Cardiovascular disorders
Before administering digoxin to a client, a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the:
kidneys. Explanation: After digoxin is metabolized, the kidneys eliminate remaining digoxin as unchanged drug. Therefore, a client with renal dysfunction will require a decreased digoxin dosage. Although some drugs may be eliminated by other routes, digoxin isn't known to be eliminated by way of the lungs, feces, or skin.
The nurse has reinforced education about angina to a client who has pain from angina. Which statement made by the client indicates a need for further teaching?
"Angina pain can be relieved by nitroglycerin." Explanation: Angina pain, if unstable, may or may not be relieved by nitroglycerin. It can develop slowly or quickly, and it can radiate to the arms, neck, shoulders, and back. Angina pain usually lasts only 5 minutes but can last up to 15 to 20 minutes. It also can be described as mild or moderate.
A 2-year-old child is showing signs of shock. A 10-mL/kg bolus of normal saline solution is ordered. The child weighs 20 kg. How many milliliters should be administered? Record your answer using a whole number.
200 Explanation: Use the following equation:10 mL/kg × 20 kg = 200 mL
A client with a history of chronic obstructive pulmonary disease (COPD) arrives in the emergency department with an oxygen saturation of 84%. Which diagnostic study does the nurse prepare the client for to evaluate cellular metabolism?
Arterial blood gas (ABG) analysis Explanation: ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view the lungs' function.
A client who comes to the hospital reporting severe substernal chest pain that is radiating down the left arm is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which nursing action is a priority on admission to coronary care?.
Begin electrocardiogram (ECG) monitoring. Explanation: ECG monitoring should be started as soon as possible in a client reporting severe substernal chest pain radiating down the left arm; life-threatening dysrhythmias are the leading cause of death in the first hours after MI. Obtaining information about the client's family history of heart disease and determining if the client smokes are not immediate priorities in the acute phase of MI. Those data can be obtained from family members later. Lung fields should be auscultated after oxygenation and pain control needs are met.
For a client with cardiomyopathy, the highest priority nursing diagnosis is:
Decreased cardiac output related to reduced myocardial contractility. Explanation: Decreased cardiac output related to reduced myocardial contractility is the greatest threat to the survival of a client with cardiomyopathy. Although the other options are important nursing diagnoses, they can be addressed when cardiac output and myocardial contractility have been restored.
A nurse is caring for a hypertensive client who has been placed on a low-sodium diet. Which menu selection demonstrates the client's understanding of this diet?
Fresh green beans and chicken salad Explanation: Fresh vegetables and chicken salad are both low in sodium. Options 1, 2, and 3 all contain more that 150 mg of sodium and should be avoided by client's on sodium-restricted diets.
An elderly client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?
Homans' Explanation: A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Romberg's test assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.
The physician prescribes digoxin for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digoxin toxicity?
Hypokalemia Explanation: Conditions that may predispose a client to digoxin toxicity include hypokalemia, hypomagnesemia, hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia, hypercalcemia, and hypernatremia aren't associated with a risk of digoxin toxicity.
The nurse is reviewing the telemetry for a group of assigned clients. Sinus bradycardia would be considered a normal finding in a:
Physically conditioned adolescent. Explanation: A physically conditioned adolescent might have a lower-than-normal heart rate, which is of no significance. Growth-delayed adolescents don't have bradycardia as a normal finding. Neonates have characteristic elevated heart rates.
A client comes to the emergency department diagnosed with a ruptured aortic aneurysm. What is the priority action for this client?
Prepare the client for surgery. Explanation: When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.
After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg by mouth daily. The nurse should teach the client that this medication has been prescribed to:
Reduce platelet agglutination. Explanation: TIAs are considered forerunners of stroke. Because a stroke may result from a clot in a cerebral vessel, aspirin is prescribed to prevent clot formation by reducing platelet agglutination. A 325-mg dose of aspirin is inadequate to relieve headache pain in an adult. Aspirin has no effect on the body's immune response. Intracranial bleeding isn't associated with TIAs, and the action of aspirin probably would worsen any bleeding present.
A client with severe angina and electrocardiogram changes is seen in the emergency department. In terms of serum testing, the nurse can expect which laboratory test to be ordered?
Troponin Explanation: The client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of MI is troponin level. The other tests can show evidence of muscle injury but they're less specific indicators of myocardial damage than troponin.
A nurse is monitoring laboratory results for a client admitted with a possible myocardial infarction (MI). Which laboratory result would be used to rule out an MI?
Troponin level of less than 0.2 ng/mL (0.2 µg/L) Explanation: Cardiac troponins are proteins that exist in cardiac muscle and are released with cardiac muscle injury. A troponin level of less than 0.2 ng/mL (0.2 µg/L) is considered normal. An elevated WBC count (15,000/mm³) is seen in many disease processes and with severe necrosis, but doesn't specifically indicate MI. A total RBC count of 4.7 million/mm³ is within normal limits for males and females, but isn't used to rule out an MI. Mean corpuscular hemoglobin is an RBC index providing information about the hemoglobin concentration of RBCs, but it isn't used to rule out an MI.
A client comes to the emergency department with symptoms of a myocardial infarction (MI). The health care provider prescribes reteplase. The nurse is aware that this medication will be most effective when given at which time?
Within 1 to 3 hours of onset of symptoms Explanation: Thrombolytic agents such as reteplase can be given within 6 hours of onset of symptoms but will be most effective when started within 3 hours.
The nurse is caring for a child that is undergoing cardiac surgery. Parents ask a nurse what the activity level for their child should be post-surgery. Which response would be best?
"Encourage a balance of rest and exercise." Explanation: Activity should be increased gradually each day, allowing for a sensible balance of rest and exercise. School and large crowds should be avoided for at least 2 weeks to prevent exposure to people with active infections. Sports and contact activities should be restricted for about 6 weeks, giving the sternum enough time to heal.
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 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 teenager with heart failure who has been prescribed digoxin asks the nurse, "What will this drug do for my heart?" What is the best response by the nurse?
"It will decrease the workload of the heart." Explanation: Digoxin is a cardiac glycoside. It decreases the workload of the heart and improves myocardial function. It will not cause vasodilation and increase sodium excretion. Diuretics help remove excess fluid. Digoxin is not a vasodilator, and it will slow the heart rate, not increase it.
A client reported chest pain and received sublingual nitroglycerin. Which statement by the client indicates that this drug is producing its therapeutic effect?
"My chest pain is decreasing." Explanation: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
A nurse is caring for a client with left-sided heart failure. Which intervention takes priority in this client's care?
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.
The nurse is caring for a client preoperatively with a abdominal aortic aneurysm. What is the greatest concern by the nurse?
Aneurysm rupture Explanation: Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm, but aren't life-threatening. Cardiac arrhythmias aren't directly linked to an aneurysm.
A male client has been reporting chest pain and shortness of breath for the past 2 hours. He has a temperature of 99° F (37.2° C), a pulse of 96 beats/minute, respirations that are irregular and 16 breaths/minute, and a blood pressure of 140/96 mm Hg. He's placed on continuous cardiac monitoring to:
Assess for potentially dangerous arrhythmias. Explanation: Continuous cardiac monitoring can detect life-threatening arrhythmias, including ventricular tachycardia and fibrillation. Continuous cardiac monitoring doesn't prevent ischemia, measure heart muscle damage, or evaluate cardiovascular function.
A nurse has administered enalapril to a client. What intervention should the nurse perform to accurately determine the effectiveness of this drug?
Check blood pressure 1 hour after administration. Explanation: Angiotensin-converting-enzyme inhibitors such as enalapril suppress the excretion of angiotensin, which lowers the blood pressure, reduces fluid retention, and leads to increased urine output. Enalapril does not have diuretic properties that would reduce swelling in the extremities. Amount of urine output or client appetite will not provide information about the antihypertensive effects
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?
Explanation: Four weeks after an MI, a client's walking program should aim for a goal of 2 miles (3.2 km) in less than 1 hour. Walking 4 miles (6.4 km) in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. The other options indicate understanding of the cardiac rehabilitation program. The client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower the risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.
When caring for a child diagnosed with a ventricular septal defect, how would the nurse describe this condition when talking with the parents?
Failure of a septum to develop completely between the ventricles Explanation: Failure of a septum to develop between the ventricles results in a left-to-right shunt, which is noted as a ventricular septal defect. When the septum fails to develop between the atria, it's considered an atrial septal defect. The narrowing of the aortic arch describes coarctation of the aorta. Narrowing of the valves at the pulmonary artery describes pulmonary stenosis.
A client is admitted to the acute care facility for treatment of heart failure. The nurse expects the physician to prescribe which drug?
Furosemide Explanation: To maintain fluid balance, which is crucial for a client with heart failure, the physician typically prescribes a diuretic, such as furosemide; vasodilating agents; and drugs that increase contractility, such as digoxin. Prednisone, a corticosteroid, and hydroxychloroquine, an antimalarial agent, aren't indicated for heart failure. Lidocaine would be used only if the client also had ventricular ectopy.
A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How should the nurse intervene?
Instruct the client to flex the calf muscles and then sit up for several minutes before standing. Explanation: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to flex the calf muscles and then rise slowly to a standing position, such as by sitting up for several minutes first. Administering I.V. fluids would be inappropriate (unless the client is dehydrated) because it would counteract the effects of furosemide, possibly leading to fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would aid urine output monitoring but wouldn't minimize the effects of orthostatic hypotension.
The nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?
Low serum potassium level Explanation: Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases.
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 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 is developing a plan of palliative care for a client with end-stage cardiomyopathy. Which action is appropriate to include in the care plan?
Provide nonpharmacological measures to reduce discomfort. Explanation: Providing both pharmacological and nonpharmacological measures to reduce discomfort should be included in a plan of palliative care. Family members shouldn't be discouraged from assisting with care of the client unless they are not comfortable with it. Pain medication should be administered on a regular schedule, not just when the client asks for it. Staff members should avoid whispering when near the client because doing so may increase the strain on the client as his hearing diminishes.
The nurse is caring for a client diagnosed with left-sided cerebrovascular accident, with expressive aphasia and right-sided weakness. When administering care for this client, which intervention should the nurse delegate to unlicensed assistive personnel (UAP)?
Turn and position the client every 2 hours. Explanation: Unlicensed assistive personnel (UAP) are taught proper positioning skills, although this activity should still be supervised. It isn't necessary to accompany the client to speech therapy and would take the UAP off the unit, reducing available help. Not all UAP are taught to perform active range-of-motion exercises. It wouldn't be necessary to teach the client sign language, as the speech therapist will be working with the client to help her learn to speak again, if it is possible.
A client is admitted to the emergency department with a pulsating sensation in the abdomen and an audible bruit. Which diagnostic test would the nurse expect the health care provider to prescribe first to provide a definitive diagnosis?
Ultrasound Explanation: Ultrasound is a noninvasive, cost-effective method of determining the presence of an AAA with 95% accuracy. Arteriograms and CT scans are more expensive, require the use of contrast agents and radiation, and are riskier to the client. An abdominal aneurysm would be visible on a radiograph only if it were calcified.
The nurse suspects that a 68-year-old client has digoxin toxicity. The nurse should assess for:
Vision changes. Explanation: Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon.
A client with chronic heart failure is receiving digoxin, 0.25 mg by mouth daily, and furosemide, 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity also may cause:
Visual disturbances. Explanation: Digoxin toxicity may cause visual disturbances (such as flickering light flashes, colored or halo vision, photophobia, blurring, diplopia, and scotomata); central nervous system abnormalities (such as headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss); and cardiovascular abnormalities (abnormal heart rate and arrhythmias). Taste and smell alterations aren't associated with digoxin toxicity. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.
The nurse is caring for a client with heart failure who is receiving furosemide daily. What action should the nurse instruct the client to perform?
Weigh self daily. Explanation: When a client is being treated with furosemide, the client weighs himself or herself daily and reports any increase in weight of greater than 2 pounds in 24 hours to the health care provider. It is not necessary to check a radial pulse or blood sugar prior to administration of furosemide. Decreased peripheral edema is a desired response and would not be an indication to hold the drug.
A child with tetralogy of Fallot has clubbing of the fingers and toes. The nurse understands that this finding is related to which condition?
chronic hypoxia Explanation: Chronic hypoxia causes clubbing of the fingers and toes when untreated. Hypoxia varies with the degree of pulmonary stenosis. Polycythemia is an increased number of red blood cells as a result of chronic hypoxemia. A pansystolic murmur is heard at the middle to lower-left sternal border but has no impact on clubbing. Growth and development may appear normal.
An increase in the creatine kinase-MB isoenzyme (CK-MB) can be caused by:
myocardial necrosis. Explanation: An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can be caused by I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
