Cardiovascular Term 3
What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? 1 Arterial spasm 2 Heart muscle ischemia 3 Blocking of the coronary veins 4 Irritation of nerve endings in the cardiac plexus
2 Heart muscle ischemia Ischemia causes tissue injury and the release of chemicals, such as bradykinin, that stimulate sensory nerves and produce pain. Arterial spasm, resulting in tissue hypoxia and pain, is associated with angina pectoris. Arteries, not veins, are involved in the pathology of a myocardial infarction. Tissue injury and pain occur in the myocardium.
A client with a history of severe intermittent claudication has a femoral-popliteal bypass graft. What is an appropriate postoperative nursing intervention on the day after surgery? 1 Assist the client with walking. 2 Help the client to sit in a chair. 3 Maintain the client on bed rest. 4 Encourage the client to keep the legs elevated.
1 Assist the client with walking. Mobility reduces venous stasis and edema and enhances arterial perfusion and healing. Sitting in a chair is contraindicated; it constricts circulation at the hips and knees. Bed rest is contraindicated because it promotes the development of thrombophlebitis and pulmonary emboli. Elevating the legs will limit arterial perfusion.
A client with heart failure is digitalized and placed on a maintenance dose of digoxin (Lanoxin) 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved? 1 Diuresis and decreased pulse rate 2 Increased blood pressure and weight loss 3 Regular pulse rhythm and stable fluid balance 4 Corrected heart murmur and decreased pulse pressure
1 Diuresis and decreased pulse rate Digoxin slows the heart rate, which is reflected in a slowing of the pulse; it also increases kidney perfusion, which promotes urine formation, resulting in diuresis and decreased edema. Digoxin will decrease, not increase, the blood pressure; digoxin does promote weight loss through diuresis. Although digoxin produces diuresis as a result of improved cardiac output, which increases fluid output, it does not regulate an irregular pulse. Digoxin will not correct a heart murmur or decrease the pulse pressure.
A client is found unconscious and unresponsive. What should the nurse do first? 1 Initiate a code. 2 Check for a radial pulse. 3 Compress the lower sternum. 4 Give four full lung inflations.
1 Initiate a code. Additional help and a cardiac defibrillator must be obtained immediately. The carotid, not radial, pulse is used. Compressing the lower sternum is done after the nurse summons help. Two lung inflations are given after 30 chest compressions.
Confidence: Nailed it Stats Issue with this question? 6. Which factors should the nurse identify that can precipitate hyponatremia? (Select all that apply.) 1 Gastrointestinal (GI) suction 2 Diuretic therapy 3 Inadequate antidiuretic hormone (ADH) secretion 4 Continuous bladder irrigation 5 Parenteral infusion of 0.9% sodium chloride
1 Gastrointestinal (GI) suction 2 Diuretic therapy 4 Continuous bladder irrigation GI fluids are rich in sodium ions, which are lost by gastrointestinal suction. Most diuretics interfere with sodium reabsorption in the nephrons and have the side effect of hyponatremia . Continuous irrigation with a hypotonic solution can precipitate water intoxication, resulting in hyponatremia. Excessive water in the plasma causes dilution of the serum sodium. Inadequate ADH leads to excess water loss, which causes the serum sodium to increase (hypernatremia). Parenteral infusion of 0.9% sodium chloride is an isotonic solution that should be compatible with body fluids; if given in excess, it may lead to hypernatremia.
A woman comes to the emergency department reporting signs and symptoms determined by the health care provider to be caused by a myocardial infarction. The nurse obtains a health history. Which reported symptoms does the nurse determine are specifically related to a myocardial infarction in women? (Select all that apply.) 1 Severe fatigue 2 Sense of unease 3 Choking sensation 4 Chest pain relieved by rest 5 Pain radiating down the left arm
1 Severe fatigue 2 Sense of unease A myocardial infarction in women may be asymptomatic, atypical, or mild. Unique symptoms include overwhelming fatigue, a sense of uneasiness, indigestion, and shoulder tenderness . A sense of unease is a unique characteristic of a myocardial infarction in women. The client knows something is not right but cannot identify what it is. This uneasiness often is disregarded by the client. A choking sensation occurs in both men and women with a myocardial infarction. Chest pain relieved by rest occurs in both men and women with angina; it is caused by coronary artery spasms leading to myocardial ischemia. Angina frequently is a precursor to a myocardial infarction. Pain radiating down the left arm occurs in both men and women. It can radiate also to the neck, lower jaw, left arm, left shoulder, and, less frequently, the right arm and back.
The nurse is reviewing a teaching plan for a client that has been prescribed a 2-gram sodium diet. The plan should include which foods that are low in sodium? 1 Meat and fish 2 Fruits and juices 3 Milk and cheese 4 Dry cereals and grains
2 Fruits and juices Of all the basic food groups, fresh fruits and juices are the lowest in sodium. Most fresh meat or fish contain approximately 50 to 120 mg of sodium per 100 grams; processed meats contain approximately 1700 to 2000 mg of sodium per 100 grams. Most aged cheeses contain approximately 300 to 1100 mg of sodium per 100 grams of cheese. Most dry cereals contain approximately 900 to 1100 mg of sodium per 100 grams of cereal.
A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies the following foods. (Select all that apply.) 1 Olive oil 2 Chicken broth 3 Enriched whole milk 4 Red meats, such as beef 5 Vegetables and whole grains 6 Liver and other glandular organ meats
2 Chicken broth 3 Enriched whole milk 4 Red meats, such as beef 6 Liver and other glandular organ meats Chicken broth is high in sodium and should be avoided to prevent fluid retention and an elevated blood pressure. Enriched whole milk is high in saturated fats and contributes to hyperlipidemia; skim milk is the healthier choice. Red meats, such as beef, are high in saturated fats and should be avoided. Liver and other glandular organ meats are high in cholesterol and should be avoided. Olive oil is an unsaturated fat, which is a healthy choice. Vegetables and whole grains are low in fat and have soluble fiber, which may reduce the risk for heart disease.
A nurse is caring for two clients; one has polycythemia and the other has prolonged anemia. What do these clients have in common? 1 Increased urinary output 2 Increased cardiac workload 3 Decreased oxygen saturation 4 Decreased arterial blood pressure
2 Increased cardiac workload With anemia, the heart works harder to compensate for the reduced oxygen-carrying ability of the blood. With polycythemia, the heart works harder to propel more viscous blood through the circulatory system. Urinary output is not increased; it may be decreased to maintain blood volume in anemia and decrease blood viscosity in polycythemia. The percent of hemoglobin molecules saturated with oxygen is not affected. Clients with polycythemia will have increased blood pressure because of increased viscosity of the blood.
Which significant risk factors for coronary heart disease carry a greater risk for women than for men? (Select all that apply.) 1 Obesity 2 Smoking 3 Hypertension 4 Diabetes mellitus 5 Low levels of high-density lipoprotein (HDL) cholesterol
4 Diabetes mellitus 5 Low levels of high-density lipoprotein (HDL) cholesterol Diabetes is twice as strong a predictor of coronary heart disease in women as in men; diabetes cancels the cardiac protection that estrogen provides to premenopausal women. A low level of HDL-C (less than 35 mg/dL) has a greater bearing on coronary heart disease in women than in men and is the most important lipid factor in women; the significance of this is unclear. Obesity, smoking, and hypertension are risk factors common to both women and men.
