ADH1 Cardio
The registered nurse teaches the student nurse regarding the priority of care provided to clients with chest pain. Which activity performed by the student nurse indicates effective learning?
A client with chest pain should be first assessed for ABC, because the client may experience respiratory distress due to chest pain. Client should be placed in an upright position unless contraindicated, so that oxygen can be administered by nasal cannula or a non-rebreather mask. Heart and breath sounds should be auscultated after performing initial assessments.
A client with angina pectoris is scheduled for a stress echocardiogram. What should the nurse tell the client that an echocardiogram is?
A stress echocardiogram is noninvasive and uses echoes from pulsed high-frequency sound waves to locate and study the movements and dimensions of cardiac structures; it assesses myocardial disease, valve function, congenital heart defects, blood flow abnormalities, and systemic and pulmonic hypertension. A stress echocardiogram assesses structural defects as well as blood flow abnormalities. A stress echocardiogram is valuable in diagnosing and indicating treatment for a variety of conditions involving the heart's structure and function. A stress echocardiogram is not an invasive examination.
Which instruction would be most beneficial for an aging African-American client with hypertension?
African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Therefore instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual, but does not determine if the client has hypertension. Recording the blood pressure weekly is not a good indicator of an aging African-American client with hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested.
The primary healthcare provider prescribes 80 mg of furosemide by mouth daily. Before administering the furosemide, which action is the priority?
Although assessing skin turgor, weighing the client, and checking the intake and output are all a part of assessing for hydration, the potassium level should always be checked before administering furosemide [1] [2] [3] [4] [5] Administering furosemide in the presence of hypokalemia could cause cardiac arrhythmias.
A client is receiving metoprolol. Which side effect should the nurse teach the client to expect?
Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart's rate and contractility in response to exercise does not occur. This, combined with the drug's hypotensive effect, may lead to dizziness. Metoprolol decreases the heart rate. Flushing sensations and pounding of the heart do not represent side effects of metoprolol.
Metoprolol is prescribed for a client with hypertension. For which side effect should the nurse monitor the client?
Beta-blockers block stimulation of beta1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest. Excessive growth of hair or the presence of hair in unusual places does not occur with this medication; however, absence or loss of hair (alopecia) may occur. A side effect of this medication is fatigue, not restlessness. This medication may produce hypotension, not hypertension.
A nurse is teaching a group of clients with peripheral vascular disease about a smoking cessation program. Which physiologic effect of nicotine should the nurse explain to the group?
Constriction of the peripheral blood vessels and the resulting increase in blood pressure impairs circulation and limits the amount of oxygen being delivered to body cells, particularly in the extremities. Nicotine constricts all peripheral vessels, not just superficial ones. Its primary action is vasoconstriction; it will not dilate deep vessels. Nicotine constricts rather than dilates peripheral vessels.
The nurse provides education to a client about the side effects of furosemide. Which client statements indicate that the teaching is understood? Select all that apply.
Furosemide may cause hypovolemia, which can result in orthostatic hypotension with sudden changes in position. With loop diuretics, such as furosemide, an increased sodium load is presented to the distal tubule; this prompts an increase in sodium secretion, as well as a corresponding increase in potassium secretion. Citrus fruits, particularly oranges, are high in potassium and should be encouraged when the client is taking furosemide because this medication can cause hypokalemia. Furosemide does not cause photophobia. Lying horizontally has no relationship to furosemide.
What are the clinical manifestations of myocardial infarction in women? Select all that apply.
Indigestion, unusual fatigue, and sleep disturbances are clinical manifestations of myocardial infarction in women. Anoxia and tightness of the chest are clinical manifestations of angina pectoris, not myocardial infarction.
A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply?
Morphine is a specific central nervous system depressant used to relieve the pain associated with myocardial infarction; it also decreases apprehension and reduces cardiac oxygen demand by decreasing cardiac workload. Dilating coronary blood vessels is not the reason for the use of morphine. Decreasing anxiety and restlessness is not the primary reason for the use of morphine. Lidocaine is given intravenously to prevent fibrillation of the heart.
Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The client asks the nurse how long it should take for the chest pain to subside after nitroglycerin is taken. What should the nurse tell the client?
The onset of action of sublingual nitroglycerin tablets is rapid (1 to 3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustained-release nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.
Sublingual nitroglycerin tablets are prescribed to control periodic episodes of chest pain in the client with stable angina. Which instruction should the nurse include when teaching the client about sublingual nitroglycerin?
The primary side effects of nitroglycerin are headache and hypotension. It is not necessary to spit out saliva into which nitroglycerin has dissolved. For pain that is not relieved, additional tablets may be taken every 5 minutes up to a total of three tablets. It should be stored at room temperature.
A client is diagnosed with hypertension that is related to atherosclerosis. Which information should the nurse consider when planning care for this client?
The term atherosclerosis means a thickening of the arterial lining by lipid plaques, which become atheromas. Arterial pressure increases, not decreases, as a result of renin. Atheromas develop within the lining of the arteries, not within the cardiac muscle tissue. Mobilization of free fatty acids will produce an acid-base imbalance.
What client response indicates to the nurse that a vasodilator medication is effective?
Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.
A nurse is caring for a community-dwelling older adult with hypertension. What interventions should the nurse take to ensure the client's well-being? Select all that apply.
When caring for a community-dwelling older adult with hypertension, the nurse should promote dietary modifications, assess a client's current lifestyle and promote lifestyle changes, and monitor the client's blood pressure and weight and establish blood pressure screening programs. When caring for community-dwelling older women with cancer, the nurse should perform annual Papanicolaou (Pap) smears and mammograms for older adults. When caring for a community-dwelling older adult with arthritis, the nurse should teach the client about correct body mechanics and the availability of mechanical appliances.
The nurse providing postprocedure care to a client who had a cardiac catheterization through the femoral artery discovers a large amount of blood under the client's buttocks. After donning gloves, which action should the nurse take first?
Observing standard precautions is the first priority when dealing with any body fluid, followed by assessment of the catheterization site as the second priority. This action establishes the source of the blood and determines how much blood has been lost. Once the source of the bleeding is determined, the priority goal for this client is to stop the bleeding and ensure stability of the client by monitoring the vital signs. Changing the client's gown and bed linens is not necessary until the bleeding is controlled and the client is stabilized.
The healthcare provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond?
Isosorbide dinitrate dilates the coronary vasculature, improving the supply of oxygen to the hypoxic myocardium. Preventing blood from clotting is the action of anticoagulants. Suppressing irritability in the ventricles is the action of antidysrhythmics. Increasing the force of contraction of the heart is the action of cardiac glycosides.
A nurse is administering 40 mg of furosemide (Lasix) intravenously. Which sensation reported by the client does the nurse consider when determining that it is being administered too quickly?
Rapid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ears), loss of hearing, and ear pain. Lasix has a diuretic effect; urinary retention does not occur. Lasix does not affect the heart rate. Lasix does not cause peripheral neuropathy.
A client who has always been active is diagnosed with atherosclerosis and hypertension. The client is interested in measures that will help promote and maintain health. Which recommendation by the nurse will help the client maintain blood vessel patency?
Research has shown that decreasing stress will slow the rate of atherosclerotic development. Exercise is thought to decrease atherosclerosis and the formation of lipid plaques. Saturated fats in the diet are contraindicated because they increase the risk for atherosclerosis.
An older adult with peripheral vascular disease has stopped smoking, and the client's children want to make the home environment safe. What should the home healthcare nurse emphasize when providing instructions?
The ability to perceive extremes in temperature is limited in the presence of peripheral vascular disease. Prevention of thermal injury through avoidance of hot and cold (e.g., hot water, heating pads, ice packs) is advised. Blurred vision is not associated with peripheral vascular disease. Limiting fluid intake may precipitate dehydration, increasing the risk of thrombophlebitis. Limiting fluids may be indicated if a client has heart failure, not peripheral vascular disease. Limiting activities to reduce the workload on the heart may be important for a client with heart failure, not with peripheral vascular disease.
