Module 6: Nursing Care of Patients with Disorders of the Cardiovascular & Hematological System
The term heart failure indicates myocardial disease True False
True The term heart failure indicates myocardial disease in which impaired contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction) may cause pulmonary or systemic congestion.
Atherosclerotic lesions are of two types: fatty streaks and fibrous plaque. True False
True True: Atherosclerotic lesions are of two types: fatty streaks and fibrous plaque. Fatty streaks are yellow and smooth, fibrous plaques are composed of smooth muscle cells, collagen fibers, plasma components, and lipids
Which of the following are attractive for many patients with PAD as they may not have access to a supervised exercise program? Intermittent walking exercise programs Unsupervised walking exercise programs Physical therapy in a hospital setting Bed rest
Unsupervised walking exercise programs Unsupervised walking exercise programs are attractive for many patients with PAD as they may not have access to a supervised exercise program, their insurance will not cover a supervised exercise program, or they like the independence that an unsupervised program gives them.
Signs and symptoms of a blood ____________ reaction include fever, chills, respiratory distress, low back pain, nausea, pain at the IV site, or anything "unusual."
transfusion
The hallmark symptom of peripheral arterial occlusive disease is intermittent claudication, described as which of the following? Select all that apply. Aching Weakness Intermittent bursts of energy Activity intolerance Cramping
Aching Weakness Activity intolerance Cramping The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest.
Which medication route should the nurse utilize to administer an antihemophilic agent to the client with hemophilia following a motor vehicle accident? Oral IV Rectal Sublingual
All antihemophilic agents are administered IV and are not available for administration by oral, rectal, topical, or sublingual route.
___________ may induce a platelet disorder
Aspirin
Which of the following medications may induce a platelet disorder? Coumadin Acetaminophen Ibuprofen Aspirin
Aspirin Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion.
Atherosclerosis involves a process affecting the intima of large and medium-sized arteries. These changes consist of which of the following? Select all that apply. accumulation of proteins accumulation of lipids accumulation of carbohydrates accumulation of calcium
Atherosclerosis involves a different process, affecting the intima of large and medium-sized arteries. These changes consist of the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery. These accumulations are referred to as atheromas or plaques.
Which of the following Hepatitis can cause thrombocytopenia? A or C B or C A or B
B or C
The definitive method of establishing the diagnosis of iron deficiency anemia is by which of the following? Bone marrow aspiration iron level Hematocrit Hemoglobin
Bone marrow aspiration
The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest. The pain commonly occurs in muscle groups positioned in which of the following to the area of stenosis or occlusion? distal posterior proximal anterior
Distal
Patients with platelet dysfunction may not be at risk for significant bleeding after trauma or invasive procedures (e.g., biopsy, dental extraction). True False
False
A focused physical assessment and measurement of baseline vital signs and fluid status are important before transfusing any blood product. False True
False A systematic physical assessment and measurement of baseline vital signs and fluid status are important before transfusing any blood product.
Anemia is the most common hematologic condition affecting younger patients, particularly those admitted to hospitals. True False
False Anemia is the most common hematologic condition affecting older patients, particularly those admitted to hospitals or in long-term care facilities.
Blood pressure is the product of cardiac output added with peripheral resistance. False True
False Blood pressure is the product of cardiac output multiplied by peripheral resistance. Cardiac output is the product of the heart rate multiplied by the stroke volume. Each time the heart contracts, pressure is transferred from the contraction of the heart muscle to the blood and then pressure is exerted by the blood as it flows through the blood vessels.
Corticosteroids are administered to cure underlying disease processes. False True
False Corticosteroids are administered to control symptoms but do not cure underlying disease processes.
Researchers estimate that genetics play a role in explaining blood pressure variation between individuals in 5% to 10% of cases True False
False Researchers estimate that genetics play a role in explaining blood pressure variation between individuals in 30% to 70% of cases
Which type of anemia results from red blood cell destruction? Bleeding Iron Deficiency Hemolytic Hypoproliferative
Hemolytic- Results from RBC Destruction
Which of the following describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? Hypertensive emergency Hypertensive urgency Prehypertension Chronic hypertension
Hypertensive urgency
______________ deficiency anemia typically results when the intake of dietary iron is inadequate for hemoglobin synthesis.
Iron
Which of the following studies are performed on the initial evaluation to determine anemia? Select all that apply. Iron Studies Arterial Blood Gas Vitamin B12 and folate Hemoglobin Hematrocrit
Iron Studies Vitamin B12 and folate Hemoglobin Hematrocrit In an initial evaluation, the hemoglobin, hematocrit, reticulocyte count, and RBC indices, particularly the mean corpuscular volume (MCV) and red cell distribution width (RDW), are especially useful. Other tests include haptoglobin and erythropoietin levels. The remaining complete blood count (CBC) values are useful in determining whether the anemia is an isolated problem or part of another hematologic condition, such as leukemia or myelodysplastic syndrome (MDS). Bone marrow aspiration may be performed. In addition, other diagnostic studies may be performed to determine the presence of underlying chronic illness, such as malignancy, or the source of any blood loss, such as polyps or ulcers within the gastrointestinal (GI) tract.
Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as? Select all that apply. Kidneys Skin Lungs Heart
Kidneys Heart Lungs Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The typical outcomes of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, chronic kidney disease, strokes, and impaired vision.
Lifestyle recommendations for patients with heart failure include which of the following? Select all that apply. regular exercise avoidance of smoking restriction of dietary carbohydrates weight reduction when indicated
Lifestyle recommendations include restriction of dietary sodium; avoidance of smoking, including passive smoke; avoidance of excessive fluid and alcohol intake; weight reduction when indicated; and regular exercise.
Thrombocytopenia means which of the following? No impact on the platelet level stable platelet level High platelet level low platelet level
Low platelet level Thrombocytopenia (low platelet level) can result from various factors: decreased production of platelets within the bone marrow, increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation).
Atherosclerosis includes which of the modifiable risk factors? Select all that apply. Increasing age Nicotine use Hypertension Sedentary lifestyle
Modifiable Risk Factors Nicotine use (i.e., tobacco product such as cigarettes, e-cigarettes, or chewing tobacco) Diet (contributing to hyperlipidemia) Hypertension Diabetes (speeds the atherosclerotic process by thickening the basement membranes of both large and small vessels) Hyperlipidemia Stress Sedentary lifestyle Elevated C-reactive protein Hyperhomocysteinemia Non-modifiable Risk Factors Increasing age Female gender Familial predisposition/genetics
Iron supplements should be taken in which of the following ways? With meals On an empty stomach one hour before or two hours after a meal On a full stomach 1 hour after a meal On an empty stomach 2 hours before meals
On an empty stomach one hour before or two hours after a meal Because iron is best absorbed on an empty stomach, the patient is instructed to take the supplement an hour before meals. Most patients can use the less expensive, more standard forms of ferrous sulfate. Many patients have difficulty tolerating iron supplements because of GI side effects (primarily constipation, but also cramping, nausea, and vomiting). Decreasing the frequency of taking iron supplements, or taking with food can mitigate the GI symptoms, but will diminish absorption of the iron; thus, it may take longer to replete the iron stores
Blood pressure is the product of cardiac ________ multiplied by peripheral resistance.
Output
The diagnosis of which of the following may be made using CW Doppler and ABIs, treadmill testing for claudication, duplex ultrasonography, or other imaging studies? Systemic arterial occlusive disease Myocardial Infarction Cerebral Vascular Accident Peripheral arterial occlusive disease
Peripheral arterial occlusive disease
ITP interefers with which function? RBC Plasma Platelet WBC
Platelet Primary ITP is defined as a platelet count less than 100 × 109/L with an inexplicable absence of a cause for thrombocytopenia (Neunert, 2013). ITP is an autoimmune disorder characterized by a destruction of normal platelets by an unknown stimulus.
Which of the following is considered to be the prototype corticosteroid? Cortisone Dexamethasone Prednisone Hydrocortisone
Predisone
95% of patients with high blood pressure have this form of hypertension? Tertiary Primary Secondary Generic
Primary About 95% of patients with high blood pressure have primary hypertension (also called essential hypertension), which is defined as high blood pressure from an unidentified cause. The remaining small percentage, about 5%, have secondary hypertension
Patients with platelet dysfunction may be at risk for which of the following after trauma or invasive procedures (e.g., biopsy, dental extraction)? Significant pain Significant swelling Significant bleeding Significant loss of consciousness
Significant bleeding Patients with platelet dysfunction may be at risk for significant bleeding after trauma or invasive procedures (e.g., biopsy, dental extraction).
The following steps are taken to determine the type and severity of the reaction: ______________ the transfusion, Assess the patient carefully, Notify the primary provider, Notify the blood bank and Send the blood container and tubing to the blood bank.
Stop
Which of the following steps are taken to determine the type and severity of the reaction? Select all that apply. Notify the blood bank Assess the patient carefully Stop the transfusion Notify the primary provider of the assessment findings Hold the blood container and tubing on the unit
Stop the transfusion. Maintain the IV line with normal saline solution through new IV tubing, given at a slow rate. Assess the patient carefully. Compare the vital signs with baseline, including oxygen saturation. Assess the patient's respiratory status carefully. Note the presence of adventitious breath sounds; the use of accessory muscles; extent of dyspnea; and changes in mental status, including anxiety and confusion. Note any chills, diaphoresis, jugular vein distention, and reports of back pain or urticaria. Notify the primary provider of the assessment findings, and implement any treatments prescribed. Continue to monitor the patient's vital signs and respiratory, cardiovascular, and renal status. Notify the blood bank that a suspected transfusion reaction has occurred. Send the blood container and tubing to the blood bank for repeat typing and culture. The patient's identity and blood component identifying tags and numbers are verified.
Which laboratory level is a key diagnostic indicator of Heart Failure? BUN CBC Creatinine BNP
The BNP level is a key diagnostic indicator of HF; high levels are a sign of high cardiac filling pressure and can aid in both the diagnosis and management of HF
The diagnosis of peripheral arterial occlusive disease may be made using which of the following? Select all that apply. Treadmill testing for claudication ABIs CW Doppler X-ray Duplex ultrasonography
The diagnosis of peripheral arterial occlusive disease may be made using CW Doppler and ABIs, treadmill testing for claudication, duplex ultrasonography, or other imaging studies.
The most common direct results of atherosclerosis in arteries include which of the following? Select all that apply. obstruction by thrombosis aneurysm narrowing (stenosis) of the lumen necrosis
The most common direct results of atherosclerosis in arteries include narrowing (stenosis) of the lumen, obstruction by thrombosis, aneurysm, ulceration, and rupture.
The patient with ITP is instructed to avoid all agents that interfere with platelet function, including herbal therapies and OTC medications. The patient should avoid which of the following? Select all that apply. the Valsalva maneuver Prescription medications constipation herbal therapies vigorous flossing of the teeth
The patient with ITP is instructed to avoid all agents that interfere with platelet function, including herbal therapies and OTC medications. The patient should avoid constipation, the Valsalva maneuver (e.g., straining at stool), and vigorous flossing of the teeth. Electric razors should be used for shaving, and soft-bristled toothbrushes should replace stiff-bristled ones.
Thrombocytopenia (low platelet level) can result from which of the following factors? Select all that apply. increased consumption of platelets decreased production of platelets within the bone marrow increased destruction of platelets Increased production of platelets within the bone marrow decreased consumption of platelets
Thrombocytopenia (low platelet level) can result from various factors: decreased production of platelets within the bone marrow increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation).
Aspirin may induce a platelet disorder. True False
True
In the case of vitamin B12 deficiency, faulty absorption from the GI tract is more common in the older adult. True False
True
Like endogenous glucocorticoids, exogenous corticosteroids act at the cellular level by binding to drug receptors in target tissues. False True
True
Medications including pentoxifylline, cliostazol, aspirin, clopidogrel, and statins are used to manage intermittent claudication associated with peripheral arterial occlusive disease. True False
True
Megaloblastic anemias develop slowly (over months) and thus the body can compensate well for a long time. True False
True
Normally, the GI tract absorbs 1 to 2 mg of iron daily, but in those with hereditary hemochromatosis, this rate increases significantly. True False
True
Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. True False
True
Suppression of the HPA axis may occur with corticosteroid therapy and may lead to life-threatening inability to increase cortisol secretion when needed to cope with stress. False True
True
The G-6-PD gene is the source of the abnormality in Thalassemias. False True
True
The diagnosis of peripheral arterial occlusive disease may be made using CW Doppler and ABIs, treadmill testing for claudication, duplex ultrasonography, or other imaging studies. False True
True
The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest. False True
True
The nurse is caring for a client who has had a blood pressure reading of 148/95 for the past three visits to the clinic. This client is in stage 1 hypertension. True False
True
The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. True False
True
Most often, HF is a chronic, progressive condition that is managed with lifestyle changes and medications to prevent episodes of acute decompensated heart failure True False
True Most often, HF is a chronic, progressive condition that is managed with lifestyle changes and medications to prevent episodes of acute decompensated heart failure.
Patients with chronic alcoholism are more prone to anemia. True False
True Patients with chronic alcoholism or who take aspirin, steroids, or nonsteroidal anti-inflammatory drugs (NSAIDs) often have chronic blood loss from the GI tract, which causes iron loss and eventual anemia.
In many situations, ______________ anemia occurs when a medication or chemical is ingested in toxic amounts. However, in a few people, it develops after a medication has been taken at the recommended dosage.
aplastic
A systematic physical assessment and measurement of baseline vital signs and fluid status are important before transfusing any ______________ product.
blood
Suppression of the HPA axis may occur with corticosteroid therapy and may lead to life-threatening inability to increase ________________ secretion when needed to cope with stress.
cortisol
Systemic clinical manifestations of Right Sided Heart Failure include which of the following? Select all that apply. dependent edema orthopnea weight gain due to retention of fluid hepatomegaly
dependent edema weight gain due to retention of fluid hepatomegaly Systemic clinical manifestations of Right Sided Heart Failure include edema of the lower extremities (dependent edema), hepatomegaly (enlargement of the liver), ascites (accumulation of fluid in the peritoneal cavity), and weight gain due to retention of fluid.
Common physical manifestations for Immune Thrombocytopenic Purpura are which of the following? Select all that apply. Petechiae on the extremities Heavy menses Petechiae on the trunk Headache Easy bruising
easy bruising heavy menses petechiae on the extremities petechiae on the trunk
Signs and symptoms of a blood transfusion reaction include which of the following? Select all that apply. Respiratory distress nausea chills fever Upper back pain
fever chills respiratory distress low back pain nausea pain at the IV site anything "unusual."
Which of the following has the hallmark described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest? Sickle cell anemia intermittent claudication Chest pain Remittent claudication
intermittent claudication The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest.
Continuous monitoring in the post-operative period includes? Select all that apply. mental status pulse rate PO intake central venous pressure urine output
mental status pulse rate central venous pressure urine output Continuous monitoring of urine output, central venous pressure, mental status, and pulse rate and volume permits early recognition and treatment of fluid imbalances. Bleeding can result from the heparin given during surgery or from an anastomotic leak. A hematoma may form as well.
Which of the following medication are used in the treatment of Hypertensive crisis? Select all that apply. nitroglycerin Glyburide (Glynase) clevidipine (Cleviprex) nicardipine (Cardene)
nitroglycerin clevidipine (Cleviprex) nicardipine (Cardene) The medications of choice in hypertensive emergencies are those that have an immediate effect. Intravenous vasodilators, including sodium nicardipine (Cardene), clevidipine (Cleviprex), enalaprilat (Vasotec), and nitroglycerin have immediate actions that are short-lived (minutes to 4 hours), and they are therefore frequently used for initial treatment.
If platelet dysfunction is marked, bleeding can often be prevented by transfusion of normal _____________ before invasive procedures.
platelets
The _____________ objective in the postoperative period is to maintain adequate circulation through the arterial repair.
primary
Patients with platelet dysfunction may be at risk for ____________ bleeding after trauma or invasive procedures (e.g., biopsy, dental extraction).
significant
Which of the following assessments, along with the measurement of baseline vital signs and fluid status are important before transfusing any blood product? systematic biometric assessment Focused biometric assessment Focused physical assessment out this way systematic physical assessment
systematic physical assessment
Corticosteroids are administered to control symptoms but do not cure underlying disease processes. False True
True
Case Study Mark Ilescu is a 44-year-old client who has been diagnosed with primary hypertension. His medical history includes type 1 diabetes mellitus, with early signs of nephropathy. He had a myocardial infarction 2 years ago and has been treated with a beta-blocker, metoprolol, since that time. He has been taking hydrochlorothiazide in addition to the beta-blocker to treat his hypertension. His blood pressure today is 138/92 mm Hg, which is consistent with the readings on his last three visits. His physician has added captopril to his treatment regimen. 1. Mark states that he does not understand why he needs an additional medication considering his blood pressure is below 140 mm Hg systolic. How should the nurse respond? 2. Discuss the rationale for choosing captopril in Mark's case. 3. What should the nurse include in teaching Mark in order to minimize adverse effects of the captopril and metoprolol?
1. The nurse should explain that, although hypertension is usually defined as a systolic blood pressure above 140 mm Hg, the goal for clients with diabetes is a systolic blood pressure below 130 mm Hg and a diastolic below 80 mm Hg. The nurse should stress the importance of managing hypertension because uncontrolled hypertension can lead to increased cardiac workload and heart failure, decreased blood supply to the tissues, risk of thrombosis, and damage to the heart, brain, kidneys, and eyes. 2. In clients with diabetes, ACE inhibitors decrease proteinuria and slow the development of nephropathy. Mark has a history of diabetes and is showing early signs of nephropathy, thus the choice of captopril, an ACE inhibitor. 3. ACE inhibitors can cause a persistent cough and hyperkalemia, so the nurse should instruct Mark to observe for symptoms of hyperkalemia and should ensure that he is not taking potassium supplements. His potassium level should be monitored periodically. ACE inhibitors can cause hypotension, which can be managed by starting with a low dose and taking the drug at bedtime. Blood pressure and pulse should be assessed on an ongoing basis with initial dosage adjustments and intermittently during therapy. His diuretic, hydrochlorothiazide, may need to be held until the response to the captopril is determined. Beta-blockers can cause bradycardia, so Mark should be instructed to monitor his heart rate and notify the physician if it drops below 60 beats per minute. He should be instructed to avoid abrupt withdrawal of the beta-blocker because he has a history of myocardial infarction (MI); abrupt withdrawal in this situation has been associated with angina, ventricular dysrhythmias, and MI.
Case Study Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, chronic renal insufficiency, and hypertension. She suffered a myocardial infarction due to coronary artery disease 5 years ago. She was diagnosed with heart failure 1 year ago and has been managed with a diuretic and an ACE inhibitor. Six months ago, she developed an arrhythmia and was placed on quinidine. Over the past 2 months, her heart failure symptoms have been increasing in severity, with dyspnea and ankle edema occurring at rest or with minimal exertion. Digoxin is now being added to her heart failure treatment regimen. 1. The nurse is teaching Ms. Cook about the digoxin. What should the nurse teach Ms. Cook regarding digoxin toxicity? 2. Describe the factors that increase Ms. Cook's risk for digoxin toxicity. 3. Ms. Cook's symptoms continue to increase over the next month, and she is hospitalized for treatment of acute heart failure. She is given IV nesiritide along with an IV loop diuretic and digoxin. Discuss some of the nursing considerations related to the administration of the nesiritide.
1. The nurse should explain to Ms. Cook that digoxin has a narrow therapeutic index, so doses that are sufficient to produce therapeutic effects may also produce toxicity. Ms. Cook should be aware of signs and symptoms of toxicity, which include changes in her heart rhythm, nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes. She should be instructed to stop taking the digoxin and notify her physician immediately if she notices these symptoms. She should be instructed to eat a diet rich in potassium or to take potassium supplements regularly (if prescribed) because hypokalemia will predispose her to developing toxicity. Factors that increase Ms. Cook's risk for digoxin toxicity include her history of renal insufficiency because digoxin is excreted by the kidneys. Hypokalemia, hypothyroidism, and the quinidine that she is taking can all predispose her to toxicity. 2. The nesiritide must be given in a separate IV line since it has multiple drug incompatibilities. The client should be instructed to report pain at the injection site. Hemodynamic monitoring of her pulmonary artery pressure is indicated. The nurse should carefully monitor Ms. Cook's potassium level because she is being given IV loop diuretics along with the digoxin. The nurse should monitor Ms. Cook's blood pressure and heart rate because nesiritide decreases preload and afterload. Urinary output should be monitored as well because diuresis is a desired effect of the drug. The nurse should monitor Ms. Cook for edema, dyspnea, fatigue, and other symptoms of heart failure along with her vital signs and hemodynamic monitoring indices in order to evaluate the effect of the treatment. 3. Additionally, the client should report any numbness or tingling, shortness of breath, or chest pain. The nurse should instruct Ms. Cook that bed rest must be maintained so she must call for assistance with toileting.
Which of the following have defined the standards for blood pressure measurement, including conditions required before measurements are made, equipment specifications, and techniques for measuring blood pressure to obtain accurate and reliable readings? IHS and SHA ASH and ISH ASH and HSA HSA and HSI
ASH and ISH The ASH and ISH have defined the standards for blood pressure measurement, including conditions required before measurements are made, equipment specifications, and techniques for measuring blood pressure to obtain accurate and reliable readings (Coogan, Marra, & Lomonaco, 2015; Weber et al., 2014)
Like endogenous glucocorticoids, exogenous corticosteroids act at the __________ level by binding to drug receptors in target tissues. Protein Plasma Molecular Cellular
Cellular Like endogenous glucocorticoids, exogenous corticosteroids act at the cellular level by binding to drug receptors in target tissues.
Match the following therapeutic communication techniques with the correct definition. Acute Hemolytic Reaction Delayed hemolytic reactions Bacterial Contamination Febrile nonhemolytic reaction Transfusion-Related Acute Lung Injury (TRALI) Allergic Reaction Transfusion-Associated Circulatory Overload (TACO)
Acute - the most dangerous and potentially life-threatening Delayed - Usually occur within 14 days after transfusion Bacterial contamination - is very low but can put pt at risk when using contaminated products Febrile - Caused by antibodies Transfusion-Related - is a potentially fatal, idiosyncratic reaction Allergic reaction - some patients develop urticaria Transfusion-associated - if too much blood is infused too quickly, hypovolemia can occur
The most common disease of the arteries is which of the following? Arteriolosclerosis Arteriosclerosis Arteriolersclerosis Atherosclerosis
Arteriosclerosis (hardening of the arteries) is the most common disease of the arteries.
Hemolytic anemia is a rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat. True False
False Aplastic anemia is a rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat.
Cortisone is considered to be the prototype corticosteroid. False True
False Prednisone is considered to be the prototype corticosteroid.
Suppression of the HPA axis may occur with corticosteroid therapy and may lead to life-threatening inability to decrease cortisol secretion when needed to cope with stress. True False
False Suppression of the HPA axis may occur with corticosteroid therapy and may lead to life-threatening inability to increase cortisol secretion when needed to cope with stress.
Thalassemias are classified into two major groups according to which hemoglobin chain is diminished: alpha or omega. True False
False Thalassemias are classified into two major groups according to which hemoglobin chain is diminished: alpha or beta.
ASH & HSA have defined the standards for blood pressure measurement, including conditions required before measurements are made, equipment specifications, and techniques for measuring blood pressure to obtain accurate and reliable readings True False
False The ASH and ISH have defined the standards for blood pressure measurement, including conditions required before measurements are made, equipment specifications, and techniques for measuring blood pressure to obtain accurate and reliable readings (Coogan, Marra, & Lomonaco, 2015; Weber et al., 2014)
The destruction of red blood cells is known as hypoproliferation. True False
False The destruction of red blood cells is known as Hemolysis.
Which of the following describe the most common or potentially severe transfusion-related complications? Select all that apply. Acute Hemolytic Reaction Non-bacterial Contamination Febrile nonhemolytic reaction Transfusion-Associated Circulatory Overload (TACO) Allergic Reaction
Febrile nonhemolytic reaction Acute Hemolytic Reaction Allergic Reaction Transfusion-Associated Circulatory Overload (TACO) Bacterial Contamination Transfusion-Related Acute Lung Injury (TRALI) Delayed hemolytic reactions
The patient with which of the following is instructed to avoid all agents that interfere with platelet function, including herbal therapies and OTC medications. The patient should avoid constipation, the Valsalva maneuver (e.g., straining at stool), and vigorous flossing of the teeth. Electric razors should be used for shaving, and soft-bristled toothbrushes should replace stiff-bristled ones? ITP RA CVA MI
ITP
Which of the following are indications for corticosteroid use? Select all that apply. Psoriasis Multiple Sclerosis Pernicious anemia Idiopathic thrombocytopenic purpura Hemolytic anemia
Idiopathic thrombocytopenic purpura Hemolytic anemia
The objectives of guideline-directed patient management include which of the following? Select all that apply. Stabilize cardiac function without pharmacologic management Promotion of a lifestyle conducive to cardiac health Delay of the progression of HF and extension of life expectancy Reduction of symptoms and improvement of functional status
Improvement of cardiac function with optimal pharmacologic management Reduction of symptoms and improvement of functional status Stabilization of patient condition and lowering of the risk of hospitalization Delay of the progression of HF and extension of life expectancy Promotion of a lifestyle conducive to cardiac health
Which of the following is considered to be the primary mode of treating iron deficiency anemia? Oral iron supplementation Bone marrow aspiration Blood transfusion Intravenous iron infusion
Oral iron supplementation
Left-sided heart failure (left ventricular failure) causes different manifestations than right-sided heart failure (right ventricular failure). True False
True Left-sided heart failure (left ventricular failure) causes different manifestations than right-sided heart failure (right ventricular failure). In chronic HF, patients may have signs and symptoms of both left and right ventricular failure.
Match the following action to the rationale when attempting to determine the type and severity of the reaction. Stop the transfusion) Notify the primary provider of the assessment findings Assess the patient carefully Notify the blood bank Send the blood container and tubing to the blood bank
Stop the transfusion - Maintain the IV line with normal saline solution Notify the PP - Implement any treatments prescribed Assess - Compare vital signs with baseline Notify the blood bank - That a suspected transfusion reaction has occurred Send the blood container - for repeat typing and culture
The medications used for treating hypertension decrease which of the following? Select all that apply Strength and rate of myocardial contraction Prehypertension Renal Function Blood volume
Strength and rate of myocardial contraction Blood volume The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction.
Which of the following are the two types of major types of chronic heart failure? Systemic and local HF Congestive and Pulmonic HF Systolic and diastolic HF Compensated and decompensated HF
Systolic and diastolic HF Two major types of HF are identified by assessment of left ventricular function, usually by echocardiogram. The most common type is an alteration in ventricular contraction called systolic heart failure, which is characterized by a weakened heart muscle. A second type is diastolic heart failure, which is characterized by a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill.
People who customarily are very active tend to have more pronounced symptoms than sedentary people. True False
True People who customarily are very active or who have significant demands on their lives (e.g., a single, working mother of small children) are more likely to have symptoms, and those symptoms are more likely to be pronounced than in more sedentary people.
Which of the following are must the nurse monitor for signs and symptoms as there are potential problems associated with heart failure related to the use of diuretics? Select all that apply. Hyperkalemia Nausea, Vomiting and diarrhea Prolonged diuretic therapy Volume depletion from excessive fluid loss
These problems require ongoing nursing assessment and collaborative intervention: Excessive and repeated diuresis can lead to hypokalemia (i.e., potassium depletion). Signs include ventricular dysrhythmias, hypotension, muscle weakness, and generalized weakness. In patients receiving digoxin, hypokalemia can lead to digitalis toxicity, which increases the likelihood of dangerous dysrhythmias. Patients with HF may also develop low levels of magnesium, which can add to the risk of dysrhythmias. Hyperkalemia may occur, especially with the use of ACE inhibitors, ARBs, or spironolactone. Hyperkalemia can also lead to profound bradycardia and other dysrhythmias. Prolonged diuretic therapy may produce hyponatremia (deficiency of sodium in the blood), which can result in disorientation, weakness, muscle cramps, and anorexia. Volume depletion from excessive fluid loss may lead to dehydration and hypotension. ACE inhibitors and beta-blockers may contribute to the hypotension. Other problems associated with diuretics include increased serum creatinine (indicative of renal dysfunction) and hyperuricemia (excessive uric acid in the blood), which leads to gout.
Which bleeding disorder can result from various factors: decreased production of platelets within the bone marrow, increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation)? Thrombocytopenia Hemophilia Immune Thrombocytopenic Purpura Quantitative platelet defects
Thrombocytopenia (low platelet level) can result from various factors: decreased production of platelets within the bone marrow, increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation).
Hemolysis is often mild and self-limited. However, in the more severe Mediterranean type of G-6-PD deficiency, spontaneous recovery may not occur. True False
True
Hepatitis B or C can cause thrombocytopenia; thus, the patient should be screened for these diseases. False True
True
The impact of even mild anemia on function in older adults is significant and may include decreased physical performance, decreased mobility, increased frailty, increased rates of depression, increased risk for falling, and delirium. True False
True
The thalassemias are a group of hereditary anemias characterized by hypochromia (an abnormal decrease in the hemoglobin content of erythrocytes). True False
True
Tranexamic acid also is used for short periods (2-8 days) in patients with hemophilia to prevent or decrease bleeding from tooth extraction or menorrhagia. True False
True
With vitamin b12 deficiency, if the deficiency is due to the more common defect in absorption or the absence of intrinsic factor, replacement is by monthly intramuscular injections of vitamin B12. True False
True
Which of the following identify treatment goals of pharmacological therapy to treat peripheral arterial occlusive disease? Select all that apply. Improve symptoms of intermittent claudication. Improve endothelial function. Decrease blood glucose levels. Increase blood pressure. Decrease platelet aggregation.
improve symptoms of intermittent claudication Improve endothelial function. Decrease platelet aggregation. beneficial effects on vascular inflammation, plaque stabilization, endothelial dysfunction, and thrombosis, and have been linked to decreased rates of repeat peripheral interventions, amputations, and major adverse cardiovascular events up to 3 years postprocedure (Armstrong et al., 2014).
