class 2

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the heart are:

Cardiomegaly Systolic murmurs

What is given to the unstable patient with atrial fibrillation?

Cardioverson

General cardiovascular manifestations r/t anemia:

1 - tachycardia at basal activity 2 - murmurs & gallops heard on auscultation & when anemia is severe 3 - orthostatic hypotension

What is considered a normal, healthy hemoglobin?

Hemoglobin A [HbA] has 2 alpha & 2 beta chains; normal adults contain 98-99% HbA, with a small amount of a fetal form of hemoglobin [HbF]

What is given in cases of severe iron deficiency?

Iron solutions (iron dextran [Dexferrum, INFeD, Pri-Dextra]; ferumoxytol [Feraheme]) can be given parenterally IM iron must be given Z-track

What happens on an EKG if potassium is too low?

Isoelectric T wave or small T wave Ventriclar arrthymia

What does the Q wave represent?

It appears as the first negative deflection in the QRS complex. Reflects initial ventricular septal depolarization

The faster the heart rate, the less time the heart has for filling. What happens to cardiac output?

It decreases

______ wave is generated by the SA node and represents atrial depolarization.

P

In teaching clients at risk for bradydysrhythmias, what information does the nurse include? "Avoid potassium-containing foods." "Stop smoking and avoid caffeine." "Take nitroglycerin for a slow heartbeat." "Use a stool softener."

"Use a stool softener."

What is the most common manifestation of a SCD crisis?

Pain

What skin changes may be observed in patients with SCD?

Pallor or cyanosis r/t poor gas exchange from decreased perfusion & anemia Jaundice resulting from RBC destruction & release of bilirubin Ulcers on lower legs caused by poor perfusion

The nurse is caring for a client with heart rate of 143 beats/min. For which manifestations does the nurse observe? (Select all that apply.) Palpitations Increased energy Chest discomfort Flushing of the skin Hypotension

Palpitations Chest discomfort Hypotension

What happens on an EKG if potassium is too high?

Peaked T wave P wave begins to disappear Wide QRS Bradycardia

Conduction begins with the _________

SA node

How is sickle cell disease diagnosed?

SCD = 80-100 % HbS AS = <40% HbS number of RBCs with permanent sickling in SCS = 90%

Elevation of the ___ segment indicates myocardial injury.

ST

What is noted in the EKG when blood flow is reduced & ischemia occurs in the heart?

ST segment depression T-wave inversion

What is noted in the EKG with infarction

ST segment elevation followed by T-wave inversion and an abnormal Q wave

______ helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.

Schilling's test

What are signs of a CVA that families of children with sickle cell disease should be taught to know?

Severe, unrelieved headaches Severe vomiting Jerking or twitching of the face, legs, or arms Seizures Strange, abnormal behavior Inability to move arm or leg Stagger or an unsteady walk Stutter or slurred speech Weakness in the hands, feet, or legs Changes in vision

What type of anemia results from increased destruction of RBCs?

Sickle Cell Anemia

Which type of screening for sickle cell disease is used frequently and requires blood from a finger stick?

Sickle-turbidity test (Sickledex)

Screening for sickle cell disease:

Sickle-turbidity test (Sickledex) HbG electrophoresis

A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences? a. Egg yolks b. Brown rice c. Vegetables d. Tea

b. Brown rice

A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site?

Sinoatrial (SA) node

________ are occasionally are due to nonrespiratory causes, such as digitalis or morphine. These drugs enhance vagal tone and cause decreased heart rate and irregularity unrelated to the respiratory cycle.

Sinus arrhythmias

A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse interpret this rhythm?

Sinus dysrhythmia

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?

Sinus tachycardia

____ may be the earliest indication of hypovolemia (dysrhythmia)

Sinus tachycardia

_______ may occur with exercise or anxiety (dysrhythmia)

Sinus tachycardia

Clinical significance of atrial fibrillation

Slow the ventricular response Prolonged A fib can produce embolism & CVA

When might treatment be necessary for a patient with sinus bradycardia? When wouldn't it?

Sometimes it is normal (example = athletes) If the person is symptomatic then treat it (signs of decreased CO)

What is splenic sequestration?

Splenic sequestration refers to an acute condition of intrasplenic pooling & clumping of blood in the spleen. Often seen in children between 5 months & 2 years with sickle cell disease

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the spleen are:

Splenomegaly Susceptibility to infection Functional reduction in splenic activity progressing to autosplenectomy

17. A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? a. Assess for potential abuse b. Check for diminished sensations c. Document the findings d. Clean and dress the area

b. Check for diminished sensations

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? a. Schilling's test, elevated b. Intrinsic factor, absent. c. Sedimentation rate, 16 mm/hour d. RBCs 5.0 million

b. Intrinsic factor, absent.

A possible NANDA nursing diagnosis for a patient with a dysrhythmia would be activity intolerance r/t ________

decreased cardiac output

A possible NANDA nursing diagnosis for anemia would be delayed surgical recovery r/t ____

decreased oxygen supply to the body increased cardiac workload

A possible NANDA nursing diagnosis for anemia would be fatigue r/t ____

decreased oxygen supply to the body increased cardiac workload

The wave of______ causes the deflections of the electrocardiogram (ECG) waveforms that are recognized as the P wave and the QRS complex

depolarization

A possible NANDA nursing diagnosis for pernicious anemia would be risk for falls r/t ________

dizziness lightheadedness

When a patient arrives who appears to be in a sickling crisis, what information should be asked pertaining to their history?

- Review all activites in past 24 hours (food & fluid intake, exposure to temp extremes, drugs taken, trauma, stress, recent airplane travel, ingestion of alcohol or other recreational drugs) Ask about manifestations of infection Ask about previous crisis

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be deficient fluid volume r/t _______

- decreased intake - increased fluid requirements during sickle cell crisis - decreased ability of kidneys to concentrate urine

CNS changes in patients with SCD

during crisis, patient may have low-grade fever if the CNS has infarcts or repeated episodes of hypoxia, patients may have seizures or manifestations of a stroke

Any disorder of the heartbeat is called a_____.

dysrhythmia

How often should a person with sickle cell disease exercise?

engage in mild, low-impact exercise at least 3 times a week when not in crisis

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be activity intolerance r/t _______

fatigue effects of chronic anemia

Clinical manifestations of patients with folic acid deficiency

fatigue lightheaded SOB loss of appetite sores in mouth brittle nail beds

What is a peaked T wave a sign of?

hyperkalemia

A possible NANDA nursing diagnosis for pernicious anemia would be fatigue r/t ________

imbalanced nutrition

Prevention of infection in SCD patients:

-Frequent, thorough hand washing -mask for visitors with URI -use strict aseptic technique for all invasive procedures -continuously assess for infection -monitor CBC w/ diff daily -inspect mouth q8h for lesions indication fungal/viral infection -listen to lungs q8h for crackles, wheezes, or reduced breath sounds -inspect voided urine for odor & cloudiness -take vitals at least q4h

What are indications of iron overload?

-Gray / bronzed colored skin -SOB -arthritis -liver disease -enlarged spleen -abdominal pain -weight loss -increased serum ferritin levels

What poor pregnancy outcomes are women with sickle cell disease at risk for?

-Miscarriage -IUGR -Stillbirth -Increased risk for preelampsia & infection, particularly in urinary tract & lungs -Increased frequent & painful crisis during pregnancy

What are women with the sickle cell trait at increased risk for during pregnancy?

-Preelampsia -Intrauterine fetal death -Preterm birth -Low-birth-weight infants -Postpartum endometrisis -UTI -May be deficient in iron

Which of the following factors associates chronic gastritis with pernicious anemia? A - chronic blood loss B - inability to absorb vitamin B12 C - Overproduction of stomach acid D - Overproduction of vitamin B12

inability to absorb vitamin B12

How do you manage iron deficiency anemia?

increase oral intake from food sources

What is the most common anemia of pregnancy?

iron deficiency anemia

ST segment depression can be a sign of what?

ischemia

What does ST depression indication?

ischemia

A _____ provides one view of the heart's electrical activity.

lead

Where is the negative electrode on lead III?

left arm or under the left clavicle

Where is the positive electrode on lead I?

left arm or under the left clavicle

The ____ receives oxygenated blood from the lungs via the four pulmonary veins

left atrium

The ____ receives oxygenated blood from the lungs via the left atrium & pumps blood into the systemic circulation via the aorta

left ventricle

The healthcare provider is admitting a patient with a diagnosis of iron-deficiency anemia. The patient's skin and conjunctiva are pale, the tongue is smooth and red, and there are sores on the corners of the mouth. Which additional assessment finding will the healthcare provider identify as related to the iron-deficiency anemia? Bradycardia Spoon-shaped nails Jaundice Paresthesias

Spoon-shaped nails

The _____ is the largest & most muscular chamber of the heart

left ventricle

Sinus bradycardia is a rate of:

less than 60 beats/minute

The nurse implements which of the following for the client who is starting a Schilling test? A - Administering methylcellulose (Citrucel) B - Starting a 24- to 48 hour urine specimen collection C - Maintaining NPO status D - Starting a 72 hour stool specimen collection

Starting a 24- to 48 hour urine specimen collection

The ___ wave follows the ST segment and represents ventricular repolarization.

T

What are pregnant women recommended to do to prevent iron deficiency anemia?

Take prophylactic iron supplementation of one 325-mg tablet of ferrous sulfate twice a day May cause nausea & vomiting, so mate require IV or IM

What is shown on the EKG during hyperkalemia?

Tall, peaked T waves Widened QRS complex Prolonged PR intervals Flat P waves

Sinus tachycardia is a rate of:

more than 100 beats/minute

What does an ST elevation indicate?

myocardial infaction

The nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse should make which interpretation about this finding?

normal

Manifestations of splenic sequestration:

profound anemia hypovolemia shock

A patient with atrial fibrillation is at high risk for _______

pulmonary embolism

The ______ valve like between the right ventricle & the pulmonary artery

pulmonic semilunar valve

A possible NANDA nursing diagnosis for anemia in pregnancy would be risk for infection r/t _____

reduction in oxygen-carrying capacity of blood

why is vision loss associated with sickle cell disease?

retinopathy occurs dur to the occlusions in small blood vessels in eyes

The _______ receives deoxygenated blood from the body via the superior & inferior vena cava

right atrium

On an EKG, what do the horizontal strips represent?

seconds

The _____ valves prevent blood from flowing back into the ventricles during relaxation

semilunar

What happens on an EKG if calcium is too low

shortens QT interval --- (this is what that EKG booklet they gave us said, but i think it is wrong. Google it)

___________ requires treatment with Atropine only if symptomatic (dysrhythmia)

sinus bradycardia

What might an x-ray of a patient with sickle cell disease show?

skull may show "crew cut" appearance as result of bone surface cell destruction & new growth Joints may show necrosis & destruction

Normal sinus rhythm originates from _____

the sinus node

The _____ valve is located on the right side of the heart

tricuspid

That does the T wave represent

ventricular depolarization & ventricular diastole

A possible NANDA nursing diagnosis for pernicious anemia would be impaired oral mucous membrane r/t ________

vitamin deficience

Prevention of a sickle cell crisis:

-drink at least 3-4L of liquids every day -avoid alcohol -avoid smoking or tobacco -contact HCP @ first sign of infection -get flu shot every year -ask HCP about taking the pneumonia vaccine -avoid temp extremes -wear socks & gloves when going outside on cold days -avoid planes with unpressurized passenger cabins -avoid travel to high altitudes -make sure you HCP knows you have SCD, esp. the anesthesia provider & radiologist -consider genetic counseling -avoid strenuous physical activity

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be ineffective peripheral tissue perfusion r/t _______

-effects of red cell sickling -infarction of tissues

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be risk for decreased cardiac tissue perfusion r/t _______

-effects of red cell sickling -infarction of tissues

List some non-pharmacologic approaches to help patients in a sickle cell crisis

-heating pad -warm compresses -keeping room warm -aroma therapy -massage -meditation -soft music

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be impaired physical mobility r/t _______

-pain -fatigue

Each small square on an EKG represents ___ seconds

0.04

The normal QRS complex duration ranges from _____

0.04 to 0.1 second

What is the normal duration for the PR interval?

0.12 to 0.20 seconds

Each large square on an EKG represents ___ seconds

0.20

what is the normal duration of the QT interval?

0.32-0.4

General integumentary manifestations r/t anemia:

1 - pallor (especially in ears, nail beds, palmar creases, conjuctivate, & around mouth) 2 - cool to touch 3 - intolerance of cold temperatures 4 - nails become brittle & concave over time

What are the 3 main causes of anemia?

1 - Blood loss 2 - Decreased RBC production 3 - Increased RBC production

List the order of treatment for a sickle cell crisis

1 - HYDRATION 2 - oxygenation 3 - pain control

General respiratory manifestations of anemia:

1 - dyspnea on exertion 2 - decreased oxygen saturation levels

General neurologic manifestations of anemia:

1 - increased somnolence & fatigue 2 - headache

The nurse has provided medication instructions to a client with an iron deficiency anemia who will be taking iron supplements. Which statement, if made by the client, indicates an understanding of this medication? 1. "I need to increase my fluid intake." 2. "I should eliminate fiber foods from my diet." 3. "I need to take the medication with water before a meal." 4. "I should be sure to chew the tablet thoroughly before swallowing it."

1. "I need to increase my fluid intake."

The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided? 1. "I will eat enough daily fiber to prevent straining at stool." 2. "I will try to exercise vigorously to strengthen my heart muscle." 3. "I will drink 3000 to 3500 mL of fluid daily to promote good kidney function." 4. "Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels."

1. "I will eat enough daily fiber to prevent straining at stool."

A client is seen by the nurse in the health care clinic with a diagnosis of mild anemia. The anemia is believed to be a result of her menstrual period. The client asks the nurse how much blood is lost during a menstrual period. What is the nurse's best response? 1. 40 mL 2. 50 mL 3. 60 mL 4. 70 mL

1. 40 mL

A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply. 1. Emotional stress 2. Atrial fibrillation 3. Nutritional anemia 4. Peptic ulcer disease 5. Recent upper respiratory infection

1. Emotional stress 2. Atrial fibrillation 3. Nutritional anemia 5. Recent upper respiratory infection

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding? 1. Hypotension 2. Flat neck veins 3. Complaints of nausea 4. Complaints of headache

1. Hypotension The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

The nurse is preparing a plan of care for a client with sickle cell crisis who will be admitted to the nursing unit. The nurse should include which intervention as a priority in the plan of care for the client? 1. Initiate an intravenous (IV) line for the administration of fluids. 2. Consult with the psychiatric department regarding genetic counseling. 3. Call the blood bank and request preparation of a unit of packed red blood cells. 4. Call the respiratory department to prepare for intubation and mechanical ventilation.

1. Initiate an intravenous (IV) line for the administration of fluids.

The nurse is preparing to perform an assessment on a client being admitted to the hospital with a diagnosis of sickle cell crisis, vaso-occlusive crisis. Which findings should the nurse expect to note on assessment of the client? Select all that apply. 1. Pallor 2. Fever 3. Joint swelling 4. Blurred vision 5. Abdominal pain

1. Pallor 2. Fever 3. Joint swelling 5. Abdominal pain Blurred vision is not a manifestation of crisis.

A client with rapid-rate atrial fibrillation asks a nurse why the health care provider is going to perform carotid sinus massage. Which is a correct explanation? 1. The vagus nerve slows the heart rate. 2. The diaphragmatic nerve slows the heart rate. 3. The diaphragmatic nerve overdrives the rhythm. 4. The vagus nerve increases the heart rate, overdriving the rhythm.

1. The vagus nerve slows the heart rate.

Normal Hbg range for women

12-16 g/L

What is the normal serum ferritin values

12-300ng/mL

Normal Hbg range for men

14-18 g/L

A 15-month-old child has just been diagnosed with sickle-cell-anemia. The mother is pregnant & asks if the child she is carrying will also have SCD. She says that neither her nor her husband has SCD. The nurses reply should be based on which understanding? 1 - There is a 50% chance that each child they have will have SCD 2 - The chance of have another child with SCD is 1 in 4 3 - Parents do not usually have 2 children in a row with SCD 4 - If the child is a boy, there is a 50% chance that he will have SCD

2 - The chance of have another child with SCD is 1 in 4

A patient is receiving ferrous sulfate to treat iron-deficiency anemia. When reviewing the laboratory report, the healthcare provider notes the patient's reticulocyte count has increased. How should the healthcare provider interpret these findings? A - The patient is beginning to recover from the anemia. B - The ferrous sulfate dosage should be discontinued. C - The ferrous sulfate dosage should be increased. D - The patient is not responding to treatment.

A - The patient is beginning to recover from the anemia.

A nurse is assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. The nurse plans care with the understanding that the heart normally sends out how many liters of blood per minute to the body? 1. 2 L/min 2. 5 L/min 3. 10 L/min 4. 15 L/min

2. 5 L/min

The Purkinje fibers can act as the pacemaker with a rate between ___ & ___ beats/minute she higher pacemakers (SA or AV node) fail

20 & 40 beats per minute

If both parents have the sickle cell trait, what are the chances that the child will have the disease?

25%

Which waveform indicates proper function of the sinoatrial (SA) node? The QRS complex is present. The PR interval is 0.24 second. A P wave precedes every QRS complex. The ST segment is elevated.

A P wave precedes every QRS complex.

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1. Check the blood pressure. 2. Call the health care provider. 3. Check the client and the chest leads. 4. Initiate cardiopulmonary resuscitation (CPR).

3. Check the client and the chest leads.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1. Call a code. 2. Call the health care provider. 3. Check the client's status and lead placement. 4. Press the recorder button on the electrocardiogram console.

3. Check the client's status and lead placement.

A hospitalized client is experiencing a decrease in blood pressure. The nurse plans care for the client, knowing that this change will have which primary effect on his or her heart? 1. Decreased heart rate 2. Increased contractility 3. Decreased myocardial blood flow 4. Increased resistance to electrical stimulation

3. Decreased myocardial blood flow

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? 1. Flat neck veins 2. Nausea and vomiting 3. Hypotension and dizziness 4. Clubbed fingertips and headache

3. Hypotension and dizziness

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? 1. Sinus bradycardia 2. Sick sinus syndrome 3. Normal sinus rhythm 4. First-degree heart block

3. Normal sinus rhythm Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? 1. Chloride level of 98 mEq/L 2. Sodium level of 135 mEq/L 3. Potassium level of 6.8 mEq/L 4. Magnesium level of 1.6 mEq/L

3. Potassium level of 6.8 mEq/L

A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block? 1. Presence of Q waves 2. Tall, peaked T waves 3. Prolonged PR interval 4. Widened QRS complex

3. Prolonged PR interval

The health care provider has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure? 1. Questions the client about allergies to iodine or shellfish 2. Has the client sign an informed consent form for an invasive procedure 3. Tells the client that the procedure is painless and takes 30 to 60 minutes 4. Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure

3. Tells the client that the procedure is painless and takes 30 to 60 minutes

Normal RBC range for women

3.2-5.4 million/mL

Normal Hct range for women

37% - 47%

A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement? 1. "The work of breathing is increased when the client is anemic." 2. "Blood flows more slowly when the hemoglobin or hematocrit is low." 3. "The body has to work harder to fight infection in the presence of anemia." 4. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

4. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

The nurse has provided instructions to a client with sickle cell disease regarding measures that will prevent a sickle cell crisis. Which statement, if made by the client, indicates an understanding of these measures? 1. "I need to avoid any exercise." 2. "I need to avoid increasing my fluid intake." 3. "I need to avoid going outdoors in warm weather." 4. "I need to avoid situations that may lead to an infection."

4. "I need to avoid situations that may lead to an infection."

A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further research on the anatomy and physiology of the heart? 1. "The coronary arteries branch from the aorta." 2. "The coronary arteries supply the heart muscle with blood." 3. "The left coronary artery provides blood for the left atrium and the left ventricle." 4. "The left coronary artery supplies the right atrium and right ventricle with blood."

4. "The left coronary artery supplies the right atrium and right ventricle with blood."

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? 1. Before each P wave 2. Just after each P wave 3. Just after each T wave 4. Before each QRS complex

4. Before each QRS complex

client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1. Sensation of palpitations 2. Causative factors, such as caffeine 3. Precipitating factors, such as infection 4. Blood pressure and oxygen saturation

4. Blood pressure and oxygen saturation Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation

A nurse is caring for a client with unstable ventricular tachycardia. The nurse should instruct the client to take which action, if prescribed, during an episode of ventricular tachycardia? 1. Lie down flat in bed. 2. Remove any metal jewelry. 3. Breathe deeply, regularly, and easily. 4. Inhale deeply and cough forcefully every 1 to 3 seconds.

4. Inhale deeply and cough forcefully every 1 to 3 seconds.

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most anticipate in this client if PVCs are occurring? 1. A P wave preceding every QRS complex 2. QRS complexes that are short and narrow 3. Inverted P waves before the QRS complexes 4. Premature beats followed by a compensatory pause

4. Premature beats followed by a compensatory pause

The nurse is performing an assessment on a client with a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client? 1. Dyspnea 2. Dusky mucous membranes 3. Shortness of breath on exertion 4. Red tongue that is smooth and sore

4. Red tongue that is smooth and sore

A client with angina has a 12-lead electrocardiogram taken during an episode of chest pain. The nurse should examine the tracing for which electrocardiographic (ECG) change caused by myocardial ischemia? 1. Tall, peaked T waves 2. Prolonged PR interval 3. Widened QRS complex 4. ST segment elevation or depression

4. ST segment elevation or depression

The nurse is performing an assessment on a client with a diagnosis of anemia that developed as a result of blood loss after a traumatic injury. The nurse should expect to note which sign or symptom in the client as a result of the anemia? 1. Bradycardia 2. Muscle cramps 3. Increased respiratory rate 4. Shortness of breath with activity

4. Shortness of breath with activity The client with anemia is likely to experience shortness of breath and complain of fatigue because of the decreased ability of the blood to carry oxygen to the tissues to meet metabolic demands

Normal RBC range for men

4.7 - 6.1 million

What is abnormal about the RBCs of individuals with sickle cell anemia?

40% (or more) of the total hemoglobin is composed of an abnormal beta chain called hemoglobin S [HbS]

What is the intrinsic rate of the AV node?

40-60 BPM

Normal Hct range for men

42% - 52%

The SA node generates electrical impulses at ____ to ____ times per minute & is controlled by ________

60-100 times per minute Controlled by the sympathetic & parasympathetic nervous system

What is the folate requirement during pregnancy

600 mcg is recommended Higher doses is needed when pregnancy with multiples & for women on anticonvulsants

What serum ferritin values are considered diagnostic of iron deficiency anemia?

<10ng/mL

Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. A - "He drinks over 3 cups of milk per day." B - "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." C - "He refuses to eat more than 2 different kinds of vegetables." D - "He doesn't like meat, but he will eat small amounts of it." E - "He sleeps 12 hours every night and take a 2-hour nap."

A - "He drinks over 3 cups of milk per day." B - "I can't keep enough apple juice in the house; he must drink over 10 ounces per day."

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A - "What activities were you able to do 6 months ago compared with the present?" B - "How long have you had this problem?" C - "Have you been able to keep up with all your usual activities?" D - "Are you more tired now than you used to be?"

A - "What activities were you able to do 6 months ago compared with the present?"

A patient who is being treated for iron-deficiency anemia is prescribed ferrous sulfate tablets. The teaching plan for this patient should include which of these instructions? Select all that apply. A - "You should take this medication between meals on an empty stomach." B - "You should eat a low fiber diet when you are taking this medication." C - "Be sure to keep your iron pills out of the reach of young children." D - "Your stools may turn dark green or black, but this is harmless." E - "Avoid taking this medication with coffee." F - "Taking the medication with an antacid will decrease stomach irritation."

A - "You should take this medication between meals on an empty stomach." C - "Be sure to keep your iron pills out of the reach of young children." D - "Your stools may turn dark green or black, but this is harmless." E - "Avoid taking this medication with coffee."

A patient who has a hemoglobin level of 6.4 g/dL refuses a blood transfusion on religious grounds. Which of these would the healthcare provider expect to administer as part of this patient's plan of care? Select all that apply. A - Epoetin alfa (Procrit) B - Lactated Ringer's solution C - Fresh frozen plasma D - Ferrous sulfate E - Folic acid

A - Epoetin alfa (Procrit) D - Ferrous sulfate E - Folic acid

A patient who has severe iron-deficiency anemia will receive iron dextran IV. When administering this medication to the patient, which of these actions should the healthcare provider implement? A - Give a small test dose and observe the patient for several minutes. B - Administer the medication IV push over 1 minute into a large vein. C - Add the iron dextran to the patient's parenteral nutrition solution. D - Dilute the medication in 50mL normal saline and infuse over 30 minutes

A - Give a small test dose and observe the patient for several minutes.

The healthcare provider is caring for a patient who reports increasing fatigue over the past 4 months. The patient has no significant past medical history and takes no daily medications. A complete blood count was ordered. What do these results tell the healthcare provider about the patient? Hemoglobin 10g/dL Hematocrit 29% Decreased MCV Decreased MCHC Select all that apply. A - The patient is deficient in iron. B - The patient is deficient in B vitamins. C - Tissue oxygenation is impaired. D - Red blood cells are small and pale. E - Red blood cells are large and of various shapes F - Red blood cell function is normal.

A - The patient is deficient in iron. C - Tissue oxygenation is impaired. D - Red blood cells are small and pale.

A patient comes in with a new diagnosis of persistent atrial fibrillation with a rapid ventricular response. Although the client has had no previous cardiac problems, the client has been in A. Fib for more than 2 days. The nurse should anticipate that the HCP is likely to initially order: (select all that apply) A - oxygen B - Immediate cardioverson C - Administration of amiodarone D - Initiation of a IV heparin infusion E - Immediate catheter-directed ablation of the AV node F - administration of a calcium channel antagonist such as diltiazem

A - oxygen C - Administration of amiodarone D - Initiation of a IV heparin infusion F - administration of a calcium channel antagonist such as diltiazem

What happens in supraventricular tachycardia?

A conduction signal loops & reenters the atrium causing rapid, atrial driven HR usually above 140 BPM

_________ occurs when atrial tissue becomes irritable.

A premature atrial complex (contraction) (PAC)

The nurse is teaching a client with newly diagnosed anemia about conserving energy. What does the nurse tell the client? (Select all that apply.) A. "Allow others to perform your care during periods of extreme fatigue." B. "Drink small quantities of protein shakes and nutritional supplements daily." C. "Perform a complete bath daily to reduce your chance of getting an infection." D. "Provide yourself with four to six small, easy-to-eat meals daily." E. "Perform your care activities in groups to conserve your energy." F. "Stop activity when shortness of breath or palpitations are present."

A. "Allow others to perform your care during periods of extreme fatigue." B. "Drink small quantities of protein shakes and nutritional supplements daily." D. "Provide yourself with four to six small, easy-to-eat meals daily." F. "Stop activity when shortness of breath or palpitations are present."

The nurse is caring for a client who has developed a bradycardia. Which possible causes does the nurse investigate? (Select all that apply.) A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) C. Client stating that he just had a cup of coffee D. Client becoming emotional when visitors arrived E. Diltiazem (Cardizem) administered 1 hour ago

A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) E. Diltiazem (Cardizem) administered 1 hour ago

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? A. Dairy products B. Grains C. Leafy vegetables D. Starchy vegetables

A. Dairy products

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention? A. Defibrillation B. Cardiopulmonary resuscitation (CPR) C. Administration of epinephrine D. Administration of oxygen

A. Defibrillation Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt; therefore, this intervention is not used

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action does the nurse take next? A. Prepare for defibrillation. B. Establish IV access. C. Place an oral airway and ventilate. D. Start cardiopulmonary resuscitation (CPR).

A. Prepare for defibrillation. After immediate defibrillation, establish IV access, place an oral airway, and ventilate. CPR will be started after unsuccessful defibrillation.

What is the most important nursing consideration when caring for a child with sickle cell anemia? A. Teach the parents and child how to minimize crises. B. Refer the parents and child for genetic counseling. C. Help the child and family to adjust to a short-term disease. D. Observe for complications of multiple blood transfusions.

A. Teach the parents and child how to minimize crises.

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the lungs are:

Altered pulmonary function Susceptibility to infections Pulmonary insufficiency

The primary purpose of the Schilling test is to measure the client's ability to: Store vitamin B12 Digest vitamin B12 Absorb vitamin B12 Produce vitamin B12

Absorb vitamin B12 Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.

Treatment of supraventricular tachycardia?

Adenosine given rapid IV push

What happens on an EKG if magnesium is too low

Almost identical to hypokalemia Isoelectric T wave or small T wave Ventriclar arrthymia

What does a prominent U wave indicate?

An electrolyte abnormality, such as hypokalemia

What happens to oxygen consumption when heart rate increases?

An increase in heart rate increases oxygen consumption

Foods rich in vitamin B12

Animal proteins Fish Eggs Nuts Dairy! Dried beans Citrus fruit Leafy green veggies!

On an EKG, what does the PR interval represent?

The time it takes for an impulse to travel from the atrial through the AV node, bundle of His, & bundle branches to the Purkinje fibers

What is the benefit of PCD opioid treatment of patients with SCD?

There is less change of over sedation

______ may be caused by CAD, MI, HTN, pulmonary embolism, pericarditis, or hyperthyroidism (dysrhythmia)

Atrial fibrillation

Which rhythm is often seen in COPD, but may be seen with CAD and Atrial septal defects?

Atrial flutter

The _______ valves close at the beginning of ventricular contraction & prevent blood from flowing back into the atria from the ventricles

Atrioventricular

________ (pacing function) is the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively.

Automaticity

Effects of vasoocclusive phenomena in patients with sickle cell disease on the extremities are:

Avascular necrosis of hip or shoulder Skeletal deformities, especially lordosis & kyphosis Chronic leg ulcers Susceptibility to osteomyelitis

When is the first heart sound (S1) heard?

As the atrioventricular valves close

________ = a loss of electrical signal so it doesn't respond to defibrillation (dysrhythmia)

Asystole

Where is the first heart sound (S1) heart loudest?

At the apex of the heart

Where is the SA node located?

At the junction of the superior vena cave & the right atrium

A client's electrocardiogram shows that the atrial and ventricular rhythms are irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition?

Atrial fibrillation

The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm?

Atrial fibrillation

With which dysrhythmia is there a major risk for thrombotic events?

Atrial fibrillation

A 53-year-old who has pernicious anemia is being seen in the physician's office. Because the client has pernicious anemia, which comment is of greatest concern? A - "I have been having trouble reading the news paper" B - "I have pain up and down my legs" C - "My knees hurt when i climb stairs" D - "I am so tired of having a headache"

B - "I have pain up and down my legs"

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? A - "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." B - "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." C - "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." D - "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

B - "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."

The healthcare provider is assisting a patient with severe anemia with ambulation. The patient suddenly experiences dyspnea. What should the healthcare provider do first? A - Administer oxygen to the patient. B - Ask a colleague to get a wheelchair for the patient. C - Quickly assist the patient back to their bed. D- Ease the patient to the floor to prevent injury.

B - Ask a colleague to get a wheelchair for the patient.

A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A - Little is known about iron-deficiency anemia and its relationship to infection in children. B - Children with iron deficiency anemia are more susceptible to infection than are other children. C - Children with iron-deficiency anemia are less susceptible to infection than are other children. D - Children with iron-deficient anemia are equally as susceptible to infection as are other children.

B - Children with iron deficiency anemia are more susceptible to infection than are other children. Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? A - Schilling's test, elevated B - Intrinsic factor, absent. C - Sedimentation rate, 16 mm/hour D - RBCs 5.0 million

B - Intrinsic factor, absent.

The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? A- Pulse rate increased by 20 bpm immediately after the activity B - Respiratory rate decreased by 5 breaths/minute C - Diastolic blood pressure increased by 7 mm Hg D - Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

B - Respiratory rate decreased by 5 breaths/minute

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information? A. "Are your feet or hands cold, even when you are in bed?" B. "Do you feel more tired after you get up and go to the bathroom?" C. "How much exercise do you get?" D. "What is your endurance level?"

B. "Do you feel more tired after you get up and go to the bathroom?"

The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction? A. "Frequent handwashing is an important habit for me to develop." B. "Getting an annual 'flu shot' would be dangerous for me." C. "I must take my penicillin pills as prescribed, all the time." D. "The pneumonia vaccine is protection that I need."

B. "Getting an annual 'flu shot' would be dangerous for me."

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to A. administer 100% oxygen to relieve hypoxia. B. administer pain medication to relieve symptoms. C. notify practitioner because chest syndrome is suspected. D. notify practitioner because child may be having a stroke.

C. notify practitioner because chest syndrome is suspected.

What may decrease absorption of iron?

Caffeine Milk Anticonvulsants Contraceptives

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information does the nurse include? A. "Sickle cell disease will be inherited by your children." B. "The sickle cell trait will be inherited by your children." C. "Your children will have the disease, but your grandchildren will not." D. "Your children will not have the disease, but your grandchildren could."

B. "The sickle cell trait will be inherited by your children."

What are the typical clinical manifestations of anemia? (Select all that apply.) A. Decreased breath sounds B. Dyspnea on exertion C. Elevated temperature D. Fatigue E. Pallor F. Tachycardia

B. Dyspnea on exertion D. Fatigue E. Pallor F. Tachycardia

Which risk factors are known to contribute to atrial fibrillation? (Select all that apply.) A.Use of beta-adrenergic blockers B. Excessive alcohol use C. Advancing age D. High blood pressure E. Palpitations

B. Excessive alcohol use C. Advancing age D. High blood pressure

The nurse is caring for a client with sickle cell disease. Which action is most effective in reducing the potential for sepsis in this client? A . Administering prophylactic drug therapy B. Frequent and thorough handwashing C. Monitoring laboratory values to look for abnormalities D. Taking vital signs every 4 hours, day and night

B. Frequent and thorough handwashing

Why is chronic hemolytic anemia a complication of sickle cell disease?

Because sickled RBCs only live for 10-20 days (not the normal 120 days) --- this is why the patient is always anemic & why they have low hemoglobin

Why are behavioral changes seen in patients with SCD?

Behavioral changes are early signs of cerebral hypoxia from poor diffusion

When should you recommend at patient take iron supplements? (time of day)

Between meals for better absorption & to reduce GI distress

What are the risk factors for iron deficiency anemia?

Bleeding (peptic ulcer disease, trauma, pregnancy, heavy menstrual periods, hemorrhoids) Duodenal absorption impairment Dietary intake below minimum requirement (vegans, cultural) Age or gender (more common in women & older adults)

A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences? Egg yolks Brown rice Vegetables Tea

Brown rice

_________ is a continuation of the AV node; located at the interventricular septum

Bundle of his

Clinical significance of atrial flutter

Can cause the patient to progress to atrial fibrillation

When auscultating the heart, which of the following characteristics or statements best describes the first heart sound (S1)? A - Heard lat in diastole B - Heard early in diastole C - Closure of the mitral & tricuspid valves D - Closure of the aortic & pulmonic valves

C - Closure of the mitral & tricuspid valves

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? A - Check the dressing and drains for frank bleeding B - Call the physician C - Continue to monitor vital signs D - Start oxygen at 2L/min per NC

C - Continue to monitor vital signs The nurse should continue to monitor the client, because this value reflects a normal physiologic response. The physician does not need to be called, and oxygen does not need to be started based on these laboratory findings. Immediately after surgery, the client's hematocrit reflects a falsely high value related to the body's compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 day post-op. By the second to third day, this response decreases and the client's hematocrit level is more reflective of the amount of RBCs in the plasma. Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit.

A patient is being evaluated for iron-deficiency anemia. Which of these laboratory results would the healthcare provider expect? Select all that apply. Select all that apply. A - Increased hemoglobin B - Increased mean corpuscular volume (MCV) C - Decreased serum ferritin D - Decreased hematocrit E - Increased total iron binding capacity (TIBC)

C - Decreased serum ferritin D - Decreased hematocrit E - Increased total iron binding capacity (TIBC)

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A - Autoimmune reaction complicated by hypoxia B - Lack of oxygen in the red blood cells C - Obstruction to circulation D - Elevated serum bilirubin concentration.

C - Obstruction to circulation

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A - Autoimmune reaction complicated by hypoxia B - Lack of oxygen in the red blood cells C - Obstruction to circulation D - Elevated serum bilirubin concentration.

C - Obstruction to circulation

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis? A - Ineffective coping related to the presence of a life-threatening disease B - Decreased cardiac output related to abnormal hemoglobin formation C - Pain related to tissue anoxia D - Excess fluid volume related to infection

C - Pain related to tissue anoxia

Which of the following arrthymias is commonly found in neonates & infants? A - Atrial fibrillation B - Bradyarrhythmias C - Premature atrial contractions D - Premature ventricular contractions

C - Premature atrial contractions

______ are the result of disturbances of cardiac electrical impulse formation, conduction, or both.

Cardiac dysrhythmias

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? A. "It is important to consume a diet high in green leafy vegetables." B. "You should take aspirin or ibuprofen for headache." C. "Report nosebleeds to your provider immediately." D. "Avoid caffeinated beverages."

C. "Report nosebleeds to your provider immediately."

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? A. "SCA is not inherited." B. "All siblings will have SCA." C. "There is a 25% chance of a sibling having SCA." D. "There is a 50% chance of a sibling having SCA."

C. "There is a 25% chance of a sibling having SCA."

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88 beats/min. For which additional therapy does the nurse plan? A. Synchronized cardioversion B. Electrophysiology studies (EPS) C. Anticoagulation D. Radiofrequency ablation therapy

C. Anticoagulation Because of the risk for thromboembolism, anticoagulation is necessary.

An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best indicator? A. Conjunctiva of the eye B. Soles of the feet C. Roof of the mouth D. Shins

C. Roof of the mouth

A client's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? A. Normal sinus rhythm B. Sinus bradycardia C. Sinus tachycardia D. Sinus rhythm with premature ventricular contractions

C. Sinus tachycardia

A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following interventions would be implemented first? Assume that there are orders for each intervention. A. Adjust the room temperature B. Give a bolus of IV fluids C. Start O2 D. Administer meperidine (Demerol) 75mg IV push

C. Start O2

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? A. The client is semi-recumbent in bed. B. Chest leads are placed as for the previous ECG. C. The client is instructed to breathe deeply through the mouth. D. The client is instructed to lie still.

C. The client is instructed to breathe deeply through the mouth. While obtaining a 12-lead ECG, remind the client to be as still as possible in a semi-reclined position, breathing normally. Any repetitive movement will cause artifact and could lead to inaccurate interpretation of the ECG. Normal breathing is required or artifacts will be observed, perhaps leading to inaccurate interpretation of the ECG.

_______ are abnormal rhythms of the heart's electrical system that can affect its ability to effectively pump oxygenated blood throughout the body.

Cardiac dysrhythmias

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? Defibrillate the client at 200 joules. Check the client for a pulse. Cardiovert the client at 50 joules. Give the client IV lidocaine.

Check the client for a pulse. The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone. If the client is pulseless or nonresponsive, the client is unstable and defibrillation is used.

______ is the ability to send an electrical stimulus from cell membrane to cell membrane.

Conductivity

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60 beats/min; a P wave precedes each QRS complex, and the PR interval is 0.20 second. Additional vital signs are as follows: blood pressure 118/68 mm Hg, respiratory rate 16 breaths/min, and temperature 98.8° F. All of these medications are available on the medication record. What action does the nurse take? Administer atropine. Administer digoxin. Administer clonidine. Continue to monitor.

Continue to monitor.

______ is the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart.

Contractility

When is the second heart sound (S2) heard?

When the semilunar valves close

How do you determine the heart rate using the 6 second strip method?

Count the number of p waves in 6 seconds & multiply by ten

A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? A - "I have been drinking plenty of fluids." B - "I have been gargling with warm salt water for my sore tongue." C - "I have 3 to 4 loose stools per day." D - "I take a vitamin B12 tablet every day."

D - "I take a vitamin B12 tablet every day." Vitamin B12 needw to be injected every month, because the ileum has been surgically removed.

If a sickle-turbidity test becomes positive, what happens?

Hbg electrophoresis is needed distinguishes between children with the trait & those with the disease

Normal ranges of hematocrit, hemoglobin, & ferritin during pregnancy

Hematocrit > 33% Hemoglobin > 11 g/dL Ferritin > 12 mcg/L

The mothers asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A - "The placenta bars passage of the hemoglobin S from the mother to the fetus." B - "The red bone marrow does not begin to produce hemoglobin S until several months after birth." C - "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D - "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

D - "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? A - "Vitamin B12 will cause ringing in the eats before a toxic level is reached." B - "Vitamin B12 may cause a very mild skin rash initially." C - "Vitamin B12 may cause mild nausea but nothing toxic." D - "Vitamin B12 is generally free of toxicity because it is water soluble."

D - "Vitamin B12 is generally free of toxicity because it is water soluble."

Which of the following may be seen in a 1-year-old with supraventricular tachycardia? A - HR of 100 BPM B - HR of 190 BPM C - HR less than 80 BPM D - HR more than 240 BPM

D - HR more than 240 BPM

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? A - An elevated hemoglobin level B - A decreased reticulocyte count C - An elevated RBC count D - Red blood cells that are microcytic and hypochromic

D - Red blood cells that are microcytic and hypochromic

During an assessment of a patient experiencing acute hemorrhage and anemia, the healthcare provider would most likely expect to find: A - Hypotension B - Jaundice C - Nausea D - Tachycardia

D - Tachycardia

The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of the following would the nurse include in the physical assessment? A. Palpate the spleen B. Take the blood pressure C. Examine the feet for petechiae D. Examine the tongue

D. Examine the tongue The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so examining the tongue should be included in the physical assessment.

The nurse is caring for a client who is in sickle cell crisis. What action does the nurse perform first? A. Apply cool compresses to the client's forehead. B. Encourage the client's use of two methods of birth control. C. Increase food sources of iron in the client's diet. D. Provide pain medications as needed.

D. Provide pain medications as needed.

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? A. The client states he is dizzy and weak. B. The nurse notes dyspnea. C. The client has a heart rate of 42 beats/min. D. The monitor shows an increase in heart rate.

D. The monitor shows an increase in heart rate.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is A. a symptom of iron deficiency anemia. B. an adverse effect of the iron preparation. C. an indicator of an iron preparation overdose. D. a normally expected change due to the iron preparation.

D. a normally expected change due to the iron preparation.

What lab values are low in patients with sickle cell anemia?

Hematocrit r/t short RBC lifespan & RBC destruction

Effects of vasoocclusive phenomena in patients with sickle cell disease on the CNS are:

Hemiparesis Seizures

When do the semilunar valves close?

When the ventricles begin to relax

What abdominal changes are seen in patients with SCD?

Damage to the liver & spleen occur early from many episodes of hypoxia & ischemia in crisis, abdominal pain is diffuse & steady, involving the back & legs The liver & spleen may feel from & enlarged with nodular or "lumpy" texture in later stages of the disease

What foods are considered high in iron

Dark green leafy vegetables Dried fruits (rasins) Egg yolks Legumes Liver Organ meat Kidney beans

The healthcare provider is teaching an adolescent patient how to include iron-rich foods in the diet. Which of these, if selected by the patient, would indicate correct understanding of the teaching? Yogurt Oranges Bananas Dark green vegetables

Dark green vegetables

What is the general problem with iron deficiency anemia?

Decreased iron supply for the developing RBC

On an EKG, what does the P wave represent?

Depolarization

_____ occurs when the normally negatively charged cells within the heart muscle develop a positive charge.

Depolarization

Interventions for sinus bradycardia

Determine cause ---If medication is cause, withhold & notify Oxygen as prescribed Atropine sulfate as prescribed Monitor for hypotension Give fluids

A patient who is anemic has a hemoglobin that is 9g /dL, and a hematocrit is 30% 30%. Which of these interventions should be a priority in the patient's plan of care? Transfuse 1 unit packed red blood cells. Administer epoetin alfa (Procrit) subcutaneously. Determine the cause of the anemia. Administer iron dextran IM.

Determine the cause of the anemia.

How is wandering atrial pacemaker diagnosed?

Diagnosed by at least 3 different P wave configurations seen in the same lead

What are the causes of vitamin B12 deficiency anemia

Diets lacking dairy products (vegans) Small bowel resection chronic diarrhea diverticula tapeworms overgrowth of intestinal bacteria

What medications are used to slow ventricular response in atrial fibrillation?

Digoxin calcium channel blockers beta blockers diltiazam amiodarone

A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A - Adds dried fruit to cereal and baked goods B - Cooks tomato-based foods in iron pots C - Drinks coffee or tea with meals D - Adds vitamin C to all meals

Drinks coffee or tea with meals Coffee and tea increase gastrointestinal mobility and inhibit the absorption of nonheme iron

Why are hip replacements often seen in patients with sickle cell disease?

Due to avascular necrosis--- the vaso-occlusion causes inadequate oxygenation to the bones (like the hip)

When do the semilunar valves open?

During ventricular contraction

What does the ST segment represent?

Early ventricular repolarization

What is the treatment of sinus tachycardia?

Eliminate cause

What are the only hopes for asystole?

Epinephrine & atropine

Which of the following blood components is decreased in anemia? Erythrocytes Granulocytes Leukocytes Platelets

Erythrocytes

______ is the ability of non-pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells and to depolarize.

Excitability

What can give us information about force of contraction (since an EKG cannot do this)?

Feeling the pulse

A possible NANDA nursing diagnosis for anemia would be impaired comfort r/t ____

Feelings of always being cold from decreased hemoglobin & decreased metabolism

What must be determined before treatment for atrial fibrillation can occur?

First, determine length/onset of A.Fib

What is shown on the EKG during hypokalemia?

Flattening & inversion of the T wave Appearance of a U wave ST depression

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? Infection Trauma Fluid overload Stress

Fluid overload

What type of anemia is common with alcohol abuse?

Folate deficiency

What is folic acid needed for?

Folic acid is needed for hemoglobin production & DNA synthesis

How does the cell absorb folic acid?

Folic acid is pulled into the cell by vitamin B12

How is the PR interval measured?

From the beginning of the P wave to the end of the PR segment

How is the QT interval measured?

From the beginning of the QRS complex to the end of the T wave

What is the most common reason for anemia in adults?

GI bleed

What should the nurse do if their SCD patient has fever?

Have diagnostic testing for sepsis including CBC w/ diff, blood cultures, reticulocyte count, urine culture, & chest x-ray

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? Heparin Atropine Dobutamine Magnesium sulfate

Heparin The loss of coordinated atrial contractions in atrial fibrillation can lead to pooling of blood, resulting in thrombus formation. The client is at high risk for pulmonary embolism! Thrombi may form within the right atrium and then move through the right ventricle to the lungs. In addition, the client is at risk for systemic emboli, particularly an embolic stroke, which may cause severe neurologic impairment or death. Heparin and other anticoagulants (e.g., enoxaparin [Lovenox] and warfarin [Coumadin]) are used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the liver are:

Hepatomegaly Cirrhosis Intrahepatic cholestasis

A 32-year-old client is recovering from a sickle cell crisis. His discomfort is controlled with pain medications and he is to be discharged. What medication does the nurse expect to be prescribed for him before his discharge? Heparin (Heparin) Hydroxyurea (Droxia) Tissue plasminogen activator (t-PA) Warfarin (Coumadin)

Hydroxyurea (Droxia)

________ has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD).

Hydroxyurea (Droxia)

_____ can cause a shortened ST segment & a widened T wave, artioventricular block, tachycardia or bradycardia, digitalis, hypersensitivity, & cardiac arrest.

Hypercalemia

____ causes asystole & ventricular dysrhythmias

Hyperkalemia

a postoperative client. What post-transfusion electrolyte imbalance does the nurse want to rule out? Hypercalcemia Hyperkalemia Hypomagnesemia Hyponatremia

Hyperkalemia During transfusion, some cells are damaged. These cells release potassium, thus raising the client's serum potassium level (hyperkalemia). This complication is especially common with packed cells and whole-blood products

_____ causes ventricular dysrhythmias, prolonged ST & QT intervals, & cardiac arrest

Hypocalcemia

What does a U wave suggest?

Hypokalemia

_____ causes increased cardiac electrical instability, ventricular dysrhythmias, & increased risk of digoxin toxicity.

Hypokalemia

What are the signs & symptoms of atrial fibrillation?

Hypotension Lightheadedness Palpitations SOB Chest pains

Prevention of folic acid deficiency:

Identify high risk patients --older, debilitated patients with alcoholism --patients at risk for malnutrition --those with increased folic acid requirements Diet rich in foods containing folic acid & vitamin B12

When might a third heart sound (S3) be heard?

If ventricular wall compliance is decreased & if structures in the ventricular wall vibrate; this can occur in conditions such as heart failure or valvular regurgitation A third heart sound may be normal in individuals younger than 30 years old.

When is sinus tachycardia dangerous?

In patients with acute MI because increases in heart rate increase the oxygen demand & decrease the oxygen supply

When is sinus tachycardia considered normal?

In response to increased metabolic demands such as exercise

How should women labor who have sickle cell disease?

In side-lying position

Where is iron stored?

In the liver connected to apoferrin. When it is connected, it becomes ferritin

Where is the AV node located?

In the lower aspect of the atrial septum

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the kidneys are:

Inability to concentrate urine Enuresis Progressive renal failure

What is the treatment of vitamin B12 deficiency when the cause is dietary deficiency?

Increase intake of foods rich in vitamin B12

Who is at risk for sickle cell disease?

Individuals with parents heterozygous for HbS or of African American descent

Briefly describe the pathophysiology of iron deficiency anemia

Insufficient iron impedes the synthesis of hemoglobin, thereby reducing the amount of oxygen transported in the blood Results in microcytic (small), hypochromic (less color) erythrocytes owing to a low concentration of hemoglobin in each cell

Effects of vasoocclusive phenomena in patients with sickle cell disease on areas of the eyes are:

Intraocular abnormalities with visual disturbances Sometimes progressive retinal detachment & blindness

A recently admitted client who is in sickle cell crisis requests "something for pain." What does the nurse administer? Intramuscular (IM) morphine sulfate Intravenous (IV) hydromorphone (Dilaudid) Oral ibuprofen (Motrin) Oral morphine sulfate (MS-Contin)

Intravenous (IV) hydromorphone (Dilaudid)

What lab values are reduced in individuals with iron deficiency anemia?

Iron Ferritin (<10) H&H

What is the most common type of anemia?

Iron deficiency anemia

What is significant about hemoglobin S [HbS]?

It is sensitive to low oxygen content of the RBCs

What does the circumflex coronary artery supply?

Left atrium Lateral & posterior surfaces of the left ventricle

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures?

Left atrium to left ventricle

Where is the positive electrode on lead II?

Left leg or lowest rib, left midclavicular line

Where is the positive electrode on lead III?

Left leg or lowest rib, left midclavicular line

The healthcare provider is counseling a pregnant woman who is a lacto-ovo vegetarian about foods to include in her diet to avoid iron-deficiency anemia. Which of these foods should be included? Select all that apply. Legumes Eggs Raisins Oranges Cheese

Legumes Eggs Raisins

What happens on an EKG if calcium is too high?

Lengthens QT interval

What is a prolonged QT a sign of?

Low Mg or Ca++

Interventions for folic acid deficiency

Managed with scheduled folic acid replacement therapy Administer folic acid PO or IV Increase foods high in folic acid Avoid alcohol Anticonvulsants & oral contraceptives can slow absorption Folate requirement increases during pregnancy

Manifestations of vitamin B12 deficiency anemia

May be mild or severe Develops slowly Pallor Jaundice Glossitis Fatigue Weight loss

Manifestations of pernicious anemia

May be mild or severe Develops slowly Pallor Jaundice Glossitis Fatigue Weight loss Paresthesias in feet & hands; poor balance

How do we test to know if someone has iron deficiency anemia?

Measure ferritin levels Decreased = iron deficiency

The healthcare provider is reviewing the medical record of a patient who reports increasing fatigue and shortness of breath when taking walks. A series of fecal occult blood tests are noted to be positive. Further testing of the patient's blood is likely to reveal which of these red blood cell characteristics? Macrocytic, normochromic Microcytic, normochromic Microcytic, hypochromic Normocytic, hypochromic

Microcytic, hypochromic

ST segment elevation can be a sign of what?

Myocardial injury

Should women with sickle cell disease take an iron supplement?

NO! Potential for iron overload

What happens to the QRS complex during supraventricular tachycardia?

Narrows

Which of the following symptoms is expected with hemoglobin of 10 g/dl? None Pallor Palpitations Shortness of breath

None Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.

Clinical significance of premature atrial contractions

None - they require no treatment

Significance of sinus arrhythmia

Normal in children & young adults, abnormal in older adults

Why do bone changes occur in patients with SCD?

Occur as a result of chronically stimulated marrow & low bone oxygen levels

Musculoskeletal changes in patients with SCD:

Occur because arms/legs are often sites of blood vessel occlusion Joints may be damaged from hypoxic episodes & have necrotic degeneration

When might a fourth heart sound (S4) be heart?

On atrial systole if resistance to ventricular filling is present; This is an abnormal finding & the causes include cardiac hypertrophy, disease, or injury to the ventricular wall

What occurs during atrial flutter?

One foci in atrium fires rapidly, leading to sawtooth P waves & regular QRS with HR between 75-175

What types of pain medications are indicated for a patient in a sickle cell crisis?

Opioids (morphine & hydromorphone [Dilaudid] IV via PCA NSAIDs

Nursing implications for individuals taking iron

Oral care after liquid (stains teeth) Fluids increase, iron hardens stool Stool may turn black Increase fiber Give stool softener if needed Increase activity Educate on black, tarry stool Test dose before IVPB

Descrive normal sinus rhythm:

Originates from sinus node Atrial & ventricular rhythms are regular 60-100 beats/minute PR & QRS intervals are within normal limits

A client with anemia may be tired due to a tissue deficiency of which of the following substances? Carbon dioxide Factor VIII Oxygen T-cell antibodies

Oxygen

The____ wave is a deflection representing atrial depolarization.

P

A 32-year-old client recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? Cefaclor (Ceclor) Gentamicin (Garamycin) Penicillin V (Pen-V K) Vancomycin (Vancocin)

Penicillin V (Pen-V K) Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in clients with sickle cell disease.

______ = anemia resulting from failure to absorb vitamin B12 that is caused by a deficiency of intrinsic factor, which is needed for intestinal absorption of vitamin B12

Pernicious anemia

Common causes of folic acid deficiency:

Poor nutrition Malabsorption (Crohn's, Celiac, Cancer) Drugs (Anticonvulsants, oral contraceptives) Gastric bypass Ileostomy Sickle cell Chronic alcoholics

General manifestations of children with sickle cell disease:

Possible growth retardation Chronic anemia Possible delayed sexual maturation Marked susceptibility to sepsis

Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? Rice cereal, whole milk, and yellow vegetables Potato, peas, and chicken Macaroni, cheese, and ham Pudding, green vegetables, and rice

Potato, peas, and chicken

What is priapism? What is it associated with? Why does this happen?

Priapism = prolonged penile erection seen in patients with SCD -Caused by excessive vascular engorgement in erectile tissue -During episode, patient usually cannot urinate

What happens on an EKG if magnesium is too high?

Prolonged PR interval Prolonged QRS Prolonged QT

These cells are responsible for the rapid conduction of electrical impulses throughout the ventricles, leading to ventricular depolarization and the subsequent ventricular muscle contraction

Purkinje cells

The _ wave is the first negative deflection and is not present in all leads

Q

When the __ wave is abnormally present in a lead, it represents myocardial necrosis (cell death)

Q

The____ duration represents the time required for depolarization of both ventricles.

QRS

The_____ represents ventricular depolarization.

QRS complex

The ___ interval represents the total time required for ventricular depolarization and repolarization

QT

Normal RBC, hemoglobin, and hematocrit for children:

RBC = 4.5 - 5.5 million/microliter Hemoglobin = 11.5 - 15.5 g/dL Hematocrit = 35%-45%

Significant of supraventricular tachycardia

Rapid rate can cause decreased cardiac output

Describe supraventricular tachycardia

Rate = 150-250 bpm rhythm = regular P wave = differs from sinus; may be buried in T wave PR interval = difficult to assess QRS interval = less than 0.1 seconds

Describe premature atrial contractions

Rate = 60-100 bpm Rhythm = irregular P wave = notched, flattened, hidden, biphasic PR interval = normal

Describe sinus arrhythmia

Rate = 60-100 bpm Rhythm = irregular P wave = present before QRS, upright/round, consistent PR interval = 0.12-0.2 seconds

Describe wandering atrial pacemaker

Rate = 60-100 bpm Rhythm = regular or irregular P wave = size, shape, direction may change from beat to beat PR interval = variable with ectopic focus

Describe atrial flutter

Rate = Atrial rate 240-400 bpm; ventricular rate varies with degree of block (usually 60-100) Rhythm = may be regular to irregular P wave = Sawtooth wave pattern PR interval = not true P wave, so PR interval not measured

Describe atrial fibrillation

Rate = atrial rate of 400-600; vary by extent of block; rate does not determine A fib Rhythm = irregularly irregular P wave = No discernible P wave PR interval = none

Describe Sinus bradycardia

Regular rhythm Rate < 60 bpm PR interval & QRS within normal limits

Describe sinus tachycardia

Regular rhythm Rate > 100 bpm PR interval 0.12 - 0.20 P wave present before every QRS, upright & sounded, consistent in shape & size

What lab values are high in patients with sickle cell anemia?

Reticulocyte (indicates anemia of long duration) Total bilirubion (because damaged RBCs release iron & bilirubin) Total WBC count r/t inflammation cause by tissue hypoxia & ischemia

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? Platelet count Hematocrit level Reticulocyte count Hemoglobin level

Reticulocyte count A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, and increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

Where is the negative electrode on lead I?

Right arm or under the right clavicle

Where is the negative electrode on lead II?

Right arm or under the right clavicle

What does the right main coronary artery supply?

Right atrium & ventricle Inferior portion of left ventricle Posterior septal wall SA & AV nodes

What cardiovascular changes are seen in patients with sickle cell disease?

Risk for high-output heart failure r/t anemia Extremities distal to occlusion are cool to touch w/ slow capillary refill & may have reduced / absent pulses HR may be rapid BP may be average to low

______ represents time required for atrial depolarization and for the impulse delay in the atrioventricular node and travel time to the Purkinje fibers

The PR interval

______ spread the wave of depolarization through the ventricles

The Purkinje fibers

____ represents ventricular depolarization.

The QRS complex

What does the R wave represent?

The R wave is the first positive deflection in the QRS complex.

What does the S wave represent?

The S wave appears as the second negative deflection in the QRS complex.

_____ is the heart's primary pacemaker

The SA node

The U wave may follow which wave?

The T wave

What does the left anterior descending artery supply?

The anterior wall of the left ventricle The anterior ventricular septum The apex of the left ventricle

What happens if the sinoatrial node fails?

The atrioventricular node can initial & sustain a heart rate of 40-60 beats per minute

Where is the second heart sound (S2) heard loudest?

The base of the heart

If blockage occurs in _____, an individual is at risk for myocardial infarction.

The coronary arteries

______ provides a graphic representation, or picture, of cardiac electrical activity

The electrocardiogram (ECG)

What does the left main coronary artery consist of?

The left anterior descending coronary artery The circumflex coronary artery

What is the main pacemaker that initiates each heartbeat?

The sinoatrial (SA) node

Specialized cells of the myocardium are responsible for cardiac conduction. They consist of what?

The sinoatrial node The atrioventricular junctional area Bundle branch system

What type of fluids are given to a patient in a sickle cell crisis?

They patients blood is hypertonic r/t dehydration, so hypotonic fluids are usually infused Urge patient to drink water or juices (no caffeine or alcohol)

Why must a woman's partner but tested before having children?

To determine the couple's risk of producing children with sickle cell disease rather than the sickle cell trait

What can help to increase HbA levels in patients with SCD, but can cause iron overload?

Transfusions

What is Hydroxyura?

US FDA approved drug for sickle cell disease --increases production of HbF --reduces endothelial adhesion of sickle cells --improves the sickle hydration --increases nitricoxide production (a vasodilator) --lowers leukocyte & reticulocyte counts

How long would an individual take iron supplements for mild iron loss for?

Until the hemoglobin level returns to normal

Clinical significance of wandering atrial pacemaker

Usually associated with no signs & symptoms Dig toxicity

What does the QRS complex represent?

Ventricular depolarization

What does the QT interval represent?

Ventricular refractor time or the total time required for ventricular depolarization & repolarization

Kidney & urinary changes in patients with SCD:

Very common as a result of poor perfusion & decreased tissue gas exchange the urine concentrates protein, & the patient may not be able to concentrate urine eventually, the kidneys fail, resulting in little or no urine output

_____ results in the failure to activate the enzyme to move folic acid into precursor RBCs so that cell division & growth into functional RBCs can occur

Vitamin B12 deficiency anemia

What is the treatment of pernicious anemia?

Vitamin B12 injections weekly at first, the monthly for the rest of their lives Cannot be given PO because it will not be absorbed

What increases absorption of iron?

Vitamin C

On an EKG, what do the vertical strips represent?

Voltage

What is prescribed for patients with chronic atrial fibrillation?

Warfarin because of risk for thrombus formation in left atrium that embolic to the brain

Why is hydration so important for treatment of a sickle cell crisis?

Water decreases the viscosity of the blood, therefore the sickled blood cells won't get caught in the small blood vessels as easily

What are the manifestations of iron deficiency anemia?

Weakness & pallor Fatigue Reduced exercise tolerance Fissures at the corners of the mouth

When is sinus tachycardia considered a compensatory mechanism?

When blood pressure decreases, heart rate increases to increase production of oxygenated blood

When do the atrioventricular valves open?

When the ventricles relax

Risk factors for folic acid deficiency

Women taking anticonvulsant medication Pregnant women with a multifetal gestation Pregnancy increases folic acid demand Can cause neural tube defects (spin bifida)

Can acidosis trigger sickling?

Yes

Impulses from the sinus node move directly through atrial muscle and lead to ______, which is reflected in a P wave on the ECG.

atrial depolarization

What dysrhythmia occurs where there is a lack of P waves?

atrial fibrillation

What is the general definition of anemia?

a decrease in the number of either RBCs, hematocrit (Hct) or hemoglobin (Hbg)

Define anemia

a decrease in the number of either RBCs, hematocrit (hct) or hemoglobin (hgb)

Wolf Parkinson White syndrome has what?

a shortened PR interval

The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? a. Eggs b. Lettuce c. Citrus fruits d. Cheese

a. Eggs

What does the atrial kick contribute to?

additional blood volume for a greater cardiac output.

A possible NANDA nursing diagnosis for anemia would be risk for injury r/t ____

alteration in peripheral sensory perception

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be risk for infection r/t _______

alterations in splenic function

A possible NANDA nursing diagnosis for a person with a dysrhythmia would be decreased cardiac output r/t ________

altered electrical conduction

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be impaired comfort r/t _______

altered health status

The ___ valve lies between the left ventricle & the aorta

aortic semilunar valve

The ______ receives electrical impulses from the sinoatrial node

atrioventricular (AV) node

The _____ valve is located on the left side of the heart

bicuspid (mitral)

The primary purpose of the Schilling test is to measure the client's ability to: a. Store vitamin B12 b. Digest vitamin B12 c. Absorb vitamin B12 d. Produce vitamin B12

c. Absorb vitamin B12

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? a. Whole grains b. Green leafy vegetables c. Meats and dairy products d. Broccoli and Brussels sprouts

c. Meats and dairy products

What does a T wave inversion indicate?

cardiac ischemia

A possible NANDA nursing diagnosis for anemia would be anxiety r/t ____

cause of disease

A possible NANDA nursing diagnosis for anemia would be impaired memory r/t ____

change in cognition from decreased oxygen supply to the body

A possible NANDA nursing diagnosis for patients in a sickle cell crisis would be risk for disproportionate growth r/t _______

chronic illness

A possible NANDA nursing diagnosis for anemia in pregnancy would be risk for disturbed maternal/fetal dyad r/t _____

compromised oxygen transport

_________ is the mechanical activity of the heart

contractility

The ____ supply the capillaries of the myocardium with blood

coronary arteries

How do you determine the ventricular rate in a 6 second strip?

count the number of R raves or QRS complexes in 6 seconds & multiply by 10

A possible NANDA nursing diagnosis for a person with a dysrhythmia would be risk for ineffective cerebral tissue perfusion r/t ________

decreased blood supply to the brain from dysrhythmia