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The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse? A. "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis." B. . "Arteriosclerosis and atherosclerosis are the same disorder. The terms are interchangeable." C. "Atherosclerosis and arteriosclerosis are disorders in which the lining of the vessels become narrowed due to plaque formation." D. "Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining."
A. "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis." Rationale: Arteriosclerosis is a complex condition that produces structural changes to the arteries usually associated with loss of elasticity. Atherosclerosis is a specific type and most common cause of arteriosclerosis. Both disorders affect the ability of the vessels to deliver blood and are considered occlusive disorders, but the causes differ. Vessels that become dilated and weakened are referred to as aneurysms, not arteriosclerosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Arteriosclerosis and Atherosclerosis, p. 850.
A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? A. "Practice meticulous foot care." B. "Consider cutting down on your smoking." C. "Reduce your level of exercise." D. "See the physician if complications occur."
A. "Practice meticulous foot care." Rationale: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Chart 30-3, p. 855.
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? A. "See if rest relieves the chest pain before using the nitroglycerin." B. "Call 911 if you develop a headache following nitroglycerin use." C. "Place the nitroglycerin tablet between cheek and gum." D. "Only take one nitroglycerin tablet for each episode of angina."
A. "See if rest relieves the chest pain before using the nitroglycerin." Rationale: Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 27: Management of Patients With Coronary Vascular Disorders, p. 759.
A nurse is providing education about maintaining tissue integrity to a client with peripheral arterial disease. Which of the following statements by the client indicates a need for clarification? A. "Shoes made of synthetic material are best for my feet." B. "It is important to apply sunscreen to the top of my feet when wearing sandals." C. "I should apply powder daily because my feet perspire." D. "I can use lamb's wool between my toes if necessary."
A. "Shoes made of synthetic material are best for my feet." Rationale: The client should wear leather shoes with an extra-depth toe box. Synthetic shoes do not allow air to circulate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Maintaining Tissue Integrity, p. 856.
The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day? A. 2 or fewer B. 2 or 3 C. 4 or 5 D. 7 or 8
A. 2 or fewer Rationale: Two or fewer servings of lean meat, fish, and poultry are recommended in the DASH diet. The diet also recommends two or three servings of low-fat or fat-free dairy foods, four or five servings of fruits and vegetables, and seven or eight servings of grains and grain products. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Table 31-3, p. 889.
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Clopidogrel B. Amlodipine C. Diltiazem D. Felodipine
A. Clopidogrel Rationale: Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, p. 760.
A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.) A. Creatinine B. Blood urea nitrogen (BUN) C. Complete blood count (CBC) D. Urine for culture and sensitivity E. AST and ALT
A. Creatinine B. Blood urea nitrogen (BUN) Rationale: Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and serum creatinine levels) may manifest as nocturia (getting up during the night to urinate). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Clinical Manifestations, p. 887.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? A. Decreases resting heart rate B. Decreases cholesterol level C. Increases cardiac output D. Decreases platelet aggregation
A. Decreases resting heart rate Rationale: The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, p. 759.
When assessing venous disease in a client's lower extremities, the nurse knows that what test will most likely be prescribed? A. Duplex ultrasonography B. Echocardiography C. Positron emission tomography (PET) D. Radiography
A. Duplex ultrasonography Rationale: Duplex ultrasound may be used to determine the level and extent of venous disease as well as its chronicity. Radiographs (x-rays), PET scanning, and echocardiography are never used for this purpose as they do not allow visualization of blood flow. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Duplex Ultrasonography, p. 848.
The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. A. Elevated blood pressure B. Alcohol use C. Obesity D. Physical inactivity E. Increasing age F. Family history
A. Elevated blood pressure B. Alcohol use C. Obesity D. Physical inactivity Rationale: Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factors for CAD. A family history of CAD, increasing age (more than 45 years for men and more than 55 years for women), sex (men develop CAD at an earlier age than women), and race are risk factors for CAD that are nonmodifiable. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart 27-1 Coronary Artery Disease Risk Factors, p. 752.
The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? A. Eyes B. Kidney C. Heart D. Musculoskeletal system
A. Eyes Rationale: Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018.
A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. A. Family history of coronary heart disease B. Age greater than 45 years for men C. African-American descent D. Body mass index (BMI) of 23 E. Elevated C-reactive protein
A. Family history of coronary heart disease B. Age greater than 45 years for men C. African-American descent E. Elevated C-reactive protein Rationale: Risk factors for coronary heart disease (CHD) include family history of CHD, age older than 45 years for men and 65 years for women, African-American race, BMI of 25 or greater, and elevated C-reactive protein. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart 27-1, p. 752.
The nurse is caring for a client who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? A. Lipids and fibrous tissue B. White blood cells C. Lipoproteins D. High-density cholesterol
A. Lipids and fibrous tissue Rationale: As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of white cells, lipoproteins, or high-density cholesterol. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Pathophysiology, p. 751.
A client has just received a diagnosis of hypertension after the completion of diagnostics. What can the client do to decrease the consequences of hypertension? Select all that apply. A. Lose weight. B. Manage stress effectively. C. Use smokeless tobacco. D. Get plenty of rest.
A. Lose weight. B. Manage stress effectively. Rationale: Obesity, inactivity, smoking, excessive alcohol intake, and ineffective stress management are risk factors for hypertension. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, p. 884.
A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension? A. Noncompliance (nonadherence to therapeutic regimen) B. Deficient knowledge (disease process) C. Excess fluid volume D. Imbalanced nutrition: More than body requirements
A. Noncompliance (nonadherence to therapeutic regimen) Rationale: Noncompliance is the most serious problem in managing a client with hypertension. One authority estimates that 40% to 60% of hypertensive clients fail to comply with ordered treatment. Reasons for noncompliance include lack of symptoms, which makes the problem seem less serious; the difficulty of making required lifestyle changes, such as eating a low-sodium diet, stopping smoking, and losing or managing weight; adverse reactions to antihypertensive drugs; and the inconvenience and high cost of obtaining health care. Deficient knowledge contributes to noncompliance; Excess fluid volume, caused by excess sodium intake, and Imbalanced nutrition: More than body requirements may result from noncompliance. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Diagnosis, p. 894.
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. A. Reduces myocardial oxygen consumption B. Decreases the urge to use tobacco C. Dilates blood vessels D. Decreases ischemia E. Relieves pain
A. Reduces myocardial oxygen consumption C. Dilates blood vessels D. Decreases ischemia E. Relieves pain Rationale: Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Nitroglycerin, p. 759.
A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to the client? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use. C. Cover the patch in plastic wrap after applying. D. Seek emergency treatment if flushing or nausea occurs.stor
A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use. Rationale: Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea. Reference: Medical-Surgical Nursing,
A nurse is admitting a new client with a deep vein thrombosis in her left leg. During the admission process, which information provided by the client would be a contraindication to anticoagulant therapy? A. Scheduled eye surgery in 1 week B. A cerebral vascular bleed 10 years ago C. Three vaginal births, the most recent 18 months ago D. Diet that includes many green, leafy vegetables every day
A. Scheduled eye surgery in 1 week Rationale: Contraindications to anticoagulant therapy include recent or impending eye surgery, recent cerebral vascular bleeds, and recent childbirth. A diet including green leafy vegetables is not a contraindication. Reference: Medical-Surgical Nursing, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Chart 30-9, p. 871.
The nurse is teaching a client about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply. A. Transient ischemic attacks (TIAs) B.. Cerebrovascular disease C. Retinal hemorrhage D. Venous insufficiency E. Right ventricular hypertrophy
A. Transient ischemic attacks (TIAs) B.. Cerebrovascular disease C. Retinal hemorrhage Rationale: Potential complications of hypertension include the following: left ventricular hypertrophy; MI; heart failure; transient ischemic attacks; cerebrovascular disease; renal insufficiency and failure; and retinal hemorrhage. Venous insufficiency and right ventricular hypertrophy are not potential complications of uncontrolled hypertension. Reference: Medical-Surgical Nursing, Chapter 31: Assessment and Management of Patients With Hypertension, Collaborative Problems/Potential Complications, p. 895.
An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: A. an expected part of the aging process. B. a vascular occlusive disease. C. a condition in which the lumen of arteries fill with scar tissue. D. high level of blood fat.
A. an expected part of the aging process Rationale: Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Arteriosclerosis does not involve scar tissue formation. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, p. 850.
The client is asking the nurse about heart-healthy food choices for lunch. What are foods that are heart healthy? Select all that apply. A. soy yogurt B. baked chicken leg C. white rice with butter D. broiled trout E. blueberries
A. soy yogurt D. broiled trout E. blueberries Rationale: Heart-healthy foods include soy products, fish high in omega-3s, and fruit. The chicken leg has more fat than a chicken breast. The white rice does not have enough fiber, so brown rice is a better option. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders.
Hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg or a diastolic blood pressure greater than _____ mm Hg over a sustained period. A.140/90 B. 130/80 C. 110/60 D. 120/70
B. 130/80 Rationale: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Hypertension, p. 885.
A client is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in client teaching before discharge? A. Adequate carbohydrate intake B. Application of graduated compression stockings C. Prophylactic antibiotic therapy D. Methods of keeping the wound area dry
B. Application of graduated compression stockings Rationale: Graduated compression stockings usually are prescribed for clients with venous insufficiency. The required pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, p. 872.
A nurse is providing education to a client about monitoring blood pressure readings at home. What reminders will the nurse review with the client? Select all that apply. A. Avoid smoking cigarettes for 1 hour prior to taking blood pressure. B. Avoid talking during the measurement. C. Sit with both feet on the ground during the measurement. D. Ensure at least 5 minutes of quiet rest before measurements. E. Be sure the forearm is well supported at heart level while taking blood pressure
B. Avoid talking during the measurement. C. Sit with both feet on the ground during the measurement. D. Ensure at least 5 minutes of quiet rest before measurements. E. Be sure the forearm is well supported at heart level while taking blood pressure Rationale: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffeine for 30 minutes before measuring blood pressure; (2) sit quietly for 5 minutes before the measurement (no talking); and (3) have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, p. 894.
The nurse is providing education about the nutrient content of the Therapeutic Lifestyle Changes (TLC) diet to a community group. What information will the nurse provide? Select all that apply. A. Cholesterol should be less than 1 gram per day. B. Carbohydrates should make up 50% to 60% of the total calories. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. E. Total fat should make up only 5% of the total calories.
B. Carbohydrates should make up 50% to 60% of the total calories. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. Rationale: According to the nutrient content of the TLC diet, cholesterol should make up less than 200 mg/day, carbohydrates should make up 50% to 60% of the total calories, dietary fiber should be 20 to 30 grams per day, protein should make approximately 15% of the total calories, and fat should make up 25% to 30% of the total calories. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Dietary Measures, p. 754.
The nurse is reviewing the medication administration record of a client who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A. Increased venous return B. Decreased peripheral resistance C. Decreased blood volume D. Decreased strength and rate of myocardial contractions E. Decreased blood viscosity
B. Decreased peripheral resistance C. Decreased blood volume D. Decreased strength and rate of myocardial contractions Rationale: The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Pharmacologic Therapy, p. 889.
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? A. Hyperlipidemia B. Hypertension C. Glucose intolerance D. Obesity
B. Hypertension Rationale: Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Pathophysiology, p. 751.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. A. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. B. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. C. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. D. Renew the supply every 6 months. E. Take the tablet in anticipation of any activity that can produce pain. F. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
B. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. D. Renew the supply every 6 months. E. Take the tablet in anticipation of any activity that can produce pain. F. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Rationale: Nitroglycerine is very unstable and should be carried securely in its original container (capped, dark, glass bottle). The tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerine is also volatile and is inactivated by heat, moisture, air, light, and time. Therefore, storage and replacement is recommended every 6 months. Refer to Box 14-3 in the text. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, nitroglycerin, p. 759.
The community health nurse cares for many clients who have hypertension. What nursing diagnosis is most common among clients who are being treated for this health problem? A. Deficient knowledge regarding the lifestyle modifications for management of hypertension B. Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C. Deficient knowledge regarding BP monitoring D. Noncompliance with treatment regimen related to medication costs
B. Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many clients, this is related to adverse effects of medications. Medication cost is relevant for many clients, but adverse effects are thought to be a more significant barrier. Many clients are aware of necessary lifestyle modification, but do not adhere to them. Most clients are aware of the need to monitor their BP. Reference: Medical-Surgical Nursing,, Chapter 31: Assessment and Management of Patients With Hypertension, Nursing Diagnoses, p. 894.
While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? A. Stop the heparin infusion immediately. B. Notify the health care provider. C. Administer a coumarin derivative, as ordered, to counteract heparin. D. Reassure the client that bleeding gums are a normal effect of heparin.
B. Notify the health care provider. Rationale: Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the health care provider, who will evaluate the client's condition. The health care provider should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the health care provider orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Heparin, p. 760.
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. decrease anxiety B. enhance myocardial oxygenation C. administer sublingual nitroglycerin D. educate the client about his symptoms
B. enhance myocardial oxygenation Rationale: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care, neither is a priority when a client is compromised. Reference: Medical-Surgical Nursing, Chapter 27: Management of Patients with Coronary Vascular Disorders, Assessment, p. 767. Under chart 27-7
A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? A. hyperuricemia B. increased liver enzymes C. hyperglycemia D. severe muscle pain
B. increased liver enzymes Rationale: Myopathy and increased liver enzymes are significant side effects of the statin Lipitor. Hyperuricemia occurs when too much uric acid is present in the blood; it is not a side effect of the statins. Hyperglycemia is increased blood glucose, which is not a side effect of the statins. Severe muscle pain is an adverse effect of statins, but it does not require monitoring. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Table 27-2, p. 756.
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." B. "Client will verbalize the intention to avoid exercise." C. "Client will verbalize the intention to stop smoking." D. "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
C. "Client will verbalize the intention to stop smoking." Rationale: A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart 27-5, p. 762.
The nurse is writing a care plan for a client who has been diagnosed with angina pectoris. The client describes herself as being "distressed" and "shocked" by her new diagnosis. What nursing diagnosis is most clearly suggested by the woman's statement? A. Spiritual distress related to change in health status B. Acute confusion related to prognosis for recovery C. Anxiety related to cardiac symptoms D. Deficient knowledge related to treatment of angina pectoris
C. Anxiety related to cardiac symptoms Rationale: Although further assessment is warranted, it is not unlikely that the client is experiencing anxiety. In clients with CAD, this often relates to the threat of sudden death. There is no evidence of confusion (i.e., delirium or dementia) and there may or may not be a spiritual element to her concerns. Similarly, it is not clear that a lack of knowledge or information is the root of her anxiety. Reference: Medical-Surgical Chapter 27: Management of Patients with Coronary Vascular Disorders, Nursing Diagnoses, p. 761.
The nurse is caring for a client with long-standing hypertension. As a client advocate, which instruction is most helpful in preventing further complications? A. Maintain a healthy diet of fruits and vegetables. B. Focus on exercise at least twice a week. C. Obtain a regular appointment with eye doctor. D. Avoid use of caffeinated beverages
C. Obtain a regular appointment with eye doctor. Rationale: When a client has long-standing hypertension, the high blood pressure damages the arterial vascular system. As a client advocate, the nurse must instruct on not only prevention but also on early identification of complications. Damages may occur to the tiny arteries in the eyes compromising vision. The most helpful instruction is to maintain a regular appointment with an eye doctor. The other options are good instruction for a healthy lifestyle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 31: Assessment and Management of Patients With Hypertension, Hypertension, p. 885.
The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities? A. Administer a diuretic to decrease the edema in the left lower extremity. B. Assist with active range-of-motion (ROM) exercises to the left lower extremity. C. Apply cool compresses to the left lower extremity. D. Apply a heating pad to the patient's abdomen.
D. Apply a heating pad to the patient's abdomen. Rationale: Nursing interventions may involve applications of warmth to promote arterial flow and instructions to the patient to avoid exposure to cold temperatures, which causes vasoconstriction. Adequate clothing and warm temperatures protect the patient from chilling. If chilling occurs, a warm bath or drink is helpful. A hot water bottle or heating pad may be applied to the patient's abdomen, causing vasodilation throughout the lower extremities. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Promoting Vasodilation and Preventing Vascular Compression, p. 853.
A client presents to the clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause? A. Decreased cardiac output B. Decreased cardiac contractility C. Infarction of the myocardium D. Coronary arteriosclerosis
D. Coronary arteriosclerosis Rationale: In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Pathophysiology, p. 757.
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A. Uterus B. Blood vessels C. Bronchi D. Heart
D. Heart Rationale: Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Beta-Adrenergic Blocking Agents, p. 759.
A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? A. Application of ace wraps from the toe to below the knees B. Use of antiembolic stockings C. Elevation of the legs above the heart D. Keeping the legs in a neutral or dependent position
D. Keeping the legs in a neutral or dependent position Rationale: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Concept Mastery Alert, p. 853.
The hospital nurse is caring for a client who tells the nurse that he has an angina attack beginning. What is the nurse's most appropriate initial action? A. Have the client sit down and put his head between his knees. B. Have the client perform pursed-lip breathing. C. Have the client stand still and bend over at the waist. D. Place the client on bed rest in a semi-Fowler position.
D. Place the client on bed rest in a semi-Fowler position. Rationale: When a client experiences angina, the client is directed to stop all activities and sit or rest in bed in a semi-Fowler position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. There is no need to have the client put his head between his legs because cerebral perfusion is not lacking Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Treating Angina, p. 761.
