Med/Surg: Cardio
3 Absorb vitamin B12 Pernicious anemia is caused by the inability to absorb vitamin B12, resulting from a lack of intrinsic factor in gastric juices; for the Schilling test, radioactive vitamin B12 is administered and its absorption and excretion can be ascertained. Vitamin B12 is not produced in the body. Storing, digesting, and producing vitamin B12 are not measured by this test.
A Schilling test is prescribed for a client who is suspected of having pernicious anemia. The nurse considers that the primary purpose of the Schilling test is to determine the client's ability to: 1 Store vitamin B12 2 Digest vitamin B12 3 Absorb vitamin B12 4 Produce vitamin B12
4 Aspirin (ASA) Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better, hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and is not the drug of choice to relieve the pain associated with an MI. Midazolam HCl is a sedative-hypnotic that is used for its calming effect, but it will not relieve the pain of an MI. Alprazolam is an anxiolytic that is used for its calming effect, but it will not relieve the pain of an MI.
A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? 1 Gabapentin (Neurontin) 2 Midazolam HCI (Versed) 3 Alprazolam (Xanax) 4 Aspirin (ASA)
1 Reduction in the circulating blood volume A decreased intravascular volume results in hypovolemia and hypotension, which is evidenced by a decreased blood pressure and a decreased pulse pressure. Vasomotor stimulation to the arterial walls is increased with shock. Vasodilation resulting from diminished vasoconstrictor tone is a description of neurogenic shock, which is unlikely in this situation. Although electrolyte imbalances can precipitate cardiac decompensation, cardiogenic shock is unlikely in this situation.
A client sustains multiple internal injuries in a motor vehicle accident. While performing the client's initial assessment, the nurse identifies that the client's blood pressure suddenly drops from 134/90 to 80/60 mm Hg. What most likely has caused this drop in blood pressure? 1 Reduction in the circulating blood volume 2 Diminished vasomotor stimulation to the arterial wall 3 Vasodilation resulting from diminished vasoconstrictor tone 4 Cardiac decompensation resulting from electrolyte imbalance
2 Intermittent claudication Intermittent claudication is pain that results when the arterial system is unable to provide adequate blood flow to the tissues in the presence of increased demands for oxygen and nutrients during exercise; it is relieved by rest. Rest pain is not a response to exercise; it occurs in the extremities during rest, especially at night. Phantom limb sensation is the presence of unusual sensations or pain in the residual limb after an amputation. Raynaud's phenomenon is intermittent episodes of constricted arteries and arterioles in response to extreme cold or emotional stress, causing pallor, paresthesias, and pain.
A client with peripheral arterial insufficiency tells the nurse that walking sometimes results in severe pain in the calf muscles. The nurse responds that this pain is called: 1 Rest pain 2 Intermittent claudication 3 Phantom limb sensation 4 Raynaud's phenomenon
4 "Do not take an extra pill because you may become hypoglycemic when exercising." Exercise improves glucose metabolism; exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional anti-diabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacological therapy.
A client with type 2 diabetes is taking one glyburide (Micronase) tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? 1 "You will need to decrease how much you are exercising." 2 "An extra pill will help your body use glucose when exercising." 3 "The amount of medication you need to take is not related to exercising." 4 "Do not take an extra pill because you may become hypoglycemic when exercising."
1 Call the rapid response team These are classic symptoms of a myocardial infarction; further medical evaluation and intervention are needed immediately. Performing a nutritional assessment presumes a dietary problem when a more serious situation may exist. Discussing possible sources of stress with the client considers only an emotional source of the reported symptoms and ignores a potential medical emergency. Providing reassurance while helping the client to focus on pleasant topics provides false reassurance and ignores a potential medical emergency.
A hospitalized client puts the call light on and reports a sudden onset of chest pain that feels like a pressure or weight on the chest. The client also states, "I feel nauseated and very weak." What action should the nurse take? 1 Call the rapid response team 2 Perform a nutritional assessment 3 Discuss possible sources of stress with the client 4 Provide reassurance while helping the client to focus on pleasant topics
4 Diastolic blood pressure that remains higher than 90 mm Hg A sustained diastolic pressure that exceeds 90 mm Hg reflects pathology and indicates hypertension. Tachycardia reflects the heart rate, not the pressures within the arteries. Extended Korotkoff sound is heard when measuring blood pressure by auscultation; it is unrelated to hypertension. Sustained systolic pressure ranging from 110 to 120 mm Hg is an expected systolic blood pressure.
A nurse is caring for a client with hypertension. Which assessment finding most significantly indicates that a client is hypertensive? 1 Tachycardia 2 Extended Korotkoff sound 3 Sustained systolic pressure ranging from 110 to 120 mm Hg 4 Diastolic blood pressure that remains higher than 90 mm Hg
3 Monthly, for the rest of my life." Because the intrinsic factor does not return to gastric secretions even with therapy, B12 injections will be required for the remainder of the client's life. The drug must be taken on a regular basis for the rest of the client's life.
A nurse provides teaching regarding vitamin B12 injections to a client with pernicious anemia. The nurse concludes that the teaching was understood when the client states, "I must take the drug: 1 When feeling fatigued." 2 Until my symptoms subside." 3 Monthly, for the rest of my life." 4 During exacerbations of anemia."
2 Hemoglobin (Hb) A CBC includes red blood cell (RBC) count and RBC indices, white blood cell (WBC) count and WBC differential count, Hb, hematocrit (Hct), and platelet count. A blood glucose level is not part of a CBC. The C-reactive protein level is not part of a CBC. BUN is not part of a CBC. Topics
During a yearly physical examination a complete blood count (CBC) is performed to determine a client's hematological status. The nurse recalls that the CBC is composed of several tests, one of which is the level of: 1 Blood glucose 2 Hemoglobin (Hb) 3 C-reactive protein 4 Blood urea nitrogen (BUN)
3 Peripheral vasoconstriction Nicotine causes spasms and constriction of the smooth muscles of the arterial vasculature, compromising blood flow to the distal extremities. Nicotine does not directly cause pain and tingling, although these may occur as consequences of nicotine-induced vasoconstriction. Vasoconstriction from nicotine will not result in such severe effects as cyanosis and necrosis. Smoking increases the carboxyhemoglobin level in the blood; carbon monoxide combines with hemoglobin and occupies the sites on the hemoglobin molecule that bind with oxygen, thus decreasing oxygen content.
The nurse encourages a client with Raynaud's disease to stop smoking because it causes: 1 Pain and tingling 2 Cyanosis and necrosis 3 Peripheral vasoconstriction 4 Excessive blood oxygen content
3 Absence of the pedal pulse Absence of the left pedal pulse indicates inadequate circulatory status of the left lower extremity. Mottling of the left leg may indicate impaired circulation, but observation of both extremities for comparison is necessary. Coolness of the left foot is a less significant indication of arterial occlusive disease than the absence of a pulse. Thickening of the toenails on the left foot is not as significant as the pulse; this can occur because of inadequate circulation, aging, or fungal infection. Topics
The nurse is caring for a client who has an occlusion of the left femoral artery and is scheduled for an arteriogram. Which clinical finding is most significant when assessing the left extremity before the arteriogram? 1 Mottling of the leg 2 Coolness of the foot 3 Absence of the pedal pulse 4 Thickening of the toenails on the foot
3 Avoid massaging the injection site after the injection The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The drug should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally heparin is provided by the pharmacy department in single dose syringes.
To prevent excessive bruising when administering subcutaneous heparin, the nurse should: 1 Administer the injection via the Z-track technique 2 Inject the drug into the vastus lateralus muscle in the thigh 3 Avoid massaging the injection site after the injection 4 Use 2 mL of sterile normal saline to dilute the heparin
1 Increases the cardiac workload Irritability and restlessness associated with anxiety increase the metabolic rate, heart rate, and blood pressure; these complicate heart failure. Anxiety does not directly interfere with respirations; an increase in cardiac workload will increase respirations. Anxiety alone usually does not elevate the body temperature. Anxiety can cause an increase in the amount of oxygen used and leads to an increased respiratory rate.
What effect of anxiety makes it particularly important for the nurse to reduce the anxiety of a client with heart failure? 1 Increases the cardiac workload 2 Interferes with usual respirations 3 Produces an elevation in temperature 4 Decreases the amount of oxygen used