Basic ECG, Hemophilia, PVD/PAD
The nurse is assessing the lower extremities of the client with peripheral arterial disease. Which findings are expected? (Select all that apply.) -Thickened toe nails -Feet appear dusky red in dependent position -Feet become pale when they are elevated -Warm skin -Hair loss
-Thickened toe nails -Feet appear dusky red in dependent position -Feet become pale when they are elevated -Hair loss
What are some Causes of Bradycardia?
-Valsalva maneuver - well-trained athletes (increased vagal tone) - Elderly - SA dysfunction - Medications (beta blockers, digoxin, opioids, parasympathomimetics) - hypothyroidism - hypothermia - hypoxemia - organophosphate poisoning - MI - OSA - increased ICP - infections (Lyme, Chagas, Q fever, RMSF, leptospirosis, typhoid, typhus, babesiosis, yellow and dengue fever)
A client who has heart failure is taking Digoxin 0.5 mg every day. What serum digoxin level would be considered therapeutic?
0.5 to 2ng/mL
Which client is at greatest risk for coronary artery disease? A 56-year-old male with elevated HDL who takes atorvastatin. -A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago. -A 43-year-old male with a family history of coronary artery disease and a total cholesterol level of 158. -A 65-year-old female who is obese with a decreased high-density lipoprotein level.
A 65 year old female who is obese with decreased high density lipoprotein level. Rationale: The women who is 65 years old, is overweight, and has an elevated LDL is at greatest risk. Total cholesterol > 200, LDL > 100, HDL < 40 in men, < 50 in women, women 55 years and older, smoking, and obesity increase the risk of CAD. Atorvastatin decreases LDL and decreases fisk of CAD. The combination of pos-menopause, obesity, and high LDL places this client at greatest risk.
What are Causes of Tachycardia?
Pain Hypotension Hypovolemia Anemia Hypoxia Hypoglycemia MI Heart Failure Hyperthyroidism Anxiety/Panic Epinephrine Norepinephrine Atropine Caffeine Theophyline OTC med with pseudophedrine
A client reports intermittent chest pain which usually lasts less than five minutes and is associated with activity. What heal care prover order does the nurse anticipate?
Administer nitroglycerin 0.3 mg sublingual every 5 minutes as needed for chest pain.
What instructions should the nurse give a client experiencing signs and symptoms related to arterial insufficiency?
Avoid smoking cigarettes and exposure to the cold. Rationale: Smoking and exposure to the cold cause arterial vasoconstriction and should be avoided. Tylenol does not affect platelet aggregation. Clopidogrl is not take "as needed". Elevating feet is not recommended for arterial insufficiency.
What is the Treatment for Tachycardia?
Beta Blockers Calcium Channel Blockers Adenosine Synchronized Cardioversion (heart shocked to get it back to normal)
What are signs and symptoms of Bradycardia?
Dizzy Fatigue Chest pain Syncope Pale cool skin Disorientation Confusion Dyspnea
Before administering a client's morning dose of digoxin, the nurse auscultates the client's apical pulse rate at 59 bpm. What is the appropriate nursing intervention?
Hold the medication and notify the healthcare provider.
The Registered Nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. For which classic signs of preeclampsia will the nurse assess? -Increased pulse rate - Hypertension -Generalized edema -Increased respiratory rate - Low grade fever -Proteinuria
Hypertension Generalized edema Proteinuria
A large U wave may indicate what?
Hypokalemia
What is the Treatment for Bradycardia?
IV Atropine Transcutaneous pacing Dopamine Epinephrine
A child with Hemophilia presents with a burning sensation in the knee and reluctance to move the body par. After collaborating with the care team, what action should the nurse take?
Institute rest, ic, compression, and elevation. Rationale: The child is displaying symptoms of bleeding into the joint and factor replacement is indicated. The RICE interventions are used to help control the bleeding. NSAIDs and aspirin containing compounds contribute to bleeding and should never be used to control pain for the client with hemophilia. PT is instituted after the acute bleeding to prevent further dame.
A nurse reviews the plan for a client prescribed enoxaparin. Which laboratory result should the nurse report to the provider prior to administering the medication?
Platelets 83,000/uL Rationale: Normal platelet reference range is 150-400 x 103/uL. A platelet value of 83,000/uL would put this client at risk. Enoxaparin is given to prevent the formation of clots, and might compromise this client ability to clot because of the pre-existing low platelet value.
A diagnosis of Hemophilia is confirmed in an infant. Which instruction should the nurse provide the parents as the infant becomes more mobile and starts to crawl?
Provide extra padding into the baby's pants and shirt, and have the baby crawl on floors with carpet.
The nurse is caring for a client diagnosed with heart failure. Which action should the nurse take?
Record the clients input, output and daily weights accurately. Rationale: It is important to accurately assess and document the clients intake and output, and daily weights to monitor fluid retention status.
A student athlete is required to have an ECG before participating on the college team. There is no pertinent health history; blood pressure is 114/64, and the ECG result indicates bradycardia with a heart rate of 58. Which should the nurse anticipate from the health care provider?
The student will be allowed to participate on the soccer team. Rational: For an athletic individual, sinus bradycardia is not an unusual assessment. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal and playing does not need to be stopped.
The nurse is caring for a child diagnosed with hemophilia. Which statement explains the treatment plan for hemophilia?
The treatment of choice is Desmopressin, a synthetic derivative of the antidiuretic hormone vasopressin.
What is happening during the PR interval?
Time needed for depolarization and impulse to travel through nodes and Purkinje Fibers.
The nurse is unable to palpate a pedal pulse on the client diagnosed with peripheral artery disease. Which action should the nurse take?
Use the doppler device to check for pulse.
A client is receiving warfarin for anticoagulant therapy. What is the medication that reverses the effects of warfarin?
Vitamin K
Which intervention should the nurse use when applying a nitroglycerin patch to a client?
Wear gloves while applying the patch. Rational: to prevent absorption of the medication through the skin on the nurse's hands, the nurse should wear gloves when applying a NTG patch or NTG cream. Shaving the skin might abrade the area. Washing with hot water will cause vasodilation and increase the absorption of the medication. Sunlight is not contraindicated for patients wearing NTG patches.
When assessing a client with mitral valve prolapse, the nurse auscultates a murmur. How would the sound of the murmur be described?
a whooshing sound heard during systole
What is happening during the P wave?
atrial depolarization
What are the ventricles doing during the QRS complex?
contracting
What is the atria doing during the P wave?
contracting
A client is receiving heparin for a deep venous thrombosis. Which medication reverses the effects of heparin?
protamine sulfate
If the U wave is present, what is happening during the U wave
recovery of the Pukinje conduction
What is happening to the atria during the T wave?
refilling
What is happening during the QT interval?
time for ventricular depolarization and repolarization
What is happening during the QRS complex?
ventricular depolarization
What is happening during the T wave?
ventricular repolarization
