Complex Care Exam #1

medications for pulmonary edema:

-diuretics: -nitroglycerin -morphine -netiride

How is HTN diagnosed?

2 or more BP readings that are 1-4 weeks apart. (make sure patient has had no coffee or tobacco)

48) In order to prevent the development of tolerance, the nurse instructs the patient to: Apply the nitroglycerin patch every other day Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night Use the nitroglycerin patch for acute episodes of angina only

3. Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

SVR

800-1200

a. protamine sulfate

A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin? a. protamine sulfate b. vitamin K c. aminocaproic acid d. vitamin C

Pericarditis

A condition caused by inflammation of the pericardial sac

d. Serum glucose (sugar)

A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels? a. Hemoglobin and hematocrit b. Blood urea nitrogen (BUN) c. Arterial blood gases d. Serum glucose (sugar)

What is the most common symptom in a client with abdominal aortic aneurysm? a. Abdominal pain b. Diaphoresis c. Headache d. Upper back pain

Abdominal pain lower not upper back pain

Non-modifiable risk factors for HTN?

Age, family history, gender, African American

Other factors that influence BP?

Alteration to sympathetic nervous system Decreased vasodilation INsulin resistance Renal issues

A high-risk population that should be targeted in the primary prevention of hypertension is A. smokers. B. African Americans. C. business executives. D. middle-aged women.

B. African Americans.

Conditions such as shock and severe dehydration resulting from extracellular fluid loss cause: A. Hypoxia B. Hypovolemia C. Hypervolemia D. Uncontrolled bleeding

B. Hypovolemia Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume (hypovolemia).

Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? a. Antihypertensive b. Beta-adrenergic blockers c. Calcium channel blockers d. Nitrates

Beta adrenergic blockers

Fast-acting oral agents used in HTN urgency?>

Beta blockers Ace inhibitors

The nurse is caring for a client who has undergone cardiac catheterization. The client says to the nurse, "The doctor said my cardiac output was 5.5 L/min. What is normal cardiac output?" Which of the following is the nurse's best response? A. "It is best to ask your doctor." B. "Did the test make you feel upset?" C. "The normal cardiac output for an adult is 4 to 6 L/min." D. "Are you able to explain why are you asking this question?"

C. "The normal cardiac output for an adult is 4 to 6 L/min."

The most common pathologic finding in individuals with sudden cardiac death is A. cardiomyopathies. B. mitral valve disease. C. atherosclerotic heart disease. D. left ventricular hypertrophy.

C. atherosclerotic heart disease.

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the A. atria. B. AV node. C. ventricles. D. bundle of His.

C. ventricles.

d. Constant, irritating cough

Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects? a. Nausea and vomiting b. Dizziness and headaches c. Upset stomach d. Constant, irritating cough

Equation for BP? Is it a single factor that causes HTN?

Cardiac output x Peripheral Resistance Multifactorial

A patient receiving the drug simvastatin (Zocor) should be taught this medication helps to prevent coronary heart disease by: Increasing lower-density lipoprotein. Controlling lower-density lipoprotein. Increasing triglycerides. Increasing very low-density lipoprotein.

Controlling lower-density lipoprotein. Rationale: The Heart Protective Study has also shown that controlling low-density lipoprotein (LDL) with simvastatin (Zocor) assists in the prevention of coronary heart disease by raising HDL. Responses 1, 3, and 4 are incorrect.

When checking the capillary filling time of a patient, the color returns in 10 seconds. The nurse recognizes this finding as indicative of A. a normal response. B. thrombus formation in the veins. C. lymphatic obstruction of venous return. D. impaired arterial flow to the extremities.

D. impaired arterial flow to the extremities.

General Myocarditis assessment findings

Fever, fatigue, malaise, myalgia, pharyngitis, dyspnea, lymphadenopathy, N/V

V-Fib (def.)

Fine to coarse irregular baseline; no identifiable QRS or P waves

Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy? a. Heart failure b. DM c. MI d. Pericardial effusion

HF

A-fib (def)

HR 50-180 BPM. No discernable/measurable P wave, a fine/coarse baseline. Irregular ventricular rate

Sinus Tachycardia (def.)

HR >100 *AND* RRR

Where can HTN cause end organ damage?

Heart Brain Kidney Eyes Peripheral

What type of exercise should you discourage people with HTN from doing?

Heavy weight lifting

Subjective ways to help diagnosis HTN?

History (meds, diet, alcohol, tobacco) Family History

Nurses can best help older clients prevent hypertension by teaching: Low-fat, low-cholesterol diets. The importance of exercise. How to handle stressful situations. How to maintain a normal blood pressure.

How to maintain a normal blood pressure. Rationale: Hypertension is a major risk factor for other cardiovascular conditions. In persons older than 50, systolic blood pressure greater than 140 mm Hg is a much more important cardiovascular disease risk factor than is diastolic blood pressure. The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg. Answers 1, 2, and 3 are important elements to include in education of a patient with blood pressure elevation, and are included in the correct answer.

What is benign HTN?

INtermittent process in the late 30s- early 50s gradually becomes permanent slow onset

for severe heart failure or decompensating heart failure what would you give:

IV inotropes: milrinone and dobutamine vasodilators: nitroprusside, neseritide, and nitroglycerin

Medications for HTN crisis?

IV vasodilators, sodium nitroprusside, enalapril, nitroglycerin

A-flutter Significance

Inc. HR can increase CO and lead to CHF in pts. with other heart problems

What is secondary HTN?

Known cause (Sleep apnea, drug induced, renal issues, endocrine issues)

What studies can be used to diagnose HTN?

Look for end organ damage Urinalysis Intravenous Pyelography BMP and cholesterol labs 12 lead EKG/CXR

Endocarditis Assessment findings

Low Grade Fever -Chills, Weakness, Malaise, fatigue, and anorexia -Arthralgia's, myalgia's, back pain, abd. discomfort, weight loss, HA, clubbing fingers -Splinter hemorrhages in nail beds -Petechia, Janeway's lesions, Roth's spots -Osler's nodes -Murmurs -SOB, emboli to lungs

Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm? a. Abdominal pain b. Absent pedal pulses c. Angina d. Lower back pain

Lower back pain

Sinus brady (significance)

May cause decreased CO or BP

Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.) Mental status changes Agitation Frequent falls Sudden changes in GI function

Mental status changes Agitation Frequent falls Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.

A client in the ICU has an elevated pulmonary artery wedge pressure. What should be included in this client's plan of care? -Monitor intake and output. -Replace fluids. -Administer blood products as prescribed. -Administer calcium channel blockers as prescribed.

Monitor I &O

Interventions for white coat syndrome?

Monitor at home Have someone else take BP

ANS: A Adequate fluid administration is essential before administration of vasopressors to patients with hypovolemic shock. The patient's low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration.

Norepinephrine (Levophed) has been prescribed for a patient who was admitted with dehydration and hypotension. Which patient data indicate that the nurse should consult with the health care provider before starting the norepinephrine? a. The patient's central venous pressure is 3 mm Hg. b. The patient is in sinus tachycardia at 120 beats/min. c. The patient is receiving low dose dopamine (Intropin). d. The patient has had no urine output since being admitted.

How are ACE inhibitors used in HTN?

Prevent renin-angiotensin mechanism decreases BP

What is a HTN crisis?

REquires immediate attention Happens because -poorly controlled -HTN undiagnosed -BP meds stopped

Dietary Management of HTN?

Reduce sodium intake to 2-4g/day Increase potassium DASH diet adjust calorie intake

What is DASH diet?

Rich in fruits, veggies, and low-fat dairy products. LIMIT FAT INTAKE TO <30% of cals

PVC (clinical associations)

Stimulants (caffine), meds, crack cocaine, low K, hypoxia, MI, CHF, CAD, EI, fever, stress

Complications of HTN?

Stroke CAD CHF Renal Failure Eye changes

End organ damage in brain?

Stroke or TIA

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication? Sublingual nitroglycerin Cardiac glycosides HMG-CoA reductase inhibitors Morphine sulfate

Sublingual nitroglycerin Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.

Myocardial Infarction

Sustained ischemia causing irreversible myocardial cell death

What is pre-HTN? what is the treatment?

Systolic pressure 120-139 and diastolic 80-90. Monitor B/P, begin lifestyle modifications

T wave

Ventricular repolarization

c. Risk for injury

Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy? a. Potential for fluid volume excess b. Potential for pain c. Risk for injury d. Potential for body image disturbance

ST Elevated MI (STEMI)

an MI with ST segment elevation on the 12 lead EKG

narrowed pulse pressure:

cardiac tamponade

normal blood flow through the heart:

the superior and inferior vena cava bring unoxygenated (venous) blood back to the heart the blood then enters into the right atrium and is then pumped through the tricuspid valve into the right ventricle the blood is then pumped into the pulmonary artery to the lungs and then is taken (oxygenated) through the pulmonary vein to the left atrium. blood goes through the mitral valve into the R ventricle where it is then pumped through the aorta to the rest of the body.

ACS (Unstable angina/NSTEMI) diagnosis and interventions

-12 lead EKG/ECG monitoring -CXR -CBC, Troponin, CK-MB, Myoglobin -O2 therapy -Nitro, Antiplatelet therapy, Morphine, Anticoagulant therapy, ASA, B-blockers, ACE inhibitors/ARB's -Coronary angiography/PCI

STEMI diagnosis and interventions

-12 lead EKG/ECG monitoring -CXR -CBC, Troponin, CK-MB, Myoglobin -O2 therapy -Nitro, Antiplatelet therapy, Morphine, Anticoagulant therapy, ASA, B-blockers, ACE inhibitors/ARB's -Coronary angiography/PCI -Thrombolytic therapy -CABG

Examples of Acute Coronary Syndrome assessment findings

-Anxious, fearful, restless, distressed, fatigued -Fear of impending doom -Cool, clammy, pale skin -Tachycardia/bradycardia -Increased or decreased BP -Dysrhythmias -Pulsas alterans, pulse deficit -S3, S4, murmurs -Positive serum markers, increased WBC count -CP/chest discomfort/pressure/squeezing -Possible radiation of symptoms to jaw, neck, shoulders, back, arm -Indigestion, heartburn, N/V, belching -Palpitations, dyspnea, dizziness, weakness -S&S of previous MI

morphine: pulmonary edema

-vasodilation 2mg IV push for vasodilation to decrease preload and after load

nitroglycerin: pulmonary edema

-vasodilation decreases after load (pressure) -decreased after load = increased CO because the heart is pumping against less pressure, and more blood can be moved forward

50) When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: Moderate doses of two different types of diuretics are more effective than a large dose of one type This combination promotes diuresis but decreases the risk of hypokalemia This combination prevents dehydration and hypovolemia Using two drugs increases osmolality of plasma and the glomerular filtration rate

2. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-loosing diuretic. Giving these together minimizes electrolyte imbalance

13) A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: Call for the doctor Start an intravenous line Obtain a portable chest radiograph Draw blood for laboratory studies

2. Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

20) The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to: Open and dilate the blocked coronary arteries Assess the extent of arterial blockage Bypass obstructed vessels Assess the functional adequacy of the valves and heart muscle.

2. Cardiac catherization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catherization results.

The client in shock has the following vital signs: T 99.8° F, P 132 beats/min, R 32 breaths/min, and BP 80/58 mm Hg. Calculate the pulse pressure.

22 mm Hg Pulse pressure is the difference between the systolic and diastolic pressures: 80 (systolic) - 58 (diastolic) = 22 (pulse pressure)

What is HTN emergency?

>180/>120 AND evidence of end organ damage

A client recovering from an open reduction of the femur suddenly feels light-headed, with increased anxiety and agitation. Which key vital sign differentiates a pulmonary embolism from early sepsis? A. Temperature B. Pulse C. Respiration D. Blood pressure

A. Temperature A sign of early sepsis is low-grade fever. Both early sepsis and thrombus may cause tachycardia, tachypnea, and hypotension.

An important nursing responsibility for a patient having an invasive cardiovascular diagnostic study is A. checking the peripheral pulses and percutaneous site. B. instructing the patient about radioactive isotope injection. C. informing the patient that general anesthesia will be given. D. assisting the patient to do a surgical scrub of the insertion site.

A. checking the peripheral pulses and percutaneous site.

A pulsating abdominal mass usually indicates which of the following conditions? a. Abdominal aortic aneurysm b. Enlarged spleen c. Gastic distention d. Gastritis

AAA

Rheumatic Fever

An acute inflammatory disease of the heart potentially involving all layers

The patient who is most likely to have the highest risk for deep vein thrombosis is a A. 25-year-old obese woman who is 3 days postpartum. B. 40-year-old woman who smokes and uses oral contraceptives. C. 62-year-old man who has had a stroke with left-sided hemiparesis. D. 72-year-old man who had a suprapubic prostatectomy for cancer of the prostate.

B. 40-year-old woman who smokes and uses oral contraceptives.

Nursing interventions indicated in the plan of care for the patient with acute lower extremity deep vein thrombosis include A. applying elastic compression stockings. B. administering anticoagulants as ordered. C. positioning the leg dependently to promote arterial circulation. D. encouraging walking and leg exercises to promote venous return.

B. administering anticoagulants as ordered.

A P wave on an ECG represents an impulse A. arising at the SA node and repolarizing the atria. B. arising at the SA node and depolarizing the atria. C. arising at the AV node and depolarizing the atria. D. arising at the AV node and spreading to the bundle of His.

B. arising at the SA node and depolarizing the atria.

A-flutter clinical associations

CAD, PE, Cor Pulmonale, chronic lung disease

Unstable angina

Chest pain that is new in onset, occurs at rest, or has worsening patterns

Management of HTN urgency?

Close BP monitoring Oral medications to normalize BP in first 24-48hours

A-fib significance

Decreased CO, possible thrombi, can cause SOB

Clinical profile of a ADHF Wet-Cold pt.

PAWP inc. CO dec. Altered mental status, decreased O2 sat, reduced UO, shock

b. Hyperkalemia

The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

b. "I will increase fiber in my diet."

Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)? a. "I will take Questran 1 hour before my other medications." b. "I will increase fiber in my diet." c. "I will weigh myself weekly." d. "I will have my blood pressure checked weekly."

A patient with a small abdominal aneurysm is not a good surgical candidate. The nurse teaches the patient that one of the best ways to prevent expansion of the lesion is to:

control hypertension with prescribed therapy.

The critical care nurse is concerned about increased oxygen demand for which of the following patients? (Select all that apply) A critically ill post-op patient who is shivering. A patient who has indications of developing septic shock. A patient who had percutaneous transluminal coronary angioplasty. A newly admitted multiple trauma patient.

critically ill post op patient who has indications a newly admitted

Acute Coronary Syndrome

develops and encompasses the spectrum of unstable angina, non-STEMI, and STEMI

widened pulse pressure:

increased ICP

Normal conduction for heart

originates in the SA node

A-fib clinical associations

seen in pts. with other heart problems (high BP, CHF, CAD)

The nurse demonstrates an understanding of the relationship of clinical symptoms to preload when making which of the following statements? "When a patient has fluid overload, right heart preload is reduced." "Cough and crackles following a fluid bolus indicate elevated preload." "The patient with a right ventricular infarction has decreased preload." "Peripheral edema is associated with elevated left heart preload."

Cough and crackles #2 is correct. It describes the symptoms of left-sided heart failure, which is associated with elevated left heart preload. #1 contains errors in clinical reasoning as fluid overload increases preload. #3 describes a patient situation in which right sided preload is increased. #4 is incorrect because peripheral edema is associated with right-sided heart failure.

Prolonged pressure on the skin causes reddened areas at the point of contact due to A. arterial vasodilation from smooth muscle relaxation. B. compression of veins resulting in venous engorgement. C. occlusion of major arteries causing infarction of the tissue. D. tissue damage and inflammation resulting from impaired capillary blood flow.

D

Which clients are at immediate risk for hypovolemic shock? (Select all that apply.) A. Unrestrained client in motor vehicle accident B. Construction worker C. Athlete D. Surgical intensive care client E. 85-year-old with gastrointestinal virus

A. Unrestrained client in motor vehicle accident D. Surgical intensive care client E. 85-year-old with gastrointestinal virus The client who is unrestrained in a motor vehicle accident is prone to multiple trauma and bleeding. Surgical clients are at high risk for hypovolemic shock owing to fluid loss and hemorrhage. Older adult clients are prone to shock; a gastrointestinal virus results in fluid losses. Unless injured or working in excessive heat, the construction worker and the athlete are not at risk for hypovolemic shock; they may be at risk for dehydration.

When assessing the patient, the nurse notes a palpable precordial thrill. This finding may be caused by A. heart murmurs. B. gallop rhythms. C. pulmonary edema. D. right ventricular hypertrophy.

A. heart murmurs.

The primary causes of death in patients with heart transplants in the first year include A. infection and rejection. B. rejection and arrhythmias. C. arrhythmias and infection. D. myocardial infarction and lymphoma.

A. infection and rejection.

A patient with newly diagnosed hypertension has a blood pressure of 158/98 after 12 months of exercise and diet modifications. The nurse advises the patient that A. medication may be required because the BP is still not within the normal range. B. continued monitoring of the BP every 3 to 6 months is all that will be necessary for treatment. C. because lifestyle modifications were not effective they do not need to be continued and drugs will be used. D. he will have to make more vigorous changes in his lifestyle if he wants to stay off medication for his hypertension.

A. medication may be required because the BP is still not within the normal range.

A patient with chronic congestive heart failure and atrial fibrillation is treated with a digitalis preparation and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to A. monitor serum potassium levels. B. keep an accurate measure of intake and output. C. teach the patient about dietary restriction of potassium. D. withhold the digitalis and notify the health care provider if the heart rate is irregular. A. monitor serum potassium levels.

A. monitor serum potassium levels.

The drug used in the management of a patient with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is A. morphine. B. amrinone. C. dobutamine. D. aminophylline.

A. morphine.

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to A. notify the physician. B. elevate the leg to promote venous return. C. wrap the leg in a blanket to provide warmth. D. perform passive range of motion to stimulate circulation to the leg.

A. notify the physician.

When providing discharge instructions to a patient with a new permanent pacemaker, the nurse teaches the patient to A. take and record a daily pulse rate. B. request special hand scanning at airport and other security gates. C. immobilize the arm and shoulder on the side of the pacemaker insertion for 6 weeks. D. avoid microwave ovens because they emit radio waves that alter pacemaker function.

A. take and record a daily pulse rate.

An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? Observe electrocardiogram readings and report deviations to the nurse. Assist the client with ambulation three times during the shift. Monitor vital signs every 15 minutes and report each reading to the nurse. Accurately weigh the patient, and report and record the readings.

Accurately weigh the patient, and report and record the readings. Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care.

V-Fib clinical associations

Acute MI, CAD, caridomyopathy, hypoxemia

V Tach. clinical associations

Acute MI, low K, CAD, long QT

Management of HTN emergency?

Acute/life threatening--- ICU Reduce BP by 25% IN FIRST HOUR Reduce to <160/100 in first 6 hours (exceptions are ischemic stroke and aoritc dissection)

ANS: B Antibiotics should be administered within the first hour for patients who have sepsis or suspected sepsis in order to prevent progression to systemic inflammatory response syndrome (SIRS) and septic shock. The data on the other patients indicate that they are more stable. Crackles heard only at the lung bases do not require immediate intervention in a patient who has had a myocardial infarction. Mild bradycardia does not usually require atropine in patients who have a spinal cord injury. The findings for the patient admitted with anaphylaxis indicate resolution of bronchospasm and hypotension.

After change-of-shift report in the progressive care unit, who should the nurse care for first? a. Patient who had an inferior myocardial infarction 2 days ago and has crackles in the lung bases b. Patient with suspected urosepsis who has new orders for urine and blood cultures and antibiotics c. Patient who had a T5 spinal cord injury 1 week ago and currently has a heart rate of 54 beats/minute d. Patient admitted with anaphylaxis 3 hours ago who now has clear lung sounds and a blood pressure of 108/58 mm Hg

ANS: B When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Methylprednisolone (Solu-Medrol) is considered if blood pressure does not respond first to fluids and vasopressors. Nitroprusside is an arterial vasodilator and would further decrease SVR.

After receiving 2 L of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for a. nitroglycerine (Tridil). b. norepinephrine (Levophed). c. sodium nitroprusside (Nipride). d. methylprednisolone (Solu-Medrol).

Modification of lifestyle behaviors to help manage hypertension does not include which of the following? (Select all that apply.) Weight loss of even 10 pounds The DASH diet Fruits, vegetables, and whole grains Alcohol intake with meals

Alcohol intake with meals \ Rationale: Weight loss of even 10 pounds; fruits, vegetables, and whole grains; the DASH diet; and a daily exercise regimen will help reduce high blood pressure. Alcohol intake with meals should be reduced to help manage high blood pressure.

Endocarditits

An infection of the endocardial layer of the heart

ANS: C Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will improve cardiac output. Changes in the D5/.9 NS and nitroglycerin infusions will not directly decrease SVR. Increasing the dopamine will tend to increase SVR.

An older patient with cardiogenic shock is cool and clammy and hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate doing next? a. Increase the rate for the dopamine (Intropin) infusion. b. Decrease the rate for the nitroglycerin (Tridil) infusion. c. Increase the rate for the sodium nitroprusside (Nipride) infusion. d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion.

Which of the following are direct causes of chronic ischemic pain? (Select all that apply.) Aortic stenosis Acid reflux Pulmonary embolus Herpes zoster (shingles)

Aortic stenosis Acid reflux Pulmonary embolus Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain. Integrated Process: Nursing Process; Evaluation Cognitive Level: Evaluation NCLEX-RN Test Plan: Physiological Integrity; Physiological Adaptation Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain.

Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be : A. placing her in a trendeleburg position B. putting several warm blankets on her C. monitoring her hourly urine output D. assessing her VS especially her RR

Assessing her VS especially her RR Shock is characterized by reduced tissue and organ perfusion and eventual organ dysfunction and failure. Checking on the VS especially the RR, which detects need for oxygenation, is a priority to help detect its progress and provide for prompt management before the occurrence of complications

What is the most common cause of abdominal aortic aneurysm? a. Atherosclerosis b. DM c. HPN d. Syphilis

Atherosclerosis Plaques build up on the wall of the vessel and weaken it, causing an aneurysm.

P wave

Atrial depolarization (LEADS TO atrial contraction)

Which of the following groups of symptoms indicated a ruptured abdominal aneurysm? a. Lower back pain, increased BP, decreased RBC, increased WBC b. Severe lower back pain, decreased BP, decreased RBC, increased WBC c. Severe lower back pain, decreased BP, decreased RBC, decreased WBC d. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

B Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased - not increase. The WBC count increases as cells migrate to the site of injury.

The nurse suspects left-sided heart failure in a newly admitted client when the nurse notes which of the following symptoms? (Select all that apply.) A. Distended neck veins B. Bilateral crackles in the lungs C. Weight gain of 2 lb in past 2 days D. Shortness of breath, especially at night .

B. Bilateral crackles in the lungs D. Shortness of breath, especially at night Left-sided heart failure results in ineffective ejection of blood from the left ventricle. This causes a backup of blood into the lungs. Thus, symptoms of left-sided heart failure are usually related to the lungs

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome? A. Hourly urine output 10 to 12 mL/hr B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg C. Blood glucose 245 mg/dL D. Serum creatinine 3.6 mg/dL

B. Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg Dopamine improves blood flow by increasing peripheral resistance, which increases blood pressure—a positive response in this case. Urine output less than 30 mL/hr or 0.5 mL/kg/hr and elevations in serum creatinine indicate poor tissue perfusion to the kidney and are a negative consequence of shock, not a positive response. Although a blood glucose of 245 mg/dL is an abnormal finding, dopamine increases blood pressure and myocardial contractility, not glucose levels.

A client asks why smoking is a major risk factor for heart disease. In formulating a response, the nurse incorporates the understanding that nicotine: A. Causes vasodilation B. Causes vasoconstriction C. Increases the level of high-density lipoproteins D. Increases the oxygen-carrying capacity of hemoglobin

B. Causes vasoconstriction

Which problem in the clients below best demonstrates the highest risk for hypovolemic shock? A. Client receiving a blood transfusion B. Client with severe ascites C. Client with myocardial infarction D. Client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

B. Client with severe ascites Fluid shifts from vascular to intra-abdominal may cause decreased circulating blood volume and poor tissue perfusion. Volume depletion is only one reason why a person may require a blood transfusion; anemia is another. The client receiving a blood transfusion does not have as high a risk as the client with severe ascites. Myocardial infarction results in tissue necrosis in the heart muscle; no blood or fluid losses occur. Owing to excess antidiuretic hormone secretion, the client with SIADH will retain fluid and therefore is not at risk for hypovolemic shock.

Which laboratory result is seen in late sepsis? A. Decreased serum lactate B. Decreased segmented neutrophil count C. Increased numbers of monocytes D. Increased platelet count

B. Decreased segmented neutrophil count A decreased segmented neutrophil count is indicative of late sepsis. Serum lactate is increased in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis; late in sepsis, platelets may decrease due to consumptive coagulopathy.

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action does the nurse take first? A. Administer the antibiotic immediately. B. Ensure that blood cultures were drawn. C. Obtain signature for informed consent. D. Take the client's vital signs.

B. Ensure that blood cultures were drawn. Cultures must be taken to identify the organism for more targeted antibiotic treatment before antibiotics are administered. Antibiotics are not administered until after all cultures are taken. A signed consent is not needed for medication administration. Monitoring the client's vital signs is important, but the antibiotic must be administered within 1 to 3 hours; timing is essential.

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present? A. PaCO2 58 mm Hg B. Lactate 9.0 mmol/L C. Partial thromboplastin time 64 seconds D. Potassium 2.8 mEq/L

B. Lactate 9.0 mmol/L Poor tissue oxygenation at the cellular level causes anaerobic metabolism, with the by-product of lactic acid. Elevated partial pressure of carbon dioxide occurs with hypoventilation, which may be related to respiratory muscle fatigue, secretions, and causes other than hypoxia. Coagulation times reflect the ability of the blood to clot, not oxygenation at the cellular level. Elevation in potassium appears in septic shock due to acidosis; this value is decreased and is not consistent with septic shock.

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated? A. Localized erythema and edema B. Low-grade fever and mild hypotension C. Low oxygen saturation rate and decreased cognition D. Reduced urinary output and increased respiratory rate

B. Low-grade fever and mild hypotension Low-grade fever and mild hypotension indicate very early sepsis, but with treatment, the probability of recovery is high. Localized erythema and edema indicate local infection. A low oxygen saturation rate and decreased cognition indicate active (not early) sepsis. Reduced urinary output and increased respiratory rate indicate severe sepsis.

How does the nurse recognize that a positive outcome has occurred when administering plasma protein fraction (Plasmanate)? A. Urine output 20 to 30 mL/hr for the last 4 hours B. Mean arterial pressure (MAP) 70 mm Hg C. Albumin 3.5 g/dL D. Hemoglobin 7.6 g/dL

B. Mean arterial pressure (MAP) 70 mm Hg Plasmanate expands the blood volume and helps maintain MAP greater than 65 mm Hg, which is a desired outcome in shock. Urine output should be 0.5 mL/kg/hr, or greater than 30 mL/hr. Albumin levels reflect nutritional status, which may be poor in shock states due to an increased need for calories. Plasmanate expands blood volume by exerting increasing colloid osmotic pressure in the bloodstream, pulling fluid into the vascular space; this does not improve an abnormal hemoglobin.

A postoperative client is admitted to the intensive care unit with hypovolemic shock. Which nursing action does the nurse delegate to an experienced nursing assistant? A. Obtain vital signs every 15 minutes. B. Measure hourly urine output. C. Check oxygen saturation. D. Assess level of alertness.

B. Measure hourly urine output. Monitoring hourly urine output is included in nursing assistant education and does not require special clinical judgment; the nurse evaluates the results. Obtaining vital signs, monitoring oxygen saturation, and assessing mental status in critically ill clients requires the clinical judgment of the critical care nurse because immediate intervention may be needed.

The nurse plans care for the patient with an implantable cardioverter-defibrillator based on the knowledge that A. antiarrhythmia drugs can be discontinued. B. all members of the patient's family should learn CPR. C. the patient should not drive until 1 month after the ICD has been implanted. D. the patient is usually relieved to have the device implanted to prevent arrhythmias.

B. all members of the patient's family should learn CPR.

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is A. hyperlipidemia. B. excessive alcohol intake. C. a family history of hypertension. D. consumption of a high-carbohydrate, high-calcium diet

B. excessive alcohol intake.

A patient is admitted to the hospital in hypertensive crisis. The nurse recognizes that the hypertensive urgency differs from hypertensive emergency in that A. the BP is always higher in a hypertensive emergency. B. hypertensive emergencies are associated with evidence of target organ damage. C. hypertensive urgency is treated with rest and tranquilizers to lower the BP. D. hypertensive emergencies require intraarterial catheter measurement of the BP.

B. hypertensive emergencies are associated with evidence of target organ damage.

Rest pain is a manifestation of peripheral arterial disease that occurs as a result of A. the beginning of a venous leg ulcer. B. inadequate blood flow to the nerves of the feet. C. inadequate blood flow to the muscles during exercise. D. inadequate blood flow to the skin after application of the heat.

B. inadequate blood flow to the nerves of the feet.

The auscultatory area in the left midclavicular line at the level of the fifth ICS is the A. aortic area. B. mitral area. C. tricuspid area. D. pulmonic area.

B. mitral area.

The cardiac monitor of a patient in the cardiac care unit following an acute MI indicates ventricular bigeminy. The nurse anticipates A. performing defibrillation. B. treatment with IV lidocaine. C. insertion of a temporary pacemaker. D. continuing monitoring without other treatment.

B. treatment with IV lidocaine.

What is HTN Urgency?

BP is very high but NO evidence of target organ damage. (causes nosebleeds, H/A and anxiety)

How are calcium channel blockers used in HTN?

Block calcium influx of smooth muscle cells producing vasodilation

In planning activity for the patient recovering from an MI, the nurse recognizes that the healing heart wall is most vulnerable to stress A. 3 weeks after the infarction. B. 4 to 6 days after the infarction. C. 10 to 14 days after the infarction. D. when healing is complete at 6 to 8 weeks. C. 10 to 14 days after the infarction.

C. 10 to 14 days after the infarction.

The nurse is caring for a client in the refractory stage of cardiogenic shock. Which intervention does the nurse consider? A. Admission to rehabilitation hospital for ambulatory retraining B. Collaboration with home care agency for return to home C. Discussion with family and provider regarding palliative care D. Enrollment in a cardiac transplantation program

C. Discussion with family and provider regarding palliative care In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care should be considered. Rehabilitation or returning home is unlikely. The client with sustained tissue hypoxia is not a candidate for organ transplantation.

Which problem places a client at highest risk for sepsis? A. Pernicious anemia B. Pericarditis C. Post kidney transplant D. Client owns an iguana

C. Post kidney transplant The post-kidney transplant client will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms. Pernicious anemia is related to lack of vitamin B12, not to bone marrow failure (aplastic anemia), which would place the client at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the immune-suppressed kidney transplant client has a very high risk for infection, sepsis, and death.

The nurse is concerned when a client's heart rate, which is normally 95 beats per minute, rises to 220 beats per minute, because a rate this high will: A. Exhaust the client B. Decrease metabolic rate C. Reduce coronary artery perfusion D. Provide too much blood flow to major organs

C. Reduce coronary artery perfusion Coronary arteries fill and perfuse the myocardium (heart muscle) during diastole. When the heart rate is elevated, more time is spent in systole and less in diastole; hence, the myocardium may not be perfused adequately. The client may be exhausted, but the primary concern is myocardial perfusion. Major organs will adjust to increased blood flow. This is usually not a problem. With a heart rate this high, metabolic rate will be increased, not decreased.

What typical sign/symptom indicates the early stage of septic shock? A. Pallor and cool skin B. Blood pressure 84/50 mm Hg C. Tachypnea and tachycardia D. Respiratory acidosis

C. Tachypnea and tachycardia Signs of systemic inflammatory response syndrome, which precedes sepsis, include rapid respiratory rate, leukocytosis, and tachycardia. In the early stage of septic shock, the client is usually warm and febrile. Hypotension does not develop until later in septic shock due to compensatory mechanisms. Respiratory alkalosis occurs early in shock because of an increased respiratory rate.

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder involve A. diffuse involvement of plaque formation in coronary veins. B. formation of fibrous tissue around coronary artery orifices. C. accumulation of lipid and fibrous tissue within the coronary arteries. D. chronic vasoconstriction of coronary arteries leading to permanent vasospasm.

C. accumulation of lipid and fibrous tissue within the coronary arteries.

When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of A. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation. B. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation. C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate. D. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate.

C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate.

A 62-year-old woman weighs 92 kg and has a history of daily alcohol intake, smoking, high blood pressure, high sodium intake, and sedentary lifestyle. The nurse identifies the risk factors most highly related to peripheral arterial disease in this patient as A. sex and age. B. weight and alcohol intake. C. cigarette smoking and hypertension. D. sedentary lifestyle and high sodium intake.

C. cigarette smoking and hypertension.

Significant risk factors for peripheral arterial disease include A. sedentary lifestyle, stress, obesity. B. advanced age, female gender, familial tendency. C. cigarette smoking, hyperlipidemia, hypertension. D. protein S deficiency, protein C deficiency, factor V Leiden mutation.

C. cigarette smoking, hyperlipidemia, hypertension.

A patient is admitted to the CCU with chest pain of 24 hours' duration, ECG findings consistent with an acute MI, and occasional ventricular arrhythmias. The nurse plans care for the patient based on the expectation that the patient will be managed with A. endotracheal intubation. B. subcutaneous nitroglycerin. C. continuous ECG monitoring. D. thrombolytic therapy with tissue plasminogen activator.

C. continuous ECG monitoring.

When assessing the cardiovascular system of a 79-year-old patient, the nurse expects to find A. a narrowed pulse pressure. B. diminished carotid artery pulses. C. difficulty in isolating the apical pulse. D. an increased heart rate in response to stress.

C. difficulty in isolating the apical pulse.

The nurse suspects the presence of a deep vein thrombosis based on the findings of A. paresthesia and coolness of the leg. B. pain in the calf that occurs with exercise. C. generalized edema of the involved extremity. D. pallor and cyanosis of the involved extremity.

C. generalized edema of the involved extremity.

A patient with an MI of the anterior wall of the left ventricle most likely has an occlusion of then A. right marginal artery. B. left circumflex artery. C. left anterior descending artery. D. right anterior descending artery.

C. left anterior descending artery. Progress

A compensatory mechanism involved in congestive heart failure that leads to inappropriate fluid retention and additional workload of the heart is A. ventricular dilation. B. ventricular hypertrophy. C. neurohormonal response. D. sympathetic nervous system activation.

C. neurohormonal response.

A patient with a tricuspid valve disorder will have impaired blood flow between the A. vena cava and right atrium. B. left atrium and left ventricle. C. right atrium and right ventricle. D. right ventricle and pulmonary artery.

C. right atrium and right ventricle.

The nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that A. family members may be at risk because of the infectious nature of the disease. B. medical management of the disorder focuses on treatment of the underlying cause. C. the prognosis of the patient is poor, and emotional support is a high priority of care. D. the condition may be successfully treated with surgical ventriculomyotomy and myectomy.

C. the prognosis of the patient is poor, and emotional support is a high priority of care.

A-flutter treatment

Cardioversion, Ca++ blocker, Amiodarone, Dig or Beta blockers

A-flutter (def)

Characterized by recurring, regular saw toothed shaped flutter waves. Ratio of 3:1 or 4:1 or 2:1 flutter to QRS. Normal QRS. Ventricular rate 150, Atrial rate 300 in 2:1

End organ damage in kidneys?

Chronic Renal disease Decreased GFR

d. To suppress platelet aggregation

Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy? a. To dissolve the blood clot b. To decrease tissue necrosis c. To inhibit hepatic synthesis of vitamin K d. To suppress platelet aggregation

Endocarditis D&I

-Ask (history of dental/urologic/surgical/ OB history) -blood cultures, ESR, CRP -2D echo -CXR -EKG -Cardiac cath. -prophylactic antibiotics -Valve replacement

PVC significance

-Benign in normal heart -In a diseased heart: decrease CO and lead to CHF and CP

Pericarditis D&I

-CBC, ESR, CRP -EKG, CXR -2D echo -CT, MRI -PEricardiocentesis, pericardial window -PEricardial biopsy -Treatment of underlying cause -Bedrest -NSAID -Corticosteroids

Rheumatic Fever Assessment findings (including labs)

-Carditis (heart murmurs/enlargement, pericarditis) -Arthritis (*very common*) -Sydenham's chorea (involuntary movement of the face and limbs) -Muscle weakness (gait disturbances/speech issues) -Erythema marginatum lesions -Sub Q nodules (normally severe RF: hard, painless, swelling over joints) -Fever -Increased ESR, WBC, CRP, positive Strep A -EKG- prolonged PR interval

Myocarditis D&I

-EKG, labs (ESR, CRP, CBC, Cardiac markers, viral titers) -Myocardial biopsy -Nuclear scans/ echo/ MRI -Manage heart symptoms (ACE inhibitors, B-blockers, Diuretics, IVF/supportive pressors), DIG, Anticoagulant therapy) -Supportive measures (O2, bed rest, LVAD/ Intraaortic balloon pump)

Rheumatic Fever D&I

-H&P -Labs- ESR, WBC, CRP -EKG -CXR -2D Echo -Bed rest -Antibiotics -NSAIDs -Salicylates -Corticosteroids

ADHF Diagnoses

-H&P (to determine underlying cause) -Daily weights -Na+ and fluid (maybe) restrictions -Serum labs (chemistry, cardiac markers, BNP, LFT, thyroid function test, CBC, lipid profile, renal function/UA) -CXR -12 lead EKG -2D echo -Nuclear imaging studies -Cardiac cath. -Measure LV finction -Endomyocaridal biopsy

nesiritde

-IV infusion: short term therapy *CANNOT GIVE FOR MORE THAN 48 HOURS -vasodilates veins and arteries and has a diuretic effect

Acute Decompensated HF Assessment findings

-Interstitial edema -Tachypnea -Frothy Sputum (Alveolar edema) -Pulmonary Edema -Anxious (MS changes), pale, cyanotic -Cool, clammy skin -INC HR/RR -Crackles, wheezing, rhonchi -Increased or decreased BP

STEMI specific assessment findings

-Non-STEMI/Unstable angina assessment -Severe, immobilizing CP not relieved by position change or nitrate -Ashen, clammy, cool skin -Crackles in lungs -N/V -Altered Mental Status -ST-elevations, T wave abnormalities

Sinus brady (clinical associations)

-Normal in athletes, sleep, valsalva maneuver and vagal tone -Increased ICP, hypogly, hypothyroidism, inferior MI

cardiac tamponade:

-blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart -this can happen if the client has had a motor vehicle accident, right ventricular biopsy, an MI, pericarditis, or hemorrhage post CABG *can occur with as little at 20-50 mL's

bumetadine (Bumex)

-can be given IV push or as a continuous IV infusion to provide rapid fluid removal 1-2 mg IV push given over 1-2 minutes

lasis (furosemide)

-causes diuresis and vasodilation which traps more blood out in the arms and legs and reduced the preload 40 mg IV push over 1-2 minutes to prevent hypotension and ottotoxicity (20 mg/ minute)

before administering digoxin what should you do?

-check HR : apical pulse (5th intercostal space-- midclavicular line) -check level -check potassium and other electrolytes *chances of toxicity increase with an abnormal potassium level (hypokalemia + digoxin = toxicity), however any electrolyte imbalance can cause toxicity

client education/ teaching: pacemaker

-check pulse daily -ID card or bracelet -avoid electromagnetic fields (cell phones or large motors) -avoid MRI's

signs and symptoms of cardiac tamponade:

-decreased cardiac output -CVP will be increased: heart is being squeezed -BP will be dropping -- because CO is dropping -hallmark sign: increasing CVP and decreasing BP -muffled or distant heart sounds -neck veins distended, but clear lung sounds -pressure in all 4 chambers are the same -shock-- CO is decerased -narrowed pulse pressure (from the baseline) *difference between the systolic and diastolic

pathophysiology of pulmonary edema:

-fluid is backing up into the lungs -the heart is unable to move the volume forward -pulmonary edema usually occurs at night, when the client goes to bed -increased venous return and cannot handle the extra fluid

what can cause pacemaker malfunctions?

-incorrect programming -electrodes can dislodge -battery may be depleted

post procedural care: pacemaker

-monitor the incision site -most common complication: electrode displacement -assisted passive range of motion to prevent frozen shoulder -keep the client from raising the arm higher than shoulder height

chronic arterial insufficiency:

-pain: intermittent claudication that progresses to pain at rest -pulses: will be decreased or absent -color: pale when elevated and red with lowering of the leg -temperature: cool -edema: absent or mild -skin changes: thin, shiny, loss of hair over foot/ toes, nail thickening -ulceration: if present will involve toes or trauma on feet (painful) -gangrene: may develop -compression: not used

chronic venous insufficiency:

-pain: non to aching pain depending on the dependency of the area -pulses: normal (may be difficult to palpate due to edema) -color: normal (may see petechiae or brown pigmentation with chronic condition) -temperature: normal -edema: present -skin changes: brown pigmentation around ankles, possible thinking of skin, and scarring may develop -ulceration: if present, will be on sides of the ankles -gangrene: does not develop -compression: used -ELEVATE

Pericarditis Assessment finding

-referred pain to the trapezius muscle -Dyspnea (d/t short breaths to avoid pain) -*Pericardial friction rub* -Muffled heart tones -Progressive, frequently severem sharp chest pain

treatment of arterial disease:

-since arterial blood is not getting to the tissue elevation will increase the pain. LOWER EXTREMITIES IF ARTERIAL treated with angioplasty or endarectomy -- goal is to enhance perfusion

signs and symptoms of pulmonary edema:

-sudden onset -breathless -restless/ anxious -severe hypoxia -productive cough (pink, frothy sputum)

position for pulmonary edema:

-upright position with the legs down improves cardiac output promotes pooling of blood in the lower extremities

venous disorders:

-vein = not an oxygenation issue -inflammation and chronic ulcers can occur with venous disorders -could develop a DVT ELEVATE VEINS *never delay treatment

12) When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. Reflects electrical impulse beginning at the SA node Indicated electrical impulse beginning at the AV node Reflects atrial muscle depolarization Identifies ventricular muscle depolarization Has duration of normally 0.11 seconds or less.

1, 3, 5. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

47) Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch? "Apply the patch to a nonhairy, nonfatty area of the upper torso or arms." "Apply the patch to the same site each day to maintain consistent drug absorption." "If you get a headache, remove the patch for 4 hours and then reapply." "If you get chest pain, apply a second patch right next to the first patch."

1. A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

34) Which of the following terms describes the force against which the ventricle must expel blood? Afterload Cardiac output Overload Preload

1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

10) A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first: Administer the morphine Obtain a 12-lead ECG Obtain the lab work Order the chest x-ray

1. Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.

33) Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions? Changes in blood pressure Changes in arterial oxygen tension Changes in arterial carbon dioxide tension Changes in heart rate

1. Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.

22) The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: Headache High blood pressure Shortness of breath Stomach cramps

1. Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.

45) A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours? Creatine kinase (CK or CPK) Lactic dehydrogenase (LDH) LDH-1 LDH-2

1. Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the blood stream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.

46) A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: Decreased arterial blood flow secondary to vasoconstriction Decreased arterial blood flow leading to hyperemia Atherosclerotic obstruction of the arteries Trauma to the lower extremities

1. Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

4) A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? Review the intake and output records for the last 2 days Change the time of diuretic administration from morning to evening Request a sodium restriction of 1 g/day from the physician. Order daily weights starting the following morning.

1. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.

17) Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: Cerebrovascular accident Liver disease Myocardial infarction Pulmonary disease

1. Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA's can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.

15) When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

1. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

40) Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn't understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is: "Cardiac rehabilitation is not a cure but can help restore you to many of your former activities." "Here we teach you to gradually change your lifestyle to accommodate your heart disease." "You are probably right but we can gradually increase your activities so that you can live a more active life." "Do you feel that you will have to make some changes in your life now?"

1. Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity about it.

5) A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: Check the client status and lead placement Press the recorder button on the electrocardiogram console. Call the physician Call a code blue

1. Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

19) Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? A change in the pattern of her pain Pain during sex Pain during an argument with her husband Pain during or after an activity such as lawnmowing

1. The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

CVP:

2-6

25) When do coronary arteries primarily receive blood flow? During inspiration During diastolic During expiration During systole

2. Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow.

3) A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? Strict bed rest for 24 hours after transfer Bathroom privileges and self-care activities Unsupervised hallway ambulation with distances under 200 feet Ad lib activities because the client is monitored.

2. On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).

11) When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: Help keep him well hydrated Dissolve clots he may have Prevent kidney failure Treat potential cardiac arrhythmias.

2. Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.

9) A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

2. Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.

43) A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? Monitoring vital signs Completing a physical assessment Maintaining cardiac monitoring Maintaining at least one IV access site

3. Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the MI monitoring.

49) Direct-acting vasodilators have which of the following effects on the heart rate? Heart rate decreases Heart rate remains significantly unchanged Heart rate increases Heart rate becomes irregular

3. Heart rate increases in response to decreased blood pressure caused by vasodilation.

44) A client is experiencing tachycardia. The nurse's understanding of the physiological basis for this symptom is explained by which of the following statements? The demand for oxygen is decreased because of pleural involvement The inflammatory process causes the body to demand more oxygen to meet its needs. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension. Respirations are labored.

3. The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart's having to beat faster to meet the body's needs for oxygen. .

27) A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this? Aortic Mitral Pulmonic Tricupsid

3. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.

2) A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? "Have you ever had this pain before?" "Can you describe the pain to me?" "Does the pain get worse when you breathe in?" "Can you rate the pain on a scale of 1-10, with 10 being the worst?"

3. Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

16) The most important long-term goal for a client with hypertension would be to: Learn how to avoid stress Explore a job change or early retirement Make a commitment to long-term therapy Control high blood pressure

3. Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.

37) One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? Hypocalcemia Hypermagnesemia Hypokalemia Hypernatremia

3. Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

18) During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem? Visit her friend earlier in the day. Rest for at least an hour before climbing the stairs. Take a nitroglycerin tablet before climbing the stairs. Lie down once she reaches the friend's apartment.

3. Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

21) As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principle effects are produced by: Antispasmotic effect on the pericardium Causing an increased mycocardial oxygen demand Vasodilation of peripheral vasculature Improved conductivity in the myocardium

3. Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

41) To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse: In all extremities At the insertion site Distal to the catheter insertion Above the catheter insertion

3. Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

36) A 57-year-old client with a history of asthma is prescribed propanolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first? Monitor the apical pulse rate Instruct the client to take medication with food Question the physician about the order Caution the client to rise slowly when standing.

3. Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

23) Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? Take one tablet every 2 to 5 minutes until the pain stops. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

3. The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets. Sublingual nitroglycerin appears in the blood stream within 2 to 3 minutes and is metabolized within about 10 minutes.

32) Which of the following factors can cause blood pressure to drop to normal levels? Kidneys' excretion of sodium only Kidneys' retention of sodium and water Kidneys' excretion of sodium and water Kidneys' retention of sodium and excretion of water

3. The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.

24) Which of the following arteries primarily feeds the anterior wall of the heart? Circumflex artery Internal mammary artery Left anterior descending artery Right coronary artery

3. The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.

26) Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? Anterior Apical Inferior Lateral

3. The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.

8) A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: The same as the client's own baseline level Lower than the needed therapeutic level Within the therapeutic range Higher than the therapeutic range

3. The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.

28) Which of the following blood tests is most indicative of cardiac damage? Lactate dehydrogenase Complete blood count (CBC) Troponin I Creatine kinase (CK)

3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.

6) A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? Seating the client with arm bared, supported, and at heart level. Measuring the blood pressure after the client has been seated quietly for 5 minutes. Using a cuff with a rubber bladder that encircles at least 80% of the limb. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

4. BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.

38) A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? "Eat foods high in potassium." "Take daily potassium supplements." "Discontinue sodium restrictions." "Avoid salt substitutes."

4. Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.

14) The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? Cancer Hypertension Liver disease Myocardial infarction

4. Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is normal).

35) Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? Afterload Cardiac index Cardiac output Preload

4. Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload. Afterload is the force against which the ventricle must expel blood. Cardiac index is the individualized measurement of cardiac output, based on the client's body surface area. Cardiac output is the amount of blood the heart is expelling per minute.

29) Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? Cardiac catherization Cardiac enzymes Echocardiogram Electrocardiogram (ECG)

4. The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catherization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.

39) When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the: Impulse to begin atrial contraction Impulse to transverse the atria to the AV node SA node to discharge the impulse to begin atrial depolarization Impulse to travel to the ventricles

4. The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

7) IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? Vitamin K Aminocaporic acid Potassium chloride Protamine sulfate

4. The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.

30) Which of the following types of pain is most characteristic of angina? Knifelike Sharp Shooting Tightness

4. The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.

1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? Intake and output Baseline peripheral pulse rates Height and weight Allergy to iodine or shellfish

4. This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.

42) A client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect: Normal vs. abnormal tissue Damage in areas of the heart Ventricular function Myocardial scarring and perfusion

4. This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood pool scan.

31) Which of the following parameters is the major determinate of diastolic blood pressure? Baroreceptors Cardiac output Renal function Vascular resistance

4. Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.

The nurse demonstrates an understanding of oxygen supply and demand when identifying the following reported SvO2 values as indicative of increased oxygen extraction at the tissue level: (Select all that apply) SvO2 = 48% SvO2 = 54% SvO2 = 64% SvO2 = 76%

48 54 Decreased values of venous oxygen saturation indicate that more oxygen is being extracted for use at the tissue level.

A-Fib T(x)

<48 hrs: Decrease ventricular response, cardioversion >48 hrs: anticoagulation for 3-4 weeks and post cardioversion for 4 weeks Pt can also ablast the the errant part of the heart

Who is most at risk for HTN?

>55 years old African-Americans Men and post-menopausal women

When do we treat PVC?

>6 per minute Come in couplets or triplets Multifocal R on T

ANS: C Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock

A 19-year-old patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock? a. Inspiratory crackles. b. Cool, clammy extremities. c. Apical heart rate 45 beats/min. d. Temperature 101.2° F (38.4° C).

b. "These factors may put you at higher risk for myopathy."

A 70-year-old client who is taking several cardiac antidysrhythmic medications has been prescribed simvastatin (Zocor) 80 mg/day. What is essential information for the nurse to teach the client? a. "This dose may lower your cholesterol too much." b. "These factors may put you at higher risk for myopathy." c. "You should not take this drug with cardiac medications." d. "This combination will cause you to have nausea and vomiting."

ANS: A Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. The other orders are appropriate.

A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse rate is 120/minute and the central venous pressure and pulmonary artery wedge pressure are low. Which order by the health care provider will the nurse question? a. Give PRN furosemide (Lasix) 40 mg IV. b. Increase normal saline infusion to 250 mL/hr. c. Administer hydrocortisone (Solu-Cortef) 100 mg IV. d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg.

c. Hypotension

A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication? a. Hypokalemia b. Dysrhythmias c. Hypotension d. Increased intracranial pressure

b. Hepatic disease

A client diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor). The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history? a. Chronic pulmonary disease b. Hepatic disease c. Leukemia d. Renal disease

c. Hyperlipidemia

A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? a. Hypolipidemia b. Normolipidemia c. Hyperlipidemia d. Alipidemia

b. Administer protamine sulfate.

A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? a. Teach the client about the phenytoin. b. Administer protamine sulfate. c. Assess the INR before surgery. d. Administer vitamin K.

c. High-ceiling (loop) diuretic

A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug? a. Thiazide diuretic b. Osmotic diuretic c. High-ceiling (loop) diuretic d. Potassium-sparing diuretic

c. Thrombolytic agent

A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery? a. Anticoagulant agent b. Antiplatelet agent c. Thrombolytic agent d. Low-molecular-weight heparin (LMWH)

b. warfarin (Coumadin)

A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? a. enoxaparin sodium (Lovenox) b. warfarin (Coumadin) c. bivalirudin (Angiomax) d. lepirudin (Refludan)

b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record.

A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor ECG continuously. f. Insert an arterial line for continuous blood pressure monitoring.

b. Respiratory assessment

A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client? a. Assessment of blood glucose levels b. Respiratory assessment c. Orthostatic blood pressure assessment d. Teaching about potential tachycardia

d. Subcutaneously

A client is prescribed dalteparin (Fragmin). LMWH is administered via which route? a. Intravenously b. Intramuscularly c. Intradermally d. Subcutaneously

a. A longer half-life than heparin

A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life? a. A longer half-life than heparin b. A shorter half-life than heparin c. The same half-life as heparin d. A four-times shorter half-life than heparin

c. Muscle pain.

A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse? a. Headache. b. Slight nausea. c. Muscle pain. d. Fatigue.

b. "You may experience headaches with this medication."

A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client? a. "Take aspirin before the medication if you experience facial flushing." b. "You may experience headaches with this medication." c. "You will need to have weekly blood drawn to assess for hyperkalemia." d. "Cholesterol levels will need to be assessed daily for one week."

b. Blocking angiotensin II from AT1 receptors

A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what? a. Inhibiting angiotensin-converting enzyme b. Blocking angiotensin II from AT1 receptors c. Preventing the release of angiotensin I d. Promoting the release of aldosterone

b. Activated partial thromboplastin time (aPTT) of 120 seconds *normal therapeutic range is 45-75 secs

A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse? a. Platelet count of 150,000 b. Activated partial thromboplastin time (aPTT) of 120 seconds c. INR of 1.0 d. Blood urea nitrogen (BUN) level of 12 mg/dL

c. "I will increase dark-green, leafy vegetables in my diet."

A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse? a. "I will avoid contact sports." b. "I will take my medication in the early evening each day." c. "I will increase dark-green, leafy vegetables in my diet." d. "I will contact my health care provider if I develop excessive bruising."

b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."

A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? a. "Your concern is valid. I will call the doctor to discontinue the heparin." b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

a. Evaluate digoxin levels.

A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? a. Evaluate digoxin levels. b. Withhold the furosemide c. Administer potassium. d. Document the findings and reassess in 1 hour.

a. "I take aspirin daily for headaches."

A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring? a. "I take aspirin daily for headaches." b. "I take ibuprofen (Motrin) at least once a week for joint pain." c. "Whenever I have a fever, I take acetaminophen (Tylenol)." d. "I take my medicine first thing in the morning."

b. Hypokalemia

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

d. Liver enzymes

A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor? a. Blood urea nitrogen b. Complete blood count c. Cardiac enzymes d. Liver enzymes

b. Elevated INR range *therapeutic range is 2.0-3.0

A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what? a. Within normal range b. Elevated INR range c. Low INR range d. Low average INR range

a. "Apply the patch to a nonhairy area of the upper torso or arm."

A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? a. "Apply the patch to a nonhairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."

b. Decrease the intravenous nitroglycerin by 10 mcg/min.

A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? a. Assess the client's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Stop the nitroglycerin infusion for 1 hour, and then restart. d. Recheck the client's vital signs in 15 minutes but continue the infusion.

c. Fish

A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? a. Apricots b. Bananas c. Fish d. Strawberries

a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.) a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. d. Call the health care provider after taking 5 tablets if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

b. Administer vitamin K.

A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? a. Administer vitamin E. b. Administer vitamin K. c. Administer protamine sulfate. d. Administer calcium gluconate.

b. Teach the client of potential drug interactions with anticoagulants.

A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. b. Teach the client of potential drug interactions with anticoagulants. c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. d. Explain that the headache is an expected side effect and will subside shortly.

c. Lungs clear.

A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working? a. Potassium level decreased from 4.5 to 3.5 mEq/L. b. Crackles auscultated in the bases. c. Lungs clear. d. Output 30 mL/hr.

c. Decreased aldosterone

A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? a. Decreased potassium level b. Decreased crackles in the lung bases c. Decreased aldosterone d. Decreased ankle edema

c. Stage 1 hypertension

A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage? a. Normal b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension

b. It is the desired level of HDL.

A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level? a. It is lower than the desired level of HDL. b. It is the desired level of HDL. c. It is higher than the desired level of HDL. d. It is a much lower HDL level than desired.

a. Administer ordered dose of digoxin.

A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? a. Administer ordered dose of digoxin. b. Hold future digoxin doses. c. Administer potassium. d. Call the health care provider.

Myocarditis

A focal or diffuse inflammation of the myocardium

b. 0.5 to 2.0 ng/mL

A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin? a. 0.1 to 1.5 ng/mL b. 0.5 to 2.0 ng/mL c. 1.0 to 2.5 ng/mL d. 2.0 to 4.0 ng/mL

c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.

A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client? a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia. b. The fact that Lasix has been proven to decrease symptoms with pneumonia. c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency. d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.

ANS: C Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since nitroprusside is a vasodilator, the blood pressure may be low even if the medication is effective. Absence of a heart murmur and a decrease in troponin level are not indicators of improvement in shock.

A nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock. Which finding indicates that the medication is effective? a. No new heart murmurs b. Decreased troponin level c. Warm, pink, and dry skin d. Blood pressure 92/40 mm Hg

c. Have the client increase fluids and fiber in his diet.

A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do? a. Call the health care provider to change the medication. b. Tell the client to skip a dose of the medication. c. Have the client increase fluids and fiber in his diet. d. Administer an enema to the client.

a. Call the health care provider to switch the medication.

A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? a. Call the health care provider to switch the medication. b. Assess the client for other symptoms of upper respiratory infection. c. Instruct the client to take antitussive medication until the symptoms subside. d. Tell the client that the cough will subside in a few days.

c. gemfibrozil (Lopid)

A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer? a. cholestyramine (Questran) b. colestipol (Colestid) c. gemfibrozil (Lopid) d. simvastatin (Zocor)

ANS: A The patient's elevated pulmonary artery wedge pressure indicates volume excess. A saline infusion at 250 mL/hr will exacerbate the volume excess. The other actions are appropriate for the patient.

A nurse is caring for a patient with shock of unknown etiology whose hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure. Which collaborative intervention ordered by the health care provider should the nurse question? a. Infuse normal saline at 250 mL/hr. b. Keep head of bed elevated to 30 degrees. c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg. d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.

d. Client stating that pain is 0 out of 10

A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure 120/80 mm Hg b. Heart rate 70 beats per minute c. ECG without evidence of ST changes d. Client stating that pain is 0 out of 10

c. Administer the medication into subcutaneous tissue.

A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention? a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle. b. Utilize the Z-track method to inject the medication. c. Administer the medication into subcutaneous tissue. d. Rub the administration site after injecting.

ANS: A The initial actions of the nurse are focused on the ABCs—airway, breathing, and circulation—and administration of oxygen should be done first. The other actions should be accomplished as rapidly as possible after oxygen administration.

A patient is admitted to the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a. administer oxygen. b. obtain a 12-lead electrocardiogram (ECG). c. obtain the blood pressure. d. check the level of consciousness.

ANS: C The first priority in the initial management of shock is maintenance of the airway and ventilation. ECG monitoring, insertion of IV catheters, and obtaining blood for transfusions should also be rapidly accomplished but only after actions to maximize oxygen delivery have been implemented.

A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which intervention ordered by the health care provider should the nurse implement first? a. Insert two large-bore IV catheters. b. Initiate continuous electrocardiogram (ECG) monitoring. c. Provide oxygen at 100% per non-rebreather mask. d. Draw blood to type and crossmatch for transfusions.

ANS: B The PAWP indicates that the patient's preload is elevated, and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase heart rate and myocardial oxygen demand. 5% human albumin would also increase the PAWP. Hydrocortisone might be considered for septic or anaphylactic shock.

A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The nurse will anticipate an order for which medication? a. 5% human albumin b. Furosemide (Lasix) IV c. Epinephrine (Adrenalin) drip d. Hydrocortisone (Solu-Cortef)

ANS: A Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions also are appropriate, and should be initiated quickly as well.

A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 104° F, and blood glucose 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first? a. Give normal saline IV at 500 mL/hr. b. Give acetaminophen (Tylenol) 650 mg rectally. c. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL. d. Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.

ANS: A, B, D, E All of the actions are appropriate except to give large volumes of lactated Ringer's solution. The patient with neurogenic shock usually has a normal blood volume, and it is important not to volume overload the patient. In addition, lactated Ringer's solution is used cautiously in all shock situations because the failing liver cannot convert lactate to bicarbonate.

A patient with suspected neurogenic shock after a diving accident has arrived in the emergency department. A cervical collar is in place. Which actions should the nurse take (select all that apply)? a. Prepare to administer atropine IV. b. Obtain baseline body temperature. c. Infuse large volumes of lactated Ringer's solution. d. Provide high-flow oxygen (100%) by non-rebreather mask. e. Prepare for emergent intubation and mechanical ventilation.

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says, A. "I would like to add weight lifting to my exercise program." B. "I can't keep my blood pressure normal without medication." C. "I can change my diet to decrease my intake of saturated fats." D. "I will change my lifestyle to reduce activities that increase my stress."

A. "I would like to add weight lifting to my exercise program."

A client is exhibiting signs and symptoms of early shock. What is important for the nurse to do to support the psychosocial integrity of the client? (Select all that apply.) A. Ask family members to stay with the client. B. Call the health care provider. C. Increase IV and oxygen rates. D. Remain with the client. E. Reassure the client that everything is being done for him or her.

A. Ask family members to stay with the client. D. Remain with the client. E. Reassure the client that everything is being done for him or her. Having a familiar person nearby may provide comfort to the client. The nurse should remain with the client who is demonstrating physiologic deterioration. Offering genuine reassurance supports the client who is anxious. The health care provider should be notified, and increasing IV and oxygen rates may be needed, but these actions do not support the client's psychosocial integrity.

A client is admitted to the hospital with two of the systemic inflammatory response syndrome variables: temperature of 95° F (35° C) and high white blood cell count. Which intervention from the sepsis resuscitation bundle does the nurse initiate? A. Broad-spectrum antibiotics B. Blood transfusion C. Cooling baths D. NPO status

A. Broad-spectrum antibiotics Broad-spectrum antibiotics must be initiated within 1 hour of establishing diagnosis. A blood transfusion is indicated for low red blood cell count or low hemoglobin and hematocrit; transfusion is not part of the sepsis resuscitation bundle. Cooling baths are not indicated because the client is hypothermic, nor is this part of the sepsis resuscitation bundle. NPO status is not indicated for this client, nor is it part of the sepsis resuscitation bundle.

The nursing assistant is concerned about a postoperative client with blood pressure (BP) of 90/60 mm Hg, heart rate of 80 beats/min, and respirations of 22 breaths/min. What does the supervising nurse do? A. Compare these vital signs with the last several readings. B. Request that the surgeon see the client. C. Increase the rate of intravenous fluids. D. Reassess vital signs using different equipment.

A. Compare these vital signs with the last several readings. Vital sign trends must be taken into consideration; a BP of 90/60 mm Hg may be normal for this client. Calling the surgeon is not necessary at this point, and increasing IV fluids is not indicated. The same equipment should be used when vital signs are taken postoperatively.

The client with which problem is at highest risk for hypovolemic shock? A. Esophageal varices B. Kidney failure C. Arthritis and daily acetaminophen use D. Kidney stone

A. Esophageal varices Esophageal varices are caused by portal hypertension; the portal vessels are under high pressure and are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock. As the kidneys fail, fluid is typically retained, causing fluid volume excess, not hypovolemia. Nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen, not acetaminophen, predispose the client to gastrointestinal bleeding and hypovolemia. Although a kidney stone may cause hematuria, there is not generally massive blood loss or hypovolemia.

The client with which laboratory result is at risk for hemorrhagic shock? A. International normalized ratio (INR) 7.9 B. Partial thromboplastin time (PTT) 12.5 seconds C. Platelets 170,000/mm3 D. Hemoglobin 8.2 g/dL

A. International normalized ratio (INR) 7.9 Prolonged INR indicates that blood takes longer than normal to clot; this client is at risk for bleeding. PTT of 12.5 seconds and a platelet value of 170,000/mm3 are both normal and pose no risk for bleeding. Although a hemoglobin of 8.2 g/dL is low, the client could have severe iron deficiency or could have received medication affecting the bone marrow.

The nurse reviews the medical record of a client with hemorrhagic shock, which contains the following information: Pulse 140 beats/min and thready, ABG respiratory acidosis, Blood pressure 60/40 mm Hg, Lactate level 7 mOsm/L, Respirations 40/min and shallow. All of these provider prescriptions are given for the client. Which does the nurse carry out first? A. Notify anesthesia for endotracheal intubation. B. Give Plasmanate 1 unit now. C. Give normal saline solution 250 mL/hr. D. Type and crossmatch for 4 units of packed red blood cells (PRBCs).

A. Notify anesthesia for endotracheal intubation. Establishing an airway is the priority in all emergency situations. Although administering Plasmanate and normal saline, and typing and crossmatching for 4 units of PRBCs are important actions, airway always takes priority.

Which problem places a person at highest risk for septic shock? A. Kidney failure B. Cirrhosis C. Lung cancer D. 40% burn injury

D. 40% burn injury The skin forms the first barrier to prevent entry of organisms into the body; this client is at very high risk for sepsis and death. Although the client with kidney failure has an increased risk for infection, his skin is intact, unlike the client with burn injury. Although the liver acts as a filter for pathogens, the client with cirrhosis has intact skin, unlike the burned client. The client with lung cancer may be at risk for increased secretions and infection, but risk is not as high as for a client with open skin.

A client with hypovolemic shock has these vital signs: temperature 97.9° F; pulse 122 beats/min; blood pressure 86/48 mm Hg; respirations 24 breaths/min; urine output 20 mL for last 2 hours; skin cool and clammy. Which medication order for this client does the nurse question? A. Dopamine (Intropin) 12 mcg/kg/min B. Dobutamine (Dobutrex) 5 mcg/kg/min C. Plasmanate 1 unit D. Bumetanide (Bumex) 1 mg IV

D. Bumetanide (Bumex) 1 mg IV A diuretic such as bumetanide will decrease blood volume in a client who is already hypovolemic; this order should be questioned because this is not an appropriate action to expand the client's blood volume. The other orders are appropriate for improving blood pressure in shock, and do not need to be questioned.

When caring for an obtunded client admitted with shock of unknown origin, which action does the nurse take first? A. Obtain IV access and hang prescribed fluid infusions. B. Apply the automatic blood pressure cuff. C. Assess level of consciousness and pupil reaction to light. D. Check the airway and respiratory status.

D. Check the airway and respiratory status. When caring for any client, determining airway and respiratory status is the priority. The airway takes priority over obtaining IV access, applying the blood pressure cuff, and assessing for changes in the client's mental status.

Left-sided heart failure is characterized by: A. Increased cardiac output B. Lowered cardiac pressures C. Decreased functioning of the left atrium D. Decreased functioning of the left ventricle

D. Decreased functioning of the left ventricle Left-sided heart failure is an abnormal condition characterized by decreased functioning of the left ventricle. If left ventricular failure is significant, the amount of blood ejected from the left ventricle drops greatly, which results in decreased cardiac output. Progress

A person who starts smoking in adolescence and continues to smoke into middle age: A. Has an increased risk for alcoholism B. Has an increased risk for obesity and diabetes C. Has an increased risk for stress-related illnesses D. Has an increased risk for cardiopulmonary disease and lung cancer

D. Has an increased risk for cardiopulmonary disease and lung cancer The risk of lung cancer is 10 times greater for a person who smokes than for a nonsmoker. Cigarette smoking worsens peripheral vascular and coronary artery disease. Inhaled nicotine causes vasoconstriction of peripheral and coronary blood vessels, increasing blood pressure and decreasing blood flow to peripheral vessels.

Which nurse should be assigned to care for an intubated client who has septic shock as the result of a methicillin-resistant Staphylococcus aureus (MRSA) infection? A. The LPN/LVN who has 20 years of experience B. The new RN who recently finished orienting and is working independently with moderately complex clients C. The RN who will also be caring for a client who had coronary artery bypass graft (CABG) surgery 12 hours ago D. The RN with 2 years of experience in intensive care

D. The RN with 2 years of experience in intensive care The RN with current intensive care experience who is not caring for a postoperative client would be an appropriate assignment. Care of the unstable client with intubation and mechanical ventilation is not within the scope of practice for the LPN/LVN. A client who is experiencing septic shock is too complex for the new RN. Although the RN who is also caring for the post-CABG client is experienced, this assignment will put the post-CABG client at risk for MRSA infection.

If a patient has decreased cardiac output caused by fluid volume deficit and marked vasodilation, the regulatory mechanism that will increase the blood pressure by improving both of these is A. release of antidiuretic hormone (ADH). B. secretion of prostaglandins PGE C. stimulation of the sympathetic nervous system. D. activation of the renin-angiotensin-aldosterone system.

D. activation of the renin-angiotensin-aldosterone system.Q

The nurse instructs the patient discharged on anticoagulant therapy to A. limit intake of vitamin C. B. report symptoms of nausea to the physician. C. have blood drawn routinely to check electrolytes. D. be aware of and report signs or symptoms of bleeding.

D. be aware of and report signs or symptoms of bleeding.

The nurse prepares a patient for electrical cardioversion knowing that cardioversion differs from defibrillation in that A. defibrillation requires a greater dose of electrical current. B. defibrillation is synchronized to countershock during the QRS complex. C. cardioversion is indicated only for treatment of atrial tachyarrhythmias. D. cardioversion may be done on a nonemergency basis with sedation of the patient.

D. cardioversion may be done on a nonemergency basis with sedation of the patient.

A patient with a stable blood pressure and no symptoms has the following electrocardiogram characteristics: atrial rate—74 and regular; ventricular rate—62 and irregular; P wave—normal contour; PR interval—lengthens progressively until a P wave is not conducted; QRS—normal contour. The nurse would expect that treatment would involve A. epinephrine 1 mg IV push. B. isoproterenol IV continuous drip. C. immediate insertion of a temporary pacemaker. D. careful observation for symptoms of hypotension.

D. careful observation for symptoms of hypotension.

A patient with a deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest pain. Initially the most appropriate action by the nurse is to A. auscultate for abnormal lung sounds. B. administer oxygen and notify the physician. C. ask the patient to cough and deep breathe to clear the airways. D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that A. all patients with elevated BP require medication. B. it is not necessary to limit salt in the diet if taking a diuretic. C. obese persons must achieve a normal weight in order to lower BP. D. lifestyle modifications are indicated for all persons with elevated BP.

D. lifestyle modifications are indicated for all persons with elevated BP.

Target organ damage that can occur from hypertension includes A. headache and dizziness. B. retinopathy and diabetes. C. hypercholesterolemia and renal dysfunction. D. renal dysfunction and left ventricular hypertrophy.

D. renal dysfunction and left ventricular hypertrophy.

The nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock? A. Hypotension B. Bradypnea C. Heart blocks D. Tachycardia

D. tachycardia Heart and respiratory rates increased from the client's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart.

The clinical spectrum of acute coronary syndrome includes A. unstable angina and STEMI. B. unstable angina and NSTEMI. C. stable angina and sudden cardiac death. D. unstable angina, STEMI, and NSTEMI.

D. unstable angina, STEMI, and NSTEMI.

A major consideration in the management of the older adult with hypertension is to A. prevent pseudohypertension from converting to true hypertension. B. recognize that the older adult is less likely to comply with the drug therapy than a younger adult. C. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

What should you take caution in when decreasing BPs in HTN crisis?

DO NOT DROP TO QUICKLY

V. Tach treatment

Defib and Amiodarone (or lidocaine)

Late myocarditis assessment findings

Development of HF S3 heart sound, crackles, JVD Syncope, peripheral edema and angina

Drugs for A-Fib

Diltazem, Metoprolol, Digoxin (long term), coumadin, ASA

In which of the following areas is an abdominal aortic aneurysm most commonly located? a. Distal to the iliac arteries b. Distal to the renal arteries c. Adjacent to the aortic branch d. Proximal to the renal arteries`

Distal to the renal arteries

Medical Management of HTN?

Diuretics Beta Blockers Calcium Channel Blockers ACE inhibitors

b. Dizziness c. Headache e. Ankle edema

During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.) a. Insomnia b. Dizziness c. Headache d. Angioedema e. Ankle edema f. Hacking cough

ANS: A The changes in mental status are indicative that the patient is in the progressive stage of shock and that rapid intervention is needed to prevent further deterioration. The other information is consistent with compensatory shock

During change-of-shift report, the nurse is told that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse to report to the health care provider? a. New onset of confusion b. Heart rate 112 beats/minute c. Decreased bowel sounds d. Pale, cool, and dry extremities

Which of the following diagnostic tests is preferred for evaluating heart valve function? Chest x-ray Duplex Doppler Echocardiogram Electrocardiogram

Echocardiogram Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it allows the visualization of the valves as they open and close. A chest x-ray will determine the size of the heart, the duplex measures blood flow through major arteries, and an electrocardiogram identifies electrical activity.

Asystole clinical associations

End stage cardiac disease, prolonged arrest

Asystole T(x):

Epinephrine, atropine, CPR

It is important that the nurse be knowledgeable about cardiac output in order to: Evaluate blood flow to peripheral tissues. Determine the electrical activity of the myocardium. Provide information on the immediate need for oxygen. Implement nutritional changes.

Evaluate blood flow to peripheral tissues. Rationale: Blood flow to the tissues is measured clinically as the cardiac output, and assists to predict tissue perfusion. Electrical activity is evaluated more effectively by EKG. While the cardiac output is important for perfusion and oxygenation of tissues, the oxygen saturation would provide more valuable information. Nutritional changes would be targeted to sodium and would depend on symptoms of disease. Integrated Process: Nursing Process; Planning Cognitive Level: Evaluation NCLEX-RN Test Plan: Health Promotion and Maintenance

SInus tach. Clinical associations

Exercise, pain, fever, hypovolemia, hypoxia, anemia, certain drugs

Sinus brady (def.)

HR<60 *AND* regular rate and rhythm

Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms? a. DM b. HTN c. PVD d. Syphilis

HTN continuous pressure on the vessel walls from HTN causes the walls to weaken

What is white coat hypertension?

HTN in people who are normotensive except when the BP is measured by a healthcare worker.

HTN results from which changes in the equation for BP (CO/PR)

HTN occurs when either CO or PR increases

What is primary HTN?

HTN of unknown etiology (95% of cases)

V-Fib T(x)

Immediate defib and CPR

What would intravenous pyelography show?

Injecting dye and lights up veins and arteries. Shows if there is Peripheral Vascular Disease

How are beta blockers used for HTN?

Interfere with transmission of neuro-hormonal facilitators of vasoconstriction (vasodilation)

Which of the following assessments would be an important finding for a patient with arterial disease? Intermittent claudication with exercise Brownish discoloration around the ankles Non-pitting edema on the lower extremities Altered sensation to touch

Intermittent claudication with exercise Rationale: Intermittent claudication is a common finding in persons with arterial disease, usually due to progression of atherosclerosis and alteration of tissue perfusion to the extremities. In venous disease, valves of the veins in the extremities become incompetent, resulting in higher pressures than normal in the veins. The pressure is transmitted to the capillaries of the lower extremities, resulting in thickening and non-pitting edema of tissues around the ankles. Prolonged thickening results in the red blood cells' being pressed outside the capillaries. The cells eventually break down, resulting in collection of hemosiderin deposits being collected in the area. Altered sensation to touch would be due to neuropathic changes commonly found with diabetes mellitus.

End organ damage in heart?

Left ventricular hypertrophy Angina, MI CHF

What is the best way to help combat HTN?

Lifestyle modification (suggested for initial 6-12 months after diagnosis)

Sinus Tach, Significance

May cause dizziness, low BP, increased myocardial O2 consumption which can lead to CP and MI

While monitoring a client's pulmonary artery pressure the nurse sees a distinct notch in the waveform. What should the nurse do about this finding? -Contact the physician. -Take another measurement. -Nothing. This is a normal finding. -Prepare the client to have the catheter repositioned.

Nothing. This is a normal finding.

ADHF Interventions

O2 by mask/NC High Fowler's BiPAP ET tube/ ventilation Circulatory assist device VS, hourly UO Continuous ECG, pulse ox/ hemodynamic monitoring -Drug therapy (B-Adrenergic Agonist)

Modifable risk factors for HTN?

Obesity, high NA, smoking, heavy alcohol, stress, oral contraceptives, atherosclerosis

Clinical profile of a Dry-Cold ADHF pt.

PAWP low or normal Dec. CO -Edema, hypoTN, cool extremities

Clinical profile of a Dry-Warm ADHF pt.

PAWP normal CO normal no S&S

Clinical profile of a ADHF Wet-Warm pt.

PAWP up CO normal Dyspea, edema, orthopnea

R on T phenomenon definition

PVC falls on T wave of preceding beat. Can lead to V Tach or V Fib.

End organ damage in periphery?

Peripheral arterial disease

Early myocarditis assessment findings

Pleuritic CP Pericardial friction rub and effusion

Causes of HTN emergency?

Pregnancy MI Dissecting Aortic Aneurysm Intracranial Hemorrhage

What relaxation techniques help with HTN?

Progressive relaxation Mediation Biofeedback Yoga

V Tach. significance

Pt has severe decreased CO due to poor ventricular filling

A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is: A. Loss of sensation in the lower extremities B. Back pain that lessens when standing C. Decreased urinary output D. Pulsations in the periumbilical area

Pulsations in the periumbilical area

Preventricular Contractions (def.)

QRS that occurs right after T wave. Impulse originates in the ventricle; QRS is wide and T wave is inverted. No palpable pulse or beat

How are diuretics used for HTN?

Renal excretion of NA and water

What is systolic pressure?

Represents pressure during cardiac contraction, reflects cardiac output.

What is diastolic pressure?

Represents the ARTERIAL pressure during cardiac relaxation/ ventricular filling

V-Fib significance

Results in immediate LOC, no pulse, apnea, seizures

A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation? Left atrium Right atrium Right ventricle Left ventricle

Right atrium Rationale: The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.

Which of the following drug classifications should the nurse question if prescribed for a person with congested heart failure (CHF)? Angiotensin-converting enzyme (ACE) inhibitor Beta-adrenergic blocker Alpha adrenergic antagonist Rosiglitazone (Avandia)

Rosiglitazone (Avandia) Correct answer: Thiazolidinediones, like rosiglitazone (Avandia), are glucose-reducing drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker, has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and beta2 receptors in various organs, resulting in reduction of heart rate and the force of contraction, and suppresses impulse conduction through the AV node, all of which slows the progression of the disease process. Carvedilol (Coreg) is another beta-adrenergic blocker used to treat heart failure.

V Tach (def)

Run of 3 or more PVC's. Ectopic focus in ventricle. Ventricle takes over as pacemaker. Rate of 110-250

Education/Teaching for HTN?

Self-measurement of BP (look in grocery stores, talk to insurance companies)

How is diagnosis of HTN confirmed?

Serial arterial BPs of 140/90.

WHat is malignant HTN?

Severe HTN Diastolic >120 or systolic >180. HTN crisis

PR interval

Spread of impulse through atria to AV node

What is hypertension?

Systolic pressure >140 and diastolic pressure >90

c. To block the beta1-adrenergic receptors in the cardiac tissues

The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug? a. To increase the beta1 and beta2 receptors in the cardiac tissues b. To increase the flow of oxygen to the cardiac tissues c. To block the beta1-adrenergic receptors in the cardiac tissues d. To block the beta2-adrenergic receptors in the cardiac tissues

b. "It's best to keep it in its original container away from heat and light."

The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry it in your pocket." d. "It's best to lock them in the glove compartment to keep them away from heat and light."

a. Administer an additional dose of warfarin (Coumadin).

The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take? a. Administer an additional dose of warfarin (Coumadin). b. Hold the next dose of warfarin (Coumadin). c. Increase the heparin drip rate. d. Administer protamine sulfate.

a. Increase the serum digoxin sensitivity level

The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin? a. Increase the serum digoxin sensitivity level b. Decrease the serum digoxin sensitivity level c. Not have any effect on the serum digoxin sensitivity level d. Cause a low average serum digoxin sensitivity level

b. Rhabdomyolysis

The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for? a. Myasthenia gravis b. Rhabdomyolysis c. Dyskinesia d. Agranulocytosis

a. It is in the high (elevated) range.

The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? a. It is in the high (elevated) range. b. It is in the low (decreased) range. c. It is within the normal range. d. It is in the low average range.

ANS: C A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient has been assessed for possible liver abnormalities. Vasopressor infusion is not used as the initial therapy for hypovolemic shock. Patients in shock need to be kept warm not cool.

The emergency department (ED) nurse receives report that a patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. hypothermia blanket. b. lactated Ringer's solution. c. two 14-gauge IV catheters. d. dopamine (Intropin) infusion.

ANS: B Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other interventions are also appropriate but would not be the first ones completed.

The following interventions are ordered by the health care provider for a patient who has respiratory distress and syncope after eating strawberries. Which will the nurse complete first? a. Start a normal saline infusion. b. Give epinephrine (Adrenalin). c. Start continuous ECG monitoring. d. Give diphenhydramine (Benadryl).

b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.

The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker? a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. c. The beta blocker dose should be maintained while taking another antianginal drug. d. Half the beta blocker dose should be taken for the next several weeks.

c. Decrease heart rate and decrease myocardial contractility.

The nurse acknowledges that beta blockers are as effective as antianginals because they do what? a. Increase oxygen to the systemic circulation. b. Maintain heart rate and blood pressure. c. Decrease heart rate and decrease myocardial contractility. d. Decrease heart rate and increase myocardial contractility.

a. Diuretic

The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug? a. Diuretic b. Alpha blocker c. ACE inhibitor d. Alpha/beta blocker

a. Hypokalemia

The nurse acknowledges that which condition could occur when taking furosemide? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

d. "I should use a soft toothbrush for dental hygiene."

The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? a. "I will double my dose if I forget to take it the day before." b. "I should keep taking ibuprofen for my arthritis." c. "I should decrease the dose if I start bruising easily." d. "I should use a soft toothbrush for dental hygiene."

a. Beta1 blocker

The nurse explains that which beta blocker category is preferred for treating hypertension? a. Beta1 blocker b. Beta2 blocker c. Beta1 and beta2 blockers d. Beta2 and beta3 blockers

c. Administer 2 mEq potassium chloride per kilogram per day IV.

The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention? a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. b. Administer Kayexalate. c. Administer 2 mEq potassium chloride per kilogram per day IV. d. Administer PhosLo, two tablets three times per day.

c. Beta blockers and ACE inhibitors

The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients? a. Diuretics b. Calcium channel blockers and vasodilators c. Beta blockers and ACE inhibitors d. Alpha blockers

d. Get up slowly from a sitting to a standing position.

The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? a. Change the patch daily at the same time. b. Remove the patch before taking a shower or bath. c. Do not take other antihypertensive medications while on this patch. d. Get up slowly from a sitting to a standing position.

ANS: B Because patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing. The other information will also be reported, but does not indicate deterioration of the patient's status.

The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider? a. Blood pressure (BP) 92/56 mm Hg b. Skin cool and clammy c. Oxygen saturation 92% d. Heart rate 118 beats/minute

d. Chest pain

The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? a. Blood pressure 110/90 mm Hg b. Flushing c. Headache d. Chest pain

b. Heart rate 58 beats per minute

The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate 110 beats per minute b. Heart rate 58 beats per minute c. Urinary output 40 mL/hr d. Blood pressure 90/50 mm Hg

d. spironolactone (Aldactone)

The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)

b. "Take this medication at the same time each day."

The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include? a. "Take this medication on an empty stomach." b. "Take this medication at the same time each day." c. "Take this medication with breakfast." d. "Take this medication with an antacid."

c. Bleeding may increase when taken with aspirin.

The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.

a. 150 to 200 mg/dL

The nurse knows that the client's cholesterol level should be within which range? a. 150 to 200 mg/dL b. 200 to 225 mg/dL c. 225 to 250 mg/dL d. Greater than 250 mg/dL

b. hydrochlorothiazide

The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? a. chlorthalidone b. hydrochlorothiazide c. bendroflumethiazide d. potassium-sparing diuretic

b. Administer aspirin 30 minutes before nicotinic acid.

The nurse plans which intervention to decrease the flushing reaction of niacin? a. Administer niacin with an antacid. b. Administer aspirin 30 minutes before nicotinic acid. c. Administer diphenhydramine hydrochloride (Benadryl) with niacin. d. Apply cold compresses to the head and neck.

b. To administer digoxin immune FAB (antidote)

The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? a. To administer atropine b. To administer digoxin immune FAB c. To administer epinephrine d. To administer Kayexalate

c. Client is on oral contraceptives.

The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? a. Client takes medications with grape juice. b. Client takes herbal therapy including kava kava. c. Client is on oral contraceptives. d. Client was started on penicillin for a respiratory infection.

a. Impaction

The nurse would question an order for cholestyramine (Questran) if the client has which condition? a. Impaction b. Glaucoma c. Hepatic disease d. Renal disease

ANS: C The coldness and pallor at the infusion site suggest extravasation of the phenylephrine. The nurse should discontinue the IV and, if possible, infuse the medication into a central line. An apical pulse of 58 is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28-mL urinary output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin is consistent with early neurogenic shock, but it does not indicate a need for a change in therapy or immediate action.

The patient with neurogenic shock is receiving a phenylephrine (Neo-Synephrine) infusion through a right forearm IV. Which assessment finding obtained by the nurse indicates a need for immediate action? a. The patient's heart rate is 58 beats/minute. b. The patient's extremities are warm and dry. c. The patient's IV infusion site is cool and pale. d. The patient's urine output is 28 mL over the last hour.

A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect? A. The patient will be admitted to the medicine unit for observation and medication. B. The patient will be admitted to the day surgery unit for sclerotherapy. C. The patient will be admitted to the surgical unit and resection will be scheduled. D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.

The patients will be admitted to the surgical unit and resection will be rescheduled

A client with post-myocardial infarction develops acute bacterial pericarditis. Which of the following medications would the physician most likely prescribe as the primary drug? Ticarcillin disodium (Ticar) Acetaminophen (Tylenol) Ibuprofen (Motrin) Trioxsalen (Trisoralen)

Ticarcillin disodium (Ticar) Rationale: Acute bacterial pericarditis is a complication that can occur post-myocardial infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.

ANS: D Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The other assessments also will be done, but these will not help in determining the effectiveness of the pantoprazole administration.

To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform? a. Auscultate bowel sounds. b. Palpate for abdominal pain. c. Ask the patient about nausea. d. Check stools for occult blood.

Asystole def

Total absence of electircal activity (ALWAYS CHECK ANOTHER LEAD)

Sinus Tach. (Tx)

Treat underlying cause, B-blockers, CCB, vagal maneuvers; goal is to decrease HR and O2 consumption

What meds do we give for PVC?

Treat with: Amiodarone, Lidocane, B adrenergic blockers, procainamide

Which of the following diagnostic studies most likely would confirm a myocardial infarction? Serum myoglobin level Creatinine kinase (CK) White blood cell count (WBC) Troponin T levels

Troponin T levels Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8 hours after the infarct (tissue necrosis) but also can occur with other types of tissue damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an inflammatory response. Troponin levels are more elevated than are the other cardiac enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue necrosis).

Clinical manifestations of HTN?

Usually produces no symptoms can show - H/A when rising - Drowsiness - Visual disturbance - N/V

Physical Exam findings to help diagnose HTN?

VS Weight Fundoscopic exam of eyes check for JVD Auscultate heart for increased HR, or s1/s2 sounds

QRS complex

Ventricular depolarization

A common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered? Aspirin (acetylsalicylic acid) Warfarin sodium (Coumadin) Simvastatin (Zocor) Vinorelbine tartrate (Navelbine)

Warfarin sodium (Coumadin) Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic.

b. Apply the ointment to a nonhairy part of the upper torso.

What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? a. Use the fingers to spread the ointment evenly over a 3-inch area. b. Apply the ointment to a nonhairy part of the upper torso. c. Massage the ointment into the skin. d. Cover the application paper with ointment before use.

b. "This combination promotes diuresis but decreases the risk of hypokalemia."

What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

b. Continuous blood pressures d. Presence of chest pain

What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) a. Continuous oxygen saturation b. Continuous blood pressures c. Hourly ECGs d. Presence of chest pain e. Serum nitroglycerin levels f. Visual acuity

d. "This medication will work for 24 hours and you will need to change the patch daily."

What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? a. "This medication works faster than sublingual nitroglycerin works." b. "This medication is the strongest of any nitroglycerin preparation available." c. "This medication should be used only when you are experiencing chest pain." d. "This medication will work for 24 hours and you will need to change the patch daily."

c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.

What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? a. Apply the nitroglycerin patch every other day. b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. d. Use the nitroglycerin patch for acute episodes of angina only.

c. Hydrochlorothiazide

What would cause the same client's electrolyte imbalance? a. High dose of digoxin b. Digoxin taken daily c. Hydrochlorothiazide d. Low dose of hydrochlorothiaizde

b. Headaches

When a client first takes a nitrate, the nurse expects which symptom that often occurs? a. Nausea and vomiting b. Headaches c. Stomach cramps d. Irregular pulse rate

a. Inhibits absorption of dietary cholesterol in the intestines.

When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what? a. Inhibits absorption of dietary cholesterol in the intestines. b. Binds with bile acids in the intestines to reduce LDL levels. c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver. d. Forms insoluble complexes and reduces circulating cholesterol in blood.

a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

ANS: D Patients with neurogenic shock may have poikilothermia. The room temperature should be kept warm to avoid hypothermia. The other actions by the new RN are appropriate.

When the nurse educator is evaluating the skills of a new registered nurse (RN) caring for patients experiencing shock, which action by the new RN indicates a need for more education? a. Placing the pulse oximeter on the ear for a patient with septic shock b. Keeping the head of the bed flat for a patient with hypovolemic shock c. Increasing the nitroprusside (Nipride) infusion rate for a patient with a high SVR d. Maintaining the room temperature at 66° to 68° F for a patient with neurogenic shock

b. Elevated liver function tests

Which assessment finding in a client taking an HMG-CoA reductase inhibitor will the nurse act on immediately? a. Decreased hemoglobin b. Elevated liver function tests c. Elevated HDL d. Elevated LDL

b. Crackles in the lungs

Which assessment finding will alert the nurse to possible toxic effects of amiodarone? a. Heart rate 100 beats per minute b. Crackles in the lungs c. Elevated blood urea nitrogen d. Decreased hemoglobin

a. Loss of appetite with slight bradycardia

Which assessment finding will alert the nurse to suspect early digoxin toxicity? a. Loss of appetite with slight bradycardia b. Blood pressure 90/60 mm Hg c. Heart rate 110 beats per minute d. Confusion and diarrhea

a. Decreased intracranial pressure

Which assessment indicates a therapeutic effect of mannitol (Osmitrol)? a. Decreased intracranial pressure b. Decreased potassium c. Increased urine osmolality d. Decreased serum osmolality

ANS: D Because the airway edema that is associated with anaphylaxis can affect airway and breathing, the oxygen saturation is the most critical assessment. Improvements in the other assessments will also be expected with effective treatment of anaphylactic shock.

Which assessment information is most important for the nurse to obtain to evaluate whether treatment of a patient with anaphylactic shock has been effective? a. Heart rate b. Orientation c. Blood pressure d. Oxygen saturation

a. Client states that she has no chest pain.

Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Client states that she has no chest pain. b. Client states that the swelling in her feet is reduced. c. Client states the she does not feel dizzy. d. Client states that she feels stronger.

c. The client who has stopped taking a beta blocker due to cost.

Which client will the nurse assess first? a. The client who has been on beta blockers for 1 day. b. The client who is on a beta blocker and a thiazide diuretic. c. The client who has stopped taking a beta blocker due to cost. d. The client who is taking a beta blocker and Lasix (furosemide).

c. A 47-year-old client with anuria

Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)? a. A 67-year-old client with type 1 diabetes mellitus b. A 21-year-old client with a head injury c. A 47-year-old client with anuria d. A 55-year-old client receiving cisplatin to treat ovarian cancer

ANS: A The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure. The crackles, chest pressure, and cool extremities are all consistent with the patient's diagnosis of cardiogenic shock.

Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the patient may be developing multiple organ dysfunction syndrome (MODS)? a. The patient's serum creatinine level is elevated. b. The patient complains of intermittent chest pressure. c. The patient's extremities are cool and pulses are weak. d. The patient has bilateral crackles throughout lung fields.

ANS: C Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion. The other information is consistent with the patient's diagnosis and should be reported to the health care provider but does not indicate a need for a change in therapy.

Which finding about a patient who is receiving vasopressin (Pitressin) to treat septic shock is most important for the nurse to communicate to the health care provider? a. The patient's urine output is 18 mL/hr. b. The patient's heart rate is 110 beats/minute. c. The patient is complaining of chest pain. d. The patient's peripheral pulses are weak.

ANS: B Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level, CVP, and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion.

Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been effective? a. Hemoglobin is within normal limits. b. Urine output is 60 mL over the last hour. c. Central venous pressure (CVP) is normal. d. Mean arterial pressure (MAP) is 72 mm Hg.

ANS: B Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently. The head of the bed is usually elevated to decrease dyspnea in patients with cardiogenic shock. Elevated temperature and flushing or itching of the skin are not typical of cardiogenic shock.

Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock? a. Check temperature every 2 hours. b. Monitor breath sounds frequently. c. Maintain patient in supine position. d. Assess skin for flushing and itching.

a. Alteration in cardiac output related to effects on the sympathetic nervous system

Which is a priority nursing diagnosis for a client taking an antihypertensive medication? a. Alteration in cardiac output related to effects on the sympathetic nervous system b. Knowledge deficit related to medication regimen c. Fatigue related to side effects of medication d. Alteration in comfort related to nonproductive cough

b. Fasting blood glucose level of 140 mg/dL

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

ANS: A, B, C, E Because sepsis is the most frequent etiology for SIRS, measures to avoid infection such as removing indwelling urinary catheters as soon as possible, use of aseptic technique, and early ambulation should be included in the plan of care. Adequate nutrition is important in preventing SIRS. Enteral, rather than parenteral, nutrition is preferred when patients are unable to take oral feedings because enteral nutrition helps maintain the integrity of the intestine, thus decreasing infection risk. Antibiotics should be administered within 1 hour after being prescribed to decrease the risk of sepsis progressing to SIRS.

Which preventive actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS) in patients admitted to the hospital (select all that apply)? a. Use aseptic technique when caring for invasive lines or devices. b. Ambulate postoperative patients as soon as possible after surgery. c. Remove indwelling urinary catheters as soon as possible after surgery. d. Advocate for parenteral nutrition for patients who cannot take oral feedings. e. Administer prescribed antibiotics within 1 hour for patients with possible sepsis.

a. "I will check my blood pressure daily and take my medication when it is over 140/90."

Which statement indicates that the client needs additional instruction about antihypertensive treatment? a. "I will check my blood pressure daily and take my medication when it is over 140/90." b. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." c. "I will change my position slowly to prevent feeling dizzy." d. "I will not mow my lawn until I see how this medication makes me feel."

d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."

Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)? a. "The medication may cause constipation, so I will increase fluid and fiber in my diet." b. "I should take this medication 1 hour after or 4 hours before my other medications." c. "I might need to take fat-soluble vitamins to supplement my diet." d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."

d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." b. "I should keep my nitroglycerin in a cool, dry place." c. "I should change positions slowly to avoid getting dizzy." d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."

Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications? a. "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." b. "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." c. "I will stop taking the medication if it causes nausea and vomiting." d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."

To demonstrate an understanding of the concept of afterload, the nurse identifies which of the following patients as having increased afterload? A hypothermic post-op coronary artery bypass surgical patient. A post-op carotid endarterectomy patient on nitroprusside (Nipride). A patient presenting in the early stages of septic shock. A patient with chest pain who is receiving IV nitroglycerin

a hypothermic post-op #1 is correct. Hypothermia causes vasoconstriction, which leads to increased afterload. #2, #3 and #4 are all patient scenarios in which the patient is experiencing vasodilation, which leads to decreased afterload.

A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include: a. CT scan B. angiography c. echocardiography d. ultrasound

a. CT scan

Nursing assessment of a client receiving serum albumin for treatment of shock should include: a.) Assessing lung sounds. b.) Monitoring glucose. c.) Monitoring the potassium level. d.) Monitoring hemoglobin and hematocrit.

a.) Assessing lung sounds. Rationale: Colloids pull fluid into vascular space. Circulatory overload could occur. The nurse should assess the client for symptoms of heart failure.

A client in shock is prescribed an inotropic drug to act on alpha and beta receptors. The nurse will most likely be administering: a.) Dopamine. b.) Dobutamine. c.) Pavulon. d.) Milrinone.

a.) Dopamine.

A patient is admitted to the emergency department after sustaining abdominal injuries and a broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory rate 34 breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type of shock? a.) Hypovolemic b.) Cardiogenic c.) Neurogenic d.) Distributive

a.) Hypovolemic

Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic hypovolemic shock? a.) Lactated Ringers (LR) b.) 10% Dextrose in Water (D 10 W) c.) One-half Normal Saline (1/2% NS) d.) Packed Red Blood Cells (PRBC)

a.) Lactated Ringers (LR)

The client experiences shock following a spinal cord injury. This type of shock is classified as: a.) Hypovolemic. b.) Neurogenic. c.) Cardiogenic. d.) Anaphylactic.

a.) Neurogenic.

A client has been diagnosed with sepsis. The nurse will most likely find which of the following when assessing this client: Select all that apply: a.) Rapid shallow respirations. b.) Severe hypotension. c.) Mental status changes. d.) Elevated temperature. e.) Lactic acidosis. f.) Oliguria.

a.) Rapid shallow respirations. d.) Elevated temperature.

The client in shock is prescribed an infusion of lactated Ringer's solution. The nurse recognizes that the function of this fluid in the treatment of shock is to: a.) Replace fluid, and promote urine output. b.) Draw water into cells. c.) Draw water from cells to blood vessels. d.) Maintain vascular volume.

a.) Replace fluid, and promote urine output.

A patient in compensated septic shock has hemodynamic monitoring with a pulmonary artery catheter and an arterial catheter. Which information obtained by the nurse indicates that the patient is still in the compensatory stage of shock? a.) The cardiac output is elevated. b.) The central venous pressure (CVP) is increased. c.) The systemic vascular resistance (SVR) is high. d.) The PAWP is high.

a.) The cardiac output is elevated. Rationale: In the early stages of septic shock, the cardiac output is high. The other hemodynamic changes would indicate that the patient had developed progressive or refractory septic shock.

A patient with a myocardial infarction (MI) and cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Hemodynamic monitoring reveals an elevated PAWP and decreased cardiac output. The nurse will anticipate: a.) administration of furosemide (Lasix) IV. b.) titration of an epinephrine (Adrenalin) drip. c.) administration of a normal saline bolus. d.) assisting with endotracheal intubation.

a.) administration of furosemide (Lasix) IV. Rationale: The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase myocardial oxygen demand and might extend the MI. The PAWP is already elevated, so normal saline boluses would be contraindicated. There is no indication that the patient requires endotracheal intubation.

When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the nurse will anticipate administration of large volumes of crystalloids when the a.) cardiac output is increased and the central venous pressure (CVP) is low. b.) pulmonary artery wedge pressure (PAWP) is increased, and the urine output is low. c.) heart rate is decreased, and the systemic vascular resistance is low. d.) cardiac output is decreased and the PAWP is high.

a.) cardiac output is increased and the central venous pressure (CVP) is low. Rationale: A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is indicated. Increased PAWP indicates that the patient has excessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated. Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenic shock, and fluids should be infused cautiously.

The nurse evaluates that fluid resuscitation for a 70 kg patient in shock is effective on finding that the patient's a.) urine output is 40 ml over the last hour. b.) hemoglobin is within normal limits. c.) CVP has decreased. d.) mean arterial pressure (MAP) is 65 mm Hg.

a.) urine output is 40 ml over the last hour. Rationale: Assessment of end-organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level is not useful in determining whether fluid administration has been effective unless the patient is bleeding and receiving blood. A decrease in CVP indicates that more fluid is needed. The MAP is at the low normal range, but does not clearly indicate that tissue perfusion is adequate.

A patient outcome that is appropriate for the patient in shock who has a nursing diagnosis of decreased cardiac output related to relative hypovolemia is a.) urine output of 0.5 ml/kg/hr. b.) decreased peripheral edema. c.) decreased CVP. d.) oxygen saturation 90% or more.

a.) urine output of 0.5 ml/kg/hr. Rationale: A urine output of 0.5 ml/kg/hr indicates adequate renal perfusion, which is a good indicator of cardiac output. The patient may continue to have peripheral edema because fluid infusions may be needed despite third-spacing of fluids in relative hypovolemia. Decreased central venous pressure (CVP) for a patient with relative hypovolemia indicates that additional fluid infusion is necessary. An oxygen saturation of 90% will not necessarily indicate that cardiac output has improved.

The nurse is planning the care of a client with an elevated pulmonary artery systolic pressure. What should be included in this plan of care?

administer diuretics monitor I&O Reduce preload by administering diuretcs and imposing fluid and sodium restrictions. The use of inotropic medications might be prescribed. An intraaortic balloon pump might be indicated. Nursing care should also include measuring intake and output and daily weights. Activities should be planned around rest periods.

Non-STEMI

an MI without ST segment elevation

Acute Decompensated Heart Failure

an increase in the pulmonary venous pressure caused by LV failure

A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is: A. Buerger's disease B. CHF C. Secondary hypertension D. Aneurysm

aneurysm

Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client? a. HPN b. Aneurysm rupture c. Cardiac arrythmias d. Diminished pedal pulses

aneurysm rupture

arterial disorders:

atherosclerosis in one place - it is everywhere it is a medical emergency if you have an acute arterial occlusion client will report numbness and pain the extremity will be cold no palpable pulse more symptomatic in the lower extremities intermittent claudication: hallmark sign -pain with activity *pain is only with an artery: no oxygen is getting to the extremity -causing coldness, numbness, decreased peripheral pulses, atrophy, bruit, skin and nail changes, and ulceration -pain at rest = severe obstruction

Sinus brady treatment

atropine 0.5 mg

During preoperative prep of patient scheduled for an abdominal aortic aneurysm the nurse establishes basline data for the patient knowing that a. postop all pphysiologic processes will be altered b. The cause of the aneurysm is a systemic vasuclar disease c. surgery will be canceled if any function is not normal d. blood pressure and HR will be maintained below normal levels during surgery

b. The cause of the aneurysm is a systemic vascular disease

During the patient's acute postop period following repair of an aneurysm, the nurse should ensure that: a. hypothermia is maintained to decrease 02 need b. the blood pressure and all peripheral pulses are evaluated at least every hour c. IV fluids are admin at a rate to keep urine at 100 ml / hr d. patient's bp is kept lower than baseline

b. the blood pressure and all peripheral pulses are evaluated at least every hour

An intensive care nurse, is assessing a patient with suspected sepsis. Which predisposing factors would expect to be found in the patient with septic shock? a.) A 45 year old client with a history of renal insufficiency. b.) A client age 65, with a history of cancer who is recovering from an abdominal peritoneal resection. c.) A 27 year old with pyelonephritis responding to treatment with an antibiotic. d.) A 50 year old with community acquired tuberculosis.

b.) A client age 65, with a history of cancer who is recovering from an abdominal peritoneal resection.

A patient who has been involved in a motor-vehicle crash is admitted to the ED with cool, clammy skin, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first? a.) Insert two 14-gauge IV catheters. b.) Administer oxygen at 100% per non-rebreather mask. c.) Place the patient on continuous cardiac monitor. d.) Draw blood to type and crossmatch for transfusions.

b.) Administer oxygen at 100% per non-rebreather mask. Rationale: The first priority in the initial management of shock is maintenance of the airway and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions should also be rapidly accomplished, but only after actions to maximize oxygen delivery have been implemented.

The acute care nurse is planning an inservice to present evidence based practices to address the increasing incidence in ventilator associated pneumonia. Interventions included in this protocol include: a.) Avoid the use of agents that increase the pH of the stomach as these blocks their antibacterial properties. b.) Maintaining the head of the bed at 30 degrees and strict hand washing before and after any patient contact. c.) Changing the ventilator circuit at least every 24 hours. d.) Provide routine oral care with a combination of alcohol based products.

b.) Maintaining the head of the bed at 30 degrees and strict hand washing before and after any patient contact.

Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention includes: a.) Monitoring for fluid overload. b.) Monitoring for cardiac dysrhythmias. c.) Monitoring respiratory status. d.) Monitoring for hypotension.

b.) Monitoring for cardiac dysrhythmias. Rationale: Dobutamine is beneficial in cases where shock is caused by heart failure. The drug increases contractility, and has the potential to cause dysrhythmias.

A patient who is receiving chemotherapy is admitted to the hospital with acute dehydration caused by nausea and vomiting. Which action will the nurse include in the plan of care to best prevent the development of shock, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction syndrome (MODS)? a.) Administer all medications through the patient's indwelling central line. b.) Place the patient in a private room. c.) Restrict the patient to foods that have been well-cooked or processed. d.) Insert a nasogastric (NG) tube for enteral feeding.

b.) Place the patient in a private room. Rationale: The patient who has received chemotherapy is immune compromised, and placing the patient in a private room will decrease the exposure to other patients and reduce infection/sepsis risk. Administration of medications through the central line increases the risk for infection and sepsis. There is no indication that the patient is neutropenic, and restricting the patient to cooked and processed foods is likely to decrease oral intake further and cause further malnutrition, a risk factor for sepsis and shock. Insertion of an NG tube is invasive and will not decrease the patient's nausea and vomiting.

To monitor a patient with severe acute pancreatitis for the early organ damage associated with MODS, the most important assessments for the nurse to make are a.) stool guaiac and bowel sounds. b.) lung sounds and oxygenation status. c.) serum creatinine and urinary output. d.) serum bilirubin levels and skin color.

b.) lung sounds and oxygenation status. Rationale: The respiratory system is usually the FIRST system to show the signs of MODS because of the direct effect of inflammatory mediators on the pulmonary system. The other assessment data are also important to collect, but they will not indicate the development of MODS as early.

A patient is treated in the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a.) check the blood pressure. b.) obtain an oxygen saturation. c.) attach a cardiac monitor. d.) check level of consciousness.

b.) obtain an oxygen saturation. Rationale: The initial actions of the nurse are focused on the ABCs, and assessing the airway and ventilation is necessary. The other assessments should be accomplished as rapidly as possible after the oxygen saturation is determined and addressed.

The nurse caring for a patient in shock notifies the health care provider of the patient's deteriorating status when the patient's ABG results include: a.) pH 7.48, PaCO2 33 mm Hg. b.) pH 7.33, PaCO2 30 mm Hg. c.) pH 7.41, PaCO2 50 mm Hg. d.) pH 7.38, PaCO2 45 mm Hg.

b.) pH 7.33, PaCO2 30 mm Hg. Rationale: The patient's low pH in spite of a respiratory alkalosis indicates that the patient has severe metabolic acidosis and is experiencing the progressive stage of shock; rapid changes in therapy are needed. The values in the answer beginning "pH 7.48" suggest a mild respiratory alkalosis (consistent with compensated shock). The values in the answer beginning "pH 7.41" suggest compensated respiratory acidosis. The values in the answer beginning "pH 7.38" are normal.

While caring for a seriously ill patient, the nurse determines that the patient may be in the compensatory stage of shock on finding a.) cold, mottled extremities. b.) restlessness and apprehension. c.) a heart rate of 120 and cool, clammy skin. d.) systolic BP less than 90 mm Hg.

b.) restlessness and apprehension. Rationale: Restlessness and apprehension are typical during the compensatory stage of shock. Cold, mottled extremities, cool and clammy skin, and a systolic BP less than 90 are associated with the progressive and refractory stages.

Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client? a. Bruit b. Crackles c. Dullness d. Friction rubs

bruit

The triage nurse receives a call from a community member who is driving an unconscious friend with multiple injuries after a motorcycle accident to the hospital. The caller states that they will be arriving in 1 minute. In preparation for the patient's arrival, the nurse will obtain a.) a liter of lactated Ringer's solution. b.) 500 ml of 5% albumin. c. ) two 14-gauge IV catheters. d.) a retention catheter.

c. ) two 14-gauge IV catheters. Rationale: A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient had been assessed for possible liver abnormalities. Although colloids may sometimes be used for volume expansion, it is generally accepted that crystalloids should be used as the initial therapy for fluid resuscitation. A catheter would likely be ordered, but in the 1 minute that the nurse has to obtain supplies, the IV catheters would take priority.

Following an ascending aortic aneurysm repair, the nurse monitors for and immediately reports: a. shallow resp and poor coughing b. decreased drainaged from chest tubes c. change in level of consciousness and ability to speak d. lower extremity pulses that are decreased from pre-op baseline

c. change in level of consciousness and ability to speak

A client is progressing into the third stage of shock. The nurse will expect this client to demonstrate: Choose all that apply: a.) Intractable circulatory failure. b.) Neuroendocrine responses. c.) Demonstrating MODS. d.) Buildup of metabolic wastes. e.) Profound hypotension. f.) Increase in lactic acidosis.

c.) Demonstrating MODS. d.) Buildup of metabolic wastes.

A 4.5 kg infant is admitted to the pediatric intensive care unit after 33 days of watery diarrhea. The infant is diagnosed with severe dehydration. The infant's skin is mottled and turgor is poor. Capillary refill is delayed, and there is an absence of tears with crying. Which intervention should be the priority action by the healthcare provider? a.) Calculate the mean arterial pressure b.) Draw blood for a complete blood count c.) Establish vascular access d.) Take a complete set of vital signs

c.) Establish vascular access Rationale: Vascular access should be established quickly in order to replace lost volume before shock progresses.

The healthcare provider is caring for a patient who has septic shock. Which of these should the healthcare provider administer to the patient first? a.) Antibiotics to treat the underlying infection. b.) Corticosteroids to reduce inflammation. c.) IV fluids to increase intravascular volume. d.) Vasopressors to increase blood pressure.

c.) IV fluids to increase intravascular volume. Rationale: Circulation and perfusion are addressed first so IV fluids will be started immediately. After blood cultures are obtained, broad-spectrum antibiotics should be administered without delay. Vasopressors are administered if the patient is not responding to the fluid challenge. Corticosteroids may be considered to address the inflammatory-induced vasodilation and capillary leakage.

When performing a physical assessment of a patient with severe sepsis, what abnormal assessment would the nurse expect to find? a.) A WBC of 8,100 despite the presence of chills. b.) A blood pressure of 100/72 with a capillary refill of <3 seconds. c.) Leucocytosis in a patient with absent bowel sounds. d.) Renal output that fluctuates according to intravenous intake.

c.) Leucocytosis in a patient with absent bowel sounds. Rationale: Leucocytosis in a patient with absent bowel sounds A white count > 12,000/mm3 and a left shift is one of the diagnostic criteria. Absent bowel sounds indicate a possible ileus. This would allow translocation of the intestinal flora into the bloodstream.

A patient who has pericarditis related to radiation therapy, becomes dyspneic, and has a rapid, weak pulse. Heart sounds are muffled, and a 12 mmHg drop in blood pressure is noted on inspiration. The healthcare provider's interventions are aimed at preventing which type of shock? a.) Distributive b.) Neurogenic c.) Obstructive d.) Cardiogenic

c.) Obstructive Rationale: Obstructive shock can be caused by anything that impedes the heart's ability to contract and pump blood around the body, as with cardiac tamponade.

Which of the following assessment findings is an early indication of hypovolemic shock? a.) Diminished bowel sounds b.) Increased urinary output c.) Tachycardia d.) Hypertension

c.) Tachycardia Rationale: Tachycardia is an early symptom as the body compensates for a declining blood pressure the heart rate increases to circulate the blood faster to prevent tissue hypoxia.

Multiple organ dysfunction syndrome (MODS) develops in severe sepsis as a result of systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation and damage to the endothelium. Which of the following statements best describes the management of MODS? a.) The use of proton pump inhibitors and H2 agents to increase the pH of the stomach inhibit the development of stress ulcers, an ileus and malabsorption issues. b.) Maintaining ventilator settings that ensure a tidal volume of at least 6 mL/kg of body weight will keep the lungs from being injured by endothelial damage. c.) There is no specific therapies for MODS other than supportive care and the early recognition of dysfunctional organ(s). d.) Much of the organ damage that occurs with MODS in the setting of severe sepsis is associated with pre-existing conditions.

c.) There is no specific therapies for MODS other than supportive care and the early recognition of dysfunctional organ(s).

Sepsis is the most common cause of disseminated intravascular coagulation (DIC). All of the following statements concerning this life threatening complications are true except: a.) The rapidity of onset is determined by the intensity of the trigger and is related to the condition of the patient's liver, bone marrow and endothelium. b.) In the early phase, the patient may demonstrate manifestations of thrombosis and microemboli. c.) Though a coagulopathy is present, excessive blood loss rarely results in hemorrhagic shock. d.) The most critical intervention for DIC is the early identification and treatment of the underlying disorder.

c.) Though a coagulopathy is present, excessive blood loss rarely results in hemorrhagic shock.

When caring for a patient who has just been admitted with septic shock, which of these assessment data will be of greatest concern to the nurse? a.) BP 88/56 mm Hg b.) Apical pulse 110 beats/min c.) Urine output 15 ml for 2 hours d.) Arterial oxygen saturation 90%

c.) Urine output 15 ml for 2 hours Rationale: The best data for assessing the adequacy of cardiac output are those that provide information about end-organ perfusion such as urine output by the kidneys. The low urine output is an indicator that renal tissue perfusion is inadequate and the patient is in the progressive stage of shock. The low BP, increase in pulse, and low-normal O2 saturation are more typical of compensated septic shock.

A patient with massive trauma and possible spinal cord injury is admitted to the ED. The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock, based on the finding of a.) cool, clammy skin. b.) shortness of breath. c.) heart rate of 48 beats/min d.) BP of 82/40 mm Hg.

c.) heart rate of 48 beats/min Rationale: The normal sympathetic response to shock/hypotension is an increase in heart rate. The presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock. The other symptoms are consistent with hypovolemic shock.

A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of a.) nitroglycerine (Tridil). b.) dobutamine (Dobutrex). c.) norepinephrine (Levophed). d.) sodium nitroprusside (Nipride).

c.) norepinephrine (Levophed). Rationale: When fluid resuscitation is unsuccessful, administration of vasopressor drugs is used to increase the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Dobutamine will increase stroke volume, but it would also further decrease SVR. Nitroprusside is an arterial vasodilator and would further decrease SVR.

A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the compensatory physiologic mechanism that leads to altered urinary output is a.) activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries. b.) stimulation of cardiac -adrenergic receptors, leading to increased cardiac output. c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. d.) movement of interstitial fluid to the intravascular space, increasing renal blood flow.

c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. Rationale: The release of aldosterone and ADH lead to the decrease in urine output by increasing the reabsorption of sodium and water in the renal tubules. SNS stimulation leads to renal artery vasoconstriction. -Receptor stimulation does increase cardiac output, but this would improve urine output. During shock, fluid leaks from the intravascular space into the interstitial space.

When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect which two patient findings to normalize? a.) Intensity of peripheral pulses and body temperature. b.) Peripheral pulses and heart rate (HR). c.) Metabolic alkalosis and oxygen saturation. d.) Cardiac output (CO) and blood pressure (BP).

d.) Cardiac output (CO) and blood pressure (BP).

The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and jugular veins are flat. Which of these actions is most appropriate for the nurse to take? a.) Slow the IV infusion rate b.) Administer dopamine c.) No interventions are needed at this time d.) Increase the IV infusion rate

d.) Increase the IV infusion rate

The nurse is caring for a patient admitted with a urinary tract infection and sepsis. Which information obtained in the assessment indicates a need for a change in therapy? a.) The patient is restless and anxious. b.) The patient has a heart rate of 134. c.) The patient has hypotonic bowel sounds. d.) The patient has a temperature of 94.1° F.

d.) The patient has a temperature of 94.1° F. Rationale: Hypothermia is an indication that the patient is in the progressive stage of shock. The other data are consistent with compensated shock.

low sodium diet:

decreases fluid retention and helps decrease preload watch salt substitutes: they can contain excessive potassium canned/processed foods and OTC meds can contain alot of sodium

signs and symptoms of digoxin toxicity:

early: anorexia, nausea, and vomiting late: arrhythmias and vision changes

fixed rate pacemakers

fire at a fixed rate constantly

pulmonary edema:

fluid in the lungs anyone is at risk, however, the following are just at an increased risk: -receiving IV fluids very quickly -the very young -the very old -anyone with a history of kidney or heart disease

diuretics:

furosemide hydrochlorothiazide bumetadine spironolactone action: decerases preload (volume) nursing considerations: give in the AM

if you see fluid retention always think ______________ first

heart problem

pre-load:

is the amount of blood returning to the right side of the heart and the muscle stretch that the volume causes ANP is released when we have this stretch *with increased preload = increased workload of the heart CVP: 2-6 or 6-12

a demand pacemaker

kicks in only when the patient needs it

signs and symptoms of malfunction:

loss of capture: when no contraction follows the stimulus the pacemaker can fire inappropriately = failure to sense watch for signs of decreased CO or decreased rate rate = the most concrete thing to assess

heart failure treatments:

low sodium diet elevate the head of the bed daily weights: report any weight gain above 2 lbs a day or 5 lbs a week report signs and symptoms of recurrent failure pacemaker balloon pump

When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated? a. Right upper quadrant b. Directly over the umbilicus c. Middle lower abdomen to the left of the midline d. Midline lower abdomen to the right of the midline

middle lower abdomen to the left of the midline

How much alcohol should you drink if you have HTN?

no more than 2 drinks a day

treatment go pulmonary edema:

oxygen: the priority nursing action is to administer high flow O2 monitor oxygen saturation and try to keep above 90% by titrating

The critical care nurse is describing the process of insertion of a pulmonary artery catheter to a colleague. The nurse demonstrates good understanding of the procedure by discussing the potential for stimulation of dysrhythmia during: initial introduction of the catheter into the central vessel. advancement of the catheter through the triscuspid valve. passing of the catheter through the right ventricle. inflation of the balloon upon reaching the pulmonary artery.

passing of the catheter through the RV

treatment of cardiac tamponade:

pericardiocentesis to remove the fluid from about the heart surgery-- may have to have a drain put in place

prevention of pulmonary edema:

prevent if possible -check lung sounds and avoid fluid volume excess

The nurse identifies which of the following patients as experiencing the most significant problem with oxygen carrying capacity? -The patient with SaO2 99; pO2 90; Hgb 7.5; Hct 22.3. -The patient with SaO2 95; pO2 90; Hgb 11.3; Hct 33.8. -The patient with SaO2 97; pO2 94; Hgb 10.8; Hct 31.4. -The patient with SaO2 94; pO2 90; Hgb 12.1; Hct 37.2.

pt with SaO2 99 This patient has SaO2 and pO2 within normal limits, but has significantly decreased Hgb and Hct, which impacts oxygen carrying capacity

The critical care nurse understands that effective contractility is critical to cardiac output. The nurse correctly identifies which of the following patients as being "at risk" for decreased cardiac output related to contractility concerns? A patient with a serum Ca++ level of 7.0. A patient with a serum K+ level of 6.0. A patient receiving an infusion of dopamine. A patient receiving an infusion of norepinephrine.

pt with serum k of 6 #2 is correct as hyperkalemia leads to decreased myocardial contractility and subsequently, decreased cardiac output. #1, #3 and #4 all represent situations in which contractility and cardiac output would increase.

When the nurse suspects that pressure waveforms are underdamped, it is appropriate to: fast flush to establish catheter patency. remove air bubbles in the pressure tubing. assess for blood in the pressure tubing. remove excess stopcocks on the tubing.

remove excess stopcocks on tubing

End organ damage in Eyes?

retinopathy

Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area? a. Hernia b. Stage 1 pressure ulcer c. Retroperitoneal rupture at the repair site d. Rapid expansion of the aneurysm

retropertioneal rupture at repair site

The nurse caring for a patient with an arterial line knows that a sterile cap which is removed for any reason: should be replaced with a fresh sterile cap. may be replaced after completion of the task. should be carefully handled to avoid contamination. may be piggy backed onto another cap temporarily.

should be replaced with a fresh sterile cap

What are systolic and diastolic blood pressures used for?

showing severity of disease Showing people at risk for stroke, MI, and aneurysm Guidelines to medicinal therapy

Which of the following treatments is the definitive one for a ruptured aneurysm? a. Antihypertensive medication administration b. Aortogram c. Beta-adrenergic blocker administration d. Surgical intervention

surgical intervention

The nurse knows that zero and calibration should be done how frequently to assure accurate readings by pressure monitoring devices? Only during system set-up. At least once following initial set-up. At least every day. Whenever readings are questioned.

whenever readings are questions

pacemaker:

your natural pacemaker is your SA node -- it sends out impulses making your heart contract if your heart rate drops below 60 cardiac output can decrease pacemakers are used to increase the heart rate with symptomatic bradycardia pacemakers can be temporary or permanent - invasive and non-invasive *can be demand or fixed always worry if the HR is less than the set rate it is okay for the rate to increase, but should never decrease