Cardiovascular PowerPoint Practice Questions

Case Study 2 Cont.: Two hours later, the patient is admitted to the cardiac stepdown unit with orders for a saline lock, cardiac diet, and oxygen at 2 L per nasal cannula with follow-up cardiac enzymes Q6 hours, and 12-lead ECG in 6 hours. One hour later, the patient reports severe shortness of breath. His oxygen saturation has dropped to 88%, BP is 96/54, and his monitor shows sinus tachycardia with a rate of 114. He reports mild chest pain. 1.What do you suspect is happening to the patient at this time? 2.The patient's laboratory values include troponin T 0.6 mg/mL. What is your best interpretation of this finding?

ANS: 1.Based on the history of the recent CP and now increased shortness of breath with hypoxemia, the nurse can conclude that the patient may be experiencing worsening heart failure. 2.Troponin T is elevated. This substance is not found in healthy patients; any rise indicates cardiac necrosis or acute MI.

Case Study 2 Cont.: During morning care, the patient develops shortness of breath, fatigue, and tachycardia. 1.What is your interpretation of these findings? 2.What interventions would you begin at this time?

ANS: 1.The patient has developed fatigue from too much exertion. 2.Energy management—provide physical and emotional rest; arrange nursing care to provide periods of rest; provide assistance with any care the patient is unable to complete for himself; observe and document the patient's response to activity; as the patient improves, consult with a physical therapist; gradually increase activity based on the patient's responses.

Case Study 3 Cont: The patient's condition improves, and he is returned to the cardiac stepdown unit. He is to be discharged after 6 days in the hospital. What patient teaching should you provide before he is discharged from the hospital?

ANS: •Assist the patient in securing personal medical identification alert devices that provide information regarding his heart condition. •In collaboration with the interdisciplinary health care team, assess the patient for activity tolerance and help design an appropriate exercise regimen. •Teach about the signs and symptoms of cardiovascular disease and when to seek medical assistance. •Instruct him about all of his current medications and the most common side effects. •Give him printed information as needed. •Teach him the importance of decreasing the risk for CAD. •Be sure that he has adequate support at home after discharge from the hospital.

A patient who smokes asks the nurse, "Smoking just hurts my lungs, not my heart, right?" Which nursing response is appropriate? A."Smoking is a major risk factor for coronary artery disease and peripheral vascular disease." B."You are correct, smoking only hurts the lungs." C."The primary impact of smoking is only on the heart." D."What concerns you most about smoking?"

ANS: A Cigarette smoking is a major risk factor for CVD, specifically coronary artery disease (CAD) and peripheral vascular disease (PVD). The other options are inappropriate.

Case Study 2 Cont.: After assessing the patient, you document the following (+) jugular venous distention 2+ edema in feet and ankles Swollen hands and fingers Distended abdomen Bibasilar crackles on auscultation Productive cough with pink-tinged sputum What is your most likely interpretation of these findings? A.Biventricular failure (both L and R heart failure) B.Class IV heart failure C.Left-sided heart failure D.Right-sided heart failure

ANS: A The patient has key features of both right-sided and left-sided heart failure = biventricular failure.

Identify the laboratory test that is most specific for myocardial infarction and cardiac necrosis. A.Troponin B.HDL C.CK-MB D.CK

ANS: A Troponins T and I are not found in healthy patients, so any rise in values indicates cardiac necrosis or acute MI. Specific markers of myocardial injury, troponins T and I, have a wide diagnostic time frame, making them useful for patients who present several hours after the onset of chest pain. Even low levels of troponin T are treated aggressively because of increased risk for death from cardiovascular disease (CVD). Prior to the development of highly sensitive troponin levels, providers relied upon creatinine kinase (CK), its isoenzyme (CK-MB), and myoglobin to assist with diagnosis of acute myocardial infarction. Use of these cardiac markers is no longer recommended (Amsterdam, 2014; Jaffe & Morrow, 2015). •

Case Study 2 Cont.: You immediately notify the provider and within 45 minutes, the patient is transferred to the CCU for close monitoring. He is in serious condition and has developed crackles bilaterally, and his chest pain level has increased. What medications do you anticipate will be ordered for this patient? (Select all that apply.) A.Morphine B.Furosemide (Lasix) C.Atenolol (Tenormin) D.Prednisone (Deltasone) E.Acetaminophen (Tylenol)

ANS: A, B, C Based on the assessment findings, several medications will be ordered including IV diuretics (furosemide) and supplemental oxygen. If congestion and shortness of breath become critical, the patient may need to be placed on a ventilator until the fluid volume overload is under control. Once-a-day beta-adrenergic blocking agents (atenolol) decrease the size of the infarct, the occurrence of ventricular dysrhythmias, and mortality rates in patients with MI. A cardioselective beta-blocking agent is usually prescribed within the first 1 to 2 hours after an MI if the patient is hemodynamically stable. Beta blockers slow the heart rate and decrease the force of cardiac contraction. Medical interventions aim to relieve pain and decrease myocardial oxygen requirements through preload and afterload reduction. IV morphine is used to decrease pulmonary congestion and relieve pain.

A patient with hypertension is discussing the cause of hypertension. Which statement by the nurse is appropriate? A."Pregnancy can cause essential hypertension." B."High cholesterol can be a big factor in the development of essential hypertension." C."Stopping intake of caffeine can cause hypertension to go away." D.Race is associated with secondary hypertension.

ANS: B

The nurse is caring for four clients with a history of hypertension. Which client would require intervention? A.40-year-old with chronic kidney disease, BP 138/80. B.58-year-old on diuretics, BP 160/80 C.28-year-old with LDL-C 140 mg/dL, BP 114/84 D.30-year-old with pre-eclampsia, BP 120/68

ANS: B A patient on diuretics that remains hypertensive requires intervention. The other options have a normal blood pressure.

Case Study 2 Cont.: The nurse expects what outcome in a patient who is taking a beta blocker for mild heart failure? A.Improved urinary output B.Improved activity tolerance C.Increased myocardial contractility D.Increased myocardial oxygen

ANS: B Beta-blocker therapy for mild and moderate heart failure can lead to improvement in symptoms, including improved activity tolerance and less orthopnea.

Case Study 6: At the end of the visit, the provider prescribes hydrochlorothiazide (HydroDIURIL) 25 mg PO each morning to manage the patient's hypertension. Which statement do you include when teaching the patient about this drug? A."This is a loop diuretic that decreases sodium reabsorption." B."Eat foods rich in potassium, such as bananas and orange juice." C."A potassium supplement will be prescribed along with this drug." D."HydroDIURIL is a potassium-sparing diuretic that helps prevent the loss of essential potassium."

ANS: B Hydrochlorothiazide is a thiazide diuretic. The most frequent side effect is hypokalemia, so it's important to teach patients the signs of low potassium, as well as which foods are rich in potassium. Some patients need a potassium supplement, but this is prescribed based on the patient's serum potassium level.

Case Study 2: A 51-year-old man came to the hospital 2 days ago for recurrent exacerbation of heart failure. He weighs 237 lbs and is 5ʹ8ʺ tall. He has IV access in his left forearm and is on oxygen at 2 L per nasal cannula. When you assess the patient, he is sitting on the side of the bed and appears to be short of breath. He tells you that he has just returned from the bathroom. He is sweating and his nasal cannula is laying on the bedside table. Which action should you take first? A.Take his vital signs. B.Replace the nasal cannula. C.Sit him up in a bedside chair. D.Call the Rapid Response Team.

ANS: B The patient has exerted himself in ambulating to and from the bathroom. He also has been without supplemental oxygen. The first action should be to replace his nasal cannula. He has a history of heart failure and will often require supplemental oxygen. Taking his vital signs can be done once his oxygen is restored. If he wants to sit up, he should be positioned in bed, not in a bedside chair. Calling the Rapid Response Team is not necessary.

Case Study 1 Cont: Ten minutes later, the patient is still in SVT and reports substernal chest pain and dizziness. Which action will you expect the physcian to take to treat the dysrhythmia? A.Order a 12-lead ECG. B.Perform carotid massage. C.Administer amiodarone (Cordarone) IV push. D.Instruct the patient to take several deep breaths.

ANS: B The physician may perform vagal stimulation such as carotid massage, which may be successful in terminating the dysrhythmia; however, it may only be temporarily successful.

A patient has recently been admitted with a diagnosis of coronary artery disease. What lab assessments would the nurse anticipate? (Select all that apply.) A.Total Cholesterol 120 mg/dL (normal = 150-250 mg/dl) B.Triglycerides 168 mg/dL (normal = 75-165 mg/dl) C.HDL 32 mg/dL (normal = 34-69 mg/dl) D.CRP 0.8 mg/dL (normal = <3.0 mg/L) E.LDL 60 mg/dL (normal = 105-180 mg/dl)

ANS: B, C • Triglycerides that are elevated signal increased risk for CAD and would be anticipated in a patient diagnosed with CAD. Low HDL values indicate an increased risk for CAD and would be anticipated in a patient with CAD. The other values are normal values. These values would likely be elevated in a patient with CAD.

Case Study 2 Cont.: During the evening shift, the patient has a bedside echocardiogram, which reveals an ejection fraction (EF) of 30%. Thinking back to pharmacology.... Based on this finding, which medications might the provider order? (Select all that apply.) A.Multivitamin 1 PO each day B.Lisinopril (Zestril) 5 mg PO daily C.Digoxin (Lanoxin) 0.25 mg PO daily D.Ibuprofen (Advil) 200 PO mg twice daily E.Furosemide (Lasix) 20

ANS: B, C, E Commonly prescribed drug classes for patients with heart failure include ACE inhibitors (lisinopril), diuretics (furosemide), nitrates (digoxin), human B-type natriuretic peptides, inotropics, and beta-adrenergic blockers.

A woman has been experiencing atypical angina. What symptoms would the nurse anticipate? (Select all that apply.) A.Vomiting B.Indigestion C.Aching jaw pain D.Depression E.Irregular bowel movements F.Decreased patterns of activity

ANS: B, C, F Rationale: Many women experience atypical angina which manifests as indigestion, pain between the shoulders, an aching jaw, or a choking sensation that occurs with exertion. These symptoms typically manifest during stressful circumstances or during activities of daily living. Woman may curtail activity (decreased patterns of activity) as a result of the angina, and health care providers need to ask about changes in routine.

Case Study 6 cont: The patient is diagnosed with hypertension. He asks what he can do to improve his health. Which points do you include in your teaching plan? (Select all that apply.) A.Limiting smoking and caffeine to moderate use B.Making lifestyle changes to control blood pressure C.Checking blood pressure only at the clinic to ensure accuracy D.Exercising and weight loss to decrease the need for BP medications E.Alternative therapies such as relaxation techniques to help decrease stress associated with hypertension

ANS: B, D, E Lifestyle changes, exercising, weight loss, and alternative therapies are all important components to successfully managing blood pressure. Part of the care plan should include teaching the patient to monitor his blood pressure on a daily basis, not just at his clinical visits. Smoking and caffeine intake should be completely avoided.

Case Study 1 Cont: The SVT resolves immediately after IV adenosine (Adenocard) is administered. Because the patient has experienced repeated episodes of symptomatic SVT, a cardiologist has been consulted and treatment options discussed. What is the preferred treatment for recurrent SVT? A.Atrial overdrive pacing B.Synchronized electrical shock C.Radiofrequency catheter ablation D.Daily administration of diltiazem (Cardizem)

ANS: C If SVT is continuous, the patient should be studied in the electrophysiology laboratory. The preferred treatment is radiofrequency catheter ablation. Radiofrequency ablation is a procedure that can cure many types of fast heart rates. Using special wires or catheters that are threaded into the heart, radiofrequency energy (low-voltage, high-frequency electricity) is targeted toward the area(s) causing the abnormal heart rhythm, permanently damaging small areas of tissue with heat. The damaged tissue is no longer capable of generating or conducting electrical impulses. If the procedure is successful, this prevents the dysrhythmia from being generated, thereby curing the patient.

The nurse is assessing a patient's heart sounds and has difficulty auscultating the first heart sound, S1. Which nursing response is most appropriate? A.Listen at the base of the heart. B.Listen only for higher pitched sounds. C.Ask the patient to lay on his left side. D.Ask the patient to hold their breath for 15 seconds.

ANS: C If the nurse is having difficulty hearing the heart sounds, ask the patient to lean forward or roll to his or her left side. This will make the sounds more audible for auscultation. The first heart sound is low pitched and is best her at the apex of the heart. Asking the patient to hold their breath for 15 seconds is not appropriate and while it will decrease respiratory noise, it will not make the heart sounds more audible as with positioning or correct auscultation location.

Case Study 1 Cont: The patient's SVT returns after 30 minutes. What medication do you anticipate will be ordered for the patient? A.Magnesium sulfate 1 g IVP B.Lidocaine (Xylocaine) 75 mg IVP C.Adenosine (Adenocard) 6 mg IVP D.Mexiletine (Mexitil) 300 mg PO q8h

ANS: C The appropriate medication to administer is adenosine (Adenocard), which is the drug used for SVT. The nurse should give the medication as ordered to include 6 mg IV over 1 to 3 seconds followed by 20 mL saline flush. It may be repeated in 1 to 2 minutes if necessary. The nurse should monitor the patient's heart rate and rhythm carefully after administration of the medication. Be sure to have the crash cart available because a short period of asystole is common after administration. Bradycardia and hypotension may also occur.

Case Study 2 Cont.: The next morning, the patient is taken to the cardiac catheterization laboratory. The cardiologist finds that there is an 80% blockage in the proximal LAD coronary artery. Which procedure is most likely to be performed to correct this condition? A.Coronary atherectomy B.Coronary artery bypass graft surgery C.PTCA with coronary artery stent placement D.Percutaneous transluminal coronary angioplasty (PTCA)

ANS: C The most common complication of PTCA is re-blockage of the coronary artery. For this reason, a coronary stent is placed to keep the re-opened artery from closing again.

Case Study 2 Cont.: Which of the following symptoms would the nurse anticipate in a patient with right-sided heart failure? (Select all that apply.) A.Pulmonary congestion B.Shortness of breath C.Neck vein distension D.Enlarged abdominal girth E.A third heart sound

ANS: C, D Right ventricular failure is associated with increased systemic venous pressures and congestions, which creates neck vein distension and enlarged abdominal girth. The other options are associated with left-sided heart failure.

What is the most common symptom when a patient is diagnosed with hypertension? A.Headache B.Slurred speech C.Fainting and dizziness D.Hypertension is often asymptomatic

ANS: D Hypertension is often asymptomatic and has become known as the "silent killer" due to the lack of symptoms. Headaches may occur but not always. Hypertension does not cause slurred speech or fainting.

Case Study 3: A patient presents to the ED and is diagnosed with an acute MI. The patient's spouse asks what type of damage has been caused by the "heart attack." What is the appropriate nursing response? A."The pain is controlled, so there is no damage." B."It will take years to know the extent of the damage to the heart muscle." C."The medication will dilate the blood vessels and any damage will be corrected." D."A heart attack evolves over several hours. We won't know the extent of the damage immediately."

ANS: D Infarction is a dynamic process that does not occur instantly. The MI evolves over a period of several hours. Controlled pain does not indicate that there is no cardiac muscle damage. The medications do vasodilate to prevent further damage. They do not correct damage that has already been incurred.

Case Study 2 Cont.: Fifteen minutes after the oxygen is replaced via nasal cannula and he has rested, the patient denies being short of breath. You obtain an oxygen saturation, which is 96%. Based on this result, what should you do next? A.Call the provider as soon as possible. B.Encourage the patient to take some deep breaths. C.Increase the oxygen level to 5 L per nasal cannula. D.Continue the assessment, as 96% is considered acceptable.

ANS: D Once the patient's oxygen is replaced, he denies shortness of breath. The supplemental oxygen and a period of rest resulted in his oxygen saturation being 96%, which is acceptable. The oxygen should not be increased, nor does he need to take deep breaths because the patient's SaO2 is normal and he is not short of breath.

Case Study 6 Cont: You check the patient's vital signs with the following results: BP—142/90 mm Hg HR—86/min R—8/min T—97º F Based on these readings, does the patient have hypertension? Explain your response.

ANS: The patient's blood pressure indicates he may have hypertension. However, blood pressure should be checked in both arms and two or more readings should be taken at each visit, with the average of the readings used as the value for the visit.

Case Study 5: A 58-year-old African-American man is visiting his health care provider for an annual check-up. His family history includes: hypertension type 2 diabetes cigarette smoker 30 pounds overweight. He works as a car salesman in a very competitive market. What are this patient's risk factors for hypertension?

ANS: This patient has several risk factors for hypertension including his age, being African American, having a positive family history for high blood pressure and diabetes, smoking, being overweight, and having job-related stress.

Case Study 4: Paramedics arrive at the ED with a 78-year-old man who presents with severe chest pain. In triage, he reports that he experienced chest pain for several hours before calling 911. He reports that he takes "heart medications" but he does not know their names. He rates his chest pain as a 9 on a 0-to-10 scale. Patient history includes an MI 6 years ago that resulted in stent placement for severe CAD. One stent was placed in the LAD and another in his circumflex artery. He states that his health care provider told him he also has heart failure. What laboratory tests do you anticipate the provider will order for this patient?

ANS: While there is no single ideal test to diagnose MI, the most common laboratory tests include troponins T and I, creatine kinase-MB (CK-MB), and myoglobin. These cardiac markers are specific for MI and cardiac necrosis. Troponins T and I and myoglobin rise quickly. CK-MB is the most specific marker for MI, but does not peak until about 24 hours after the onset of pain. CAD, coronary artery disease; LAD, left anterior descending artery.

The nurse must be alert for signs of respiratory acidosis in the client with emphysema, because this individual has a long-term problem with oxygen maintenance and: Select one: a. Hyperverntilation occurs, even if the cause is not physiologic b. An inability to fully exhale retained CO2 c. There is a loss of carbon dioxide from the body's buffer pool d. Localized tissue necrosis occurs as a result of poor oxygen supply

Answer- B

Case Study 1: A 28-year-old woman with a history of hypertension and tachycardia comes to the hospital clinic stating that she doesn't feel well. You connect her to a cardiac monitor and observe that she is in SVT with a rate varying between 160 and 180. She reports shortness of breath, palpitations, and weakness. She appears very nervous and anxious, and her BP is 88/56 mm Hg. What is your priority intervention?

Oxygen should be administered at 2 L per nasal cannula.

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse how to manage the amount of oxygen given. How should the nurse instruct the client? a.Do not exceed 2 L/min. b.Adjust the oxygen depending on SpO2. c.Do not exceed 1 L/min. d.Adjust the oxygen depending on respiratory rate.

• •Answer- B •The client with COPD is often dependent on oxygen, and has compensated for chronically lower O2 levels and higher CO2 levels. The oxygen should be adjusted depending on the SpO2, which should be 88% to 92%. Increasing the O2 too much, resulting too high of SpO2 should be avoided in COPD patients. All other options are incorrect. •Test-Taking Strategy: Focus on the subject, oxygen delivery rate for the client with COPD. Use knowledge of basic respiratory physiology and note that the SpO2 is acceptable between 88% and 92% with this disorder. •

A nurse evaluates prescriptions for a patient with chronic atrial fibrillation. Which medication would the nurse expect to find on this patient's medication administration record to prevent a common complication of this condition? (Select all that apply) a.Atropine b.Warfarin (Coumadin) c.Lidocaine d.Intravenous Heparin

• •B & D •Atrial fibrillation puts patients at risk for developing emboli. Patients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

A nurse assesses a patient who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention? a.Urinary output less than intake b.Bruising at the insertion site c.Slurred speech and confusion d.Discomfort in the left leg

• •C •A left-sided cardiac catheterization specifically increases the risk for a cerebral vascular accident. A change in neurologic status needs to be acted on immediately. Discomfort and bruising are expected at the site. If intake decreases, a patient can become dehydrated because of dye excretion. The second intervention would be to increase the patient's fluid status. Neurologic changes would take priority.

A nurse teaches a patient who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement would the nurse include in this patient's teaching? a."Minimize or abstain from caffeine." b."Lie on your side until the attack subsides." c."Use your oxygen when you experience PACs." d."Take amiodarone (Cordarone) daily to prevent PACs."

•A •PACs usually have no hemodynamic consequences. For a patient experiencing infrequent PACs, the nurse would explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen is not necessary. Although medications may be needed to control symptomatic dysrhythmias, for infrequent PACs, the patient first should try lifestyle changes to control them

A nurse is caring for a patient with a history of renal insufficiency who is scheduled for a cardiac catheterization. What actions would the nurse take prior to the catheterization? (Select all that apply) a.Assess for allergies to iodine. b.Administer intravenous fluids. c.Assess blood urea nitrogen (BUN) and creatinine results. d.Insert a Foley catheter.

•A, B, C •If the patient has kidney disease (as indicated by BUN and creatinine results), fluids may be given 12 to 24 hours before the procedure for renal protection. The patient would be assessed for allergies to iodine, including shellfish; the contrast medium used during the catheterization contains iodine. A Foley catheter and central venous catheter are not required for the procedure and would only increase the patient's risk for infection. Prophylactic antibiotics are not administered prior to a cardiac catheterization.

A nurse cares for a patient with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations would the nurse assess? Select all that apply a.Decrease in cardiac output b.Increase in cardiac output c.Decrease in blood pressure d.Increase in blood pressure e.Decrease in urine output f.Increase in urine output

•A, C, E •Elevated heart rates in a healthy patient initially cause blood pressure and cardiac output to increase. However, in a patient who has congestive heart failure or a patient with long-term tachycardia, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall. •

The nurse is making morning rounds to assess assigned patients. Of the following patients with history of asthma, which patient is of highest priority to assess first? Select one: a. A 25-year-old patient with a heart rate of 110 beats/min b. A 42-year-old patient with an oxygen saturation level of 91% at rest c. A 35-year-old patient who has a longer expiratory phase than inspiratory phase d. A 66-year-old patient with a barrel chest and clubbed fingernails

•ANS-C

A patient with the diagnosis of chronic obstructive pulmonary disease (COPD) becomes increasingly short of breath. Which nursing intervention is most appropriate? a. Administer O2 using a Venturi mask at 24% b. Begin oxygen therapy using a simple face mask at 8L c. Do not administer O2 due to history of COPD d. Use nasal cannula to administer high flow oxygen

•Answer- A

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD). Which questions would the nurse ask to determine the patient's activity tolerance? (Select all that apply) Select one: a. "Do you walk upstairs every day?" b. "Have you lost any weight lately?" c. "Do you have any difficulty sleeping?" d. "How long does it take to perform your morning routine?"

•Answer- A, D

A nurse cares for a patient who has a heart rate averaging 46 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate? a."Make certain that your bath water is warm." b."Avoid straining while having a bowel movement." c."Limit your intake of caffeinated drinks to one a day." d."Avoid strenuous exercise such as running."

•B •Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

After teaching a patient who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the patient's understanding. Which statement by the patient indicates a correct understanding of the teaching? a."I should wear a snug-fitting shirt over the ICD." b."I will avoid sources of strong electromagnetic fields." c."I should participate in a strenuous exercise program." d."Now I can discontinue my antidysrhythmic medication."

•B •The patient being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Patients should avoid tight clothing, which could cause irritation over the ICD generator. The patient should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The patient should continue all prescribed medications. •

A nurse assesses a patient 2 hours after a cardiac angiography via the left femoral artery. The nurse notes that the left pedal pulse is weak. What action would the nurse take? a.Elevate the leg and apply a sandbag to the entrance site. b.Increase the flow rate of intravenous fluids. c.Assess the color and temperature of the left leg. d.Document the finding as "left pedal pulse of +1/4."

•C •Loss of a pulse distal to an angiography entry site is serious, indicating a possible arterial obstruction. The pulse may be faint because of edema. The left pulse would be compared with the right, and pulses would be compared with previous assessments, especially before the procedure. Assessing color (pale, cyanosis) and temperature (cool, cold) will identify a decrease in circulation. Once all peripheral and vascular assessment data are acquired, the primary healthcare provider would be notified. Simply documenting the findings is inappropriate. The leg would be positioned below the level of the heart or dangling to increase blood flow to the distal portion of the leg. Increasing intravenous fluids will not address the patient's problem.

A nurse cares for a patient with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions would the nurse implement to address this patient's concerns? a.Administer oxygen therapy at 2 L per nasal cannula. b.Provide the patient with a sleeping pill to stimulate rest. c.Schedule periods of exercise and rest during the day. d.Ask unlicensed assistive personnel to help bathe the patient.

•C •Patients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse would schedule periods of exercise and rest during the day to decrease fatigue. The other interventions will not assist the patient with self-care activities. •

A client has just returned from the cardiac catheterization laboratory. The left-sided femoral vessel was used as the access site. How should the nurse position the client? Select one: a.Knee chest, with the foot of the bed elevated b.Semi Fowler's, with the knees placed on top of 1 pillow c.Supine, with the head of the bed elevated 45 to 90 degrees d.Supine, with the head of the bed elevated about 15 degrees

•Following cardiac catheterization, the extremity used for catheter insertion is kept straight for 4 to 6 hours. If the femoral artery was used, strict bed rest is necessary for 6 to 12 hours. The client may turn from side to side. The head of the bed is not elevated more than 15 degrees (unless otherwise prescribed) to prevent kinking of the blood vessel at the groin and possible arterial occlusion.

The nurse is assessing the functioning of a chest tube drainage system in a client who has just returned from the recovery room following a thoracotomy with wedge resection. Which are the expected assessment findings? Select all that apply. a.50 mL of drainage in the drainage collection chamber b.Drainage system maintained below the client's chest c.Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation d.Occlusive dressing in place over the chest tube insertion site e.Vigorous bubbling in the suction control chamber f.Excessive bubbling in the water seal chamber

•Rationale: A, B, C, DThe bubbling of water in the water seal chamber indicates air drainage from the client and usually is seen when intrathoracic pressure is higher than atmospheric pressure, and may occur during exhalation, coughing, or sneezing. Excessive bubbling in the water seal chamber may indicate an air leak, an unexpected finding. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation is expected. An absence of fluctuation may indicate that the chest tube is obstructed or that the lung has reexpanded and that no more air is leaking into the pleural space. Gentle (not vigorous) bubbling should be noted in the suction control chamber. A total of 50 mL of drainage is not excessive in a client returning to the nursing unit from the recovery room. Drainage that is more than 70 to 100 mL/hour is considered excessive and requires notification of the health care provider. The chest tube insertion site is covered with an occlusive (airtight) dressing to prevent air from entering the pleural space. Positioning the drainage system below the client's chest allows gravity to drain the pleural space.

The nurse is providing education to a group of adolescents diagnosed with asthma. The nurse informs the group that which can be triggers for an asthma attack? Select all that apply. a.Non-steroidal anti-inflammatories b.Exercise c.Cold air d.Hot air e.An upper respiratory infection (URI)

•Rationale: A, B, C, ETriggers for asthma include response to the presence of specific allergens; general irritants such as cold air, dry air, or fine airborne particles; microorganisms; and aspirin and other NSAIDs. Increased airway sensitivity (hyperresponsiveness) can occur with exercise, with an upper respiratory illness, and for unknown reasons. Clean air and adequate rest and sleep help to promote lung function.

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. a.Decreased oxygen saturation with mild exercise b.A low arterial PCo2 level c.A widened diaphragm noted on the chest x-ray d.A hyperinflated chest noted on the chest x-ray e.Pulmonary function tests that demonstrate increased vital capacity

•Rationale: A, DClinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity. •Test-Taking Strategy: Focus on the subject, manifestations of COPD. Think about the pathophysiology associated with this disorder. Remember that hypercapnia, a hyperinflated chest, a flat diaphragm, oxygen desaturation on exercise, and decreased vital capacity are manifestations. •

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply. a.Teach diaphragmatic and pursed-lip breathing. b.Reduce fluid intake to less than 1500 mL/day. c.Encourage alternating activity with rest periods. d.Keep the client in a supine position as much as possible. e.Teach the client techniques of chest physiotherapy.

•Rationale: A,C, EFluids are encouraged, not reduced, to liquefy secretions for easier expectoration. Diaphragmatic and pursed-lip breathing assists in opening alveoli and eases dyspnea. The client should be encouraged to perform activities and exercise, such as dressing and walking, as tolerated with rest periods in between. Chest physiotherapy consists of percussion, vibration, and postural drainage. These techniques are helpful in removing secretions. Elevating the head of the bed assists with breathing.

The nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate and notes that the client is receiving 2 L/min. The client's SpO2 level is 86%. Based on this assessment, which action is appropriate? a.Maintain at 2 L/min and call respiratory therapy for a breathing treatment. b.Increase to 3 L/min and titrate until the SpO2 is 92%. c.Place the client on a nonrebreather mask on 100% FiO2. d.Increase to 3 L/min and titrate until the SpO2 is 95%.

•Rationale: BOxygen is used cautiously and should be titrated to the lowest amount needed. The current recommendation is that hypoxia should be treated with oxygen and that oxygen should be titrated to keep the SpO2 level between 88% and 92%. An SpO2 of 95% is the recommended level for a healthy individual and may not be achieved in a patient with long-standing emphysema; therefore, option 1 is incorrect. A nonrebreather mask is not necessary at this point, and increasing oxygen via nasal cannula should be attempted first; therefore, option 3 is incorrect. It may be necessary to call respiratory therapy for a breathing treatment; however, the oxygen needs to be titrated, making option 4 incorrect. •Test-Taking Strategy: Focus on the subject, oxygen therapy for a client who has emphysema and the potential for hypoxia. Note the word appropriate. Note that there are two parts to each option and that both parts need to be correct. Recall that in the client with emphysema, and all other respiratory conditions, hypoxia needs to be treated. Therefore option 4 can be deleted. Focus on the data in the question to eliminate 3 because a nonrebreather is unnecessary. For the remaining options, focus on the client's diagnosis and recall that a SpO2 of 95% is the recommended level for a healthy individual. •

The nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly? a.The client puffs out the cheeks when breathing out through the mouth. b.The client breathes in through the mouth. c.The client breathes out slowly through the mouth. d.The client avoids using the abdominal muscles to breathe out.

•Rationale: C Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. The client should close the mouth and breathe in through the nose. The client then purses the lips and breathes out slowly through the mouth, without puffing the cheeks. The client should spend at least twice the amount of time breathing out that it took to breathe in. The client should use the abdominal muscles to assist in squeezing out all of the air. The client also is instructed to use this technique during any physical activity, inhale before beginning the activity, and exhale while performing the activity. The client is also instructed that he or she should never hold the breath.