Cardiovascular Disorders
A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the last several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?
Blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL
The nurse instructs a client with coronary artery disease in the proper use of nitroglycerin. The client has had 2 previous episodes of coronary artery disease. At the onset of chest pain, what should the client do?
Call 911 when three nitroglycerin tablets taken every 5 minutes are not effective.
The plan of care for a client with hypertension taking propranolol hydrochloride should include:
Instructing the client to notify the health care provider of irregular or slowed pulse rate.
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?
"Client walks 4 miles (6.4 kilometers) in 1 hour every day."
Which statement would lead the nurse to determine that a client lacks understanding of her acute cardiac illness and the ability to make changes in her lifestyle?
"I already have my airline ticket, so I will not miss my meeting tomorrow."
A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response by the nurse is best?
"It isn't a problem to rescind your DNR order; I'll let your physician know your wishes right away."
A client with peripheral vascular disease has poor circulation. The nurse should assess the client for changes in: (Select all that apply.)
-Nail bed color -Skin temperature -Pain in extremity
A nurse on the telemetry unit is faced with various monitor rhythms. Which rhythm takes priority?
A client's cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation.
The client is admitted in septic shock. Which assessment data warrants immediate intervention by the nurse?
A urinary output of 50 mL in the past 3 hours
A nurse is caring for a client who is experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. What is the nurse's priority action?
Administer atropine 0.5 mg IV push as ordered.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:
Aspirin or clopidogrel.
A nurse places electrodes on a collapsed individual who was visiting a hospitalized family member, the monitor exhibits the following. Which interventions would the nurse do first?
Assess the client's airway, breathing, and circulation.
The telemetry unit nurse is caring for a client who was just transferred from the coronary care unit (CCU). The client is anxious because he fears he will not be monitored as closely as he was in the CCU. How can the nurse allay his fears?
Assign the same nurse to the client when possible.
A nurse is preparing a teaching plan for a male client newly prescribed atenolol. Which information is important for the nurse to teach this client?
Causes and treatments for erectile dysfunction
Which clinical manifestation would be most indicative of complete arterial obstruction in the lower extremities?
Coldness
A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for:
Dependent edema.
When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI) and who has premature ventricular contractions, the expected outcome of the drug is to:
Dissolve clots.
The nurse is caring for a client in the intensive care unit. Which drug is most commonly used to treat cardiogenic shock?
Dopamine
The nurse observes that an older female has small to moderate, distended and tortuous veins running along the inner aspect of her lower legs. The nurse should:
Encourage the client to avoid standing in one position for long periods of time.
Which signs and symptoms accompany a diagnosis of pericarditis?
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
A physician orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?
Heparin sodium
A client weighs 300 lb (136 kg) and has a history of deep vein thrombosis and thrombophlebitis. When coaching a client about behaviors to maintain health, the nurse determines that the client has understood the nurse's instructions when the client states a willingness to:
Lose weight by following a reduced calorie, balanced diet.
A client with peripheral artery l disease has femoral-popliteal bypass surgery. The primary goal of the plan of care after surgery is to:
Maintain circulation.
A client is admitted with a diagnosis of thrombophlebitis and deep vein thrombosis of the right leg. A loading dose of heparin has been given in the emergency department, and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve:
Monitoring the client's activated partial thromboplastin time (aPTT) and International Normalized Ratio (PT/INR).
A nurse administers the first dose of nadolol to a client with a blood pressure of 180/96. During an assessment, 4 hours later, which information indicates that the client needs immediate intervention?
The client has wheezing throughout their lung fields.
A group of clients has been taught external cardiac compressions. Which of the following hand placements would demonstrate that learning has occurred?
The heel of one hand on the sternum and the heel of the other on top of it, with the fingers interlocking.
A client is given amiodarone in the emergency department for a dysrhythmia. Which finding indicates the drug is having the desired effect?
The number of premature ventricular contractions is decreasing.
A client with severe angina pectoris and ST-segment elevation on an electrocardiogram is being seen in the emergency department. In terms of diagnostic laboratory testing, it's most important for the nurse to advocate ordering a:
Troponin level.
A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents:
Ventricular depolarization.
The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The nurse knows that the client understands the discharge plan when the client:
Verbalizes safety precautions needed to prevent pacemaker malfunction.
A client with Raynaud's phenomenon is considering having a sympathectomy. This nurse should tell the client that the surgery is performed:
When all other treatment alternatives have failed.
While the nurse is assisting a client to ambulate as part of a cardiac rehabilitation program, the client has midsternal burning. The nurse should:
Stop and assess the client further.
On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend?
Taking daily walks
A nurse is providing discharge instructions to a client with peripheral vascular disease that include stress-reduction techniques. The client asks the nurse, "Why is reducing stress so important?" What is the nurse's best response?
"Stress reduction techniques are helpful because stress stimulates the release of vasoconstricting catecholamines."
The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs?
Baked chicken, an apple, and a slice of white bread
A client who has a history of bacterial endocarditis is scheduled to have oral surgery to remove a tooth. What should the nurse instruct the client to do?
Be sure the dentist prescribes a prophylactic antibiotic prior to the oral surgery.
Prior to administering plasminogen activator (t-PA) to a client admitted with a stroke, the nurse should verify that the client: (Select all that apply.)
Has a blood pressure within normal limits. Has had symptoms of the stroke less than 3 hours. Does not have active internal bleeding.
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol, 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
Heart
The client has been prescribed lisinopril to treat hypertension. The nurse should assess the client for which electrolyte imbalance?
Hyperkalemia
Which activity is least effective in preventing sensory deprivation during a client's stay in the cardiac care unit?
Keeping the door closed to provide privacy
A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?
Pericardial friction rub
A client is admitted to the emergency department reporting severe abdominal pain. A radiograph reveals a large abdominal aortic aneurysm. The primary goal at this time is to:
Prepare the client for emergency surgery.
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description?
Protamine sulfate
A client is discharged to a heart rehabilitation program. What lifestyle changes would be appropriate for the nurse to review?
Reduced cholesterol levels, progressive activity levels, and coping strategies
A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?
The client demonstrates ability to tolerate more activity without chest pain.
A client on telemetry reports that he has been having chest pain. The hospital unit has standing orders that allow the nurse to begin treating the client before notifying the physician. Place the following nursing actions in proper chronological order. Use all options.
-Check vital signs, particularly blood pressure. -Administer sublingual nitroglycerin. -Evaluate the effectiveness of the treatment given. -Document the effectiveness of the treatment given. -Report findings to the physician.
The nurse is assessing a client who has a long history of uncontrolled hypertension. The nurse should assess the client for damage in which area of the eye?
Retina
Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to:
Revascularize the blocked coronary artery.
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:
Forcing blood into the deep venous system.
The nurse monitors the serum electrolyte levels of a client who is taking digoxin. Which electrolyte imbalance is a common cause of digoxin toxicity?
Hypokalemia
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?
Increased pulmonary artery diastolic pressure
The nurse is assessing a client with superficial thrombophlebitis in the greater saphenous vein of the left leg. The client has "aching" in the leg. Which finding indicates the nurse should contact the health care provider (HCP) to request a prescription to improve the client's comfort?
Red, warm, palpable linear cord along the vein that is painful on palpation
