Mod 3 exam 1
Which class of antihypertensive agents should be avoided by patients with asthma?
Beta-adrenergic blocking agents
Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?
Blood pressure has decreased.
The nurse is assessing a patient who is being evaluated for hyperlipidemia. Which assessment will most increase the risk of coronary artery disease (CAD)?
Blood pressure, 168/90 mm Hg
Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.)
Bradycardia Headache Visual disturbance Gastrointestinal complaints
How frequently are nitroglycerin tablets discarded and prescriptions refilled?
Every 6 months
When are sustained-release nitroglycerin tablets administered?
Every 8 to 12 hours
A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a _____ position.
Fowler's
The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed?
Furosemide (Lasix)
The nurse is reviewing lab work received on a patient admitted with the diagnosis of dehydration. The nurse will notify the physician of which lab value?
Serum sodium level: 115 mEq/L
Amiodarone is contraindicated for patients with which condition?
Severe sinus node dysfunction causing bradycardia
What should a person with unstable angina avoid?
Shoveling snow
Which medication is a potassium sparing diuretic?
Spironolactone (Aldactone)
How should the nurse advise a patient with an international normalized ratio (INR) of 5.8?
Stop taking the anticoagulant and notify health care provider.
Following an angiogram with the insertion site of the left groin, the nurse will include in the plan of care provisions for: (Select all that apply.)
checking pedal pulses. checking color and warmth of left leg frequently. sandbagging over insertion site.
The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse's reaction is one of:
satisfaction. This is good cholesterol control.
The nurse takes into consideration that age-related changes can affect the peripheral circulation because of:
sclerosed blood vessels.
The nurse clarifies that the master pacemaker of the heart is the:
sinoatrial (SA) node.
The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as:
sinus tachycardia.
A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include:
substernal pain that radiates down the left arm.
What is the rationale behind administering calcium channel blockers to patients with angina?
they dilate blood vessels
The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into:
ventricular tachycardia and death.
The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient?
"Carry the medication with you at all times."
The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask?
"Have you contacted your physician about your dental appointment?"
The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says:
"I always take off the telemetry device when I shower."
During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure?
"I have to sleep in my recliner and I have this hacking cough."
Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)?
"I try to eat more green leafy vegetables, especially broccoli, spinach, and kale."
The nurse has provided patient teaching about potassium sparing diuretic therapy. Which statement by the patient indicates a need for further teaching?
"I will use a salt substitute because I limit my salt intake."
A patient asks the nurse how amlodipine (Norvasc) works to reduce the blood pressure. Which response will the nurse provide?
"It causes blood vessel dilation."
Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure?
"Report nausea and vomiting to your health care provider."
A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up and asks if the medication should be discontinued. What is the nurse's best response?
"Rise to a sitting or standing position slowly; your symptoms will resolve."
Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?
"This is a common adverse effect that can be managed with acetaminophen."
The nurse assesses pitting edema that can be depressed approximately 1/4 inch and refills in 15 seconds. The nurse would document this assessment as:
+2 edema.
What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.)
.Detect thrombi before a cardioversionc .Visualize vegetation on the heart valvese. Visualize abscesses on the heart valves
Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.)
.Take medication at the same time each day. Report to physician cuts that do not stop bleeding with direct pressure.
The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between:
2 and 3.
Which medication combinations may be beneficial in treating angina pectoris?
ACE inhibitors and statins
The nurse is preparing medications for a patient. When is the best time for the nurse to administer lovastatin (Mevacor)?
During the patient's dinner
The nurse identifies the "lub" sound of the "lub/dub" of the cardiac cycle as the sound of the:
AV valves closing.
Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?
Administer the medication under the tongue.
Which medication lowers blood pressure by directly inhibiting renin?
Aliskiren (Tekturna)
What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?
Allow for a daily 8- to 12-hour nitrate free period.
Which is the initial manifestation of digoxin toxicity in children?
Atrial dysrhythmia
Which patient teaching would help to prevent venous stasis? (Select all that apply.)
Avoid crossing the legs at the knee. Elevate legs when lying in bed or sitting. Wear elastic stockings when ambulating.
Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?
Edematous, red scaly skin on medial surface of the leg
A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?
CK-MB
Which medication, if administered with spironolactone (Aldactone), will alert the nurse to assess the patient for signs and symptoms of hyperkalemia?
Captopril (Capoten)
A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?
Change positions slowly.
The nurse is performing pain assessment on a patient admitted for evaluation of angina. Which type of angina is precipitated by physical exertion and is relieved by rest?
Chronic stable
The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)?
Cocaine use
Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?
Cover the patch with a clear plastic wrap.
Which nursing assessment is most important to determine fluid status for a patient with heart failure?
Daily weights
The nurse points out which of the following as modifiable risks for coronary artery disease (CAD)? (Select all that apply.)
Diabetes mellitus Smoking Hypertension Hyperlipidemia
Which drug will be administered to a patient being admitted with severe digoxin intoxication?
Digoxin immune Fab (Digibind)
When assessing a patient with a possible MI, what should the nurse assess for? (Select all that apply.)
Hypertension Pallor Diaphoresis Cardiac rhythm changes
The nurse instructs the patient to avoid the sudden discontinuation of beta-adrenergic blockers so as to avoid which symptom?
Increased angina
Which is the mechanism of action demonstrated by exercise in managing blood glucose levels?
Increased muscle mass and less fat tends to normalize blood glucose levels because glucose is used by muscle cells when exercising.
Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?
Injectable lidocaine without preservative
Which is true about postural hypotension during therapy with direct vasodilators?
It gradually resolves with continued medication use.
Which statement is true regarding the pain associated with angina?
It is highly variable in intensity and location.
The nurse would expect to assess which serum potassium level in a patient who has severe vomiting and diarrhea?
Less than 3.5 mEq/L
What is the most critical approach to the treatment of metabolic syndrome?
Lifestyle management
The nurse is treating a patient who had a pacemaker inserted 8 years ago for the correction of atrial fibrillation. Which diagnostic test may no longer be available to the patient because of this older model implanted device?
MRI
The nurse caring for a patient recovering from a myocardial infarction (MI) teaches which method to avoid the Valsalva's maneuver during a bowel movement?
Mouth breathing
The nurse is performing a head-to-toe assessment on a resident in a long-term care facility with a history of angina pectoris. When assessing peripheral perfusion, the nurse will perform which intervention(s)? (Select all that apply.)
Note any loss of hair on lower legs. Check pedal pulses.
A patient with a body mass index (BMI) of 25 would be considered to be in which weight category?
Over weight
The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot?
Pain, which would be a positive Homans' sign
The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention?
Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema.
A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
Protamine sulfate
The nurse outlines which of the following as conditions that would disqualify a candidate for a heart transplant? (Select all that apply)
Recent malignancy. Peptic ulcer disease Severe obesity
An older adult male patient with long-term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John's wort. What results with the use of this herbal supplement?
Reduced therapeutic benefits of digoxin
How does propranolol (Inderal) control hypertension?
Reduces the sympathetic stimulation in cardiac muscle
Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.)
Review of the digoxin blood level Review of serum electrolytes, liver, and kidney function studies Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight
What is the major cause of cardiac valve disease?
Rheumatic fever
What is the second step in the path of blood through the coronary circulation?
Right atrium
What is the difference between primary and secondary hypertension?
Secondary hypertension is caused by another disorder like renal disease.
Which patient assessment would alert the nurse to withhold a loop diuretic?
Serum potassium of 2.6 mEq/L
Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?
Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes.
What is mean arterial pressure (MAP)?
The average pressure throughout each cycle of the heartbeat
The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take?
The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take?
The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times?
The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times?
The nurse is explaining to a patient how ACE inhibitors affect blood pressure. Which statement accurately describes the action of these medications?
They inhibit vasoconstriction.
What do dark or "cold" spots on a thallium scan indicate?
Tissue that has inadequate perfusion
The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply.)
Using mittens in cold weather Practicing stress-reducing techniques Complete smoking cessation Using caution when cleaning the refrigerator or freezer
What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient?
Walk 2 miles in less than 60 minutes after 12 weeks.
When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta-adrenergic blocker?
Wheezing
Prior to the administration of a beta-adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action?
Withhold the medication and notify the health care provider.
A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation. The physician orders dofetilide (Tikosyn). Before initiating this medication, the nurse will
assess potassium level.
The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for:
cessation of smoking.
The patient has been hospitalized for hypertensive episodes three times in the last months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse's immediate course of action would be to:
collect more information to identify his reasons for noncompliance.
A 37-year-old male presents at the emergency department reporting severe vomiting for the past 48 hours. When assessing skin turgor, the nurse will
gently pinch the skin together over the sternum.
The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause:
heart failure
The nurse encourages the patient who is recovering from a myocardial infarct (MI) to ask the health care provider to prescribe a cardiac rehabilitation series in order to learn to: (Select all that apply.)
improve stamina. strengthen muscles. reduce risk of further problems. understand heart condition.
The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can:
increase the action of the Coumadin.
The nurse would assess closely for signs of right-sided heart failure which include: (Select all that apply.)
increasing abdominal girth. edema of feet and ankles. distended jugular veins.
The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having:
indigestion
After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of:
infective endocarditis.
The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of:
moderate heart failure.
The nurse is aware that the muscle layer of the heart, which is responsible for the heart's contraction, is the:
myocardium.
Which instruction by the nurse is accurate to include in a patient's care to manage metabolic syndrome?
reduce stress