MED SURG CH 32: Concepts of Care for Patients with Cardiac Problems

24. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia should the nurse assess? a. Preventricular contractions b. Atrial fibrillation c. Symptomatic bradycardia d. Sinus tachycardia

b. atrial fibrillation atrial fibrillation is a clinical manfestation of mitral valve regurgitation and stenosis.

7. A nurse prepares to discharge a client who has heart failure. Which questions should the nurse ask to ensure this client's safety prior to discharging home? (Select all that apply.) a. "Are your bedroom and bathroom on the first floor?" b. "What social support do you have at home?" c. "Will you be able to afford your oxygen therapy?" d. "What spiritual beliefs may impact your recovery?" e. "Are you able to accurately weigh yourself at home?"

a. "Are your bedroom and bathroom on the first floor?" b. "What social support do you have at home?" d. "What spiritual beliefs may impact your recovery?"

6. A nurse is teaching a client with heart failure who has been prescribed enalapril (Vasotec). Which statement should the nurse include in this client's teaching? a. "Avoid using salt substitutes." b. "Take your medication with food." c. "Avoid using aspirin-containing products." d. "Check your pulse daily."

a. "Avoid salt substitutes" ACE inhibitors inhibit the secretion of potassium. hyperkalemia can be a life threatening side effect, and clients should be taught to limit potassium intake

4. After teaching a client with congestive heart failure (CHF), the nurse assesses the client's understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.) a. "I'll read the nutritional labels on food items for salt content." b. "I will drink at least 3 liters of water each day." c. "Using salt in moderation will reduce the workload of my heart." d. "I will eat oatmeal for breakfast instead of ham and eggs." e. "Substituting fresh vegetables for canned ones will lower my salt intake."

a. "I'll read the nutritional labels on food items for salt content." d. "I will eat oatmeal for breakfast instead of eggs and ham." e. "Substituting fresh vegetables for canned ones will lower my salt intake" nutritional therapy for CHF is focused on decreasing sodium and water retention to decrease the workload of the heart.

5. A nurse cares for a client with right-sided heart failure. The client asks, "Why do I need to weigh myself every day?" How should the nurse respond? a. "Weight is the best indication that you are gaining or losing fluid." b. "Daily weights will help us make sure that you're eating properly." c. "The hospital requires that all inpatients be weighed daily." d. "You need to lose weight to decrease the incidence of heart failure."

a. "weight is the best indication that you are gaining or losing fluid"

21. A nurse cares for an older adult client with heart failure. The client states, "I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die." How should the nurse respond? a. "Would you like to talk more about this?" b. "You are lucky to have such a devoted daughter." c. "It is normal to feel as though you are a burden." d. "Would you like to meet with the chaplain?"

a. "would you like to talk more about this?

11. A nurse admits a client who is experiencing an exacerbation of heart failure. Which action should the nurse take first? a. Assess the client's respiratory status. b. Draw blood to assess the client's serum electrolytes. c. Administer intravenous furosemide (Lasix). d. Ask the client about current medications.

a. Assess the client's respiratory status

2. A nurse evaluates laboratory results for a client with heart failure. Which results should the nurse expect? (Select all that apply.) a. Hematocrit: 32.8% b. Serum sodium: 130 mEq/L c. Serum potassium: 4.0 mEq/L d. Serum creatinine: 1.0 mg/dL e. Proteinuria f. Microalbuminuria

a. Hematocrit: 32.8% b. serum sodium: 130 mEq/L e. proteinuria f. microalbuminuria

13. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" How should the nurse respond? a. "The prosthetic valve places you at greater risk for a heart attack." b. "Blood clots form more easily in artificial replacement valves." c. "The vein taken from your leg reduces circulation in the leg." d. "The surgery left a lot of small clots in your heart and lungs."

b. "Blood clots form more easily in artificial replacement valves" synthetic valve prostheses and scar tissue provide surfaces on which platelets can aggregate easily and initiate the formation of blood clots.

14. After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client's understanding. Which client statement indicates a need for additional teaching? a. "I'll be able to carry heavy loads after 6 months of rest." b. "I will have my teeth cleaned by my dentist in 2 weeks." c. "I must avoid eating foods high in vitamin K, like spinach." d. "I must use an electric razor instead of a straight razor to shave."

b. "I will have my teeth cleaned by my dentist in 2 weeks" clients who have defective or repaired valves are at high risk for endocarditis. the client who has had valve surgery should avoid dental procedures for 6 months because of the risk for endocarditis.

20. A nurse assesses a client who has a history of heart failure. Which question should the nurse ask to assess the extent of the client's heart failure? a. "Do you have trouble breathing or chest pain?" b. "Are you able to walk upstairs without fatigue?" c. "Do you awake with breathlessness during the night?" d. "Do you have new-onset heaviness in your legs?"

b. "are you able to walk upstairs without fatigue?"

12. A nurse assesses a client with mitral valve stenosis. What clinical manifestation should alert the nurse to the possibility that the client's stenosis has progressed? a. Oxygen saturation of 92% b. Dyspnea on exertion c. Muted systolic murmur d. Upper extremity weakness

b. dyspnea on exertion dyspnea on exertion develops as the mitral valvular orifice narrows and pressures in the lungs increases.

10. A nurse teaches a client who has a history of heart failure. Which statement should the nurse include in this client's discharge teaching? a. "Avoid drinking more than 3 quarts of liquids each day." b. "Eat six small meals daily instead of three larger meals." c. "When you feel short of breath, take an additional diuretic." d. "Weigh yourself daily while wearing the same amount of clothing."

d. "Weigh yourself daily while wearing the same amount of clothing." clients with heart failure are instructed to weigh themselves daily to detect worsening heart failure early, and thus avoid complications.

5. A nurse collaborates with assistive personnel (AP) to provide care for a client with congestive heart failure. Which instructions would the nurse provide to the AP when delegating care for this client? (Select all that apply.) a. "Reposition the client every 2 hours." b. "Teach the client to perform deep-breathing exercises." c. "Accurately record intake and output." d. "Use the same scale to weigh the client each morning." e. "Place the client on oxygen if the client becomes short of breath."

A. "reposition the client every 2 hours" C. "accurately record intake and output" D. "use the same scale to weigh the client each morning"

15. A nurse cares for a client with infective endocarditis. Which infection control precautions should the nurse use? a. Standard Precautions b. Bleeding precautions c. Reverse isolation d. Contact isolation

A. Standard precautions the client with infective endocarditis does not pose any specific threat of transmitting the causative organism.

9. a nurse is caring for a client who was admitted for hypertrophic cardiomyopathy (HCM). what interprofessional care does the nurse anticipate providing? a. administering beta blockers b. administering high dose furosemide c. preparing for cardiac catheterization d. loading the client on digitalis e. instructing the client to avoid strenuous activity f. teaching the client how to use the CardioMEMS

a. administering beta blockers c. preparing for a cardiac catheterization e. instructing the client to avoid strenuous exercise

23. a nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. which nonpharmacologic comfort measure would the nurse implement? a. apply an ice pack to the clients chest b. provide a neck rub, especially on the left side c. allow the client to lie in bed with the lights down d. sit the client up with a pillow to lean forward on

d. sit the client up pain from acute pericarditis may worsen when the client lays supine.

1. A nurse assesses clients on a cardiac unit. which client would the nurse identify as being the greatest risk for the development of left sided heart failure? a. a 36 yo woman with aortic stenosis b. a 42 yo man with pulmonary hypertension c. a 59 yo woman who smokes cigarettes daily d. a 70 yo man who had a cerebral vascular accident

a. a 36 yo woman with aortic stenosis causes of left sided heart failure include mitral or aortic valve disease, coronary artery disease, and hypertension. pulmnary hypertension and chronic cigarette smoking are risk factors for right sided heart failure

3. a nurse assesses clients on a cardiac unit. which clients would the nurse identify as the greatest risk for the development of acute pericarditis? (select all that apply) a. a 36 yo woman with systemic lupus erythematosus (SLE) b. a 42 yo man recovering from coronary artery bypass graft surgery c. a 59 yo woman recovering from a hysterectomy d. an 80 yo woman with a bacterial infection of the respiratory tract e. an 88 yo woman with a stage 3 sacral ulcer

a. a 36 yo woman with systemic lupis erythematosus b. a 42 yo man recovering from coronary artery bypass graft surgery d. an 80 yo woman with a bacterial infection of the respiraory tract acute pericarditis is most commonly associated with acute exacerbations of SLE, dressler syndrome, inflammation of the cardiac sac after cardiac surgery or mi, and infective organisms

4. While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. Which action should the nurse take next? a. Assess for symptoms of left-sided heart failure. b. Document this as a normal finding. c. Call the health care provider immediately. d. Transfer the client to the intensive care unit.

a. assess for symptoms of left sided heart failure the presence of an s3 gallop is an early diastolic filling sound indicative of increasing left ventricular pressure and left ventricular failure.

1. a nurse is assessing a client with left sided heart failure. for which clinical manifestations would the nurse asses? a. pulmonary crackles b. confusion c. pulmonary hypertension d. dependent edema e. cough that worsens at night f. jugular vein distention

a. pulmonary crackles b. confusion e. cough that worsens at night

8. A nurse assesses a client who is recovering from a heart transplant. Which assessment findings should alert the nurse to the possibility of heart transplant rejection? (Select all that apply.) a. Shortness of breath b. Abdominal bloating c. New-onset bradycardia d. Increased ejection fraction e. Hypertension f. fatigue

a. shortness of breath b. abdominal bloating c. new-onset bradycardia f. fatigue

18. a nurse is providing discharge teaching to a client recovering from a heart transplant. which statement would the nurse include? a. "use a soft brisled tooth brush and avoid flossing" b. "avoid large crowds and people who are sick" c. "change positions slowly to avoid hypotension" e. "check your heart rate before taking the medication"

b. "avoid large crowds and people who are sick" clients who have had heart transplants must take immunosuppressant therapy for the rest of their lives

22. A nurse teaches a client with heart failure about energy conservation. Which statement should the nurse include in this client's teaching? a. "Walk until you become short of breath, and then walk back home." b. "Begin walking 200 feet a day three times a week." c. "Do not lift heavy weights for 6 months." d. "Eat plenty of protein to build up your strength."

b. "begin walking 200 feet a day three times a week" a client who has heart failure would be taught to conserve energy and given an exercise plan.

3. a nurse assesses a client admitted to the cardiac unit. which statement by the client alerts the nurse to the possibility of right sided heart failure? a. "i sleep with four pillows at night" b. "my shoes fit really tight lately" c. "i wake up coughing every night" d. "i have trouble catching my breath"

b. "my shoes fit really tight lately" signs of systemic congestion occur with right sided heart failure. fluid is retained, pressure builds up in the venous system, and peripheral edema develops. left sided heart failure symptoms include respiratory symptoms.

6. a nurse prepares to discharge a client who has heart failure. based on national quality measures, what actions would the nurse complete prior to discharging the client? (select all that apply) a. teach the client about energy conservation techniques b. ensure that the client is prescribed a beta blocker c. document a discussion about advanced directives d. confirm that a post discharge nurse visit has been scheduled e. consult a social worker for additional resources f. care transition record transmitted to next level of care within 7 days of discharge

b. ensure that the client is prescribed a beta blocker c. document a discussion about advanced directives d. confirm that a post discharge nurse visit has been scheduled f. care transition records transmitted to next level of care within 7 days of discharge

16. A nurse assesses a client with pericarditis. Which assessment finding should the nurse expect to find? a. Heart rate that speeds up and slows down b. Friction rub at the left lower sternal border c. Presence of a regular gallop rhythm d. Coarse crackles in bilateral lung bases

b. friction rub at the left lower sternal border the client with pericarditis may present with pericardial friction rub at the left lower sternal border. this sound is the result of friction from inflamed pericardial layers when they rub together

7. After administering the first dose of captopril to a client with heart failure, the nurse implements interventions to decrease complications. Which intervention is most important for the nurse to implement? a. Provide food to decrease nausea and aid in absorption. b. Instruct the client to ask for assistance when rising from bed. c. Collaborate with assistive personnel to bathe the client. d. Monitor potassium levels and check for symptoms of hypokalemia.

b. instruct the client to ask for assistance when rising from bed hypotension is a side effect of ACE inhibitors

17. After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, "Why is this important?" How should the nurse respond? a. "Rapid position changes can create shear and friction forces, which can tear out your internal vascular sutures." b. "Your new vascular connections are more sensitive to position changes, leading to increased intravascular pressure and dizziness." c. "Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes." d. "While your heart is recovering, blood flow is diverted away from the brain, increasing the risk for stroke when you stand up."

c. "Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes"

2. A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? a. "I have been drinking more water than usual." b. "I am awakened by the need to urinate at night." c. "I must stop halfway up the stairs to catch my breath." d. "I have experienced blurred vision on several occasions."

c. "i must stop halfway up the stairs to catch my breath" clients with left sided heart failure report weakness or fatigue while performing normal activities of daily living, as well as difficulty breathing or catching their breath.

9. a nurse teaches a client who is prescribed digoxin therapy. which statement would the nurse include in this clients teaching? a. "avoid taking aspirin or aspirin containing products" b. "increase your intake of foods that are high in potassium" c. "hold this medication if your pulse rate is below 80 beats/min d. "do not take this medication within 1 hour of taking an antacid"

d. "do not take this medication within 1 hour of taking an antacid" gastrointestinal absorption of digoxin is erratic. many medications, especially antacids, interfere with its absorption

19. A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, "I know a transplant is my last chance, but I don't want to become a vegetable." How should the nurse respond? a. "Would you like to speak with a priest or chaplain?" b. "I will arrange for a psychiatrist to speak with you." c. "Do you want to come off the transplant list?" d. "Would you like information about advance directives?"

d. "would you like information about advance directives?" the client is verbalizing a real concern or fear about negative outcomes of the surgery. this anxiety itself can have a negative effect of the surgery because of the sympathetic stimulation.

8. a nurse assesses a client after administering the first dose of a nitrate. the client reports a headache. what action would the nurse take? a. initiate oxygen therapy b. hold the next dose c. instruct the client to drink water d. administer PRN acetaminophen

d. administer PRN acetaminophen the vasodilating effects of nitrates frequently cause clients to have headaches during the initial period of therapy. the nurse would inform the client about this side effect and offer mild analgesics.