Cardiovascular AQ
A nurse is preparing medications. Which client's health problem motivates the nurse to question a prescription for a beta blocker? Coronary artery disease Essential hypertension Acute heart failure Sinus tachycardia
Acute heart failure Beta blockers reduce cardiac output and must be started slowly, so they are contraindicated for clients with acute heart failure. Beta blockers are used to treat coronary artery disease because they decrease myocardial oxygen demand by reducing peripheral resistance and cardiac contractility. Beta blockers are used to treat essential hypertension because they cause vasodilation and decrease cardiac contractility. Beta blockers lower heart rate.
How can the nurse best describe heart failure to a client? A cardiac condition caused by inadequate circulating blood volume An acute state in which the pulmonary circulation pressure decreases An inability of the heart to pump blood in proportion to metabolic needs A chronic state in which the systolic blood pressure drops below 90 mm Hg
An inability of the heart to pump blood in proportion to metabolic needs As the heart fails, cardiac output decreases; eventually the decrease will reach a level that prevents tissues from receiving adequate oxygen and nutrients. Heart failure is related to an increased, not decreased, circulating blood volume. The condition may be acute or chronic; the pulmonary pressure increases and capillary fluid is forced into the alveoli. The blood pressure usually does not drop.
When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? Interview the client for a health history. Assess the client's heart and lung sounds. Monitor the client's pulse and temperature. Obtain the client's blood specimen for electrolytes.
Assess the client's heart and lung sounds. With heart failure, the left ventricle is not functioning effectively, which is evidenced by an increased heart rate and crackles associated with pulmonary edema. The health history interview is done after vital signs and breath sounds are obtained and the client is stabilized. Although an infection would complicate heart failure, there are no signs that indicate this client has an infection. Obtaining the client's blood specimen for electrolytes is inappropriate for immediate monitoring; it should be done after vital signs and clinical assessments have been completed.
What should the nurse include in a teaching plan for a client taking calcium channel blockers such as nifedipine? Select all that apply. Select all that apply Reduce calcium intake. Report peripheral edema. Expect temporary hair loss. Avoid drinking grapefruit juice. Change to a standing position slowly.
Avoid drinking grapefruit juice. Change to a standing position slowly. Report peripheral edema. Changing positions slowly helps reduce orthostatic hypotension. Peripheral edema may occur as a result of heart failure and must be reported. Grapefruit juice affects the metabolism of calcium channel blockers and should be avoided. Reducing calcium intake is unnecessary because calcium levels are not affected. Hair loss does not occur.
An older adult client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation should alert the nurse to the fact that the client may be developing a life-threatening response to the drug? Difficulty breathing Increased pulse rate Orthostatic hypotension Increased blood glucose
Difficulty breathing Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol. A decreased, not increased, pulse rate is associated with atenolol. It does not usually affect beta 2 (vascular) receptor sites, which will cause an increase in pulse rate. Orthostatic hypotension may be experienced; however, it can be minimized by teaching the client to move from lying to sitting and from sitting to standing positions slowly to allow the body time for the blood pressure to adjust to the change in position. Atenolol will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the drug may mask the clinical manifestations of hypoglycemia.
An older adult client is diagnosed with left-sided congestive heart failure. Which assessments should the nurse expect to find? Select all that apply. Select all that apply Dyspnea Crackles Hacking cough Peripheral edema Jugular distention
Dyspnea Crackles Hacking cough The left ventricle pumps oxygen-rich blood to the rest of the body. Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents the body from getting enough oxygen-rich blood. The blood backs up into the lungs instead, which causes a buildup of fluid. Common symptoms may include: dyspnea, shallow respirations, crackles, dry, hacking cough, and frothy, pink-tinged sputum. Right-sided heart failure occurs when the right side of the heart can't perform its job effectively. Common symptoms of right-sided heart failure include peripheral edema, weight gain, and jugular distention.
A client presents to the emergency department with symptoms of acute myocardial infarction (MI). Which results will the nurse expect to find upon assessment? Decreased breath sounds Elevated serum troponin I Decreased creatine kinase-MB (CK-MB) Elevated brain natriuretic peptide (BNP) level
Elevated serum troponin I Elevations of troponin I levels are indicative and specific for cardiac muscle damage. Decreased breath sounds would indicate a pulmonary problem. An increase in CK-MB would indicate MI. Elevated BNP levels would indicate heart failure, which is a potential complication of acute myocardial infarction.
What client response indicates to the nurse that a vasodilator medication is effective? Absence of adventitious breath sounds Increase in the daily amount of urine produced Pulse rate decreases from 110 to 75 beats/min Blood pressure changes from 154/90 to 126/72 mm Hg
Blood pressure changes from 154/90 to 126/72 mm Hg Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.
Metoprolol is prescribed for a client with hypertension. For which side effect should the nurse monitor the client? Hirsutism Bradycardia Restlessness Hypertension
Bradycardia Beta-blockers block stimulation of beta 1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest. Excessive growth of hair or the presence of hair in unusual places does not occur with this medication; however, absence or loss of hair (alopecia) may occur. A side effect of this medication is fatigue, not restlessness. This medication may produce hypotension, not hypertension.
A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin? Headaches Bradycardia Hypertension Junctional tachycardia
Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.
The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)? Pregnancy Inactivity Aerobic exercise Tight clothing
Inactivity A DVT, or thrombus, may form as a result of venous stasis. It may lodge in a vein and can cause venous occlusion. Inactivity is a major cause of venous stasis leading to DVT. Pregnancy and tight clothing are also risk factors for DVT secondary to inactivity. Aerobic exercise is not a risk factor for DVT.
A client with heart failure has anxiety. Which effect of anxiety makes it particularly important for the nurse to reduce the anxiety of this client? Increases the cardiac workload Interferes with usual respirations Produces an elevation in temperature Decreases the amount of oxygen used
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.
A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure? Select all that apply. Select all that apply Dependent edema Swollen hands and fingers Collapsed neck veins Right upper quadrant discomfort Oliguria
Dependent edema Swollen hands and fingers Right upper quadrant discomfort With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. Jugular venous collapse and oliguria are key features of left-sided heart failure. Left-sided heart failure is associated with decreased cardiac output.
The nurse provides discharge teaching to a client who has received prescriptions for digoxin, furosemide, and a 2-gram sodium diet. Which statement from the client indicates that further teaching is needed? "I must check my pulse every day." "I can gradually increase my exercise as long as I take rest periods." "I should call my healthcare provider if I have difficulty breathing when I am lying flat." "I can use a little table salt on my food as long as I do not use it when cooking food."
"I can use a little table salt on my food as long as I do not use it when cooking food." The response "I can use a little table salt on my food as long as I do not use it when cooking" demonstrates that the client did not understand the discharge teaching. Table salt and foods high in sodium should be avoided. Sodium intake causes fluid retention, which can precipitate a fluid volume excess, which contributes to heart failure. Digoxin should be withheld if the client's pulse is less than a preset rate (i.e., 60 beats per minute) because this is a sign of digoxin toxicity; the risk of digoxin toxicity is increased if the client develops hypokalemia as a result of receiving furosemide. Slowly increasing activities while ensuring rest periods limits the stress on the heart and is desirable. Orthopnea is a sign of pulmonary edema related to heart failure, and the healthcare provider should be notified.
A nurse is caring for a client who has been admitted with right-sided heart failure. The nurse notes that the client has dependent edema around the area of the feet and ankles. To characterize the severity of the edema, the nurse presses the medial malleolus area, noting an 8 mm depression after release. How should the edema be documented? 1+ 2+ 3+ 4+
4+ Dependent edema around the area of feet and ankles often indicates right-sided heart failure or venous insufficiency. The nurse should assess for pitting edema by pressing firmly for several seconds, then releasing to assess for any depression left on the skin. The grading of 1+ to 4+ characterizes the severity of the edema. A grade of 4+ indicates an 8 mm depression. A grade of 1+ indicates a 2 mm depression. A grade of 2+ indicates a 4 mm depression. A grade of 3+ indicates a 6 mm depression.
A client with a history of hypertension and left ventricular failure arrives for a scheduled clinic appointment and tells the nurse, "My feet are killing me. These shoes got so tight." What is the nurse's best initial action? Weigh the client. Notify the primary healthcare provider. Take the client's pulse rate. Listen to the client's breath sounds.
Listen to the client's breath sounds. After the assessment protocol of airway, breathing, and circulation (ABCs), the nurse should assess the client's breath sounds for crackles that may indicate the development of heart failure. Although the client should be weighed, it is not the priority. Shoes that become too tight indicate pedal edema, which is a sign of fluid retention; 1 L of fluid weighs 2.2 pounds (1 kilogram). Eventually the primary healthcare provider will be notified, but the nurse should have more data for the primary healthcare provider. Taking the client's pulse rate will happen, but not as a priority.
A client with a history of heart failure on daily weights has a 2-pound (0.9 kilogram) weight gain and pitting edema in lower extremities bilaterally. Which action should the nurse take next? Check the record to ascertain the code status. Encourage increased intake of favorite drink. Perform a head-to-toe assessment, including vital signs. Continue to monitor daily weights and edema and to document findings.
Perform a head-to-toe assessment, including vital signs. Performing a head-to-toe assessment, including vital signs, would indicate symptoms, such as jugular distention with right-sided heart failure, or pulmonary issues (crackles) associated with left-sided heart failure. Checking the record for code status is not a priority and should have been established and known on an elderly client. Increasing intake will make the problem of fluid retention worse. Continuing to monitor daily weights without an assessment may miss worsening symptoms.
The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. Which is the priority nursing intervention? Initiate oxygen therapy Obtain chest x-ray film immediately Place client in a high-Fowler position Assess the client for a pleural friction rub
Place client in a high-Fowler position Placing the client in a high-Fowler position promotes lung expansion and gas exchange; it also decreases venous return and cardiac workload. Initiating oxygen therapy may be done, but positioning should be done first because it will have an immediate effect. Time is needed to set up the system for the delivery of oxygen. Maintaining adequate oxygen exchange is the priority; an x-ray film can be obtained, but after breathing is supported. A friction rub is related to inflammation of the pleura, not to heart failure.
A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider? Hematocrit 46% Hemoglobin 14.1 g/dL (141 mmol/L) Potassium 3.0 mEq/L (3.0 mmol/L) White blood cell 9200/mm 3 (9.2 × 10 9/L)
Potassium 3.0 mEq/L (3.0 mmol/L) A potassium level of 3.0 mEq/L (3.0 mmol/L) is indicative of hypokalemia. Normal values for an adult are 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Potassium, calcium, and magnesium control the rate and force of heart contractions. Diuretics often are used to reduce fluid volume, so the heart does not work as hard. Furosemide is a potassium-losing diuretic. Hypokalemia can result in death from dysrhythmia; therefore this must be addressed. The hematocrit level of 46% is within the normal range. A hemoglobin of 14.1 (141 mmol/L) is within normal values. White blood cell level of 9200 cells/mm 3is within the normal range of 4000 to 11,000 cells/mm 3 (4 to 11 × 10 9/L).
The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. What is the pathophysiological reason for the excessive edema? Shift of fluid into the interstitial spaces Weakening of the cell wall Increased intravascular compliance Increased intracellular fluid volume
Shift of fluid into the interstitial spaces Edema is defined as the accumulation of fluid in the interstitial spaces. When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. Weakening of the cell wall may cause leakage of fluid, but this is not the pathologic reason related to heart failure. Increased intravascular compliance would prevent fluid from shifting into the tissue. Intracellular volume is maintained within the cell and not in the tissue.
A client hospitalized for heart failure is receiving digoxin and will continue taking the drug after discharge. What should be included in the plan of care for the next few days? Monitoring vital signs and encouraging a vigorous aerobic exercise program Providing written material on the adverse effects of the medication Contacting Social Services for a home health nursing consultation Teaching the client how to count the pulse
Teaching the client how to count the pulse Adverse effects of digoxin include many types of dysrhythmias. If the client's apical pulse rate is less than 60, the medication is "held" and the primary healthcare provider is notified. Because the client will be taking the medication at home, the client should be taught how to take an accurate pulse and to contact the healthcare provider if the rate falls outside predetermined parameters. The client will be assuming responsibility for drug administration at home; teaching is the priority. Vigorous exercise is not recommended for clients who have heart failure. Providing written material on the adverse effects may not meet all of the client's learning needs. There is nothing in the question to suggest the client requires home healthcare.
To prepare a client for surgery, which explanation by a nurse would be accurate related to pneumatic compression devices? They help the venous blood return to the heart. They will not cause discomfort, but gently massage the legs. They are used instead of anticoagulant therapy. They must be worn until the first time the client gets out of bed.
They help the venous blood return to the heart. Deep vein thrombosis (DVT) is a potential complication of any surgery lasting longer than 30 minutes. The purpose of pneumatic compression devices is to increase venous return. Clients often complain about pneumatic compression devices being hot and itchy. In addition to the pneumatic compression devices, a mechanical form of DVT prophylaxis, pharmaceutical prophylaxis is often required. Pneumatic compression devices are continued until the client is up ambulating frequently throughout the day.
A client is admitted to the hospital with the diagnosis of myocardial infarction. The nurse should monitor this client for which signs and symptoms associated with heart failure? Select all that apply Weight loss Unusual fatigue Dependent edema Nocturnal dyspnea Increased urinary output
Unusual fatigue Dependent edema Nocturnal dyspnea Unusual fatigue is attributed to inadequate perfusion of body tissues because of decreased cardiac output in response to cardiac ischemia; women more commonly report unusual fatigue than men. Dependent edema occurs with right ventricular failure because of hypervolemia. Dyspnea at night, which usually requires the assumption of the orthopneic position, is a sign of left ventricular failure. Orthopnea, a compensatory mechanism, limits venous return, which decreases pulmonary congestion and promotes ventilation, easing the dyspnea. Weight gain, not loss, occurs because of fluid retention. Urinary output decreases, not increases, with heart failure because the sympathetic nervous system and the renin-angiotensin-aldosterone system stimulate the retention of sodium and water in the kidneys.
