Chapter 48 CV and PVD

A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh-high compression stockings. Which of the following actions should the nurse take?

Apply the stockings to the client in the morning upon awakening and before getting out of bed

The nurse is providing patient teaching for a patient with Raynaud disease. Which information should be included?

Avoid cold Practice stress reduction techniques comply with smoking cessation limit caffeine intake

A nurse is reviewing the laboratory findings of a client who is being evaluated for a myocardial infarction (MI). Which of the following laboratory studies are likely to show elevations if the MI occurred within the last 6 hours? (SELECT ALL THAT APPLY)

CK-MB Troponin I Troponin T Myoglobin

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 (VT) , followed by ventricular fibrillation (VF). The client suddenly lose consciousness. Which action would the nurse take FIRST?

Call for help and initiate CPR Rationale: When ventricular fibrillation occurs, the nurse remains with the client and initiates CPR until a defibrillator is available and attached to the client

A 10 year old patient is diagnosed with rheumatic fever. Of all the manifestations seen in rheumatic fever, which is most likely to lead to permanent complications?

Carditis

A patient has Buerger disease. What is the most important aspect of patient compliance to decrease signs and symptoms of Buerger disease?

Cessation of tobacco use

What is the best nursing action that will lessen the severity of a patient's orthostatic hypotension?

Change his position routinely, especially from horizontal to vertical

What is the most useful noninvasive diagnostic tool for evaluating the patient with heart failure?

Echocardiogram

The nurse is aware that the patient will benefit from the administration of streptokinase and tissue plasminogen activators when administered how long after admission for acute MI signs and symptoms?

In the first 30 minutes to 1 hour

A patient is admitted to the medical floor with a diagnosis of HF. Which assessment findings are consistent with the medical diagnosis?

Increase in abdominal girth Pitting edema

A patient has a diagnosis of hypertension. When providing discharge teaching what should the nurse include?

Instruction to limit sodium intake to 2g/day education on continuing to take antihypertensive medications as prescribed

A nurse is collecting data on a client who has mitral valve insufficiency. Which of the following findings should the nurse expect?

Neck vein distention

When caring for a patient whose health care provider has ordered furosemide (Lasix), what will the nurse recognize when the medication is having the desired effect?

Production of urine is increased The patient's weight decreases

A patient is admitted to the hospital with a diagnosis of heart failure. Recently the patient's symptoms have been getting worse as a result of arteriosclerosis. In establishing a patient care plan, what is the primary goal of treatment?

Reduce the workload of the heart

A patient has a history of angina pectoris. To decrease the pain from angina pectoris, what should the patient do?

Take a cardiac glycoside at the first symptom of cardiac pain.

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level?

activated partial thromboplastin time (aPTT) of 55 seconds Rationale: 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.

A patient is admitted with a diagnosis of possible aortic abdominal aneurysm. What is the most important factor to monitor as a possible complication?

blood pressure

The nurse is teaching the client who is scheduled for a coronary angiography. Which of the following statements should the nurse make?

"you will need to keep your affected leg straight following the procedure".

A nurse is assisting with the care of a client who has a possible dissecting abdominal aortic aneurysm. Which of the following actions is the priority for the nurse to take? A) septic 1). Failure of the heart to pump effectively due to a cardiac cause B). Distributive 2). Significant loss of fluid volume C). Obstructive 3). Failure of the heart to pump effectively due to a non-cardiac cause D). Hypovolemic 4). widespread vasodilation and increased capillary permeability E). Cardiogenic 5). type of distributive shock, caused by infection elsewhere in the body entering bloodstream

A). 5 B). 4 C) 3 D) 2 E). 1

A nurse is reviewing the results of client's ankle-brachial index report in the medical record. The nurse notes the results are consistent with presence of peripheral arterial disease (PAD) indicating need for client education if what value is noted?

ABI less than 0.9

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 understands that the client is at risk for which?

Acute Kidney injury Rationale: The client 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 peritoneal dialysis or hemodialysis.

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse (RN) and expects which interventions to be prescribed? select all that apply?

Administering oxygen Inserting a Foley catheter Administering furosemide administering morphine sulfate intravenously Rationale: Pulmonary edema is a life threatening event that can result from severe heart failure. During pulmonary edema the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high fowlers position to ease the work of breathing. Furosemide will eliminate the fluid. A foley cath is inserted to measure output. Morphine reduces venous return and decreases anxiety and the work of breathing. Transporting the client to coronary care is not a priority if client responds to treatment well

To use an external cardiac defibrillator on a client, which action would be performed to check the cardiac rhythm?

Applying the adhesive patch electrodes to the skin and moving away from the client. Rationale: Nurse is doing CPR, the pads from the AED placed. The nurse stops CPR and instructs everyone to move away and not touch the client. The defibrillator then analyzes the rhythm which may take up to 30 secs. then after it shocks continue.

When a patient returns to the unit following cardiac catheterization, which nursing activity should follow immediately after taking of vital signs?

Assessing the patient's peripheral pulses.

A nurse in the emergency department is assisting with admitting a client who has a blood pressure of 266/147 mm Hg and reports severe headache and blurred vision. Which of the following actions should the nurse suggest taking first?

Assist with obtaining IV access

What is the primary goal of patient teaching after a myocardial infarction?

Assisting the patient in developing a healthy lifestyle.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1.Call a code. 2.Call the health care provider. 3.Check the client's status and lead placement. 4.Press the recorder button on the electrocardiogram console.

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 the equipment is the first action by the nurse

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, 0.4mg, sublingually. After 5 minutes, the client states, "my chest still hurts". Which appropriate actions would the nurse take? SELECT ALL THAT APPLY?

Check the clients pain level check the client's blood pressure administer a second nitroglycerin, 0.4mg, sublingually

The nurse is assessing a patient and suspects the patient is experiencing thrombophlebitis in the lower leg. What symptoms would the nurse assess?

Edema of the extremity calf is warm to the touch pain in the effected extremity

A nurse in the emergency department is assisting with the care of a client who has a possible dissecting abdominal aortic aneurysm. Which of the following actions is the priority for the nurse to take?

Ensure the client has IV access

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?

I'll continue my nicotinic acid from the health food store".

A patient experienced intense chest pain, anxiety, and nausea. The admitting diagnosis is suspected myocardial infarction. When providing care for the patient in the emergency department, the nurse must understand what about a myocardial infarction?

It involves a critical reduction in blood supply to the myocardium

The nurse is assisting with caring for the client immediately after incision of a permanent demand pacemaker via the right subclavian vein. The nurse prevents dislodgement of the pacing catheter by implementing which intervention?

Limiting movement and abduction of the right arm Rationale: In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgment. The nurse helps prevent this complication by limiting the client's activities.

The nurse is checking the neurovascular status of a client who returned to the surgical nursing 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 this data, the nurse would make which determination about the client's neurovascular status?

Normal, cause by increased blood flow through the leg Rationale: and expected outcome with surgery is warmth, redness, edema in the surgical extremity cause by increased blood flow.

A nurse is assisting with the care of a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. Which of the following prescriptions should the nurse anticipate the provider to prescribe?

Pacemaker insertion(bradycardia).

A nurse is collecting data from a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect?

Pallor on elevation of the limbs, and rubor when the limbs are dependent

A nurse is reinforcing teaching with a client who has a new diagnosis of severe peripheral arterial disease. Which of the following instructions should the nurse include?

Place both legs in a dependent position while sleeping

A nurse is assisting with the care of a client who has heart failure. Which actions should the nurse take?

Place in high fowlers and administer o2 as prescribed. Monitor Vital signs and hemodynamic pressures. Monitor daily weight and I&O. Check for short of breathe and dyspnea on exertion. Monitor diagnostic results. Check for medication toxicity. Encourage bed rest nd energy. Conserve energy until the client is stable. Maintain dietary restrictions and restrict fluid and sodium intake.

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?

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

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?

Pulmonary embolism 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 signs/ symptoms include dyspnea, cough, diaphoresis, and apprehension

A nurse is assisting with care for a client who is one day postoperative following coronary artery bypass grafting(CABG) surgery. The client declines to perform coughing and deep breathing because they are concerned about causing pain at their incision site. Which action should the nurse take?

Reinforcing teaching with the client to splint their incision with a pillow

A patient with a history of IV drug use is diagnosed with acute infective endocarditis. Which nursing intervention for this patient is most appropriate?

Restricted activity for several weeks

A patient presents with dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention. What does the nurse suspect the patient is experiencing?

Right sided heart failure

A nurse on a cardiac unit is collecting data on a group of clients who have heart failure. Sort the following findings into manifestations of left- sided heart failure and manifestations of right sided heart failure. A) crackles in lungs B). Jugular vein distention C) pink frothy sputum d) Dependent edema e). S3 heart sound (gallop) f). Abdomen distention

Right: B,D,F Left: A, C, E

A patient receives a diagnosis of angina pectoris, with no subsequent cardiac involvement. The health care provider prescribes nitroglycerin. What explanation would the nurse give to this patient about why this medication is given sublingually?

Superficial blood vessels promote rapid absorption of the medication

A nurse is collecting data on a client who has pulmonary edema. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY)

Tachypnea Persistent cough Orthopnea

A nurse is reinforcing discharge teaching for a client who has a new prescription for furosemide 20 mg PO twice daily. What information should the nurse include about the timing of the administration of furosemide when providing discharge teaching?

Take 2nd dose no later than 5pm

A nurse is providing teaching to a client who has atrial fibrillation and has a new prescription for an anticoagulant. Which of the following information should the nurse include in the teaching?

The anticoagulant will decrease the risk of blood clots

A nurse in an outpatient clinic is assisting with collecting data from a client who has type 2 diabetes mellitus and hypertension who has recently received a new prescription for metoprolol. Which of the following client data should the nurse report to the provider?

The client has a heart rate of 50/min

The primary health care provider is going to perform carotid massage on a client with rapid rate atrial fibrillation. Which interventions would the nurse anticipate?

The client would be placed on a cardiac monitor Rhythm strips would be obtained before, during and after the procedure Vital signs, cardiac rhythm, and LOC would be monitored the procedure.

An 86 year old patient is receiving an intravenous infusion at 83ML/h via an electronic infusion pump. Why is it so vital that the IV lines of older adult patients be monitored carefully?

These patients are at an increased risk for developing fluid overload of the circulatory system

A nurse is reviewing discharge instructions with a client following an femoropopliteal bypass graft. Which of the following instructions should the nurse include?(SELECT ALL THAT APPLY)

sit with legs uncrossed Walk regularly

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a PRIORITY nursing intervention?

Monitor for signs of bleeding.

A nurse in the emergency department is collecting data from a client who is being treated for shock. Which of the following manifestations should the nurse expect to find? (SELECT ALL THAT APPLY)

Slow capillary refill Hypotension Tachypnea

When providing patient teaching regarding coronary artery disease, the nurse can include which of the following when advising the patient about modifiable risk factors?

Smoking Cholesterol level obesity

A nurse is assisting with the admission of a client who has a suspected myocardial infarction(MI) and a history of angina. Which of the following findings will help the nurse distinguish stable angina from an MI?

Stable angina can be relieved with rest and nitroglycerin

A 75 year old patient is diagnosed with heart failure. The nursing diagnosis of "activity intolerance, related to dyspnea and fatigue", would be appropriate. What nursing intervention would be most appropriate for this diagnosis?

plan frequent rest periods

A nurse is screening a client for hypertension. Which of the following statements by the clients increase their risk for developing hypertension? (SELECT ALL THAT APPLY)

"Buttered popcorn is one of my favorite daily snacks". "I drink at least 2-3 beers a day

Used to diagnose cardiomegaly and pneumothorax, and to evaluate lungs

Chest x ray

The nurse at the provider's office is reviewing the laboratory test results for the client. The nurse should identify that which of the following results indicates the client is at risk for heart disease? (SELECT ALL THAT APPLY)

Cholesterol (total) 245mg/dL LDL 140 mg/dL

The nurse is teaching the newly licensed nurse about caring for the client who is to have a CVP line placed. Which of the following statements by the newly licensed nurse indicates an understanding?

"A chest x-ray is needed to verify placement after the procedure".

used to detect structural changes of the heart, including cardiomegaly, cardiac tamponade, cardiomyopathy, aortic dissection or aneurysm, and pericardial effusion

Computerized tomography (CT)

A nurse is reinforcing teaching with a client who has hypertension and received a new prescription for spironolactone. Which of the following statements by the client indicates an understanding of the teaching?

"I should monitor rhythm of my heart rate".

A nurse is caring for a client who has a deep vein thrombosis(DVT) and has been taking unfractionated heparin for 1 week. Two days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both heparin and warfarin at the same time. Which of the following statements should the nurse make?

"It takes 3 to 4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued

The nurse has reinforced instructions to the client with Raynaud's disease about self-management of the disease process. The nurse determines that the client NEEDS FURTHER TEACHING if the client makes which statement?

"Moving to a warmer climate would help" Rationale: moving to a warmer climate may not be necessarily beneficial because the symptoms could still occur with the use of air conditioning and during periods of cooler weather.

A nurse is reviewing information with a newly licensed nurse about the use of cardiopulmonary bypass during the surgery for coronary artery bypass grafting. Which of the following statements should the nurse include?(SELECT ALL THAT APPLY)

"The client's demand for oxygen is lowered". "Motion of the heart stops" "rewarming of the client takes place"

A nurse is reinforcing teaching with a client who is scheduled for an echocardiogram. Which of the following statements should the nurse include in the teaching?

"The test allows us to see how your heart valves work".

A nurse is reinforcing teaching with client who has a new prescription for clopidogrel. Which of the following statements should the nurse make? (SELECT ALL THAT APPLY).

"avoid taking herbal supplements while taking this medication" "monitor for the presence of black, tarry stools.

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?

"ibuprofen taken 3o minutes before the nicotinic acid will decrease the flushing

A nurse is reinforcing teaching to a client who has a new diagnosis of an aneurysm. The client asks the nurse to explain what causes an aneurysm to rupture. Which of the following statements should the nurse give?

"it is due to hypertension

A nurse is collecting data from a client who has a suspected occlusion of a graft of the abdominal aorta. Which of the following manifestations should the nurse expect?

Coolness of inferior graft extremity

A nurse is collecting data on a client who has a new diagnosis of a thoracic aortic aneurysm. Which of the following findings should the nurse expect?

Cough Shortness of breath Altered swallowing

A nurse assisting with the care of a group of clients. The nurse should recognize which of the following clients is at risk for the development of a dysrhythmia?(SELECT ALL THAT APPLY)

A client who has metabolic alkalosis A client who has alcohol use disorder A client who underwent stent placement in a coronary artery.

A nurse is teaching a newly licensed nurse about vascular access devices. Match the following vascular access devices with the associated characteristics. A) implanted port 1). used for short-term access B). Percutaneous inserted central catheter (PICC) 2). Inserted above or below the antecubital fossa c). Nontunneled percutaneous central venous catheter 3). surgically inserted into the chest wall

A goes with 3 b goes with 2 c goes with 1

A nurse is collecting data from clients who are experiencing complications following angioplasty that was performed by insertion through the femoral artery. Match the findings to the complication the nurse should suspect? A). Hemorrhage 1). Hematoma at the groin B).Elevated BUN and creatinine 2). Cardiac tamponade C). rash and wheezing 3). Allergic reaction to contrast dye D). jugular venous distention(JVD) 4). acute kidney injury(AKI

A) 1 B). 4 C)3 D). 2

A nurse is assisting with teaching a class about medications used to treat heart failure. Match the medication class with the associated adverse effect. A) Anticoagulants 1). hypokalemia B). ACE inhibitors 2) dry cough C) Loop diuretics' 3). bruising

A). 3 B). 2 C). 1

A nurse is assisting with teaching a class about valvular disease. Match the valvular dysfunction with the associated manifestations. A), aortic insufficiency 1). Apical diastolic murmur b). aortic stenosis 2). S3 heart sound c). Mitral insufficiency 3). Narrowed pulse pressure d). Mitral stenosis 4). bounding pulse

A). 4 B). 3 C) 2 D). 1

A nurse is assisting with the care of clients who have had MI and is reviewing the medications prescribed for them. Match each classification with the name of the medication. A) Antiplatelet agent 1). Nitroglycerin B). Anticoagulant 2). Metoprolol C) Beta Blocker 3). Heparin D). Vasodilator 4). Clopidogrel

A). 4 B). 3 C). 2 D). 1

A client with myocardial infarction 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?

Crackles Rationale: wheezes, rhonchi, and diminished breath sounds are not associated with pulmonary edema.

A nurse is reinforcing teaching with a client who has heart failure and new prescriptions for furosemide and digoxin. Which of the following instructions should the nurse include?(SELECT ALL THAT APPLY)

Monitor daily weight Hold digoxin if heart rate is less than 60/min Decrease sodium intake

Used to identify coronary artery blockage

Cardiac catherization

The nurse is collecting data on a client with a diagnosis of right sided heart failure. The nurse would expect to note which specific characteristic of this condition?

Dependent edema Rationale: other parts of the body that does not involve the lungs

What actions would the nurse expect to be used to treat heart failure?

Diuretics' agents ACE inhibitors, beta-adrenergic blockers(carvedilol) nitrates oxygen therapy

Used to monitor ECG changes

ECG

Used to detect cardiomegaly and cardiomyopathy; evaluate of cardiac contractility and function, ejection fraction, and valve function

Echocardiogram

A nurse is assisting with collecting data from a client following peripheral bypass graft surgery of the left lower extremity and recognizes unexpected manifestations that should be immediately reported to the provider. Sort the following by whether they are expected or unexpected findings A). trace of serosanguinous drainage on dressing b). capillary refill of affected limb of 6 seconds c). pallor of the limb d). pulse of 2+ in the affected limb

Expected: A,D unexpected: B,C

A nurse is caring for a client following cardioversion. Which of the following should the nurse include in the documentation of this procedure? (SELECT ALL THAT APPLY).

Follow up ECG Energy settings used Skin condition under electrodes

A nurse is assisting with the care of a client who has pericarditis. Which of the following findings should the nurse expect?(SELECT ALL THAT APPLY)

Friction rub Cough' Chest pain

Before administering a dose of digoxin to an assigned patient, the nurse observes that the patient's pulse rate is 52. What is the most appropriate nursing action?

Hold the medication and notify the health care provider

A nurse is reviewing the medical records of several clients to identify risk factors for valvular heart disease. What are the risk factors for valvular heart disease?

Hypertension, rheumatic fever, infective endocarditis, congenital malformations, Marfan syndrome(connective tissue disorder that affects the heart and other areas of the body). Older adult clients are at risk for valvular heart disease due to degenerative calcification and atherosclerosis

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?

I will take enteric coated aspirin for my headache because it is coated. rationale: aspirin containing products need to be avoided while taking warfarin

A nurse is contributing to the plan of care for a client following a surgical placement of an endovascular stent graft to repair an aneurysm. Which of the following interventions should the nurse recommend for inclusion in the plan of care?

Monitor pulses distal from procedure site Monitor for an increase in pain below the graft site Monitor procedure site for bleeding monitor vital signs frequently.

The nurse is monitoring a client following cardioversion. Which observation's would be of HIGHEST PRIORITY to the nurse?

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

A nurse is assisting with teaching a class about risk factors for inflammatory heart disease. The nurse should instruct that which of the following conditions is a risk factor for rheumatic heart disease?

Streptococcal Pharyngitis

A nurse is preparing to assist with the adminstration of medications to a client who is experiencing septic shock. Why should the nurse expect the RN to adminster IV antibiotics within 1 hour of diagnosis

gram negative bacteria should be introduced 1 hour of a septic shock diagnosis

When a patient is receiving heparin therapy, what would be the nurse's most appropriate action?

observe emesis, urine, and stools for blood

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for: a. Familial tendency toward peripheral vascular disease b. Smoking history c. Recent exposures to allergens d. History of insect bites

smoking history Rationale: The mixture of arterial and venous manifestations( claudification and phlebitis, respectively) in the young male client suggests thromboangitis obliterans (Buergers disease). This is a relatively uncommon disorder characterized by inflammation and thrombosis of smaller arteries and veins. This disorder is typically found in young men who smoke. The cause is unknown but is suspected to have an autoimmune component.

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?

take the medication with food Rationale: to prevent a headache from occurring

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol?

the development of audible expiratory wheezes

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noticing which signs/ symptoms?

visual disturbances nausea and vomiting serum potassium level of 3.9 mEq/L