Chapter 7 Cardiovascular Problems

The clinic nurse obtains this information about a client who is taking warfarin after having a DVT. which finding is most indicative of a need for a change in therapy

INR is 1.2

Two weeks ago, a client with heart failure received a new prescription for carvedilol 12.5mg orally. Which finding by the nurse who is evaluating the client in the cardiology unit is of most concern?

Sinus bradycardia at a rate of 48bpm

A client with acute coronary syndrome is receiving a continuous heparin infusion. The client is to receive 700U/hr. Based on the heparin concentration on the label, the nurse will set the infusion pump to deliver

17.5 ml/hr

While working on the cardiac step-down unit, the nurse is precepting a newly graduated RN who has been in a 6 week orientation program. Which client will be best to assign to the new graduate?

A 33yo client admitted a week ago with endocarditis who will be receiving a schedulred dose of ceftriaxone 2g IV

The nurse has just received a change-of-shift report about these clients on the coronary step-down unit. Which one will the nurse assess first?

A 45yo client with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hours before the shift change.

The nurse is working with an experienced unlicensed UAP and an LPN on the telemetry unit. A client who had an acute MI 3 days ago has been reporting fatigue and chest discomfort when ambulating. Which nursing activity included in the care plan is best assigned to the LPN?

Admin nitroglycerin 0.4mg sublingually is chest discomfort occurs during client actus ivities

The ED nurse is caring for a client who was just admitted with left anterior chest pain, possible acute MI. Which action will the nurse take first?

Administer SL nitroglycerin

The nurse assesses a client who has just returned to the recovery area after undergoing coronary angiotherapy. Which information is most concerning?

Apical pulse is 122 beats/min

A client seen in the clinic with SOB and fatigue is being educated for a possible diagnosis of heart failure. Which laboratory results will be most useful to monitor?

B-type natriuretic peptide

The nurse makes a home visit to evaluate a hypertensive client who has been taking enalapril. Which finding is most important to report to the HCP?

Client complains about a frequent dry cough

Which client is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general med-surg unit?

Client receiving IV furosemide to treat acute left ventricular failure

An 80yo client on the coronary step-down unit tells the nurse "I do not need to take that docusate. I never get constipated!" Which action by the nurse is most appropriate?

Explain that his decreased activity level may cause constipation

The nurse has given morphine sulfate 4mg IV to a client who is having an acute MI. When evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action?

Persisting chest pain at a level of 1

The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which lab value will be most important to monitor?

Potassium level

At 10AM, a hospitalized client receives a new order for transesophageal echocardiography as soon as possible. Which action will the nurse take first?

Put the client on 'nothing by mouth' (NPO) status

The clinic nurse is evaluating a client who has coronary artery stenting through the right femoral artery a week previously and is taking metoprolol, clopidogrel, and aspirin. Which information reported by the client is most important to report to health care provider?

Stools have been black in color

Which finding in a client with aortic stenosis will be most important for the nurse to report to the health care provider?

Temperature of 102.1F

During a home visit to an 88yo client who is taking digoxin 0.25mg/day to treat heart failure and atrial fibrillation. Which finding is most important to communicate to the HCP?

Vision that is becoming fuzzy

The nurse is participating as a team member in the resuscitation of a client who has had a cardiac arrest. The HCP who is directing the resuscitation asks the nurse to administer epinephrine 1mg IV. After giving the medication, which action should the nurse take next?

state: epinephrine 1 mg have been given

The nurse is ambulating a cardiac surgery client whose HR suddenly increase to 146 beats/min. In which order will the nurse take the following actions?

- Have the client sit down - Admin PRN O2 by nasal cannula - Check the BP - Call the HCP

The HCP prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to assign to an experienced LPN/LVN who is working at the ED? Select all that apply

- attaching cardiac monitors - obtaining a 12 lead ECG - Having the client chew and swallow aspirin 162mg

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply

- how to monitor and record daily weight - symptoms of worsening heart failure - how to read food labels for sodium content - date and time for follow-up appointments

While reviewing a hospitalized client's medical record, the nurse obtains this information about CV risk factors. which interventions will be important to include in the discharge plan for this client? Select all that apply.

- referral to community programs that assist in smoking cessation - teaching about the impact of family history on CV disease

During the intial post-op assessment of a client who has just been transferred to the PACU after repair of an abdominal aortic aneurysm, the nurse obtains these data. which finding has the most immediate implications for the client's care?

Arterial line indicates a BP of 190/112mmhg

A client who systolic blood pressure is always higher than 140mmhg in the clinic tells the nurse, "my BP at home is always fine!" what action should the nurse take next?

Ask the client to obtain BP BID with and automatic BP cuff at home and bring the results into the clinic in a week

A resident in a long-term care facility who has venous stasis ulcers is treated with an Unna boot. Which nursing activity included in the residents in care is best for the nurse to delegate to the UAP?

Assisting the client in cleaning around the Unna boot

The nurse is preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had a MI and the client's spouse. The client says, I don't see why I need any teaching. I dont think I need to change anything right now. Which response is most appropriate?

Can you tell me why you don't feel that you need to make any changes

When the nurse is monitoring a 53yo client who is undergoing a treadmill stress test, which finding will require the most immediate action?

Chest pain level 3 (on a scale of 0-10) R: indicates myocardial ischemia, stop testing

A client with stable angina has a prescription for ranolazine 500mg BID. Which client finding is most important for the nurse to discuss with the health care provider?

Client reports having chronic constipation.

A client who is scheduled for coronary arteriogram is admitted to the hospital on the day of the procedure. Which client information is most important for the nurse to communicate to the HCP before the procedure?

Client took metformin 500mg this morning

The nurse is monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need immediate intervention?

Client who has had an acute MI and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions

The nurse in the cardiovascular clinic receives telephone calls from four clients. Which client should be scheduled to be seen most urgently?

Client with a-fib who reports episodes of lightheadedness and syncope

A client is in the ED who is being monitored with a portable cardiac monitor/defibrillator develops this rhythm..... Which action will the nurse take first?

Defibrillate at 200J

The nurse is developing a standardized care plain for the postop care of clients undergoing cardiac surgery. The unit is staffed with RNs, LPNs, and UAPs. WHich nursing activity will need to be performed by RN staff members?

Developing an individual plan for discharge teaching based on discharge medicatiosn and needed lifestyle changes

The HCP telephones the nurse with new scripts for a client with angina who is already taking aspirin. Which medication is most important to clarify further with the HCP?

Ibuprofen 200mg every q4 as needed

The charge nurse in a long term care facility that employs RNs, LPNs, and UAPs has developed a plane for the ongoing assessment of all residents with a diagnosis of heart failure. Which activity included in the plan is most appropriate to assign to an LPN team member?

Listening to lung sounds and checking for edema each week

Based on this information in a client medical record, which topic is the highest priority for the nurse to include in the initial teaching plan for a 26 year old client who has blood pressure ranging from 150/84-162/90mmhg?

Low sodium food choices when eating out

The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is most important to discuss with the health care provider

Low-density lipoprotein (LDL) cholesterol is 170mg/dl (4.4mmol/L) r: elevated, indicates need for further assessment, a change in meds or both

The nurse is working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to an experienced UAP?

Measuring ankle and brachial pressures in a client for whom the ankle brachial index is to be calculated

A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. The nurse notes that no pulse is palpable in the left foot and that it is cold and pale. Which action should the nurse take next?

Notify the HCP about the change in status

The nurse is caring for a client who has heart failure and has a new script for sacubitril-valsartan. Which client information is most important to discuss with the HCP before administration?

The client receives lisinopril 10mg/day

At 9PM the nurse admits a 63yo client with a diagnosis of acute MI. which finding is most important to communicate with the HCP who is considering the use of fibrinolytic therapy with tissue plaminogen activator (alteplase) for the client?

The client reports having continuous chest pain since 8AM R: 12 hours of MI pain becomes irreversible damage

A client who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. which laboratory test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol?

Troponin I level R: elevated 3 hours post-mi, very specific

The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with DVT. Which medication is most important to double-check with another licensed nurse?

Warfarin 2.5mg PO