this change and focuses on affective learning.

A nurse is reviewing the laboratory results of a client who is at risk for developing diabetes mellitus. The nurse should recognize that which of the following results indicates the client meets the criteria for diagnosis of diabetes mellitus? A. HbA1c 5.5% B. 2 hr blood glucose 170 mg/dL C. Fasting blood glucose 155 mg/dL D. Casual blood glucose 180 mg/dL

C. Fasting blood glucose 155 mg/dL DM diagnosis: fasting BG above 126 mg/dL, HbA1c > 6.5%, 2 hr BG (oral glucose tolerance test) > 200 mg/dL, casual BG > 200 mg/dL

The nurse is caring for a patient with chronic venous insufficiency (CVI). The nurse should recognize that blood often has difficulty moving in which direction? A. From the heart to the lungs B. From the heart to the brain C. From the legs to the heart D. From the heart to the upper extremities

C. From the legs to the heart The central problem in chronic venous insufficiency (CVI) begins with low pressure that is normally present in the venous system. With such low pressure, blood sometimes has difficulty moving from the legs to the heart, especially when the person is standing.

A nurse is caring for a client who has type 1 diabetes mellitus. Which of the following recommendations should the nurse make to the client for a sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar

C. Nonnutritive sugar substitute Pts with DM 1 need to limit carbohydrate intake. Nonnutritive sugar substitutes allow pt to sweeten taste of foods w/out increasing carb intakes.

A patient with swollen veins in the lower left leg has developed a leg ulcer. Which medical condition should the nurse consider as contributing to this ulcer? A. Deep vein thrombosis B. Obesity C. Phlebitis D. Diabetes

C. Phlebitis - Phlebitis refers to swelling of a vein or veins and is a contributing risk factor for the development of leg ulcers. - Obesity and deep vein thrombosis are risk factors for leg ulcers, but are not defined as swelling of a vein or veins. - Diabetes may complicate this condition; however, this is not considered to be a direct risk factor for leg ulcers.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Ranitidine B. Guafenesin C. Prednisone D. Atorvastatin

C. Prednisone Prednisone- glucose intolerance and hyperglycemia, pt might require increased dosage of hypoglycemic med. Ranitidine- serum creatinine levels Guafenesin- drowsiness and dizziness Atorvastatin- thyroid fxn tests

The nurse notes that a patient has hypertension. Which type of hypertension should the nurse recall is the most common and is caused by many factors? A. Secondary hypertension B. Malignant hypertension C. Primary hypertension D. White coat hypertension

C. Primary hypertension - Primary hypertension is thought to account for about 90% of the cases diagnosed and has been associated with a large number of factors including genetics, age, race, diet (especially sodium intake), smoking, alcohol consumption, and sedentary lifestyle. - Malignant hypertension is a relatively rare condition that occurs when diastolic pressure exceeds 120 mmHg. - If there is an identifiable cause, hypertension is classified as secondary hypertension. - White coat hypertension occurs when a patient experiences fight-or-flight symptoms around medical workers.

Which medical condition can be caused by plaque formation in the carotid arteries? A. Myocardial infarction B. Chronic kidney disease C. Stroke D. Peripheral vascular disease

C. Stroke If plaque is found in the carotid arteries, it is referred to as carotid artery disease, which can lead to stroke. Plaque found in the heart, kidneys, or vessels of the extremities will lead to medical conditions other than stroke.

A nurse is caring for a client who has uncontrolled type 1 diabetes mellitus. Which of the following findings should the nurse expect? A. Hypertension B. Hematuria C. Weight loss D. Bradycardia

C. Weight loss Hypotension, weight loss, and tachycardia are expected findings. Hematuria is not.

A post-myocardial infarction client states to the nurse, "I was amazed that I did not have more damage to my heart. My healthcare provider said I have a good collateral circulation. How did this help?" How should the nurse respond? A. "Collateral circulation removed dead heart tissue after the heart attack." B. "Collateral circulation increased your chest pain so that you sought medical attention sooner." C. "Collateral circulation fed the heart muscle when main routes of blood flow were blocked." D. "Collateral circulation stopped the blockage that caused the heart attack."

C. "Collateral circulation fed the heart muscle when main routes of blood flow were blocked."

A patient is dizzy, lightheaded, and has a blood pressure of 74/32 mmHg. The nurse recognizes that hypotension can have which consequences for the heart? Can lead to increased oxygen delivery to the coronary arteries. Can increases preload, which leads to increased cardiac output Can decrease afterload, making it easier for the heart to pump oxygen to the heart muscle Can lead to increased cardiac oxygen demand

Can lead to increased cardiac oxygen demand Hypotension results in increased myocardial oxygen requirements and lower oxygen delivery, and may accelerate the time to irreversible injury of cardiac muscle. Hypotension does reduce afterload, but it also decreases preload, which decreases cardiac output leading to insufficient blood flow through the heart. This causes decreased blood flow, and therefore decreased oxygen delivery, to the coronary muscle.

The nurse is teaching a class of parents about health promotion for children. Which recommendation should the nurse include to help prevent or regress coronary artery disease (CAD)? Children should maintain a healthy weight, blood pressure, and not be exposed to smoke. Children should eat a balanced diet and avoid snacks. Children should exercise twice a day for a minimum of 20 minutes each session. Children should live in a smoke-free environment.

Children should maintain a healthy weight, blood pressure, and not be exposed to smoke. Children and young adults are not immune to atherosclerosis, which is the leading cause of death in developed and developing countries. Interventions to promote a healthy lifestyle, such as maintaining a healthy weight and blood pressure, and abstaining from smoking are necessary to prevent atherosclerosis, or to regress developed and developing atheromas at any age before they cause coronary artery disease. Just exercising, diet, and a smoke-free environment alone are not enough to prevent CAD.

A patient with narrowing of the coronary arteries denies any symptoms or episodes of chest pain. Which condition should the nurse suspect? Acute coronary syndrome (ACS) Unstable angina Myocardial infarction (MI) Coronary artery disease (CAD)

Coronary artery disease (CAD) Decreased blood flow to the heart occurs with coronary artery disease. Unstable angina, myocardial infarction, and acute coronary syndrome are the result of the blood flow to the heart being occluded or disrupted.

The nurse is assessing for pulsus paradoxus in a patient who was in a car accident. Which of the following results suggest the patient is developing cardiac tamponade? A. An increase of 10 mm Hg in diastolic blood pressure during inspiration B. An increase of 10 mm Hg in systolic blood pressure during inspiration C. A decrease of 10 mm Hg in diastolic blood pressure during inspiration D. A decrease of 10 mm Hg in systolic blood pressure during inspiration

When assessing patient with reduced cerebral perfusion, the nurse should be alert for which early finding? A. Angina B. Claudication C. Dyspnea D. Altered mental status

Which characteristics in an adult patient would the nurse assess as having poor cardiovascular health using the American Heart Association's Life's Simple 7? A. Cholesterol 150 mg/dL, quit smoking cigarettes 15 months ago, weight of 24 kg/m2 B. 60 minutes/week of moderate physical activity, weight of 26 kg/m2, quit 9 smoking months ago C. Systolic blood pressure 124 mm Hg, blood glucose 105 mg/dL, 3 healthy diet components D. Blood glucose 126 mg/dL, lack of physical activity, current smoker

Which finding is the nurse likely to assess in a patient with pericarditis? A. Pain that worsens on sitting upright B. pain that worsens when lying prone C. Pain that worsens on exhalation D. Pain that worsens with deep inspiration

Which manifestation does the nurse expect a patient to exhibit in high-output heart failure? A. Cool skin B. Dry, scaly skin C. Flat neck veins D. Strong peripheral pulses

Which of the following interventions would the emergency department nurse anticipate in a patient being treated for a non-ST-segment elevation myocardial infarction (NSTEMI)? A. Intravenous beta blocker B. Enteric-coated aspirin C. Intravenous nitroglycerin, if the patient has recently used a phosphodiesterase inhibitor drug D. Sublingual nitroglycerin for up to three doses 5 minute apart

Which of the following medications would the nurse anticipate administering to a patient with systolic heart failure to reduce fluid volume and relieve congestion? A. Inotropes B. Beta blockers C. Nitrates D. Diuretics

A nurse is caring for a 7-year-old child who has an upper respiratory infection and type 1 diabetes mellitus. Which of the following statements by the mother indicates a need for further instruction? A. "I will encourage her to drink half a cup of water or sugar-free fluids every 30 minutes." B. "I will report a change in her breathing or any signs of confusion." C. "I will notify the doctor if her temperature is not controlled with acetaminophen." D. "I will continue to check his blood sugar two times every day."

D. "I will continue to check his blood sugar two times every day." Pt with type 1 DM and is ill is at risk of DKA (breakdown of body fat for energy and ketones in blood and urine). Acute illness increase glucose levels, so glucose levels and urine ketones should be checked every 3 hr. BID is not enough.

The nurse notes a bruit present over a patient's carotid artery. Which medical condition should the nurse suspect this patient is experiencing? A. Thrombosis B. Aneurysm C. Hypertension D. Atherosclerosis

D. Atherosclerosis - Diagnosis of peripheral artery disease and atherosclerosis is accomplished by a thorough physical examination and several diagnostic tests. Listening with a stethoscope over certain arteries may help detect a bruit, a whooshing sound that occurs as blood tumbles over and around areas of plaque buildup. - Thrombosis is diagnosed through a d-dimer and imaging tests. - Hypertension is diagnosed through direct measurement. - Aneurysm is diagnosed through imaging procedures.

Which medical condition in childhood is likely to develop in individuals with homozygous familial hypercholesterolemia? A. Chronic renal disease B. Chronic obstructive pulmonary disease (COPD) C. Alzheimer disease D. Cardiovascular disease

D. Cardiovascular disease - The genetic nature of atherosclerosis is evidenced by individuals who inherit familial hypercholesterolemia, a condition in which the blood contains extremely high levels of cholesterol. Individuals with homozygous familial hypercholesterolemia develop severe cardiovascular disease in childhood and often die in their mid-30s. - Atherosclerosis is said to be a risk factor for Alzheimer disease and chronic renal disease, but not until later in life. - Atherosclerosis does not influence the development of chronic obstructive pulmonary disease (COPD).

A patient with hypertension has been prescribed an angiotensin-converting enzyme (ACE) inhibitor medication. Which effect does this class of medication have on the body? A. Causes vasoconstriction B. Increases the formation of angiotensin II C. Increases aldosterone secretion D. Causes more sodium to be excreted

D. Causes more sodium to be excreted Drugs blocking the renin-angiotensin-aldosterone system (RAAS) have become first-line drugs in treating both hypertension and heart failure. The primary medications in this class block angiotensin-converting enzyme (ACE). Blocking ACE reduces the formation of angiotensin II, resulting in less vasoconstriction and less sympathetic nervous system (SNS) activation, thus lowering blood pressure. The blocking of angiotensin II also lowers aldosterone secretion, which in turn allows more sodium to be excreted. The increase in sodium excretion results in decreased arterial wall pressure.

While performing an assessment, the nurse suspects a deep vein thrombosis (DVT). Which blood test should the nurse expect to be ordered? A. Complete blood count (CBC) B. Hemoglobin and hematocrit C. Prothrombin time-International Normalized Ratio (PT-INR) D. D-dimer

D. D-dimer - If a deep vein thrombosis (DVT) is suspected, a D-dimer test may be prescribed. A positive D-dimer test indicates the presence of abnormally high amounts of fibrin degradation products in the blood. This suggests that a high level of clot formation and breakdown is occurring. - A complete blood count (CBC) will not be of any use for blood clot indication. - A PT-INR is used to help diagnose the cause of unexplained bleeding and if anticoagulant medication is effective. - Hemoglobin and hematocrit measure the volume of red blood cells compared to the total blood volume.

A patient is diagnosed with arteriosclerosis. Which medical condition should the nurse identify as a nonmodifiable risk factor for this disorder? A. Diabetes B. Hypertension C. Obesity D. Hypercholesterolemia

D. Hypercholesterolemia - The genetic nature of atherosclerosis is evidenced by people who inherit familial hypercholesterolemia, a condition in which the blood contains extremely high levels of cholesterol. - Diabetes, obesity, and hypertension are all classified as modifiable risk factors for atherosclerosis.

Which teaching is a priority for the nurse to include during discharge for a client with coronary artery disease? A. Timetable for returning to normal activity B. Safety concerns C. Follow-up care D. Lifestyle changes

D. Lifestyle changes

Which type of lipid is the primary carrier of cholesterol and promotes the development of atherosclerosis when levels are elevated? A. Very low-density lipoproteins B. High-density lipoproteins C. Triglycerides D. Low-density lipoproteins

D. Low-density lipoproteins Low-density lipoproteins (LDLs) are the primary carriers of cholesterol. Elevated levels of LDLs promote atherosclerosis because LDL deposits cholesterol on the arterial walls. LDL can also be considered a mnemonic for "less desirable lipoproteins". Triglycerides are transported to adipose tissue for storage by very low-density lipoproteins. High-density lipoproteins help clear cholesterol from the arteries, transporting them to the liver for excretion. Very low-density lipoproteins are transformed into LDL molecules after triglycerides have been transported to adipose tissue. When it comes to LDLs, think, "we want low"; for HDLs, think, "we want high."

A patient has a blood pressure of 136/84 mmHg. Which advice should the nurse give to this patient? A. Increase consumption of saturated fat and cholesterol B. Decrease physical activity C. Increase fluid intake D. Restrict sodium

D. Restrict sodium - The first step in treating chronic hypertension (HTN) is to implement therapeutic lifestyle changes, such as restricting sodium intake. Minor to moderate HTN may respond to therapeutic lifestyle changes without the need for medications. The therapeutic lifestyle changes are the same as those for other cardiovascular disorders. - Increasing fluid intake, decreasing physical activity, and increasing consumption of saturated fat and cholesterol will all increase blood pressure.

The nurse reviews the abnormal ECG findings for a client who denies having any chest pain. However, the client has a history of hypertension and diabetes. Which is the explanation for an abnormal ECG result in the absence of chest pain for this client? A. Hypertension B. Stroke C. Hyperlipidemia D. Silent angina

D. Silent angina

Which mechanism increases blood flow to the coronary arteries? A. Platelet aggregation B. Fat and fibrin deposits on the arterial walls C. Spasms of normal or already narrowed arterial vessels D. Vasodilation of the arteries

D. Vasodilation of the arteries

A patient is being treated for systolic heart failure. Which finding should the nurse expect when caring for this patient? Increased contractility Bradycardia Preserved ejection fraction Decreased ejection fraction

Decreased ejection fraction This is identified as heart failure (HF) with reduced ejection fraction because the primary deficit in these patients is associated with a reduced ejection fraction. HF is usually associated with tachycardia and decreased contractility. Preserved ejection fraction is related to diastolic heart failure.

A patient is undergoing testing to verify a diagnosis of hypertension. Which symptom(s) might the patient with suspected hypertension report to the nurse? Restless legs when sleeping Frequent headaches and nocturia Burning sensation upon urinating Polyuria, polyphagia, and polydipsia

Frequent headaches and nocturia The most common symptoms that hypertensive patients report are headaches and nocturia. Polyuria, polyphagia, and polydipsia are signs of diabetes mellitus. Burning sensation when urinating indicates a urinary tract infection. Restless legs while sleeping can be associated with electrolyte or muscle issues and is not associated with hypertension. Hypertension (HTN) increases the afterload on the left ventricle. This can lead to ventricular remodeling and lead to heart failure. HTN can lead to decreased perfusion to the organs such as the kidneys, brain, heart, and eyes.

A patient reports increased fatigue and shortness of breath during exercise but feels fine when not exercising. Which disorder should the nurse suspect? High-output heart failure (HF) Right-sided heart failure (HF) Heart failure with preserved ejection fraction (HFpEF) Heart failure (HF) related to systolic dysfunction

Heart failure with preserved ejection fraction (HFpEF) A form of heart failure (HF) commonly known as diastolic heart failure is seen in patients with normal contractility of the heart but abnormal relaxation of the heart. This type of HF is called heart failure with preserved ejection fraction (HFpEF), because these patients have HF in the presence of a normal EF. Left ventricular EF may be normal in these individuals at rest, but during exercise or at other times of increased demand, myocardial contractility may remain the same or even worsen. It is not related to just right-sided HF, high output HF, or systolic HF.

A patient is admitted with heart failure (HF). Which finding should cause the nurse to suspect right-sided HF in this patient? Dyspnea Confusion Cyanosis Hepatomegaly

Hepatomegaly Hepatomegaly (enlarged liver) is a result of the backward effects of right-sided HF due to congestion in the systemic venous system. Dyspnea (shortness of breath) is a common symptom of left-sided HF and is related to the pulmonary congestion that impairs gas exchange. Cyanosis is a symptom of left-sided HF and is the bluish appearance of skin and mucous membranes due to the lack of oxygenation to the peripheral tissues from decreased cardiac output. Decreased cardiac output due to left-sided HF also leads to a decreased amount of oxygen delivered to the brain, which causes confusion.

The public health nurse is providing heart failure prevention education at a community health fair. Which information should the nurse include during this presentation? Advanced age is the greatest risk factor for heart failure. Hypertension is the greatest risk factor for heart failure. Female gender is the greatest risk factor for heart failure. Heart attack is the greatest risk factor for heart failure.

Hypertension is the greatest risk factor for heart failure. Although gender differences exist in the risks for developing heart failure (HF), studies have identified that hypertension has the greatest impact. Risk for heart failure with myocardial infarction (MI) is also high, but not high as with hypertension. Heart failure is the most common reason for hospitalization in those older than 65 years, but decreasing hypertension is the best prevention of HF.

The nurse assesses hypotension and dyspnea in a patient with sepsis. Which related complication should the nurse anticipate developing in this patient? Increased systemic vascular resistance (SVR) Hypervolemia Cool, clammy skin Decreased cardiac output (CO)

Hypervolemia High-output HF is marked by an unusually low systemic vascular resistance (SVR) and an elevated cardiac output. Sepsis, which is a systemic inflammatory response to an infection, can lead to high-output heart failure (HF). Sepsis produces profound vasodilation which leads to low blood pressure and neurohormonal effects. In sepsis, the systemic vascular resistance is decreased, cardiac output is increased, and skin remains warm.

A patient presents with a high risk for sudden cardiac death due to dysrhythmia. Which treatment should the nurse expect to be ordered that will best address the patient's condition? A wearable cardioverter-defibrillator vest Implantable cardioverter-defibrillators (ICDs) Pacemaker insertion An automated external defibrillator (AED)

Implantable cardioverter-defibrillators (ICDs) Implantable cardioverter-defibrillators (ICDs) are best to help prevent death from cardiac arrest. This treatment has been associated with reduced mortality in patients who are at high risk for sudden cardiac death. Pacemakers are indicated mainly for symptomatic bradydysrhythmias or for patients with asymptomatic bradydysrhythmia if development of serious or symptomatic dysrhythmia is likely. A wearable cardioverter-defibrillator vest is a temporary option until an ICD can be implanted. An AED is not the best option, because it requires a second person to operate.

A patient is admitted for symptoms related to a heart problem. During assessment, which finding should lead the nurse to suspect right-sided heart failure? Increased ascites Pulmonary edema Increased dyspnea Cyanosis in the extremities

Increased ascites Ascites is a result of the backward effects of right-sided heart failure due to congestion in the systemic venous system. Dyspnea (shortness of breath) is a common symptom of left-sided heart failure and is related to the pulmonary congestion that impairs gas exchange. Cyanosis is a symptom of left-sided heart failure and is the bluish appearance of skin and mucous membranes due to the lack of oxygenation to the peripheral tissues from decreased cardiac output. Pulmonary edema is related to left-sided heart failure as fluid backs up into the lungs.

The nurse assesses a patient who has been sitting up in a chair for several hours.Which finding should the nurse recognize as being related to right-sided heart failure? Increased rales in the lung bases Increased edema in the feet and ankles Poor peripheral perfusion Pulmonary edema with pink frothy sputum

Increased edema in the feet and ankles Peripheral edema, as evidenced by increased ankle and foot edema, is a clinical manifestation of right-sided heart failure (HF). Increased rales, pulmonary edema, and poor peripheral perfusion are all manifestations of left-sided heart failure. Right-sided heart failure (HF) occurs when the right side of the heart is unable to pump blood sufficient to meet the needs of the body. There is a lack of forward flow of blood through the lungs to the left ventricle, which leads to decreased left ventricular preload and reduced cardiac output. There is a backup of blood through the venous circulation to the liver, the mesentery, and the periphery.

A patient with a heart rate of 150 beats/min reports chest pain. The nurse should recognize this heart rate can lead to which condition? Occlusion of the coronary arteries that will decrease oxygenation to the coronary muscles Increased myocardial oxygen demand that can cause cell damage due to decreased oxygenation Increased cardiac output and better coronary perfusion to the coronary arteries Decreased oxygen demand leaving more oxygen available for the tissues of the body

Increased myocardial oxygen demand that can cause cell damage due to decreased oxygenation Increased, not decreased, myocardial oxygen requirements, resulting from tachycardia (abnormal rapid heart rate, generally more than 100 beats per minute) may accelerate the time to irreversible coronary injury due to decreased oxygenation of the coronary muscles. Tachycardia does not result in better perfusion to the coronary arteries. Tachycardia does not cause occlusion of the arteries.

The nurse is teaching a patient about the risk factors for coronary artery disease. Which risk factor is considered modifiable? Age Gender Ethnicity Insulin resistance

Insulin resistance A patient can change their activity or diet to decrease obesity, and therefore it is classified as a modifiable risk factor. Age, gender, and ethnicity cannot be changed, making them nonmodifiable risk factors. Additional Learning Major modifiable risk factors that contribute to a risk of CAD include: Smoking and tobacco use. Lack of physical activity. Poor nutrition. Obesity. Hypertension. Dyslipidemias. Insulin resistance. Metabolic syndrome. Sleep apnea. Stress. Depression.

A patient with a history of atherosclerosis has chest pain that is unrelated to activity, unpredictable, and often occurs while at rest. The patient reports the pain has been becoming more frequent and severe. The nurse recognizes that the patient is at severe risk for which disorder? Coronary artery disease Myocardial infarction Hypertension Stable angina

Myocardial infarction This patient's angina is unpredictable and occurs at rest, which places the patient at high risk of a myocardial infarction. Hypertension alone does not result in severe chest pain at rest. Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold, or stress. Coronary artery disease is the cause of angina, which is a result of chest pain.

A patient with a history of atherosclerosis has chest pain that is unrelated to activity, unpredictable, and often occurs while at rest. The patient reports the pain has been becoming more frequent and severe. The nurse recognizes that the patient is at severe risk for which disorder? Stable angina Coronary artery disease Hypertension Myocardial infarction

Which risk factor for coronary artery disease should the nurse consider as modifiable? Gender Age Periodontal disease Ethnicity

Periodontal disease Peridontal disease can be modified by dental care. Gender, age, and ethnicity are nonmodifiable risk factors.

A pregnant patient with a history of hypertension is experiencing shortness of breath, weight gain, and peripheral edema. For which potential complication of pregnancy should the nurse assess this patient? Peripartum cardiomyopathy from a congenital heart defect Postpartum cardiomyopathy that has led to heart failure Peripartum cardiomyopathy from hypertension Peripartum cardiomyopathy from a myocardial infarction (MI)

Peripartum cardiomyopathy from hypertension Peripartum cardiomyopathy is a type of pregnancy-related heart failure that usually develops during the last month of pregnancy and can occur up to 6 months after the end of pregnancy. Since the patient is still pregnant, it is not postpartum. The patient has no history of a myocardial infarction (MI) or congenital heart defect that could lead to heart failure.

Which condition is related to right-sided heart failure? Peripheral edema Poor peripheral perfusion Cor pulmonale Pulmonary edema

Peripheral edema Peripheral edema is a clinical manifestation of right-sided heart failure (HF). Cor pulmonale, pulmonary edema, and poor peripheral perfusion are all manifestations of left-sided heart failure.

A patient is diagnosed with atherosclerotic plaque in the coronary arteries. Which statement about coronary plaque is correct? Plaque is a stable narrowing that can be resolved with diet changes. Plaque is at risk for rupture that could result in occlusion of the artery. Plaque in the coronary arteries causes collateral circulation that will prevent damage to the heart. Plaque remains asymptomatic and causes no change in coronary oxygenation.

Plaque is at risk for rupture that could result in occlusion of the artery. When atherosclerotic plaque ruptures, it is the stimulus for thrombogenesis and blood flow obstruction. Plaque cannot be resolved with just dietary changes. Plaque causes narrowing that can decrease oxygen to the coronary muscle. Collateral circulation can develop, but may not prevent damage to heart muscle.

A patient with a history of diabetes is 1 month postpartum and begins to experience shortness of breath and ascites. Which complication of pregnancy should the nurse suspect is occurring? Peripartum cardiomyopathy that has resulted in heart failure Peripartum cardiomyopathy related to hypertension (HTN) Peripartum cardiomyopathy related to a myocardial infarction (MI) Postpartum cardiomyopathy related to diabetes

Postpartum cardiomyopathy related to diabetes Pregnancy cardiomyopathy is a type of pregnancy-related heart failure (HF) that usually develops during the last month of pregnancy and can occur up to 6 months after the end of pregnancy. Since the patient is not pregnant, it is not peripartum. The patient has no history of a myocardial infarction (MI) or hypertension (HTN) that could lead to HF.

Which statement reflects the function of an electrocardiogram (ECG). Shows the presence of dysrhythmias Reveals valvular strength Computes cardiac preload Measures cardiac output

Shows the presence of dysrhythmias The electrocardiogram (ECG) is used to assess and record the heart's electrical activity and show the presence of dysrhythmias related to cardiovascular disease. An ECG may indicate cardiac irregularities but cannot determine preload, cardiac output, or the strength of the valves.

The nurse is caring for a patient with a history of atherosclerosis. The patient reports chest pain that occurs with physical exertion or stress and is relieved with a sublingual nitroglycerine tablet. The nurse recognizes the patient as most likely experiencing which disorder? Acute coronary syndrome Myocardial infarction Stable angina Prinzmetal angina

Stable angina Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold or stress, and is relieved by nitroglycerin. Prinzmetal (variant) angina occurs unpredictably and often at night. The patient is currently experiencing a predictable form of angina. Clinical manifestations of myocardial infarction include pain that is less predictable, more prolonged, and unrelieved by sublingual nitroglycerin. Clinical manifestations of acute coronary syndrome include pain that is more severe and longer than previously experienced, is not predictable, and is unrelieved by sublingual nitroglycerin.

A patient with an elevated C-reactive protein (CRP) is being evaluated for coronary artery disease. For which complication is the patient most at risk? Pericardial inflammation Atrial fibrillation Stroke Heart failure

Stroke With coronary artery disease and elevated C-reactive protein, the patient is at risk for a stroke. An elevated plasma or serum CRP level is strongly associated with atherosclerosis and CAD and is predictive of cardiovascular events such as MI, stroke, peripheral artery disease, and sudden cardiac death. CRP does not impact the electrical activity (such as atrial fibrillation) or pumping activity (such as heart failure) of the heart. Increased levels indicate inflammation, but that alone does not lead to angina or myocardial infarction, because those are caused by narrowing of the lumen of the artery.

A patient is diagnosed with a decreased ejection fraction. For which health problem should the nurse plan care for in this patient? Diastolic heart failure Tachycardia Bradycardia Systolic heart failure

Systolic heart failure This is identified as heart failure with reduced ejection fraction, because the characteristic HF in such patients is associated with a reduced ejection fraction. HF is usually associated with tachycardia and decreased afterload. Preserved ejection fraction is related to diastolic heart failure.

A patient diagnosed with atherosclerosis in the coronary arteries reports chest pain while exercising, but states it subsides with rest. Which description about the patient's chest pain is correct? The chest pain is a sign of a myocardial infarction (MI). The chest pain is a sign of collateral circulation that bypasses any occlusion. The chest pain is a result of imbalance of myocardial oxygen supply and demand. The chest pain is a sign of plaque that has ruptured and completely occluded a coronary artery.

The chest pain is a result of imbalance of myocardial oxygen supply and demand. The chest pain is symptom of oxygenation imbalance. The sudden imbalance of myocardial oxygen consumption, which is the amount of oxygen consumed by the heart, and the myocardial demand, which is the amount of energy required, is the hallmark of acute coronary syndrome (ACS). The chest pain alone does not indicate that an MI has occurred or an artery has been completely occluded. Even partial occlusion can cause chest pain without cellular death. Collateral circulation cannot bypass any occlusion to prevent damage.

A patient with left-sided heart failure is diagnosed with hepatomegaly. The nurse should conclude that which cause resulted in the change to patient's liver? The left side of the heart is pumping too much blood to the body. The patient developed a pulmonary embolism, resulting in right-sided heart failure (HF). The patient is now experiencing decreased right-sided afterload. The left-sided heart failure (HF) now has caused right-sided HF.

The left-sided heart failure (HF) now has caused right-sided HF. Right-sided heart failure (HF) can be caused by many conditions but is typically caused by left-sided HF. Hepatomegaly is a sign of right-sided HF as fluid backs up into the body. Hepatomegaly is not a forward effect of left-sided HF. Right-sided afterload is increased in HF. The patient had left-sided HF as a cause, not a pulmonary embolism.

The nurse notes ascites while assessing a patient with left-sided heart failure (HF). Which conclusion should the nurse make about this finding? The patient is now experiencing decreased right-sided preload. The patient is now experiencing signs of right-sided heart failure (HF). The patient now has primary pulmonary hypertension. The left side of the heart is not pumping enough blood to the body.

The patient is now experiencing signs of right-sided heart failure (HF). Right-sided heart failure can be caused by many conditions but is most typically caused by left-sided heart failure (HF). Ascites is a sign of right-sided HF, because fluid backs up into the body. Ascites is not a forward effect of left-sided HF. Right-sided preload is increased in HF. The patient's left-sided HF, not primary pulmonary hypertension (HTN), is most likely the cause of the patient's right-sided heart failure.

A patient has been diagnosed with suspected mitral regurgitation. Which diagnostic test should the nurse expect to be ordered to confirm the diagnosis? Coronary angiogram Transesophageal echocardiography (TEE) Electrocardiogram (ECG) Chest x-ray

Transesophageal echocardiography (TEE Transesophageal echocardiography (TEE) is the standard diagnostic test used for initial evaluation and as follow-up for the patient with known or suspected valvular disorder to determine cause, severity, hemodynamic effects, prognosis, and timing of interventions. Electrocardiogram is measurement of the electrical signals of the heart, not the valve function. Coronary angiogram is used to look at perfusion of the coronary angiogram. Diagnosis may be based on incidental findings on chest x-ray or other noninvasive testing or as a result of auscultation of a heart murmur during a physical examination, but TEE is best for visualization.

The nurse is monitoring a client who has been newly diagnosed with diabetes mellitus for signs of complications. Which statement made by the client would indicate hyperglycemia and thus warrant health care provider notification?

"I am urinating a lot."

The nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching?

"I need to stop my insulin."

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?

"I should not exercise in the late afternoon."

rapid-acting insulins peak in

1-3 hrs

How should the nurse respond when a patient with diabetes asks about the role of beta cells in the pancreas? A. "Beta cells secrete insulin." B. "Beta cells secrete glucagon." C. "Beta cells secrete somatostatin." D. "Beta cells secrete pancreatic polypeptide."

What is the most appropriate response by the nurse when a 20-year-old woman pregnant with her first child and diagnosed with gestational diabetes mellitus (GDM) asks if she will develop diabetes in the future? A. "There is a chance that you may develop diabetes in the next 10-20 years, so monitoring would be appropriate." B. "Your risk for developing diabetes in the future is high because you are young." C. "You cannot develop gestational diabetes (GDM) in future pregnancies, this only happens with your first pregnancy." D. "It is impossible to tell—we don't know anything about the risk factors for diabetes."

The staff development nurse is teaching a class on diabetes to newly hired nurses at General Hospital. The nurse explains that during glycogenolysis which of the following occurs? A. Insulin increases, glucagon decreases. B. Insulin and growth hormone increase, cortisol decreases. C. Insulin decreases; glucagon, cortisol, growth hormone and epinephrine increase. D. Insulin decreases, glucagon and norepinephrine/epinephrine increase.

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Rotate NPH vial. b. Withdraw regular insulin. c. Withdraw 20 units of NPH. d. Inject 20 units of air into NPH vial. e. Inject 2 units of air into regular insulin vial.

ANS: A, D, E, B, C When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin.

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? a. "Do you feel bloated after eating?" b. "Have you seen any skin changes?" c. "Do you need to increase your insulin dosage when you are stressed?" d. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask but would not help in identifying autonomic neuropathy.

After the nurse has finished teaching a patient who has a new prescription for exenatide (Byetta), which patient statement indicates that the teaching has been effective? a. "I may feel hungrier than usual when I take this medicine." b. "I will not need to worry about hypoglycemia with the Byetta." c. "I should take my daily aspirin at least an hour before the Byetta." d. "I will take the pill at the same time I eat breakfast in the morning."

ANS: C Because exenatide slows gastric emptying, oral medications should be taken at least 1 hour before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety. Hypoglycemia can occur with this medication.

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to a. save the lunch tray for the patient's later return to the unit. b. ask that diagnostic testing area staff to start a 5% dextrose IV. c. send a glass of milk or orange juice to the patient in the diagnostic testing area. d. request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

how is HHS treated

Aggressive fluid and electrolyte replacement and insulin

A nurse is caring for a client who has type I diabetes mellitus and is not following the guidelines for therapy. Which of the following should the nurse consider as contributing factors to the client's nonadherence? (Select all that apply.) A. Gender B. Culture C. Literacy D. Dexterity E. Motivation

B. Culture C. Literacy D. Dexterity E. Motivation Gender does not contribute to nonadherence. Culture (sociocultural background, beliefs, practices, values, and traditions). Literacy (ability to read and correctly administer med) and dexterity (physical ability to use equipment needed) affect adherence. Motivation to follow Tx plan and pt perception of seriousness of illness affect adherence.

A child diagnosed with type 1 diabetes six months ago is being seen in the clinic because the mother has questions about why her child has not needed insulin for the past week. Which response by the mother indicates that more teaching is needed? A. "The honeymoon period will most likely end in a few months." B. "I still need to check my child's blood glucose levels." C. "My child no longer has diabetes." D. "This period of insulin production is temporary."

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? A. Grapefruit juice B. Milk C. Alcohol D. Coffee

C. Alcohol The nurse should teach the pt to avoid alcohol while taking this med to prevent disulfiram reaction, such as nausea, headache, and hypoglycemia. Grapefruit juice can cause atorvastatin toxicity if used while taking atorvastatin. Milk, coffee, and caffeine do not interact with chlorpropamide.

Which laboratory finding indicates to the nurse that a patient has an impaired fasting glucose (IFG)? A. An blood glucose level 2 hours after an oral glucose tolerance test that is high but not diagnostic of diabetes B. A fasting blood glucose level is diagnostic for diabetes C. Increased insulin and decreased glucagon levels two hours after fasting D. A fasting blood glucose level or A1c higher than normal but not diagnostic for diabetes

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pulse and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?

Check the client's capillary blood glucose.

A woman in her 26th week of pregnancy is undergoing a one-step 75-gram oral glucose tolerance test (OGTT). Which finding indicates that gestational diabetes is present? A. A 2-hour plasma glucose level of 145 mg/dL B. A 3-hour plasma glucose level of 135 mg/dL C. A 1-hour plasma glucose level of 160 mg/dL D. A fasting plasma glucose level of 92 mg/dL

The nurse caring for a patient with uncontrolled diabetes notes deep and rapid respirations. The nurse documents this respiratory pattern as: A. shortness of breath. B. orthopnea. C. Cheyne-Stokes respiration. D. Kussmaul respiration.

A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? A. "I am to take my blood sugar reading after meals." B. "Insulin allows me to eat ice cream at bedtime." C. "A weight reduction program will make me hypoglycemic." D. "I give the insulin injections in my abdominal area."

D. "I give the insulin injections in my abdominal area." Pt should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar state (HHS) precipitated by acute illness. The client states to the nurse, "I will call the doctor next time I can't eat for more than a day or so." The nurse plans care, understanding that which statement accurately reflects this client's level of knowledge?

The client needs immediate education before discharge.

The nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse should focus on which potential problem for this client?

Dehydration

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding should the nurse expect to note as confirming this diagnosis?

Elevated blood glucose and low plasma bicarbonate

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?

Excessive thirst and urine output

During the postabsorptive state, what process provides glucose for the brain and nervous tissue?

Gluconeogenesis

A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider's documentation and would expect to note which diagnosis?

Hyperglycemic hyperosmolar state (HHS)

The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list?

Increased thirst

In the absorptive state, what hormone stimulates glucose uptake into tissues?

Insulin

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?

Intravenous (IV) infusion of normal saline

What is the role of aldosterone

It causes the kidneys to keep sodium and water.

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?

Less than 50 mg/dL

The nurse is reinforcing instructions with a client with diabetes mellitus who is recovering from diabetic ketoacidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?

Monitor blood glucose levels frequently.

long acting insulins peak

None (safer)

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection?

Plan for injection rotation

What metabolic state is characterized by a higher ratio of glucagon to insulin?

Postabsorptive state

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?

Rotate the insulin injection sites systematically.

The nurse reinforces teaching with a client with diabetes mellitus regarding differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be taken if which symptom develops?

Shakiness

What happens to excess glucose during the absorptive state?

Stored as glycogen or lipids

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is reinforcing instructions to the client regarding the program. Which should the nurse include in the instructions?

Take a blood glucose test before exercising.

Which client complaint should alert the nurse to a possible hypoglycemic reaction?

Tremors and double vision

During RAAS activation, what gland releases aldosterone

adrenal cortex

When the patient is ketotic, exercise may result in

an increase in blood glucose

Autonomic neuropathy can cause

delayed gastric emptying

Patients should be taught not to administer insulin into a site that will be

exercised

hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

When the RAAS is activated due to a change in body hemodynamics, the SNS stimulates the ___________________ cells in the kidneys to release renin

juxtaglomerular cells

hyperglycemia symptoms

lots of eating, peeing, drinking. blurred vision, fatigue, weight loss

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