MedSurg2 Review Quiz 1

What to do if INR is 2.0 in an ischemic CVA pt

give warfarin to get up to 2.5

HIT (heparin induced thrombocytopenia)

if pt has platelets that decreased by half within 24 hrs after starting heparin VERY deadly

S2

"dubb" is the aortic and pulmonic valves closing at the beginning of Diastole

S1

"lubb" is the atrioventricular valves closing at the beginning of systole

Digoxin (cardiac glycoside)

-increase the heart's pumping efficiency (i.e. cardiac output) by increasing the force of contraction while decreasing overall HR.-tx for heart failure.-helps stabilize heart rhythm in pts w/atrial fibrillation.-Help to decrease the excitability of the heart & allow it to more properly fill w/blood before contracting (beating)

normal levels for hgb

12 to 18 Below 7 = Blood Trans

normal levels for calcium

8.4 to 10.6

Rationale: B. Ethacrynic acid, a high-ceiling loop diuretic similar in actions and effects to furosemide (Lasix), can cause ototoxicity, which can lead to permanent hearing loss. While hearing loss is transient with furosemide, it is sometimes permanent with ethacrynic acid.

A healthcare professional is caring for a patient who is about to begin taking ethacrynic acid (Edecrin) to treat heart failure. The health care professional should tell the patient to report which of the following indications of a potentially serious adverse reaction? A. Shortness of breath B. Hearing loss C. Swelling in the legs D. Blurred Vision

Answer B A client who has peripheral arterial disease can display dry, scaly, pale, or mottled skin( patchy and irregular colors ) with minimal body hair because of the narrowing of the arteries in the legs and feet. Because of the narrowing of the arteries it causes decrease blood flow to the distal extremities, which can lead to tissue damage. Manifestations - intermittent claudication ( leg pain w/ exercise ) cold or numb feet when at rest, loss of hair on the lower legs, and weakened pulse.

A nurse in a clinic is collecting data from a client who has a history of peripheral arterial disease. Which of the following findings on the client's lower extremities should the nurse expect? A. Pitting edema B. Cool, pale skin with minimal body hair C. Areas of reddish-brown pigmentation D. Sunburned appearance with desquamation

Rationale:A. When blood flow to the heart is compromised, ischemia causes chest pain. Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from angina.

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from MI? A. Stable angina can be relieved with rest and nitroglycerin B. The pain of an MI resolves in less than 15 min C. The type of activity that causes an MI can be identified D. Stable angina can occur for longer than 30min

C. After a myocardial infarction, the electrical conduction system of the heart can be irritable and prone to dysrhythmias. Ischemic tissue caused by the infarction can also interfere with the normal conduction patterns of the heart's electrical system.

A nurse is assisting in monitoring a client who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hr? A. Infective endocarditis B. Pericarditis C. Ventricular dysrhythmias D. Pulmonary emboli

Answer A Rationale The nurse should administer antihypertensive medication for elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall.

A nurse is assisting in the care of a client who has abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are BP 160/98 mm Hg, hr 102/min, respirations 22/min and SpO2 95%. Which of the following actions should the nurse take? A. Administer an antihypertensive medication for blood pressure B. Monitor for a urinary output of 20 mL/hr C. Withhold pain medication to prepare for surgery D. Take vital signs every 2 hours

Answer D. Administer antihypertensive medication - The nurse should administer antihypertensive medication for the elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall.

A nurse is assisting in the care of a client who has abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are BP 160/98 mm Hg, hr 102/min, respirations 22/min and SpO2 95%. Which of the following actions should the nurse take? A. Monitor that urinary output is 20 mL/hr B. Withold pain meds to prep for surgery C. Take vitals every 2 hr. D. Administer antihypertensive meds

Correct answers : A Because of insufficient blood flow to the coronary arteries and decreased oxygen supply. The chest pain is caused by artery spasms.

A nurse is assisting with data collection from a client who has a history of unstable angina. Which of the following should the nurse expect? 1) The client reports chest pain when at rest. 2) Nitroglycerine relieves chest pain. 3) Chest pain lasts for under 5 minutes 4) Physical exertion does not precipitate chest pain.

Rationale: C. According to the ABC priority setting framework, the first change the nurse should recommend is to stop using tobacco products. Nicotine causes vasoconstriction, elevates blood pressure, and narrows coronary arteries.

A nurse is assisting with the community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should be made first? A. Diet Modification B. Relaxation exercises C. Tobacco cessation D. Exercise Routine

Answer D. The nurse should enforce fluid restrictions to help reduce fluid retention in the lungs and lower extremities.

A nurse is caring for a client who has advanced heart failure. Which of the following actions should the nurse take? A.Place the client in a low-Fowler's position B. Assist the client to use the incentive spirometer every 4 hours C. Weigh the client every other day D. Enforce fluid restrictions

Answer: A weight gain of 1 kg (2.2 lb) in 1 day alerts the nurse that the client is retaining fluid and is at risk of fluid volume overload. This is an indication that the client's heart failure is worsening.

A nurse is caring for a client who has late-stage heart failure and is experiencing fluid volume overload. Which of the following findings should the nurse expect? A. Weight gain 1 kg (2.2 lb) in 1 day. B. Pitting edema +1 C. Client reports a nocturnal cough D. B-Type Natriuretic Peptide (BNP) level of 100 pg/ml

Answer A) .The nurse should elevate the client's legs above his heart to promote venous return by gravity. During discharge teaching, the nurse should reinforce the importance of periodic positioning of the legs above the heart

A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which of the following action should the nurse take A).Position the client supine with his legs elevated when in bed. B).Encourage the client to ambulate for 15 min every hour while awake for the first 24 hr. C).Tell the client to sit with his legs dependent after ambulating. D).Reinforce with the client that he should wear knee-length socks for 2 weeks after surgery

Answer: A. hypoglycemia; there are two factors that increase the client's risk for hypoglycemia. 1. Carvedilol, an alpha/ beta blocker, potentiates the hypoglycemic effects of insulin and oral hypoglycemic drugs. 2. carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.

A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking BOTH drugs concurrently, the nurse should identify that the client is as an increased risk for which of the following conditions? A. Hyperglycemia B. Bradycardia C. Hypotension D. Hypoglycemia

Answer: B. On his left side in Trendelenburg position Rationale: This position helps trap the air in the apex of the right atrium rather than allowing it to enter the right ventricle and, from there, move to the pulmonary arterial system.

A nurse is caring for a patient who has a central venous catheter and suddenly develops dyspnea, tachycardia, and dizziness. The nurse suspects air embolism and clamps the catheter immediately. The nurse should reposition the patient in which of the following positions? A. Supine with a pillow beneath the legs B. On his left side in Trendelenburg position C. Upright and leaning over the overbed table D. On his right side with the head of the bed elevated 15 degrees

Answer: C. report of sudden, severe back pain An aortic aneurysm is a weak spot in the wall of of the aorta that allows the aorta to expand and increase in diameter. Sudden, increasing lower abdominal and back pain indicates that the aneurysm is extending downward and pressing on the lumbar sacral nerve roots.

A nurse is collecting data from A client who has an abdominal aortic aneurysm (AAA). Which of the following findings indicates that the AAA is expanding ? A. Increased BP and decreased pulse rate B. Jugular-vein distention and peripheral edema C. Reports of sudden, severe back pain D. Report of retrosternal chest pain radiating to the left arm

Answer D *Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is extending downward and pressing on lumbar spinal nerve roots, causing pain.ing, or ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is extending downward and pressing on lumbar spinal nerve roots, causing pain.

A nurse is collecting data from a client who has an abdominal pain aortic aneurysm. Which of the following manifestation should the nurse expect? a)Midsternal chest pain b)Thrill c)Pitting edema in lower extremities d)Lower back discomfort

Answer A C E Deep vein thrombosis can cause hardening along the affected blood vessel and prominence of superficial vein.Additionally, DVT causes pain and tenderness in the calf and an increased circumference of the leg due to swelling.

A nurse is collecting data from a client who has deep-vein thrombosis in her left calf. Which of the following manifestations should the nurse expect to find? (Select all that apply) A.Hardening along the blood vessel B. Absence of a peripheral pulse C. Tenderness in the calf D. Cool skin on the leg E. Increase leg circumference

Rationale B Prothrombin time - The nurse should review the client's prothrombin time after the administration of FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in the prothrombin time. (Activated PTT : 60 - 70 secs. & Non Active PTT : 30 - 40 secs.)

A nurse is evaluating a client's repeat laboratory results 4 hr. After administering fresh frozen plasma (FFP). Which of the following laboratory values should the nurse review? A. WBC count B. Prothrombin time - The nurse should review the client's prothrombin time after the administration of FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in the prothrombin time. (Activated PTT : 60 - 70 secs. & Non Active PTT : 30 - 40 secs.) C. Platelet count D. Hematocrit

Answer c The nurse should apply the safety and risk reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. Using the ABC Priority-setting framework, the nurse should stop the infusion to prevent any further administration of blood to prevent circulatory collapse.

A nurse is monitoring a client who is receiving a transfusion of packed red blood cells. Which of the following actions should the nurse take first when suspecting a transfusion reaction? A. Prepare emergency meds B. Monitor vitals every 5 minutes C. Stop the infusion D. Send the blood container and tubing to the lab

Rationale: B. C. E. GI bleeding with dark stools or coffee-ground emesis is an adverse effect of aspirin therapy. Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy. Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy.

A nurse is monitoring a client who takes aspirin 81mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.) A.Hypertension B. Coffee-ground emesis C.Tinnitus D.Paresthesias of the extremities E.Nausea

Answer A B D Depending on the providers prescription, the client should remain flat or with the head of the bed elevated to no more than 30 degrees for 2 to 6 hours after the procedure. The amount of time depends on the type of closure device the provider uses. The client will receive a mild sedative for relaxation and comfort prior to the procedure. A soft knee brace can help keep the client from bending the knee after the procedure.

A nurse is preparing a client for cardiac catheterization. Which of the following pieces of information should the nurse reinforce with the client before the procedure? (select all that apply) A. "You'll have to lie flat for several hours after the procedure." B. "You'll receive medication to relax you before the procedure." C. "You'll feel a very cool sensation after the injection of the dye." D. "You'll have to keep your leg straight after the procedure.' E. "You'll have to limit the amount of fluid you drink for the first 24 hours."

Answer: B) Muscle Pain Simvastin, an HMG- Coa reductase inhibitor( station), can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious adverse effect, protein breaks down and is excreted, resulting in kidney damage.

A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy? A)Bronchoconstriction B)Muscle pain C) Lip numbness D)Somnolence

Rationale:A. The nurse should reinforce that the client should avoid lifting her arm or shoulder on the side of the pacemaker because dislodgement of the pacer leads can occur .

A nurse is reinforcing discharge teaching with a client who has a new permanent pacemaker. Which of the following information should the nurse include in the teaching? A. "Avoid lifting both arms above your head when dressing" B. "Use your cell phone on the same ear as the pacemaker site is located" C. "Avoid travel by airplane" D. "Hiccups are unexpected outcome of having a pacemaker"

Rationale: A medium baked potato is the best food source of potassium because it contains 926mg potassium per serving.

A nurse is reinforcing discharge teaching with a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following food selections should the nurse include as having the HIGHEST source of potassium? a. 1 medium apple b. 1 medium baked potato c. 1 slice of toast with 1 tbsp peanut butter d. 1 large scrambled eggs

Answer: B. "I will notify my doctor before I have dental procedures." The nurse should inform the client of ways to decrease the risk of recurrence of infective endocarditis. The client should notify the provider prior to undergoing invasive or dental procedures due to the need for prophylactic antibiotic therapy to reduce the risk of a streptococcal infection.

A nurse is reinforcing discharge teaching with a client who has infective endocarditis and how to prevent recurrence. Which of the following statements by the client indicates an understanding of the the teaching? A. "I will reschedule any body piercings if I have a fever." B. "I will notify my doctor before I have dental procedures." C. "I will floss my teeth twice a day as a part of my oral care." D. "I will wear a mask when I go out in public."

Answer D Coronary artery disease is a primary risk factor for the development of heart failure. Other risk factors for heart failure include hypertension, cardiomyopathy, tobacco use, family history, and hyperthyroidism.

A nurse is reinforcing teaching with a 70-year-old client about risk factors for heart failure. The client has mild asthma, diabetes melitus, and coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My diabetes increases my risk for heart failure" B. "My asthma makes it more likely for me to have heart failure" C. "My age does not increase my risk for heart failure" D. "My coronary artery disease is a risk factor for heart failure"

Rationale: B. The nurse should instruct the client to monitor heart rate and report any changes to the provider

A nurse is reinforcing teaching with a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25mg/day. Which of the following statements by the client indicates an understanding of the teaching? A. I should eat a lot of fruits and vegetables. Especially bananas and potatoes B. I will report any changes in heart rate to my provider C. I should replace the saltshaker on my table with a salt substitute D. I will decrease the dose of this medication when I no longer have headaches and facial redness

Rationale: A. The client should take simvastatin in the evening because nighttime is when the most cholesterol synthesis takes place. Taking statin medications in the evening increases the medications effectiveness.

A nurse is reinforcing teaching with a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include"? A. Take this medication in the evening B. Change positions slowly when rising from a chair C. Maintain a steady intake of green, leafy vegetables D. Consume no more than 1L/day of fluid

Answer A Rationale: increasing dietary fiber intake can help prevent constipation which is an adverse effect of verapamil.

A nurse is reinforcing teaching with a client who has a new prescription for verapamil to control HTN. Which of the following instructions should the nurse include? A. Increase amount of dietary fiber in the diet B. Drink grapefruit juice daily to increase vitamin C intake C. Decrease amount of calcium in the diet D. Withhold food for 1 hr after taking the medication

Answer B The nurse should encourage the client to increase her consumption of iron rich foods, including meat, fish, and poultry. A 3 oz serving of beef liver contains 4.17 mg of iron.

A nurse is reinforcing teaching with a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of the which of the following foods? A.Beef Liver B. Oranges C. Turnips D. Whole Milk

answer : Simvastatin is an HMG-CoA reductase inhibitor. It blocks synthesis of cholesterol of the body to help lower cholesterol levels (STATINS)

A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia A. Simvastatin B. Furosemide C. Losartan D. Nitroglycerin

Rationale:C. Troponin T levels will still be evident 10-14 days following an MI.

A nurse is reviewing the laboratory findings of a client who has myocardial infarction( MI) and reports that dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A. CKMB B. Troponin I C. Troponin T D. Myoglobin

A nurse is assisting in the care of a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mmHg,heart rate 102/min, respirations 22/min and SpO2 95%. Which of the following actions should tHE nurse take?

A)Administer an antihypertensive medication for blood pressure B)Monitor for urinary output of 20 mL/hr C)Withhold pain medication to prepare for surgery D)Take vital signs every 2 Hrs Correct Answer: A Rationale: The nurse should administer antihypertensive medication for the elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall.

A nurse is reinforcing teaching with a 70-year-old client about risk factors for heart failure. The client has mild asthma, diabetes melitus, and coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching?

A. "My diabetes increases my risk for heart failure." B. "My asthma makes it more likely for me to have heart failure." C. "My age does not increases my risk for heart failure." D. "My coronary artery disease is a risk factor for heart failure." Answer: D. Coronary artery disease is a primary risk factor for the development of heart failure. Other risk factors for heart failure include hypertension, cardiomyopathy, tobacco use, family history, and hyperthyroidism.

1. A nurse is collecting data from a client who has deep-vein thrombosis in her left calf. Which of the following manifestations should the nurse expect to find? (Select all that apply)

A. Hardening Along The blood Vessels B. Absence of a peripheral pulse C. Tenderness in the Calf D. Cool skin on the leg E.Increased leg circumference Answer: A,C,E

A nurse is assisting in the plan of care for a client who is having percutaneous transluminal coronary angioplasty (PTCA) with stent placement. Which of the following actions should the nurse anticipate in the postoperative plan of care?

A. Reinforce teaching with the client about a long-term conditioning program B.Administer scheduled doses of acetaminophen C. Check for peak laboratory markers of myocardial damage D.Initiate an aspirin regimen Rationale: D. The nurse should plan to initiate an aspirin regimen or another antiplatelet agent. The antiplatelet medication maintains the patency of the stent by reducing platelet aggregation.

1. A nurse is assisting in the plan of care for a client who is having PTCA percutaneous transluminal coronary angioplasty with a stent placement. Which of the following actions should the nurse anticipate in the post operative plan of care?

A. Reinforce with the client about long term conditioning program. B. Administer scheduled doses of acetaminophen. C. Check for peak laboratory markers of myocardial damage. D. Initiate an aspirin regimen. ANSWER: D initiate an aspirin regimen. Nurse should initiate aspirin regimen or another antiplatelet agent. Antiplatelet medication maintains patency of the stent by reducing platelet aggregation.

A nurse is assisting in monitoring a client who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hours?

A. Ventricular Dysrhythmias B. Infective Endocarditis C. Pulmonary Emboli D. Pericarditis Answer A After a MI, the electrical conduction system of the heart can be irritable and prone to dysrhythmias Ischemic tissue caused by the infarction can also interfere with the normal conduction patterns of the heart's electrical system.

A nurse is administering a loop diuretic to a client who has 3+ pitting edema in the lower extremities. Which of the following actions should the nurse take?

A. Weight the client weekly B. Monitor the client for ototoxicity C.Place the client on a 24-hour urine collection analysis D. Monitor for hypoglycemia Answer B Rationale: The nurse should monitor the client for ototoxicity, and the client should report any manifestations of hearing impairment while on the loop diuretic. The nurse should use caution when a loop diuretic is used in conjunction with other ototoxic medications such as aminoglycoside antibiotcs.

PQRST- P

Atrioventricular contraction/Depolarization/Systole (meaning blood leaves chamber/ventricle)

Valves of the heart

Atrioventricular valves- tricuspid and bicuspid Semilunar valves- aortic and pulmonic

coronary blood flow

Blood enters coronary blood flow through the right and left coronary arteries Flows through coronary circulation Returns to systemic circulation via coronary veins

Non modifiable

Family Gender Age Ethnicity

I will increase my intake on dark green leafy foods

Client on warfarin, what requires intervention from pt

SA (sinoatrial node)= pacemaker, located in Right Atrium AV (atrioventricular node) Bundle of His Purkinje Fibers In this Order!!!

Conduction/ Impulses of the heart

What do you report to HCP about enoxaprin

HH that has been decreased BP that drops atleast 20 pts

Modifiable

Smoking Hyperlipidemia HTN, DM, Obesity Sedentary Lifestyle Stress Psychosocial

cardiac catheterization

Tachycardia is the early sign of bleeding Tachycardia is also the early sign of shock Lay flat on bed No flexion (for up to 12 hours) Can go through femoral, arm or neck Contrast dye is used Femoral is cleaned and numbed with local anesthetic, feel pressure and shouldnt feel pain Femoral when removed, gentle pressure, a stitch, a patch or a plug to prevent bleeding Always have sandag near pt bedside, in case of bleeding Sterile gloves in case of bleeding Invasive procedure used to see chambers, heart valves, great heart valves and coronary arteries Used to measure pressure w/in the heart AND blood volume relationship to cardiac competence Valvular defects, arterial occlusion and congenital abnormalities are determined NO ASPIRIN, TO REDUCE BLEEDING

PQRST-QRS

Ventricular contraction

PQRST-T

Ventricular relaxation/relax/ repolarization/diastole (open and blood goes inside chamber/ventricle)

Regurgitation Murmur

When the valve doesn't work correctly- meaning the valve doesn't close all the way OR Someone is born with stenosis (2 forms narrow and stricture). Stricture is when the valve is too small so that blood cant properly get in the ventricle or the blood comes back up. When the blood comes back up thats when you hear MURMUR (hence regurgitation)

holter monitor

a battery-operated portable device that measures and records your heart's activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used.

S1, S2, S3

abnormal heartbeat CHF

S1,S2,S3,S4

abnormal heartbeat Tennessee,Mississippi, sounds like horse galloping

Heparin

antidote is protamine sulfate normal PTT is 46-70 (50) monitor platelets (normal is 150-400) hold if less than 50 platelets only given SQ IV

what to do if INR is 4 to 5

assess for bleeding get vitamin k antidote ready

meds that increase heart rate

atropine

Meds that slow the heart rate

beta blockers- olol calcium channel blockers- zem/pine digoxin

location of aortic semilunar valve

located at the opening between the left ventricle and the aorta

location of pulmonary semilunar valve

located at the opening between the right ventricle and the pulmonary trunk

location of bicuspid valve

located between the left atrium and left ventricle

location of tricuspid

located between the right atrium and right ventricle

New med Fondaparinux

no risk for HIT BUT risk for epidural bleeds dont give to pt w/back,paralysis or decreased LOC DONT give med for atleast 6hrs after surgery no anticoags while spinal epidural cath in place

warfarin

normal INR 2-3 (2.5 to 3.5 for heart valve replacement), antidote is vitamin k (phytonadione aquamephyton), frequent blood test

levels for digoxin

normal levels for hf are between 0.5 and 0.9 nano grams normal levels for heart arrhythmia are between 0.5 and 2.0 nano grams

Room air

only 21%

Right ventricle

pumps blood into the pulmonary artery (lungs)

Left ventricle

pumps oxygenated blood to the body through the aorta

Right atrium

receives deoxygenated blood from the body, pumps blood to the right ventricle

Left atrium

receives oxygenated blood from the pulmonary vein, pumps blood to the left ventricle

4 Chambers of the heart

right atrium, right ventricle, left atrium, left ventricle

atrioventricular node

slows the impulse to allow the atria to fill the ventricles

Sinoatrial (SA) node

the pacemaker of the heart, also a secondary pacemaker of the heart

how to administer heparin

use a 25g needle 5/8 inch inject at a 90 degree angle location is 2 inches from belly button NO THIGH NOT IV