Cardio Exam 2 Study Guide

Question 1

Which labs are monitored in the client receiving heparin therapy?

Answer 1

aPTT, platelet counts.

Question 2

Discuss possible food interactions while undergoing heparin therapy.

Answer 2

vegetables high in vitamin K

Question 3

Why is Benadryl used in clients receiving a transfusion?

Answer 3

For mild allergies during or up to 24 hours after transfusion. Findings include itching, urticaria, and flushing.

Question 4

List three nursing interventions for preventing venous stasis.

Answer 4

Elevate limb, wear pressure stockings, ROM. Rest.

Question 5

List the signs and symptoms of folic acid deficiency.

Answer 5

pallor, progressive weakness and fatigue, SOB, glossitis, cheilosis, and diarrhea.

Question 6

Discuss the function of erythrocytes, granulocytes, thrombocytes and lymphocytes.

Answer 6

Erythrocytes: Red Blood Cell’s. Contain hemoglobin and these transport oxygen and carbon dioxide to and from the tissues.

Granulocytes: WBC with secretory granites in its cytoplasm. “basophil”. Function is to fight off pathogens such as bacteria and fungi.

Thrombocytes: Platelets. Function is to stop bleeding by clumping and clotting blood vessel injuries.

Lymphocytes: WBC that function as part of the immune system. Properly respond to foreign invaders in the body.

Question 7

State the normal range for neutrophils.

Answer 7

The percent of neutrophils consists of the segmented (fully mature) neutrophils) + the bands (almost mature neutrophils). The normal range for the ANC = 1.5 to 8.0 (1,500 to 8,000/mm3).

Question 8

Describe the location of the mitral valve.

Answer 8

Between the Left Atrium and Left Ventricle

Question 9

Define pernicious anemia.

Answer 9

Vitamin B12 deficiency. Lack of intrinsic factor.

Question 10

Discuss the relationship of red blood cell count and blood viscosity.

Answer 10

RBCs contribute thickness (viscosity) to the blood.

Question 11

List the risk factors for deep vein thrombosis.

Answer 11

Hip surgery, total knee arthroplasty, open prostate surgery (prolonged immobility)

Heart failure, immobility, pregnancy, contraceptives.

Question 12

Discuss the teaching for the client discharged on iron preparations.

Answer 12

have hemoglobin checked q4-6 weeks.
vitamin C can increase oral absorption.
instruct to take supplements between meals to increase absorption.

Question 13

list the effects of thrombolytic therapy

Answer 13

for the medication to dissolve a clot or clear blocked blood vessels

Question 14

Describe the nursing interventions for suspected phlebitis at an IV site.

Answer 14

Monitor for: ven induration (hard), redness, pain or burning, discomfort, warmth, edema, red streaks, fever.

Observe site q2h, non tunneled catheters require intact sterile dressing. use smallest gauge needle in largest vein possible. clean site and change sites per facility protocol.

Question 15

Discuss the expected lab findings for the client with disseminated intravascular coagulation (DIC).

Answer 15

low platelet count, low fibrinogen count

PT and PTT. decreased clotting factors V and VIII.

positive D-dimer test

peripheral blood smear shows schistocytes

Question 16

Describe two important interventions for the client with decreasing blood pressure.

Answer 16

lie down, start IV, oxygen, administer vasopressin.

• drink more water
• safety
• semi fowlers position
• 02
• take medications to raise
• wear compression stockings
• trendelenburg

Question 17

List an adverse effect of epoetin alfa (Epogen).

Answer 17

Raises blood pressure. Check often.

Question 18

Discuss myocarditis, its treatment and prognosis.

Answer 18

Myocarditis is the inflammation of the heart’s muscular walls.

Treatment includes: medication to regulate the heartbeat and improve heart function. Rare occasions will need a device such as a pacemaker.

Caused by a viral, fungal, or bacterial infection. Also Crohn’s disease.

Question 19

Discuss the care of the client following a vein ligation and stripping.

Answer 19

Post-op:
- maintain elastic bandages on the legs
- monitor groin and leg for bleeding through the bandages
- monitor extremity for edema, warmth, color, pulses
- elevate legs above the heart
- encourage client to perform ROM in legs
- review the client instruction to elevate the legs when sitting, and avoid dangling them over the side of the bed
CHECK DRESSING. PRESSURE DRESSING.

Question 20

Discuss how the client with Raynaud’s disease can prevent the onset of symptoms.

Answer 20

Keep warm, do not smoke, don’t stress, avoid aggravating medications, exercise regularly.

Question 21

Discuss the pathophysiology of sickle cell anemia.

Answer 21

HbS becomes crystalized when hypoxemia occurs –> rigid, elongated RBCs that form a sickle shape –> increase blood viscosity (thickness) and hemolysis of the cell –> accumulation in the smaller blood vessels and capillaries –> vessel obstruction –> tissue death

Question 22

List the signs and symptoms of disseminated intravascular coagulation (DIC)..

Answer 22

abnormal bleeding, petechiae, ecchymosis, epistaxis, hemoptysis, cyanosis: cold, mottled fingers and toes, severe muscle, back abdominal and chest pain, dyspnea, confusion, oliguria, shock

Question 23

How should IV dextran be administered?

Answer 23

Parenteral iron supplement (iron dextran) are only given for severe anemia. Administer using the z-track method.

Administer doses of 2 mL or less, IV, once a day, until the calculated total amount required has been reached

Question 24

How does heparin work in treating thrombophlebitis?

Answer 24

It works by preventing new clots and prevents enlargement of existing clots.

Question 25

What is the greatest priority in the care of a client with varicose veins with edema and ulcerations.

Answer 25

Proper nutrition and proper wound healing

Question 26

list the normal lab value ranges fro hematocrit, hemoglobin, RBC's and platelets

Answer 26

Hematocrit: F: 12 - 16 M: 14 - 18 Hemoglobin: F: 37 - 47 M: 42 - 52 RBC: 5,000 - 10,000 Platelets: 150,000 - 400,000

Question 27

Which lab test is used to confirm rheumatic endocarditis?

Answer 27

Blood cultures to detect bacterial infection Throat culture to deter strep.

Question 28

give the definition and example of cardiogenic shock

Answer 28

Condition when the heart suddenly can't pump enough blood to meet the body's needs. EXAMPLES: heart attack, myocarditis, endocarditis, arrhythmias.

Question 29

Describe the priority assessment of the client with an arterial occlusion of the leg.

Answer 29

Assess for a negative homan's sign.

Question 30

List 3 signs or symptoms of anemia.

Answer 30

pallor, fatigue, irritability, dyspnea.

Question 31

Which labs are monitored in the client with DIC?

Answer 31

pT, pTT, clotting time. decreased clotting factors V and VIII decreased serum platelet count, fibrinogen level Positive D-dimer test (specific fibrinogen test for DIC) Peripheral blood smear shows Schistocytes

Question 32

List the priority diagnosis for the client in sickle cell crisis.

Answer 32

A blood test can check for hemoglobin S

Question 33

List a medication used to treat a client with hemophilia A.

Answer 33

IV administration of cryoprecipitate or lyophilized factor VII or IX to increase clotting factor levels and permit normal hemostasis

Question 34

Define and discuss the treatment of hemarthrosis.

Answer 34

blood in the joints. pain, welling, tenderness, inability to walk and move. Joint aspiration RICE.

Question 35

List 5 food sources for iron.

Answer 35

``` Beans Dark leafy greens Enriched rice Whole grains Meat ```

Question 36

List the signs and symptoms of aplastic anemia.

Answer 36

fatigue, weakness, pallor and dyspnea. petechiae or ecchymosis, infection.

Question 37

List 2 expected lab values for the client with polycythemia vera.

Answer 37

increased RBC mass and total blood volume

Question 38

How is heparin-induced thrombocytopenia treated?

Answer 38

the drug caused the problem. Remove the underlying cause (chemo, heparin, alcohol) blood transfusion, platelet infusion, corticosteroids, immunosuppressants, splenectomy ADMINISTER PROTAMIN SULFATE

Question 39

List the signs and symptoms of polycythemia vera.

Answer 39

- HTN - Headaches, dizziness, vision and hearing disruptions - Ruddy red color in the face, hands, feet, and mucous membranes - Severe, painful pruritis of fingers and toes - Hepatomegaly, splenomegaly, JVD - Thrombosis --> stroke, angina, and PVD

Question 40

Discuss the treatment for hypovolemic shock.

Answer 40

IV Lactated Ringers or 0.9% NaCl to increase preload and maintain adequate ventricular filling blood transfusion plasma expanders surgical intervention

Question 41

List 3 adverse effects of daily aspirin therapy.

Answer 41

Stroke caused by burst of blood vessel, GI bleeds, internal bleeding.

Question 42

List the signs or symptoms of a suspected occlusion or rupture of a graft of the abdominal aorta.

Answer 42

flank pain, feeling that something is wrong

Question 43

Discuss the pathophysiology of DIC.

Answer 43

Triggered by endothelial damage, release of tissue factors into circulation, or inappropriate activation of the clotting cascade by an endotoxin. Extensive thrombin enters systemic circulation and overwhelms natural anticoagulants --> clot formation. Widespread clotting consumes clotting factors and activates fibrinolytic processes with anticoagulant production --> hemorrhage.

Question 44

List an expected finding in the physical assessment of client who has a history of mitral valve insufficiency.

Answer 44

frothy sputum S/S: Left side heart failure

Question 45

Discuss thrombocytopenia and its treatment.

Answer 45

Deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury. Platelet transfusion.

Question 46

Define: thrombocytosis, leukocytosis, pernicious anemia and pancytopenia

Answer 46

Thrombocytosis is a disorder in which your body produces too many platelets Leukocytosis is an increase in the number of white cells in the blood, especially during an infection. Pernicious anemia is a condition in which the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12. Pancytopenia is a deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

Question 47

Discuss the medication that might be given for a mild allergic reaction to a blood transfusion.

Answer 47

administer antihistamine such as benedryl

Question 48

Describe the expected treatment for the client with sickle cell crisis.

Answer 48

Treatments include medications, blood transfusions, and rarely a bone-marrow transplant.

Question 49

List the normal range for digoxin.

Answer 49

If you're receiving treatment for heart failure, the normal level of digoxin is between 0.5 and 2.0 nanograms of medication per milliliter of blood (ng/ml). If you're being treated for a heart arrhythmia, the normal level of the drug is between 1.5 and 2.5 ng/ml.

Question 50

List the cells known for phagocytic activity.

Answer 50

T CELLS AND B CELLS

Question 51

List two early indicators of shock.

Answer 51

early: - restlessness - hypotension later: - loss of consciousness - drop in BP

Question 52

List the signs and symptoms of bacteria endocarditis.

Answer 52

AKA Infective Endocarditis. Findings: fever, flulike symptoms, murmur, petechiae, positive blood cultures, splinter hemorrhages.

Question 53

List two possible nursing interventions for the client with peripheral vascular disease reporting cold feet.

Answer 53

Wear socks, move feet for adequate circulation

Question 54

Discuss the teaching for the client prescribed erythropoietin (Epogen).

Answer 54

reinforce the importance of having hug and hit evaluated two times per week.

Question 55

List instructions to provide the client who is taking supplemental iron.

Answer 55

have hemoglobin checked q4-6 weeks. vitamin C can increase oral absorption. instruct to take supplements between meals to increase absorption.

Question 56

Compare and contrast a thrombus and an embolus.

Answer 56

Thrombus is a clot that forms in the vein. An embolus is anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass.

Question 57

Discuss the etiology, diagnosis and treatment of rheumatic fever.

Answer 57

.

Question 58

List a cause of chronic venous insufficiency.

Answer 58

immobility

Question 59

Be able to do dosage calculation.

Answer 59

D/H x ml

Question 60

Discuss the teaching for the client undergoing a bone marrow biopsy.

Answer 60

- sign informed consent - provide accurate info and emotional support - position prone, local anesthesia used: client will have sensation of pressure and pushing - postural iliac crest most common site - apply pressure post procedure 5-10 mins after - check vitals, medicate for pain, monitor bleeding and infection.

Question 61

List labs that may be elevated during the infectious process.

Answer 61

WBC

Question 62

List an expected finding in the client with pericarditis.

Answer 62

Respiratory infection. | S/S pericardial friction rub, SOB, Pain received by sitting and leaning forward

Question 63

Discuss the care of the client in the acute stage of bacterial endocarditis.

Answer 63

.

Question 64

Discuss the discharge teaching for the client with aplastic anemia.

Answer 64

stay away from infectious people. proper nutrition. wash hands. SAFETY. AVOID PUNCTURES. ELECTRIC RAZOR, SOFT BRISTLE TOOTHBRUSH.

Question 65

What should the nurse monitor in the client undergoing heparin therapy?

Answer 65

aPTT labs. Monitor SOB and chest pain.

Question 66

List the priority assessment for the client with acute infective (bacterial) endocarditis.

Answer 66

Blood and throat cultures. Assess throat, vitals, and labs.

Question 67

Which medications are used to treat hemophilia A.

Answer 67

cryoprecipitate for A and IV of factor IX for B. fresh frozen plasma or PRBCs

Question 68

List the priority of care for the client with neutropenia.

Answer 68

Keep the patient clean and free from any infections.

Question 69

Discuss the Schilling test.

Answer 69

This test measures vitamin B12 absorption. Used to differentiate between malabsorption and pernicious anemia.

Question 70

List the function of hemoglobin and hematocrit in the body.

Answer 70

decreased levels indicate anemia. hemoglobin is a protein in RBC's that is responsible for delivery of oxygen to tissues. hematocrit measures the volume of RBCs compared to the total good volume.

Question 71

List 3 risk factors for pernicious anemia.

Answer 71

1. resection of the stomach or ileum 2. loss of pancreatic secretions 3. chronic gastritis 4. alcohol 5. gastric bypass

Question 72

Which labs are typically drawn in the client with hemophilia?

Answer 72

low serum factor VIII and prolonged PTT in A laboratory analysis reveals deficient factor IX and normal factor VIII in B normal platelet count and bleeding time normal PT and INR

Question 73

Discuss the treatment for the client with thrombophlebitis.

Answer 73

Therapy must be started within 5 days after the development of the clot for therapy to be effective. These are effective within the first 24 hours: - abciximab (ReoPro) - eptifibatide (Integrilin) - Monitor for bleeding (intracerebral) - Instruct patient about bleeding precautions. ** bladed razor, soft toothbrush

Question 74

Describe the expected findings in the client with an aortic aneurysm.

Answer 74

Abdominal Aortis Aneurysm - the main blood vessel that delivers blood to the body, at the level of the abdomen FINDINGS: - constant gnawing feeling in abdomen; flank or back pain - pulsating abdominal mass (do not palpate!) - bruit - elevated BP

Question 75

Discuss the universal recipient and universal donor in regards to blood transfusions.

Answer 75

Type O blood is the universal donor AB is the universal recipient

Question 76

What stimulates the production of red blood cells?

Answer 76

Low numbers of oxygen levels will trigger the kidney and liver to create erythropoietin in the bone marrow.

Question 77

List the expected findings in the client with fluid volume excess.

Answer 77

``` JVD peripheral edema SOB HTN Increased and labored respirations ```

Question 78

List the signs and symptoms of polycythemia vera and thrombocytopenia.

Answer 78

Polycythemia - HTN, Headaches, dizziness, ruddy red color on face, hands, feet, severe, painful pruritis of fingers and toes, hepatomegaly. Thrombocytopenia - petechiae, ecchymosis, prolonged bleeding, menorrhagia, blood in stool

Question 79

List 3 nursing interventions for the client who is having fluid overload.

Answer 79

Provide diuretic, manage fluid, monitor daily I&O with weight.

Question 80

Discuss the treatment of pernicious anemia.

Answer 80

vitamin B12 supplement for life

Question 81

List the antidote for heparin.

Answer 81

protamine sulfate

Question 82

Describe the position of the client to undergo a bone marrow biopsy from the iliac crest.

Answer 82

Prone or side lying to expose the iliac crest

Question 83

List the expected findings in the client with a low platelet count.

Answer 83

- purpura - petechiae - nosebleeds - bleeding gums - bleeding from wounds that lasts for a - prolonged period or doesn’t stop on its own - heavy menstrual bleeding - bleeding from the rectum - blood in the stools - blood in the urine

Question 84

Discuss the procedure for verifying packed red blood cells for transfusion.

Answer 84

- Review lab values (packed RBC's prescribed for clients who have an Hgb of less than 8g/dl) - verify prescription - obtain blood samples - ensure client has 20 gauge or larger IV - review client date for hx of reactions inspect blood products from the blood bank for discoloration, excessive bubbles, or cloudiness. - confirm identity, blood compatibility, and expiration time of the blood with another nurse - provide 0.09% sodium chloride to prime the blood - obtain baseline vitals

Question 85

List the signs and symptoms of transfusion reaction. What should the nurse do first if this occurs?

Answer 85

Stop the transfusion immediately. Initiate saline infusion (initiated with a separate line), save blood bag to go back for testing, obtain urine specimen, notify primary provider.