2501 Exam 2 Chronic Cardiac

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was unsuccessful? 1. Rising blood pressure 2. Clearly audible heart sounds 3. Client expressions of relief 4. Rising central venous pressure

4. Rising central venous pressure Rationale: Following pericardiocentesis, a rise in blood pressure and a fall in central venous pressure are expected. The client usually expresses immediate relief. Heart sounds are no longer muffled or distant.

A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1. 0.5 to 2 ng/mL 2. 1.2 to 2.8 ng/mL 3. 3.0 to 5.0 ng/mL 4. 3.5 to 5.5 ng/mL

1. 0.5 to 2 ng/mL

A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1. Anterior chest pain 2. Pericardial friction rub 3. Weakness and irritability 4. Chest pain that worsens on inspiration

2. Pericardial friction rub

The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? 1. "I'll need to become a strict vegetarian." 2. "I should use polyunsaturated oils in my diet." 3. "I need to substitute eggs and whole milk for meat." 4. "I should eliminate all cholesterol and fat from my diet."

2. "I should use polyunsaturated oils in my diet." Rationale: The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian.

The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? 1. Use nail polish to protect the nail beds from injury. 2. Stop smoking because it causes cutaneous vasospasm. 3. Wear gloves for all activities involving use of both hands. 4. Always wear warm clothing even in warm climates to prevent vasoconstriction.

2. Stop smoking because it causes cutaneous vasospasm. Rationale: Raynaud's disease is peripheral vascular disease characterized by abnormal vasoconstriction in the extremities. Smoking cessation is one of the most important lifestyle changes that the client must make. The nurse should emphasize the effects of tobacco on the blood vessels and the principles involved in stopping smoking. The nurse needs to provide information to the client about smoking cessation programs available in the community.

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? 1. Sleep with the head of bed flat. 2. Weigh himself or herself on a daily basis. 3. Take a double dose of the diuretic if peripheral edema is noted. 4. Withhold prescribed digoxin (Lanoxin) if slight respiratory distress occurs.

2. Weigh himself or herself on a daily basis. Rationale: The client can best determine fluid status at home by weighing himself or herself on a daily basis. Increases of 2 to 3 lb in a short period are reported to the health care provider (HCP). The client should sleep with the head of the bed elevated. During recumbent sleep, fluid (which has seeped into the interstitium with the assistance of the effects of gravity) is rapidly reabsorbed into the systemic circulation. Sleeping with the head of the bed flat is therefore avoided. The client does not modify medication dosages without consulting the HCP.

A client who began medication therapy with prazosin hydrochloride (Minipress) 1 week earlier arrives at the health care clinic for follow-up evaluation and care. The nurse interprets that the client is experiencing the expected benefit of therapy if which is noted? 1. Increased pulse 2. Increased platelet count 3. Decreased blood pressure 4. Decreased blood glucose level

3. Decreased blood pressure Rationale: Prazosin hydrochloride is an antihypertensive medication used to treat high blood pressure. A decrease in blood pressure indicates a therapeutic effect from the medication. It is an alpha-adrenergic blocker

The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? 1. "I need to be sure not to go barefoot around the house." 2. "If I cut my toenails, I need to be sure that I cut them straight across." 3. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." 4. "I need to be sure that I elevate my leg above my heart level for at least an hour every day."

4. "I need to be sure that I elevate my leg above my heart level for at least an hour every day." Rationale: Foot care instructions for the client with peripheral arterial disease are the same as those for a client with diabetes mellitus. The client with arterial disease, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if venous stasis is also present. Page 788

The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease? 1. Checking for a rash on the digits 2. Observing for softening of the nails or nail beds 3. Palpating for a rapid or irregular peripheral pulse 4. Palpating for diminished or absent peripheral pulses

4. Palpating for diminished or absent peripheral pulses

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which assessments are most critical before the procedure? 1. Intake and output 2. Height and weight 3. Allergy to iodine or shellfish 4. Baseline peripheral pulse rates

3. Allergy to iodine or shellfish

A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem? 1. Ambulates 10 feet farther each day 2. Verbalizes the benefits of increasing activity 3. Chooses a healthy diet that meets caloric needs 4. Sleeps without awakening throughout the night

1. Ambulates 10 feet farther each day page 840

A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse plans care for the client, knowing that the failure of the aortic valve to close completely allows blood to flow retrograde through which structures? 1. Aorta to left ventricle 2. Left ventricle to left atrium 3. Right ventricle to right atrium 4. Pulmonary artery to right ventricle

1. Aorta to left ventricle Rationale: The aortic valve separates the aorta from the left ventricle.

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? 1. Chest pain 2. Urge to cough 3. Warm, flushed feeling 4. Pressure at the insertion site

1. Chest pain Rationale: The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's prescriptions? Select all that apply. 1. Elevation of the right leg 2. Ambulation in the hall every 4 hours 3. Application of moist heat to the right leg 4. Administration of acetaminophen (Tylenol) 5. Monitoring for signs of pulmonary embolism

1. Elevation of the right leg 3. Application of moist heat to the right leg 4. Administration of acetaminophen (Tylenol) 5. Monitoring for signs of pulmonary embolism

A client who is taking chlorothiazide (HydroDIURIL) comes to the clinic for periodic evaluation. In monitoring the client's laboratory test results for medication side effects, what is the clinic nurse most likely to note if a side effect is present? 1. Hypokalemia 2. Hypocalcemia 3. Hypernatremia 4. Hyperphosphatemia

1. Hypokalemia Rationale: The client taking a potassium-losing diuretic such as chlorothiazide should be monitored for decreased potassium levels. Other possible fluid and electrolyte imbalances that occur with use of this medication include hypercalcemia, hyponatremia, hypophosphatemia, and hypomagnesemia.

The nurse develops a plan of care for a client with deep vein thrombosis. Which client position or activity in the plan should be included? 1. Out-of-bed activities as desired 2. Bed rest with the affected extremity kept flat 3. Bed rest with elevation of the affected extremity 4. Bed rest with the affected extremity in a dependent position

3. Bed rest with elevation of the affected extremity Rationale: For the client with deep vein thrombosis, elevation of the affected leg facilitates blood flow by the force of gravity and also decreases venous pressure, which in turn relieves edema and pain. Bed rest is indicated to prevent emboli and to prevent pressure fluctuations in the venous system that occur with walking. Page 800

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider will most likely prescribe which option? 1. Maintain bed rest. 2. Maintain the affected leg in a dependent position. 3. Administer an opioid analgesic every 4 hours around the clock. 4. Apply cool packs to the affected leg for 20 minutes every 4 hours.

1. Maintain bed rest. Rationale: Standard management for the client with DVT includes bed rest; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Ambulation is contraindicated because such activity can cause the thrombus to dislodge and travel to the lungs. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen (Tylenol). Page 800

The nurse is providing care to a client admitted for coronary artery disease (CAD) and a history of tobacco use. What is the most important element of the nurse's focused assessment regarding the client's smoking history? 1. Number of pack-years 2. Desire to quit smoking 3. Brand of cigarettes used 4. Number of past attempts to quit smoking

1. Number of pack-years

What should the nurse teach a client about an expected outcome of nesiritide (Natrecor) administration? 1. The client will have an increase in urine output. 2. The client will have an absence of dysrhythmias. 3. The client will have an increase in blood pressure. 4. The client will have an increase in pulmonary capillary wedge pressure.

1. The client will have an increase in urine output. Rationale: Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output.

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? 1. The neurovascular status is normal because of increased blood flow through the leg. 2. The neurovascular status is moderately impaired, and the surgeon should be called. 3. The neurovascular status is slightly deteriorating and should be monitored for another hour. 4. The neurovascular status is adequate from an arterial approach, but venous complications are arising.

1. The neurovascular status is normal because of increased blood flow through the leg. Rationale: An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow.

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1. Soak the feet in hot water daily. 2. Be careful not to injure the legs or feet. 3. Use a heating pad on the legs to aid vasodilation. 4. Walk each day to increase circulation to the legs. 5. Cut down on the amount of fats consumed in the diet.

2. Be careful not to injure the legs or feet. 4. Walk each day to increase circulation to the legs. 5. Cut down on the amount of fats consumed in the diet. Rationale: Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity is contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further.

A nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is most likely unrelated to the aneurysm? 1. Pulsatile abdominal mass 2. Hyperactive bowel sounds in the area 3. Systolic bruit over the area of the mass 4. Subjective sensation of "heart beating" in the abdomen

2. Hyperactive bowel sounds in the area Rationale: Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.

A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? 1. Bilateral edema 2. Increased calf circumference 3. Diminished distal peripheral pulses 4. Coolness and pallor of the affected limb

2. Increased calf circumference Rationale: The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often, thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a complication.

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures? 1. Left ventricle to aorta 2. Left atrium to left ventricle 3. Right atrium to right ventricle 4. Right ventricle to pulmonary artery

2. Left atrium to left ventricle Rationale: The mitral valve separates the left atrium from the left ventricle

Atorvastatin (Lipitor) has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication? 1. Neutrophil count 2. Liver function studies 3. White blood cell count 4. Complete blood cell (CBC) count

2. Liver function studies

The home health nurse is visiting a client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery? 1. "I need to count my pulse every day." 2. "I have to do deep breathing exercises every 2 hours." 3. "I threw away my straight razor and bought an electric razor." 4. "I have to go to the bathroom frequently because of my medication."

3. "I threw away my straight razor and bought an electric razor." Rationale: Prosthetic valves require long-term anticoagulation to prevent clots from forming on the "foreign" tissue implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding, such as the use of straight razors.

A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused on reduction of which specific problem associated with this type of heart failure? 1. Ascites 2. Pedal edema 3. Bilateral lung crackles 4. Jugular vein distention

3. Bilateral lung crackles Rationale: The client with heart failure may present with different symptoms, depending on whether the right or the left side of the heart is failing. Adventitious breath sounds, such as crackles, are an indicator of decreased left-sided heart function. Peripheral edema, jugular vein distention, and ascites all can be present because of insufficiency of the pumping action of the right side of the heart.

Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the action of the medication. How should nurse respond about the action of this medication? 1. Increases plasma cholesterol 2. Increases plasma triglycerides 3. Decreases low-density lipoproteins (LDLs) 4. Decreases high-density lipoproteins (HDLs)

3. Decreases low-density lipoproteins (LDLs) Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. It decreases LDL cholesterol and plasma triglycerides and increases HDL cholesterol (the good cholesterol).

Gemfibrozil (Lopid) is prescribed for a client. Which laboratory finding should alert the nurse about the need to withhold the medication and contact the health care provider? 1. Elevated glucose 2. Elevated triglycerides 3. Elevated liver function tests 4. Elevated blood urea nitrogen (BUN)

3. Elevated liver function tests Lopid is a Fibric Acids (Fibrates)

The nurse has been given a medication prescription to administer intravenous (IV) hydralazine (Apresoline). The nurse obtains which priority piece of equipment needed for use during administration of this medication? 1. Pulse oximetry 2. Cardiac monitor 3. Noninvasive blood pressure cuff 4. Nonrebreather oxygen face mask

3. Noninvasive blood pressure cuff Rationale: Hydralazine is an antihypertensive medication used for moderate to severe hypertension. Because the blood pressure and pulse should be monitored frequently after administration, a noninvasive blood pressure cuff should be obtained.

A client's total cholesterol level is 344 mg/dL, low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL, and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL. Based on analysis of the data, how should the nurse direct client teaching? 1. The client should maintain the current dietary regimen but increase activity level. 2. Results are inconclusive unless the triglyceride level is also screened, so teaching is not indicated at this time. 3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. 4. The client is at low risk for cardiovascular disease, so the client should be encouraged to continue to follow the current regimen.

3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. Rationale: In the absence of documented cardiovascular disease, the desired goal is to have the total cholesterol level lower than 200 mg/dL. A desired LDL-C level for all individuals is lower than 100 mg/dL, and a desirable HDL-C level is higher than 40 mg/dL. Because the client's levels are outside the range for all three values to a significant degree, the client is at high risk for developing cardiovascular disease and requires teaching on risk factor reduction.

A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure? 1. Eat breakfast just before the procedure. 2. Wear firm, rigid shoes, such as workboots. 3. Wear loose clothing with a shirt that buttons in front. 4. Avoid cigarettes for 30 minutes before the procedure.

3. Wear loose clothing with a shirt that buttons in front. Rationale: The client should wear loose, comfortable clothing for the procedure. Electrocardiogram (ECG) lead placement is enhanced if the client wears a shirt that buttons in the front. The client should receive nothing by mouth after bedtime or for a minimum of 2 hours before the test. The client should wear rubber-soled, supportive shoes, such as athletic training shoes. The client should avoid smoking, alcohol, and caffeine on the day of the test. Inadequate or incorrect preparation can interfere with the test, with the potential for a false-positive result.

A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions? 1. "It will really hurt when the catheter is first put in." 2. "I will receive general anesthesia for the procedure." 3. "I will have to go to the operating room for this procedure." 4. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours."

4. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours." Rationale: It is common for the client to feel fatigued after the cardiac catheterization procedure. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. Other preprocedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection.

A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

The nurse witnesses an accident whereby a pedestrian is hit by an automobile. The nurse stops at the scene and assesses the victim. The nurse notes that the victim is responsive and has suffered trauma to the thorax resulting in a flail chest involving at least three ribs. What is the nurse's priority action for this victim? 1. Assist the victim to sit up. 2. Remove the victim's shirt. 3. Turn the victim onto the side with the flail chest. 4. Apply firm but gentle pressure with the hands to the flail segment.

4. Apply firm but gentle pressure with the hands to the flail segment. Rationale: If flail chest is present, the nurse applies firm yet gentle pressure to the flail segments of the ribs to stabilize the chest wall, which will ultimately help the victim's respiratory status. The nurse does not move an injured client for fear of worsening an undetected spinal injury. Removing the victim's shirt is of no value in this situation and could in fact result in chilling the victim, which is counterproductive. Injured clients should be kept warm until help arrives at the scene. Page 683

Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg? 1. Monitor oxygen saturation with pulse oximetry. 2. Assess activity tolerance before and after exercise. 3. Observe the client's cardiac rhythm with telemetry. 4. Assess peripheral pulses with an ultrasonic Doppler device.

4. Assess peripheral pulses with an ultrasonic Doppler device. Rationale: Acute arterial insufficiency is associated with interruption of arterial blood flow to an organ, tissue, or extremity. It is associated with an acutely painful pasty-colored leg. The priority is for the nurse to perform a comprehensive assessment of peripheral circulation. When pulses are difficult to palpate, the Doppler device is useful to determine the presence of blood flow to the area. The Doppler directs sound waves toward the artery being examined, which emits an audible sound. The nurse must document that the pulse was present via Doppler and not palpation

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1. Assessing pain 2. Administering vasodilators 3. Avoiding over-the-counter medications 4. Moving slowly from a sitting to a standing position

4. Moving slowly from a sitting to a standing position Rationale: Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls

A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction? 1. Take antibiotics until the chest pain is fully resolved. 2. Take acetaminophen (Tylenol) if the chest pain worsens. 3. Use a firm-bristle toothbrush and floss vigorously to prevent cavities. 4. Notify all health care providers (HCP) of the history of infective endocarditis before any invasive procedures.

4. Notify all health care providers (HCP) of the history of infective endocarditis before any invasive procedures. The client should alert any HCP about the history of infective endocarditis before any procedure that involves instrumentation. The HCP should place the client on prophylactic antibiotics if an invasive procedure is needed. Antibiotics should be taken for the full course of therapy. The client should notify the HCP if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a portal of entry for bacterial infection.

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? 1. Dietitian 2. Medical social worker 3. Pain management clinic 4. Smoking-cessation program

4. Smoking-cessation program Rationale: Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking-cessation program may be helpful for many clients. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops.