Week 4

is caused by IC, trauma, or aortic dissection.

Acute aortic regurgitation (AR)

a condition that occurs when your heart's aortic valve doesn't close tightly

Aortic regurgitation

results in left ventricular hypertrophy and increased myocardial oxygen consumption. As the disease progresses, cardiac output (CO) is reduced, leading to decreased tissue perfusion, pulmonary hypertension, and HF.

Aortic stenosis

occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body.

Aortic stenosis (AS)

A P wave on an ECG represents an impulse arising at the a. SA node and repolarizing the atria b. SA node and depolarizing the atria c. AV node and depolarizing the atria d. AV node and spreading to the bundle of His

B

The auscultatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve? a. Aortic b. Mitral c. Tricuspid d. Pulmonic

B

The portion of the vascular system responsible for hemostasis is the a. thin capillary vessels b. endothelial layer of the arteries c. elastic middle layer of the veins d. smooth muscle of the arterial wall

B

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is? a. a low-calcium diet b. excessive alcohol consumption c. a family history of hypertension d. consumption of a high-protein diet

B

A nurse is caring for four clients. Which of the following clients should the nurse identify as being at risk of acquiring rheumatic endocarditis? A. Older adult who has chronic obstructive pulmonary disease B. Child who has streptococcal pharyngitis C. Middle-aged adult who has lupus erythematosus D. Young adult who recently received a body tattoo

B A child who has streptococcal pharyngitis is at risk for developing rheumatic fever which could result in rheumatic endocarditis

A nurse is completing discharge teaching with a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following food selections should the nurse include as having the highest source of potassium? a. 1 medium apple b. 1 medium baked potato c. 1 slice toast with 1 tbsp peanut butter d. 1 large scrambled egg

B A medium baked potato is the best food source of potassium because it contains 926 mg potassium per serving.

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? a. Respiratory rate of 18 and heart rate of 90 b. Regurgitant murmur at the mitral valve area c. Heart rate of 94 and capillary refill time of 2 seconds d. Point of maximal impulse palpable in fourth intercostal space

B A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.

A nurse is completing discharge teaching with a client who had a surgical placement of mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching? a. "I will be glad to get back to my exercise routine right away" b. "I will have my prothrombin time checked on a regular basis" c. "I will talk to my dentist about no longer needing antibiotics before dental exams" d. "I will continue to limit my intake of foods containing potassium"

B Anticoagulant therapy with warfarin (Coumadin) is necessary for the client following placement of a mechanical heart valve; the client's prothrombin time will be checked on a regular basis.

The nurse admits a 73-year-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? a. Clonidine (Catapres) b. Bumetanide (Bumex) c. Amiloride (Midamor) d. Spironolactone (Aldactone)

B Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? a. Acute anxiety b. Hypotension and tachycardia c. Peripheral edema and weight gain d. Paroxysmal nocturnal dyspnea (PND)

B Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

The nurse provides discharge instructions for a 40-year-old woman who is newly diagnosed with cardiomyopathy. Which statement, if made by the patient, indicates that further teaching is necessary? A. "I will avoid lifting heavy objects." B. "I can drink alcohol in moderation." C. "My family will need to take a CPR course." D. "I will reduce stress by learning guided imagery."

B Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

The nurse performs discharge teaching for a 68-year-old man who is newly diagnosed with infective endocarditis with a history of IV substance abuse. Which statement by the patient indicates to the nurse that teaching was successful? A. "I will need antibiotics before having any invasive procedure or surgery." B. "I will inform my dentist about my hospitalization for infective endocarditis." C. "I should not be alarmed if I have difficulty breathing or pink-tinged sputum." D. "An elevated temperature is expected and can be managed by taking acetaminophen."

B Patients with infective endocarditis should inform their dental providers of their health history. Antibiotic prophylaxis is recommended for patients with a history of infective endocarditis who have certain dental procedures performed. Antibiotics are not indicated before genitourinary or gastrointestinal procedures unless an infection is present. Patients should immediately report the presence of fever or clinical manifestations indicating heart failure to their health care provider.

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? a. Broiled fish b. Roasted duck c. Roasted turkey d. Baked chicken breast

B Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall CVD risk. The other meats are lower in fat and are therefore acceptable in the diet.

A nurse is caring for a 72-year-old client who is to undergo a percutaneous balloon valvuloplasty. The client's daughter asks the nurse to explain the expected outcome of this procedure. Which of the following responses should the nurse give? a. "This will improve blood flow in your mother's coronary arteries" b. "This will permit your mother to resume her activities of daily living" c. "This will prolong your mother's life" d. "This will reverse the effects to the damaged area"

B Surgery is indicated for older adult clients when manifestations interfere with activities of daily living.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? a. Withhold the daily dose until the following day. b. Withhold the dose and report the potassium level. c. Give the digoxin with a salty snack, such as crackers. d. Give the digoxin with extra fluids to dilute the sodium level.

B The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statements by the client indicates an understanding of the teaching? A. "I should eat a lot of fruits and vegetables, especially bananas and potatoes" B. "I will report any changes in heart rate to my provider" C. "I should replace the salt shaker on my table with a salt substitute" D. "I will decrease the dose of this medication when I no longer have headaches and facial redness"

B The nurse should teach the client to monitor her heart rate and report any changes to her provider

The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? a. Long-term anticoagulation therapy b. Antibiotic prophylaxis for dental care c. Exercise plan to increase cardiac tolerance d. Take β-adrenergic blockers to control palpitations.

B The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears these sounds. How should the nurse document what is heard? a. Diastolic murmur b. Third heart sound (S3) c. Fourth heart sound (S4) d. Normal heart sounds (S1, S2)

B The third heart sound is heard closely after the S2 and is known as a ventricular gallop because it is a vibration of the ventricular walls associated with decreased compliance of the ventricles during filling. It occurs with left ventricular failure. Murmurs sound like turbulence between normal heart sounds and are caused by abnormal blood flow through diseased valves. The S4 heart sound is a vibration caused by atrial contraction, precedes the S1, and is known as an atrial gallop. The normal S1 and S2 are heard when the valves close normally.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? a. High-potassium foods b. Drugs to treat erectile dysfunction c. Nonsteroidal antiinflammatory drugs d. Over-the-counter H2-receptor blockers

B The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

A 59-year-old man has presented to the emergency department with chest pain. What component of his subsequent blood work is most clearly indicative of a myocardial infarction (MI)? a. CK-MB b. Troponin c. Myoglobin d. C-reactive protein

B Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.

A nurse is caring for a client who has heart failure and reports increased SOB. The nurse increases the clients oxygen per protocol. Which of the following actions should the nurse take first? a. Obtain the client's weight b. Assist the client into high-Fowler's position c. Auscultate lung sounds d. Check oxygen saturation with pulse oximeter

B Using the airway, breathing, and circulation (ABC) priority approach to client care, the first action thee nurse should take is to assist the client into high-Fowler's position. This will decrease venous return to the heart (preload) and help relieve lung congestion.

Patients with a heart transplantation are at risk for which complications in the first year after transplantation? (Select all that apply) a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death

B, C, E

A nurse is screening a male client for hypertension. The nurse should identify that which of the following actions by the client increase his risk for hypertension? (Select all that apply) A. Drinking 8 oz nonfat milk daily B. Eating popcorn at the movie theater C. Walking 1 mile daily at 12 min/mile pace D. Consuming 36 oz beer daily E. Getting a massage once a week

B, D Popcorn at a movie theater contains a large quantity of sodium and fat, which increases the risk for hypertension.

The force exerted by the blood against the walls of teh blood vessel

Blood Pressure

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is a. ventricular dilation b. ventricular hypertrophy c. neurohormonal response d. sympathetic nervous system activation

C

A patient with a tricuspid valve disorder will have impaired blood flow between the a. vena cava and right atrium b. left atrium and left ventricle c. right atrium and right ventricle d. right ventricle and pulmonary artery

C

The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which intervention would be a priority? a. encourage caregivers to learn CPR b. consider a consultation with hospice for palliative care c. monitor the patients response to prescribe medications d. arrange for the patient to enter a cardiac rehabilitation program

C

The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition? a. fatigue b. peripheral edema c. jugular vein distention d. thickened pericardium on echocardiography

C

When assessing the cardiovascular system of a 79-year-old patient, you might expect to find a. a narrowed pulse pressure b. diminished carotid artery pulses c. difficulty in isolating the apical pulse d. an increased heart rate in response to stress

C

A 72-year-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? A. Aspirin B. Oxygen C. Nitroglycerin D. Morphine sulfate

C Aspirin, oxygen, nitroglycerin, and morphine sulfate are all commonly used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a drop in blood pressure.

A nurse is completing the admission physical assessment of client who has a history of mitral valve insufficiency. Which of the following findings should the nurse expect? a. s4 heart sound b. petechiae c. crackles in the lung bases d. splenomegaly

C Crackles in the lung bases is an expected finding in a client who has pulmonary congestion due to mitral valve insufficiency

A nurse in an urgent care clinic is obtaining a history from a clinic who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in 2 weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider? A. Takes psyllium daily as a fiber laxative B. Drinks skim milk daily as a bedtime snack C. Takes metoprolol daily after meals D. Drinks grapefruit juice daily with breakfast

C Metoprolol can mask the effects of hypoglycemia in clients who have diabetes mellitus

The nurse teaches a 28-year-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which statement by the patient requires an intervention by the nurse? a. "I will avoid adding salt to my food during or after cooking." b. "If I lose weight, I might not need to continue taking medications." c. "I can lower my blood pressure by switching to smokeless tobacco." d. "Diet changes can be as effective as taking blood pressure medications."

C Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (such as the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.

What nursing action should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? a. Teach the patient how to manage his or her physical activity. b. Teach the patient about the need for ongoing anticoagulation. c. Teach the patient about the need for continuous antibiotic prophylaxis. d. Teach the patient about the need to maintain standard infection control procedures.

C Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation is not indicated in this patient population. Standard precautions are indicated for all patients.

A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? a. "The complications of this infection will affect the skin, hair, and balance." b. "You will not feel well if you do not take the medicine and get over this infection." c. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." d. "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

C Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. The complications do not include hair or balance. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say.

A nurse is caring for a client who is admitted to the emergency department with a blood pressure of 266/147 mm Hg. The client reports a headache and double vision. The client states that she ran out of her diltiazem 3 days ago, and is unable to purchase more. Which of the following actions should the nurse take first? A. Administer acetaminophen for headache B. Provide teaching regarding the importance of not abruptly stopping an antihypertensive C. Obtain IV access and prepare to administer an IV antihypertensive D. Call social services for a referral for financial assistance in obtaining prescription medication

C The greatest risk to the client is injury due to a blood pressure of 266/147 mm Hg, which can be life-threatening and should be lowered as soon as possible. Obtaining IV access will permit administration of an IV hypertensive, which will act more rapidly than by the oral route.

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? a. BUN of 15 mg/dL b. Serum uric acid of 3.8 mg/dL c. Serum creatinine of 2.6 mg/dL d. Serum potassium of 3.5 mEq/L

C The normal serum creatinine level is 0.6-1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other lab results are within normal limits.

A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? a. Perform a bladder scan to assess for urinary retention. b. Restrict the patient's oral fluid intake to 500 mL per day. c. Assist the patient to a sitting position with arms on the overbed table. d. Instruct the patient to use pursed-lip breathing until the dyspnea subsides.

C The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for: a. Diastolic murmur b. Peripheral edema c. Shortness of breath on exertion d. Right upper quadrant tenderness

C The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.

When collecting subjective data related to the cardiovascular system, which information should be obtained from the patient? (Select all that apply) a. Annual income b. Smoking history c. Religious preference d. Number of pillows used to sleep e. Blood for basic laboratory studies

C, D

You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (Select all that apply) a. increases SVR b. produces diuresis c. improves contractility d. dilates renal blood vessels e. works on the ß1-receptors in the heart

C, E

occurs when compensatory mechanisms maintain an adequate CO needed for tissue perfusion

Cardiac Compensation

occurs when these mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results.

Cardiac Decompensation

develops as the pericardial effusion increases in volume

Cardiac tamponade

the transfer of a healthy donor heart to a patient with a diseased heart

Cardiac transplantation

is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body.

Cardiomyopathy

is a group of diseases that directly affect the structure or function of the myocardium.

Cardiomyopathy (CMP)

is classified as primary (refers to those conditions in which the etiology of the heart disease is unknown) or secondary (the cause of the myocardial disease is known and is a result of another disease process.

Cardiomyopathy (CMP)

is generally the result of rheumatic heart disease, a congenital bicuspid aortic valve, syphilis, or chronic rheumatic conditions.

Chronis AR

A patient with newly discovered high BP has an average reading of 15/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension c. Lifestyle changes are less important, since they were not effective, and medications will be started d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications

A

The nurse recognizes that primary manifestations of systolic failure include a. ↓ EF and ↑ PAWP b. ↓ PAWP and ↑ EF c. ↓ pulmonary hypertension associated with normal EF d. ↓ afterload and ↓ left ventricular end-diastolic pressure

A

When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of a. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation b. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation c. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation d. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate

A

When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmurs c. gallop rhythms d. pericardial friction rubs

A

When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of a. valvular heart disease b. pulmonary ypertension c. superior vena cava syndrome d. hypertrophy of the right ventricle

A

Which diagnostic study best differentiates the various types of cardiomyopathy? a. echocardiography b. arterial blood gases c. cardiac catheterization d. endomyocardial biopsy

A

Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever? a. administration of antibiotics as ordered b. Management of pain with opioid analgesics c. encouragement of fluid intake for hydration d. performance of frequent active range-of-motion exercises

A

While doing an admission assessment, the nurse notes clubbing of the patient's fingers. Based on this finding, the nurse will question the patient about which disease process? a. Endocarditis b. Acute kidney injury c. Myocardial infarction d. Chronic thrombophlebitis

A Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and/or prolonged oxygen deficiency. Clinical manifestations of acute kidney injury, myocardial infarction, and chronic thrombophlebitis will not include clubbing of the fingers.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? a. Reduce preload. b. Decrease afterload. c. Increase contractility. d. Promote vasodilation.

A Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

A nurse in a clinic is caring for a client who has been on long-term NSAID therapy to treat myocarditis. Which of the following laboratory findings should the nurse report to the provider? A. Platelets 100,000/mm³ B. Serum glucose 110 mg/dL C. Serum creatinine 0.7 mg/dL D. Amino alanine transferase (ALT) 30 IU/L

A Long-term NSAID therapy can lower platelets. This finding is outside the expected reference range and should be reported to the provider

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? a. Pulsus paradoxus b. Prolonged PR intervals c. Widened pulse pressure d. Clubbing of the fingers

A Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluids he is allowed. Which of the following statements is an appropriate response by the nurse? a. "Pour the amount of fluid you drink into an empty 2- liter bottle to keep track of how much you drink" b. "Each glass contains 8 ounces. There are 30 mililiters per ounce, so you can have a total of 8 glasses or cups of fluid each day" c. "This is the same as 2 quarts, or about the same as two pots of coffee" d. " Take sips of water or ice chips so you will not take in too much fluid"

A Pouring the amount of fluid consumed into an empty 2 L bottle provides a visual guide for the client as to the amount consumed and how to plan daily intake

A nurse is assessing a clinet who has splinter hemorrhages in her nail beds andd reports a fever. The nurse should identify these findings as manifestations of which of the following disorders? A. Infective endocarditis B. Pericarditis C. Myocarditis D. Rheumatic endocarditis

A Splinter hemmorhages in nail beds and a report of fever are findings associated with infective endocarditis

A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication at which of the following times of the day? A. Morning B. Immediately after lunch C. Immediately before dinner D. Bedtime

A The client should take furosemide, a diuretic, in the morning so that the peak action and duration of the medication occurs during waking hours.

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? A. Prompt recognition and treatment of streptococcal pharyngitis B. Completion of 4 to 6 days of antibiotic therapy for infective endocarditis of respiratory infections in children born with heart defects C. Avoidance of respiratory infections in children who have rheumatoid arthritis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

A The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.

are activated to maintain adequate cardiac output (CO). Several counterregulatory processes are activated, including the production of hormones from the heart muscle to promote vasodilation.

Compensatory mechanisms

A major consideration in the management of the older adult with hypertension is to a. prevent primary hypertension from converting to secondary hypertension b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult c. ensure that the patient receives larger initial doses of anti-hypertensive drugs because of impaired absorption d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap

D

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that a. all patients with elevated BP require medication b. obese persons must achieve normal weight to lower BP c. it is not necessary to limit salt in the diet if taking a diuretic d. lifestyle modifications are indicated for all persons with elevated BP

D

Priority nursing management for a patient with myocarditis includes interventions related to a. meticulous skin care b. antibiotic prophylaxis c. tight glycemic control d. oxygenation and ventilation

D

Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation? a. Reduction in peripheral edema and weight b. Carotid venous distention and new-onset atrial fibrillation c. Significant pulses paradoxus and diminished peripheral pulses d. SOB on minimal exertion and a diastolic murmur

D

Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? a. "You may remove the monitor only to shower or bathe." b. "You should connect the monitor whenever you feel symptoms." c. "You should refrain from exercising while wearing this monitor." d. "You will need to keep a diary of all your activities and symptoms."

D A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.

A nurse is caring for a client who has pericarditis. Which of the following findings should the nurse expect? a. Petechiae b. Murmur c. Rash d. Friction rub

D A friction rub can be heard during auscultation of a client who has pericarditis

A nurse is admitting a client who has suspected rheumatic endocarditis. The nurse should anticipate a prescription from the provider for which of the following laboratory tests to assist in confirmation of this diagnosis? A. Arterial blood gases B. Serum albumin C. Liver enzymes D. Throat culture

D A throat culture can reveal the presence of streptococcus, which is the leading cause of rheumatic endocarditis

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? a. ADHF b. Chronic HF c. Left-sided HF d. Right-sided HF

D An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia and nausea

D Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do? (Select all that apply) a. Monitor serum potassium levels b. Teach the patient how to take a pulse rate c. Keep an accurate measure of intake and output d. Teach the patient about dietary restriction of potassium e. Withhold digitalis and notify healthcare provider if heart rate is irregular

A, B

Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization? (Select all that apply) a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. Assisting the patient to ambulate to the bathroom to void d. Informing the patient that he will be sleepy from the general anesthesia e. Instructing the patient about the risks of the radioactive isotope injection

A, B

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations (select all that apply)? Select all that apply. a. Osler's nodes b. Janeway's lesions c. Splinter hemorrhages d. Subcutaneous nodules e. Erythema marginatum lesions

A, B, C Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

Assessment of an IV cocaine user with infective endocarditis should focus on which signs and symptoms? (Select all that apply) a. Retinal hemorrhage b. Splinter hemorrages c. Presence of Osler's nodes d. Painless nodules over bony prominences e. Painless erythematous macules on teh palms and soles

A, B, C, E

A patient has a severe blockage in his right coronary artery. Which cardiac structures are most likely to be affected by this blockage? (Select all that apply) a. AV node b. Left ventricle c. Coronary sinus d. Right ventricle e. Pulmonic valve

A, B, D

A patient is admitted with myocarditis. While performing the initial assessment, the nurse may find which clinical signs and symptoms? (Select all that apply) a. Angina b. Pleuritic chest pain c. Splinter hemorrhages d. Pericardial friction rub e. Presence of Osler's nodes

A, B, D

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? Select all that apply. a. Administer ordered morphine sulfate. b. Position patient in a semi-Fowler's position. c. Position patient on left side with head of bed flat. d. Instruct patient on the use of relaxation techniques. e. Use a calm, reassuring approach while talking to patient.

A, B, D, E Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults (select all that apply)? Select all that apply. a. Systolic murmur b. Diminished pedal pulses c. Increased maximal heart rate d. Decreased maximal heart rate e. Increased recovery time from activity

A, B, D, E Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.

A nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? (Select all that apply) a. dyspnea b. client report of fatigue c. bradycardia d. pleural friction rub e. peripheral edema

A, B, E Dyspnea is a manifestation of right-sided valvular heart disease. A client's report of fatigue is a manifestation of right-sided valvular heart disease. Peripheral edema is a manifestation of right-sided valvular heart disease.

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestations are expected findings? (Select all that apply) a. tachypnea b. persistent cough c. increased urinary output d. thick, yellow sputum e. orthopnea

A, B, E Tachypnea is an expected finding in a client who has pulmonary edema. A persistent cough with pink, frothy sputum is an expected finding in a client who has pulmonary edema. Orthopnea is an expected finding in a client who has pulmonary edema.

The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life? Select all that apply. a. Decrease preload and afterload. b. Relieve left ventricular outflow obstruction. c. Control heart failure by enhancing myocardial contractility. d. Improve diastolic filling and the underlying disease process. e. Improve ventricular filling by reducing ventricular contractility.

A, C The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.

A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to UAP? (Select all that apply) a. obtain and record daily weight b. determine apical-radial pulse rate c. observe for overt signs of bleeding d. obtain and record vital signs, including pulse oximetry e. Teach the patient how to purchase a Medic Alert bracelet

A, C, D

A patient is admitted to the hospital in hypertensive emergency (BP 244/142). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be appropriate for this patient? (Select all that apply) a. Measure hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continue BP monitoring with an intraarterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

A, C, E

Which BP-regulating mechanism(s) can result in the development of hypertension if defective? (Select all that apply) a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the paraasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

A, C, E

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? (Select all that apply) a. surgical repair of an atrial septal defect at age 2 b. measles infection during childhood c. hypertension for 5 years d. weight gain of 10 lb in past year e. diastolic murmur present

A, C, E A history of congenital malformations is a risk factor for valvular heart disease. Hypertension places a client at risk for valvular heart disease. A murmur indicates turbulent blood flow, which is often due to valvular heart disease.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? Select all that apply. a. Left ventricular function is documented. b. Controlling dysrhythmias will eliminate HF. c. Prescription for digoxin (Lanoxin) at discharge d. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge e. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

A, D, E The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.

A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should the nurse recommend for the client? (Select all that apply) a. 1 slice cheddar cheese b. 1 medium beef hot dog c. 3. oz Atlantic salmon d. 3 oz roasted chicken breast e. 2 oz lean baked ham

A, c, D One slice of cheddar cheese contains 180 mg sodium. Three ounces of Atlantic salmon contains 37 mg sodium. Three ounces roasted chicken breast contains 62 mg sodium. Foods should be less than 300 mg per serving for a 2,000 mg sodium-restricted diet

A 44-year-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After the nurse teaches him about the medication, which statement by the patient indicates his correct understanding? a. "If I take this medication, I will not need to follow a special diet." b. "It is normal to have some swelling in my face while taking this medication." c. "I will need to eat foods such as bananas and potatoes that are high in potassium." d. "If I develop a dry cough while taking this medication, I should notify my doctor."

D Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced-sodium diet.

Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? a. Infection b. Acute rejection c. Immunosuppression d. Cardiac vasculopathy

D Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A 55-year-old female patient develops acute pericarditis after a myocardial infarction. It is most important for the nurse to assess for which clinical manifestation of a possible complication? A. Presence of a pericardial friction rub B. Distant and muffled apical heart sounds C. Increased chest pain with deep breathing D. Decreased blood pressure with tachycardia

D Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms indicating cardiac tamponade include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.

A 74-year-old woman who is admitted with severe dyspnea has a history of heart failure and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? a. Serum potassium b. Serum homocysteine c. High-density lipoprotein d. b-type natriuretic peptide (BNP)

D Elevation of b-type natriuretic peptide (BNP) indicates the presence of heart failure. Elevations help to distinguish cardiac vs. respiratory causes of dyspnea. Elevated potassium, homocysteine, or HDL levels may indicate increased risk for cardiovascular disorders but do not indicate that cardiac disease is present.

The patient with pericarditis is complaining of chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? a. Corticosteroids b. Morphine sulfate c. Proton pump inhibitor d. Nonsteroidal antiinflammatory drugs

D Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of GI bleeding from the NSAIDs.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? a. Taper the patient off his current medications. b. Continue education for the patient and his family. c. Pursue experimental therapies or surgical options. d. Choose interventions to promote comfort and prevent suffering.

D The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? a. Urine output b. Heart rhythm c. Breath sounds d. Blood pressure

D The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? a. Aortic valve replacement b. Take nitroglycerin for chest pain. c. Open commissurotomy (valvulotomy) procedure d. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

D The percutaneous transluminal balloon valvuloplasty (PTBV) procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes mellitus. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Nitroglycerin is used cautiously for chest pain because it can reduce BP and worsen chest pain in patients with aortic stenosis. Open commissurotomy procedure is used for mitral stenosis.

is a critical part of the care of patients with HF

DRUG THERAPY

the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood. (Heart can't fill)

Diastole

the inability of the ventricles to relax and fill during diastole

Diastolic failure

is an abnormal clinical syndrome that involves inadequate pumping and/or filling of the heart

Heart failure

defined as a persistent systolic BP (SBP) of 140 mmHg or more, diastolic BP (DBP) of 90 mmHg or more, or current use of antihypertensive medication

Hypertension

a term used to indicate either a hypertensive urgency or emergency

Hypertensive crisis

an increase in the muscle mass and cardiac wall thickness in response to overwork and strain.

Hypertrophy

is defined as an average SBP of 140 or more, coupled with an average DBP of less than 90.

Isolated systolic hypertension (ISH)

refers to the average pressure within the arterial system that is felt by organs in the body

Mean arterial pressure (MAP=(SBP+2DBP)/3

is a focal or diffuse inflammation of the myocardium caused by viruses, bacteria, fungi, radiation therapy, and pharmacologic and chemical factors. "Inflammation of the heart muscle"

Myocarditis

including cardiac resynchronization therapy, biventricular pacing, intra-aortic balloon pump, and ventricular assist devices, are an integral part of the management of HF patients.

NONPHARMACOLOGIC THERAPIES

is shortness of breath (dyspnea) which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.

Orthopnea or orthopnoea

A decrease of 20 or more in SBP, a decrease of 10 or more in DBP, and/or an increase in the HR of 20 beats/min or more from sitting to standing indicates

Orthostatic hypotension

Occurs when the patient is asleep and is caused by the reabsorption of fluid from dependent body areas when the patient is flat

Paroxysmal nocturnal dyspnea (PND)

is caused by inflammation of the pericardial sac (the pericardium).

Pericarditis

is defined as SBP of 120 to 139 mmHg or DBP of 80 to 89 mmHg

Prehypertension

is elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension

Primary hypertension

is fluid accumulation in the lungs, which collects in air sacs. This fluid collects in air sacs in the lungs, making it difficult to breathe. It leads to impaired gas exchange and may cause respiratory failure.

Pulmonary Edema

This is an acute, life-threatening situation in which the lung alveoli become filled with serosanguineous fluid

Pulmonary edema

The difference between the SBP and DBP is the

Pulse pressure (BP of 120/80 = pulse pressure of 40)

is an inflammatory disease of the heart that occurs as a complication following group A streptococcal pharyngitis.

Rheumatic fever (RF)

is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever

Rheumatic fever (RF)

is a chronic condition resulting from RF that is characterized by scarring and deformity of the heart valves.

Rheumatic heart disease

is elevated BP with a specific cause that often can be identified and corrected

Secondary hypertension

The force opposing the movement of blood within the blood vessels

Systemic vascular resistance (SVR)

the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries. (Heart can't pump)

Systole

results from an inability of the heart to pump blood effectively

Systolic failure

Over time, ventricular remodeling, dilation, and hypertrophy develop and lead to

chronic HF

is long-term (chronic) inflammation of the sac-like covering of the heart (the pericardium) with thickening and scarring

chronic constrictive pericarditis

is done with a left-sided heart catheterization

coronary angiography

is when the heart's ability to pump blood is lessened because its main pumping chamber, the left ventricle, is enlarged and weakened.

dilated cardiomyopathy

sustained lifts of the chest wall in the precordial area that can be seen or palpated

heaves

is a disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood.

hypertrophic cardiomyopathy

is defined as an infection of the endocardial layer of the heart.

infective endocarditis (IE)

a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium.

mitral valve prolapse (MVP)

The turbulent blood flow across the affected valve results in a

murmur

an inflammation of the heart muscle (myocardium)

myocarditis

an invasive procedure that involves using a needle and catheter to remove fluid (called a pericardial effusion) from the sac around the heart (the pericardium). Is usually performed for pericardial effusion with acute cardiac tamponade, purulant pericaraditis, and suspected neoplasm.

pericardiocentesis

is a condition caused by inflammation of the pericardial sac

pericarditis

Also called the apical pulse

point of maximal impulse (PMI)

is the expulsion of material from the pharynx, or esophagus, usually characterized by the presence of undigested food or blood

regurgitation

damage to one or more heart valves that remains after an episode of acute rheumatic fever (ARF) is resolved

rheumatic heart disease

the abnormal narrowing of a passage in the body.

stenosis

an enlargement of the chambers of the heart. It occurs when pressure in the heart chambers (usually the LV) is elevated over time.

Dilation

are used to reduce edema, pulmonary venous pressure, and preload

Diuretics

an abnormal clinical syndrome that involves inadequate pumping and/or filling of the heart. This results in the inability of the heart to provide sufficient blood to meet the oxygen needs of the tissues.

Heart Failure

is caused by MI, chronic rheumatic heart disease, mitral valve prolapse, ischemic papillary muscle dysfunction, and IE.

Mitral regurgitation (MR)

is an abnormality of the mitral valve leaflets and the papillary muscles or chordae that allows the leaflets to prolapse, or buckle, back into the left atrium during systole. The etiology of MVP is unknown.

Mitral valve prolapse

the membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane.

Pericardium

The most common form of HF is left-sided HF from left ventricular dysfunction. Blood backs up into the left atrium and into the pulmonary veins, causing

pulmonary congestion and edema

Decompensation of chronic HF usually begins with signs of fluid retention, such as weight gain, exertional dyspnea, or orthopnea. Patients with a new diagnosis of HF are more likely to present with

pulmonary edema

The edema of chronic HF is often treated by dietary restriction of

sodium

results from scarring with consequent loss of elasticity of the pericardial sac. The end result is that the pericardium impairs the ability of the atria and ventricles to stretch adequately during diastole.

Chronic constrictive pericarditis

are the primary drug of choice in chronic HF patients with systolic failure

Angiotensin-converting enzyme (ACE) inhibitors

may be used in patients who are ACE inhibitor intolerant

Angiotension II receptor blockers

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? a. Urine output b. Lung sounds c. Blood pressure d. Respiratory rate

C Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. What should the nurse do next? a. Assess his adherence to therapy. b. Ask him to make an exercise plan. c. Instruct him to use the DASH diet. d. Request a prescription for a thiazide diuretic.

A A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation resulting in decreased SVR and arterial BP and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to assess his adherence to therapy.

During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg-weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, the best nursing diagnosis for the patient is: A. activity intolerance related to fatigue B. disturbed body image related to weight gain C. Impaired skin integrity related to ankle edema D. impaired gas exchange related to dyspnea on exertion

A Activity intolerance related to fatigue

In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? a. Atherosclerosis b. Hyperthyroidism c. Arteriovenous fistula d. Cardiac dysrhythmias

A Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration? a. Pulse 48 b. Respirations 24 c. Blood pressure 118/74 d. Oxygen saturation 93%

A Because esmolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? a. Calculated by multiplying the patient's stroke volume by the heart rate b. The average amount of blood ejected during one complete cardiac cycle c. Determined by measuring the electrical activity of the heart and the patient's heart rate d. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure

A Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

A70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed for her to continue at home. Which response by the nurse is accurate? a. "The medication prevents blood clots from forming in your heart." b. "The medication dissolves clots that develop in your coronary arteries." c. "The medication reduces clotting by decreasing serum potassium levels." d. "The medication increases your heart rate so that clots do not form in your heart."

A Chronic heart failure causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has bilateral crackles b. The patient has 4+ peripheral edema c. The patient has a loud systolic murmur across the precordium d. The patient has a palpable thrill felt over the left anterior chest

A Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension? A. A 56-year-old man whose father died at age 62 from a stroke B. A 30-year-old female advertising agent who is unmarried and lives alone C. A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland D. A 43-year-old man who travels extensively with his job and exercises only on weekends

A History of a close blood relative (e.g., father to son) with hypertension is associated with an increased risk for developing hypertension; atherosclerosis is the most common cause of cerebrovascular disease. Hypertension is the major risk factor for cerebral atherosclerosis and stroke.

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. b. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d. Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

A Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

The nurse takes blood pressures at a health fair. The nurse identifies which person as most at risk for developing hypertension? a. A 52-year-old male who smokes and has a parent with hypertension b. A 30-year-old female advertising agent who is unmarried and lives alone c. A 68-year-old male who uses herbal remedies to treat an enlarged prostate gland d. A 43-year-old female who travels extensively for work and exercises only on weekends

A Hypertension is more prevalent in men who are less than 55 years of age. Smoking tobacco greatly increases the risk of cardiovascular disease. A history of a close blood relative (e.g., parents, sibling) with hypertension is associated with an increased risk for developing hypertension. Other risk factors would include increasing age, sedentary lifestyle, and stress.

A 64-year-old patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? a. IV sedation may be administered to help the patient relax. b. Food and fluids are restricted for 2 hours before the procedure. c. Ambulation is restricted for up to 6 hours before the procedure. d. Ambulation is restricted for up to 6 hours before the procedure.

A IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing, but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.

At a clinic visit, the nurse provides dietary teaching for a 56-year-old woman who was recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? a. "I will limit the amount of milk and cheese in my diet." b. "I can add salt when cooking foods but not at the table." c. "I will take an extra diuretic pill when I eat a lot of salt." d. "I can have unlimited amounts of foods labeled as reduced sodium."

A Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to: a. Promote rest to decrease myocardial oxygen demand b. Teach the patient about the need for anticoagulant therapy c. Teach the patient to use sublingual nitroglycerin for chest pain d. Raise the head of the bed 60 degrees to decrease venous return

A Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? a. Take medications as prescribed. b. Use oxygen when feeling short of breath. c. Only ask the physician's office questions. d. Encourage most activity in the morning when rested.

A The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply)? Select all that apply. a. Assess for return of gag reflex. b. Assess groin for hematoma or bleeding. c. Monitor vital signs and oxygen saturation. d. Position patient supine with head of bed flat. e. Assess lower extremities for circulatory compromise.

A, C The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

is a worsening of the symptoms, typically shortness of breath (dyspnea), edema, and fatigue, in a patient with existing heart disease. ADHF is a common and potentially serious cause of acute respiratory distress.

Acute decompensated heart failure (ADHF)

The nurse is assessing a 62-year-old woman undergoing radiation treatment for breast cancer. How should the nurse position the patient to auscultate for signs of acute pericarditis? a. Supine without a pillow b. Sitting and leaning forward c. Left lateral sidelying position d. Head of bed at a 45-degree angle

B A pericardial friction rub indicates pericariditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration.

The home care nurse visits a 73-year-old Hispanic woman with chronic heart failure. Which clinical manifestations, if assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? a. Fatigue, orthopnea, and dependent edema b. Severe dyspnea and blood-streaked, frothy sputum c. Temperature is 100.4o F and pulse is 102 beats/minute d. Respirations 26 breaths/minute despite oxygen by nasal cannula

B Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate > 30 breaths per minute, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? a. Weight loss of 2 lb b. Blood pressure 128/86 c. Absence of ankle edema d. Output of 600 mL per 8 hours

B Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

The nurse is assessing a patient with myocarditis before administering the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider? a. Leukocytosis b. Irregular pulse c. Generalized myalgia d. Complaint of fatigue

B Myocarditis predisposes the heart to digoxin-associated dysrhythmias and toxicity. The other findings are common symptoms of myocarditis and there is no urgent need to report these.

To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should: a. Listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. Auscultate by placing the diaphragm of the stethoscope on the lower left sternal border. c. Ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. Feel the pericardial area with the palm of the hand to detect vibrations with cardiac contraction.

B Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history will be most pertinent to ask? a. "Do you use any illegal IV drugs?" b. "Have you had a recent sore throat?" c. "Have you injured your chest in the last few weeks?" d. "Do you have a family history of congenital heart disease?"

B Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever, and would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

The patient is confused about how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. The nurse can help the patient understand this with which explanation? a. "The one vessel curves around from the left side to the right ventricle." b. "The LAD supplies blood to the left side of the heart and part of the right ventricle." c. "The right ventricle is supplied during systole primarily by the right coronary artery." d. "It is actually on your right side of the heart, but we call it the left anterior descending vessel."

B The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of 58-year-old female patient admitted with heart failure. The patient is obese. The nurse should intervene if what is observed? a. The UAP waits 2 minutes after position changes to take orthostatic pressures. b. The UAP deflates the blood pressure cuff at a rate of 8 to 10 mm Hg per second. c. The UAP takes the blood pressure with the patient's arm at the level of the heart. d. The UAP takes a forearm blood pressure because the largest cuff will not fit the patient's upper arm

B The cuff should be deflated at a rate of 2 to 3 mm Hg per second. The arm should be supported at the level of the heart for accurate blood pressure measurements. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a. Restrict all caffeine. b. Restrict sodium intake. c. Increase protein intake. d. Use calcium supplements.

B The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy is most important for the nurse to assess before this procedure? a. Iron b. Iodine c. Aspirin d. Penicillin

B The physician will usually use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.

A 55-year-old man with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding should the nurse expect? a. Pulse deficit b. Systolic murmur c. Distended neck veins d. Splinter hemorrhages

B The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Distended neck veins may be caused by right-sided heart failure. Splinter hemorrhages occur in patients with infective endocarditis.

Auscultation of a patient's heart reveals the presence of a murmur. What is this assessment finding a result of? a. Increased viscosity of the patient's blood b. Turbulent blood flow across a heart valve c. Friction between the heart and the myocardium d. A deficit in heart conductivity that impairs normal contractility

B Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next? a. Repeat BP and P in this position. b. Take BP and P with patient sitting. c. Record the BP and P measurements. d. Take BP and P with patient standing.

B When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing position with BP measured again, within 1 to 2 minutes. The results are then recorded with a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.

A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? a. Women are less likely to delay seeking treatment than men. b. Women are more likely to have noncardiac symptoms of heart disease. c. Women are often less ill when presenting for treatment of heart disease. d. Women experience more symptoms of heart disease at a younger age than men.

B Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.

in combination with ACE inhibitors and diuretics have improved survival of patients with HF

B-Adrenergic blockers (Beta-blockers)

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for, given the patient's health history? a. Hypocapnia b. Tachycardia c. Bronchospasm d. Nausea and vomiting

C Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are effective? a. Assess for the presence of a paradoxical pulse. b. Monitor for changes in the patient's sedimentation rate. c. Assess for the presence of jugular venous distention (JVD). d. Check the electrocardiogram (ECG) for ST segment changes.

C Because the most common finding on physical examination for a patient with chronic constrictive pericarditis is jugular venous distention, a decrease in JVD indicates improvement. Paradoxical pulse, ST-segment ECG changes, and changes in sedimentation rates occur with acute pericarditis but are not expected in chronic constrictive pericarditis.

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? A. 2+ pedal edema B. heart rate of 56 beats/minute C. Blood pressure (BP) of 88/42 mm Hg D. Complaints of fatigue

C Blood Pressure (BP) of 88/42 mm Hg

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? a. Position the patient supine. b. Ask the patient to hold his or her breath. c. Palpate the radial pulse while auscultating the apical pulse. d. Use the bell of the stethoscope when auscultating S1 and S2.

C In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? a. Blocks β-adrenergic effects. b. Relaxes arterial and venous smooth muscle. c. Inhibits conversion of angiotensin I to angiotensin II. d. Reduces sympathetic outflow from central nervous system.

C Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased SVR and BP.

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

C Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and child bearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.

The nurse prepares to administer digoxin (Lanoxin) 0.125 mg to an 82-year-old man admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? a. Prothrombin time b. Urine specific gravity c. Serum potassium level d. Hemoglobin and hematocrit

C Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.

A patient's BP has not responded consistently to prescribed drugs for hypertension. The first cause of this lack of responsiveness the nurse should explore is a. progressive target organ damage. b. the possibility of drug interactions. c. the patient not adhering to therapy. d. the patient's possible use of recreational drugs.

C Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? a. Depolarization of the atria b. Repolarization of the ventricles c. Depolarization from AV node throughout ventricles d. The length of time it takes for the impulse to travel from the atria to the ventricles

C The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles. INCORRECT

A 67-year-old woman with a history of coronary artery disease and prior myocardial infarction is admitted to the emergency department with a blood pressure of 234/148 mm Hg and started on IV nitroprusside (Nitropress). What should the nurse determine as an appropriate goal for the first hour of treatment? a. Mean arterial pressure lower than 70 mm Hg b. Mean arterial pressure no more than 120 mm Hg c. Mean arterial pressure no lower than 133 mm Hg d. Mean arterial pressure between 70 and 110 mm Hg

C The initial treatment goal is to decrease mean arterial pressure by no more than 25% within minutes to 1 hour. If the patient is stable, the goal for BP is 160/100 to 110 mm Hg over the next 2 to 6 hours. Lowering the blood pressure too much may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. Additional gradual reductions toward a normal blood pressure should be implemented over the next 24 to 48 hours if the patient is clinically stable.

The patient has chronic hypertension. Today she has gone to the ED, and her blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? a. Is the patient pregnant? b. Does the patient need to urinate? c. Does the patient have a headache or confusion? d. Is the patient taking antiseizure medications as prescribed?

C The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which PRN medication would be most appropriate for the nurse to give? a. Fentanyl b. IV morphine sulfate c. Oral ibuprofen d. Oral acetaminophen

C The pain associated with pericarditis is caused by inflammation, NSAIds (ex: ibuprofen) are most effective.

The nurse determines that which blood pressure would meet the criteria for a diagnosis of stage 1 hypertension (select all that apply)? a. 134/84 mm Hg b. 138/88 mm Hg c. 144/92 mm Hg d. 156/96 mm Hg e. 182/100 mm Hg

C, D Stage 1 hypertension is diagnosed when the systolic blood pressure is 140-159 mm Hg or the diastolic blood pressure is 90-99 mm Hg. 182/100 meets the criteria for Stage 2.

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women (select all that apply)? Select all that apply. a. Lose weight. b. Limit nuts and seeds. c. Limit sodium and fat intake. d. Increase fruits and vegetables. e. Exercise 30 minutes most days.

C, D, E Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Nuts and seeds and dried beans are used for protein intake. Weight loss may or may not be necessary for the individual.

The nurse determines that the patient has stage 2 hypertension when the patient's average blood pressure is (select all that apply) a. .150/96 mm Hg. b. 155/88 mm Hg. c. 172/92 mm Hg. d. 160/110 mm Hg. e. 182/106 mm Hg.

C, D, E Stage 2 hypertension is diagnosed when systolic blood pressure is greater than or equal to 160 mm Hg or diastolic blood pressure is greater than or equal to 100 mm Hg.

can be used in patients who remain symptomatic despite being on ACE and B-blocker therapy. Diet teaching and weight management are critical to the patient's control of chronic HF.

Digitalis Glycosides

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? a. Stenosis of the heart valves b. Decreased adrenergic sensitivity c. Increased parasympathetic activity d. Loss of elasticity in arterial vessels

D An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

D Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IC). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine (Ismelin)? a. "A fast heart rate is a side effect to watch for while taking guanethidine." b. "Stop the drug and notify your doctor if you experience any nausea or vomiting." c. "Because this drug may affect the lungs in large doses, it may also help your breathing." d. "Make position changes slowly, especially when rising from lying down to a standing position."

D Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings may also be helpful. Tachycardia or lung effects are not evident with guanethidine.

On return from surgery, the patient is wearing intermittent sequential compression stockings that he does not want to keep on. How should the nurse explain their necessity to the patient while he is on bed rest? a. The socks keep the legs warm while the patient is not moving much. b. The socks maintain the blood flow to the legs while the patient is on bed rest. c. The socks keep the blood pressure down while the patient is stressed after surgery. d. The socks provide compression of the veins to keep the blood moving back to the heart.

D Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.

THE NURSE IS CARING FOR A PATIENT WHO IS RECEIVING IV FUROSEMIDE (LASIX) AND MORPHINE FOR THE TREATMENT OF ACUTE DECOMPENSATED HEART FAILURE (ADHF) WITH SEVERE ORTHOPNEA. WHICH CLINICAL FINDING IS THE BEST INDICATOR THAT THE TREATMENT HAS BEEN EFFECTIVE? A. Weight loss of 2 lbs in 24 hours B. Hourly urine output greater than 60 mL C. Reduction in patient complaints of chest pain D. Reduced dyspnea with the head of bed at 30 degrees

D Reduced dyspnea with the head of bed at 30 degrees

A patient's blood pressure has not responded to the prescribed drugs for hypertension. Which of the following should the nurse assess first? a. Potential for drug interactions b. Progressive target organ damage c. Possible use of recreational drugs d. Patient's adherence to drug therapy

D Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

D The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs about the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient terminal or end-stage cardiomyopathy may consider heart transplantation

Clinical manifestations develop acutely after an infectious process or slowly over a period of time. *Most people eventually develop HF.*

Dilated Cardiomyopathy