Delmars ch 4 Cardiac Disorders

15. the nurse assists the client with coronary artery disease to select which of the following menu choices? select all that apply: [ ] 1. mozzarella cheese [ ] 2. grilled cheddar cheese sandwich [ ] 3. tomato juice [ ] 4. peanut-butter sandwich [ ] 5. 2% milk [ ] 6. tortilla

15. 1. 6. cheddar cheese has higher fat content than mozzarella cheese, and a canned vegetable drink often has high sodium content. peanutbutter is a high-fat item. skim milk is preferred to 2%. tortilla is a low-fat item.

16. a child's mother asks the nurse how her child got hypertension and what it means. in explaining hypertension in children, the nurse would most appropriately respond that in children, hypertension "is 1. generally related to another disease process." 2. generally not treated." 3. usually nothing to worry about." 4. related to cholesterol levels."

. 16. 1. secondary hypertension is much more common in children than primary hypertension. it is usually a manifestation of another disease process. hypertension in children is of concern and treatable. the association with cholesterol is not applicable.

20. the parents of a 3-year-old child with tetralogy of fallot tell the nurse that their child frequently squats during play. Based on an understanding of tetralogy of fallot, the nurse recognizes that this is 1. normal for the child's developmental age. 2. a sign of constipation. 3. a compensatory mechanism. 4. a disinterest in engaging in play.

. 20. 3. tetralogy of fallot is comprised of a ventral septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. squatting helps the child's circulatory system compensate for episodes of hypoxemia, especially during active periods

21. Which of the following should the nurse include in the plan of care for a child diagnosed with secondary hypertension? 1. Weight control 2. managing cholesterol levels 3. use of diuretics 4. treatment of the underlying condition

. 21. 4. secondary hypertension in a child is related to an underlying disease process. treatment of that condition will most commonly significantly improve the hypertension. Weight control, use of diuretics, and managing the cholesterol level are common treatments for primary hypertension, which is rare in children.

24. a child with an atrioventricular canal has been experiencing difficulty breathing and productive cough for 3 days. on admission, the nurse notes nasal flaring and retractions. at this point the nurse's priority action is to 1. inform the physician of the client's worsening condition. 2. administer oxygen via mask. 3. reassure the parents. 4. obtain the child's weight.

. 24. 2. an atrioventricular canal is a defect that allows blood to flow among all four chambers. an atrial septal defect is continuous with a ventricular septal defect along the septum, also affecting both av valves (mitral and tricuspid), creating essentially one large chamber. Blood flow direction depends on the child's peripheral resistance and pulmonary resistance as well as ventricular pressures. this defect is seen in Down syndrome. this client is experiencing labored breathing and requires oxygen immediately. this can be applied quickly before calling the physician. reassuring the parents and obtaining a weight are also important interventions, but immediate oxygen could reduce the difficulty of breathing for this child and help stabilize the condition.

8. which of the following is the priority nursing intervention for a client who is receiving adenosine (adenocard) for supraventricular tachycardia (svt)? 1. Document the presence of peripheral pulses 2. Monitor the pulse oximetry 3. assure a patent iv in the antecubital vein 4. prepare for emergency defibrillation

. 8. 3. adenosine (adenocard) is an antiarrhythmic that must be given in a large vessel, closest to the heart, due to its extremely short half-life. Documenting the presence of peripheral pulses, monitoring the pulse oximetry, and preparing for emergency defibrillation are all appropriate interventions, but the drug cannot be administered without iv access, so this is the priority

9. a client has been taking viagra and is now experiencing angina. the physician has prescribed nitroglycerin p.r.n. for the angina. which of the following should the nurse include in the discharge instructions? 1. viagra should not be used within 24 hours of taking nitroglycerin 2. nitroglycerin and viagra should be taken at the same time 3. viagra is not effective when used in combination with nitroglycerin 4. the effect of nitroglycerin is impaired by concurrent use with viagra

. 9. 1. when used in combination, viagra and nitroglycerin may cause life-threatening hypotension. the manufacturer's recommendations state that viagra should not be used within 24 hours of taking nitroglycerin.

1. which of the following is the priority for the nurse to assess before administering digoxin (lanoxin)? 1. auscultate the apical pulse for 1 full minute 2. palpate the radial pulse for 60 seconds 3. Monitor the renal function tests 4. assess the serum potassium

1. 1. a long-standing hallmark in the nursing interventions of the plan of care for a client taking digoxin (lanoxin) is to take the apical pulse for a full minute. this is the priority nursing action. Bradycardia, in which the pulse is less than 60 beats per minute for 1 full minute, is one potential sign of digoxin toxicity. although monitoring the renal function tests and serum potassium are appropriate interventions in the plan of care for a client taking lanoxin, they are not the priority.

15. Which of the following should the nurse include in the discharge instructions for an infant with an atrial septal defect? 1. a discussion of speech development 2. Cardiopulmonary resuscitation 3. the necessity of monitoring for obesity 4. home oxygen saturation monitoring

15. 2. an atrial septal defect is an abnormal connection between the right and left atria. Children with any heart defect are at a higher risk for heart failure. instruction in cardiopulmonary resuscitation (Cpr) increases parental confidence and prepares them to handle an emergency

. 1. during a routine physical examination, a client reports recent occipital headaches, blurred vision, fatigue, and increasing edema. the nurse reports these findings as indicative of 1. endocarditis. 2. hypovolemic shock. 3. hypertension. 4. ventricular tachycardia.

1. 3. clinical manifestations of hypertension include blurred vision, fatigue, occipital headaches, and increased edema.

3. after medication teaching on atenolol (tenormin), which of the following statements by a client with diabetes mellitus demonstrates an understanding of the atenolol? 1. "it may cause hyperglycemia." 2. "it may mask an early indication of hypoglycemia." 3. "it may increase the action of insulin." 4. "it may diminish the action of insulin."

3. 2. Beta blockers, such as atenolol (tenormin), depress the heart rate and prevent tachycardia, one of the early indications of hypoglycemia.

10. the nurse is caring for a client who has an allergy to penicillin. immediately after receiving cefazolin (ancef) iv for prophylaxis for a pacemaker insertion, the client becomes restless, tachycardic, and hypotensive. which of the following interventions should the nurse implement as the priority? 1. administer epinephrine (adrenaline) 2. obtain stat blood culture 3. administer thrombolytic therapy 4. administer atropine

10. 1. blood cultures and iv antibiotics are appropriate for a client in septic shock. thrombolytic therapy is indicated for some clients experiencing an acute mi or peripheral clot. atropine would be appropriate for an individual who has symptomatic bradycardia or heart block. the client has a known allergy to penicillin, and cefazolin (ancef) is a related cephalosporin, so the client is likely experiencing a severe allergic reaction. the priority intervention for anaphylactic shock would be to monitor the airway and give epinephrine, while infusing rapid iv fluids for hypotension.

10. the nurse is caring for a child with Kawasaki disease. Which of the following would indicate to the nurse that the client's condition is deteriorating? 1. Bradycardia 2. strep throat 3. arrhythmias 4. hypotension

10. 3. Kawasaki disease is a multisystem vasculitis that affects the coronary arteries. hypotension and strep throat are not manifestations seen in Kawasaki disease. Cardiac complications are the most serious and contribute to morbidity and mortality. tachycardia, a gallop rhythm, and congestive heart failure may occur.

10. which of the following adverse reactions should the nurse assess in a 70-year-old adult who is receiving a continuous infusion of lidocaine? 1. hypertension 2. osteoarthritis 3. confusion 4. Decreased visual acuity

10. 3. lidocaine is an antiarrhythmic used in the treatment of ventricular arrhythmias. confusion is a potential adverse reaction of a lidocaine infusion and is more common in the older adult.

11. the nurse would expect which of the following clinical manifestations to be present in a 9-month-old infant with hypoplastic left heart? select all that apply: [ ] 1. heart murmur [ ] 2. Cyanosis [ ] 3. hypertension [ ] 4. heart rate of 130 beats per minute [ ] 5. tachypnea [ ] 6. syncope

11. 1. 2. 5. heart murmur and cyanosis would be characteristic of hypoplastic left heart. heart rate of 130 at rest is within normal range for an infant. increasing respiratory crackles could indicate an increased load on the right ventricle and increased potential for heart failure. hypotension is also a manifestation.

1. Based on an understanding of beta blockers used for unstable angina, the nurse administers a beta blocker because of which of the following actions? 1. to increase myocardial contractility 2. to decrease heart rate 3. to promote cardiovascular fluid shift 4. coronary artery vasodilation

11. 2. Beta blockers decrease the heart rate, diminishing the work of the heart and the oxygen needs, which results in a decrease in the anginal pain.

11. after a myocardial infarction, a client has concerns about when it is safe to resume sexual activity. the most appropriate response by the nurse is 1. "you should really talk to your doctor about that." 2. "continue with the sexual practice with which you are most comfortable." 3. "you need to first undergo a cardiac stress test." 4. "when you're able to climb two flights of stairs comfortably."

11. 4. discussing timing for the client to resume sexual activity should be handled matter-offactly by the nurse while discussing other activities. the client may not be physically ready to continue with comfortable sexual practices immediately after the myocardial infarction. the client needs an objective indicator. a cardiac stress test is not necessary prior to resuming sexual activity, while the ability to climb two flights of stairs comfortably is a good guideline.

12. which of the following interventions should the nurse include in the plan of care for a client taking an ace inhibitor? 1. Monitor the blood pressure closely for 2 hours after the first dose 2. Begin with a high dose and gradually decrease the dose 3. administer potassium supplements to the client 4. Begin with daily dosing followed by dosing every other day

12. 1. ace inhibitors used in the treatment of hypertension have a high potential for "first dose" hypotension, necessitating precautionary blood pressure monitoring

12. in preparing a client for a transesophageal echocardiogram (tee), the nurse should include which of the following in the client education? 1. "you will be able to eat only soft foods for the first day after the procedure." 2. "you will need a designated driver to take you home." 3. "the procedure involves a series of x-rays that may require you to come back." 4. "the procedure involves a balloon that will press plaque against the blocked walls of your coronary artery."

12. 2. after a transesophageal echocardiogram (tee), the client should be able to eat lukewarm food as soon as the gag reflex returns, usually just a few hours after receiving anesthetizing spray in the back of the throat. x-rays are not involved, nor is the client undergoing a balloon procedure such as the coronary angioplasty. having a designated driver will be needed after a transesophageal echocardiogram because the client has received iv sedation.

12. the nurse is administering digoxin (lanoxin) to a child with cardiac disease. the nurse should report which of the following manifestations indicative of digoxin toxicity? select all that apply: [ ] 1. hypertension [ ] 2. Cyanosis [ ] 3. visual disturbances [ ] 4. inconsolability [ ] 5. Weakness [ ] 6. Headache

12. 3. 5. 6. Clinical manifestations of digoxin toxicity are visual disturbances, weakness, headache, apathy, and psychosis.

13. the nurse selects from which of the following calcium-channel blockers to administer to a client with hypertension? select all that apply: [ ] 1. amlodipine (norvasc) [ ] 2. enoxaparin (lovenox) [ ] 3. Dabigatran etexilate (pradaxa) [ ] 4. verapamil (calan) [ ] 5. Diltiazem hydrochloride (cardizem) [ ] 6. Mexiletine (Mexitil)

13. 1. 5. 6. amlodipine (norvasc), diltiazem hydrochloride (cardizem), and verapamil (calan) are all calcium-channel blockers. enoxaparin (lovenox) is a low-molecularweight heparin. Dabigatran etexilate (pradaxa) is an oral anticoagulant. Mexiletine (Mexitil) is a class B antidysrhythmic.

13. after receiving a permanent pacemaker, the client asks the nurse if there are any activities to avoid during a vacation scheduled for 4 months after discharge. which of the following is the most appropriate response by the nurse? 1. "there are no restrictions on your activity." 2. "you should avoid working over a running engine." 3. "avoid standing in front of microwave ovens." 4. "swimming in the ocean should be avoided."

13. 2. early microwave ovens required avoidance by persons with pacemakers, but not current models. swimming would be contraindicated for the first few weeks due to abduction of the arm while the leads were still adhering to the muscle of the heart. however, 4 months postoperatively, the client should be able to abduct arms for swimming. working over a running engine, as well as being near highfrequency power waves, is contraindicated for anyone with a permanent pacemaker

13. the nurse is caring for a child with a possible diagnosis of rheumatic fever. Which of the following assessment findings does the nurse evaluate as a diagnostic criterion? 1. Decreased erythrocyte sedimentation rate 2. Bradycardia 3. elevation of antistreptolysin (aso) levels 4. Desquamation of the fingertips

13. 3. streptococcal infection precedes the development of rheumatic fever by approximately 2 weeks. elevation of antistreptolysin (aso) levels indicates a recent strep infection.

14. When preparing discharge teaching for a family of a child recovering from rheumatic fever, the nurse's priority instruction is 1. the child needs to take prophylactic antibiotics to prevent endocarditis. 2. the child should resume school activities as soon as tolerated. 3. parents should inform the school nurse of the child's illness. 4. parents should monitor the child for poor appetite and growth.

14. 1. rheumatic fever is thought to be an autoimmune disorder related to group a streptococcal infection. future streptococcal infection and the risk for endocarditis can be prevented with prophylactic antibiotic administration. resuming school activities and informing the school nurse about the illness may be appropriate interventions, but they are of lower priority. poor appetite and growth do not generally occur with rheumatic fever unless the child already has experienced significant heart damage.

14. a client's family member asks the nurse how to know if the client is improving while receiving furosemide (lasix) for congestive heart failure. the nurse's response should be based on the understanding that improvement in the client's condition is characterized by 1. diminishing oxygen needs. 2. increased thirst. 3. weight gain. 4. intake greater than output.

14. 1. with congestive heart failure (chf), fluid accumulates in the lung tissue due to ineffective pump action by the heart. as a diuretic, furosemide (lasix) works to remove excess bodily fluids via the kidneys. the fluid shifts out of the lung tissue and therefore diminishes oxygen needs.

14. after a client with coronary artery disease develops heavy, substernal chest pain, which of the following interventions should the nurse do first? 1. administer 2 puffs of albuterol (proventil) by mouth 2. administer 1 tablet of nitroglycerin under the tongue every 5 minutes; call 911 if no relief after 15 minutes 3. administer 0.04-mg iv push nitroglycerin slowly over 1 to 2 minutes 4. administer immediate synchronized cardioversion

14. 2. administering albuterol (proventil) in a situation where a client had exercise-induced asthma and experienced shortness of breath would be appropriate. however, for a client with known cardiac disease who is experiencing chest pain, the inhaler would not be appropriate. nitroglycerin is not given iv push. immediate synchronized cardioversion is appropriate for the client in pulseless ventricular tachycardia or ventricular fibrillation. correct administration of nitroglycerin for a client who has coronary artery disease involves 1 nitroglycerin tablet every 5 minutes (if blood pressure is above 90 systolic) for up to 3 tablets, then calling 911 if no relief.

15. a client with congestive heart disease returns to the clinic with muscle aching. the physician orders a potassium level, which shows hypokalemia. the drug regimen includes furosemide (lasix) 80 mg b.i.d. in addition to treatment with a potassium supplement, the nurse administers which of the following prescribed drugs? 1. Bumetanide (Bumex) 2. torsemide (Demadex) 3. spironolactone (aldactone) 4. clonidine (catapres)

15. 3. spironolactone (aldactone) is a potassiumsparing diuretic. its diuretic action is scant and it works to retain potassium. it is very often used in combination with the more powerful loop diuretics, such as furosemide (lasix), to counteract their potassium-wasting effects. Bumetanide (Bumex) and torsemide (Demadex) are loop diuretics, which deplete the body of potassium. clonidine (catapres) is an antihypertensive.

16. while providing care to a client on cholestyramine (questran), the nurse should monitor the client for which of the following? select all that apply: [ ] 1. Urinary retention [ ] 2. abdominal pain [ ] 3. Bradycardia [ ] 4. flatulence [ ] 5. constipation [ ] 6. confusion

16. 2. 4. 5. cholestyramine (questran) is an antihyperlipidemic. it absorbs and combines with intestinal bile acids, forming an insoluble, nonabsorbable complex that is excreted in the feces. adverse reactions include abdominal pain, flatulence, and constipation.

16. in caring for a client with a cardiac history, the client has a temperature of 39.4°c or 103°F, becomes tachycardic, hypotensive, and short of breath while exhibiting cool, clammy skin and a decreased urine output. the client also has positive blood cultures. the nurse should include which of the following in the plan of care for this client? 1. assistance with pericardiocentesis 2. administration of antihypertensives 3. administration of vasopressors 4. assistance with defibrillation

16. 3. a client who is exhibiting a temperature of 39.4°c, or 103°F, becomes tachycardic, hypotensive, and has shortness of breath with cold, clammy skin and a decreased urine output has signs of septic shock (systemic infection) with known positive blood cultures. a pericardiocentesis is an intervention for cardiac tamponade, a condition that may also result in shock, but is also generally accompanied by muffled heart sounds and pulsus paradoxus, neither of which are presented in this client. antihypertensive drugs would cause the client's blood pressure to drop even further. if the client were in a pulseless ventricular tachycardia or fibrillation, emergency defibrillation would be indicated, but no dysrhythmia is present in the scenario. vasopressors are indicated to raise the blood pressure. rapid iv fluid administration and inotropic drugs may be used as well.

17. Which of the following should the nurse include in the preoperative teaching for the parents of a child scheduled for cardiac surgery? 1. a warning to avoid bringing toys from home to the hospital 2. a warning that siblings should not visit 3. Concepts of pain management 4. a tour of the general pediatric care unit

17. 3. it is appropriate to instruct the parents of a child scheduled for cardiac surgery in the concepts of pain management. toys from home can be comforting to a hospitalized child as can sibling visits. siblings are also comforted by seeing the child in person. although a tour of the intensive care unit is appropriate, the tour of general pediatrics can come later as necessary.

17. the nurse is caring for a client on a heparin infusion when the client expresses concern over a progressively painful headache. which of the following is the priority nursing action? 1. stop the heparin infusion 2. administer protamine 3. notify the physician 4. administer morphine

17. 3. the priority nursing action is to notify the physician. headache, although rare, is an adverse reaction to a heparin hypersensitivity. the nurse may anticipate stopping the heparin infusion or administering protamine sulfate, a heparin antagonist, but the priority intervention is to notify the physician of a potential hypersensitivity.

17. which of the following should the nurse include in the preoperative teaching for a client scheduled for coronary artery bypass graft (cabg) surgery? 1. a liquid diet will be ordered for the first 4 to 5 days postoperatively 2. coughing is to be avoided in order to protect the sternal incision 3. the hospital stay is generally about 10 days 4. high-calorie supplements are encouraged in the first few weeks postoperative

17. 4. the first meal after coronary artery bypass graft surgery may be clear liquids, but the client quickly progresses to a low-fat and low-salt diet as soon as it can be tolerated. coughing is important to clear the airways, and is done by splinting the sternum with a pillow. hospital stays are generally 4 to 5 days. a poor appetite may be present for the first few weeks and clients are encouraged to try high-calorie supplements.

18. a nurse caring for a young child with a newly diagnosed atrial septal defect would 1. prepare the child for echocardiogram. 2. discuss life expectancy with the parents. 3. assess for signs of liver damage. 4. monitor the child for cyanotic spells.

18. 1. an atrial septal defect is an abnormality between the left and right atria. a chest x-ray and an echocardiogram are generally performed to demonstrate the increase in the heart size and location and size of the defect. Cyanotic spells are generally not seen in atrial septal defects. Cyanosis itself is rare unless the defect in the septum is large enough to allow significant mixing of oxygenated and unoxygenated blood.

18. a client has been taking warfarin sodium (coumadin) for the prevention of deep vein thrombosis. when the home care nurse arrives for a weekly visit, the client reports having been using aspirin (acetylsalicylic acid) daily for arthritic pain since hearing a commercial ontelevision bolstering its benefits. which of the following is the most appropriate response by the nurse, based on an understanding of the effect of combining coumadin with aspirin? 1. "as long as you use aspirin only once a day, there will be no problems." 2. "coumadin and aspirin used in combination increases the potential for bleeding." 3. "aspirin and coumadin may be used safely together." 4. "coumadin may be used with aspirin without problem if vitamin k is taken with each dose."

18. 2. aspirin inhibits platelet aggregation, diminishing the potential for clot formation. warfarin (coumadin) is an anticoagulant that interferes with blood clot formation by interfering with the synthesis of vitamin k clotting factors, resulting in depletion of the clotting factors. the combination of coumadin and aspirin increases the potential for bleeding

18. the nurse observes the ecg rhythm of a client who has received a new permanent pacemaker for third-degree heart block. several spikes are noted on the rhythm, but are not followed by any other waveforms. the nurse recognizes this as 1. an indication that the pacemaker is adhering to the heart. 2. a normal finding because spikes should never be seen on a pacemaker ecg rhythm strip. 3. the sinoatrial (s-a) node is beating appropriately but may not show up on the rhythm strip. 4. an abnormal finding because every spike on the ecg strip should be followed by a waveform.

18. 4. although it is true that the pacemaker leads need time to adhere to the heart muscle after implantation, the correct precaution is to keep the affected side's arm near the body for about 1 to 3 weeks. it does not mean that the device won't function properly as soon as it is implanted. spikes are seen on an ecg waveform strip when the pacemaker discharges an electrical stimulus to the heart and should be followed by a p wave (for atrial depolarization) or a Qrs wave (ventricular depolarization) as indicated by pacemaker programming.

19. the nurse assesses the left foot of a client with known coronary artery disease that has become suddenly cold, painful, and pulseless. which of the following would be the priority intervention for this client? 1. notify the physician 2. provide education to the client about probable bypass surgery for the client's leg the following week 3. instruct the client on importance of daily doses of warfarin (coumadin) 4. instruct the client to restrict activity, keeping it warm and elevated until it heals

19. 1. scheduling bypass surgery for a week after the left foot of a client has suddenly become cold, painful, and pulseless is not an aggressive enough treatment, as ischemia, tissue necrosis, and gangrene may happen within several hours from an acute arterial occlusion. warfarin (coumadin) anticoagulant therapy would be likely after the intervention for this occlusion, but is not the nurse's immediate priority. keeping the limb elevated may actually cause more pain, and is indicated for someone with venous stasis or venous phlebitis. the nurse needs to notify the physician immediately so this client can be seen and arrangements can be made for immediate transport to a hospital where the client can be evaluated for possible catheter-directed thrombolytic therapy, emergency embolectomy, or bypass surgery.

19. the nurse is instructing a client on clopidogrel bisulfate (plavix). which of the following statements by the client indicates an understanding of the effect of this drug? 1. "i should ambulate slowly." 2. "i may experience hypotension." 3. "i should use caution taking other drugs that cause bleeding." 4. "i should take a stool softener while on this drug."

19. 3. clopidogrel bisulfate (plavix) is an antiplatelet drug that inhibits platelet aggregation, diminishing the potential for clot formation. caution should be used when taking other drugs that may increase bleeding. plavix may cause the adverse reactions of hypertension and diarrhea.

19. to reduce cardiac workload, the nurse should implement which of the following nursing interventions for a child in heart failure? 1. place the child in trendelenburg position 2. encourage fluids 3. schedule regular meals three times a day 4. provide a quiet environment

19. 4. placing a child with a cardiac condition in a trendelenburg position and encouraging fluids would actually increase cardiac workload. the preferred method of feeding to reduce cardiac workload is to feed five to six small meals a day. a quiet environment reduces stress and anxiety, resulting in a reduced cardiac workload

22. the nurse caring for an infant with patent ductus arteriosus informs the parents that corrective surgery will prevent 1. pulmonary vascular congestion. 2. increased systemic venous pressure. 3. cerebral vascular hemorrhage. 4. hepatomegaly.

22. 1. the ductus arteriosus is a direct connection between the main pulmonary artery and the aorta. When the connection remains open several weeks after birth in a full-term infant, it is a patent ductus arteriosus. patent ductus arteriosus causes an increase in blood flow in the reverse of what it was in fetal life as systemic pressure increases relative to pulmonary pressures. this causes an increase in pulmonary flow through the pulmonary artery. pulmonary vascular congestion is the risk in this case.

2. the nurse is reviewing the chart of a child with coarctation of the aorta. Which of the following findings would the nurse anticipate? 1. Congestive heart failure 2. Cerebral hypertension 3. hypoxemia 4. femoral artery hypertension

2. 2. Coarctation of the aorta is a stenosis most commonly located within the thoracic aorta that increases systemic resistance at the site of the coarctation. this causes an increase in pressure proximal to the coarctation, causing hypertension in the cerebral arteries. arteries distal to the coarctation have reduced pressure, causing lower extremity hypotension.

2. Upon finding a client in cardiac arrest, the nurse should administer which of the following drugs first? 1. atropine 2. epinephrine 3. lidocaine 4. atenolol (tenormin)

2. 2. epinephrine is the initial drug administered for cardiac arrest using the advanced cardiac life support (acls) algorithm. atropine is used to restore cardiac rate in a client experiencing symptomatic sinus bradycardia. lidocaine is used in the treatment of arrhythmias. atenolol (tenormin) is a beta-adrenergic blocking drug used for hypertension

2. a client's parents ask the nurse, "what is the prognosis of myocarditis?" the most appropriate response by the nurse is 1. "a heart transplant would be very promising." 2. "most often, a person will do well with coronary artery bypass surgery." 3. "a coronary angioplasty would only involve a 1- to 3-day hospitalization." 4. "recovery usually happens without any special treatment."

2. 4. a heart transplant is a late-stage intervention for cardiomyopathy, which rarely results from myocarditis. coronary artery bypass surgery is indicated for people with . 2 vessel disease not responsive to medical treatment. coronary angioplasty is indicated for people with coronary artery lesions causing angina-related symptoms. myocarditis is often asymptomatic and most often resolves spontaneously

22. the nurse is developing a medication schedule for a client receiving simvastatin (Zocor).to promote maximal effectiveness, the nurse should administer the drug 1. 30 minutes before a meal. 2. with meals. 3. at bedtime. 4. early in the morning.

22. 3. simvastatin (Zocor) is an antihyperlipidemic. Because cholesterol synthesis normally increases during the night, statins such as Zocor are most effective when given in the evening.

20. the nurse should monitor a client with an acute myocardial infarction who is receiving intravenous streptokinase (streptase) for which of the following serious adverse reactions? 1. intracranial hemorrhage 2. intractable nausea 3. extension of myocardial damage 4. pulmonary embolus

20. 1. streptokinase (streptase) is a thrombolytic enzyme used in the treatment of deep vein thrombosis, arterial thrombosis, acute evolving myocardial infarction, and pulmonary embolism, and to clear an occluded arteriovenous and iv cannula. it is a priority that the client is monitored for an intracranial hemorrhage that could potentially lead to coma and death.

20. plans for nursing interventions for a client in the acute stage of bacterial endocarditis should include which of the following interventions? 1. daily ecgs 2. administration of analgesics as needed 3. strict fluid restriction 4. aggressive physical therapy

20. 2. antibiotics to combat the bacterial infection and analgesics for aches that may occur are appropriate interventions for acute-stage bacterial endocarditis. adequate fluid intake is important also. however, aggressive physical therapy is contraindicated in the acute stage because the client needs to reserve some physical resources for recovery. daily ecgs are not necessary for acute bacterial endocarditis.

21. which of the following is a priority for the nurse to report when obtaining a history from a client scheduled for a coronary angiogram? 1. a history of rheumatic heart disease 2. a history of allergy to shellfish 3. a recent diagnosis of hyperlipidemia 4. a previous coronary angioplasty to the right coronary artery

21. 2. although obtaining a clear record of the client's cardiac history is important prior to a coronary angiogram, it is a priority to notify the physician of an allergy to shellfish. the client with a shellfish allergy is more likely to be allergic to the contrast dye used in the procedure. an order may be given to give diphenhydramine (benadryl), steroids, or extra iv fluids before the procedure. the chart should be marked for an allergy to shellfish.

21. the nurse is caring for a client taking atorvastatin (lipitor). the client admits to consuming 6 to 12 beers daily. the nurse should monitor the client for what potentially serious adverse reaction to lipitor? 1. nephrotoxicity 2. hypertension 3. hepatotoxicity 4. Dyspepsia

21. 3. atorvastatin (lipitor) is an antihyperlipidemic and hMG-coa reduction inhibitor. the risk for hepatotoxicity while using lipitor is increased by excessive alcohol ingestion.

22. which of the following should the nurse include in the plan of care for a client following a coronary angiogram? 1. vigorous leg exercises 2. immediate cardiac stress test 3. encourage fluids 4. activity restriction for 4 to 6 weeks

22. 3. the client's leg on the side where the cardiologist entered the femoral artery needs to remain still for a period of time after the procedure (usually 2 to 4 hours) in order to allow the arterial site to seal. a cardiac stress test would not be indicated because the angiogram provides a more definitive diagnostic work-up. a 4- to 6-week activity restriction may be indicated after a large myocardial infarction, but not for a simple coronary angiogram, after which the client can begin walking hours later. the client should be encouraged to drink fluids to protect the kidneys from the contrast dye.

23. Which of the following is the nurse's priority intervention in a child with pulmonary stenosis? 1. monitor for indications of congestive heart failure 2. educate the parents regarding home medications 3. provide sensory preparation for a chest x-ray 4. Discuss the child's nutritional and developmental needs

23. 1. pulmonary stenosis is a narrowing of the pulmonary valve and obstruction of the blood flow from the right ventricle to the lungs. monitoring the child for congestive heart failure is the priority as it is potentially life threatening. provision of sensory preparation for the x-ray is also important but not as significant as monitoring for congestive heart failure (Chf). educating the parents abouthome medications and discussing the child's nutritional and developmental needs are appropriate interventions later in the

23. the nurse assesses a client taking heparin for thrombocytopenia when the platelets drop below what level mm3? ___________

23. 100,000. heparin-induced thrombocytopenia is a state characterized by increased thrombosis despite a reduction in circulating platelets less than 100,000/mm3.

23. the nurse is teaching a class to student nurses on rheumatic fever. which of the following should the nurse include in the class? rheumatic fever 1. occurs mainly in the elderly. 2. is more likely to develop after a varicella zoster infection. 3. is diagnosed easily with a throat culture and serum antistreptolysin titer. 4. may be diagnosed by a series of two-step blood cultures.

23. 3. rheumatic fever occurs primarily in young adults and is mostly likely to develop after a group a beta-hemolytic streptococcal upper respiratory infection. diagnosis is not done by a series of blood cultures, but rather with a throat culture and serum antistreptolysin titer.

24. which of the following should the nurse include in the plan of care for the client experiencing pain from a deep vein thrombosis (dvt) of the leg who is receiving heparin and warfarin (coumadin)? administration of 1. aspirin 325 mg p.o. every 4 hours. 2. patient-controlled analgesic of iv morphine. 3. hydromorphine hydrochloride (dilaudid) 2 mg intramuscular every 4 hours. 4. ibuprofen (motrin) 400 mg p.o. every 6 hours p.r.n.

24. 2. a daily dose of aspirin would be ordered for antiplatelet effect, not for pain control. a client with a deep vein thrombosis would be receiving heparin therapy, so intramuscular injections should be avoided (due to possible hematoma formation at injection sites). ibuprofen (motrin) is also contraindicated for a client receiving oral anticoagulants due to possible drug interaction. the best solution to this client's pain would be patient-controlled iv analgesic.

24. the nurse is caring for a client admitted with severe rectal bleeding who is receiving warfarin (coumadin) therapy. which of the following interventions should have priority in the plan of care? 1. accurate intake and output 2. Discontinue the warfarin 3. assure a patent 18-gauge iv 4. administer vitamin k

24. 3. although maintaining an accurate intake and output, discontinuing the coumadin, and administering vitamin k may be anticipated, the priority intervention is to assure an 18-gauge iv needed for potential transfusion of blood, if bleeding causes hypovolemia and low hemoglobin.

25. the client with a recent diagnosis of cardiomyopathy asks the nurse, "what contributed to my getting this illness?" the most appropriate response is to say that the majority of clients with cardiomyopathy also have 1. hypertension. 2. a viral infection. 3. a genetic trait. 4. an unknown cause.

25. 4. although hypertension, viral infection, or a genetic trait may all be possible reasons for developing cardiomyopathy, the majority of cases are idiopathic (unknown reason).

25. the registered nurse is preparing to delegate assignments for the day. which of the following assignments would be appropriate to delegate to a licensed practical nurse? 1. contact a client's physician when the blood pressure is lower than 100 mm hg before administering a beta2-adrenergic blocker 2. Monitor the heparin level daily before administering heparin 3. question administration of streptokinase (streptase) to a client admitted and suspected of an intracranial hemorrhage 4. take the blood pressure before administering a dose of verapamil (calan

25. 4. contacting a client's physician, monitoring the heparin level, and questioning the administration of a drug are all nursing tasks that should be performed by a registered nurse. a licensed practical nurse (lpn) may take a blood pressure before administering a drug. lpns are trained to take the blood pressure; if the blood pressure is too low or too high, it becomes the responsibility of the registered nurse to notify the physician.

25. the nurse is assessing an infant who has been transferred from another facility for examination of possible cardiac anomalies. the child has congestive heart failure, is severely cyanotic, and is on mechanical ventilation. the chest x-ray shows an abnormally large right ventricle and a very small left ventricle. the nurse recognizes that this is most likely 1. coarctation of the aorta. 2. an atrioventricular canal defect. 3. truncus arteriosus. 4. hypoplastic left heart syndrome.

25. 4. hypoplastic left heart syndrome is characterized by a lack of development of the left ventricle secondary to mitral valve atresia or aortic atresia. the result is a small hypoplastic left ventricle not capable of cardiac function.

3. the nurse is planning the care for a client in the acute stage of bacterial endocarditis. which of the following interventions should the nurse include? select all that apply: [ ] 1. rest [ ] 2. Fluid restriction [ ] 3. vitamin k (aquamephyton) [ ] 4. analgesics [ ] 5. antibiotics [ ] 6. physical therapy

3. 1. 4. 5. rest is indicated during the acute stage of bacterial endocarditis, along with acetaminophen (tylenol) or salicylic acid (aspirin) for aches and antibiotics to fight the infectious organism. steroids are not indicated and fluids should be encouraged rather than restricted. vitamin k is used for reversal of warfarin (coumadin) that would cause the blood to be too thin.

26. the nurse is teaching the client what to expect after coronary artery bypass graft surgery (cabg). which of the following client statements demonstrates that the client correctly understood the teaching? 1. "i will be given a pen and paper to communicate, because i will still have a breathing tube in my throat." 2. "i will be fed with a tube into my stomach until i can eat again." 3. "pain medicine is generally not needed after this surgery." 4. "the nurses will be checking on me every 4 hours.

26. 1. a nasogastric tube may be used to decompress the stomach after coronary artery bypass graft surgery, but is not immediately used for feeding unless the client cannot eat in the days following surgery. pain medication is offered regularly because the client will most likely experience pain in the sternal incision as well as leg, if a graft was taken from there. immediately after cabg surgery the nurses will be assessing the client every 15 minutes and more frequently as needed until the client becomes stable. it is correct that the client should expect to use hand signals and writing to communicate in the first few hours after surgery while on the ventilator.

26. the registered nurse is preparing clinical assignments for a pediatric unit. Which of the following nursing assignments may be delegated to a licensed practical nurse? 1. instruct the parents of a child with septal defect in cardiopulmonary resuscitation 2. inform the parents of a child with an atrioventricular canal of the clinical manifestations of congestive heart failure 3. assist a child with tetralogy of fallot to a knee-chest position during an acute hypoxic spell 4. assess a child with tricuspid atresia for growth retardation and failure to thrive

26. 3. nursing assignments involving skills such as instructing, informing, or assessing should be performed only by a registered nurse. a licensed practical nurse may assist a child with tetralogy of fallot to a knee-chest position during an acute hypoxic spell because the initial instruction has taken place.

27. the nurse evaluates the pr interval to have what measurement? ____________________

27. 0.12 to 0.20 second

28. the nurse reports the following ecg strip to be indicative of which of the following dysrhythmias? 1. ventricular fibrillation 2. atrial flutter 3. atrial fibrillation 4. ventricular tachycardia

28. 2. atrial flutter is a dysrhythmia characterized by a very irritable atrium. the atria fire at a rate of 250 to 350 beats per minute. the waveforms produced resemble the teeth of a saw. ventricular fibrillation is a lethal rhythm characterized by a chaotic rhythm that originates in the ventricles. it is an unorganized and uncoordinated series of rapid impulses that cause the heart to fibrillate rather than contract. atrial fibrillation is an extremely irritable rhythm originating in the atrium. there is a constant generalized quivering with no sign of organized atrial activity. ventricular tachycardia is a lethal rhythm that exists when three or more premature ventricular contractions (pvcs) occur in a row at a rate greater than 100 beats per minute.

29. the nurse assesses the rate of ventricular tachycardia to be at what rate? ___________________________________

29. 120-180 beats per minute

3. the nurse is planning care for a 2-year-old child immediately following cardiac catheterization. Which of these activities should have the highest priority? 1. Change the dressing at the puncture site 2. apply direct pressure to the catheterization site for at least 15 minutes 3. monitor the heart rate for at least 1 minute during vital signs 4. start oral fluids

3. 2. Direct pressure on the site for 15 minutes and frequent monitoring of the occlusive pressure dressing will decrease the risk of complications from hematoma or hemorrhage following cardiac catheterization. the dressing should not be changed immediately postprocedure, as disruption of the clot may cause life-threatening hemorrhage. monitoring the heart rate for 1 minute during vital signs and starting oral fluids are appropriate actions in postoperative care, but are of lower priority in the assessment and care of the child immediately post-op.

30. a client is brought to the emergency room with a third-degree heart block after experiencing an acute anterior myocardial infarction. which of the following interventions is the priority on an emergency basis? 1. temporary pacemaker 2. administer lidocaine 3. cardioversion 4. administer atropine

30. 1. a third-degree heart block is a lethal rhythm. it is the complete blockage of the atrial impulses into the ventricles. the block may be at the a-v node, bundle of his, or bundle branches resulting in the atria and ventricles beating independently of each other. the atrial rate is usually normal while the ventricular rate is very slow and below 55 beats per minute. the causes may be an anterior myocardial infarction, coronary artery disease, surgery, aging, or drug toxicity such as digoxin, procainamide (procanbid), or verapamil (calan).

31. the nurse should include which of the following in the plan of care of a client after a pacemaker is inserted? 1. instruct the client to avoid lifting the arm on the pacemaker side above shoulder height 2. encourage the client to exercise the shoulder and arm on the side of the pacemaker four times a day 3. encourage the client to wash the pacemaker incision with warm soapy water twice a day 4. instruct the client to avoid the use of microwave ovens

31. 1. a client who had a pacemaker inserted should be instructed to stay on bed rest for 12 hours with minimal activity of the affected arm and shoulder to prevent dislodging the leads of the pacemaker. the client should also be instructed to keep the insertion area dry for 1 week postinsertion. it is not necessary to avoid microwave ovens because they do not threaten the function of the pacemaker.

32. Following morning assessments, the registered nurse may delegate which of the following clients with a dysrhythmia to a licensed practical nurse to care for? a client with 1. ventricular tachycardia. 2. sinus bradycardia. 3. ventricular fibrillation. 4. sinus rhythm with a second-degree a-v block type ii (mobitz ii).

32. 2. ventricular tachycardia and ventricular fibrillation are lethal dysrhythmias that require immediate intervention to maintain life. sinus rhythm with a second-degree a-v block type ii (mobitz ii) requires pacemaker placement. sinus bradycardia is a dysrhythmia that generally goes unnoticed because the client can compensate for the decreased cardiac output. treatment is not necessary unless the client becomes symptomatic.

33. the nurse is monitoring the ecg tracing on the central monitors on a cardiac unit. which of the following dysrhythmias is a priority for the nurse to report first? 1. sinus rhythm with a first-degree a-v block 2. supraventricular tachycardia (svt) 3. atrial fibrillation 4. idioventricular rhythm (ventricular escape rhythm)

33. 4. idioventricular rhythm (ventricular escape rhythm) is a lethal rhythm in which there is a high pacemaker failure. no impulses are conducted to the ventricles from above the bundle of his. supraventricular tachycardia (svt) is a term used to describe tachydysrhythmias that cannot be classified more accurately. treatment depends on the severity of the client's clinical manifestations. a sinus rhythm with a first-degree a-v block is a consistent delay in the a-v conduction. generally no intervention is recommended. atrial fibrillation is a constant quivering of the heart caused by extreme atrial irritability. the atrial rate is controlled with calciumchannel blockers and beta blockers. cardioversion may be necessary and is most successful if performed within 3 days of treatment.

34. the nurse prioritizes the following clients with dysrhythmias in order of their care. prioritize the following clients, from highest to lowest priority, in the order in which care should be performed. ___ 1. a client with sinus bradycardia ___ 2. a client with atrial flutter ___ 3. a client with ventricular fibrillation ___ 4. a client with sinus tachycardia

34. 3. 2. 4. 1. a client with sinus bradycardia is generally symptomatic with treatment not being necessary. a client with sinus tachycardia should be assessed for the cause and treated as needed. the most common drugs used are beta blockers. the ventricular response is controlled in a client with atrial flutter through the administration of calciumchannel blockers. ventricular fibrillation is a lethal rhythm in which the heart fibrillates. a code and cpr must be performed immediately or the client will die.

35. in caring for a client with atrial flutter, which of the following goals would have priority? 1. reduce the ventricular rate to below 100 beats per minute 2. identify and treat the underlying cause 3. control the heart rate and maintain cardiac output 4. increase the heart rate

35. 3. the goal for a client with atrial fibrillation is to reduce the ventricular response rate to below 100 beats per minute. an appropriate goal for a client with sinus tachycardia is to identify and treat the underlying cause. it is a priority to control the heart rate and maintain cardiac output in a client with atrial flutter. a goal of increasing the heart rate would be an appropriate goal for a client with a junctional rhythm.

36. which of the following should the nurse include in the plan of care for a client with sinus tachycardia? 1. administer lidocaine 2. assess the client 3. administer atropine 4. cardioversion

36. 2. sinus tachycardia is a dysrhythmia in which the s-a node discharges at more than 100 beats per minute. the nursing interventions include assessing the client for the cause and treat as needed. the most commonly used drugs are beta blockers.

4. a client who has hypertension asks the nurse why a urine sample is needed. the nurse informs the client it is to check for 1. protein, which may indicate the kidneys are affected. 2. illegal drugs, which may have caused the hypertension. 3. infection, which may cause the blood pressure to rise. 4. the appropriate drug level of the antihypertensive medication.

4. 1. hypertension is not normally caused by illegal drugs nor by infection. drug levels are more frequently done by serum analysis rather than urine, and appropriate levels of antihypertensives are judged by the serial blood pressure readings of the client. a urine test that showed high levels of microalbuminuria and proteinuria may indicate that the client's hypertension has caused poor blood supply to the kidneys, resulting in renal dysfunction.

4. the nurse is caring for a client with hypertension. which of the following drugs should the nurse administer? 1. Mexiletine (Mexitil) 2. triamterene and hydrochlorothiazide (Dyazide) 3. Digoxin (lanoxin) 4. warfarin

4. 2. Dyazide contains a combination of potassiumsparing diuretic and thiazide diuretic, triamterene and hydrochlorothiazide, to induce antihypertension by diminishing blood volume. Mexiletine (Mexitil) is an antiarrhythmic used in the treatment of ventricular arrhythmias. Digoxin (lanoxin) is a cardiac glycoside used in the treatment of congestive heart failure and to slow the heart rate in a client with sinus tachycardia. warfarin (coumadin) is an anticoagulant.

4. the nurse includes which of the following in a discharge teaching plan for parents of a child who has just undergone a cardiac catheterization for a cardiac defect? 1. monitor the dressing and stitches until the return appointment 2. maintain the postsurgical clear liquid diet for 48 hours 3. use a home cardiac monitoring system 4. administer antibiotics for two weeks

4. 4. after a cardiac catheterization, the dressing will be removed before discharge and stitches are not necessary for this procedure. the postprocedure diet is the child's usual diet, and home cardiac monitors are not used after cardiac catheterization. antibiotics are used for children with heart defects prophylactically to minimize the risk of infection.

5. the nurse asks the mother of a child suspected of having a congenital heart defect about eating patterns and activities. Based on an understanding of this child's condition, which of the following should the nurse consider before recommending a plan of care? 1. poor feeding and activity intolerance are common in children with congenital heart disease 2. the child's favorite foods and playtime activities are essential to compliance with therapy 3. the parenting techniques should be assessed 4. mealtimes should be coordinated to the child's activity schedule

5. 1. poor appetite and feeding patterns and activity intolerance are common to many congenital heart diseases. this is the primary consideration for the nurse before recommending the child's plan of care.

5. Based on an understanding of nitroglycerin, the nurse administers it for which of the following reasons to a client with angina? 1. increase afterload 2. increase preload 3. constrict the arteries 4. Dilate the veins

5. 4. nitroglycerin is a coronary vasodilator used in the treatment of angina. the venodilation decreases preload by decreasing blood return to the heart. Decreased preload diminishes the work of the heart, which reduces the oxygen needs and diminishes the anginal pain.

5. which of the following orders should the nurse question in a client who has been admitted with a possible myocardial infarction and active peptic ulcer disease? 1. nitroglycerin sl 2. oxygen by nasal cannula 3. morphine iv 4. aspirin po

5. 4. nitroglycerin, oxygen, morphine, and aspirin are all appropriate interventions for a client suspected of having a myocardial infarction. however, a client with an active peptic ulcer should not be considered a candidate for aspirin, due to its antiplatelet effects possibly promoting more gastrointestinal (gi) bleeding.

6. the nurse is caring for a client with atrial fibrillation who is being treated with a variety of drugs. the nurse administers which of the following drugs in combination with quinidine that may result in an increased level of the drug? 1. furosemide (lasix) 2. Digoxin (lanoxin) 3. propranolol (inderal) 4. triamterene and hydrochlorothiazide (Dyazide)

6. 2. quinidine is an antiarrhythmic used in combination with digoxin and may potentially double digoxin levels. furosemide (lasix) is a loop diuretic. Digoxin (lanoxin) is a cardiac glycoside used to control the rapid ventricular contraction rate in atrial fibrillation or atrial flutter, slow the heart rate in sinus tachycardia, and in the treatment of recurrent paroxysmal atrial tachycardia with paroxysmal av junctional rhythm. propranolol (inderal) is a beta-adrenergic blocking drug used in the treatment of hypertension. triamterene and hydrochlorothiazide (Dyazide) is a combination antihypertensive drug.

6. the nurse's client asks, "how did i get rheumatic heart disease?" the most appropriate response by the nurse is that rheumatic heart disease is frequently a result of 1. hypertension. 2. streptococcal infection. 3. genetic tendency. 4. pregnancy.

6. 2. rheumatic heart disease commonly occurs in children after an infection of group a betahemolytic streptococcal pharyngitis.

6. the nurse is evaluating heart sounds in four children. Which of the following heart sounds found in a 4-year-old child does the nurse report as pathologic? 1. s1 2. s2 3. s3 4. s4

6. 4. the s1 and s2 are normal heart sounds at the beginning (closure of av valves) and end (closure of semilunar valves) of ventricular systole. the s3 sound occurs early in diastole and is considered normal in children and young adults, but is a sound of cardiac disease in older adults. s4 is a rare sound and not heard in a normal heart.

7. which of the following interventions are a priority during exacerbation of left-sided heart failure? select all that apply: [ ] 1. metered dose inhaler of albuterol [ ] 2. high-Fowler's position [ ] 3. oxygen [ ] 4. iv fluids [ ] 5. incentive inspirometer [ ] 6. diuretics

7. 2. 3. 6. nursing interventions that are a priority for a client with an acute exacerbation of left-sided heart failure include having the client assume a high-Fowler's position, oxygen, and diuretics to reduce the fluid volume. albuterol is used for a client with asthma. iv fluid flush would be harmful for a client experiencing respiratory distress from left-sided heart failure.

7. the nurse should administer amiodarone (cordarone) to treat which of the following arrhythmias? 1. sinus bradycardia 2. Bundle branch block 3. ventricular tachycardia 4. junctional rhythm

7. 3. amiodarone (cordarone) is an antiarrhythmic that prolongs the duration of the action potential and refractory period, thus preventing life-threatening ventricular arrhythmias such as ventricular tachycardia by decreasing the sinus rate. sinus bradycardia, bundle branch block, and junctional rhythm are all arrhythmias in which there is a slow heart rate

7. a 5-year-old child is scheduled for an echocardiogram. she asks the nurse if the test will hurt. Which of the following is the nurse's best response? 1. "it is different for everyone." 2. "i'm not sure. you should ask your physician." 3. "there will be a jelly that will feel cool, but it won't hurt." 4. "the various positions you will have to assume may cause a little discomfort."

7. 3. an echocardiogram is noninvasive and painless. the child needs to be reassured.

8. the nurse is preparing a client to be discharged after a new diagnosis of heart failure. which of the following statements by the client shows an appropriate understanding of the nurse's teaching? 1. "i will do weekly finger-stick monitoring of my sodium levels." 2. "i will call my doctor if i gain more than 2 pounds in a day." 3. "i will take my angiotensin-converting enzyme (ace) inhibitor as needed for shortness of breath." 4. "i will not take my diuretic pill on weekends when i am traveling, in order to avoid incontinence."

8. 2. while finger-stick glucose levels are done by clients to monitor their diabetes, sodium fingerstick levels are not done. ace inhibitors need to be taken daily, as prescribed (not p.r.n.). diuretic pills may be delayed a few hours before a big event, but not skipped or the client may end up with a heart failure exacerbation. a client who calls about a sudden weight gain may receive instructions from the health care provider to come in to be evaluated or may be instructed to take an extra diuretic pill at home.

8. the nurse is caring for a child with tetralogy of fallot who experiences an episode of acute cyanosis. Which of the following is the primary clinical manifestation the nurse will assess? 1. Decreased respiratory rate 2. Decreased pulse rate and blood pressure 3. loss of consciousness 4. anxiousness and irritability

8. 4. tetralogy of fallot is comprised of a ventral septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. During a cyanotic spell, pulse and respiratory rates increase to compensate for decreased oxygen levels. anxiety and irritability are the most common manifestation in children with hypoxic spells. loss of consciousness is more likely to be seen in states of severe heart failure.

9. the nurse should monitor a client after a coronary angioplasty for which of the following clinical manifestations indicating cardiac tamponade? select all that apply: [ ] 1. muffled heart sounds [ ] 2. headache [ ] 3. hypotension [ ] 4. vision changes [ ] 5. cool, diaphoretic skin [ ] 6. Tachycardia

9. 1. 3. 5. 6. clinical manifestations of cardiac tamponade include muffled heart sounds, tachycardia, low blood pressure, and cool, diaphoretic skin. these clinical manifestations indicate shock, possibly caused by a dissection (cutting) of a coronary artery, a ventricle, or the septum during the coronary angioplasty.

9. Which of the following should be included in the discharge teaching the nurse is preparing for the parents of a child with tetralogy of fallot? 1. a demonstration of suctioning procedures 2. the signs of infection 3. use of the knee-chest position for cyanotic spells 4. Complete bed rest

9. 3. tetralogy of fallot is comprised of a ventral septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. the use of the knee-chest position is effective in decreasing cardiac workload. Complete bed rest is inappropriate; as much normal activity as can be tolerated is encouraged. signs of infection and suctioning are not a part of the care for a child with tetralogy of fallot.