Cardio Mastery Ms. Robinson 2019

Before discharge, which instruction should the nurse give to a client receiving digoxin? "Take an extra dose of digoxin if you miss one dose." "Call the physician if your heart rate goes above 120 beats/minute." "Call the physician if your pulse drops below 80 beats/minute." "Take digoxin with meals."

"Call the physician if your heart rate goes above 120 beats/minute." Explanation: The nurse should instruct the client to notify the physician if a rapid heart rate develops because cardiac arrhythmias may occur with digoxin toxicity. To prevent toxicity, the client should be instructed never to take an extra dose of digoxin if a dose is missed. The nurse should show the client how to take her pulse and to call the physician if her pulse rate drops below 60 beats/minute, not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. Digoxin shouldn't be administered with meals because doing so slows the absorption rate.

Propranolol has been prescribed for a teen who has been diagnosed with hypertension. When discussing the medication with the teen, which statement indicates the need for further instruction? "I should take this medication daily on an empty stomach." "It is best to take this medication at the same time each day." "I may experience dizziness with this medication." "If I experience weight gain, I need to contact my health care provider."

"I should take this medication daily on an empty stomach." Explanation: Propranolol is used in the management of hypertension. The medication is taken daily. It is recommended that it be taken at the same time each day. The drug is administered with food. Side effects include changes in sleep pattern, dizziness, and lightheadedness. Side effects such as skin afflictions, weight gain, and difficulty breathing should be reported promptly to the health care provider.

The nurse is talking with a client about everyday activities. Which statement made by the client indicates a risk factor for coronary artery disease (CAD)? "I exercise every other day." "My cholesterol is 180." "I smoke 1 ½ packs of cigarettes a day." "No one in my family has heart problems."

"I smoke 1 ½ packs of cigarettes a day." Explanation: Smoking increases risk of CAD. Exercise decreases the risk of CAD. Heredity increases the risk factor for CAD. A cholesterol level of 180 is normal.

A nurse is reinforcing education for the parents of a child with congenital aortic stenosis. Which statement should the nurse include in the education about this disorder? "It can result from rheumatic fever (infection with group A streptococci)." "It accounts for 25% of all congenital defects." "It causes an increase in cardiac output." "It's classified as an acyanotic defect with increased pulmonary blood flow."

"It can result from rheumatic fever (infection with group A streptococci)." Explanation: Aortic stenosis can result from rheumatic fever, which can damage the aortic valve in the first 8 weeks of pregnancy. It accounts for about 5% of all congenital heart defects. It causes a decrease in cardiac output. It's classified as an acyanotic defect with obstructed flow from the ventricles.

A client who has just been diagnosed with myocardial infarction (MI) begins to cry and tells the nurse that his brother died of a heart attack last year. Which response by the nurse is most appropriate? "Just because your brother died of a heart attack doesn't mean that you will." "Don't worry, we're all here to help you. We won't let you die." "Do you want to talk about your family?" "You sound as though you think you're going to die."

"You sound as though you think you're going to die." Explanation: The client's questions and concerns should be acknowledged and addressed by the nurse after an MI. The nurse shouldn't give false reassurance or ignore the client's immediate concern.

The nurse is administering digoxin to a client diagnosed with congestive heart failure (CHF). The health care provider has ordered digoxin 0.125 mg PO daily. Calculate how many tablets will the nurse administer from a unit dose of 0.25 mg/tablet?

0.5 Explanation: 0.125 mg tab 0.125 = 0.5 tab 0.25 mg 0.25

A nurse is caring for a client with a new prescription of digoxin. Which client statement would indicate the need for further teaching about digoxin? Select all that apply. 1. "I will take the digoxin at 9 a.m. daily." 2. "I will take the digoxin with my antacids at night." 3. "I will take my pulse before each dose of digoxin." 4. "If I forget a dose, I will catch up by doubling the next dose." 5. "I will notify my doctor if experiencing increased fatigue or muscle weakness." 6. "I understand that I will need annual blood work to check therapeutic levels."

2. "I will take the digoxin with my antacids at night." 4. "If I forget a dose, I will catch up by doubling the next dose." 6. "I understand that I will need annual blood work to check therapeutic levels." Digoxin is a cardiac glycoside that slows and strengthens the heart, providing a more regular rhythm. Digoxin has a narrowed therapeutic window requiring serum blood level monitoring initially at every 2 weeks to monthly. It is usually helpful for a client to take digoxin at a specific time each day to establish its blood level and routine for administration. The nurse should teach the client to take the pulse before each dose of digoxin and to notify the practitioner if the rate or rhythm changes, specifically if the rate drops to less than 60 beats/minute. The client should also be instructed to report increasing fatigue or muscle weakness immediately, as these are signs of digitalis (digoxin) toxicity. Antacids inhibit the absorption of digoxin, so digoxin should not be taken with these drugs. If the client forgets to take a dose of digoxin, he or she may take the missed dose only up to 12 hours later.

A nurse is obtaining data from a client who is at risk for cardiac tamponade due to chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if the blood pressure is 108/82 mm Hg? Record your answer using a whole number.

26 Pulse pressure is the difference between systolic and diastolic pressures: 108 - 82 = 26. Normally, systolic pressure exceeds diastolic pressure by about 40 mm Hg. Narrowed pulse pressure, a difference of less than 30 mm Hg, is a sign of cardiac tamponade.

A nurse is monitoring a client who has just returned from a vein ligation and stripping. Which is an appropriate nursing intervention? Dangle the client's legs at the bedside. Apply bilateral compression stockings. Position the client supine with legs flat on the bed. Remove the drain after 24 hours.

Apply bilateral compression stockings. Explanation: Postoperative care of a client with a vein ligation and stripping includes elevation of the extremity, compression stockings, anticoagulant therapy, and assessment of the circulation of the affected extremity. Their is no drain in place after this type of surgery.

The nurse is caring for a child with acute thrombophlebitis. What nursing actions are appropriate in the care of this child? Wrap leg with cool cloth and keep the client's leg lower than the level of the heart. Increase the client's activity level and encourage leg exercises. Administer nitroglycerin and oxygen at 2 L/min. Apply warm soaks and elevate the client's legs higher than the level of the heart.

Apply warm soaks and elevate the client's legs higher than the level of the heart. Explanation: To help treat thrombophlebitis, the nurse should prevent venostasis with measures such as applying warm soaks and elevating the client's legs. The client should remain on bed rest during the acute phase, after which the client may begin to walk while wearing antiembolism stockings. Treatment for thrombophlebitis may also include anticoagulants to prolong clotting time.

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should be instructed to avoid which of the following? 1. High volumes of fluid intake 2. Aerobic exercise programs 3. Caffeine-containing products 4. Foods rich in protein

Caffeine-containing products Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High-fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.

A client diagnosed with acute arterial occlusive disease is scheduled to undergo an atherectomy. What is the priority nursing intervention for this client immediately after the procedure? Monitor vital signs every 4 hours. Closely monitor catheter site for bleeding. Ambulate the client as soon as possible. Teach client about the importance of exercise.

Closely monitor catheter site for bleeding. Explanation: Atherectomy is a surgical treatment used for acute arterial occlusive disease. After the procedure, the client should be monitored frequently for bleeding at the catheter site, and vital signs should be taken every 15 minutes times four, and then every hour for the first few hours. Ambulation should be delayed for the first 12 hours, and exercise is not a priority at this time.

The nurse is caring for a child undergoing cardiac surgery? Which home care instruction is most appropriate? Maintain the prescribed medication regimen until the health care provider makes a change. Maintain a sodium-restricted diet. Routine dental care can be resumed. Immunizations are delayed indefinitely.

Drugs such as digoxin and furosemide shouldn't be stopped abruptly. There are no diet restrictions, so the child may resume a regular diet. Routine dental care is usually delayed 4 to 5 months after surgery. Immunizations may be delayed 6 to 8 weeks after surgery.

A client taking a new prescription for propranolol calls the clinic to report a weight gain of 3 lb (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse's best action? Due to fluid accumulation, have the client assessed for worsening heart failure by the health care provider. Gather the client's dietary intake for the past 24 hours. Review medication administration with the client. Gather data about the client's knowledge of expected effect of the drug.

Due to fluid accumulation, have the client assessed for worsening heart failure by the health care provider. Explanation: The nurse is most correct in identifying fluid accumulation with the identifying signs of increased weight gain, shortness of breath, and swollen ankles. In a client with an underlying cardiac problem such as heart failure, the sympathetic nervous system is active, providing a crucial level of compensation for the failing heart. Removing this compensation by using a beta blocker places the client at risk for precipitating or exacerbating heart failure, consequently making the client's heart failure worse, especially when treatment begins. The client needs to be assessed for heart failure, a potential adverse effect of beta blockers. Dietary intake does not cause a 3-lb weight gain in 2 days. Assessing medication administration and knowledge is helpful information, but is not the best action at this time.

The nurse is caring for a child who has recently been diagnosed with a cardiovascular disorder. The child's parents do not seem to be accepting of the diagnosis and the changes the diagnosis will make in their lives. What initial action by the nurse will be most therapeutic? 1. Encourage the parents to consider genetic counseling to consider the risk for future children born to them. 2. Review the planned treatments with the parents and assess understanding of them. 3. Encourage the parents to discuss their feelings about the loss of their child's health. 4. Refer the parents to a counselor.

Encourage the parents to discuss their feelings about the loss of their child's health. Explanation: Grief and feelings of loss by the parents are expected phenomena when a child receives a diagnosis of a chronic health concern. Parents will need to work through the feelings that the anticipated future of their child may be modified. Genetic counseling may be needed if the disorder is hereditary, but in this case it is premature and the focus needs to be on assisting the family to navigate through their feelings and focus on the care of their child. Education about the treatment plan is needed but it does not meet the needs discussed in this scenario. Counseling may be of benefit but the nurse must first promote communication with the parents.

The nurse advises a client recovering from a myocardial infarction to decrease fat and sodium intake. Which foods should the nurse instruct the client to avoid? Select all that apply. pepperoni pizza oatmeal bacon cheese apple juice soft drinks

Explanation: Foods high in sodium include cheese, processed meats such as pepperoni and bacon, and soft drinks. Bacon and cheese also have a high fat content.

A 9-year-old child had cardiac surgery 2 days ago. The child tells the nurse: "I'm sore and I don't want to move today." Which action by the nurse is most appropriate? Agree to allow the child to rest today after promising to get up tomorrow. Medicate the child for discomfort and then begin activities related to ambulation. Tell the child he or she will get sicker if he or she doesn't get up. Ask the parents to encourage the child to get up.

Medicate the child for discomfort and then begin activities related to ambulation. Explanation: Postoperative pain is an anticipated occurrence. Despite the discomfort, the client must ambulate. Prolonging ambulation for a day may promote complications. Medicating the child will allow the child to achieve an increased level of comfort prior to the activity. The child should know that ambulation does aid in preventing complications, but it does not manage the root problem, which is pain. Threats should not be used. The parents should be involved in the care being delivered, but this approach does not alleviate the issue, which is pain.

The nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms would suggest circulatory impairment? Numbness, cool skin temperature, and pallor Swelling, warm skin temperature, and drainage Numbness, warm skin temperature, and redness Redness, cool skin temperature, and swelling

Numbness, cool skin temperature, and pallor Explanation: Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include warm skin with normal return of skin color after blanching and normal sensation.

A nurse places electrodes on a collapsed individual who was visiting a hospitalized family member. The monitor displays the waveform depicted in the image. Which intervention should the nurse do first? Place the client on oxygen. Confirm the rhythm with a 12-lead electrocardiogram. Begin chest compressions. Observe the client's airway, breathing, and circulation.

Observe the client's airway, breathing, and circulation. Explanation: The rhythm the client is experiencing is ventricular tachycardia (VT). The nurse must first assess the airway, breathing, and circulation and the level of consciousness to establish the client's stability and obtain further help from nursing staff. Different actions are required if the client's VT is unstable or pulseless.

A nurse is caring for a client with left-sided heart failure. Which intervention takes priority in this client's care? obtaining daily weight applying oxygen administering diuretics restricting oral fluids

administering diuretics Explanation: Diuretics, such as furosemide, reduce total blood volume and circulatory congestion in the client with left-sided heart failure. Obtaining the client's daily weight is important but not the priority. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but do not decrease fluid volume excess.

A client comes to the emergency department reporting chest discomfort and tingling of the fingers. The electrocardiogram shows a heart rate of 136 beats/minute and no other changes; respirations are 28 and shallow. Which nursing intervention has the greatest priority? helping the client to calm down obtaining a detailed medical history maintaining the client's IV fluids apply O2 at 3 L via nasal cannula

apply O2 at 3 L via nasal cannula Explanation: The client is exhibiting anxiety and the nurse should assist the client to calm down. Feelings of panic and/or fear, cold or sweaty hands and/or feet, shortness of breath/hyperventilation, heart palpitations, numbness or tingling in the hands or feet, nausea, and dizziness are signs and symptoms of panic from anxiety. Anxiety can adversely affect the client's heart rate and rhythm by stimulating the autonomic nervous system. The threat of death is an immediate and real concern for the client. The other nursing interventions are valid, but they are not the priority in this situation. Add a Note

Which condition most commonly results in coronary artery disease (CAD)? 1. atherosclerosis 2. diabetes 3. myocardial infarction (MI) 4. renal failure

atherosclerosis Explanation: Atherosclerosis, or plaque formation, is the leading cause of CAD. Diabetes is a risk factor for CAD but isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. MI is commonly a result of CAD.

A client who has a deep vein thrombosis (DVT) reports dyspnea and chest pain and has diminished breath sounds. Which condition does the nurse prepare treatment for? hemothorax pneumothorax pulmonary embolism pulmonary hypertension

pulmonary embolism Explanation: The most common complication of a DVT is a pulmonary embolus. A pulmonary embolism is a thrombus that forms in a vein, travels to the lungs, and lodges in the pulmonary vasculature. Hemothorax refers to blood in the pleural space. Pneumothorax is caused by an opening in the pleura. Pulmonary hypertension is an increase in pulmonary artery pressure, which increases the workload of the right ventricle.

The nurse is obtaining data from a new client in the cardiovascular clinic. When asking about childhood diseases and disorders associated with structural heart disease, the nurse should consider which finding significant? croup rheumatic fever severe staphylococcal infection medullary sponge kidney

rheumatic fever Explanation: Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup—a severe upper airway inflammation and obstruction that typically strikes children ages 3 months and 3 years—may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, eventually may lead to hypertension but doesn't damage heart structures.

A nurse is reinforcing education with a client who has hypertension. The nurse recognizes that the education has been effective when the client makes which statement? "I shouldn't adjust my medication without my health care provider's advice." "I can stop taking my medication when I no longer have headaches." "I should stop taking my medication if I have adverse effects." "I only have to take the medication when I feel bad."

"I shouldn't adjust my medication without my health care provider's advice." Explanation: Medication for blood pressure control must not be adjusted or stopped without primary care provider approval. Any medication changes require close monitoring of the client. Medication must be continued on a regular schedule, or the client's blood pressure will rise. Therefore, client teaching has been ineffective when the client states that (a) the medication may be discontinued when the headaches cease, or (b) medication should be taken when the client feels bad. If serious adverse effects occur, the client should notify the health care provider. Other medications can be substituted without the adverse effects.

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and prescribes sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, the nurse should provide which instruction? 1. "Be sure to take safety precautions because nitroglycerin may cause your blood pressure to drop when you change positions. 2. "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure they're fresh." 3. "A burning sensation after administration indicates that the nitroglycerin tablets are are potent." 4. "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed, to a maximum of four doses."

"Be sure to take safety precautions because nitroglycerin may cause your blood pressure to drop when you change positions. Explanation: Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina and may repeat the dose every 10 to 15 minutes for up to three doses; if this doesn't bring relief, the client should seek immediate medical attention.

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. He also reports nausea, diaphoresis, and shortness of breath. What should the nurse do? Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. Gain I.V. access, give sublingual nitroglycerin (Nitrostat), and alert the cardiac catheterization team. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Explanation: Cardiac chest pain is caused by myocardial ischemia. Administering supplemental oxygen increases the myocardial oxygen supply. Cardiac monitoring helps detect life-threatening arrhythmias. The nurse should ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain by taking vital signs. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team before completing the initial assessment is premature.

A male client is receiving digoxin and furosemide to treat heart failure. He reports feeling weak and having muscle cramps. His apical pulse is 76 beats/minute; respirations, 16 breaths/minute; and blood pressure, 148/86 mm Hg. What action should the nurse take? Tell the client that he's probably weak from inactivity. Look at the chart for his last potassium level and contact the physician. Look at the chart for his last digoxin level and notify the physician. Notify the physician that the client is experiencing heart failure.

Look at the chart for his last potassium level and contact the physician. Explanation: Muscle weakness and cramping are signs of hypokalemia, which can be an adverse effect of furosemide. If the nurse doesn't follow up on his complaints, the client's hypokalemia will worsen. The client isn't exhibiting symptoms indicative of digoxin toxicity or heart failure, so there's no need to notify the physician.