Clayton Ch. 25-27
A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?
Continue with the prescribed rate.
What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction?
Lyses the blood clot
The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.)
Prevent platelet aggregation. Prevent the extension of existing clots. Inhibit steps in the fibrin clot formation cascade. Prolong bleeding time.
The nurse is preparing to provide personal care to a patient with peripheral vascular disease. When providing foot care, the nurse will
change socks daily.
Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.)
Hypertension Addiction to smoking Exercise tolerance
Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?
Leave the needle in place for 10 seconds after injection.
Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?
Petechiae
Which patient statement indicates to the nurse that the patient has a good understanding of PVD?
"Controlling contributing factors may affect the progression of the disease."
The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.)
"Do not make any major changes to your diet without discussing it with your health care provider." "Keep outpatient laboratory appointments for monitoring of therapy." "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." "Avoid aspirin products."
The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching?
"Grapefruit juice will increase the effects of this medication."
A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?
"Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."
A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective?
"I have less leg cramping when I walk"
The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?
"I will rinse my mouth with mouthwash instead of brushing my teeth."
Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure?
"Report nausea and vomiting to your health care provider."
The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate?
"This medication reduces the resistance your heart has to pump against."
Which drug is used to obtain vasodilation in the treatment of chronic heart failure?
ACE inhibitors
The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take?
Administer the medication; (Toddler normal heart rate is 90-120bpm)
When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects?
Antihypertensive
Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.)
Assess electrolyte levels Report daily weight fluctuations Maintain skin hygiene
Which is the initial manifestation of digoxin toxicity in children?
Atrial dysrhythmias
The nurse is preparing a teaching plan for a patient with Raynaud's disease who is soon to be discharged. What information will be included to improve circulation and prevent complications of this disease? (Select all that apply.)
Begin a daily exercise program Keep hands and feet warm Smoking cessation will improve outcomes
Which are included in the baseline assessment of PVD? (Select all that apply.)
History of heart disease Smoking and dietary habits Current medications Weight Limb pain
Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event?
Cardiac valve replacement
Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)? (Select all that apply.)
Check for intolerance to caffeine Obtain baseline data on pain that may be present Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia. Ask specifically if the patient has any cardiac symptoms or dizziness
Which nursing assessment is most important to determine fluid status for a patient with heart failure?
Daily weights
Which drug will be administered to a patient being admitted with severe digoxin intoxication?
Digoxin immune Fab (Digibind)
The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.)
Diminished exercise tolerance Shortness of Breath with activity
Which nursing intervention(s) would be accurate when administering lovenox subcutaneously? (Select all that apply.)
Documenting ecchymotic areas Monitoring of vital signs
Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest?
Encourage passive leg exercises.
A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a _____ position.
Fowler's
The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will
Implement deep breathing and coughing exercises.
The nurse has admitted a resident with the diagnosis of PVD to a long-term care facility. When providing care to this patient, the nurse will (Select all that apply.)
Implement pain management as ordered Assess skin temperature Palpate pedal pulses
Which assessment verifies increased blood perfusion to the lower extremities?
Increased amplitude of pedal pulses
Which action of ACE inhibitors results in effective treatment of heart failure?
Increased cardiac output
What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease?
Increases erythrocyte flexibility
The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will (Select all that apply.)
Inject slowly Alternate sites every 24 hours
Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output?
Inotropic
The nurse is assessing the patient's leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first?
Obtain a doppler ultrasound device for auscultation
What is the mechanism of action of drugs used to treat thromboembolic disease?
Preventing platelet aggregation and inhibiting clot formation
A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
Protamine sulfate
An older adult male patient with long-term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John's wort. What results with the use of this herbal supplement?
Reduced therapeutic benefits of digoxin
The nurse is providing education to a patient with altered cardiac function. When instructing this patient the nurse will encourage (Select all that apply.)
Regular, mild exercise Good skin care Stress reduction
Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.)
Review of the digoxin blood level Review of serum electrolytes, liver, and kidney function studies Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight
The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?
Spinach
A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?
Stop the heparin drip
What will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.)
Stress reduction techniques An exercise program Bed positioning techniques
Which statement(s) about vasodilators is/are true? (Select all that apply.)
They reduce systemic vascular resistance They reduce preload They decrease pulmonary congestion They increase tissue perfusion to muscles and organs
Anticoagulant therapy may be used for which situation(s)? (Select all that apply.)
To prevent stroke in patients at high risk Following a myocardial infarction Following total hip or knee joint replacement surgery With DVT To prevent thrombosis in immobilized patients
Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue
for 12 days postsurgically.
The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed?
furosemide (Lasix)