Cardiovascular problems

A client is receiving digoxin daily . The nurse sus pects digoxin toxicity after noting which signs symptoms ? Select all that apply . 1. Visual disturbances 2. Nausea and vomiting 3. Apical pulse rate of 63 beats / min 4. Serum digoxin level of 2.3 ng / mL 5. Serum potassium level of 3.9 mEq / L

1,2,4 Rationale : Signs / symptoms of digoxin toxicity include gastro intestinal signs , bradycardia visual disturbances , and hypoka lemia . A therapeutic serum digoxin level ranges from 0.8 to 2.0 ng / mL . The serum potassium level would be between 3.5 mEq / L and 5.0 mEq / L . The apical pulse must be greater than or equal to 60 beats min .

The nurse is planning to administer hydrochloro thiazide to a client . Which are concerns related to the administration of this medication ? 1 . Hypouricemia , hyperkalemiaenonto 2. Hypokalemia , hyperglycemia , sulfa allergy 3. Hypokalemia , increased risk of osteoporosis 4. Hyperkalemia , hypoglycemia , penicillin allergy

2 Rationale : Thiazide diuretics such as hydrochlorothiazide are sulfa - based medications , and a client with a sulfa allergy is at risk for an allergic reaction . Also, clients are at risk for hypokalemia , hyperglycemia , hypercalcemia , hyperlipidemia , and hyperuricemia

Isosorbide mononitrate is prescribed for a client with angina pectoris . The client tells the nurse that the medication is causing a headache Which action would the nurse suggest to the client 1. Cut the dose in half . 2. Discontinue the medication . 3. Take the medication with food . 4. Contact the primary health care provider ( PHCP ) .

3 Rationale : Isosorbide mononitrate is an antianginal medica tion Headache is a frequent side effect of isosorbide mono nitrate and usually disappears during continued therapy . If a headache occurs during therapy , the client would be instructed to take the medication with food or meals . It is not necessary to contact the PHCP unless the headaches persist with ther apy . It is not appropriate to instruct the client to discontinue therapy or adjust the dosages .

A client is diagnosed with an acute myocardial in farction and is receiving tissue plasminogen activator , alteplase . Which action is a priority nursing intervention ? 1. Monitor for kidney failure . 2. Monitor psychosocial status . 3. Monitor for signs of bleeding . 4. Have heparin sodium available .

3 Rationale : Tissue plasminogen activator is a thrombolytic Hemorrhage is a complication of any type of thrombolytic medication . The client is monitored for bleeding . Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions . Heparin is given after thrombolytic therapy , but the question is not asking about follow up medications

A hospitalized client with coronary artery disease complains of substernal chest pain . After checking the client's heart rate and blood pressure , the nurse administers nitroglycerin , 0.4 mg , sublingually . After 5 minutes , the client states , " My chest still hurts . " Which appropriate actions would the nurse take ? Select all that apply .

3 , 4 , 5 Rationale : The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes as needed ( PRN ) for chest pain for a total dose of three tablets . The registered nurse is notified immediately if a client complains of chest pain . In this situation , because the client is still complaining of chest pain , the nurse would administer a second nitroglycerin tablet . The nurse would check the client's pain level and the client's blood pressure before administering each nitroglycerin dose . There are no data in the question that indicate the need to call a code blue In addition , it is not necessary to contact the client's family unless the client has requested this .

A client is taking nicotinic acid for hyperlipidemia, and the nurse reinforces instructions to the client about the medication . Which statement by the client indicates an understanding of the instructions ? 1. " It is not necessary to avoid drinking alcohol . " 2. " The medication needs to be taken with meals to decrease flushing . " 3. " Clay - colored stools are a common side effect and are not a concern . " 4. " Ibuprofen taken 30 minutes before the nicotinic acid will decrease the flushing . "

4 Rationale: Flushing is a side effect of this medication. asprin or a nonsteroidal anti-inflammatory medication can be taken 30 minutes before taking the medication to decrease flushing . Alcohol consumption enhance this side effect . The medication needs to be taken needs to be avoided because it will Cardiovascular with meals ; this will decrease gastrointestinal upset . Taking the medication with meals has no effect on the flushing . Clay colored stools are a sign of hepatic dysfunction and must be immediately reported to the PHCP .

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium . Which statement made by the client reflects the need for further teaching ? 1. " I will take my pills every day at the same time . " 2. " I will be certain to avoid alcohol consumption . " 3. " I have already called my family to pick up a MedicAlert bracelet . " 4. " I will take enteric coated aspirin for my headaches because it is coated . "

4 Rationale : Aspirin - containing products need to be avoided while taking this medication . Alcohol consumption needs to be avoided by a client taking warfarin sodium . Taking pre scribed medication at the same time each day increases client compliance . The MedicAlert bracelet provides health care per tion sonnel with emergency information .

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg / dL . The client is taking cholestyramine . Which statement made by the client indicates the need for further teaching ? 1. " Constipation and bloating might be a problem . " 2. " I'll continue to watch my diet and reduce my fats . " 3. " Walking a mile each day will help the whole process . " 4. " I'll continue my nicotinic acid from the health food store . "

4 Rationale : Nicotinic acid ( niacin ) , even an over the counter lead to liver abnormalities All lipid lowering medications can also cause liver abnormalities , so a combination of nicotinic acid and cholestyramine resin is to be avoided . Constipation and bloating are the two most common side effects . Walking and the reduction of fats in the diet are therapeutic measures to reduce cho lesterol and triglyceride levels

Heparin sodium is prescribed for the client . Which laboratory result indicates that the heparin is pre scribed at a therapeutic level ? 1. Thrombocyte count of 100,000 mm³ 2. Prothrombin time ( PT ) of 21 seconds 3. International normalized ratio ( INR ) of 2.3 4. Activated partial thromboplastin time ( aPTT ) of 55 seconds

4 Rationale : The aPTT will assess the therapeutic effect of hepa rin sodium . The normal aPTT is 30 to 40 seconds . To maintain a therapeutic level , the aPTT would be 1.5 to 2.5 times the normal value . The PT and INR will assess for the therapeutic effect of warfarin sodium . A decreased thrombocyte count can cause bleeding .

A 24-year-old man seeks medical attention for complaint of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. The nurse would check the client's medical history for which finding next? A) Smoking history B) Recent exposure to allergens C) History of recent insect bites D) Familial tendency toward peripheral vascular disease

A

The nurse in a medical unit is caring for a client with HF. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse and expects which interventions to be prescribed? SATA A) Administering oxygen B) Inserting a foley catheter C) Administering furosemide D) Administering morphine sulfate intravenously E) Transporting the client to the coronary care unit F) Placing the client in a high-fowlers side-lying position

A, B, C, D Rationale: The patient should be put in a high-fowlers position. Furosemide will eliminate accumulated fluid, a foley catheter is done to accurately measure output, IV morphine sulfate reduces venous return (preload), decreases anxiety, and reduces the work of breathing. Transferring the client is not a priority and may not be necessary if the treatment is successful.

The nurse is checking the neurovascular status of a client who returned to the surgical unit 4 hours ago after undergoing an aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. Based on the data, the nurse would make which determination about the client's neurovascular status? A) Moderately impaired, and the surgeon would be called B) Normal, caused by increased blood flow through the leg C) Slightly deteriorating, and would be monitored for another hour D) Adequate from an arterial approach, but venous complications are arising

B Rationale: An expected outcome of surgery is warmth, redness, and edema in the surgical extremity caused by increased blood flow.

The nurse is assisting with caring for the client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. The nurse prevents dislodgment of the pacing catheter by implementing which intervention? A) Limiting movement and abduction of the left arm B) Limiting movement and abduction of the right arm C) Assisting the client to get out of bed and ambulate with a walker D) Having the physical therapist do active range of motion to the right arm

B Rationale: In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgement. The nurse helps prevent this complication by limiting the client's activities.

The nurse is monitoring a client following a cardioversion. Which observations would be of the highest priority to the nurse? A) BP B) Status of airway C) Oxygen flow rate D) Level of consciousness

B Rationale: Nursing responsibilities after cardioversion include Maintenace of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. Airway is the priority.

A client with MI suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds expecting to hear which breath sounds bilaterally. A) Rhonchi B) Crackles C) Wheezes D) Diminished breath sounds

B Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Wheezes, rhonchi, and diminished breath sounds are not associated with pulmonary edema.

A postcardiac surgery client with a blood urea nitrogen (BUN) level of 45 mg/dL and a serum creatinine level of 2.2 mg/dL has a total 2-hour urine output of 25 mL. The nurse understand that the client is at risk for which condition? A) Hypovolemia B) Acute kidney injury C) Glomerulonephritis D) Urinary tract infection

B) Acute kidney injury Rationale: the client who undergoes cardiac surgery is at risk for acute kidney injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Kidney injury is signaled by a decreased urine output and increased BUN and creatinine levels. The client may need medications to increase renal perfusion and could need peritoneal dialysis or hemodialysis.

A client is wearing a continuous cardiac monitor which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. The nurse would take which action first? A) Call a code blue B) Check the client status and lead placement C) Call the primary health care provider D) Press the recorder button on the ECG console

B) Check the client status and lead placement Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Checking of the client and equipment is the first action by the nurse. z

A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath, and the client is visibly anxious. Which is a life-threatening complication that could be occurring? A) pneumonia B) Pulmonary edema C) Pulmonary embolism D) Myocardial infarction

C Rationale: Pulmonary embolism is a life-threatening complication of deep vein thrombosis and thrombophlebitis. Chest pain is the most common symptom which is sudden in onset and may be aggravated by breathing. Other s/s include dyspnea, cough, diaphoresis, and apprehension.

The nurse is caring for a client on a cardiac monitor who is alone in a room at the end of the hall. The client has a short burst of ventricular tachycardia, followed by ventricular fibrillation. The client suddenly loses consciousness. Which action would the nurse take first? A) Got to the nurse's station quickly and call a code B) Run to get a defibrillator from an adjacent nursing unit C) Call for help and initiate CPR D) Start oxygen by cannula at 10 L/min and lower the head of the bed

C Rationale: When ventricular fibrillation occurs, the nurse remains with the client and initiates CPR until a defibrillator is available and attached to the client.

The nurse is collecting data on a client with a diagnosis of right-sided HF. The nurse would expect to note which specific characteristic of this condition? A) Dyspnea B) Hacking cough C) Dependent edema D) Crackles on lung auscultation

C Rationale: right-sided HF is characterized by signs of systemic congestion that occurs as a result of right ventricular failure, fluid retention, and pressure buildup in the venous system. Edema develops in lower legs and ascends to the thighs and abdominal wall. More s/s include JVD, congestion, enlarged liver, anorexia, nausea, distended abdomen, swollen hands and fingers, polyuria, weight gain.

The nurse is preparing to ambulate a postoperative client after cardiac surgery. The nurse plans to do which to enable the client to best tolerate the ambulation? A) Provide the client with a walker B) Remove the telemetry equipment C) Encourage the client to cough and deep breath D) premedicate the client with an analgesic before ambulating

D) premedicate the client with an analgesic before ambulating Rational: The nurse would encourage regular use of pain medication for the first 48-72 hours after cardiac surgery because the analgesia will promote rest, decrease myocardial oxygen consumption caused by pain, and allow better participation in activities such as coughing, deep breathing, and ambulation.