Cardiac Flashcards
(23 cards)
A nurse is providing teaching about a health diet to a group of clients with hypertension. Which of the following statements by one of the clients indicates a need for further teaching?
A. “I can east 10 ounces of lean protein each day.”
B. “Fresh fruits make a good snack option.”
C. “I will replace table salt with dried herbs.”
D. “I can thicken gravies with cornstarch as I cook.”
A. “I can east 10 ounces of lean protein each day.”
Rational: Lean meats should be limited to 5 to 6 oz per day. This statement by a client requires additional teaching.
A nurse is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include?
A. “Take this medication before bedtime.”
B. “Monitor for leg cramps.”
C. “Avoid grapefruit juice.’
D. “Reduce intake of potassium-rich foods.”
B. “Monitor for leg cramps.”
Rational: Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.
The nurse is administering a dose of 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?
A. Muscle aches
B. Constipation
C. Pounding headache
D. Anorexia and nausea
D. Anorexia and nausea
Rational: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.
The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.
A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer?
A. Fab antibody fragments
B. Flumazenil
C. Acetylcysteine
D. Naloxone
Fab antibody fragments
Rational: Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.
A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect?
A. Hacking cough
B. Abdominal distension
C. Dependent edema
D. Jugular venous distension
Hacking Cough
Rational: A hacking cough is a manifestation of left-sided heart failure that occurs due to pulmonary congestion.
This cough may be worse at night when the client is lying down.
A nurse is caring for an older adult client who has left sided heart failure. Which of the following assessment findings should the nurse expect?
A. Frothy sputum
B. Dependent edema
C. Nocturnal polyuria
D. Jugular distention
Frothy sputum
Rational: Left-sided heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations include hacking cough, frothy sputum, wheezing, fatigue, and weakness.
A nurse is providing discharge teaching to a client who has a new diagnosis of heart failure. Which of the following instructions should the nurse include in the teaching?
A. Exercise at least three times per week.
B. Take diuretics early in the morning and before bedtime.
C. Notify the provider of a weight gain of 0.5 kg (1 lb) in a week.
D. Take naproxen for generalized discomfort.
A. Exercise at least three times per week.
The nurse encourage the client to stay as active as possible and to develop a regular exercise regimen. Clients who have heart failure who remain active appear to have improved outcomes. The client should try to walk at least three times per week and should slowly increase the amount of time walked over several months. Regular exercise strengthens the heart and cardiovascular system, thereby improving circulation and lowering blood pressure.
A nurse is assessing a client who has right-sided heart failure. Which of the following findings should the nurse expect?
A. Chest pain
B. Peripheral edema
C. Heart murmur
D. Crackles in lungs
B. Peripheral edema
Manifestations of right-sided heart failure include peripheral edema, weight gain, and distended neck veins due to impaired right ventricle functioning.
(chest pain = myocardial ischemia)
(heart murmur = valve disorder)
(lung crackles = left-sided heart failure)
Waist circumference (central obesity) is a strong predictor of long-term complications related to obesity, such as coronary artery disease.
Waist circumference (Greater than 100 cm males, Greater than 88 cm in females)
Rational: Central obesity due to excessive abdominal fat is a risk factor for metabolic syndrome. Metabolic syndrome increases the risk for the development of diabetes and coronary artery disease.
A nurse is reinforcing teaching with a client who has a new diagnosis of stable angina pectoris. Which of the following information about anginal pain should the nurse include in the teaching for stable angina?
A. exertion and anxiety can trigger the pain
B. the pain often radiates to the jaw or the back
C. the pain usually lasts more than 20 min
D. the pain persists with rest and organic nitrates
Exertion and anxiety can trigger the pain.
Rationale: Exertion and anxiety can trigger the pain of angina, unless it is variant angina, which occurs at rest
A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?
A. “I’ll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart.”
B. “I’ll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period.”
C. “I’ll dial 911 when I have pain and then take the nitroglycerin tablets.”
D. “I’ll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.”
D. “I’ll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.”
Rational: If 1 nitroglycerin tablet does not relieve the client’s pain, he should access emergency services and then take 2 more tablets at 5-min intervals if he still has pain.
A nurse is teaching a client about following a low-cholesterol diet after coronary artery bypass grafting. Which of the following client food choices reflects the client’s understanding of these dietary instructions?
A. Liver
B. Milk
C. Beans
D. Eggs
C. Beans
Rational: Any food that does not contain animal products does not contain cholesterol. Beans are a good source of protein for a client who follows a low-cholesterol diet.
A nurse is assessing a client who has hypercholesteremia and takes simvastatin. Potential adverse effect?
a. urinary retention
b. muscle weakness
c. orthostatic hypotension
d. blurred vision
B. Muscle weakness
Rational: Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness
A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?
A. The client follows a low-fat diet to reduce cholesterol.
B. The client drinks a glass of grapefruit juice every day.
C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant.
D. The client uses garlic to lower cholesterol levels.
D. The client uses garlic to lower cholesterol levels.
Rational: The nurse should recognize that garlic can potentiate the action of the warfarin.
A nurse is reviewing the lab results for a client who has a history of atherosclerosis and notes elevated cholesterol levels. Which of the following statements by the client indicates the nurse should plan follow-up teaching on a low-cholesterol diet?
A. “I flavor my meat with lemon juice.”
B. “I eat two eggs for breakfast each morning.”
C. “I cook my food with canola oil.”
D. “I take an omega-3 supplement daily.”
B. “I eat two eggs for breakfast each morning.”
Rational: Clients should limit egg yolks to two to three per week.
Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?
A. The patient states that the pain “wakes me up at night.”
B. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
C. The patient states that the pain has increased in frequency over the last week.
D. The patient states that the pain “goes away” with one sublingual nitroglycerin tablet.
D. The patient states that the pain “goes away” with one sublingual nitroglycerin tablet.
Rational: Chronic stable angina is typically relieved by rest or nitroglycerin.
The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina.
When caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
A. Give the scheduled aspirin and lipid-lowering medication.
B. Perform the initial assessment of the catheter insertion site.
C. Teach the patient about the usual postprocedure plan of care.
D. Titrate the heparin infusion according to the agency protocol.
A Give the scheduled aspirin and lipid-lowering medication.
Rational: Administration of oral medications is within the scope of practice for LPNs/LVNs.
The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN).
Which patient at the cardiovascular clinic requires the most immediate action by the nurse?
A. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL
B. Patient with stable angina whose chest pain has recently increased in frequency
C. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL
D. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg
B> Patient with stable angina whose chest pain has recently increased in frequency.
Rational: The change in the intensity of chest pain suggests unstable angina. This will require rapid implementation of interventions, such as cardiac catheterization and possible percutaneous coronary intervention.
During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention?
A. The patient’s pulse has dropped from 68 to 57 beats/min.
B. The patient complains that the fingers and toes feel quite cold.
C. The patient has developed wheezes throughout the lung fields.
D. The patient’s blood pressure (BP) reading is now 158/91 mm Hg.
C. The patient has developed wheezes throughout the lung fields.
Rational: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective b-blockers) is occurring.
The nurse should immediately obtain an O2 saturation measurement, apply supplemental O2, and notify the health care provider.
The mild decrease in heart rate and complaint of cold fingers and toes are associated with b-receptor blockade but do not require any change in therapy.
The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.
The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
A. Serum creatinine of 2.8 mg/dL
B. Serum potassium of 4.5 mEq/L
C. Serum hemoglobin of 14.7 g/dL
D. Blood glucose level of 96 mg/dL
A. Serum Creatinine of 2.8 mg/dL
Rational: (The elevated serum creatinine (normal 0.7 to 1.2) indicates renal damage caused by hypertension. The other laboratory results are normal.)
A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first?
A: Tell the patient why a change in drug dosage is needed.
B: Ask the patient if the medication is being taken as prescribed.
C: Review with the patient any lifestyle changes made to help control BP.
D: Teach the patient that multiple drugs are often needed to treat hypertension.
B: Ask the patient if the medication is being taken as prescribed.
Rational: Because non-adherence with antihypertensive therapy is common, the nurse’s initial action would be to determine whether the client is taking the atenolol as prescribed.
When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse?
A. Patient complaint of feeling tired
B. Sinus tachycardia at a rate of 110 beats/min
C. Inversion of T waves on the electrocardiogram
D. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg
C. Inversion of T waves on the Electrocardiogram
Rational: ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate O2 delivery and that the exercise test should be stopped immediately.
A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the plan to take?
A. Instruct the client to perform range-of-motion exercises to his lower extremities.
B. Perform neurovascular checks with vital signs.
C. Ambulate the client 1 hr following the procedure.
D. Restrict the client’s fluid intake.
B. Perform neurovascular checks with vital signs.
Rational: The nurse should assess color, temperature, and pulse in the affected extremity and monitor the client for neurovascular changes that can indicate a stroke, such as slurred speech and visual disturbances
