NUR 113

b Research indicates that the type natriuretic peptide levels increase the clients with poor live ventricular function and symptomatic heart failure and can be used to differentiate heart failure from other causes of dyspnea and fatigue such as pneumonia. The other values should also be monitored but do not indicate whether the client has heart failure

A Client seen in the clinic with the shortness of breath and fatigue is being evaluated for possible diagnosis of heart failure. Which lab result will be most useful to monitor? A. Serum potassium b. B-type natriuretic peptide c. BUN D. Hematocrit

b Cardiac troponin levels are elevated three hours after the onset of MI and are very specific to cardiac muscle injury or infarction. Creatinine kinase MB and myoglobin levels also increase with MI but creatinine kinase levels take at least six hours to increase and myoglobin is nonspecific. Elevated see reactive protein levels Argus factor for coronary artery disease but are not useful in detecting a cute injury or infarction

A client who has just arrived in the ED report substernal and left arm discomfort that is been going on for about three hours. Which lab test will be most helpful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol? A. Creatinine kinase MB level B. Troponin one level C. Myoglobin level D. C reactive protein level

c The client visual disturbances may be a sign of digoxin toxicity. The nurse should notify the healthcare provider and obtain in order to measure the digoxin level. An irregular pulse is expected with a fib there are no contraindications to taking digoxin with food and crackles that clear with coughing are indicated of atelectasis not worsening of heart failure

During a home visit to an 88-year-old client who is taking the digoxin 0.25 mg per day to treat heart failure and atrial fibrillation the nurse obtained this assessment information. Which finding is most important to communicate to the healthcare provider? A. Apical pulse 68 bpm and irregular b. digoxin taken with meals c. Vision that is becoming fuzzy D. Long crackles that clear after coughing

d The clients low density lipoprotein level continues to be elevated and indicates a need for further assessment, or change your medication or both. Although statin medications may cause the BUN and potassium to increase the clients BUN and potassium are not elevated. Although ongoing monitoring of liver function is recommended when statins are used this clients AST is normal

The nurse is reviewing the lab results for a client with an elevated cholesterol level who is taking Lipitor. Which result is most important to discuss with the healthcare provider? A. Serum potassium is 3.4 B. BUN is 9 C. AST is 30 D. LDL cholesterol is 170

a Administration of nitroglycerin in appropriate client monitoring for therapeutic an adverse effects are included in the LPN education and scope of practice. Monitoring her blood pressure pulse and oxygen should be delegated to the UAP. Client teacher requires RN level education and scope of practice

The nurse is working with an experienced UAP and an LPN on the telemetry unit. A client who had an acute MI three days ago has been reporting fatigue and chest discomfort when ambulating. Which nursing activity included in the care plan is best assigned to the LPN? A. Administering nitroglycerin 0.4 mg sub lingually if chest discomfort occurs during client activities b. Monitoring pulse blood pressure and oxygen for an after client ambulation C. Teaching the client energy conservation techniques to decrease myocardial oxygen demand D. Explaining the rationale for alternating rest periods with exercise to the client and family

c Research indicates that mortality is decrease in clients with heart goes better blocking medications such as carvedilol. When beta blocker therapy is started for clients with heart failure heart failure symptoms may initially become worse for a few weeks so increase boutique activity intolerance weight gain and edema or not indicated of a need to discontinue the medication at this time. However a heart rate of 48 bpm indicates the need to decrease the carvedilol dose

Two weeks ago a client with heart failure receive a new prescription for carvedilol 12.5 mg orally. Which finding by the nurse who is evaluating the client in the cardiology clinic is of most concern? A. Reports of increased fatigue in activity intolerance B. Weight increase of 0.5 KG over one week. c. Sinus bradycardia At a rate of 48 bpm D. Traces of edema noted over both ankles

b

a nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. the nurse should recognize that the concurrent use of which of the following medications places the client at risk for digoxin toxicity? a. phenytoin b. verapamil c. warfarin d. aluminum hydroxide

c The AHA recommends home blood pressure monitoring for clients with hypertension because home blood pressure monitoring provides more accurate data about usual blood pressure then periodic monitoring. The other actions may be necessary but further assessment of the clients usual blood pressure is needed before decisions about therapy can be made

A client who systolic blood pressure is always higher than 140 is in the clinic and tells the nurse, my blood pressure at home is always fine. What action should the nurse take next? A. Instruct the client about the effects of untreated high blood pressure on the cardiovascular and cerebrovascular systems b. Educate the client about lifestyle changes such as low sodium diet daily exercise and restricting alcohol use to no more than two beers per day c. Ask the client to obtain blood pressure twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week d. Provide the client with a hand out describing the various types of antihypertensive medications with the medication effects and adverse effects

c Chronic constipation is a common adverse effect of Ranolazine. Rinaldi does not impact heart rate or blood pressure and can't be taken with beta blockers or nitrates. The other information may also be reported to the HCP but does not require a change in the clients plan of care

A client with stable angina has a prescription for ranolazine 500 mg twice a day. Which client finding is most important for the nurse to discuss with the healthcare provider? A. Heart rate is 52 bpm b. Client is also taking Carvedilol for angina c. Client reports having chronic constipation d. Blood pressure is 106/56

d Because continuous chest pain lasting for more than 12 hours indicates that reversible myocardial injury has progressed to irreversible myocardial necrolysis fibrinolytic drugs are usually not recommended for clients with chest pain that has lasted for more than 12 hours. The other information is also important to communicate but will not impact the decision about alteplase use

At 9 PM the nurse administer 63-year-old client with a diagnosis of acute MI. Which finding is most important to communicate to the healthcare provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator for the client? A. The client was treated with alteplase about eight months ago B. The client takes famotidine for gastroesophageal reflux disease C. The client has ST segment elevation on the ECG D. The client reports having continuous chest pain since 8 AM

c Hyperkalemia is a common adverse effect of those angiotensin converting enzyme inhibitor's and potassium sparing diuretics. The other lab values may be affected by these medications but are not as likely or as potentially life-threatening

Nurse is caring for a hospitalized client with a heart failure who is receiving captopril and spironlactone. Which lab value will be most important to monitor? A. Sodium level B. Blood glucose level C. Potassium D. Alkaline phosphate

b An INR of 1.2 is not within the expected therapeutic range of 2 to 3 and indicates a need for an increase in warfarin dose. The blood pressure is in the low-normal range. Although the client will be encouraged to avoid injury, increased bruising is common when clients are taking anticoagulants and not a reason to discontinue the medication. Although foods that are high in vitamin K will have an impact on INR this is not a concern when these foods are eaten Consistently because the warfarin dose will be adjusted accordingly

The clinic nurse obtains is information about a client who is taking warfarin after having a DVT. Which finding is most indicated of a need for change in therapy? A. Blood pressure is 106/54 B. International normalized ratio (INR) is 1.2 c. Bruises are noted at sites were blood has been drawn D. Client reports eating a green salad for lunch every day

c The priority for a client with unstable angina or MI is treatment of pain. It is important to remember to assess vital signs before administering sub lingual nitroglycerin. The other activities should also be accomplish rapidly but are not as high a priority

The emergency department nurse is caring for a client who was just admitted with left anterior chest pain possible acute MI. Which action should the nurse take first? A. Insert an IV catheter b. Auscultate heart sounds C. Administer sub lingual nitroglycerin D. Draw blood for troponin one measurement

b NSAIDS other than aspirin inhibit the beneficial effect of aspirin and coronary artery disease. Current AHA guidelines recommend against the use of other NSAIDs for clients with cardiovascular disease. The other medications should be verified because the orders were received by telephone

The healthcare provider telephones the nurse with the new prescriptions for a client with angina who is already take an aspirin. Which medication is most important to clarify further with the healthcare provider? A. clopidogrel 75 mg per day B. Ibuprofen 200 mg every four hours as needed c. Metoprolol 50 mg per day D. Nitroglycerin patch 0.4 mg/hr

d The goal in pain management for the client with an acute MI is to completely eliminate the pain. Even in pain related at a level one out of 10 should be treated with additional morphine. The other data indicate a need for ongoing assessment for the possible adverse effects of hypertension and respiratory depression and tachycardia but do not require further action at this time

The nurse has given morphine for milligrams IV to a client who is having an acute MI. When evaluating the clients response five minutes after giving the medication which finding indicates a need for immediate further action? A. blood pressure decrease from 114/65 to 106/58 B. Respiratory rate dropped from 18 to 12 C. Cardiac monitor indicating sinus rhythm at a rate of 96 bpm D. Persisting chest pain at a level one

b, d, c, a Because it increase heart rate may be associated with a drop in blood pressure and with lightheadedness the nurses first action should be to decrease the risk for a fall but having a client sit down. Cardiac ischemia may be causing the clients tachycardia and administration of supplemental oxygen should be the next action. Assessment of blood pressure should be done next. Finally the healthcare provider should be notified about the clients response to activity because changes in therapy may be indicated

The nurse is ambulating a cardiac surgery client his heart rate suddenly increased to 146 bpm. In which order will the nurse take the following actions? A. Call the clients health care provider b. Have the client sit down C. Check the clients blood pressure D. Administer as needed oxygen by nasal cannula

b Kiss combination angiotensin receptor blocker Nepera lysing blockers markedly increase the risk for angioedema and clients who are also taking angiotensin converting enzyme inhibitor's, the concimittent use of the lisinopril and Valsartan is contra indicated. In addition the risk for other adverse effects such as hyperkalemia and hypertension is increased. The other findings should be reported to the HCP but do not indicate a need to withhold the valsartan

The nurse is caring for a client who has heart failure and has a new prescription for ValSartan. Which client information is most important to discuss with the healthcare provider before administration of the medication? A. The clients oxygen is 92% B. The client receives lisinopril 10 mg per day C. The clients blood pressure is 150/90 d. The clients potassium is 3.3

d Anticoagulant medications are Hailer medications and require special safeguards such as double checking the medication by two nurses before administration. Although the other medications require the usual medication safety procedures double checking is not needed

The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with DVT. Which medication is most important to double check with another licensed nurse? A. famotidine 20 mg IV b. furosemide 40 mg IV C. Digoxin 0.25 mg PO D. Warfarin 2.5 Milligrams PO

c A persistent irritating cough is a possible adverse effect of a CE inhibitors such as Elanapril in his common reason for changing to another medication category. The other assessment data indicates a need for more client teaching an ongoing monitoring but would not require a change in therapy

The nurse makes a home visit to evaluate a hypertensive client who has been taking enalapril. Which finding is most important to report to the healthcare provider? A. Client reports frequent urination b. Clients blood pressure is 138/86 C. Client complains about a frequent dry cough d. Client states, I get dizzy sometimes if I stand up fast

c

a nurse in a providers office is monitoring blood electrolyte levels for 4 clients who take digoxin. which of the following electrolyte levels increases the clients risk for digoxin toxicity? a. calcium 9.2 b. calcium 10.3 c. potassium 3.4 d. potassium 4.8

b For behavior to change the client must be aware of the need to make changes. This response acknowledges the client statement and ask for further clarification. This week is a nurse more information about the clients feelings, current diet and activity level and may increase the willingness to learn. The other responses indicate an intention to teach whether the client is ready or not and are not likely to lead to changes in lifestyle

The nurses are planning to implement teaching about a heart healthy diet and activity levels for a client who has had a myocardial infarction and the clients spouse. The client says I don't see why i need any teaching I don't think I need to change anything right now. Which response is most appropriate? A. Do you think your family may want you to make some lifestyle changes? B. Can you tell me why are you don't feel that you need to make any changes? c. You were still in the stage of denial but if you want this information later on D. Even though you don't want to change it is important that you have this teaching

b An RN who worked on a medical surgical unit would be familiar with left ventricular failure administration of IV medication and ongoing monitoring for therapeutic and adverse effects of furosemide. The other clients need to be cared for by RNs who are more familiar with the care of clients who have acute coronary syndrome and with collaborative treatments such as coronary angioplasty and coronary artery stenting

Which client is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general medical surgical unit? A. Client requiring discharge teaching about coronary artery stenting before going home today B. Client receiving IV furosemide to treat acute left ventricular failure C. Client who just transferred in from the radiology department after a coronary angioplasty D. Client just admitted with unstable angina who has orders for a heparin infusion and aspirin

a, c, e, f Avoid rehospitalization topics that should be included when discharging a client with heart failure include low sodium diet purpose in common side effects of medications such as ace inhibitors and beta blockers what to do if symptoms of worsening heart failure and her and Follow up appointments. The nurse will teach the client that a moderate increase in heart rate and respiratory effort is normal with exercise. Antibiotics are not included in the treatment regimen for heart failure which is not an infectious process

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply a. How to monitor and record daily weight b. Importance of stopping exercise if heart rate increases c. Symptoms of worsening heart failure D. Purpose of chronic antibiotic therapy E. How to read food labels for sodium content F. Date and time for follow-up appointments

b

a nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. which of the following findings is an expected effect of this medication? a. lowered HR b. increased urine output c. decreased conduction through the AV nodes d. vasoconstriction of renal blood vessels

a

a nurse is admitting a client who has a suspected MI and a history of angina. which of the following findings will help the nurse distinguish stable angina from an MI? a. stable angina can be relieved with rest and nitroglycerin b. the main of an MI resolves in less than 15 minutes c. the type of activity that causes an MI can be identified d. stable angina can occur for longer than 30 minutes

c

a nurse is an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. which of the following conditions should the nurse monitor the client for as an adverse reaction? a. intestinal ileus b. neutropenia c. delirium d. hyperthermia

a

a nurse is caring for a client who asks why the provider prescribed daily aspirin. which of the following responses should the nurse make? a. aspiring reduces the formation of blood clots that could cause a MI b. aspirin relieved the pain due to myocardial ischemia c. aspirin dissolves clots that are forming in your coronary arteries d. aspirin relieves headaches that are caused by other medications

b

a nurse is caring for a client who has HF and reports increased SOB. which of the following actions should the nurse make first? a. obtain the clients weight b. assist the client into high fowlers position c. auscultate the lung sounds d. check oxygen saturation with pulse oximeter

c

a nurse is caring for a client who has a new prescription for captopril for HTN/ the nurse should monitor the client for which of the following as an adverse effect? a. hypokalemia b. hypernatremia c. neutropenia d. bradycardia

a, b, e

a nurse is completing the admission assessment of a client who has suspected pulmonary edema. which of the following manifestations are expected findings? select all that apply a. tachypnea b. persistent cough c. increased urinary output d. thick yellow sputum e. orthopnea

a, c, e

a nurse is planning care for a client who is receiving furosemide IV for peripheral edema. which of the following interventions should the nurse include in the plan of care? select all that apply a. assess for tinnitus b. report urine output of 50 ml/hr c. monitor blood potassium levels d. elevate the HOB slowly before ambulation e. recommend eating a banana daily

b, d, e

a nurse is planning to administer a first dose of captopril to a client who has HTN. which of the following medications can intensify first dose of hypotension? select all that apply a. simvastatin b. hydrochlorothiazide c. phenytoin d. clonidine e. aliskiren

c

a nurse is presenting a community education program on recommended lifestyle changes to prevent angina and MI. which of the following changes should the nurse recommend first? a. diet modification b. relaxation exercises c. smoking cessation d. taking omega-3 capsules

a

a nurse is providing discharge teaching to a client who has HF and is on a 2,000 ml/day fluid restriction.the client asks the nurse how to determine the appropriate amount of fluids they are allowed. which of the following statements is appropriate for the nurse to make? a. pour the amount of fluid you drink into an empty 2 liter bottle to keep track of how much you drink b. each glass contains 8 ounces. there are 30 ml per ounce so you can have a total of 8 glasses per day c. this is the same as 2 quarts or about the same as 2 pots of coffee d. take sips of water or ice chips so you will not take in too much fluid

a

a nurse is providing information to a client who has a new prescription for hydrochlorothiazide. which of the following information should the nurse include? a. take the medication with food b. plan to take the medication at bedtime c. expect increased swelling of the ankles d. fluid intake should be limited in the morning

a, c, e

a nurse is providing teaching to a client who has a new prescription for digoxin. the nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? select all that apply a. fatigue b. constipation c. anorexia d. rash e. blurred vision

a

a nurse is reviewing the health record of a client who asks about using propranolol to treat HTN. the nurse should recognize which of the following conditions is a contraindication for taking propranolol? a. asthma b. glaucoma c. HTN d. tachycardia

c

a nurse is talking with a client who has class 1 heart failure and asks about obtaining a ventricular assist device (VAD). which of the following statement should the nurse make? a. VADs are only implanted during heart transplant b. a VAD helps to pace the heart c. VADs are used when HF is nonresponsive to medications d.a VAD is used for clients who also have chronic lung issue

a, e

a nurse is teaching a client who has HF and a new prescription for digoxin and furosemide. which of the following information should the nurse include? select all that apply a. daily weight first thing in the morning b. decrease potassium intake c. expect muscle weakness when taking digoxin d. hold digoxin if HR is less than 70 e. decrease sodium intake

a

a nurse is teaching a client who has a new prescription for digoxin to treat HF. which of the following instructions should the nurse include in the teaching? a. contact provider is HR is less than 60/min b. check pulse for 30 seconds and multiply times 2 c. increase intake of sodium d. take with food if nausea occurs

a

a nurse is teaching a client who has a new prescription for verapamil to control HTN. which of the following instructions should the nurse include? a. increase fiber in the diet b. drink grapefruit juice to increase vit c absorption c. decrease calcium in the diet d. withhold food for 1 hour after administration

d

a nurse is teaching a client who has angina about a new prescription for metoprolol. which of the following statements by the client indicates understanding of the teaching? a. i should place the tablet under my tongue b. i should have my clotting time checked weekly c. i will report any ringing in my ears d. i will call my doctor if my pulse rate is less than 60

c

a nurse on a cardiac unit is reviewing the lab findings of a client who has a dx of MI and reports that his dyspnea began 2 weeks ago. which of the following cardiac enzymes which of the following cardiac enzymes would confirm the MI occurred 14 days ago? a. CK-MB b. troponin 1 c. troponin T d. myoglobin