PrepU test 4

Which of the following describes difficulty breathing when lying flat? a) Bradypnea b) Paroxysmal nocturnal dyspnea (PND) c) Orthopnea d) Tachypnea

C,Orthopnea occurs when the patient is having difficulty breathing when laying flat. Sudden attacks of dyspnea at night are known as paroxysmal nocturnal dyspnea. Tachypnea is a rapid breathing rate and bradypnea is a slow breathing rate.

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? a) "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor." b) "I won't be able to jog again even with rehabilitation." c) "Rehabilitation will help me function as well as I physically can." d) "When I finish the rehabilitation program I'll never have to worry about heart trouble again."

C,The client demonstrates understanding of cardiac rehabilitation when he states that it helps the client reach his activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education

You are caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? a) Examine the client's mental and emotional status. b) Examine for pain around the shoulder and neck region. c) Examine the extremities and assess skin color, capillary refill time, and tissue integrity. d) Examine the extremities for skin lesions.

C< The nurse examines the extremities and assesses skin color, temperature, capillary refill time, and tissue integrity and not for skin lesions for clients with thrombosis. Examining the client's mental and emotional status or examining for pain around the shoulder and neck region will not assist the nurse in evaluating a client with thrombosis.

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Fatigue lasting more than 1 month b) Dyspnea c) Uncontrolled restlessness d) Constant chest pain

D

For a client with cardiomyopathy, the most important nursing diagnosis is: a) Decreased cardiac output related to reduced myocardial contractility. b) Ineffective coping related to fear of debilitating illness. c) Anxiety related to actual threat to health status. d) Excess fluid volume related to fluid retention and altered compensatory mechanisms.

A Decreased cardiac output related to reduced myocardial contractility is the greatest threat to the survival of a client with cardiomyopathy. Although Excess fluid volume, Ineffective coping, and Anxiety are important nursing diagnoses, the nurse can address them when the client has improved cardiac output and myocardial contractility.

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? a) Computed tomography angiography (CTA) b) Angiography c) Magnetic resonance angiography (MRA) d) Doppler ultrasound

A, A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 18: Nursing Management: Patients With Vascular Disorders and Problems of Peripheral Circulation, p. 494, Table 18-1.

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis? a) History of aortic valve replacement b) History of diabetes mellitus c) Age d) Race

A, A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although race, age, and a history of diabetes mellitus may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: a) 1.5 to 2.5 times the baseline control. b) 3.5 times the baseline control. c) 2.5 to 3.0 times the baseline control. d) 4.5 times the baseline control.

A, A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

The most common site of aneurysm formation is in the: a) abdominal aorta, just below the renal arteries. b) aortic arch, around the ascending and descending aorta. c) ascending aorta, around the aortic arch. d) descending aorta, beyond the subclavian arteries.

A, About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

Which condition most commonly results in coronary artery disease (CAD)? a) Atherosclerosis b) Diabetes mellitus c) Myocardial infarction d) Renal failure

A, Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.

A 76-year-old client has a significant history of congestive heart failure. During his semiannual cardiology examination, for what should you, as his nurse, specifically assess? Choose all correct options. a) Monitor the client for signs of lethargy or confusion b) Examine the client's neck for distended veins c) Examine the client's joints for crepitus d) Examine the client's eyes for excess tears

A, B Examine the client's neck for distended veins, monitor the client for signs of lethargy or confusion---->During a head-to-toe assessment of a client with congestive heart failure, the nurse checks for dyspnea, auscultates apical heart rate and counts radial heart rate, measures BP, and documents any signs of peripheral edema, lethargy, or confusion

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? a) Hypertrophic b) Restrictive c) Arrhythmogenic right ventricular cardiomyopathy d) Dilated

A, Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Bibasilar crackles b) Jugular vein distention c) Dependent edema d) Right upper quadrant pain

A, Bibasilar crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload and indicate left-sided heart failure. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.

The nurse is caring for a patient diagnosed with myocarditis. The nurse understands that which of the following is the hallmark of myocarditis? a) Cardiac muscle inflammation b) Chest pain c) Shortness of breath d) Pericardial friction rub

A, Cardiac muscle inflammation that results in myocyte necrosis is the hallmark of myocarditis. Chest pain, a pericardial friction rub, and shortness of breath occur in pericarditis.

Which complication of cardiac surgery occurs when there is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? a) Cardiac tamponade b) Hypothermia c) Fluid overload d) Hypertension

A, Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high PAWP, CVP, and pulmonary artery diastolic pressure as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? a) Rheumatic fever b) Medullary sponge kidney c) Croup d) Severe staphylococcal infection

A, Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate? a) Decreased cardiac output b) Ineffective thermoregulation c) Risk for deficient fluid volume d) Risk for peripheral neurovascular dysfunction

A, Decreased cardiac output is an appropriate nursing diagnosis for a client with HCM because the hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems.

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to: a) assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. b) give the client an I.M. vitamin K injection and notify the physician of the results. c) notify the next shift to hold the daily 5 p.m. dose of warfarin. d) call the physician to request an increase in the warfarin dose.

A, For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.

A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound? a) Hyperbaric oxygen b) Enzymatic debridement c) Vacuum-assisted closure device d) Surgical debridement

A, Hyperbaric oxygenation (HBO) may be beneficial as an adjunct treatment in patients with diabetes with no signs of wound healing after 30 days of standard wound treatment. HBO is accomplished by placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen. Treatment regimens vary from 90 to 120 minutes once daily for 30 to 90 sessions. The process by which HBO is thought to work involves several factors. The edema in the wound area is decreased because high oxygen tension facilitates vasoconstriction and enhances the ability of leukocytes to phagocytize and kill bacteria. In addition, HBO is thought to increase diffusion of oxygen to the hypoxic wound, thereby enhancing epithelial migration and improving collagen production.

A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? a) Blood pressure 84/52 mm Hg b) Pulse rate of 84 beats/minute c) Respiration 26 breaths/minute d) Temperature of 100.2° F (37.9° C)

A, Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration

Jack Donohue, a 62-year-old stock broker, attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitation during and after his morning jogs. Jack's family history reveals includes coronary artery disease. His lipid profile reveals his LDL level to be 122 mg/dl. Which of the following correctly states the Jack's condition? a) High LDL level b) Fasting LDL level c) Normal LDL level d) Low LDL level

A, LDL levels above 100 mg/dl are considered high. The goal is to decrease the LDL level below 100 mg/dl.

Which of the following are risk factors related to venous stasis for DVT and pulmonary embolism? a) Obesity b) Surgery c) Trauma d) Pacing wires

A, Obesity is a risk factor for DVT and PE related to venous stasis. Trauma, pacing wires, and surgery are related to endothelial damage as a risk factor for DCAT and PE.

When the nurse observes that the patient has increased difficulty breathing when lying flat, the nurse records that the patient is demonstrating a) orthopnea. b) paroxysmal nocturnal dyspnea. c) dyspnea on exertion. d) hyperpnea.

A, Patients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to high Fowler's position. Dyspnea on exertion refers to difficulty breathing with activity. Hyperpnea refers to increased rate and depth of respiration. Paroxysmal nocturnal dyspnea refers to orthopnea that occurs only at night

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Enteric fistula c) Graft occlusion d) Hemorrhage and shock

A, Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? a) Leg edema b) Cyanosis of the lips c) Bilateral crackles d) Productive cough

A, Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a) left calf circumference 1" (2.5 cm) larger than the right. b) a decrease in the left pedal pulse. c) loss of hair on the lower portion of the left leg. d) pallor and coolness of the left foot.

A, Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT

A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level? a) Severely reduced b) High c) Normal d) Slightly reduced

A, The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure.

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume? a) Leaning forward while sitting b) Prone c) Supine d) Semi-Fowler's

A, The nurse should encourage the client to lean forward, because this position causes the heart to pull away from the diaphragmatic pleurae of the lungs, helping relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action and therefore don't relieve chest pain associated with pericarditis.

Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis? a) Maintain the client on bed rest b) Elevate the client's head c) Eliminate all phone calls and visitors d) Administer a prescribed antipyretic

A, The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing.

The nurse is caring for a client with a valvular disorder. The client is at risk for decreased cardiac output. What nursing intervention should a nurse perform for this client? a) Measure urine output. b) Perform exercises consistently. c) Auscultate lung and heart sounds. d) Keep legs horizontal.

A, The nurse should monitor urine output every 8 hours or more often if it is less than 500 mL/day. Renal output reflects the heart's ability to perfuse the renal arteries. The client should not perform any exercises and should be on bed rest. Keeping the client's legs horizontal and auscultating lung and heart sounds will not help in this condition.

After undergoing cardiac surgery, a patient discovers a painless lump and complains to the nurse about the same. Which of the following is the most important nursing intervention for this patient? a) Reassure the patient by informing him or her that the lump will disappear with time. b) Reassure the patient and direct the patient to the physician. c) Reassure the patient by informing him or her that the lump will disappear after a course of drug therapy. d) Inform the patient that the lump will be removed by the surgeon.

A, The nurse will reassure the patient by informing him or her that the lump will disappear with time and will not require surgery, drug therapy, or a visit to the physician.

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Troponin b) Total CK c) CK-MB d) Myoglobin

A, Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Unstable b) Variant c) Refractory d) Intractable

A, Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? a) Valsartan (Diovan) b) Metolazone (Zaroxolyn) c) Carvedilol (Coreg) d) Digoxin (Lanoxin)

A, Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker)

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? a) Ulceration b) Cellulitis c) Dermatitis d) Rudor

A, Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.

When an aneurysm is small, at what interval is ultrasonography conducted as a monitoring measure? a) 6-month b) 3-month c) Yearly d) 9-month

A, When the aneurysm is small, ultrasonography is conducted at 6-month intervals. Some aneurysms remain stable over many years of observation.

The nurse is caring for a client who is status post operative from a vein stripping. What would the nurse monitor for? a) Swelling in the operative leg b) Swelling in the inoperative leg c) Blood on the dressing on the inoperative leg d) Warm, pink toes in the inoperative leg

A, When the client returns from surgery with a gauze dressing covered by elastic roller bandages on the operative leg, the nurse monitors for swelling in the operative leg(s) and its effect on circulation.

A nurse reviews an ECG strip for a patient who is admitted with symptoms of an acute MI. The nurse recognizes the classic ECG changes that occur with an MI. Select all that apply. a) Abnormal Q-waves b) Absent P-waves c) T-wave hyperactivity and inversions d) U-wave elevations e) ST-segment elevations

A,C,E These three signs are classic ECG changes suggestive of a myocardial infarction. Changes can be diagnostic to the area of cellular damage. P wave and U wave changes are not characteristic of an MI.

Which of the following are alterations noted in Virchow's triad? Select all that apply. a) Stasis of blood b) Edema c) Vessel wall injury d) Tenderness e) Altered coagulation

A,C,E, Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement? a) "I sleep on three pillows each night." b) "My feet are bigger than normal." c) "I don't have the same appetite I used to." d) "My pants don't fit around my waist."

A,Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.

A patient has been prescribed a digitalis preparation for heart failure. Which of the following should you, as her nurse, closely monitor when caring for this client? a) Electrolyte and water loss b) Flexion contractures c) Enlargement of joints d) Vasculitis

A,The nurse should closely monitor a client being administered diuretics for electrolyte and water loss. Digitalis preparations (not diuretics) are potent and may cause various toxic effects. The nurse should monitor the patient for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. However, the effects do not include vasculitis, flexion contractures, or enlargement of joints.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a) anticoagulant. b) anticonvulsant. c) antihypertensive. d) antibiotic.

A. During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses don't routinely give antibiotics during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? a) Magnesium b) Potassium c) Sodium d) Calcium

B

A nurse is discussing pharmacologic therapy used in the treatment of coronary vascular disease with a nursing student. The nurse would be correct in identifying the use of a positive inotrope as having which of the following functions? a) Decrease in heart rate b) Increase in myocardial contractility c) Increase in heart rate d) Decrease in myocardial contractility

B A positive inotrope is a medication that increases myocardial contractility (force of contraction). Medications that increase the heart rate are positive chronotropes. Negative chronotropic medications decrease the heart rate. Negative chronotropes decrease myocardial contractility. (

The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Ability to sleep through the night b) Persistent cough c) Increased appetite d) Weight loss

B) Persistent cough Explanation: Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.

A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a) Serratia marcescens b) Group A, beta-hemolytic streptococcus c) Staphylococcus aureus d) Pseudomonas aeruginosa

B, Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (Chart 28-2). Patients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure

A nurse understands that the target international normalized ratio (INR) for a patient taking Coumadin will depend on the patient's condition. A normal INR is 1.0. However, this value is increased depending on the medical condition. Select the condition that would warrant achieving an INR target value of 3.0 with anticoagulation. a) Primary prevention of deep vein thrombosis b) Prevention of recurrent deep vein thrombosis c) Hip surgery d) Cardiac stents

B, An INR goal of 2.5 can be used for deep vein thrombosis. However, when the occurrence happens more often, the value needs to increase to 3.0.

Aortic dissection may be mistaken for which of the following disease processes? a) Pneumothorax b) Myocardial infarction (MI) c) Angina d) Stroke

B, Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? a) Chronic pain b) Risk for infection c) Impaired gas exchange d) Impaired memory

B, Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.

A patient complains of a "stabbing pain and a burning sensation" in his left foot. The nurse notices that the foot is a lighter color than the rest of the skin. The artery that the nurse suspects is occluded would be the: a) Common femoral. b) Posterior tibial. c) Popliteal. d) Internal iliac.

B, Clinical symptoms of PAD are manifested in organs or muscle groups supplied by specific arterial blood flow. The posterior tibial artery is a major artery that is a common site for occlusion.

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? a) Blood pressure of 129/72 mm Hg b) Hematocrit of 30% c) Heart rate of 87 bpm d) Hemoglobin of 16 g/dL

B, Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lowered hematocrit can imply internal bleeding.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: a) elevational rubor. b) dependent pallor. c) no rubor for 10 seconds after the maneuver. d) a 30-second filling time for the veins.

B, If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves

Which of the following is the primary cause of pulmonary or peripheral congestion? a) Hepatomegaly b) Inadequate cardiac output c) Nocturia d) Ascites

B, Inadequate cardiac output; Pulmonary congestion occurs and tissue perfusion is compromised and diminished when the heart, primarily the left ventricle, cannot pump blood out of the ventricle effectively into the aorta and the systemic circulation

A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? a) The client's legs awaken him during the night with itching. b) The client can walk about 50 feet before getting pain in the right lower leg. c) The client's fingers tingle when left in one position for too long. d) The client experiences shortness of breath after walking about 50 feet.

B, Intermittent claudication is caused by the inability of the arterial system to provide adequate blood flow to the tissues when increased demands are made for oxygen and nutrients during exercise. Pain is then experienced. When the client rests and decreases demands, the pain subsides. The client can then walk the same distance and repeat the process

A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? a) Hyperuricemia b) Increased liver enzymes c) Gastrointestinal distress d) Hyperglycemia

B, Myopathy and increased liver enzymes are significant side effects of the statins, HMG-CoA reductase inhibitors that are used to affect lipoprotein metabolism.

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect? a) "My vision is blurred, so my blood pressure must be up." b) "My chest pain is decreasing." c) "I have a bad headache." d) "I feel a tingling sensation around my mouth."

B, Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Internal bleeding b) Worsening angina c) Formation of blood clots d) Thrombocytopenia

B, Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? a) Elevating the limb above heart level b) Lowering the limb so that it is dependent c) Massaging the limb after application of cold compresses d) Placing the limb in a plane horizontal to the body

B, Persistent pain in the forefoot (i.e., the anterior portion of the foot) when the patient is resting indicates a severe degree of arterial insufficiency and a critical state of ischemia. Known as rest pain, this discomfort is often worse at night and may interfere with sleep. This pain frequently requires that the extremity be lowered to a dependent position to improve perfusion to the distal tissues

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following? a) Application of antiembolytic stockings b) Administration of a vasodilating drug (as ordered by a physician) c) Ambulation d) Maintaining the client's legs elevated

B, Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolytic stockings) or preventing blood from pooling in the extremities will increase preloa

Which of the following types of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. a) Dilated cardiomyopathy (DCM) b) Restrictive cardiomyopathy (RCM) c) Arrhythmogenic right ventricular cardiomyopathy (ARVC) d) Hypertrophic cardiomyopathy (HCM)

B, RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Hypertrophic cardiomyopathy occurs when the heart muscle asymmetrically increases in size and mass, especially along the septum. Dilated cardiomyopathy is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? a) Peripheral vascular disease b) Raynaud's disease c) Arterial occlusive diseases d) Buerger's disease

B, Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? a) Redness, cool skin temperature, and swelling b) Numbness, cool skin temperature, and pallor c) Numbness, warm skin temperature, and redness d) Swelling, warm skin temperature, and drainage

B, Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include normal sensation and warm skin with normal return of skin color after blanching.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? a) History of increased aspirin use b) Recent pelvic surgery c) An active daily walking program d) A history of diabetes mellitus

B, The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? a) Cardiac catheterization b) Echocardiogram c) Phonocardiogram d) Serial enzyme studies

B, The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily.

After percutaneous transluminal coronary angioplasty (PTCA), the nurse suspects that a patient, who is on bed rest, may be experiencing the complication of bleeding. The nurse's initial action should be to do which of the following? a) Notify the health care provider. b) Apply manual pressure at the site of the insertion of the sheath. c) Decrease anticoagulant or antiplatelet therapy. d) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit.

B, The immediate nursing action would be to apply pressure, which may stop the bleeding. If the bleeding does not stop, the health care provider needs to be notified.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Hypertension b) Cardiac tamponade c) Decreased venous pressure d) Left ventricular hypertrophy

B, The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade (see Chapter 29).

You are talking about heart failure to a local community group. What would you explain is the major cause of right-sided heart failure? a) Pulmonary hypertension b) Left-sided heart failure c) Venous insufficiency d) COPD

B, The major cause of right-sided heart failure is left-sided heart failure. Neither COPD, venous insufficiency, nor pulmonary hypertension is the main cause of right-sided heart failure.

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Administer a prescribed antipyretic b) Maintain the patient on bed rest c) Elevate the patient's head d) Administer supplemental oxygen

B, The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures like minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient's head to promote maximal breathing potential.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? a) Left atrial function b) Left ventricular function c) Right atrial function d) Right ventricular function

B, The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.

A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: a) lactate dehydrogenase. b) troponin. c) myoglobin. d) creatine kinase

B, This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase and myoglobin tests can show evidence of muscle injury, but they're less specific indicators of myocardial damage than troponin.

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Statin b) Morphine IV c) Angiotensin-converting enzyme (ACE) inhibitor d) Aspirin

B, Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following? a) Valvuloplasty b) Heart transplantation c) Annuloplasty d) Xenograft tissue valve

B, When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. The other three choices have to do with failing valves and valve repairs.

A nurse assesses a patient who is being evaluated for myocarditis. Which of the following clinical manifestations are consistent with this diagnosis? Select all that apply. a) Decreased cardiac enzymes b) Orthopnea c) Bradycardia d) Palpitations e) Jugular venous distention f) An S3 gallop

B,D,E,F Signs and symptoms of myocarditis include an S3 gallop, tachycardia, tachypnea, jugular venous distention, edema, ECG abnormalities, orthopnea, and palpitations. Fulminant heart failure or sudden cardiac death can quickly develop. A minority will have elevated cardiac enzymes and WBC count. ESR will be elevated approximately 60% of the time.

Which of the following aneurysms results in bleeding into the layers of the arterial wall? a) Saccular b) Dissecting c) False d) Anastomotic

B,Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? a) Abstaining from foods that increase levels of high-density lipoproteins (HDLs) b) Taking daily walks c) Reducing daily fat intake to less than 45% of total calories d) Engaging in anaerobic exercise

B,Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL level

The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart? a) MRI b) Echocardiogram c) Nuclear angiography d) Pulmonary arterial pressure

B,The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. An MRI, pulmonary arterial pressure, and nuclear angiography do not give diagnostic information about the hearts' ejection fraction

The nurse is working with a client who has just been diagnosed with an aneurysm. What advice should the nurse provide to this client? a) Wear wool socks and mittens during cold weather. b) Avoid straining during bowel movements and coughing. c) Avoid situations that contribute to ischemic episodes. d) Minimize bowel movements and coughing.

B,The nurse advises the client with an aneurysm to avoid straining during bowel movements and coughing. The client with Raynaud's disease is asked to avoid situations that contribute to ischemic episodes and to wear wool socks and mittens during cold weather.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a) "If you feel pain during the walk, keep walking until the end of the hallway is reached." b) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." c) "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." d) "As soon as you feel pain, we will go back and elevate your legs."

B,The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise

Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed? a) Cardiac resynchronization therapy b) Heart transplant c) Ventricular access device d) Implantable cardiac defibrillator (ICD)

B. Heart transplantation involves replacing a person's diseased heart with a donor heart. This is an option for advanced HF patients when all other therapies have failed. A ventricular access device, ICD, and cardiac resynchronization therapy would be tried prior to a heart transplant.

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is most probably: a) lateral. b) posterior. c) anterior. d) inferior.

C

The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is: a) Described as crushing and substernal b) Accompanied by diaphoresis and dyspnea c) Relieved by rest and nitroglycerin d) Associated with nausea and vomiting

C

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? a) 280-300 mg/dL b) 250-275 mg/dL c) 160-190 mg/dL d) 210-240 mg/dL

C

Which of the following is inconsistent as a condition related to metabolic syndrome? a) Abdominal obesity b) Dyslipidemia c) Hypotension d) Insulin resistance

C

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? a) Listen for breath sounds over the epigastrium. b) Observe for mist in the endotracheal tube. c) Call for a chest x-ray. d) Attach a pulse oximeter probe and obtain values.

C, A chest x-ray is always obtained after ET tube placement to confirm that the tube is in the proper position within the trachea.

Which of the following values indicate a normal aPTT? a) 36 seconds b) 40 seconds c) 30 seconds d) 15 seconds

C, A normal aPTT is 21 to 35 seconds.

All of the following are clinical signs and symptoms of left-sided heart failure except for: a) Increased pulmonary venous pressure. b) Decreased amount of blood pumped into the aorta. c) A central venous pressure reading greater than 8 mm Hg. d) Increased fluid in the alveoli.

C, A normal central venous pressure (CVP) reading is 2 to 8 mm Hg. When right-sided heart, not left-sided failure occurs, the CVP reading is greater than 8 mm Hg, indicating hypervolemia or excessive fluid circulating in the body.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: a) encouraging ambulation to prevent pooling of blood. b) elevating the extremity to prevent pooling of blood. c) forcing blood into the deep venous system. d) providing warmth to the extremity.

C, Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT

You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Aneurysm b) Coronary thrombosis c) Atherosclerosis d) Raynaud's disease

C, Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. Therefore, options A, B, and D are incorrect.

A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? a) Vancocin b) Calan c) Cyclosporine d) Procardia

C, Because of advances in surgical techniques and immunosuppressive therapies, heart transplantation is now a therapeutic option for patients with end-stage heart disease. Cyclosporine (Gengraf, Neoral, and Sandimmune) and tacrolimus (Prograf, FK506) are immunosuppressants that decrease the body's rejection of foreign proteins, such as transplanted organ

You are caring for a client with suspected right-sided heart failure. What would you know that clients with suspected right-sided heart failure may experience? a) Sleeping in a chair or recliner b) Increased perspiration c) Gradual unexplained weight gain d) Increased urine output

C, Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner. Right-sided heart failure does not cause increased perspiration or increased urine outpu

What is the primary underlying disorder of pulmonary edema? a) Decreased right ventricular elasticity b) Increased left atrial contractility c) Decreased left ventricular pumping d) Increased right atrial resistance

C, Decreased left ventricular pumping; Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation leading to pulmonary edema

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? a) The patient has an ejection fraction of 65%. b) The patient has had angina longer than 3 years. c) The patient has at least a 70% occlusion of a major coronary artery. d) The patient has compromised left ventricular function.

C, For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).

The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? a) Pulse oximetry b) Listening to breath sounds c) Arterial blood gases d) End-tidal CO2

C, In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Higher than normal blood pressure and falling hematocrit b) Slow heart rate and high blood pressure c) Constant, intense back pain and falling blood pressure d) Constant, intense headache and falling blood pressure

C, Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes a) a slowed heart rate. b) diuresis. c) a vasospasm. d) depression of the cough reflex.

C, Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Nicotine has stimulant effects. Nicotine does not suppress cough. Smoking irritates the bronchial tree, causing coughing. Nicotine does not cause diuresi

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: a) Obesity. b) Stress. c) Cigarette smoking. d) Lack of exercise.

C, Nicotine decreases blood flow, increases heart rate and blood pressure, and increases the risk for clot formation by increasing platelet aggregation. Smokers have a four-fold higher risk of developing pain from arterial disease than nonsmokers. Carbon monoxide, produced by burning tobacco, combines with hemoglobin more readily than oxygen, thus depriving tissues of oxygen.

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? a) Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. b) Restrict alcohol intake to two drinks per day. c) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. d) Store the drug in a cool, well-lit place.

C, Nitrates act primarily to relax coronary smooth muscle and produce vasodilation. They can cause hypotension, which makes the client dizzy and weak. The nurse should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates are taken at the first sign of chest pain and before activities that might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three doses. If the pain persists, the client should seek medical assistance immediately. Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. Alcohol is prohibited because nitrates may enhance the effects of the alcohol.

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? a) "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses." b) "A burning sensation after administration indicates that the nitroglycerin tablets are potent." c) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." d) "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh."

C, Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place. Many brands of sublingual nitroglycerin no longer produce a burning sensation. The client should take a sublingual nitroglycerin tablet at the first sign of angina. He may repeat the dose every 5 minutes for up to three doses; if this intervention doesn't bring relief, the client should seek immediate medical attention

On assessment, the nurse knows that a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity would have heart failure classified as Stage: a) B b) D c) C d) A

C, Once a patient has structural heart disease, he has progressed from stage A to either stage B or stage C. The difference between B and C has to do with the presence of signs and symptoms of heart failure. When dyspnea and fatigue occur with exertion, heart failure is suspected.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Elevated blood pressure and rapid respirations b) Retrosternal back pain radiating to the left arm c) Increased abdominal and back pain d) Decreased pulse rate and blood pressure

C, Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected

Based on assessment data for a patient with pericarditis, select a primary nursing diagnosis. a) Fatigue related to limited activity b) Anxiety related to the diagnosis c) Acute pain related to inflammation of the pericardium d) Denial related to the severity of the disease

C, Pain is the primary symptom of the patient with pericarditis. Pain relief and the absence of complications are two major nursing goals.

A client has been diagnosed with heart failure. One of the main overall objectives of management of heart failure is which of the following? a) Achieve a blood pressure of 120/80. b) Help the client walk briskly on a treadmill at 4 to 5 miles an hour. c) Reduce the workload on the heart. d) Eliminate all sodium and fat from the diet.

C, Reduce the workload on the heart. Explanation: Specific objectives of medical maagement of heart failure include reducing the workload on the heart by reducing preload and afterload. The other choices are objectives that may be unachievable for many clients with cardiac problems and are not realistic for everyone. A diet that excluded all sodium and fat would be unhealthy.

Which of the following observations regarding ulcer formation on the patient's lower extremity indicates that the ulcer is a result of venous insufficiency? a) Is very painful to the patient, even though superficial b) Is deep, involving the joint space c) Border of the ulcer is irregular d) Base is pale to black

C, The border of an ulcer caused by arterial insufficiency is circular. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color. Venous insufficiency ulcers are usually superficial.

Which signs and symptoms accompany a diagnosis of pericarditis? a) Low urine output secondary to left ventricular dysfunction b) Pitting edema, chest discomfort, and nonspecific ST-segment elevation c) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) d) Lethargy, anorexia, and heart failure

C, The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure

The treatment for heart failure is directed toward all of the following except: a) Increasing cardiac output by strengthening muscle contraction or decreasing peripheral resistance. b) Decreasing the oxygen needs of the heart. c) Increasing preload and afterload. d) Reducing the amount of circulating blood volume.

C, The goal in treating heart failure is to decrease preload and afterload, both of which increase stress on the ventricular wall, causing an increase in the workload of the heart. Diuretics are prescribed as preload reducers.

As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. a) High-density lipoproteins (HDL) b) Total cholesterol c) Low-density lipoproteins (LDL) d) Triglycerides

C, When there is an excess of LDL, these particles adhere to vulnerable points in the arterial endothelium. Here, macrophages ingest then, leading to the formation of foam cells and the beginning of plaque formation. A harmful effect is exerted on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a) Cholesterol, 280 mg/dL b) Low density lipoprotein (LDL), 160 mg/dL c) High-density lipoprotein (HDL), 80 mg/dL d) A ratio of LDL to HDL, 4.5 to 1.0

C,A fasting lipid profile should demonstrate the following values (Alberti et al., 2009): LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients); total cholesterol less than 200 mg/dL; HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females; and triglycerides less than 150 mg/dL

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? a) Increases the atrioventricular node conduction b) Creates a positive inotropic effect c) Decreases the sinoatrial node automaticity d) Increases the heart rate

C,Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

Peripheral aneurysms may arise from which of the following areas? Select all that apply. a) Carotid artery b) Brachial artery c) Femoral artery d) Renal artery e) Popliteal artery

C,D,E Aneurysms may also arise in the peripheral vessels, most often as a result of atherosclerosis. These may involve the renal artery, femoral artery, or the popliteal artery.

Which of the following assessment results is considered a major risk factor for PAD? a) LDL of 100 mg/dL b) Cholesterol of 200 mg/dL c) BP of 160/110 mm Hg d) Triglyceride level of 150 mg/dL

C,Hypertension is considered a major risk factor for PAD. Blood pressure should be less than 130/90 mm Hg. The other laboratory results are within the recommended range of normal to high normal

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? a) In 2 days b) Within the first 24 hours c) In 3 to 5 days d) Within 12 hours

C,Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012)

In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction? a) 9 days b) 30 minutes c) 6 to 12 months d) 60 minutes

D

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: a. Inside of the ankle just above the heel. b. Exterior surface of the foot near the heel. c. Outside of the foot just below the heel. d. Anterior surface of the foot near the ankle joint.

D RATIONALE- The dorsalis pedis pulse can be palpated on the dorsal surface of the foot distal to the major prominence of the navicular bone. Refer to Figure 18-3 in the text-

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? a) "I stopped smoking and use only chewing tobacco." b) "I walk only to the mailbox in my bare feet." c) "I like to soak my feet in the hot tub every day." d) "I have my wife look at the soles of my feet each day."

D, A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities

Which of the following body system responses correlates with systolic heart failure (HF)? a) Dehydration b) Increased blood volume ejected from ventricle c) Vasodilation of skin d) Decrease in renal perfusion

D, A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure.

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: a) Thrombosis of the graft. b) Stent dislodgement. c) Decreased motor function. d) Hemorrhage.

D, All choices are serious and require medical/surgical intervention. However, hemorrhage is the most serious complication that requires immediate attention.

A patient is given a prescription for Lopressor, a beta-blocker, after being examined by his health care provider. Select the most important information the nurse should provide. a) Take the medication at the same time each day. b) Dress warmly. Blood circulation may be reduced in the extremities. c) If dizziness occurs, adjust the medication. d) Don't suddenly stop taking the medication without calling your health care provider.

D, All teaching points need to be covered, but the nurse needs to emphasize that Lopressor should not be suddenly stopped because some conditions can become worse.

A patient diagnosed with a pericarditis and pericardial effusion. Based on the physiologic mechanisms of increased pericardial fluid and its effect on the heart, which of the following effects would be expected? a) Decreased left ventricular end-diastolic pressures b) Increased venous return c) Decreased right ventricular end-diastolic pressure d) Inability of the ventricles to distend and fill adequately

D, An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart. This causes increased right and left ventricular end-diastolic pressures, decreased venous return, and inability of the ventricles to distend and fill adequately.

A health care provider orders wound debridement for a patient's venous ulcer. He writes orders for an occlusive absorptive dressing. The nurse knows that the debridement is classified as: a) Surgical. b) Wet to dry. c) Enzymatic. d) Autolytic.

D, Autolytic debridement refers to a dressing that promotes granulation tissue growth. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 18: Nursing Management: Patients With Vascular Disorders and Problems of Peripheral Circulation, p. 509.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Arterial insufficiency b) Trauma c) Neither venous nor arterial insufficiency d) Venous insufficiency

D, Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. b) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. c) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. d) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

D, Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature.

The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. a) Serum glucose of 124 mg/dL b) Bilateral rales and rhonchi c) Weight gain of 6 ounces d) Potassium level of 6 mEq/L

D, Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain isn't significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed

Which of the following is a cerebrovascular manifestation of heart failure? a) Ascites b) Tachycardia c) Nocturia d) Dizziness

D, Dizziness Explanation: Cerebrovascular manifestations of heart failure include dizziness and confusion. Tachycardia is a cardiovascular manifestation. Ascites is a GI manifestation. Nocturia is a renal manifestation.

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a) Within 5 to 7 days b) Within 12 hours c) Within 24 to 48 hours d) Within 6 hours

D, For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? a) A client 1 day post coronary stent placement b) A client with a history of repaired ventricular septal defect c) A client with hypertrophic cardiomyopathy d) A client 4 days postoperative after mitral valve replacement

D, Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.

A patient is being discharged to home. The nurse must emphasize the importance of being weighed daily. Which significant weight change would need to be reported to the patient's health care provider? a) As weight gain of 4 pounds in a week b) A weight gain of 3 pounds in a week c) A weight gain of 1 pound in a day d) A weight gain of 2½ pounds in a day

D, If there is a significant change in weight (2 to 3 pounds increase in a day or a 5 pound increase in a week), the patient should be instructed to notify his provider or to adjust medications per provider's directions.

Which of the following medications is a human brain natriuretic peptide (BNP) preparation? a) Captopril b) Enalapril c) Metoprolol d) Natrecor

D, Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing dieresis and vasodilation, reducing blood pressure, and improving cardiac output. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors

On his return to the cardiac step-down unit after his diagnostic procedure, a client awaits the report from his cardiologist. As the client's nurse, you review the process of measuring ejection fraction and explain to the client that it measures the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? a) 50% b) 40% c) 45% d) 55%

D, Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? a) Plasma protein fraction b) Phytonadione (vitamin K) c) Thrombin d) Protamine sulfate

D, Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn't given orally.) Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's used to treat clients who are in shock.

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? a) Left-sided heart failure b) Chronic heart failure c) Acute heart failure d) Right-sided heart failure

D, Signs and symptoms of Right Ventricular Failure include: Weakness; Ascites; Weight gain; Nausea, vomiting; Dysrhythmias; Elevated central venous pressure; Jugular vein distention. The scenario does not indicate whether the heart failure is chronic or acute. Therefore, options A, B, and C are incorrect.

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? a) Avoid fatty foods and exercise. b) Report changes in the usual pattern of chest pain. c) Take over-the-counter decongestants. d) Avoid situations that contribute to ischemic episodes.

D, Teaching for clients with Raynaud's disease and their family members is important. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.

When teaching a client with peripheral vascular disease about foot care, a nurse should include which instruction? a) Avoid wearing cotton socks. b) Avoid using a nail clipper to cut toenails. c) Avoid using cornstarch on the feet. d) Avoid wearing canvas shoes.

D, The client should be instructed to avoid wearing canvas shoes. Canvas shoes cause the feet to perspire, and perspiration can cause skin irritation and breakdown. Cotton and cornstarch absorb perspiration. The client should be instructed to cut toenails straight across with nail clippers

A nurse is developing a nursing care plan for a client with peripheral arterial disease. Which of the following will be the priority nursing diagnosis? a) Impaired tissue integrity b) Ineffective self-health management c) Ineffective thermoregulation d) Ineffective peripheral tissue perfusion

D, The goal is to increase arterial blood supply to the extremities; the priority nursing diagnosis is Ineffective peripheral tissue perfusion related to compromised circulation.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Acute limb ischemia b) Dizziness c) Vertigo d) Intermittent claudication

D, The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Activity intolerance b) Blood glucose level c) Mental alertness d) Inadequate tissue perfusion

D, The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.

A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? a) 15 minutes b) 20 minutes c) 25 minutes d) 10 minutes

D, The survival rate decreases for every minute that defibrillation is delayed. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. The other options are too long of a time frame.

Which of the following is the most common site for a dissecting aneurysm? a) Cervical area b) Sacral area c) Lumbar area d) Thoracic area

D, The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. a) A serum creatinine of 1.0 mg/dL b) A urine specific gravity reading of 1.021 c) An hourly urine output of 50 to 70 mL d) A serum BUN of 70 mg/dL

D, These four laboratory results should always be assessed, post cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. The lab results in the other choices are all within normal range

The nurse explains to a patient that the primary cause of a varicose vein is: a) Venospasm. b) Phlebothrombosis. c) Venous occlusion. d) An incompetent venous valve.

D, Varicose veins are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.

A 73-year-old client has been admitted to the cardiac step-down unit where you practice nursing. After diagnostics, she was brought to your unit with acute pulmonary edema. Which of the following symptoms would you expect to find during your assessment? a) Hypertensive b) Drowsiness, numbness c) Increased cardiac output d) Moist, gurgling respirations

D, lients with acute pulmonary edema experience sudden dyspnea, wheezing, orthopnea, cough, cyanosis, and tachycardia. Respirations sound moist or gurgling.

A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client? a) Keep your feet elevated above your heart. b) Wear antiembolytic stockings daily to assist with blood return to the heart. c) Do not cross your legs for more than 30 minutes at a time. d) Stop smoking.

D,Nicotine from tobacco products causes vasospasm and can thereby dramatically reduce circulation to the extremities. When the client elevates the feet above the heart level, the heart must work against gravity to supply blood to the feet. Antiembolytic stocking are helpful for venous return to the heart, but constriction is not helpful for lack of arterial blood flow. Crossing the legs for more than a few minutes at a time compresses arteries and decreases blood supply to the legs and feet.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) shave the affected leg in anticipation of surgery. b) elevate the affected leg as high as possible. c) place a heating pad around the affected calf. d) keep the affected leg level or slightly dependent.

D,While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks

Frequently, what is the earliest symptom of left-sided heart failure? a) Chest pain b) Confusion c) Anxiety d) Dyspnea on exertion

Dyspnea on exertion Explanation: Dyspnea on exertion is often the earliest symptom of left-sided heart failure.

Which of the following are characteristics of arterial insufficiency? a) Aching, cramping pain b) Superficial ulcer c) Diminished or absent pulses d) Pulses are present, may be difficult to palpate

c) Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a) Increasing blood pressure and monitoring fluid intake and output b) Decreasing blood pressure and increasing mobility c) Stabilizing heart rate and blood pressure and easing anxiety d) Increasing blood pressure and reducing mobility

c) Stabilizing heart rate and blood pressure and easing anxiety Explanation: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a) "The pain resolved after I ate a sandwich." b) "The pain got worse when I took a deep breath." c) "The pain occurred while I was mowing the lawn." d) "The pain lasted about 45 minutes."

c, Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain