Cardiac first 15

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply: •A. Raynaud's Disease is triggered by cold temperatures or stress. •B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins •C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. •D. Raynaud's Disease is prevented by glucose control.

A &C Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. vasospasm. Management: patient teaching- preventing recurrent episodes, instruct patient to wear loose, warm clothing as protection from the cold, avoid temperature extremes at all times (exercise indoor during winter months), stop using tobacco, avoid caffeine, stress management. Treatment: calcium channel blocker is the first line drug therapy when conservative measures are ineffective. Remember, calcium channel blockers work by relaxing smooth muscle of arterioles by blocking influx of calcium into the cells. This reduces frequency and severity of vasospastic attacks.

Which of the following are signs and symptoms of worsening heart failure? Select all that apply •A. Weight gain of 6 pounds per week •B. Worsening or new onset of cough •C. Hypotension •D. Increased SOB E. Confusion F. Increased urine output

A, B, D, E *Remember: UNLOAD FAST* Fluid backs up into the lung, abdomen, liver, lower body. Perform daily weights at same time everyday and report to MD weight gain of 2 lbs. in a day or 5lbs in a week. -if you have a patient that complains of shortness of breath and cough and reports that they are taking cough medicine to control the cough, you should educate them that the cough they are experiencing could be a worsening of their heart failure Place client in high fowlers position: helps decrease venous return because of the pooling of blood in the extremities. Also increases thoracic capacity, allowing for improved ventilation.

A nurse is assessing a patient who has been diagnosed with venous insufficiency. What would she expect to see? Select all: •A. swelling of the legs or ankles (edema) •B. pain that gets better when you stand and gets worse when you raise your legs •C. aching, throbbing, or a feeling of heaviness in your legs •D. thickening of the skin on your legs or ankles •E. skin that is changing color, especially around the ankles •F. Ulcers on the foot

A, C, D, E Normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don't work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs. pain that gets WORSE when you stand and gets BETTER when you raise your legs. Ulcers are common on the lower legs

You're assessing a patient's health history. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply: •A. "I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." • B. "If I stand or sit too long my legs start to feel heavy and achy." • C. "It hurts to elevate my legs." • D. "Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away."

A, C, and D Peripheral arterial disease occurs when there is impediment of blood flow to the lower extremities (hence the lower extremities are being deprived of blood flow and this causes pain). The pain most commonly occurs at night and can wake up the patient. It is known as "rest pain". This occurs because when the legs are horizontal the blood flow is compromised and it causes pain...therefore the patient will report they dangle the leg off the bed to help ease the pain (the dependent position (dangling) will help blood flow down to the extremity). In addition, it hurts to elevate the legs (again because this further compromises blood flow). Option B occurs in peripheral venous disease. Option C is known as intermittent claudication and is a HALLMARK sign and symptom in PAD.

A nurse is reviewing the medical record of a client who has heart failure. Which of the following findings should the nurse expect? •A. BNP of 200 B. Bradycardia C. Fluid restriction of 3 L per day D. 4 g sodium diet

A. Ventricular natriuretic peptide or brain natriuretic peptide, also known as B-type natriuretic peptide, is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume. The nurse should identify that a client who has heart failure will have an elevated B- type natriuretic peptide (BNP) level of > 100. BNP is released into the clients bloodstream due to decreased cardiac output, a process called natriuresis.

Because a client has mitral stenosis and is a prospective MECHANICAL valve recipient, the nurse preoperatively assesses the client's past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client? A. Medication Therapy B. Diet Modification C. Activity Restrictions D. Dental Care

A. •Anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. •Post-op, all clients with mechanical valves are maintained indefinitely on anticoagulation therapy. Adhering strictly to a dosage schedule and observing specific precautions are necessary to prevent hemorrhage or thromboembolism. Patient will need maintain proper labs for anticoagulation. •Episodic prophylaxis is required to prevent infective endocarditis after dental procedures or upper respiratory, GI, or GU surgery.

A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply: A. Elevate the lower extremities below heart level frequently B. Application of compression stockings C. Limit long periods of standing and sitting D. Use the knee-flexed position while lying in bed

B & C The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.

A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take?(Select all that apply.) A. Keep the client NPO after midnight. B. Inspect the electrode pads. C. Wash the skin with plain water before placing the electrodes. D. Instruct the client not talk during the test. E. Administer an analgesic prior to the procedure.

B & D Keep the client NPO after midnight is incorrect. The client will not receive anesthesia for to the test, so he does not need to follow a food or fluid restriction prior to the test. Inspect the electrode pads is correct. The gel is necessary to promote electrical conduction between the skin and the electrodes; therefore, the nurse should inspect the electrode pads to check that the gel is present. Wash the skin with plain water before placing the electrodes is incorrect. The nurse should wipe the skin with alcohol where she will place the electrodes to ensure the skin is free of oils. Instruct the client not talk during the test is correct. The nurse should instruct the client to lie quietly and not to talk or move to prevent the recording of artifact. Administer an analgesic prior to the procedure is incorrect. The client does not need to receive an analgesic prior to the test because the test is noninvasive and does cause any discomfort.

Which patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver (select all that apply)? a. Avoid or limit air travel. b. Take and record a daily pulse rate. c. Obtain and wear a Medic Alert ID device at all times. d. Avoid lifting arm on the side of the pacemaker above shoulder. e. Avoid microwave ovens because they interfere with pacemaker function.

B, C, D

A nurse is caring for a patient with myocarditis. The nurse has assessed vital signs, What next should the nurse do next? Select All that apply A.Instruct patient to drink fluids to flush out the virus B.Place a bedside commode in the room C.Elevate the HOB D.Assess level of consciousness E.Assist the patient with a bedpan F.Assess the patient for dyspnea, hypotension, and tachycardia.

B, C, D, F RATIONALE: Bedside commode is less stressful to the workload of the heart than a bed pan Keeping the head of the bed elevated will reduce the workload on the heart. Assess cardiovascular status frequently, watching for signs of heart failure, such as dyspnea, hypotension, and tachycardia.

You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A."It is important I quit smoking" B."To prevent my feet and legs from getting too cold at night, I will use a heating pad" C."A walking program would be beneficial in treatment of my PAD" D."I will avoid wearing tight socks or shoes"

B. Inform patients that they should avoid using heating pads on their lower extremities because they do not have good sensation and they at high risk for burns

A nurse is providing discharge teaching to a client who has an implantable cardioverter/defibrillator (ICD). Which of the following information should the nurse include? •A. The client cannot travel by air due to security screening. •B. The client should hold his cell phone on the side opposite the ICD. •C. The client should avoid the use of small electric devices. •D. The client can carry his ICD in a small pocket.

B. Rationale: The client should keep his cellular phone on the side opposite the ICD, as close proximity could interfere with the ICD's function.

A nurse is completing dietary teaching with a client who has heart failure and is prescribed a 2 g sodium diet. Which of the following statements by the client indicates an understanding of the teaching? •A. I should use salt sparingly while cooking •B. I can have yogurt as a dessert •C. I should use baking soda when I bake •D. I should use canned vegetables instead of frozen

B. The client understands the teaching when he selects yogurt as a dessert. Yogurt is a good source of calcium and protein. •Choose fat-free or low-fat dairy products. •Fat-free or low-fat (1%) milk •Fat-free or low-fat plain yogurt •Low-sodium or reduced-sodium cheese **Always choose fresh over frozen ***Know your conversions from mg to gram or gram to mg **Remember everyone has a different opinion on what is sparingly

You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A."It is important I quit smoking." B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. C. "A walking program would be beneficial in treatment of my PAD." D. "I will avoid wearing tight socks or shoes."

B. The patient should try to prevent the feet and legs from getting too cold because this causes vasoconstriction, which impedes blood flow further. Therefore, they should dress warmly with LOOSE layers. However, they should AVOID using heating pads because of the reduce of sensation from compromised blood flow. A walking program is a great way to prevent intermittent claudication, lower the cholesterol, and improve oxygen levels in the blood....which are all great ways of treating PAD.

A nurse is caring for a client who is receiving continuous cardiac monitoring. Which of the following medications should the nurse anticipate administering to treat atrial fibrillation? A. Atropine B. Diltiazem C. Epinephrine D. Phenytoin

B. Diltiazem is a calcium channel blocker and is used to slow the ventricular rate in atrial fibrillation or flutter. Diltiazem is also prescribed to treat hypertension, angina, and other tachyarrhythmias

A nurse is caring for a client who has severely elevated blood pressure. Which of the following findings should the nurse identify as a manifestation of hypertension? A. vertigo B. epistaxis C. exophthalmos D. spondylolisthesis

B. Epistaxis (a nosebleed) is a manifestation of elevated blood pressure. Hypertension is often asymptomatic, but when it is severely elevated, it can also cause headaches, dizziness, facial flushing, and fainting.

A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets? •A. Nitroglycerin •B. Aspirin •C. Morphine •D. Metoprolol

B. aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the? A. Dependent position B. Horizontal position C. Elevated position above heart level D. Knee-flexed position

C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS (PVD) disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient's lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.

A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? A. Janeway Lesions B. Roth Spots C. Osler's Nodes D. Trousseau's Sign

C. rationale: They are TENDER, red lesions on the hands and feet. Don't get this confused with Janeway Lesions which are NON-TENDER, red lesions on the PALMS of the hands and SOLES of the feet. Roth spots are retinal hemorrhages with white centers and Trousseau's Sign is found in hypocalcemia.

You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."

C. ·Some dental procedures that can cut your gums also may allow bacteria to enter your bloodstream.

When teaching a patient about risk factors for AAA (abdominal aortic aneurysm), which of the following, if stated by the patient indicates correct understanding? A) Taking ACE inhibitors or ARBS B) Being female C) Genetic disorder D) Straining while pooping

C. Aortic Aneurysm can be caused by being male, smoking, family history or congenital weakness, and hypertension

A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects? •A. Thrombophlebitis •B. Hyperactive reflexes •C. Muscle weakness •D. Hypoglycemia

C. muscle weakness; Chlorothiazide is a diuretic used to treat hypertension and CHF. It promotes the excretion of water, sodium, and potassium and can cause hypokalemia. Muscle weakness is a sign of hypokalemia.

On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

D. pericardial friction rub. •When you have pericarditis, the membrane around your heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. •pericardial friction rub is a scratching, grating, high pitched sound believed to result from friction between the roughened pericardial and epicardial surfaces. Best heard with the stethoscope diaphragm placed at the apex of the chest. It is hard to differentiate from pleural friction rub, so you can have the patient hold their breath.

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect? A. Hepatomegaly B. Pitting peripheral edema C. Jugular vein distention D. Crackles in the lung bases

D. Left sided heart failure presents with pulmonary symptoms such as crackles, dyspnea, cough and orthopnea.

A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching? A. Discontinue the medication if a rash develops. B. Expect increased salivation during the first few weeks of therapy C. Minimize fiber intake to prevent diarrhea D. Avoid driving until the clients reaction to the medication is known.

D. clonidine can cause drowsiness, weakness, sedation and other CNS effects. Over time, these effects are likely to decrease.

The MOST common cause of peripheral arterial disease is? A. Diabetes B. DVT C. Atherosclerosis D. Pregnancy

c. Atherosclerosis is the most common cause of PAD (peripheral arterial disease). This is the collection of fatty plaques on the artery wall. This blocks blood flow.

True or False Peripheral venous disease can occur due to narrowing of the valves in the veins of the lower extremities.

false Peripheral venous disease can occur due to overstretched valves of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when the veins become damaged.

A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral arterial disease. Which of the following findings should the nurse expect? A. Pitting edema B. Areas of reddish-brown pigmentation C. Dry, pale skin with minimal body hair D. Sunburned appearance with desquamation

•C. Dry, pale skin with minimal body hair Peripheral artery disease is a circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease, your extremities, usually your legs, don't receive enough blood flow to keep up with demand A client who has peripheral arterial disease can display dry, scaly, pale, or mottled skin with minimal body hair because of narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities, which can lead to tissue damage. Common manifestations are intermittent claudication (leg pain with exercise), cold or numb feet as rest, loss of hair on lower legs, and weakened pulses.