NU350: Ch 32, 33, 34, 37
The nurse obtains a blood pressure of 172/82 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
112 mm Hg MAP = (SBP + 2 DBP)/3
A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Reinforcement of teaching about the prescribed medications B. Evaluation of the patient's response to walking in the hallway C. Completion of the referral form for a home health nurse follow-up D. Education of the patient about the pathophysiology of heart disease
A
A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action should the nurse take first? A. Give PRN IV morphine sulfate 4 mg. B. Give PRN IV diazepam (Valium) 2.5 mg. C. Increase nitroglycerin infusion by 5 mcg/min. D. Increase dopamine infusion by 2 mcg/kg/min.
A
A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? A. Generalized muscle aches and pains B. Dizziness with rapid position changes C. Nausea when taking the drugs before meals D. Flushing and pruritus after taking the drugs
A
A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? A. Tadalafil (Cialas) B. Furosemide (Lasix) C. Warfarin (Coumadin) D. Diltiazem (Cardizem)
A
After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? A. "What do you think caused your chest pain?" B. "Where are you planning to go for your vacation?" C. "Sometimes plans need to change after a heart attack." D. "Recovery from a heart attack takes at least a few weeks."
A
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? A. "I will sit down before I put the nitroglycerin under my tongue." B. "I will check my pulse rate before I take any nitroglycerin tablets." C. "I will put the nitroglycerin patch on as soon as I get any chest pain." D. "I will remove the nitroglycerin patch before taking sublingual nitroglycerin."
A
Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of: A. asthma. B. daily alcohol use. C. peptic ulcer disease. D. myocardial infarction (MI).
A
The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? A. Serum creatinine of 2.8 mg/dL B. Serum potassium of 4.5 mEq/L C. Serum hemoglobin of 14.7 g/dL D. Blood glucose level of 96 mg/dL
A
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? A. 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain B. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication C. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL D. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria.
A
When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? A. Attach the heart monitor. B. Obtain the blood pressure. C. Assess the peripheral pulses. D. Auscultate the breath sounds
A
Which action by the patient with newly diagnosed Raynaud's phenomenon best demonstrates that the nurse's teaching about managing the condition has been effective? A. The patient exercises indoors during the winter months. B. The patient immerses hands in hot water when they turn pale. C. The patient takes pseudoephedrine (Sudafed) for cold symptoms. D. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).
A
Which action should the nurse include in the plan of care for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? A. Monitor blood pressure frequently. B. Encourage patient to ambulate in room. C. Teach patient to drink at least D. 3 liters of fluid daily. Titrate nesiritide dose down slowly before stopping.
A
Which action should the nurse take first to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? A. Collect a detailed diet history. B. Provide a list of low-sodium foods. C. Help the patient make an appointment with a dietitian. D. Teach the patient about foods that are high in potassium.
A
Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? A. O2 saturation of 88% B. Weight gain of 1 kg (2.2 lb) C. Heart rate of 106 beats/min D. Urine output of 50 mL over 2 hours
A
Which group of drugs will the nurse plan to include when teaching a patient who has a new diagnosis of peripheral artery disease (PAD)? A. Statins B. Antibiotics C. Thrombolytics D. Anticoagulants
A
A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest? A. O2 saturation drops from 99% to 95%. B. Heart rate increases from 66 to 98 beats/min. C. Respiratory rate goes from 14 to 20 breaths/min. D. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
B
A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse is best? A. "Most patients are able to enjoy intercourse without any complications." B. "Sexual activity uses about as much energy as climbing two flights of stairs." C. "The doctor will provide sexual guidelines when your heart is strong enough." D. "Holding and cuddling are good ways to maintain intimacy after a heart attack."
B
A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department. The patient reports a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings? A. "Have you recently taken any antihistamines?" B. "Have you consistently taken your medications?" C. "Did you take any acetaminophen (Tylenol) today?" D. "Have there been recent stressful events in your life?"
B
A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. What is the nurse's priority action? A. Teach the patient about restricting dietary sodium. B. Assess the patient for manifestations of acute heart failure. C. Ask the patient about the use of the prescribed medications. D. Have the patient recall the dietary intake for the past 3 days.
B
A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first? A. Tell the patient why a change in drug dosage is needed. B. Ask the patient if the medication is being taken as prescribed. C. Review with the patient any lifestyle changes made to help control BP. D. Teach the patient that multiple drugs are often needed to treat hypertension.
B
After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? A. Patient who is taking carvedilol (Coreg) and has a heart rate of 58. B. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L. C. Patient who is taking captopril and has a frequent nonproductive cough. D. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache.
B
After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first? A. A patient who reported dizziness after receiving the first dose of captopril. B. A patient who has new-onset confusion and restlessness and cool, clammy skin. C. A patient who is receiving oxygen and has crackles bilaterally in the lung bases. D. A patient who is receiving IV nesiritide (Natrecor), with a blood pressure of 100/62.
B
After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? A. Hyperglycemia B. Bilateral crackles C. Q waves on ECG D. Elevated troponin
B
An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse addresses that suspected cause of the hypertension? A. Instruct the patient about the need to decrease stress levels. B. Teach the patient how to self-monitor and record BPs at home. C. Tell the patient and caregiver that major dietary changes are needed. D. Schedule the patient for regular blood pressure (BP) checks in the clinic.
B
Several hours after a patient had an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 45 mL. What should the nurse anticipate will be prescribed? A. Hemoglobin count B. Increased IV fluids C. Additional antibiotics D. Serum creatinine level
B
The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). Which statement by the new nurse to the patient would require the charge nurse's intervention? A. "Make an appointment with the dietitian for teaching." B. "Increase your dietary intake of high-potassium foods." C. "Check your blood pressure at home at least once a day." D. "Move slowly when moving from lying to sitting to standing."
B
The nurse has just finished teaching a hypertensive patient about a newly prescribed drug, ramipril (Altace). Which patient statement indicates that more teaching is needed? A. "The medication may not work well if I take aspirin." B. "I can expect some swelling around my lips and face." C. "The doctor may order a blood potassium level occasionally." D. "I will call the doctor if I notice that I have a frequent cough."
B
The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute myocardial infarction? A. The pain increases with deep breathing. B. The pain has lasted longer than 30 minutes. C. The pain is relieved after the patient takes nitroglycerin. D. The pain is reproducible when the patient raises the arms.
B
The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? A. Urine output over 8 hours is 250 mL less than the fluid intake. B. The patient cannot move the left arm and leg when asked to do so. C. Tremors are noted in the fingers when the patient extends the arms. D. The patient reports a headache with pain at level 7 of 10 (0 to 10 scale).
B
The nurse is caring for a 70-yr-old patient who takes hydrochlorothiazide and enalapril (Norvasc). The patient's blood pressure (BP) continues to be high. Which patient information may indicate a need for a change? A. Patient takes a daily multivitamin tablet. B. Patient uses ibuprofen to treat osteoarthritis. C. Patient checks BP daily just after getting up. D. Patient drinks wine three to four times a week.
B
The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? A. Teach the patient about the postprocedure plan of care. B. Give the scheduled aspirin and lipid-lowering medication. C. Perform the initial assessment of the catheter insertion site. D. Titrate the heparin infusion according to the agency protocol.
B
The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). What should the nurse anticipate teaching the patient? A. Sudden cardiac death events rarely reoccur. B. Additional diagnostic testing will be required. C. Long-term anticoagulation therapy will be needed. D. Limiting physical activity will prevent future SCD events.
B
The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. What should teaching for this patient include today? A. Typical emotional responses to AMI B. When cardiac rehabilitation will begin C. Pathophysiology of coronary artery disease D. Information regarding discharge medications
B
The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). A. Which factor should the nurse focus on during the teaching session? B. Family history of coronary artery disease C. Elevated low-density lipoprotein (LDL) level D. Greater risk associated with the patient's gender E. Increased risk of cardiovascular disease with aging
B
The nurse is evaluating the discharge teaching outcomes for a patient with chronic peripheral artery disease (PAD). Which patient statement indicates a need for further instruction? A. "I will buy loose clothes that do not bind across my legs or waist." B. "I will use a heating pad on my feet at night to increase the circulation." C. "I will walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week." D. "I will change my position every hour and avoid long periods of sitting with my legs crossed."
B
The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed? A. "They will circulate my blood with a machine during surgery." B. "I will have incisions in my leg where they will remove the vein." C. "They will use an artery near my heart to go around the area that is blocked." D. "I will need to take aspirin every day after the surgery to keep the graft open."
B
The nurse obtains the following information from a patient newly diagnosed with elevated blood pressure. Which finding is most important to address with the patient? A. Low dietary fiber intake B. No regular physical exercise C. Drinks a beer with dinner every night D. Weight is 5 pounds above ideal weight
B
To improve the physical activity level for a mildly obese 68-year-old patient, which action should the nurse plan to take? A. Stress that weight loss is a major benefit of increased exercise. B. Determine what kind of physical activities the patient usually enjoys. C. Tell the patient that older adults should exercise for no more than 20 minutes at a time. D. Teach the patient to include a short warm-up period at the beginning of physical activity.
B
Which action should the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? A. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. B. Have the patient sit in a chair with the feet flat on the floor. C. Assist the patient to the supine position for BP measurements. D. Obtain two BP readings in the dominant arm and average the results.
B
Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)? A. Monitor heart rate. B. Ask about chest pain. C. Check blood pressure. D. Observe for dysrhythmias.
B
Which assessment finding for a patient receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? A. Blood glucose level of 175 mg/dL B. Serum potassium level of 3.0 mEq/L C. Orthostatic systolic BP decrease of 12 mm Hg D. Current blood pressure (BP) reading of 168/94 mm Hg
B
Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? A. Complaints of incisional chest pain B. Pallor and weakness of the right hand C. Fine crackles heard at both lung bases D. Redness on both sides of the sternal incision
B
Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension? A. 98/56 mm Hg B. 128/76 mm Hg C. 128/92 mm Hg D. 142/78 mm Hg
B
Which finding on a patient's nursing admission assessment is congruent with the initial medical diagnosis of a 6-cm thoracic aortic aneurysm? A. Low back pain B. Trouble swallowing C. Abdominal tenderness D. Changes in bowel habits
B
Which patient at the cardiovascular clinic requires the most immediate action by the nurse? A. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL. B. Patient with stable angina whose chest pain has recently increased in frequency. C. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL. D. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.
B
Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective? A. "Carvedilol will help my heart muscle work harder." B. "It is important not to suddenly stop taking the carvedilol." C. "I can expect to feel short of breath when taking carvedilol." D. "Carvedilol will increase the blood flow to my heart muscle."
B
Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)? A. Need to begin an aerobic exercise program several times weekly B. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors C. Use of salt substitutes to replace table salt when cooking and at the table D. Importance of making an annual appointment with the health care provider
B
A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate? A. "Your heart failure has not reached the end stage yet." B. "You could not manage the multiple complications of that surgery." C. "The suitability of a heart transplant for you depends on many factors." D. "Because you have diabetes, you would not be a heart transplant candidate."
C
A 62-yr-old patient who has no history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that: A. a BP recheck should be scheduled in a few weeks. B. dietary sodium and fat content should be decreased. C. diagnosis, treatment, and monitoring will be needed. D. there is danger of a stroke, requiring hospitalization.
C
A patient diagnosed with hypertension has been prescribed captopril. Which information is most important to teach the patient about this drug? A. Include high-potassium foods such as bananas in the diet. B. Increase fluid intake if dryness of the mouth is a problem. C. Change position slowly to help prevent dizziness and falls. D. Check the blood pressure in both arms before taking the drug.
C
A patient has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe. What should the nurse expect to find on assessment? A. Dilated superficial veins. B. Swollen, dry, scaly ankles. C. Prolonged capillary refill in all the toes. D. Serosanguineous drainage from the ulcer.
C
A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom? A. Assess both feet for pedal edema. B. Palpate the radial pulses bilaterally. C. Auscultate for a pericardial friction rub. D. Check the heart monitor for dysrhythmias.
C
A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first? A. Chest x-ray B. Troponin level C. Electrocardiogram (ECG) D. Insertion of a peripheral IV
C
A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? A. Auscultate the abdomen. B. Check the capillary refill. C. Auscultate the breath sounds. D. Ask about the patient's allergies.
C
A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" How should the nurse document this finding? A. Orthopnea B. Pulsus alternans C. Paroxysmal nocturnal dyspnea D. Acute bilateral pleural effusion
C
A patient who has heart failure has recently started taking digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider? A. Presence of 1+ to 2+ edema in the feet and ankles B. Palpable liver edge 2 cm below the ribs on the right side C. Serum potassium level 3.0 mEq/L after 1 week of therapy D. Weight increase from 120 pounds to 122 pounds over 3 days
C
A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Teach the patient the reasons for remaining on bed rest. B. Change the peripheral IV site according to agency policy. C. Monitor the patient's blood pressure and heart rate every hour. D. Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg.
C
A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? A. "Do you have any allergies?" B. "Do you take aspirin daily?" C. "What time did your pain begin?" D. "Can you rate the pain on a 0 to 10 scale?"
C
A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? A. Report of chest pain B. Heart rate 102 beats/min C. Pedal pulses 1+ bilaterally D. Blood pressure 103/54 mm Hg
C
A patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? A. "I plan to take the medication with food." B. "I should eat more potassium-rich foods." C. "I will call for help when I need to get up to use the bathroom." D. "I can expect to feel more short of breath for the next few days."
C
A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril? A. Decreases the heart rate. B. Controls blood glucose levels. C. Prevents changes in heart muscle. D. Reduces the frequency of chest pain.
C
A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication? A. Administer the medication at the patient's usual bedtime. B. Have the patient take the colesevelam 1 hour before breakfast. C. Give the patient's other medications 2 hours after colesevelam. D. Have the patient take the dose at the same time as the prescribed aspirin.
C
After the nurse teaches the patient with stage 1 hypertension about diet modifications, which diet choice indicates that the teaching has been most effective? A. The patient avoids eating nuts or nut butters. B. The patient restricts intake of chicken and fish. C. The patient drinks low-fat milk with each meal. D. The patient has two cups of coffee in the morning.
C
Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan? A. Reduces heart palpitations. B. Prevents coronary artery plaque. C. Decreases coronary artery spasms. D. Increases contractile force of the heart.
C
During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention? A. The patient's pulse has dropped from 68 to 57 beats/min. B. The patient reports that the fingers and toes feel quite cold. C. The patient has developed wheezes throughout the lung fields. D. The patient's blood pressure (BP) reading is now 158/92 mm Hg.
C
Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient? A. "Heparin enhances platelet aggregation at the plaque site." B. "Heparin decreases the size of the coronary artery plaque." C. "Heparin prevents the development of new clots in the coronary arteries." D. "Heparin dissolves clots that are blocking blood flow in the coronary arteries."
C
IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. Which reassessment finding during the first hours of administration indicates that the nurse should decrease the rate of nitroprusside infusion? A. Ventricular ectopy B. Dry, hacking cough C. Systolic BP below 90 mm Hg D. Heart rate below 50 beats/min
C
The nurse is administering a thrombolytic agent to a patient with an acute myocardial infarction. What patient data indicates that the nurse should stop the drug infusion? A. Bleeding from the gums B. An increase in blood pressure C. Decreased level of consciousness D. A nonsustained episode of ventricular tachycardia
C
The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? A. Weight loss of 2 lb in 24 hours B. Hourly urine output greater than 60 mL C. Reduced dyspnea with the head of bed at 30 degrees D. Patient denies experiencing chest pain or chest pressure
C
The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? A. The troponin level is elevated. B. The patient denies having a heart attack. C. Bilateral crackles in the mid-lower lobes. D. Occasional premature atrial contractions (PACs).
C
The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Which instruction should the nurse include? A. Limit dietary sources of potassium. B. Take the hydrochlorothiazide at bedtime. C. Notify the health care provider if nausea develops. D. Take the digoxin if the pulse is below 60 beats/min.
C
When teaching a patient with heart failure on a 2000-mg sodium diet, which foods should the nurse recommend limiting? A. Chicken and eggs B. Canned and frozen fruits C. Yogurt and milk products D. Fresh or frozen vegetables
C
Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol (Lopressor)? A. Patient is restless and agitated. B. Patient reports feeling anxious. C. Blood pressure is 90/54 mm Hg. D. Heart monitor shows normal sinus rhythm.
C
Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? A. Serum troponin B. Arterial blood gases C. B-type natriuretic peptide D. 12-lead electrocardiogram
C
Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider? A. Inverted P wave B. Sinus tachycardia C. ST-segment elevation D. First-degree atrioventricular block
C
Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? A. An increase in troponin levels from baseline B. A large bruise at the patient's IV insertion site C. No change in the patient's reported level of chest pain D. A decrease in ST-segment elevation on the electrocardiogram
C
Which information is most important for the nurse to include when teaching a patient newly diagnosed with hypertension? A. Most people are able to control BP through dietary changes. B. Annual BP checks are needed to monitor treatment effectiveness. C. Hypertension is usually asymptomatic until target organ damage occurs. D. Increasing physical activity controls blood pressure (BP) for most people.
C
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes? A. Inform the patient about a diet containing no saturated fat and minimal salt. B. Emphasize the increased cardiac risk unless the patient makes dietary changes. C. Help the patient modify favorite high-fat recipes by using monounsaturated oils. D. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.
C
While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." What should the nurse include in the discharge plan? A. Consult with a psychologist. B. Transfer to a long-term care facility. C. Referral to a home health care agency. D. Arrangements for around-the-clock care.
C
While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate? A. Decreased fluid volume B. Jugular vein atherosclerosis C. Increased right atrial pressure D. Incompetent jugular vein valves
C
A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? A. Anxiety B. Acute pain C. Stress management D. Decreased cardiac output
D
A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." What focused assessment should the nurse make? A. Look for the presence of tortuous veins bilaterally on the legs. B. Ask about any skin color changes that occur in response to cold. C. Assess for unilateral swelling, redness, and tenderness of either leg. D. Palpate for the presence of dorsalis pedis and posterior tibial pulses.
D
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI? A. Myoglobin B. Homocysteine C. C-reactive protein D. Cardiac-specific troponin
D
A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? A. captopril (Capoten) 25 mg B. furosemide (Lasix) 60 mg C. digoxin (Lanoxin) 0.125 mg D. carvedilol (Coreg) 3.125 mg
D
After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? A. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. B. A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). C. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. D. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).
D
An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. After the nurse notifies the health care provider, what should the nurse do next? A. Apply a compression stocking to the leg. B. Elevate the leg above the level of the heart. C. Assist the patient in gently exercising the leg. D. Keep the patient in bed in the supine position.
D
An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? A. + bilateral pedal edema B. Heart rate of 52 beats/min C. Report of increased fatigue D. Blood pressure (BP) of 88/42 mm Hg
D
Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. What medication topic should the nurse anticipate including in discharge teaching? A. B-Adrenergic blockers B. Calcium channel blockers C. Digitalis and potassium therapy regimen d. Angiotensin-converting enzyme (ACE) inhibitors
D
Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. What data would indicate to the nurse that the drug is effective? A. Decreased blood pressure and heart rate B. Improvement in the strength of the distal pulses C. Fewer complaints of having cold hands and feet D. Participation in daily activities without chest pain
D
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism of the left lower leg. Which action by the nurse is best? A. The patient's bed is placed in the Trendelenburg position. B. Two pillows are positioned under the calf of the affected leg. C. The bed is elevated at the knee and pillows are placed under both feet. D. One pillow is placed under the thighs and 2 pillows are under the lower legs.
D
The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside. Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). B. Assess the patient's environment for adverse stimuli that might increase BP. C. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. D. Set up the automatic noninvasive BP machine to take readings every 15 minutes.
D
Which action should the nurse take when giving the first dose of oral labetalol to a patient with hypertension? A. Encourage the use of hard candy to prevent dry mouth. B. Teach the patient that headaches often occur with this drug. C. Instruct the patient to call for help if heart palpitations occur. D. Ask the patient to request assistance before getting out of bed.
D
Which action will be included in the plan of care for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency? A. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. B. Organize nursing activities so that the patient has 8 hours of undisturbed sleep at night. c. Assist the patient up in the chair for meals to avoid complications associated with immobility. D. Use an automated noninvasive blood pressure machine to obtain frequent measurements.
D
Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? A. "The pain wakes me up at night." B. "The pain is level 3 to 5 (0 to 10 scale)." C. "The pain has gotten worse over the last week." D. "The pain goes away after a nitroglycerin tablet."
D
Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective? A. "I can expect nausea as a side effect of nitroglycerin." B. "I should only take nitroglycerin when I have chest pain." C. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart" D. "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart"
D
Which risk factor should the nurse focus on when teaching a patient who has a 5-cm abdominal aortic aneurysm? A. Male gender B. Turner syndrome C. Abdominal trauma history D. Uncontrolled hypertension
D
Which statement by a patient with newly diagnosed heart failure indicates to the nurse that teaching was effective? A. "I will take furosemide (Lasix) every day just before bedtime." B. "I will use the nitroglycerin patch whenever I have chest pain." C. "I will use an additional pillow if I am short of breath at night." D. "I will call the clinic if my weight goes up 3 pounds in a week."
D
Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? A. "I will switch from whole milk to 1% milk." B. "I like salmon and I will plan to eat it more often." C. "I can have a glass of wine with dinner if I want one." D. "I will miss being able to eat peanut butter sandwiches."
D
C
The nurse reviews information shown in the accompanying figure from the medical records of a 43-year-old patient. Which risk factor modification for coronary artery disease should the nurse include in patient teaching? A. Importance of daily physical activity B. Effect of weight loss on blood pressure C. Dietary changes to improve lipid levels D. Cardiac risk associated with previous tobacco use
