Perfusion 20-30 questions
Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? Serum potassium level of 3.2 mEq/L Ejection fraction of 60% B-type natriuretic peptide (BNP) of 760 ng/dL Chest x-ray report showing right middle lobe consolidation
B-type natriuretic peptide (BNP) of 760 ng/dL
The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60 beats/min; a P wave precedes each QRS complex, and the PR interval is 0.20 second. Additional vital signs are as follows: blood pressure 118/68 mm Hg, respiratory rate 16 breaths/min, and temperature 98.8° F. All of these medications are available on the medication record. What action does the nurse take? Administer atropine. Administer digoxin. Administer clonidine. Continue to monitor.
Continue to monitor.The client is displaying normal sinus rhythm.
A client has been taking furosemide (Lasix) and valsartan (Diovan) for the past year. The hospital laboratory notifies the nurse that the client's serum potassium level is 6.2 mEq/L. What is the nurse's best action at this time? A Assess the client's oxygen saturation level. B Ask the laboratory to retest the potassium level. C Give potassium as an IV infusion. D Check the client's serum creatinine.
D Check the client's serum creatinine.
Which new assessment finding in a client with sickle cell disease who currently is in crisis does the nurse report immediately to the health care provider? A Pain in the right hip with limited range of motion B Slow capillary refill in the toes of the right foot C Yellow appearance of the roof of the mouth D Facial drooping on the right side
D Facial drooping on the right side
The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention? Defibrillation Cardiopulmonary resuscitation (CPR) Administration of epinephrine Administration of oxygen
Defibrillation
Apply care to a heart failure patient with shortness of breath
Digoxin (Lanoxin) may be prescribed to improve symptoms, thereby decreasing dyspnea and improving functional activity.
Which risk factors are known to contribute to atrial fibrillation? (Select all that apply.) Use of beta-adrenergic blockers Excessive alcohol use Advancing age High blood pressure Palpitations
Excessive alcohol use Advancing age High blood pressure
Which prescription does the nurse implement first? Enalapril Heparin Furosemide Intake and output (I & O)
Furosemide
The nurse is caring for a client with heart failure in the coronary care unit. The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? Determines the client's physical limitations Encourages alternate rest and activity periods Monitors and documents heart rate, rhythm, and pulses Positions the client to alleviate dyspnea
Positions the client to alleviate dyspnea
A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription? Serum sodium level of 135 mEq/L Serum potassium level of 2.8 mEq/L Serum creatinine of 1.0 mg/dL Serum magnesium level of 1.9 mEq/L
Serum potassium level of 2.8 mEq/L
A client's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? Normal sinus rhythm Sinus bradycardia Sinus tachycardia Sinus rhythm with premature ventricular contractions
Sinus tachycardia
secondary hypertension.
Specific disease states and drugs can increase a person's susceptibility to hypertension
A client has undergone an embolectomy for acute arterial occlusion after creation of a lower arm arteriovenous fistula for dialysis. Which finding does the nurse report to the provider immediately? Swelling and tenseness in the affected area Incisional pain and tenderness at the surgical site Pink, mobile fingers An order for heparin infusion
Swelling and tenseness in the affected area
All of these client assignments have been made by the charge nurse. Which assignment is questionable? The RN with 3 years of experience caring for a client with a pulmonary embolism (PE) who is receiving heparin therapy The LPN/LVN with 5 years of experience caring for a client with leg ulcers who is awaiting nursing home placement The RN with 8 years of experience caring for a client with peripheral arterial disease (PAD) and a total cholesterol of 390 mg/dL The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure is 210/150 mm Hg
The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure is 210/150 mm Hg The client with a headache and high blood pressure has unstable hypertension and is at risk for complications such as stroke, heart failure, or renal failure. The client should be assigned to an experienced RN, who can assess for end-organ damage and administer IV medications.
The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? The client is semi-recumbent in bed. Chest leads are placed as for the previous ECG. The client is instructed to breathe deeply through the mouth. The client is instructed to lie still.
The client is instructed to breathe deeply through the mouth.
Explain the sign and symptoms of sickle cell crisis
The trauma of a burn injury can trigger a sickle cell crisis in patients who have the disease and in those who carry the trait. people describe this pain as sharp, intense, stabbing, or throbbing. Severe crises can be even more uncomfortable than post-surgical pain or childbirth. Pain can strike almost anywhere in the body and in more than one spot at a time. But the pain often occurs in the Lower back Legs Arms Abdomen Chest A crisis can be brought on by Illness Temperature changes Stress Dehydration (not drinking enough) Being at high altitudes
Discover symptoms of AAA Can have no symptoms, but people may experience: Pain areas: in the abdomen, back, or flank Also common: nausea or pulsating abdominal mass
abdominal aortic aneurysm (AAA) for abdominal, flank, or back pain. Pain is usually described as steady with a gnawing quality, unaffected by movement, and lasting for hours or days. A pulsation in the upper abdomen slightly to the left of the midline between the xyphoid process and the umbilicus may be present. A detectable aneurysm is at least 5 cm in diameter. Auscultate for a bruit over the mass, but avoid palpating the mass because it may be tender and there is risk for rupture! If expansion and impending rupture of an AAA are suspected, assess for 727severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs.
Summarize teaching for a patient diagnosed with hypertension
adults engage in aerobic physical activity 3 or 4 times a week to reduce LDL-C levels. Each session should last for 40 minutes on average and involve moderate-to-vigorous physical activity drug therapy - statins the general population ages 60 years and older, the desired BP is below 150/90. For people younger than 60 years, the desired BP is below 140/90. Patients whose blood pressures are above these desired goals should be treated with drug therapy Changes in fluid volume also affect the systemic arterial pressure. For example, if there is an excess of sodium and/or water in a person's body, the blood pressure rises
Teach patients taking anticoagulant therapy to report any signs of
bruising or unusual bleeding immediately to their health care provider.
The nurse is caring for a client who has developed a bradycardia. Which possible causes does the nurse investigate? (Select all that apply.) Bearing down for a bowel movement Possible inferior wall myocardial infarction (MI) Client stating that he just had a cup of coffee Client becoming emotional when visitors arrived Diltiazem (Cardizem) administered 1 hour ago
earing down for a bowel movement Possible inferior wall myocardial infarction (MI) Diltiazem (Cardizem) administered 1 hour ago
Prepare a teaching plan for a patient on digoxin (use, side effects, interactions, teaching_ signs of toxicity-fatigue, appetite loss, muscle weakness, confusion.... bradycardia and loss of the P wave on the ECG.Monitor serum digoxin and potassium levels (hypokalemia potentiates digoxin toxicity) may experience angina (chest pain) in response to digoxin. Administer potassium so that serum potassium is maintained between 4.0 and 5.5 mmol/L. Monitor ECG for evidence of potassium toxicity (peaking of T waves). Therapeutic serum digoxin levels range from 0.5-2 ng/mL. Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100. Evaluation/Desired Outcomes Decrease in severity of HF. Increase in cardiac output. Decrease in ventricular response in atrial tachyarrhythmias. Termination of paroxysmal atrial tachycardia.
dont take antiacids or laxatives before taking digoxin. benefits for patients in chronic heart failure (HF) with sinus rhythm and atrial fibrillation. reduces exacerbations of HF and hospitalizations when added to a regimen of ACE inhibitors or ARBs, beta blockers, and diuretics. benefits of digoxin include: • Increased contractility • Reduced heart rate (HR) • Slowing of conduction through the atrioventricular node • Inhibition of sympathetic activity while enhancing parasympathetic activity Digoxin is erratically absorbed from the GI tract. It is eliminated primarily by renal excretion. Older patients should be maintained on lower doses of the drug than younger patients. indications: -Heart failure. -Atrial fibrillation and atrial flutter (slows ventricular rate). -Paroxysmal atrial tachycardia. action: -Increases the force of myocardial contraction. -Prolongs refractory period of the AV node. -Decreases conduction through the SA and AV nodes. therapeutic effect: Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect). side effects: arrythmias (life threatening) fatigue, headache, weakness, blurred vision, yellow or green vision, nausea, anorexia, vomiting,diarrhea , thrombocytopenia, electrolyte imbalances interactions- using with diuretics - watch for hypokalemia PO: (Adults) Digitalizing dose- 0.75-1.5 mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals. Maintenance dose- 0.125-0.5 mg/day depending on patient's lean body weight, renal function, and serum level. PO: Geriatric Patients Initial daily dosage should not exceed 0.125 mg. Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult,Evaluate serum electrolyte levels (especially potassium, magnesium, and calcium) and renal and hepatic functions periodically during therapy.
Modify patient diet with B12 deficiency
increase the intake of foods rich in vitamin B12 (animal proteins, fish, eggs, nuts, dairy products, dried beans, citrus fruit, and leafy green vegetables). Vitamin supplements may be prescribed when anemia is severe
Malignant hypertension
is a severe type of elevated blood pressure that rapidly progresses. A person with this health problem usually has symptoms such as morning headaches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine). Patients are often in their 30s, 40s, or 50s with their systolic blood pressure greater than 200 mm Hg. The diastolic blood pressure is greater than 150 mm Hg or greater than 130 mm Hg when there are pre-existing complications. Unless intervention occurs promptly, a patient with malignant hypertension may experience kidney failure, left ventricular heart failure, or stroke.
Explain why patients with prosthetic valve need anticoagulant therapy
to prevent thrombus formation.
Review teaching for a patient with iron deficiency anemia
• Balance activity with rest. Take one or two naps each day. • Pace yourself; do not plan too much for one day. • Set priorities. Determine which activities are most important, and do them first. • Delegate responsibilities and tasks to your family and friends. • Plan ahead to prevent last-minute rushing and stress. • Learn your own activity tolerance, and do not exceed it. * appliances may require structural changes. The patient may also require handrails and elevated chairs and toilet seats, which facilitate transfers increasing the oral intake of iron from food sources (e.g., red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins) Instruct patients to take the iron supplement between meals for better absorption and to reduce GI distress.
Explain risk factors for atherosclerosis
• Low HDL-C • High LDL-C • Increased triglycerides • Genetic predisposition • Diabetes mellitus • Obesity • Sedentary lifestyle • Smoking • Stress • African-American or Hispanic ethnicity • Older adult
A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client? "Consume foods high in potassium." "Monitor for irregular pulse." "Monitor for muscle cramping." "Avoid grapefruit juice."
"Avoid grapefruit juice."
In teaching clients at risk for bradydysrhythmias, what information does the nurse include? "Avoid potassium-containing foods." "Stop smoking and avoid caffeine." "Take nitroglycerin for a slow heartbeat." "Use a stool softener."
"Use a stool softener." Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia.
Which teaching point does the nurse include for a client with peripheral arterial disease (PAD)? "Elevate your legs above heart level to prevent swelling." "Inspect your legs daily for brownish discoloration around the ankles." "Walk to the point of leg pain, then rest, resuming when pain stops." "Apply a heating pad to the legs if they feel cold."
"Walk to the point of leg pain, then rest, resuming when pain stops."
Which client who has just arrived in the emergency department does the nurse classify as emergent and needing immediate medical evaluation? A 60-year-old with venous insufficiency who has new-onset right calf pain and tenderness A 64-year-old with chronic venous ulcers who has a temperature of 100.1° F (37.8° C) A 69-year-old with a 40-pack-year cigarette history who is reporting foot numbness A 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic
A 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic-- manifestations suggest possible aortic dissection
Which waveform indicates proper function of the sinoatrial (SA) node? The QRS complex is present. The PR interval is 0.24 second. A P wave precedes every QRS complex. The ST segment is elevated.
A P wave precedes every QRS complex.
Essential (Primary) • Family history of hypertension • African-American ethnicity • Hyperlipidemia • Smoking • Older than 60 years or postmenopausal • Excessive sodium and caffeine intake • Overweight/obesity • Physical inactivity • Excessive alcohol intake • Low potassium, calcium, or magnesium intake • Excessive and continuous stress (Secondary) • Kidney disease • Primary aldosteronism • Pheochromocytoma • Cushing's disease • Coarctation of the aorta • Brain tumors • Encephalitis • Pregnancy • Drugs: • Estrogen (e.g., oral contraceptives) • Glucocorticoids • Mineralocorticoids • Sympathomimetics
A client is prescribed enalapril (Vasotec) for control of hypertension. What health teaching will the nurse provide before the client begins therapy? A "You may develop a higher pulse rate." B "You may notice some swelling in your feet." C "You may develop a nagging cough." D "Your diet should include foods high in sodium." *c
Which of the following findings during a female breast examination should the nurse report as suspicious for breast cancer? Multiple nodules of round, lumpy, tender tissue in both breasts A single soft, mobile, lobular nodule that is nontender A poorly defined, firm lump that is nontender and nonmovable A single soft lump that is well-defined and tender
A poorly defined, firm lump that is nontender and nonmovable
A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88 beats/min. For which additional therapy does the nurse plan? Synchronized cardioversion Electrophysiology studies (EPS) Anticoagulation Radiofrequency ablation therapy
Anticoagulation
The nurse is caring for a client with dark-colored toe ulcers and blood pressure of 190/100 mm Hg. Which nursing action does the nurse delegate to the LPN/LVN? Assess leg ulcers for evidence of infection. Administer a clonidine patch for hypertension. Obtain a request from the health care provider for a dietary consult. Develop a plan for discharge, and assess home care needs
Administer a clonidine patch for hypertension.
A client is diagnosed with left-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. A Peripheral edema B Crackles in both lungs C Breathlessness D Ascites E Tachypnea
B Crackles in both lungs C Breathlessness E Tachypnea
An older adult taking digoxin and hydrochlorothiazide (HCTZ) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 48. A family member states that the client has reported blurred vision and loss of appetite for 2 weeks. What is the nurse's first action? A Call the ED physician immediately. B Draw a serum digoxin level. C Assess for signs of hypokalemia. D Establish the client's airway.
B Draw a serum digoxin level.
For a client with an 8-cm abdominal aortic aneurysm, which problem must be addressed immediately to prevent rupture? Heart rate 52 beats/min Blood pressure 192/102 mm Hg Report of constipation Anxiety
Blood pressure 192/102 mm Hg
Which medication, when given in heart failure, may improve morbidity and mortality? Dobutamine (Dobutrex) Carvedilol (Coreg) Digoxin (Lanoxin) Bumetanide (Bumex)
Carvedilol (Coreg)
The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? Defibrillate the client at 200 joules. Check the client for a pulse. Cardiovert the client at 50 joules. Give the client IV lidocaine.
Check the client for a pulse.
The nurse is planning care for a patient with hypercalcemia secondary to bone metastasis. Which of the following interventions will be included in the plan of care? (Select all that apply.) Increasing oral fluids Placement of an oral airway at the bedside Monitoring for Chvostek's sign Implementing seizure precautions Hyperactive reflex assessment Observation for muscle weakness
Observation for muscle weakness Increasing oral fluids
When administering furosemide (Lasix) to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels? Increase red meat in the diet. Consume melons and baked potatoes. Add several portions of dairy products each day. Try replacing your usual breakfast with oatmeal or Cream of Wheat.
Consume melons and baked potatoes.
Left-Sided Heart Failure: Impaired tissue perfusion, pulmonary congestion, and edema Left-Sided Heart Failure. Left ventricular failure is associated with decreased cardiac output and elevated pulmonary venous pressure. It may appear clinically as: • Weakness • Fatigue • Dizziness • Acute confusion • Pulmonary congestion • Breathlessness • Oliguria (scant urine output)
DECREASED CARDIAC OUTPUT PULMONARY CONGESTION • Fatigue • Weakness • Oliguria during the day (nocturia at night) • Angina • Confusion, restlessness • Dizziness • Tachycardia, palpitations • Pallor • Weak peripheral pulses • Cool extremities • Hacking cough, worse at night • Dyspnea/breathlessness • Crackles or wheezes in lungs • Frothy, pink-tinged sputum • Tachypnea • S3/S4 summation gallop
Which finding in the history of a client with an abdominal aortic aneurysm (AAA) is a risk factor for aneurysm formation? Peptic ulcer disease Deep vein thrombosis (DVT) Osteoarthritis Marfan syndrome
Marfan syndrome is a risk factor for cardiovascular disorders
Express the need for funduscopic eye exam in patients with hypertension
Ocular changes can be the initial finding in an asymptomatic patient with hypertension---observe vascular changes in the retina
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? Auscultation of crackles Pedal edema Weight loss of 6 pounds since the last visit Reports sucking on ice chips all day for dry mouth
Weight loss of 6 pounds since the last visit
Essential hypertension
most common type and is not caused by an existing health problem.
Which of the following statements is essential when teaching a patient who has received an injection of iodine-131? "Do not share a toilet with anyone else for 3 days." "You need to save all your urine for the next 7 days." "No special precautions are needed, because this is a weak type of radiation." "You need to avoid contact with everyone except family members until the radiation device is removed.
"Do not share a toilet with anyone else for 3 days."
The nurse is teaching a client the precautions to take while on warfarin (Coumadin) therapy. Which statement made by the client demonstrates that teaching has been effective? "I can use an electric razor or a regular razor." "Eating foods like green beans won't interfere with my Coumadin therapy." "If I notice I am bleeding a lot, I should stop taking Coumadin right away." "When taking Coumadin, I may notice some blood in my urine."
"Eating foods like green beans won't interfere with my Coumadin therapy."
When caring for a client with an abdominal aortic aneurysm (AAA), the nurse suspects dissection of the aneurysm when the client makes which statement? "I feel my heart beating in my abdominal area." "I just started to feel a tearing pain in my belly." "I have a headache. May I have some acetaminophen?" "I have had hoarseness for a few weeks."
"I just started to feel a tearing pain in my belly." Severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs, is indicative of impending rupture of AAA.
The nurse is teaching a client with a new permanent pacemaker. Which statement by the client indicates a need for further discharge education? "I will be able to shower again soon." "I need to take my pulse every day." "I might trigger airport security metal detectors." "I no longer need my heart pills."
"I no longer need my heart pills."
The nurse discusses the importance of restricting sodium in the diet for a client with heart failure. Which statement made by the client indicates that the client needs further teaching? "I should avoid eating hamburgers." "I must cut out bacon and canned foods." "I shouldn't put the salt shaker on the table anymore." "I should avoid lunchmeats but may cook my own turkey."
"I should avoid eating hamburgers."
The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? "I will call the provider if I have a cough lasting 3 or more days." "I will report to the provider weight loss of 2 to 3 pounds in a day." "I will try walking for 1 hour each day." "I should expect occasional chest pain."
"I will call the provider if I have a cough lasting 3 or more days."
The nurse is teaching a young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching? "I must stop taking my birth control pills." "I should drink lots of water so I don't get dehydrated." "I should exercise my legs when I have been sitting or standing for a long time." "If I wear pantyhose, I won't have to wear the stockings the hospital gives me."
"If I wear pantyhose, I won't have to wear the stockings the hospital gives me."
The client, a college athlete who collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response? "How does this make you feel?" "This can be caused by taking performance-enhancing drugs." "This may be caused by a genetic trait." "Just imagine how bad it would be if you weren't in good shape."
"This may be caused by a genetic trait."
Upon entering the room, the nurse finds the patient, who has just had a mastectomy, crying. When the nurse asks about her crying, the patient states, "I know I shouldn't cry because this surgery may well save my life." What is the nurse's best response? "It is okay to cry; mourning the loss of your breast is important for getting past this." "I know this is hard, but chances of survival are greatly improved now." "Would you like to talk to someone who also has had a mastectomy?" "How have you coped with difficult situations in the past?"
"It is okay to cry; mourning the loss of your breast is important for getting past this."
A client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care? "My leg might turn very white after the surgery." "I should be concerned if my foot turns blue." "I should report a fever or any drainage." "Warmness, redness, and swelling are expected."
"My leg might turn very white after the surgery.
What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? "It is important to consume a diet high in green leafy vegetables." "You should take aspirin or ibuprofen for headache." Incorrect "Report nosebleeds to your provider immediately." "Avoid caffeinated beverages."
"Report nosebleeds to your provider immediately."
A patient with breast cancer asks the nurse why 6 weeks of daily radiation treatments is necessary. What is the nurse's best response? "Your cancer is widespread and requires more than the usual amount of radiation treatment." "The cost of larger doses of radiation for a shorter period of time is justified by the results." "Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time." "It is less likely your hair will fall out or you will become anemic if radiation is given in smaller doses over a longer period of time."
"Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time."
The client undergoing femoral popliteal bypass states that he is fearful he will lose the limb in the near future. Which response by the nurse is most therapeutic? "Are you afraid you will not be able to work?" "If you control your diabetes, you can avoid amputation." "Your concerns are valid; we can review some steps to limit disease progression." "What about the situation concerns you most?"
"Your concerns are valid; we can review some steps to limit disease progression."
After receiving change-of-shift report about these four clients, which client should the nurse assess first? A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular contractions A 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% A 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths Incorrect A 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, heart rate 104 beats/min
(Lanoxin) and has new-onset frequent premature ventricular contractions
Create a teaching plan for a patient on Zocor (use, side effects, interactions, and teaching)
(statin)Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Therefore they are contraindicated in patients with active liver disease or during pregnancy because they can cause muscle myopathies and marked decreases in liver function Simvastatin reduces levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of "good" cholesterol (high-density lipoprotein, or HDL). *avoid grapefruit *not for pregnant women Therapeutic Effects:Indicated by decreased serum triglycerides, decreased LDL, cholesterol, and modest increases in HDL cholesterol.Reduces risk of coronary death and nonfatal MI. PO 5-40 mg Adjust dosage usually at 4-wk intervals. Give in the evening. Store at 15°-30° C (59°-86° F). Adverse Effects (1%) CV: Angina. CNS: Dizziness, headache, vertigo, asthenia, fatigue, insomnia. GI: Nausea, diarrhea, vomiting, abdominal pain, constipation, flatulence, heartburn, transient elevations in liver transaminases, transient elevations in CPK. Body as a Whole: Fatigue. Respiratory: Rhinitis, cough. Interactions Drug: May increase PT when administered with warfarin Obtain baseline and periodic (q6mo) liver function during the first year and yearly thereafter. Monitor cholesterol levels throughout therapy. Monitor coagulation studies with patients receiving concurrent warfarin therapy. PT may be prolonged. Assess for and report unexplained muscle pain. Determine CPK level at onset of muscle pain. Report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever, to physician. Report signs of bleeding to physician promptly when taking concurrent warfarin.
The nurse is caring for a client with peripheral arterial disease (PAD). For which symptoms does the nurse assess? Reproducible leg pain with exercise Unilateral swelling of affected leg Decreased pain when legs are elevated Pulse oximetry reading of 90%
Reproducible leg pain with exercise
Which teaching is essential for a client who has had a permanent pacemaker inserted? Avoid talking on a cell phone. Avoid operating electrical appliances over the pacemaker. Avoid sexual activity. Do not take tub baths
Avoid operating electrical appliances over the pacemaker.
Review assessment findings for a patient with pericarditis
Assessment findings for patients with acute pericarditis include substernal precordial pain that radiates to the left side of the neck, the shoulder, or the back. pain is classically grating and oppressive and is aggravated by breathing (mainly on inspiration), coughing, and swallowing. The pain is worse when the patient is in the supine position and may be relieved by sitting up and leaning forward. A pericardial friction rub may be heard with the diaphragm of the stethoscope positioned at the left lower sternal border. This scratchy, high-pitched sound is produced when the inflamed, roughened pericardial layers create friction as their surfaces rub together. Patients with acute pericarditis may have an elevated white blood cell count and usually have a fever. Therefore blood culture and sensitivity may be analyzed in the laboratory. The ECG usually shows ST-T spiking in almost all leads simultaneously, and aVR with ST depression with the onset of inflammation, which returns to baseline with treatment. Atrial fibrillation is also common. Echocardiograms may be used to determine a pericardial effusion. Patients with chronic constrictive pericarditis have signs of right-sided HF, elevated systemic venous pressure with jugular distention, hepatic engorgement, and dependent edema. Exertional fatigue and dyspnea are common complications. Thickening of the pericardium is seen on echocardiography or a computed tomography (CT) scan.
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? Assess the client for peripheral edema. Auscultate the client's posterior breath sounds. Notify the health care provider about the client's weight gain. Remind the client about dietary sodium restrictions
Auscultate the client's posterior breath sounds.
A client who recently had a heart valve replacement is taking warfarin (Coumadin) as prescribed. What statement by the client indicates that the nurse will need to do additional health teaching? A "I will take my pulse every day, and call my doctor if it is below 60." B "I will eat foods that are high in vitamin K, such as kale and spinach." C "I will weigh myself every day in the morning using the same scale." D "I will take my blood pressure every day and call if it is too high or lo
B "I will eat foods that are high in vitamin K, such as kale and spinach."
The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Toprol). Which monitoring is essential when administering the medication? ST segment Heart rate Troponin Myoglobin
Heart rate -The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand
The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? (Select all that apply.) Chest discomfort or pain Tachycardia Expectorating thick, yellow sputum Sleeping on back without a pillow Fatigue
Chest discomfort or pain Tachycardia Fatigue
Interpret data related to claudication and peripheral artery disease
Chronic Peripheral Arterial Disease Stage I: Asymptomatic • No claudication is present. • Bruit or aneurysm may be present. • Pedal pulses are decreased or absent. Stage II: Claudication • Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. • Symptoms are reproducible with exercise. Stage III: Rest Pain • Pain while resting commonly awakens the patient at night. • Pain is described as numbness, burning, toothache-type pain. • Pain usually occurs in the distal portion of the extremity (toes, arch, forefoot, or heel), rarely in the calf or the ankle. • Pain is relieved by placing the extremity in a dependent position. Stage IV: Necrosis/Gangrene • Ulcers and blackened tissue occur on the toes, the forefoot, and the heel. • Distinctive gangrenous odor is present.
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? Ejection fraction is 25%. Client states that she is able to sleep on one pillow. Client was hospitalized five times last year with pulmonary edema. Client reports that she experiences palpitations
Client states that she is able to sleep on one pillow.
While caring for a client who has received recombinant tissue plasminogen activator (t-PA) for a large deep vein thrombus, the nurse becomes most concerned when the client develops which condition? Small amount of blood at the IV insertion site Heavy menstrual bleeding +1 pitting edema of the affected extremity Incorrect Client stating that the year is 1967
Client stating that the year is 1967--The most serious complication from thrombolytic therapy is intracerebral bleeding, manifested by changes in the level of consciousness.
Which client is best to assign to an LPN/LVN working on the telemetry unit? Client with heart failure who is receiving dobutamine (Dobutrex) Client with dilated cardiomyopathy who uses oxygen for exertional dyspnea Client with pericarditis who has a paradoxical pulse and distended jugular veins Client with rheumatic fever who has a new systolic murmur
Client with dilated cardiomyopathy who uses oxygen for exertional dyspnea
The nurse suspects that a client has developed an acute arterial occlusion of the right lower extremity based on which signs/symptoms? (Select all that apply.) Hypertension Tachycardia Bounding right pedal pulses Cold right foot Numbness and tingling of right foot Mottling of right foot and lower leg
Cold right foot Numbness and tingling of right foot Mottling of right foot and lower leg
A client who has been admitted for the third time this year for heart failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? Calls the family to lift the client's spirits Considers further assessment for depression Sedates the client to decrease myocardial oxygen demand Tells the client that things will get better
Considers further assessment for depression
Which are risk factors that are known to contribute to atherosclerosis-related diseases? (Select all that apply.) Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL Smoking Aspirin (acetylsalicylic acid [ASA]) consumption Type 2 diabetes Vegetarian diet
Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL Smoking Type 2 diabetes
The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client should the nurse question? Enalapril (Vasotec) Sodium nitroprusside (Nipride) Dopamine (Intropin) Clevidipine (Butyrate)
Dopamine (Intropin) - Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure
The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the client's last appointment. Which actions by the client indicate that teaching has been effective? (Select all that apply.) Has maintained a low-sodium, no-added-salt diet Has lost 3 pounds since last seen in the clinic Cooks food in palm oil to save money Exercises once weekly Has cut down on caffeine
Has maintained a low-sodium, no-added-salt diet Has lost 3 pounds since last seen in the clinic Has cut down on caffeine
The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? Heparin Atropine Dobutamine Magnesium sulfate
Heparin - atrial contractions in atrial fibrillation can lead to pooling of blood, resulting in thrombus formation
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8° F Pulse: 48 beats/min and irregular Respirations: 20 breaths/min Potassium level: 3.2 mEq/L What action does the nurse take? - Give the digoxin; reassess the heart rate in 30 minutes. - Give the digoxin; document assessment findings in the medical record. -Hold the digoxin, and obtain a prescription for an additional dose of furosemide. - Hold the digoxin, and obtain a prescription for a potassium supplement.
Hold the digoxin, and obtain a prescription for a potassium supplement. Digoxin causes bradycardia; hypokalemia potentiates digoxin. Because digoxin causes bradycardia, the medication should be held.
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of which medication because it raises an index of suspicion as to the worsening of the client's HF? Ibuprofen (Motrin) Hydrochlorothiazide (HydroDIURIL) NPH insulin Levothyroxine (Synthroid)
Ibuprofen (Motrin) Long-term use of nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client's HF.
The professional nurse and the nursing student are caring for a group of clients with hypertension. Which problem identified by the nursing student correctly identifies the client at risk for secondary hypertension? Psychiatric disturbance High sodium intake Physical inactivity Kidney disease
Kidney disease
Which nursing action may be delegated to a nursing assistant working on the medical unit? Determine the usual alcohol intake for a client with cardiomyopathy. Monitor the pain level for a client with acute pericarditis. Obtain daily weights for several clients with class IV heart failure. Check for peripheral edema in a client with endocarditis.
Obtain daily weights for several clients with class IV heart failure.
The nurse receives a report that a client with a pacemaker has experienced loss of capture. Which situation is consistent with this? The pacemaker spike falls on the T wave. Pacemaker spikes are noted, but no P wave or QRS complex follows. The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip. The client demonstrates hiccups.
Pacemaker spikes are noted, but no P wave or QRS complex follows.
The nurse is assessing a client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? Friction rub auscultated at the left lower sternal border Pain aggravated by breathing, coughing, and swallowing Splinter hemorrhages Thickening of the endocardium
Pain aggravated by breathing, coughing, and swallowing Splinter hemorrhages
The nurse is caring for a client with heart rate of 143 beats/min. For which manifestations does the nurse observe? (Select all that apply.) Palpitations Increased energy Chest discomfort Flushing of the skin Hypotension
Palpitations Chest discomfort Hypotension
A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure? Ankle-brachial index Dye allergy Pedal pulses Gag reflex
Pedal pulses assessment for bleeding at the arterial puncture site and monitoring for distal pulses
Identify symptoms of a patient with peripheral arterial disease
People who have P.A.D. may have symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. Symptoms may ease after resting. These symptoms are called intermittent claudication. During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won't get enough blood, which will lead to symptoms. When resting, the muscles need less blood flow, so the symptoms will go away. Other Signs and Symptoms Other signs and symptoms of P.A.D. include: Weak or absent pulses in the legs or feet Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all A pale or bluish color to the skin A lower temperature in one leg compared to the other leg Poor nail growth on the toes and decreased hair growth on the legs Erectile dysfunction, especially among men who have diabetes
Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? Monitor pulse oximetry and cardiac rate and rhythm. Reassure the client that his distress can be relieved with proper intervention. Place the client in high-Fowler's position with the legs down. Ask a family member to remain with the client.
Place the client in high-Fowler's position with the legs down.
A client is receiving unfractionated heparin (UFH) by infusion. Of which finding does the nurse notify the provider? Partial thromboplastin time (PTT) 60 seconds Platelets 32,000/mm3 White blood cells 11,000/mm Hemoglobin 12.2 g/dL
Platelets 32,000/mm3
Which finding confirms the presence of a thromboembolism? Human chorionic gonadotropin (hCG) negative Crackles at bases Positive D-dimer ( >0.5mg/L) Right leg swelling
Positive D-dimer ( >0.5mg/L) (clot breakdown).The test is often used for the diagnosis of deep vein thrombosis
A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action does the nurse take next? Prepare for defibrillation. Establish IV access. Place an oral airway and ventilate. Start cardiopulmonary resuscitation (CPR)
Prepare for defibrillation.
The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? (Select all that apply.) Respiratory rate QT interval Heart rate Heart rhythm Urine output
QT interval Heart rate Heart rhythm
*right ventricular failure:systemic venous congestion and peripheral edema
Right-Sided Heart Failure Systemic Congestion • Jugular (neck vein) distention • Enlarged liver and spleen • Anorexia and nausea • Dependent edema (legs and sacrum) • Distended abdomen • Swollen hands and fingers • Polyuria at night • Weight gain • Increased blood pressure (from excess volume) or decreased blood pressure (from failure)
Which intervention provides safety during cardioversion? Setting the defibrillator at 200 joules Obtaining informed consent Setting the defibrillator to the synchronized mode Removing oxygen
Setting the defibrillator to the synchronized mode
Which symptom reported by a client who has had a total hip replacement requires emergency action? Localized swelling of one of the lower extremities Positive Homans' sign Shortness of breath and chest pain Tenderness and redness at the IV site
Shortness of breath and chest pain
Which vascular assessment by the student nurse requires intervention by the supervising nurse? Measuring capillary refill in the fingertips Assessing pedal pulses by Doppler Measuring blood pressure in both arms Simultaneously palpating the bilateral carotids
Simultaneously palpating the bilateral carotids
The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? (Select all that apply.) Hypokalemia Sinus bradycardia Fatigue Serum digoxin level of 1.5 Anorexia
Sinus bradycardia Fatigue Anorexia
A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment result obtained the day after admission is the best indicator that the treatment has been effective? The client has diuresis of 400 mL in 24 hours. The client's blood pressure is 122/84 mm Hg. The client has an apical pulse of 82 beats/min. The client's weight decreases by 2.5 kg
The client's weight decreases by 2.5 kg
Which client is appropriate for the cardiac care unit charge nurse to assign to the float RN from the medical-surgical unit? The 64-year-old client admitted for weakness who has a sinus bradycardia with a heart rate of 58 beats/min The 71-year-old client admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min The 88-year-old client admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min The 92-year-old client admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min
The 64-year-old client admitted for weakness who has a sinus bradycardia with a heart rate of 58 beats/min The 64-year-old has a stable, asymptomatic bradycardia, which usually requires monitoring but no treatment unless the client develops symptoms and/or the slow heart rate causes a decrease in cardiac output
Indicate foods appropriate for a patient with hypertension
The DASH diet is a lifelong approach to healthy eating that's designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains. • Consume low-fat dairy products, poultry, fish, legumes, nontropical (e.g., canola) vegetable oils, and nuts. • Limit intake of sweets, sugar-sweetened beverages, and red meats. • Aim for a dietary pattern that includes 5% to 6% of calories from saturated fat. • Reduce percent of calories from trans fat.
Which sign/symptom is essential for the nurse to report to the provider when caring for a client with Raynaud's phenomenon? Nifedipine (Procardia) administration caused the blood pressure to change from 134/76 to 110/68 mm Hg. The client's extremity became white, then red temporarily. The affected extremity becomes purple and cold. The client states that the digits are painful when they are white.
The affected extremity becomes purple and cold. Cold, mottled extremities are indicative of occlusion, which could lead to gangrene. Vasodilating drugs are administered as treatment and may lower the blood pressure
he nurse is assigned to all of these clients. Which client should be assessed first? The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago The client admitted with hypertensive crisis who has a nitroprusside (Nipride) drip and blood pressure of 149/80 mm Hg The client with peripheral vascular disease who has a left leg ulcer draining purulent yellow fluid The client who had a right femoral-popliteal bypass 3 days ago and has ongoing edema of the foot
The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago
Illustrate the function of the SA node
The heart's natural pacemaker - the SA node - sends out regular electrical impulses from the top chamber (the atrium) causing it to contract and pump blood into the bottom chamber (the ventricle). The electrical impulse is then conducted to the ventricles through a form of 'junction box' called the AV node.
Demonstrate understanding of central perfusion
The heart; force of blood movement generated by cardiac output; requires cardiac function, BP, blood volume (CO= SV x HR)
How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? The client states he is dizzy and weak. The nurse notes dyspnea. The client has a heart rate of 42 beats/min. The monitor shows an increase in heart rate.
The monitor shows an increase in heart rate.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? The client ambulates around the nursing unit with a walker. The nurse monitors the client's pulse and blood pressure frequently. The nurse obtains a bedside commode before administering furosemide The nurse returns the client to bed when he becomes tachycardic.
The nurse obtains a bedside commode before administering furosemide
A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? The client's ability to understand medication teaching The risk for hypotension The potential for bradycardia Liver function tests
The risk for hypotension
The nurse caring for a client who has had abdominal aortic aneurysm (AAA) repair would be most alarmed by which finding? Urine output of 20 mL over 2 hours Blood pressure of 106/58 mm Hg Absent bowel sounds +3 pedal pulses
Urine output of 20 mL over 2 hours ---Complications post AAA stent repair include bleeding, which may manifest as signs of hypovolemia and oliguria.
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet? Less than 30% of the daily caloric intake should be derived from proteins. Use canola oil rather than palm oil. Consume 10 mg of fiber daily. Work toward lowering your high-density lipoprotein (HDL) cholesterol levels.
Use canola oil rather than palm oil.
What priority intervention will the nurse employ to prevent injury to the patient with bone cancer? Using a lift sheet when repositioning the patient Positioning the patient so the heels do not touch the mattress Providing small, frequent meals rich in calcium and phosphorus Applying pressure for a full 5 minutes after intramuscular injections
Using a lift sheet when repositioning the patient
Design teaching for a patient with atherosclerosis (causes, implications, and treatments)
caused by high blood pressure, smoking, or high cholesterol. That damage leads to the formation of plaque.As a result, not only is your heart at risk, but you are also at risk for stroke and other health problems. Smoking High cholesterol High blood pressure Diabetes Abdominal obesity ("spare tire") Stress Not eating fruits and vegetables Excess alcohol intake (more than one drink for women, one or two drinks for men, per day) Not exercising regularly
Prepare teaching for a low cholesterol diet
olive oil fish carrots lentils flax seed banana Limit total intake of fats and oils. Avoid butter, stick margarine, shortening, lard, palm and coconut oils. Limit mayonnaise, salad dressings, gravies and sauces, unless they are homemade with low-fat ingredients. Limit chocolate. Choose low-fat and nonfat products, such as low-fat mayonnaise, low-fat or non-hydrogenated peanut butter, low-fat or fat-free salad dressings and nonfat gravy. Use vegetable oil, such as canola or olive oil. Look for margarine that does not contain trans fatty acids. Use nuts in moderate amounts. Read ingredient labels carefully to determine both amount and type of fat present in foods. Limit saturated and trans fats. Avoid high-fat processed and convenience foods.Choose fish, chicken, turkey and lean meats. Use dried beans, peas, lentils and tofu. Limit egg yolks to three to four per week. If you eat red meat, limit to no more than three servings per week and choose loin or round cuts. Avoid fatty meats, such as bacon, sausage, franks, luncheon meats and ribs. Avoid all organ meats, including liver. Choose nonfat or low-fat milk, yogurt and cottage cheese. Most cheeses are high in fat. Choose cheeses made from non-fat milk, such as mozzarella and ricotta cheese. Choose light or fat-free cream cheese and sour cream. Avoid cream and sauces made with cream.
Prepare discharge teaching for a patient with AAA repair(USUALLY 10 DAYS POST-OP) You will have a Foley catheter in your bladder, so you won't need to use the restroom. For a few days, intravenous (IV) lines provide fluids and medications. You may have a nasogastric (NG) tube from your nose to your stomach for a few days to keep your stomach empty until your colon starts to function again. Although an NG tube may be somewhat uncomfortable, it prevents nausea, vomiting, and other complications. When you start to pass gas, it is a sign that your colon is working again and you'll be started on a liquid diet. You will progress to a soft diet "as tolerated," that means as long as you don't experience nausea or vomiting. You will continue a soft diet for 2 to 8 weeks after surgery, depending on your healing, as ordered by your doctor.
surgical procedure for AAA has traditionally been a resection or repair (aneurysmectomy).Postoperative care is similar to care required after an arteriogram (angiogram). Plan to have someone drive you home from the hospital. DO NOT drive yourself home. -HEPARIN THERAPY -ASPIRIN TO REDUCE STICKY BLOOD -STATIN TO REDUCE CHOLESTEROL You should be able to do most of your regular activities in 4 to 8 weeks. Before that: DO NOT lift anything heavier than 10 to 15 pounds (5 to 7 kg) until you see your health care provider. Avoid all strenuous activity, including heavy exercising, weightlifting, and other activities that make you breathe hard or strain. Short walks and using stairs are OK. Light housework is OK. DO NOT push yourself too hard. Increase how much you exercise slowly. Eat a heart-healthy diet. Get regular exercise. Stop smoking, if you smoke. Reduce stress to help lower your chances of having a blocked artery again.Call your provider if: You have pain in your belly or back that does not go away or is very bad. Your legs are swelling. You have chest pain or shortness of breath that does not go away with rest. You experience dizziness, fainting, or you are very tired. You are coughing up blood or yellow or green mucus. You have chills or a fever over 100.5°F (38°C). Your belly hurts or feels distended. You have blood in your stool or develop bloody diarrhea. You are not able to move your legs. Also call your provider if there are changes in your surgical incision, such as: The edges are pulling apart. You have green or yellow drainage. You have more redness, pain, warmth, or swelling. Your bandage is soaked with blood or clear fluid.
