exam 5
A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse? "Moderation is the key to everything." "Increase the soy in your diet." "Exercise, keep your blood sugar in check, and manage your stress." "Ask your physician to prescribe the new reverse lipid drug."
"Exercise, keep your blood sugar in check, and manage your stress."
A 55-year-old client comes to the clinic for a routine check-up. The client's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The client asks why it is important to treat hypertension, since the client denies any discomfort. What would be the nurse's best response? "Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs." "Hypertension greatly increases your risk of stroke and heart disease." "Hypertension is the leading cause of death in people your age." "Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group."
"Hypertension greatly increases your risk of stroke and heart disease."
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension often causes no symptoms." "Hypertension often causes no pain." "Hypertension often kills early in the disease process." "Hypertension is difficult to diagnose."
"Hypertension often causes no symptoms."
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? "I have my wife look at the soles of my feet each day." "I walk only to the mailbox in my bare feet." "I stopped smoking and use only chewing tobacco." "I like to soak my feet in the hot tub every day."
"I have my wife look at the soles of my feet each day." A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? "My feet are bigger than normal." "I don't have the same appetite I used to." "My pants don't fit around my waist." "I sleep on three pillows each night."
"I sleep on three pillows each night."
The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching? "I will consult a dietician to help get my weight under control." "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." "When getting up from bed, I will sit for a short period before standing up." "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills."
"If I take my blood pressure and it is normal, I don't have to take my blood pressure pills."
The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse's best answer? "People at highest risk for hypertension include clients younger than 18 years." "People at highest risk for hypertension include those with diabetes." "People at highest risk for hypertension include Asians." "People at highest risk for hypertension include the immune-compromised."
"People at highest risk for hypertension include those with diabetes."
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Age Dyslipidemia Obesity Inactivity
Age
A nurse is assisting with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 16-year-old girl An Asian adult man A 40-year-old African-American man A 50-year-old Caucasian woman
A 40-year-old African-American man
An older adult client visits the clinic for a blood pressure (BP) check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about the blood pressure medicine? A severe drop in blood pressure is possible. There are no adverse effects from blood pressure medicine. A possible adverse effect of blood pressure medicine is dizziness when you stand. Take the medicine on an empty stomach.
A possible adverse effect of blood pressure medicine is dizziness when you stand.
The major goal of therapy for a client with heart failure and pulmonary edema should be to: A.Increase cardiac output B.Improve respiratory status C.Decrease peripheral edema D.Enhance comfort
A.Increase cardiac output
A nurse is assessing a client with heart failure. The nurse should asses the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply. A.Ventricular hypertrophy B.Parasympathetic nervous stimulation C.Renin-angiotensin-aldosterone system D.Jugular venous distention E.Sympathetic nervous stimulation
A.Ventricular hypertrophy C.Renin-angiotensin-aldosterone system E.Sympathetic nervous stimulation
Which ethnic background would the nurse screen for hypertension at an early age? Mexican population African population Asian population Japanese population
African population
A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. Age greater than 45 years for men African-American descent Family history of coronary heart disease Elevated C-reactive protein Body mass index (BMI) of 23
Age greater than 45 years for men African-American descent Family history of coronary heart disease Elevated C-reactive protein
Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States? All options are correct. cardiac failure cerebrovascular accident renal disease
All options are correct.
A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered? A ventriculogram An electrocardiogram A chest x-ray An echocardiogram
An echocardiogram
Which term refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? Ischemia Angina pectoris Atheroma Atherosclerosis
Angina pectoris
A nurse is creating an education plan for a client with venous insufficiency. What measure should the nurse include in the plan? Limit activity whenever possible. Sleep with legs in a dependent position. Avoid the use of pressure stockings. Avoid tight-fitting socks.
Avoid tight-fitting socks.
A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing intervention? Administer diuretics Assess oxygen saturation Administer angiotensin II receptor blockers Administer angiotensin-converting enzyme inhibitors
Assess oxygen saturation
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? Assess the client's mental and emotional status. Assess the characteristics of chest pain. Assess the skin of the client. Assess for any kind of drug abuse.
Assess the characteristics of chest pain.
The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? Avoid the intake of canned fruit and fruit juices. Encourage increased intake of vegetables with natural sodium. Avoid the intake of processed and commercially prepared foods. Encourage increased intake of red meat.
Avoid the intake of processed and commercially prepared foods.
A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure? B-type natriuretic peptide (BNP) Complete blood count (CBC) Serum electrolytes Blood urea nitrogen (BUN)
B-type natriuretic peptide (BNP)
A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? Elevate the legs periodically for at least 15 to 20 minutes. Avoid foods with iodine. Refrain from sexual activity for a week. Elevate the legs periodically for at least an hour.
Elevate the legs periodically for at least 15 to 20 minutes.
A client with heart failure has met with his primary provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the client begins treatment, the nurse should prioritize what assessment? Blood pressure Level of consciousness (LOC) Oxygen saturation Assessment for nausea
Blood pressure
A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring? Blood pressure 80/46 mm Hg Oxygen saturation 94% Heart rate of 72 beats/minute Respiratory rate of 20 breaths/minute
Blood pressure 80/46 mm Hg The body can compensate for changes in heart function that occur over time. When cardiac output falls, the body uses certain compensatory mechanisms designed to increase stroke volume and maintain blood pressure. These compensatory mechanisms can temporarily improve the client's cardiac output but ultimately fail when contractility is further compromised. A heart rate of 72 beats/minute is within normal range as well as the blood pressure and oxygen saturation.
A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.) Creatinine Complete blood count (CBC) Blood urea nitrogen (BUN) AST and ALT Urine for culture and sensitivity
Blood urea nitrogen (BUN) Creatinine
The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? S4 ventricular gallop sign decreased O2 saturation levels oliguria pitting edema
pitting edema
Which of the following sets of conditions is an indication the client with a history of left-sided heart failure is developing pulmonary edema? A.Distended jugular veins and wheezing B.Dependent edema and anorexia C.Coarse crackles and tachycardia D.Hypotension and tachycardia
C.Coarse crackles and tachycardia
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. Take the tablet in anticipation of any activity that can produce pain. Renew the supply every 6 months. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed.
Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Take the tablet in anticipation of any activity that can produce pain. Renew the supply every 6 months. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed.
The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)? Congestion in the peripheral tissues Reduction in cardiac output Reduction in forward flow Accumulation of blood in the lungs
Congestion in the peripheral tissues Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.
A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate. The nurse should implement measures to prevent what complication? Deep vein thrombosis Thoracic aortic aneurysm Aortitis Raynaud disease
Deep vein thrombosis
A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? Diabetes, hypercholesterolemia, and heredity Age, gender, and heredity Diabetes, age, and gender Diabetes, hypercholesterolemia, and hypertension
Diabetes, hypercholesterolemia, and hypertension
Which is a characteristic of arterial insufficiency? Diminished or absent pulses Aching, cramping pain Superficial ulcer Pulses are present but may be difficult to palpate
Diminished or absent pulses A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? Engage in aerobic activity at least 30 minutes/day most days of the week. Maintain a body mass index between 30 and 35. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Limit alcohol consumption to no more that 3 drinks per day.
Engage in aerobic activity at least 30 minutes/day most days of the week.
When discussing angina pectoris secondary to atherosclerotic disease with a client, the client asks why he tends to experience chest pain when he exerts himself. The nurse should describe which of the following phenomena? Exercise increases the heart's oxygen demands. Exercise increases the metabolism of cardiac medications. Exercise causes vasoconstriction of the coronary arteries. Exercise shunts blood flow from the heart to the mesenteric area.
Exercise increases the heart's oxygen demands.
indications of L sided HF
FORCED fatigue orthopenia restlessness/rales cyanosis/confusion extreme weakness dyspnea
The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) Initial absence of edema Full superficial veins Sharp pain that may be relieved by the elevation of the extremity Brisk capillary refill of the toes Cool and cyanotic skin
Full superficial veins Sharp pain that may be relieved by the elevation of the extremity Cool and cyanotic skin
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? Cardiac tamponade Pulmonary embolism Tension pneumothorax Heart failure
Heart failure
Which is a modifiable risk factor for coronary artery disease (CAD)? Family history Hyperlipidemia Male gender Increasing age
Hyperlipidemia
A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure? Heart failure occurs when blood pressures drops. Hypertension causes the heart's chambers to shrink. Hypertension in older males regularly leads to heart failure. Hypertension causes the heart's chambers to enlarge and weaken.
Hypertension causes the heart's chambers to enlarge and weaken.
A client admitted to the medical unit with heart failure is exhibiting signs and symptoms of pulmonary edema. How should the nurse best position the client? In a high Fowler position In the Trendelenburg position In a flat, supine position On the left side-lying position
In a high Fowler position
non-modifieable risk factors for CAD
Increased age: 45 for men, 55 for women Family history Gender (men more likely) Race (higher incidence in african populations)
The treatment for heart failure is directed toward all of the following except: Decreasing the oxygen needs of the heart. Increasing cardiac output by strengthening muscle contraction or decreasing peripheral resistance. Increasing preload and afterload. Reducing the amount of circulating blood volume.
Increasing preload and afterload.
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? Ineffective peripheral tissue perfusion related to venous congestion Excess fluid volume related to peripheral vascular disease Impaired gas exchange related to increased blood flow Risk for injury related to edema
Ineffective peripheral tissue perfusion related to venous congestion
A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? Suggest that the client try an herbal supplement instead. Inform the client there should be no problems as long as she a low sodium diet is maintained. Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. Inform the client that this is why hypertension is known as "the silent killer."
Inform the client that this is why hypertension is known as "the silent killer."
Which term refers to a muscular, cramp-like pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? Bruit Aneurysm Intermittent claudication Ischemia
Intermittent claudication
The nurse identifies which symptom as a characteristic of right-sided heart failure? Jugular vein distention (JVD) Dyspnea Cough Pulmonary crackles
Jugular vein distention (JVD) JVD is a characteristic of right-sided heart failure. Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure.
Which observation regarding ulcer formation on the client's lower extremity indicates to the nurse that the ulcer is a result of venous insufficiency? Though superficial, is very painful Base is pale to black Large and superficial Is deep, involving the joint space
Large and superficial
The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? Absence of detectable total cholesterol levels Low LDL values and high HDL values High HDL values and high triglyceride values Elevated blood lipids, fasting glucose less than 100
Low LDL values and high HDL values
A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs? Decreased renal blood flow causes the renin-angiotensin-aldosterone system to increase aldosterone secretion. Low blood pressure triggers the baroreceptors to decrease sympathetic nervous system stimulation. Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Decreased renal blood flow causes the renin-angiotensin-aldosterone system to reduce secretion of aldosterone and antidiuretic hormone.
Low blood pressure triggers the baroreceptors to increase sympathetic nervous system In the early stage of heart failure, low blood pressure triggers baroreceptors in the carotid sinus and aortic arch to increase sympathetic nervous system stimulation, causing an increased heart rate, vasoconstriction, and increased myocardial oxygen consumption. Decreased renal blood flow causes the renin-angiotensin-aldosterone system to increase, not reduce, secretion of aldosterone and antidiuretic hormone, causing sodium and water retention and arterial vasoconstriction.
A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? Increase in blood volume Low serum potassium level Increase in blood pressure High serum sodium level
Low serum potassium level
The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client? Low-sodium diet Low-fat diet Low-cholesterol diet Low-potassium diet
Low-sodium diet
A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover? Maintaining a low-potassium diet Skipping a medication dose if dizziness occurs Maintaining a low-sodium diet Receiving I.V. antihypertensive medications
Maintaining a low-sodium diet
A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? White blood cell (WBC) count Platelet count Calcium Potassium
Potassium
During an adult client's last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this client's BP be categorized? Normal Prehypertensive Stage 2 hypertensive Stage 1 hypertensive
Prehypertensive
The nurse is providing discharge education to a client diagnosed with heart failure. What should the nurse teach this client to do to assess fluid balance in the home setting? Monitor and record blood pressure daily Monitor weight daily Monitor bowel movements Monitor and record radial pulses daily
Monitor weight daily
The nurse is caring for a client who has developed obvious signs of pulmonary edema. What is the priority nursing action? Stay with the client. Notify the family of the client's critical state. Lay the client flat. Update the health care provider.
Stay with the client.
The nurse is discussing cardiac hemodynamics with a nursing student, who understands the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The student asks what determines stroke volume. The correct response by the nurse is which of the following? Stroke volume depends on three factors: S-T elevation, catecholamines, and temperature. Stroke volume depends on three factors: P-R interval, preload, and contractility. Stroke volume depends on three factors: preload, afterload, and contractility. Stroke volume depends on three factors: afterload, P-R interval, and preload.
Stroke volume depends on three factors: preload, afterload, and contractility.
A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? Numbness, cool skin temperature, and pallor Swelling, warm skin temperature, and drainage Redness, cool skin temperature, and swelling Numbness, warm skin temperature, and redness
Numbness, cool skin temperature, and pallor
Which is a risk factor for venous disorders of the lower extremities? Surgery Trauma Pacing wires Obesity
Obesity
The client with cardiac failure is taught to report which symptom to the physician or clinic immediately? Persistent cough Weight loss Increased appetite Ability to sleep through the night
Persistent cough
A nursing class is practicing the measurement of blood pressures and finds a client with a blood pressure of 130/88. What lifestyle factors will the nurse discuss with the client? The DASH diet, sexual dysfunction related to required medications, and physical activity Physical activity, needed medication, and the DASH diet Physical activity, dietary sodium, and the DASH diet Weight reduction, the DASH diet, and physical activity
Physical activity, dietary sodium, and the DASH diet Lifestyle modifications to prevent and mange hypertension include weight reduction, adoption of the DASH diet, reduction of dietary sodium, physical activity, and moderation of alcohol consumption. It is not within the nursing scope of practice to decide what medications are needed. There is no evidence that this man is overweight.
L side heart failure symptoms
Proxysmal nocturnal dyspnea elevated pulmonary capillary wedge pressure pulmonary congestion: cough, crackles, wheezing, blood-tinged sputum, tachypnea restlessness, confusion, orthopnea tachycardia exertional dyspnea fatigue cyanosis
A client has been diagnosed with congestive heart failure. Which is a cause of crackles heard in the bases of the lungs? Pulmonary congestion Aortic valve stenosis Mitral valve stenosis Pulmonary hypertension
Pulmonary congestion Crackles heard in the bases of the lungs are a sign of pulmonary congestion. Heart palpitations are caused by tachydysrhythmias. Crackles heard in the bases of the lungs are not signs of pulmonary hypertension and mitral valve stenosis.
A hospitalized client with heart failure puts on the call light and states, "I've become very short of breath, and I've been coughing up this pink frothy sputum." The nurse immediately suspects which of the following complications? Hepatomegaly Decreased renal perfusion pressure Decreased cardiac workload Pulmonary edema
Pulmonary edema
Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure? Abstinence from smoking Avoid excess alcohol Push fluids Restrict dietary sodium
Push fluids
A client has been diagnosed with heart failure. One of the main overall objectives of management of heart failure is which of the following? Help the client walk briskly on a treadmill at 4 to 5 miles an hour. Eliminate all sodium and fat from the diet. Reduce the workload on the heart. Achieve a blood pressure of 120/80.
Reduce the workload on the heart.
The nurse is collaborating with the dietitian and a client with hypertension to plan dietary modifications. What modifications should be made? Increased intake of calcium and vitamin D Reduced intake of protein and carbohydrates Reduced intake of fat and sodium Increased intake of potassium, vitamin B12 and vitamin D
Reduced intake of fat and sodium
The nurse is planning the care of a client with heart failure. The nurse should identify what overall goals of this client's care? Select all that apply. Limit physical activity. Prevent endocarditis. Relieve client symptoms. Improve functional status Extend survival.
Relieve client symptoms. Improve functional status Extend survival.
The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension? Renal disease Calcium deficit Acid-based imbalance Hepatic function
Renal disease
The nurse is teaching a client about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply. Retinal hemorrhage Right ventricular hypertrophy Venous insufficiency Transient ischemic attacks (TIAs) Cerebrovascular disease
Retinal hemorrhage Transient ischemic attacks (TIAs) Cerebrovascular disease
A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize? Increasing fluids to maintain BP Taking medication first thing in the morning Rising slowly from a lying or sitting position Stopping medication if dizziness persists
Rising slowly from a lying or sitting position
3 symptoms of pt with L sided HF that has turned into pulmonary edema
SOB, Tachycardia, lungs have crackles, blood tinged sputum
Modifiable risk factors for heart disease
Smoking High BP High cholesterol Obesity Physical inactivity Diabetes Secondary risk factory: Stress, Alcohol
A client reports chest pain and palpitations during and after jogging in the mornings. The client's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk? Smoking cessation Mild meals Liquid diet Protein-rich diet
Smoking cessation
The nurse is educating the patient about administering nitroglycerin prior to discharge from the hospital. What information should the nurse include in the instructions? Take 2 nitroglycerines and if the pain is not relieved, go to the emergency department. Take 2 nitroglycerines every 10 minutes until a total of 6 pills are taken. If pain is not relieved, activate the emergency medical system. Take a nitroglycerin and if the pain is not relieved, drive to the nearest emergency department. Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system.
Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system.
The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which action? Measuring the BP after the client has been seated quietly for more than 5 minutes Using a cuff with a bladder that encircles at least 80% of the limb Using a bare forearm supported at heart level on a firm surface Taking the BP 10 minutes after nicotine or coffee ingestion
Taking the BP 10 minutes after nicotine or coffee ingestion
Following abdominal surgery, which factor predisposes a client to deep vein thrombosis? The client has been pregnant four times. The client is 5' 9" tall and weighs 128 lb (58 kg). The client usually walks 3 miles a day. The client will be immobile during and shortly after surgery.
The client will be immobile during and shortly after surgery.
The nurse is assessing an older adult client with numerous health problems. What assessment data indicates an increase in the client's risk for heart failure (HF)? The client is an African American man. The client's age is greater than 65. The client takes furosemide 20 mg/day. The client's potassium level is 4.7 mEq/L.
The client's age is greater than 65.
When assessing a client diagnosed with angina pectoris, it is most important for the nurse to gather what information? The client's symptoms and the activities that precipitate attacks The client's understanding of the pathology of angina The client's coping strategies surrounding the attacks The client's activities limitations and level of consciousness after the attacks
The client's symptoms and the activities that precipitate attacks
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? The development of cor pulmonale The development of left-sided heart failure The development of chronic obstructive pulmonary disease (COPD) The development of right-sided heart failure
The development of left-sided heart failure When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Cor pulmonale is a condition in which the heart is affected secondarily by lung damage.
The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: increases high-density lipoprotein (HDL) level. reduces stress. decreases venous congestion. aids in weight reduction.
decreases venous congestion.
indications of R sided heart failure
dependent edema (edema in the lower extremities) distended veins in the neck anorexia asites (weight gain)
A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gaiter area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? Arterial insufficiency Venous insufficiency Neither venous nor arterial insufficiency Trauma
Venous insufficiency
An occupational health nurse is providing an educational event and has been asked by an administrative worker about the risk of varicose veins. What should the nurse suggest as a proactive preventive measure for varicose veins? Wear snug-fitting ankle socks to decrease edema. Elevate the legs when tired. Walk for several minutes every hour to promote circulation. Sit with crossed legs for a few minutes each hour to promote relaxation.
Walk for several minutes every hour to promote circulation.
An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: a condition in which the lumen of arteries fill with scar tissue. a vascular occlusive disease. high level of blood fat. an expected part of the aging process.
an expected part of the aging process.
compensatory mechanisms activated in heart failure: frank-starling mechanism
because the muscle fibers are stretched the heart increases the force of contraction increased contraction force causes increased cardiac output this increases cardiac oxygen demand and can overstretch the heart muscles decreasing ability to contract
Right BACONED
bloating/weight gain/enlarged liver and spleen Anorexia/GI distress Cyanosis/Cool legs Oliguria Nausea Edema/dependent distended neck veins
Medical management of cardiac failure uses similar methodology whether it is right-sided or left-sided. Measures such as dietary modification, lifestyle changes, medications to reduce dyspnea and relieve anxiety, etc. are all used with one primary intention. The primary goal in the medical management of heart failure is to reduce: cardiac workload. oxygenation. pulmonary efficacy. cardiac output.
cardiac workload.
The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes diuresis. depresses the cough reflex. causes vasospasm. slows the heart rate.
causes vasospasm.
metroprolol (beta blocker)
change positions slowly causes orthostatic hypotension take everyday monitor BP Hold med if HR low can cause hypoglycemia in DM patients
A nurse is caring for a client with left-sided heart failure. What should the nurse anticipate using to reduce fluid volume excess? antiembolism stockings. diuretics. anticoagulants. oxygen.
diuretics.
Frequently, what is the earliest symptom of left-sided heart failure? chest pain anxiety confusion dyspnea on exertion
dyspnea on exertion
right sided heart failure symptoms
fatigue elevated peripheral venous pressure ascites enlarged liver and spleen distended jugular veins anorexia and complaints of GI distress weight gain dependent edema **may be secondary to chronic pulmonary problems**
Left FORCED
fatigue orthopnea Rales/Restlessness cyanosis/confusion extreme weakness dyspnea
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: forcing blood into the deep venous system. providing warmth to the extremity. encouraging ambulation to prevent pooling of blood. elevating the extremity to prevent pooling of blood.
forcing blood into the deep venous system.
aldosterone/renin
gets rid of NA/water
major goals of treating R sided HF and pulmonary edema
increase cardiac output increase preload and afterload this will decrease swelling in the lungs and help them breath it is considered an acute medical emergency
When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating paroxysmal nocturnal dyspnea. orthopnea. hyperpnea. dyspnea upon exertion.
orthopnea.
ADH
retains NA/water