NMNC 4410 Exam #1
A patient is questioning the nurse about circulation and perfusion. Which is the best response by the nurse? "Perfusion assists the cell by delivering oxygen and removing waste products." "Perfusion assists the body by preventing clots and increasing stamina." "Perfusion assists the heart by increasing the cardiac output." "Perfusion assists the brain by increasing mental alertness."
"Perfusion assists the cell by delivering oxygen and removing waste products." Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.
The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? "I will avoid adding salt to my food during or after cooking." "If I lose weight, I might not need to continue taking medications." "I can lower my blood pressure by switching to smokeless tobacco." "Diet changes can be as effective as taking blood pressure medications."
"I can lower my blood pressure by switching to smokeless tobacco." Rationale: Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (e.g., the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.
At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? "I will limit the amount of milk and cheese in my diet." "I can add salt when cooking foods but not at the table." "I will take an extra diuretic pill when I eat a lot of salt." "I can have unlimited amounts of foods labeled as reduced sodium."
"I will limit the amount of milk and cheese in my diet." Rationale: Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.
A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding? "If I take this medication, I will not need to follow a special diet." "It is normal to have some swelling in my face while taking this medication." "I will need to eat foods such as bananas and potatoes that are high in potassium." "If I develop a dry cough while taking this medication, I should notify my doctor."
"If I develop a dry cough while taking this medication, I should notify my doctor." Rationale: Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced sodium diet.
A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? "I should notify my cardiologist if my feet or legs start to swell." "I am supposed to report to my cardiologist if my pulse rate decreases below 60." "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."
"My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."
An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed to continue at home. What is the best response by the nurse? "The medication prevents blood clots from forming in your heart." "The medication dissolves clots that develop in your coronary arteries." "The medication reduces clotting by decreasing serum potassium levels." "The medication increases your heart rate so that clots do not form in your heart."
"The medication prevents blood clots from forming in your heart." Rationale: Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.
A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."
"This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."
A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? "Do you have any allergies?" "Can you rate the pain on a 0 to 10 scale?" "What time did your pain begin?" "Do you take aspirin daily?"
"What time did your pain begin?"
A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports that he has a dry, nonproductive cough that is very bothersome. The nurse should respond by making which statement? "The cough must be the start of a respiratory infection." "When this happens typically your PCP will change your medication to an ARB". "The medication needs to be taken with large amounts of water to prevent the cough." "This sometimes happens, and you will need to take a cough medication with each dose of medication."
"When this happens typically your PCP will change your medication to an ARB".
The nurse performs an admission assessment on a client diagnosed with angina pectoris who takes nitroglycerin for chest pain at home. During the assessment, the client complains of chest pain. The nurse should immediately ask the client which of the following question? "Do you have your nitroglycerin with you?" "Are you having any nausea?" "Where is the pain located?" "Are you allergic to any medications?"
"Where is the pain located?"
A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. Which is the best response by the nurse? "Talk with your father about past events, and that will help with the confusion." "Your father may be having mini-strokes; I will notify his physician." "Your father is just confused about some things since he is in the hospital." "The confusion will pass. Your father just has to get up and move around."
"Your father may be having mini-strokes; I will notify his physician." Periods of confusion may be related to mini-strokes, or transient ischemic attacks (TIAs). Confusion during hospitalization does not occur with every patient. Talking with the patient or thinking the confusion may pass is not a viable solution. The patient should be assessed and the reason for the confusion identified.
A patient is scheduled to take Captopril. When is the best time to administer this medication? 1 hour before a meal At bedtime In the morning 30 minutes after a meal
1 hour before a meal
A 68-yr-old male patient presents to the emergency department with a BP 210/of 118 and reports a severe headache and vomiting. You know that his BP is dangerously high and must be lowered.
149
Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? Redness on both sides of the sternal incision Pallor and weakness of the right hand Fine crackles heard at both lung bases Complaints of incisional chest pain
Pallor and weakness of the right hand
After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).
A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).
Which of the following patients does not have a risk factor for hypertension? A 68 year old male who reports smoking 2 packs of cigarettes a day. A 35 year old female with a total cholesterol level of 100. A 40 year old female with a family history of hypertension and diabetes. A 25 year old male with a BMI of 35.
A 35 year old female with a total cholesterol level of 100.
Which of the following patients is not a candidate for a beta blocker medication? A 25 year old female with migraines. A 45 year old male with angina. A 39 year old female with asthma. A 55 year old male with a history of two heart attacks.
A 39 year old female with asthma.
. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs? Auscultate lung sounds. Observe skin turgor. Measure blood pressure. Review intake and output.
Auscultate lung sounds.
The nurse is assessing a client admitted to the telemetry unit from the Emergency Department with complaints of increasing shortness of breath, and is coughing pink-tinged frothy sputum. During the history assessment, the nurse documents a history of left-sided heart failure. The nurse recognizes the presenting signs and symptoms of which heart failure complication? Acute pulmonary edema Right-sided heart failure Myocardial infarction Bacterial pneumonia
Acute pulmonary edema
A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety? (Select all that apply.) Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Position patient on left side with head of bed flat. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.
Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient. Rationale: Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.
A client with heart disease has developed pulmonary edema and is having difficulties breathing. The nurse notes that the client is breathing at a rate of 28/min and has an oxygen saturation of 90% on room air. Which best describes the first response of the nurse? Administer oxygen through a face mask to correct saturation levels Gather supplies to assist with intubation Prepare the client for a thoracentesis Administer pain medication to slow the client's breathing
Administer oxygen through a face mask to correct saturation levels
Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? Assess his adherence to therapy. Ask him to make an exercise plan. Teach him to follow the DASH diet. Request a prescription for a thiazide diuretic.
Assess his adherence to therapy. Rationale: A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to begin by assessing adherence to therapy.
A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? Review urinary output for the previous 24 hours. Restrict the patient's oral fluid intake to 500 mL/day. Assist the patient to a sitting position with arms on the overbed table. Teach the patient to use pursed-lip breathing until the dyspnea subsides.
Assist the patient to a sitting position with arms on the overbed table. Rationale: The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.
The nurse is assessing a client newly diagnosed with Stage 1 Hypertension. Which assessment finding should the nurse expect? Visual disturbances Shortness of breath Frequent nosebleeds Asymptomatic
Asymptomatic
The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching about the use of the patch, what should the nurse include? Avoid drugs to treat erectile dysfunction. Increase diet intake of high-potassium foods. Take an over-the-counter H2-receptor blocker. Avoid nonsteroidal antiinflammatory drugs (NSAIDS).
Avoid drugs to treat erectile dysfunction. Rationale: The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. NSAIDs do not pose a risk in combination with nitrates. There is no need to take an H2-receptor blocker or increase the dietary intake of high-potassium foods.
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? BP 128/78 mm Hg Weight loss of 2 lb Absence of ankle edema Output of 600 mL per 8 hours
BP 128/78 mm Hg Rationale: Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.
The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? Dehydration Infection Malnutrition Bleeding
Bleeding
What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate
Blood pressure Rationale: Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.
An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? Urine output Heart rhythm Breath sounds Blood pressure
Blood pressure Rationale: The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.
The nurse is caring for a 76-year-old male who was admitted for extreme weakness, dizziness, and orthopnea. A diagnosis of heart failure is confirmed by the cardiologist observing JVD and reading is Echo Cardiogram. Which of the following tests was most helpful in determining the diagnosis of heart failure? Brain natriuretic peptide (BNP) Renal Function Panel 12-lead EKG Complete Metabolic Panel (CMP)
Brain natriuretic peptide (BNP)
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? Hypocapnia Tachycardia Bronchospasm Nausea and vomiting
Bronchospasm Rationale: Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.
The nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? Clonidine (Catapres) Bumetanide (Bumex) Amiloride (Midamor) Spironolactone (Aldactone)
Bumetanide (Bumex) Rationale: Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.
The nurse is caring for a client who is on strict bed rest and creates a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing? Placing a pillow under the knees Encouraging active range-of-motion exercises Restricting fluids Applying a heating pad to the lower extremities
Encouraging active range-of-motion exercises
A client brought to the emergency department states that he has accidentally been taking 2 times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action? Draw a sample for type and crossmatch and transfuse the client. Prepare to administer an antidote. Draw a sample for prothrombin time (PT) and international normalized ratio (INR). Draw a sample for an activated partial thromboplastin time (aPTT) level.
Draw a sample for prothrombin time (PT) and international normalized ratio (INR).
Which family of drugs are the following medications considered: Amlodipine, Verapamil, Diltiazem? Beta blockers (BB) Calcium Channel Blockers (CCBs) ACE Inhibitors (ACEI) Angiotension Receptor Blockers (ARBs)
Calcium Channel Blockers (CCBs)
A patient is scheduled for a heart transplant. What is a major cause of death beyond the first year after a heart transplant? Infection Acute rejection Immunosuppression Cardiac vasculopathy
Cardiac vasculopathy Rationale: Beyond the first year after a heart transplant, cancer (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.
Which of the following systems of the body are affected by hypertension? Cardiovascular, gastrointestinal, reproductive, and kidney Brain, respiratory, kidney, cardiovascular None of the options are correct Cardiovascular, brain, kidney, eyes
Cardiovascular, brain, kidney, eyes
Which of the following drugs is NOT considered an Angiotension Receptor Blocker (ARBs) medication used in hypertension? Valsartan Catapres Benicar Losartan
Catapres
The provider orders an antihypertensive medication for a client whose blood pressure is 205/110 mm Hg. What assessment findings does the student nurse expect for this patient? Select All That Apply. Chest Pain Diminished pulses Pale Cool Skin Blurred Vision Severe Headache
Chest Pain Blurred Vision Severe Headache
A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options. Choose interventions to promote comfort and prevent suffering.
Choose interventions to promote comfort and prevent suffering. Rationale: The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not used in the care of hospice patients.
A provider (PHCP) stating that a client diagnosed with disseminated intravascular coagulation (DIC) requires a transfusion. Which blood product should the nurse anticipate that the PHCP will write a prescription for? Platelets Packed red blood cells Cryoprecipitate Albumin
Cryoprecipitate
The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session? Elevated low-density lipoprotein (LDL) level Increased risk of cardiovascular disease with aging Family history of myocardial infarction Greater risk associated with the patient's gender
Elevated low-density lipoprotein (LDL) level
The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of an obese patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec Waiting 2 minutes after position changes to take orthostatic pressures Taking the blood pressure with the patient's arm at the level of the heart Taking a forearm blood pressure if the largest cuff will not fit the patient's upper arm
Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec Rationale: The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. The arm should be supported at the level of the heart for accurate blood pressure measurements. Using a cuff that is too small causes a falsely high reading and too large causes a falsely low reading. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.
The nurse is monitoring a client with heart failure who takes digoxin and whose morning lab level = 2.5. What patient presentation should the nurse assess for? Tremors Diarrhea Irritability Blurred Vision Nausea & Vomiting A controlled heart rate increased urine output
Diarrhea Blurred Vision Nausea & Vomiting
The nurse is caring for a hospitalized client with admitting diagnosis of right-sided heart failure (HF). What assessment finding is most consistent with the client's diagnosis? Distended neck veins Pulmonary edema Dry hacking cough Orthopnea
Distended neck veins
A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? Is the patient pregnant? Does the patient need to urinate? Does the patient have a headache or confusion? Is the patient taking antiseizure medications as prescribed?
Does the patient have a headache or confusion? Rationale: The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. In addition, headache or confusion could represent signs and symptoms of a hemorrhagic stroke. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.
The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension causes direct pressure on organs, resulting in necrosis and scar tissue. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. Hypertension increases blood viscosity, which causes intravascular coagulation and tissue necrosis distal to occlusions.
Hypertension promotes atherosclerosis and damage to the walls of the arteries. Rationale: Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, when atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.
The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply. Hypokalemia Hypouricemia Hyperglycemia Sulfa allergy Osteoporosis Hypercalcemia
Hypokalemia Hyperglycemia Sulfa allergy Hypercalcemia
What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND)
Hypotension and tachycardia Rationale: Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.
A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia. I understand a dry cough is a common side effect with this medication. I will only take this medication if my blood pressure is high. I will make sure I consume foods high in potassium.
I will make sure I consume foods high in potassium.
What is the purpose of including exercise and activity in a cardiac rehabilitation program? (Select all that apply.) Select all that apply. Increase blood pressure Increase flexibility Increase cardiac output Increase muscle mass Increase serum lipids Increase blood flow through the arteries
Increase flexibility Increase cardiac output Increase muscle mass Increase blood flow through the arteries A cardiac rehabilitation program seeks to increase cardiac output, blood flow through the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure.
When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? Blocks β-adrenergic effects. Relaxes arterial and venous smooth muscle. Inhibits conversion of angiotensin I to angiotensin II. Reduces sympathetic outflow from central nervous system.
Inhibits conversion of angiotensin I to angiotensin II. Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-Blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the central nervous system to produce vasodilation and decreased systemic vascular resistance and blood pressure.
A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. The nurse anticipates which action is needed next? Leaving the rate of the heparin infusion as is Discontinuing the heparin infusion Decreasing the rate of the heparin infusion Increasing the rate of the heparin infusion
Leaving the rate of the heparin infusion as is
A pregnant client diagnosed with DVT 1 day ago suddenly complains of chest pain and shortness of breath and is visibly anxious. Which complication should the nurse immediately assess the client for? Pneumonia Pulmonary edema Myocardial Infarction Pulmonary Embolism
Pulmonary Embolism
The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient? (Select all that apply.) Left ventricular function is documented Controlling dysrhythmias will eliminate HF Prescription for digoxin (Lanoxin) at discharge Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen
Left ventricular function is documented Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen Rationale: The Joint Commission has identified these 3 core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.
The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.) Lose weight. Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days.
Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days. Rationale: Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Beef includes saturated fats, which should be limited. Weight loss may or may not be necessary, depending on the person.
A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem?Losartan Lisinopril Labetalol Hydrochlorothiazide
Lisinopril
The nurse is administering a dose of Digitalis (digoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? Muscle aches Constipation Loss of appetite Pounding headache
Loss of appetite Rationale: Anorexia, nausea, vomiting, blurred or yellow vision, and dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.
Which is the correct pathway for blood through the heart for systemic circulation to occur? Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs. Lungs, pulmonary vein, left atrium, left atrioventricular valve, left ventricle, aortic valve, aorta, body. Lungs, pulmonary artery, pulmonary valve, right ventricle, right atrioventricular valve, right atrium. Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs.
Lungs, pulmonary vein, left atrium, left atrioventricular valve, left ventricle, aortic valve, aorta, body.
Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques? Limiting caffeine Smoking cessation Dietary changes Multivitamins
Multivitamins
The nurse is assessing a female patient at the neighborhood clinic. The patient reports "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? Pneumonia Peptic ulcer disease Myocardial infarction Ischemia
Myocardial infarction Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration? O2 saturation 93% Pulse 48 beats/min Respirations 24 breaths/min Blood pressure 118/74 mm Hg
Pulse 48 beats/min Rationale: Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.
How do anti-hypertensive medications alter cardiac output? Increase Heart Rate Increase Stroke Volume Decrease Ejection Fraction Reduce Systemic Vascular Resistance
Reduce Systemic Vascular Resistance
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix). What outcome would demonstrate medication effectiveness? Promote vasodilation. Reduction of preload. Decrease in afterload. Increase in contractility.
Reduction of preload. Rationale: Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.
The nurse is reviewing the laboratory test results for a client with a diagnosis of DIC who is receiving a transfusion. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? Remove the fresh flowers from the client's room. Instruct family members to wear a mask when entering the client's room. Call the dietary department to report that the client will be on a low-bacteria diet. Remove the rectal thermometer from the client's room.
Remove the rectal thermometer from the client's room
When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate? Increase water intake. Restrict sodium intake. Increase protein intake. Use calcium supplements.
Restrict sodium intake. Rationale: The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Protein intake does not affect hypertension. Calcium supplements are not recommended to lower blood pressure.
Which is the correct pathway for blood through the heart for pulmonary circulation? Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Left atrium, left atrioventricular valve, left ventricle, pulmonary valve, pulmonary artery, lungs, Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs,
Right atrium, right atrioventricular valve, right ventricle, pulmonary valve, pulmonary artery, lungs,
After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? Chronic HF Left-sided HF Right-sided HF Acute decompensated HF
Right-sided HF Rationale: An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.
Lisinopril has been recently prescribed for an anemic patient newly diagnosed with hypertension. What should the nurse instruct the client about this medication? Rise slowly from a reclining to a sitting position. Discontinue the medication if nausea occurs. Expect to note a full therapeutic effect immediately. Take the medication with food only.
Rise slowly from a reclining to a sitting position.
When providing dietary teaching to a patient with hypertension, the nurse would teach the patient to restrict intake of which meat? Broiled fish Roasted duck Roasted turkey Baked chicken breast
Roasted duck Rationale: Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall cardiovascular disease risk. The other meats are lower in fat and are therefore acceptable in the diet.
In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? Serum uric acid of 3.8 mg/dL Serum creatinine of 2.6 mg/dL Serum potassium of 3.5 mEq/L Blood urea nitrogen of 15 mg/dL
Serum creatinine of 2.6 mg/dL Rationale: The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other laboratory results are within normal limits.
The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? Prothrombin time Urine specific gravity Serum potassium level Hemoglobin and hematocrit
Serum potassium level Rationale: Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.
The home care nurse visits a patient with chronic heart failure. Which assessment findings would indicate acute decompensated heart failure (pulmonary edema)? Fatigue, orthopnea, and dependent edema Severe dyspnea and blood-streaked, frothy sputum Temperature is 100.4° F and pulse is 102 beats/min Respirations 26 breaths/min despite oxygen by nasal cannula
Severe dyspnea and blood-streaked, frothy sputum Rationale: Manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.
Which is the correct sequence of events for the electrical impulses that travel through the heart to facilitate a ventricular contraction? Atrioventricular node, atrial contraction, sinoatrial node, bundle of His, purkinje fibers,ventricular contraction. Sinoatrial node, atrial contraction, atrioventricular node, purkinje fibers, bundle of His, ventricular contraction. Atrioventricular node, atrial contraction, sinoatrial node, bundle of His, ventricular contraction,purkinje fibers. Sinoatrial node, atrial contraction, atrioventricular node, bundle of His, purkinje fibers, ventricular contraction.
Sinoatrial node, atrial contraction, atrioventricular node, bundle of His, purkinje fibers, ventricular contraction.
The nurse is caring for a client who has +3 pitting edema in the legs and a potassium level of 2.3 mEq/L. The nurse expects which of the following diuretics to be ordered? Spironolactone (Aldactone) Furosemide (Lasix) Lisinopril Hydrochorithiazide
Spironolactone (Aldactone)
A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? Start an infusion of 0.9% normal saline at 100 mL/hr. Maintain the current administration rate of the nitroprusside. Request insertion of an arterial line for accurate blood pressure monitoring. Stop the nitroprusside infusion and assess the patient for potential complications.
Stop the nitroprusside infusion and assess the patient for potential complications. Rationale: Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal is to decrease MAP by no more than 25% within minutes to 1 hour. For this patient, the goal MAP would be around 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside infusion and then use fluids only if necessary to support restoration of MAP.
Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Older patients require higher doses of antihypertensive medications.
Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Rationale: Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.
The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next? Repeat BP and HR in this position. Record the BP and HR measurements. Take BP and HR with patient standing. Return the patient to the supine position.
Take BP and HR with patient standing. Rationale: The vital signs taken do not reflect orthostatic changes, so the UAP will continue with the measurements while the patient is standing. There is no need to repeat or delay the readings. The patient does not need to return to the supine position. When assessing for orthostatic changes, the UAP will take the BP and pulse in the supine position, then place the patient in a sitting position for 1 to 2 minutes and repeat the readings, and then reposition to the standing position for 1 to 2 minutes and repeat the readings. Results consistent with orthostatic changes would have a decrease of 20 mm Hg or more in systolic BP, a decrease of 10 mm Hg or more in diastolic BP, and/or an increase in HR of greater than or equal to 20 beats/min with position changes.
The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? Take medications as prescribed. Use oxygen when feeling short of breath. Direct questions only to the health care provider. Encourage most activity in the morning when rested.
Take medications as prescribed. Rationale: The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.
An ER patient who has had chest pain for several hours is admitted with a rule-out acute myocardial infarction (AMI) diagnosis. Which laboratory test is most appropriate for the nurse to monitor in determining whether the patient has had an AMI? Creatinine Kinase Troponin C-reactive protein Myoglobin
Troponin
True or False: Most patients with hypertension are asymptomatic. True False
True
The nurse is assessing the sleep patterns of a patient when the patient reports he has trouble sleeping when lying flat. Which is the best response by the nurse? Use pillows to prop yourself up while sleeping. Use nasal strips to assist with breathing. Sleep in a side-lying position. Open a window to let fresh air into the room.
Use pillows to prop yourself up while sleeping. Using pillows to prop himself up during sleep allows the patient to breathe more easily and comfortably. Nasal strips will help with breathing, but they do not always bring relief when one is lying flat. Sleeping in a side position or opening a window does not help one to breathe more easily when one is lying flat.
The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse? Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with a salty snack, such as crackers. Give the digoxin with extra fluids to dilute the sodium level.
Withhold the dose and report the potassium level. Rationale: The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and wait for the potassium level to normalize. The provider may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.
Which pulse is monitored by listening to the client's heart with a stethoscope? radial apical carotid femoral
apical
Which term is synonymous with the mitral valve? aortic valve bicuspid valve tricuspid valve pulmonic valve
bicuspid valve
Which is an example of a cardiac arrhythmia that can occur when there are issues with the electrical impulses that stimulate each heart beat? angina pectoris myocardial infarction complete heart block coronary artery disease
complete heart block
Which is the conduit for the pumping action of the heart? the lungs blood flow electrical impulses skeletal muscle movement
electrical impulses
Which test does the nurse anticipate for the client who requires monitoring for both the electrical and mechanical functions of the heart? echocardiogram cardiac stress test electrocardiogram coronary catherization
electrocardiogram
Which structure receives oxygen-poor blood from the lower body? aorta pulmonary artery inferior vena cava superior vena cava
inferior vena cava
Which valve allows oxygenated blood to flow from the left atrium to the left ventricle? aortic mitral tricuspid pulmonic
mitral
Which structure sends blood to the lungs for oxygenation to occur? pulmonary artery pulmonary vein aorta atria
pulmonary artery
Which is the only vein within the circulatory system that carries freshly oxygenated blood to the heart? jugular vein pulmonary vein inferior vena cava superior vena cava
pulmonary vein
Which structure receives blood from the lungs that is oxygen rich? atria aort pulmonary vein pulmonary artery
pulmonary vein
Which valve allows oxygen-poor blood to leave the right ventricle to enter the lungs for oxygenation? aortic mitral tricuspid pulmonic
pulmonic
Which vital sign allows the nurse to monitor the client's heart rate? pulse respirations blood pressure temp
pulse
Which structure of the heart receives oxygen-poor blood from the upper body? aorta pulmonary artery inferior vena cava superior vena cava
superior vena cava
Which is the location where ventricular systole begins? the QRS the p wave the t wave the ST segment
the QRS
Which statement is correct regarding the heart, or cardiac cycle? the heart cycle consists of one phase the heart cycle consists of two phases the heart cycle consists of three phases the heart cycle consists of four phases
the heart cycle consists of two phases
Which valve allows oxygen-poor blood to enter the right ventricle from the right atrium? aortic mitral tricuspid pulmonic
tricuspid
