Chapter 08: Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder (adult health) Flashcards Preview

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Flashcards in Chapter 08: Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder (adult health) Deck (77)
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1

Modifiable risk factors for coronary artery disease (CAD) include which group?

d. High cholesterol, obesity

2

A 63-year-old patient with an acute myocardial infarction is on a cardiac monitor and begins to show some dysrhythmias. The physician will probably prescribe which intravenous medication?

c. Lidocaine

Management of dysrhythmias is accomplished by suppressing the impulse that triggers dysrhythmias.

3

The nurse identifies the nursing diagnosis of Ineffective tissue perfusion related to decreased arterial blood flow for a patient with chronic arterial insufficiency. In evaluating the patient outcomes after patient teaching, which statement by the patient does the nurse recognize as indicating a need for further instruction?

b. “I will drink hot coffee several times a day to increase the circulation and warmth in my feet.”

Avoiding vasoconstriction from nicotine, caffeine, and stress is an important precaution for patients with decreased arterial blood flow.

4

The patient has right-sided heart failure. She will probably be comfortable in which position?

a. Dorsal recumbent

Restful sleep may be possible only in the sitting position or with the aid of extra

5

A patient is admitted from the emergency department. The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patient’s condition as

b. severe heart failure.

Class IV: Severe; patient unable to perform any physical activity without discomfort. Angina or symptoms of cardiac inefficiency may develop at rest.

6

A patient admitted from the emergency room with a diagnosis of heart failure and a NYHA classification of IV is requesting ambulation to the bathroom. Which nursing intervention would be appropriate for this patient?

c. Offer a urinal or bedpan.

Class IV: Severe: patient unable to perform any physical activity without discomfort.

7

A patient admitted from the emergency department with a diagnosis of heart failure and a NYHA classification of IV has edema in his lower extremities of +4. Which nursing intervention would aid in decreasing this edema?

b. Elevate lower extremities.

Elevate extremities when sitting or lying to promote venous return and decrease incidence of edema and venous stasis.

8

A patient, age 59, has Buerger’s disease. The most important aspect of patient compliance in order to decrease signs and symptoms of Buerger’s disease is

c. not smoking.

There is a very strong relationship between Buerger’s disease and tobacco use. It is thought that the disease occurs only in smokers, and when smoking is stopped, the disease improves. None of the palliative treatments are effective if the patient does not stop smoking.

9

A patient has heart failure. His physician’s orders include complete bed rest. The nurse knows that this order means he

d. must remain as quiet as possible, with any task requiring physical effort done for him.

Complete bed rest: Lowering oxygen requirements of the body systems with head of the bed elevated to 45 degrees to reduce myocardial oxygen demand and decrease circulating volume returning to the heart.

10

An old term defined as the condition in which the patient suffers peripheral or pulmonary congestion is called

d. congestive heart failure.

Because many patients suffer pulmonary or systemic congestion with HF, the syndrome was once called congestive heart failure.

11

A patient, age 34, is diagnosed with infective endocarditis. The nurse identifies the nursing diagnosis of Activity intolerance related to generalized weakness for him. Which intervention does the nurse plan while he is febrile?

a. Decreased activity

During the acute phase, it is essential to maintain the patient on decreased activity and provide a calm, quiet environment.

12

A 53-year-old patient with a history of dysrhythmias is to wear a Holter monitor. The nurse should explain that Holter monitoring

c. is a portable electrocardiographic device.

A Holter monitor (a small portable recorder) is attached to the patient by one to four leads, with a 2-pound tape recorder carried on a belt or shoulder strap.

13

After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of

d. infective endocarditis.

14

The patient achieves comfort in breathing only when he assumes a sitting posture. During the charting of this position, the nurse can describe this as

c. orthopnea.

15

What is defined as a distended dilated segment of an artery?

b. Aneurysm

An aneurysm is an enlarged, dilated portion of an artery.

16

A patient is admitted with a diagnosis of possible aortic aneurysm. In assessing her, it is most important to monitor her

d. blood pressure.

17

A patient, age 65, has chronic angina pectoris. Her daughter had questions about the proper use of nitroglycerin for pain management. She was unsure about how many times she should take nitroglycerin for an episode of angina. The best reply the nurse could make is

b. “If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals, call your physician and come to the hospital.”

18


The patient has been hospitalized for congestive heart failure (CHF) three times in the last 4 months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse’s immediate course of action would be to

d. collect more information to identify his reasons for noncompliance.

19

Dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention are signs and symptoms of

a. right-sided heart failure.

Inability of the right ventricle to pump blood forward into the lungs results in peripheral congestion. Edema is a sign of increased fluid in interstitial tissue and appears in dependent areas of the body such as the sacrum when supine and the feet and ankles while in an upright position.

20

A patient with newly diagnosed hypertension tells the nurse he uses a lot of salt on his foods and has not been able to lose the 30 pounds that he has gained in the last 10 years. He does not understand why he has hypertension, since he is not an anxious person. Which nursing diagnosis does the nurse identify for this patient?

a. Ineffective health maintenance related to the lack of knowledge of disease process and management

21

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include

a. substernal pain that radiates down the left arm.

22

A 56-year-old patient was admitted to the emergency department with a myocardial infarction. Cardiac enzymes were drawn. In a patient with a myocardial infarction, which laboratory values would be abnormal?

a. Elevated levels of serum glutamic oxaloacetic transaminase (SGOT) (AST), creatine phosphokinase (CPK-MB), and lactic dehydrogenase (LDH), troponin 1

*Serum cardiac markers are certain proteins that are released into the blood in large quantities from necrotic heart muscle after a myocardial infarction. These markers, specifically cardiac serum enzymes and troponin 1, are important screening diagnostic criteria for acute MI.

23

The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to

a. cocaine use.

Cardiomyopathy caused by cocaine abuse is seen more frequently than ever before. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues.

24

Restlessness, diaphoresis, severe dyspnea, tachypnea, hemoptysis, audible wheezing, and crackles are signs and symptoms of

c. pulmonary edema.

Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; cold extremities.

25

The nurse identifies the problem of a potential complication—pulmonary edema—for a patient in acute congestive heart failure (CHF). For which early symptom of this problem does the nurse assess?

a. Pink, frothy sputum

Frothy sputum is produced from air mixing with the fluid in the alveoli; the sputum is blood-tinged from blood cells that have exuded into the alveoli.

26

A patient has a diagnosis of heart failure. When the nurse walks into his room he is leaning over his bedside table and is short of breath. The medical term to describe his respiratory status is

a. orthopnea.

is an abnormal condition in which a person must sit or stand in order to breathe deeply and comfortably.

27

During the nursing history and physical assessment of a patient with left-sided heart failure, which finding might the nurse expect related to the patient’s diagnosis?

a. Orthopnea with bubbling crackles throughout the lungs


Left ventricular failure; the first is the signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough.

28

When providing discharge teaching to a patient with endocarditis regarding prevention of infections, what would the nurse stress?

b. Take antibiotics as prescribed.

29

A patient has been admitted after the insertion of a pacemaker because of bradycardia. She asks what third-degree heart block is, and the nurse replies

c. “A defect in AV junctions slows and impairs conduction of impulses from the SA node to the ventricles.”

Atrioventricular block occurs when a defect in the AV junction slows or impairs conduction of impulses from the SA node to the ventricles.

30

In evaluating pain for the management of myocardial infarction, the most important aspect using objective data is

a. patient’s vital signs during painful periods.

MI: typical vital signs reveal hypotension, pulse abnormalities such as tachycardia, a barely perceptible pulse, and early temperature elevation. Administer oxygen per protocol for 24 to 48 hours and longer if pain, hypotension, dyspnea, or dysrhythmia persist. Administer medications as prescribed: IV morphine sulfate for relief of pain and apprehension and to produce vasodilation.