Practice Problems for NUR 114 Perfusion

A 30-year-old client who is diagnosed with hyperlipidemia and hypertension asks the nurse to explain why treatment is important, stating "I feel fine, so I don't really see the need to make any changes." Which response would the nurse make? 1 "Both high blood pressure and high cholesterol contribute to development of heart disease." 2 "Lifestyle adaptations alone will be adequate as long as you continue to be asymptomatic." 3 "Usually someone with these diagnoses will have symptoms of heart disease already." 4 "You should discuss your questions about medical problems with the health care provider."

"Both high blood pressure and high cholesterol contribute to development of heart disease." Rationale: Because cardiac risk factors are cumulative in their effect on the development of coronary artery disease, treatment of both risk factors is advised before development of symptoms. Although lifestyle adaptations are an initial action in management of hypertension and hyperlipidemia, treatment with medications is also frequently required. The majority of young adults with hypertension and hyperlipidemia are asymptomatic. Although the health care provider will certainly answer questions, the nurse is also responsible for teaching clients about how to manage cardiac risk factors.

A client presents with bilateral leg pain and cramping in the lower extremities. The client has a history of cardiovascular disease, diabetes, and varicose veins. To guide the assessment of the pain and cramping, the nurse would include which question when completing the initial assessment?

"Does walking for long periods of time increase your pain?" Clients with a medical history of heart disease, hypertension, phlebitis, diabetes, or varicose veins often experience vascular-related complications. The nurse would recognize that the relationship of symptoms to exercise will clarify whether the presenting problem is vascular or musculoskeletal. Pain caused by a vascular condition tends to increase with activity. Musculoskeletal pain is not usually relieved when exercise ends. Low potassium levels can cause cramping in the lower extremities; however, given the client's health history, vascular insufficiency should be suspected. Previously healed broken bones do not cause cramping and pain.

Which of these clients seen at a health fair will be most at risk for hypertension? 23-year-old white man 44-year-old white woman 50-year-old Mexican-American woman 62-year-old African American man

African Americans have the highest risk for hypertension; before the age of 45, men are at higher risk than women. A 23-year-old white man would be a low risk for hypertension. A 44-year-old white woman would be a somewhat higher risk, but still much less than an African American man or woman. Mexican-American clients are less likely to seek treatment for hypertension, but they are not at higher risk than African Americans.

The nurse is caring for a client admitted with cardiovascular disease. During the assessment of the client's lower extremities, the nurse notes that the client has thin, shiny skin; decreased hair growth; and thickened toenails. Which condition might this indicate?

Arterial insufficiency Clients experiencing arterial insufficiency present with extremities that become pale when elevated and dusky red when lowered. Lower extremities may also be cool to touch, pulses may be absent or mild, and skin may be shiny and thin with decreased hair growth and thickened nails. Clients with venous insufficiency often have normal-colored extremities, normal temperature, normal pulses, marked edema, and brown pigmentation around the ankles. Phlebitis is an inflammation of a vein that occurs most often after trauma to the vessel wall, infection, and immobilization. Lymphedema is swelling in one or more extremities that is a direct result of impaired flow of the lymphatic system.

A client is admitted to the hospital, and benazepril is prescribed for hypertension. Which is an appropriate nursing action for clients taking this medication?

Assess for dizziness. Dizziness may occur during the first few weeks of therapy until the client adapts physiologically to the medication. Dark, tarry stools are not a side effect of benazepril. Administering the medication after meals is unnecessary; however, if nausea occurs, the medication may be taken with food or at bedtime. The blood pressure should be monitored before and after administration. An EEG is unnecessary. Cardiac monitoring may be instituted because of possible dysrhythmias.

A client with which diagnosis will be at risk for development of a pulmonary embolism?

Atrial fibrillation Inadequate atrial contraction that occurs during fibrillation leads to pooling of blood in both atria that may result in thrombus formation. Dislodgement of thrombus in the right atria will lead to pulmonary embolism, whereas dislodgement of thrombus in the left atria may lead to embolic stroke. A forearm laceration does not increase pulmonary embolism risk. Pulmonary embolism is not a complication of migraine headache. Respiratory infections do not increase pulmonary embolism risk.

A client with hypertension has received a prescription for metoprolol. Which information will the nurse include when teaching this client about metoprolol?

Do not abruptly discontinue the medication. Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. Clients should never increase medications without medical direction. The pulse rate can go lower than 70 beats per minute as long as the client is asymptomatic.

When a client is diagnosed with left-sided congestive heart failure, which assessment findings would the nurse expect? Select all that apply. One, some, or all responses may be correct.

Dyspnea Crackles Frequent cough With left ventricular failure, increases in left ventricular volume and pressure lead to pulmonary congestion, causing dyspnea, lung crackles and cough. Peripheral edema occurs when right-sided heart failure causes increases in systemic venous pressure. Jugular vein distention also occurs with right-sided failure and increased systemic venous pressure.

Which assessment finding of a client with heart failure would prompt the nurse to contact the health care provider? Select all that apply. One, some, or all responses may be correct.

Fatigue Orthopnea Pitting edema Dry hacking cough 4-pound weight gain Rationale: Signs of worsening heart failure include fatigue, weakness, and difficulty breathing when lying flat (orthopnea). Other manifestations include pitting edema, weight gain, and a dry, hacking cough.

Which parameter would the nurse assess in a client with right-sided heart failure? Select all that apply. One, some, or all responses may be correct.

Fluid volume Jugular vein distention, edema, ascites, and weight gain would be expected in a client with right-sided heart failure. Therefore, the nurse would assess fluid volume. Crackles when auscultating lung sounds; restlessness and confusion caused by impaired oxygenation; increased, shallow respiratory rate; and pulsus alternans on evaluation of peripheral pulses are associated with left-sided heart failure.

When a client with heart failure is to be discharged and tells the nurse that there are no family members who can help with care at home, which action would the nurse take first?

Question the client about current support systems. The initial action by the nurse would be assessment of the resources that the client is currently using or has available. A home health referral may be needed, but more information about the client's current resources is needed before asking the health care provider for a referral. Short-term placement in a long-term care facility is helpful for many clients to transition from hospital to home, but there is not enough information to determine whether this is a good option for this client. An assisted living facility is appropriate for many clients, but more assessment data are needed to decide whether this client would benefit from an assisted living facility.

In which order will the nurse perform these prescribed actions for a client who is in the emergency department with sudden onset of dyspnea and possible pulmonary embolism?

The initial action for a client with dyspnea and chest pain will be obtain a baseline oxygen saturation and then start oxygen administration. Because dysrhythmias can occur because of hypoxemia secondary to pulmonary embolus, the nurse will start cardiac monitoring. Rapid administration of anticoagulants is needed, but baseline coagulation studies are needed prior to starting anticoagulation.

For which clinical manifestations will the nurse monitor when caring for a client admitted with heart failure? Select all that apply. One, some, or all responses may be correct.

Unusual fatigue Dependent edema Nocturnal dyspnea Unusual fatigue is attributed to inadequate perfusion of body tissues because of decreased cardiac output in response to cardiac ischemia. Dependent edema occurs with right ventricular failure because of hypervolemia. Dyspnea at night, which usually requires the assumption of the orthopneic position, is a sign of left ventricular failure. Weight gain, not loss, occurs because of fluid retention. Urinary output decreases, not increases, with heart failure because the sympathetic nervous system and the renin-angiotensin-aldosterone system stimulate the retention of sodium and water in the kidneys.

Which topics would the nurse include in teaching for a client with a new diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct.

Use of a home blood pressure monitor Adverse effects of tobacco on blood pressure Benefits of moderate daily exercise Lifestyle management of blood pressure includes monitoring blood pressure at home frequently using a home blood pressure monitor, avoiding tobacco products, and a physically active lifestyle that includes moderate daily exercise. Daily aspirin is not recommended for clients who have hypertension, although it may be recommended for clients with known coronary artery disease or additional risk factors for cardiovascular disease. Although excessive alcohol use should be avoided, moderate alcohol consumption (2 alcoholic drinks/day for men and 1 alcoholic drink/day for women and lighter weight men) is acceptable for clients with hypertension.

The nurse provides discharge education about a diet low in saturated fat for a client with hypercholesterolemia. The nurse reviews a sample menu created by the client. The nurse concludes that the teaching is effective when the client plans to avoid which types of food?

Whole milk and hard cheeses Milk and milk products are high in fat and should be limited to reduce cholesterol levels. High-fiber foods are beneficial and should be encouraged. Canned vegetables have very little fat. Citrus fruits have no fat and should be encouraged.

Which dietary selection by a client with cardiovascular disease indicates that more education by the nurse about heart healthy diet is needed?

Whole milk with oatmeal Clients are taught to use low fat or nonfat milk products, not whole milk, to reduce intake of saturated fats in a heart-healthy diet. High-fiber foods such as beans and brown rice are recommended. Although red meat is relatively high in saturated fats, grilling of the hamburger will reduce fat and is a good option for this client. Vegetables such as spinach are low in fat and olive oil is an unsaturated fat, which is considered heart healthy.

When assessing a client with a diagnosis of peripheral arterial disease before a scheduled arteriogram, the nurse is unable to palpate the pedal pulses. Which action would the nurse take next? 1 Check the pulses with a Doppler device. 2 Notify the primary health care provider. 3 Notify the staff in the catheterization laboratory. 4 Document the findings in the client's medical record.

check pulses with a doppler Rationale: When the nurse is unable to palpate pulses, the next action would be to determine whether pulses are audible with a Doppler device. Notification of the health care provider is not immediately necessary because decreased pulse quality is expected in clients with peripheral arterial disease. The catheterization staff will be notified of the absent or decreased pedal pulses after the nurse has ascertained whether pulses are audible with the Doppler. Assessment findings will be documented in the client's record after the nurse has all the data necessary about the presence or absence of pulses with the Doppler.

When caring for a client with peripheral arterial insufficiency, how would the nurse position the client's feet and legs? 1 Place them slightly lower than the head and chest. 2 Use pillows to support the heels above the mattress. 3 Raise the knees using the knee gatch on the bed. 4 Elevate feet by raising the foot of the bed on blocks.

lower than the head and chest rationale: Gravity will assist the flow of blood to the dependent legs and feet (placed lower than the head and chest). Elevating the heels on pillows will decrease blood flow to the feet. Bending the knees with the use of the knee gatch will decrease blood flow to the feet. Elevating the foot of the bed will decrease blood flow to the feet.

Which clinical manifestations indicate a possible pulmonary embolism in a client after a total hip replacement? Select all that apply. One, some, or all responses may be correct.

sudden chest pain and abrupt onset of shortness of breath Sudden chest pain is caused by decreased oxygenation to pulmonary tissues. Because capillary perfusion is blocked by the pulmonary embolus, oxygen saturation drops and the client experiences shortness of breath, dyspnea, and tachypnea. Flushing of the face and fever are not classic signs of pulmonary embolus. The pain associated with pulmonary embolus generally is sudden in onset, severe, and located in the chest, not the hip.

Which action by a client with peripheral arterial disease indicates that more teaching about how to manage the disease is needed? 1 Applying a hot water bottle to the abdomen 2 Using a heating pad to warm the extremities 3 Drinking a warm cup of tea when feeling chilly 4 Turning the room thermostat above 72°F (23.3°C)

using a heating pad to warm the extremities rationale: The client's extremities are less able to respond to thermal stress because of peripheral vascular problems, and burns may occur with the application of a heating pad to the extremities. Applying heat to the abdomen causes reflex dilation of the arteries in the extremities and increases blood flow without untoward effects. Raising the internal temperature by drinking warm fluid prevents vascular constriction and warms the extremities. Increasing heat of the external environment will safely help prevent arterial constriction and improve client's peripheral circulation.