EAQ CARDIOVASCULAR AND RESPIRATORY HW #2

The nurse identifies premature ventricular complexes (PVCs) on a client's cardiac monitor and concludes that these complexes are a sign of what? 1 Atrial fibrillation 2 Cardiac irritability 3 Impending heart block 4 Ventricular tachycardia

2 Cardiac irritability Cardiac irritability is the cardinal reason for PVCs. Atrial fibrillation is a type of dysrhythmia, not the cause of PVCs; the source of atrial fibrillation is the atrium, not the ventricles. Impending heart block type of dysrhythmia is associated with interference with the conduction system. Ventricular tachycardia is a type of dysrhythmia, not the cause of PVCs.

How does the body compensate for respiratory alkalosis?

the kidneys excrete increased amounts of bicarbonate to lower pH levels.

Which is the clinical manifestation of chronic mitral valve regurgitation? Select all that apply. One, some, or all responses may be correct. 1 Fatigue 2 Syncope 3 Exertional dyspnea 4 Holosystolic murmur 5 Rumbling diastolic murmur

1,2,4 Fatigue Exertional dyspnea Holosystolic murmur Fatigue, exertional dyspnea, and holosystolic murmur are clinical manifestations of chronic mitral valve regurgitation. Syncope is a clinical manifestation of aortic valve stenosis, not mitral valve regurgitation. Mitral valve stenosis, not regurgitation, manifests as a rumbling diastolic murmur. (AHN CH.8 PG.336)

In which order will the nurse provide interventions for the client receiving a blood transfusion who has bibasilar crackles on auscultation and is experiencing shortness of breath and tachycardia?

1.Elevate the head of the bed to 45 degrees. 2.Apply oxygen via nasal cannula. 3.Reduce the flow rate of the transfusion. 4.Administer furosemide per provider prescription. 5.Document findings in the client record

For which clinical manifestation would the nurse assess the client with a myocardial infarction when concerned that the client may develop left ventricular failure? 1 Weight loss 2 Distended neck veins 3 Paroxysmal nocturnal dyspnea 4 Right upper quadrant tenderness

3. Paroxysmal nocturnal dyspnea Dyspnea at night, which usually requires assumption of the orthopneic position, is a symptom of left ventricular failure. Orthopnea, a compensatory mechanism, limits venous return; this decreases pulmonary congestion and promotes ventilation, easing the dyspnea. Weight gain occurs because of fluid retention. Distention of neck veins occurs with right ventricular failure because of hypervolemia. Right upper quadrant tenderness occurs with right ventricular failure because of portal hypertension and liver congestion.

The nurse identifies that the afternoon international normalized ration (INR) is 4.6 for a client who is on warfarin sodium after a total knee replacement several days ago. Which is the next action the nurse would take? 1 Assist with meal planning to decrease the intake of foods high in vitamin K. 2 Obtain a blood specimen to have a partial thromboplastin time performed. 3 Contact the health care provider to request the day's dosage of warfarin sodium. 4 Maintain the client on bed rest until the health care provider reviews the laboratory results

4, Maintain the client on bed rest until the health care provider reviews the laboratory results An INR of 4.6 is higher than the desired therapeutic level of 2 to 3.5. It is prudent to maintain bed rest to prevent injury until the health care provider evaluates the client's INR result. Decreasing the intake of food high in vitamin K is contraindicated; vitamin K is the antidote for warfarin sodium. The client should have a consistent, limited intake of food high in vitamin K. A partial thromboplastin time is performed to evaluate a client's response to the administration of heparin. Another dose of warfarin sodium may be contraindicated in light of the client's increased INR result.

Which test would the nurse assess to determine if a client is experiencing the therapeutic effect of valsartan? 1 Lipid profile 2 Apical pulse 3 Urinary output 4 Blood pressure

4. Blood pressure Angiotensin receptor blockers are a class of medicines that is used to treat high blood pressure (also known as hypertension). These medicines have names that end in 'sartan', including valsartan, irbesartan, candesartan, losartan and olmesartan.

Which sound would the nurse document in the medical record when hearing a low-pitched sound over the lungs while percussing? 1 Dull 2 Flat 3 Tympany 4 Resonance

4. Resonance Resonance is a low-pitched sound heard over the lungs during percussion in healthy individuals. Breathing sounds may be considered dull if sounds are of medium-intensity pitch and duration and are heard over areas of mixed, solid, and lung tissue. Soft, high-pitched sounds of short duration heard over very dense tissue where air is not present are described as flat sounds. Sounds with drum-like, loud, or empty quality heard over a gas-filled stomach or intestines are described as tympany.

How does the body compensate for metabolic acidosis?

The lungs excrete "blow off" carbon dioxide to raise pH levels in metabolic acidosis

How does the body compensate for respiratory acidosis?

the kidneys retain increased amounts of bicarbonate to increase pH levels.

Which question about smoking history would the nurse ask the client with uncontrolled hypertension? Select all that apply. One, some, or all responses may be correct. 1 "How long have you smoked?" 2 "Have you ever tried to stop smoking?" 3 "When was the last time you smoked?" 4 "How many cigarettes do you smoke per day?" 5 "Do you understand what effects smoking has on the body?

1,2,3,4,5 (all) When obtaining a smoking history, the nurse should ask what the client smokes (cigars/cigarettes), how many cigarettes/cigars are smoked per day, and how many years have been spent smoking. Determine if the client has tried to stop smoking in the past and how this was attempted. If the client indicates he has quit smoking, ask the date. Clients who have smoked in the past 12 months should receive smoking cessation education. It is also important to determine what the client understands regarding the effects of smoking on the vascular system.

Which intervention will the nurse include for a client who is 1 day postoperative, following femoral-popliteal bypass graft surgery? 1 Assist the client with walking. 2 Help the client to sit in a chair. 3 Maintain the client on bed rest. 4 Encourage the client to keep the legs elevated.

1. Assist the client with walking. Mobility reduces venous stasis and edema and enhances arterial perfusion and healing. Sitting in a chair is contraindicated; it constricts circulation at the hips and knees. Bed rest is contraindicated because it promotes the development of thrombophlebitis and pulmonary emboli. Elevating the legs will limit arterial perfusion.

Which clinical finding would the nurse expect the client with the diagnosis of chronic heart failure to experience? 1 Dependent edema in the evening 2 Chest pain that decreases with rest 3 Palpitations in the chest when resting 4 Frequent coughing with yellow sputum

1. Dependent edema in the evening Decreased cardiac output causes fluid retention, which results in dependent edema; this is often noticed in the evening after the client has been standing or sitting for prolonged periods. Chest pain is indicative of cardiac ischemia. Palpitations are indicative of cardiac dysrhythmias. Coughing with yellow sputum is indicative of an infectious process in the respiratory tract; pink, frothy sputum is associated with pulmonary edema that can result from heart failure.

Which responses would the nurse expect a client to exhibit when a therapeutic effect of digoxin is achieved? 1 Diuresis and decreased pulse rate 2 Increased blood pressure and weight loss 3 Regular pulse rhythm and stable fluid balance 4 Corrected heart murmur and decreased pulse pressure

1. Diuresis and decreased pulse rate Digoxin slows the heart rate, which is reflected in a slowing of the pulse; it also increases kidney perfusion, which promotes urine formation, resulting in diuresis and decreased edema. Digoxin would decrease, not increase, the blood pressure; digoxin does promote weight loss through diuresis. Although digoxin produces diuresis as a result of improved cardiac output, which increases fluid output, it would not regulate an irregular pulse. Digoxin would not correct a heart murmur or decrease pulse pressure.

Which manifestation that is treated with over-the-counter antihistamines would the nurse include in a teaching session on influenza? Select all that apply. One, some, or all responses may be correct. 1 Sneezing 2 Runny nose 3 Watery eyes 4 Nasal pruritis 5 Conjunctival pruritis

1. Sneezing 2. Runny nose 3. Watery eyes 4. Nasal pruritis 5. Conjunctival pruritis Antihistamines are the drugs of choice for the treatment of allergic rhinitis and conjunctivitis. Antihistamine agents compete with the allergy-liberated histamine for H1-receptor sites in the client's arterioles, capillaries, and secretory glands in the mucous membranes. Symptoms such as sneezing, runny nose, watery eyes, nasal pruritis, and conjunctival pruritis can be managed with antihistamines.

A health care provider prescribes 0.2 mg of cyanocobalamin (vitamin B12) intramuscularly for a client with pernicious anemia. How much solution would the nurse administer if the vial of the drug labeled 100 mcg = 1 mL is available? Record your answer using a whole number. __________mL

2 mL

Which medication does the nurse expect to be prescribed for a child with newly diagnosed cystic fibrosis? Select all that apply. One, some, or all responses may be correct. 1 Steroids Correct 2 Antibiotics 3 Antihistamines 4 Pancreatic enzymes 5 Fat-soluble vitamins

2. Antibiotics 4. Pancreatic enzymes 5. Fat-soluble vitamins Antibiotics are prescribed to treat recurrent respiratory tract infections. Thick secretions obstruct the pancreatic ducts, and essential pancreatic enzymes are blocked from reaching the duodenum; therefore, pancreatic enzymes are administered with meals to aid digestion. Fat-soluble vitamins are necessary because of the decreased absorption of fat. Steroids are not indicated in the treatment of cystic fibrosis. Antihistamines are not used because of their drying effect on the already tenacious mucus.

Which sign indicates that a client on supplemental oxygen is experiencing acute respiratory distress syndrome (ARDS)? 1 Bleeding 2 Hypoxemia 3 Bradypnea 4 Pain on inspiration

2. Hypoxemia The cardinal sign of ARDS is hypoxemia in spite of supplemental oxygen administration. Bleeding is a side effect of anticoagulation therapy for a pulmonary embolus. Tachypnea, not bradypnea, is a sign of ARDS. Pain on inspiration is a sign of fractured ribs.

How does the body compensate for metabolic alkalosis? 1 The kidneys retain bicarbonate to raise pH levels. 2 The lungs retain carbon dioxide to lower pH levels. 3 The lungs excrete carbon dioxide to raise pH levels. 4 The kidneys excrete increased amounts of bicarbonate to lower pH levels.

2. The lungs retain carbon dioxide to lower pH levels. In metabolic alkalosis, the body must lower pH levels. The lungs do this by retaining carbon dioxide. The lungs excrete carbon dioxide to raise pH levels in metabolic acidosis, but not in metabolic alkalosis. In respiratory alkalosis, the kidneys excrete increased amounts of bicarbonate to lower pH levels. In respiratory acidosis, the kidneys retain increased amounts of bicarbonate to increase pH levels.

For which side effect does the nurse assess the client with a cardiac dysrhythmia receiving digoxin and verapamil? 1 Physical agitation 2 Reflex stimulation 3 Myocardial depression 4 Respiratory stimulation

3 Myocardial depression Both digoxin and verapamil decrease cardiac impulse conduction, with resultant depression of the myocardium; verapamil decreases conduction at the sinoatrial (SA) and atrioventricular (AV) nodes, which may cause bradycardia, AV block, and cardiac arrest. Digoxin and verapamil together do not cause agitation. Side effects of verapamil include fatigue and depression, not agitation. Digoxin and verapamil do not influence the reflexes of the body. Digoxin and verapamil do not influence respirations.

Which medication would the nurse administer to specifically lower a client's elevated triglyceride level? 1 Statins 2 Ezetimibe 3 Omega-3 fatty acids 4 Bile acid-binding resins

3 Omega-3 fatty acids Medications used to lower triglyceride levels are omega-3 fatty acids. Primary medications used to lower cholesterol levels include statins, bile acid-binding resins, and ezetimibe.

Which medication requires the nurse to monitor the client for signs of hyperkalemia? 1 Furosemide 2 Metolazone 3 Spironolactone 4 Hydrochlorothiazide

3 Spironolactone Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect. Furosemide, metolazone, and hydrochlorothiazide generally cause hypokalemia.

The nurse is caring for a client admitted with shock secondary to severe gastrointestinal bleeding. Once the client is stabilized, which intervention would the nurse do next? 1 Monitor the peripheral pulses. 2 Check the level of consciousness. 3 Take a blood sample for laboratory tests. 4 Control the bleeding with a pressure dressing.

3 Take a blood sample for laboratory tests. The primary nursing intervention that should be followed in the client's condition with gastrointestinal bleeding is collection of a blood sample for laboratory diagnosis. Peripheral pulses are monitored in an ongoing manner. Level of consciousness may not be required to be monitored based on the client's condition. Controlling bleeding with a pressure dressing is usually done in case of deep lacerations and wounds.

Which medication type will the nurse explain that includes fluticasone/salmeterol and mometasone furoate/formoterol fumarate dihydrate while teaching about asthma medications? 1 Reliever medications 2 Controller medications 3 Combination medications 4 Immunotherapy medications

3 Combination medications Fluticasone/salmeterol and mometasone furoate/formoterol fumarate dihydrate are combination medications because they each contain two different medications. Reliever medications are used to treat symptoms of an exacerbation and include bronchodilators and antiinflammatory drugs. Controller medications are used to provide long-term control of asthma and include inhaled glucocorticoids, leukotriene modifiers, and mast cell stabilizers, among others. Immunotherapy is known as allergy shots.

Which condition would the nurse suspect in a client with a loud, accentuated S1 and a low-pitched, rumbling diastolic murmur who also reports palpitations and fatigue? 1 Tricuspid stenosis 2 Mitral valve stenosis 3 Aortic valve stenosis 4 Acute aortic valve regurgitation

Correct 2 Mitral valve stenosis Mitral valve stenosis is one of the valvular heart diseases characterized by fatigue, palpitations, a loud, accentuated S1, and a low-pitched, rumbling diastolic murmur. Tricuspid stenosis is characterized by peripheral edema, ascites, hepatomegaly, and a diastolic low-pitched murmur with increased intensity during inspiration. Aortic valve stenosis is characterized by angina, syncope, dyspnea on exertion, heart failure, a normal or soft S1, a diminished or absent S2, systolic murmur, and prominent S4. Acute aortic valve regurgitation is characterized by abrupt onset of profound dyspnea, chest pain, left ventricular failure, and cardiogenic shock.