Perfusion Patho
Which instruction would the nurse include when preparing discharge instructions for a client who will take enalapril for hypertension? "Change to a standing position slowly." "This may color your urine green." "The medication may cause a sore throat for the first few days." "Schedule blood tests weekly for the first 2 months."
"Change to a standing position slowly." Rationale:Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. Like many antihypertensives, it can cause orthostatic hypotension. Clients should be advised to change positions slowly to minimize this effect. This medication does not alter the color of urine or cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.
Which action describes a therapeutic effect of atenolol? Heart rate decreases Blood pressure increases Bronchospasm is relieved Pulse oximetry improves
Heart rate decreases Rationale: Atenolol, a beta-blocker, slows the rate of sinoatrial (SA) node discharge and atrioventricular (AV) node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial oxygen consumption. Blood pressure is not increased and may be decreased. Atenolol may promote bronchospasm, not relieve it. Atenolol does not directly affect gas exchange in the lungs to promote improving oxygenation.
Which action would the nurse take next when a client with a history of heart failure on daily weights has a 4-pound (1.8-kilogram) weight gain since the previous day? Perform a head-to-toe assessment. Place the client on restricted fluid intake. Discuss a restricted sodium diet with the client. Document the findings in the health care record
Perform a head-to-toe assessment. Rationale:Performing a head-to-toe assessment, including vital signs, would indicate symptoms, such as jugular distention with right-sided heart failure, or pulmonary crackles associated with left-sided heart failure. More assessment data is needed before deciding whether fluid restrictions are needed for this client. Restricting sodium in the diet is appropriate for most clients with heart failure, but an assessment for symptoms of worsening heart failure is a higher priority. Documentation of findings is needed, but not as important as assessing the client for symptoms that may indicate a need for changes in the therapeutic plan.
Which prescription by the health care provider would the nurse question when caring for a client who is hospitalized for an acute myocardial infarction? Long-acting beta blocker Daily low-dose aspirin tablet H 1 blocker to reduce gastric acid secretions Rectal suppository as needed for constipation
Rectal suppository as needed for constipation Rationale: Rectal stimulation can stimulate the vagus nerve and cause bradycardia and is avoided in clients who have had myocardial infarction. Long-acting beta blockers are commonly prescribed after myocardial infarction to prevent cardiac remodeling and heart failure. Low-dose aspirin is typically prescribed to clients with coronary artery disease or myocardial infarction to prevent new coronary artery thrombus from forming. H 1 blockers are frequently prescribed to hospitalized clients to prevent formation of stress-related gastric ulcers.
Which instruction will the nurse include in a teaching plan for a client taking a calcium channel blocker such as nifedipine? Select all that apply. One, some, or all responses may be correct. Reduce calcium intake. Report peripheral edema. Expect temporary hair loss. Avoid drinking grapefruit juice. Change to a standing position slowly
Report peripheral edema. Avoid drinking grapefruit juice. Change to a standing position slowly Rationale: Peripheral edema may occur as a result of heart failure and must be reported. Grapefruit juice affects the metabolism of calcium channel blockers and should be avoided. Changing positions slowly helps reduce orthostatic hypotension. Reducing calcium intake is unnecessary because calcium levels are not affected. Hair loss does not occur.
Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina? Blood pressure 142/90 mm Hg Report of chest pain when walking Sinus bradycardia, rate 54 on monitor Large Q waves on the electrocardiogram
Sinus bradycardia, rate 54 on monitor Rationale Because beta blockers such as metoprolol decrease heart rate, the nurse would communicate with the health care provider before giving metoprolol to a client with a slow heart rate. Administration of metoprolol to a client with a mildly elevated blood pressure is appropriate, because beta blockers lower blood pressure. Chest pain with exertion indicates possible myocardial ischemia and metoprolol will decrease cardiac oxygen demand and ischemia. Large Q waves on the electrocardiogram indicate that the client may have a history of myocardial infarction and metoprolol is appropriate to prevent further ischemia.
Which topic is most important for the nurse to include when teaching about prevention of coronary artery disease (CAD) for a 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg), smokes 1 pack a day of cigarettes, and has siblings with CAD? Select all that apply. One, some, or all responses may be correct. Age Height Weight Tobacco use Family history
Weight Tobacco Use Rationale: The focus of teaching about CAD prevention would be on modifiable risk factors such as weight and tobacco use. Although the incidence of CAD does increase with age, age is not a modifiable risk factor. Height affects body mass index but is not a modifiable risk factor for CAD. Family history of CAD does increase CAD risk but is not a modifiable risk factor.
Which medication would a nurse conclude is the cause of a decreased heart rate in a client receiving a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator? Diuretic Vasodilator ACE inhibitor Cardiac glycoside
Cardiac glycoside Rationale: A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. ACE inhibitors act on the renin-angiotensin system and are not associated with decreased heart rates
Which adverse effect of valsartan, an angiotensin II receptor antagonist, will a nurse monitor for when prescribed for a client? Constipation Hyperkalemia Hypertension Change in visual acuity
Hyperkalemia Rationale: Hyperkalemia may occur with valsartan. Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites to decrease blood pressure. Diarrhea, not constipation, may occur with valsartan. Hypotension, not hypertension, may occur. Valsartan does not cause altered visual acuity.
Which analgesic is the medication of choice for a client hospitalized with a myocardial infarction? Ketorolac Meperidine Flurazepam Morphine sulfate
Morphine sulfate Rationale: For myocardial infarction, morphine sulfate is the medication of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload. Although ketorolac and meperidine relieve pain, they do not offer all the additional benefits of morphine. In addition, meperidine has additional adverse effects. Flurazepam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the pain of a myocardial infarction.
Which antihypertensive medication class would the nurse identify as the likely cause of the cough in a client taking multiple medications for hypertension who develops a persistent, hacking cough? Thiazide diuretics Calcium channel blockers Direct renin inhibitors Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors Rationale: The ACE breaks down kinins. When ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or direct renin inhibitors.
Which angiotensin-converting enzyme inhibitor (ACE inhibitor) is appropriate for a client with liver dysfunction? Select all that apply. One, some, or all responses may be correct. Ramipril Enalapril Quinapril Captopril Lisinopril
Captopril Lisinopril Rationale: Captopril and Lisinopril are the best choices for someone with liver dysfunction because they are the only two ACE inhibitors that are not inactive in the administered form and then are metabolized to the active form once they are in the body, usually by the liver. Ramipril, Enalapril, Quinapril, and Benazepril are not good choices for the client with liver dysfunction.
Which lifestyle factor, that may have contributed to the ankle swelling, would a nurse ask about when questioning a client with heart failure and new onset ankle edema? Select all that apply. One, some, or all responses may be correct. Intake of salty foods Dietary fat intake Medication compliance Family stresses Recent travel
Intake of salty foods Medication compliance Recent travel Rationale: Fluid retention in heart failure may be caused by increased salt intake, with associated water retention. Poor adherence to medication used to treat heart failure, such as angiotensin-converting enzyme inhibitors and diuretics, may also cause fluid retention. Recent travel may cause fluid retention because of changes in environmental temperature, effects of airplane travel on fluid retention, or changes in dietary sodium intake. Increased or decreased dietary fat intake will not cause fluid retention. Stress is not a contributor to fluid retention.
The registered nurse is teaching a nursing student about monoamine oxidase inhibitors (MAOIs). Which statement made by the student indicates the need for further teaching? Select all that apply. One, some, or all responses may be correct. 'Isocarboxazid is a selective MAO-B inhibitor.' 'MAO inhibitors are prescribed as adjunct to diphenhydramine.' 'Hypertensive crisis is a reported adverse effect of MAO inhibitors.' 'MAO inhibitors are prescribed to clients with Parkinson disease.' 'Interaction of sympathomimetic medications with MAO inhibitors may cause hypertensive crisis
'Isocarboxazid is a selective MAO-B inhibitor.' 'MAO inhibitors are prescribed as adjunct to diphenhydramine. Rationale: Selegiline is a selective MAO-B inhibitor, whereas isocarboxazid is a non-selective MAO-A and MAO-B inhibitor. MAO inhibitors may be contraindicated in clients on diphenhydramine and cetirizine, as they may aggravate depression of the central nervous system. Hypertensive crisis is an adverse effect of MAO inhibitors. They can be prescribed to clients with Parkinson disease. Hypertensive crisis occurs when the sympathomimetic medications are taken with MAO inhibitors.
When asssigned the care of a client arriving in the emergency department with possible acute coronary syndrome, which prescribed action would the nurse take first? Obtain a 12 lead electrocardiogram (ECG). Draw blood for troponin and creatine kinase MB. Ask the client about level of intensity of the chest pain. Notify the cardiac catheterization laboratory about the client.
Ask the client about level of intensity of the chest pain. Rationale: Because ECG changes occur within minutes with acute coronary syndrome, an ECG should be obtained and interpreted within 10 minutes of admission for any client with possible acute coronary syndrome. Confirmation of changes indicating myocardial infarction will lead to rapid transfer to the cardiac catheterization laboratory and percutaneous coronary interventions. It is appropriate to obtain troponin and cardiac enzyme levels, but these do not immediately elevate in myocardial infarction and results will not affect immediate care of the client. Intensity of pain is asked of all clients, but is not a good reflection of the size of the ischemic area. Notification of the cardiac catheterization laboratory will be done, but the ECG will need to be done before making decisions about whether to transfer the client for interventions.
Which assessment is the priority when a client with heart failure reports a 9-pound (4-kilogram) weight gain in the past 2 weeks? Palpate the abdomen. Check for ankle edema. Auscultate breath sounds. Ask about dietary salt intake.
Auscultate breath sounds. Rationale: The client's history of heart failure and recent weight gain suggests fluid retention. The nurse would assess lung sounds first because hypoxemia may result from severe pulmonary congestion and rapid administration of treatment such as oxygen and diuretics may be needed. Right upper quadrant abdominal tenderness or ascites may also occur with heart failure exacerbation, but would not be life-threatening. Ankle edema is also likely with fluid excess associated with heart failure exacerbation, but is not life-threatening and does not need immediate action. The nurse would want to assess for reasons for the weight gain and changes in salt intake are a likely cause, but this data can be obtained after any pulmonary congestion has been treated.
Which client in the emergency department would the nurse assess first? Client with chest pressure and ST segment elevation on the electrocardiogram Client who reports a sharp chest pain with deep inspiration for the past week Client who has history of heart failure with ascites and bilateral 4+ ankle swelling Client with palpitations and paroxysmal atrial fibrillation at a rate of 136 beats/minute
Client with chest pressure and ST segment elevation on the electrocardiogram Rationale: The client with chest pressure and ST segment elevation on the electrocardiogram will need emergency treatment for ST segment elevation myocardial infarction (STEMI), including transport to the cardiac catheterization laboratory for percutaneous coronary intervention within 90 minutes, and should be seen first. The client with sharp pain with deep inspiration has symptoms consistent with pericarditis or pleural effusion and does need rapid assessment and treatment, but is not at risk for life-threatening complications. The client with heart failure and ascites and ankle swelling has symptoms of right ventricular failure that are not life-threatening. The client with palpitations and rapid atrial fibrillation will need assessment and evaluation, but the client experiencing myocardial infarction has a more life-threatening diagnosis.
Which explanation would the nurse include when teaching a client with heart failure about the reason for a low-sodium diet? Body weight control Decreased fluid retention Lowering of blood pressure Prevention of hypernatremia
Decreased fluid retention Rationale: The purpose of a low-sodium diet for clients with heart failure is to decrease fluid retention. Clients with heart failure may or may not need weight loss, but a lowsodium diet will not help with weight control. Although sodium restriction may lower blood pressure in clients with hypertension, because of the Frank-Starling law, lower sodium intake may lead to improved cardiac output and higher blood pressures in clients with heart failure. Dietary sodium intake plays very little role in serum sodium levels (high serum sodium levels is called hypernatremia), which are controlled by multiple hormonal mechanisms, including antidiuretic hormone, aldosterone, and natriuretic peptide.
When assessing a client with right ventricular heart failure, the nurse would expect which finding? Select all that apply. One, some, or all responses may be correct. Dependent edema Swollen hands and fingers Collapsed neck veins Right upper quadrant discomfort Oliguria
Dependent edema Swollen hands and fingers Right upper quadrant discomfort Rationale: With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. Jugular venous collapse and oliguria are key features of left-sided heart failure. Left-sided heart failure is associated with decreased cardiac output.
Which rationale explains why the nurse also monitors a client with a history of gastroesophageal reflux disease (GERD) for clinical manifestations of heart disease? Esophageal pain may imitate the symptoms of a heart attack. GERD may predispose the client to the development of heart disease. Strenuous exercise may exacerbate reflux problems. Similar laboratory study changes may occur in both problems.
Esophageal pain may imitate the symptoms of a heart attack. Rationale: Clients may interpret symptoms associated with myocardial infarction as esophageal reflux and ignore them. GERD does not predispose the client to heart disease. Exercise does not seem to exacerbate esophageal reflux problems unless the stomach is full when exercising. Exercising to maintain a healthy weight helps reduce esophageal reflux. Laboratory workups help differentiate these 2 diagnoses. Tests, such as cardiac enzymes, can help reveal a myocardial infarction, thereby facilitating differentiation between these problems.
Which priority nursing action would the nurse implement first when caring for a client receiving nitroglycerin for the treatment of angina? Instruct the client to sit or stand slowly Monitor the client's urine output frequently Advise the client to report when experiencing a headache Instruct client to notify the health care provider if pain does not subside after 5 minutes
Instruct the client to sit or stand slowly Rationale: Nitroglycerin is a potent antihypertensive and antianginal medication. The nurse should instruct the client to sit and stand slowly after taking the medication to prevent orthostatic hypotension. After ensuring the client's safety, the nurse should monitor the urine output. A headache is a common side effect of nitroglycerin. The client should have a tingling sensation after taking the nitroglycerin, which ensures that the medication is potent. Contacting the health care provider may be important if the pain does not subside after five minutes, but the client's immediate safety takes precedence.
Which nursing intervention will be implemented when the health care provider prescribes verapamil to be administered intravenously to a 70- year-old client with hypertension? Monitor the electrocardiogram for reflex tachycardia. Keep the client in bed for an hour after giving the medication. Dilute the dose in 50 mL of normal saline and administer it over 15 minutes. Assess the client for wheezes and history of asthma before administering the medication.
Keep the client in bed for an hour after giving the medication. Rationale: Hypotension is a common side effect of intravenously administered verapamil. Keeping the client in bed for an hour after administration provides for the safety of the client. Verapamil slows cardiac conduction as well as causing arterial dilation, so reflex tachycardia does not occur. Reflex tachycardia does occur with the dihydropyridine calcium channel blockers such as nifedipine. Verapamil should be administered undiluted when given intravenously. It is administered over 2 minutes for adults and over 3 minutes for older adults. Asthma history and wheezing would be assessed before administration of beta-receptor blockers, whereas heart rate and blood pressure would be checked before giving calcium channel blockers.
Which care plan would the nurse implement for an infant admitted to the pediatric unit with the diagnosis of heart failure? Increase the infant's fluid intake. Position the infant flat on the back. Offer the infant small, frequent feedings. Measure the infant's head circumference
Offer the infant small, frequent feedings. Rationale: Because infants with heart failure become extremely fatigued while suckling, small, frequent feedings with adequate rest periods between can improve their total intake. Infants with heart failure usually have fluids restricted to reduce the cardiac workload. Lying flat restricts lung expansion and should be avoided; positioning with the upper body elevated facilitates respirations. Infants with heart failure are not prone to hydrocephalus and do not need to have head circumference measured again if the initial newborn assessment findings are within expected limits.
Which response indicates that sublingual nitroglycerin prescribed for a client with unstable angina is effective? Pain subsides as a result of arteriole and venous dilation. Pulse rate increases because the cardiac output has been stimulated. Sublingual area tingles because sensory nerves are being triggered. Capacity for activity improves as a response to increased collateral circulation.
Pain subsides as a result of arteriole and venous dilation. Rationale: Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain. An increased pulse rate does not indicate effectiveness; it is a side effect of nitroglycerin. The tingling indicates that the medication is fresh; relief of pain is the only indicator of effectiveness. Nitroglycerin does not promote the formation of new blood vessels.
Which statement by the women indicates that the teaching has been effective after the nurse teaches a group of women about coronary artery disease (CAD) and myocardial infarction (MI)? Unusual fatigue is a common symptom of CAD in women. Women usually have a more rapid recovery than men after MI. Cardiac surgery is generally more successful in women than men. High-density lipoprotein (HDL) levels increase after menopause
Unusual fatigue is a common symptom of CAD in women. Rationale: Studies indicate that women who have myocardial infarctions often experience unusual prodromal fatigue; also, during the prodromal period, women more commonly experience upper abdominal fullness instigated by exertion or emotional stress. Women report more disability than men after a cardiac event. Women have higher mortality and more complications than men after coronary artery bypass graft surgery. Low-density lipoprotein levels increase after menopause, increasing CAD risk.
Which finding in a client who has been admitted with myocardial infarction is most important to communicate to the health care provider? High anxiety level Elevated troponin T Urine output 15 mL/h Heart rate 58 beats/minute
Urine output 15 mL/h Rationale: Heart failure is a common complication after myocardial infarction, and a low urine output may indicate left ventricular failure, which would require immediate collaborative actions such as administration of diuretics or diagnostic testing such as echocardiography. Anxiety is a normal response to stressful events such as myocardial infarction and does require action by the nurse, but is not life-threatening. An elevation in troponin T is expected with myocardial infarction. A heart rate of 58 beats/minute is very slightly below normal and heart rate will continue to be monitored by the nurse, but does not require immediate notification of the health care provider.
Which instruction will the nurse provide about an angiotensin II receptor blocker (ARB) prescribed to a client with hypertension? Select all that apply. One, some, or all responses may be correct. "Monitor the blood pressure daily." "Stop treatment if a cough develops." "Stop the medication if swelling of the mouth, lips, or face develops." "Have blood drawn for potassium levels 2 weeks after starting the medication." "Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with this medication."
"Stop the medication if swelling of the mouth, lips, or face develops." "Have blood drawn for potassium levels 2 weeks after starting the medication." Rationale: The medication should be stopped if angioedema occurs, and the health care provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. Daily monitoring of blood pressure is not indicated. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves. There is no need to avoid the use of NSAIDs while taking an ARB.
Which catecholamine receptor is responsible for increased heart rate? Beta-1 receptor Beta-2 receptor Alpha-1 receptor Alpha-2 receptor
Beta-1 receptor Rationale: Beta-1 receptors are responsible for increased heart rate. Beta-2 receptors, alpha-1 receptors, and alpha-2 receptors are not present in the heart; therefore, they are not responsible for increasing the heart rate. Beta receptors are present in such organs as blood vessels, kidneys, bronchioles, and bladder. Alpha receptors are present in such organs as eyes, skin, and liver.
Which response indicates that a beta blocker prescribed for persistent ventricular tachycardia is working effectively? Decreased anxiety Reduced chest pain Decreased heart rate Increased blood pressure
Decreased heart rate Rationale: A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta blocker is not an anxiolytic and does not reduce anxiety. A beta blocker is not an analgesic and does not reduce chest pain. Beta blockers reduce blood pressure.
Which finding on an electrocardiogram for a client reporting chest pain indicates possible acute myocardial infarction? Flattened T waves Absence of P waves Elevated ST segments Disappearance of Q waves
Elevated ST segments Rationale Elevated ST segments are an early typical finding after a myocardial infarction because of the altered repolarization of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation. Q waves do not disappear with myocardial infarction, but large Q waves are seen late in the process of infarction.
A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme (ACE) inhibitor. For which teratogenic effect of ACE inhibitors would the neonate be at risk? Growth delay Skull hypoplasia Neural tube defects Central nervous system defects
Skull hypoplasia Rationale: The use of ACE inhibitors in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. Antiseizure medications may cause neural tube defects and growth delays in the newborn. Warfarin may cause skeletal and central nervous system defects in the newborn
Which client statement indicates a need for further education when the nurse is reviewing statin therapy for hyperlipidemia in a female of childbearing age? "I will report muscle aches to my primary health care provider." "I will take my medication with grapefruit juice." "I will avoid getting pregnant while taking this medication." "I will need regular bloodwork to ensure my liver is OK
"I will take my medication with grapefruit juice." Rationale: Statin medication should not be taken with grapefruit juice because the furanocoumarins in grapefruit inactivate the enzyme CYP3A4, leading to metabolism issues and possible toxicity. Muscle myalgias are a side effect of statin therapy that should be reported because they may indicate medication toxicity. Statin therapy should be avoided during pregnancy. Liver function should be monitored during statin therapy.
Which instruction would the nurse give an unlicensed assistive personnel (UAP) to perform while caring for a client prescribed captopril? Select all that apply. One, some, or all responses may be correct Obtain blood pressure. Measure intake and output. Weigh the client every morning. Notify the nurse if the client has a dry cough. Assist the client to change positions slowly
All the above. Obtain blood pressure. Measure intake and output. Weigh the client every morning. Notify the nurse if the client has a dry cough. Assist the client to change positions slowly Rationale: ACE inhibitors such as captopril are prescribed for the management of hypertension, heart failure, and diabetic nephropathy. The nurse would ask the UAP caring for a client taking captopril to perform several tasks. The UAP would obtain the client's blood pressure. The UAP would also measure the client's intake and output as well as obtain a daily weight in the morning. This data would help the nurse determine the client's fluid volume status and is an important component of heart failure management. The UAP would be aware that a dry cough is a common side effect of ACE inhibitors. Because of the blood pressure-lowering effects of this medication, the nurse would instruct the UAP to assist the client to make sure the client changes positions slowly.
Which medication prescribed for a client with an acute episode of heart failure would the nurse question? Diuretic Beta blocker Long-acting nitrate Angiotensin receptor blocker
Beta blocker Rationale: Beta blockers reduce cardiac output and are contraindicated for clients with acute heart failure, although they are frequently used to prevent progression of chronic heart failure. Diuretics are used in acute heart failure to decrease hypervolemia and congestion. Long-acting nitrates are used in heart failure to reduce preload. Angiotensin receptor blockers are used in heart failure to decrease fluid overload and afterload.
Which adverse effect would a nurse monitor for when caring for a client with hypertension who is prescribed metoprolol? Hirsutism Bradycardia Restlessness Angina
Bradycardia Rationale: Beta-blockers block stimulation of beta 1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest. Excessive growth of hair or the presence of hair in unusual places does not occur with this medication; however, absence or loss of hair (alopecia) may occur. A side effect of this medication is fatigue, not restlessness. Metoprolol is indicated for treatment of angina, so angina will be decreased.
How would the nurse determine if a client is experiencing the therapeutic effect of valsartan? Check a lipid profile. Assess an apical pulse. Measure urinary output. Check the blood pressure.
Check the blood pressure. Rationale: Angiotensin II receptor blockers (ARBs) are antihypertensive medications that lower the blood pressure. ARBs do not directly affect lipid profile, apical pulse, or urinary output.
For which pain medication must a client receiving treatment in the emergency department be placed on electroicardiogram equipment? Client A: Asprin Client B: Methadone Client C: Butorphanol Client D: Naproxen
Client D: Naproxen Rationale: Nonsteroidal anti-inflammatory medications such as naproxen may result in cardiovascular events such as myocardial infarction, stroke, and heart failure, so the client who is on naproxen requires continuous assessment of the cardiovascular system. The nurse places client D on the electrocardiogram equipment. Aspirin does not result in myocardial infarction, stroke, or heart failure, so client A does not need to be on the electrocardiogram equipment. Methadone and butorphanol do not cause cardiovascular risks. Clients B and C do not need to be on electrocardiogram equipment.
Which effect would the nurse anticipate after captopril is prescribed for a client? Increased urine output Decreased anxiety Improved sleep Decreased blood pressure
Decreased blood pressure Rationale: Captopril is an angiotensin-converting enzyme (ACE) inhibitor antihypertensive. It does not have diuretic, sedative, or hypnotic properties. Diuretics promote fluid excretion. Sedatives reduce muscle tension and anxiety. Hypnotics promote sleep.
Which assessment finding is consistent with a client diagnosis of rightsided heart failure? Select all that apply. One, some, or all responses may be correct. Collapsed neck veins Distended abdomen Dependent edema Decreased appetite Cool extremities
Distended abdomen Dependent edema Decreased appetite Rationale: Right-sided heart failure is associated with increased systemic venous pressures and venous congestion, as manifested by an enlarged liver with possible ascites (distended abdomen), dependent edema, and anorexia (decreased appetite). Distended (not collapsed) neck veins occur in right-sided heart failure. Cool extremities are common in left-sided heart failure because of decreased cardiac output.
Which laboratory result will the nurse expect when caring for a client who presents to the emergency department with an ST-segmentelevation myocardial infarction (STEMI)? Decreased white blood cell count Elevated serum troponins I and T Decreased creatine kinase-MB (CK-MB) Decreased B-type natriuretic peptide (BNP
Elevated serum troponins I and T Rationale: Elevations of troponin I and T levels are indicative and specific for cardiac muscle damage as would occur with STEMI. White blood cell count would increase in the first days after myocardial infarction because of the inflammatory response associated with myocardial cell death. CK-MB is found in cardiac muscle and levels increase with myocardial cell death. BNP levels are not directly reflective of myocardial infarction but might increase if the client develops heart failure as a complication of myocardial infarction.
Which pain relief medication would the nurse expect to find in the plan of care of a client with a myocardial infarction admitted to the cardiac intensive care unit? Morphine Diazepam Midazolam Oxycodone
Morphine Rationale:Morphine is the medication of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. It also decreases cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.
When a client with a heart murmur reports gaining weight in spite of nausea and anorexia, which additional information would be a priority for the nurse to obtain? Presence of a cough and exertional dyspnea Dietary food and salt intake in the past 24 hours Changes in voiding and bowel patterns within the past month History of childhood streptococcal infection or rheumatic fever
Presence of a cough and exertional dyspnea Rationale: Weight gain in a client with a murmur may indicate heart failure, and the nurse would assess for other clinical manifestations of heart failure such as dyspnea and cough that may need rapid treatment. A 24-hour diet and salt intake might help in determining causes for the weight gain, but are not as important as assessment for respiratory problems that might be caused by fluid overload. Changes in elimination patterns occur with heart failure, but are not as important to assess immediately as respiratory symptoms. A history of childhood streptococcal infection or rheumatic fever would be useful in determining the cause of the murmur, but is not essential to developing any immediate interventions.
When taking the health history for a client admitted with heart failure, which assessment finding will the nurse expect the client to report? Losing weight over the past week Tingling in the upper extremities Using several pillows at night to sleep Wheezing when exposed to dust or pollen
Using several pillows at night to sleep Rationale: Heart failure causes pulmonary congestion, leading to orthopnea and the need to elevate the head and chest with pillows when lying down. Clients with worsening heart failure will report recent weight gain because of fluid retention. Tingling in the arms is not a clinical manifestation of heart failure or poor cardiac output. Wheezing in response to dust or pollen is typical of asthma, not heart failure.
Which statement by a client is consistent with a diagnosis of heart failure? 'I see spots before my eyes.' 'I am tired at the end of the day.' 'I feel bloated when I eat a large meal.' 'I have trouble breathing when I climb a flight of stairs
'I have trouble breathing when I climb a flight of stairs Rationale: Dyspnea on exertion occurs with heart failure because of the heart's inability to meet the oxygen needs of the body. Seeing spots before one's eyes is not a symptom associated with heart failure. Fatigue at the end of the day is common for many people, whereas fatigue that occurs all day is a symptom of heart failure. Feeling bloated after eating a large meal is not associated with heart failure, although feeling bloated constantly might be associated with fluid retention caused by heart failure.
Which instructions will the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine? 'Increase your intake of fiber and fluid.' 'Take the medication before you go to bed.' 'Check your pulse before taking the medication.' 'Contact your health care provider if your skin turns yellow.'
'Increase your intake of fiber and fluid.' Rationale: Fiber and fluids help prevent the most common adverse effect of constipation and its complication, fecal impaction. The medication should be taken with meals. The pulse is not affected. Cholestyramine binds bile in the intestine; therefore it reduces the incidence of jaundice.
Which laboratory value will be important for the nurse to monitor to determine whether a client with chest pain has acute coronary syndrome (ACS)? Troponin T (cTnT) C-reactive protein (CRP) Low-density lipoprotein (LDL) B-type natriuretic protein (BNP)
Troponin T (cTnT) Rationale: Cardiac troponins are released into circulation within hours after myocardial injury or infarction, and elevation in troponin levels helps determine that the client is experiencing ACS. The other three values will also be monitored but are not markers for ACS or acute myocardial infarction. C-reactive protein is a marker for inflammation and elevated levels can predict cardiac disease. Elevated LDL is a risk factor for atherosclerosis and coronary artery disease. Elevated BNP is diagnostic for heart failure.
Within which period of time would a nurse advise the client to anticipate pain relief will begin when nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina? 1 to 3 minutes 4 to 5 seconds 30 to 45 seconds 10 to 15 minutes
1 to 3 minutes Rationale: The onset of action of sublingual nitroglycerin tablets is rapid (1-3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustainedrelease nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.
Which statement by a client who is seen for follow-up in the heart failure clinic is most important for the nurse to communicate to the health care provider? 'I am unable to run 1 mile (1.6 km) now.' 'I wake up at night short of breath.' 'My spouse says I snore loudly.' 'My shoes seem larger lately.
'I wake up at night short of breath.' Rationale Paroxysmal nocturnal dyspnea (awakening at night short of breath) is a symptom of poorly controlled left ventricular failure and indicates a need for a change in the client's treatment plan. The statement that the client is unable to run a mile now does indicate that the client's activity tolerance is decreasing from the baseline, but dyspnea at rest is more concerning. More information is needed about snoring, because it may indicate sleep apnea, but snoring does not indicate that the client's heart failure is worsening. Worsening heart failure typically causes ankle swelling, and the client would report that shoes were tighter fitting.
Which diagnostic test is most important for the nurse to obtain rapidly when caring for a client who has just arrived in the emergency department with possible acute coronary syndrome (ACS)? Chest radiograph Troponin T (cTnT) Creatine kinase MB (CK-MB) 12-lead electrocardiogram (ECG)
12-lead electrocardiogram (ECG) Rationale: With acute coronary syndrome, ECG changes indicating myocardial injury and infarction occur within minutes. Because treatment for ACS usually involves actions to restore blood flow to the myocardium as rapidly as possible, it is essential that the ECG be done and evaluated immediately. The other tests are also appropriate but will be done after the ECG. Changes in the chest radiograph will occur if there is cardiac enlargement, pericardial effusion, or heart failure secondary to myocardial infarction. Troponin T will increase in an average of 4 to 6 hours with myocardial infarction. CKMB starts to increase at about 6 hours after myocardial infarction.
The nurse would instruct a client with an acute exacerbation of chronic obstructive pulmnary disease (COPD) to monitor for which indication of right-sided heart failure upon discharge? Weight gain Hypertension Increased appetite Clubbing of the nail beds
Weight gain Rationale: The most common signs and symptoms of right-sided heart failure are hepatomegaly, weight gain, jugular vein distention, and peripheral edema. Hypertension is associated with left-sided heart failure. Clients with right-sided heart failure often have decreased appetites. Clubbing is indicative of hypoxemia.
