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Med/Surg 2 Unit 3
Terms in this set (147)
The client is admitted with a diagnosis of angina caused by coronary arteriospasms. The nurse recognizes this type of angina is classified as:
Angina is relieved with nitroglycerin and rest
The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that
Dilating arteries and veins
The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action?
Vasospastic or variant angina
The nurse recognizes that the ability of organic nitrates to dilate coronary arteries is most effective for treating __________.
The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to the development of
Avoid alcohol consumption
The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include?
Negative inotropic effect.
The nurse recognizes that the mechanism for action of beta-adrenergic blockers in the treatment of angina is
Do not discontinue drug abruptly
What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina?
The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by:
Decreased dysrhythmias occur
The nurse determines that treatment of a client with a beta-adrenergic blocker for myocardial infarction has been effective when:
Mental status changes, Agitation,Frequent falls
Which of the following are least likely to be early signs of cardiac problems in older persons?
A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation?
Evaluate blood flow to peripheral tissues.
It is important that the nurse be knowledgeable about cardiac output in order to:
How to maintain a normal blood pressure.
Nurses can best help older clients prevent hypertension by teaching:
Alcohol intake with meals
Modification of lifestyle behaviors to help manage hypertension does not include which of the following?
Controlling lower-density lipoprotein.
A patient receiving the drug simvastatin (Zocor) should be taught this medication helps to prevent coronary heart disease by:
Aortic stenosis,Acid reflux,Pulmonary embolus
Which of the following are not direct causes of chronic ischemic pain? (Select all that apply.)
Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication?
Troponin T levels
Which of the following diagnostic studies most likely would confirm a myocardial infarction?
Ticarcillin disodium (Ticar)
A client with post-myocardial infarction develops acute bacterial pericarditis. Which of the following medications would the physician most likely prescribe as the primary drug?
Which of the following diagnostic tests is preferred for evaluating heart valve function?
Accurately weigh the patient, and report and record the readings.
An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient?
Which of the following drug classifications should the nurse question if prescribed for a person with congested heart failure (CHF)?
Warfarin sodium (Coumadin)
A common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered?
Intermittent claudication with exercise
Which of the following assessments would be an important finding for a patient with arterial disease?
pink, frothy sputum
A hallmark sign of pulmonary edema is:
Which of the following nursing diagnoses would be most appropriate for a client experiencing pericarditis?
Liver enlargement and tenderness,Shortness of breath, tachycardia, and orthopnea
Which of the following assessment findings by the nurse indicates left-sided heart failure
Digoxin is ordered for a client with congestive heart failure. The client is also receiving intravenous Lasix. Which of the following laboratory values is essential for the nurse to assess before administering the digoxin?
A 63-year-old female presents to the emergency department in respiratory distress manifested by tachypnea, labored respirations, cyanosis, and crackles and wheezes noted upon auscultation. The client is diagnosed with acute pulmonary edema. The nurse anticipates the administration of which of the following as the drug of choice to treat the client with acute pulmonary edema?
Embolization of vegetative lesions
A client with acute infective endocarditis (staphylococcal organism) suddenly complains of shortness of breath and chest pain. Upon assessment, the nurse notes diminished breath sounds and hemoptysis. Based on this assessment data, the nurse suspects which of the following?
Encourage annual pneumonia and influenza vaccinations
A nurse is providing teaching instruction to a client on how to prevent endocarditis. Which of the following would the nurse expect to teach?
heart transplantation is not a viable option for restrictive cardiomyopathy.
A 45-year-old female client is recently diagnosed with restrictive cardiomyopathy. The client states she knows someone at her church that had a heart transplant for cardiomyopathy, and she is optimistic that she will receive a heart transplant also. The nurse recognizes the client requires further teaching about the disease and treatment because
A 53-year-old is showing symptoms of dyspnea on exertion, angina, and exertional syncope (light-headedness with activity). Which of the following do these manifestations indicate?
The murmur of aortic regurgitation is heard in diastole as blood flows back into the left ventricle from the aorta. It is described as a "blowing," high-pitched sound heard most clearly at the third left intercostal space
Extended period of cigarette smoking
Because of a diagnosis of thromboangitis obliterans (Buerger's disease), the nurse collects which of the following about the client's health history?
"This is related to spasms of the small arteries in the fingers."
The client with Raynauds's disease asks the nurse, "Why do my fingers turn blue then white and hurt?" Which of the following is the best response?
How quickly intermittent claudication occurs.
The nurse evaluates the effectiveness of a regular exercise program for a client with peripheral arterial disease by asking the client about which of the following?
The most appropriate nursing diagnosis for an elderly client with peripheral vascular disease who tells the nurse, "My legs won't let me do what I want to do" includes which of the following?
Numbness, tingling and pain
Pale, cool skin
Because a client has acute arterial occlusion in the right leg, the nurse assesses for the following most relevant signs/symptoms?
Use a soft toothbrush
After a surgical procedure to perform an embolectomy, the nurse should provide which of the following client teaching?
Elevate the legs on a pillow, above the level of the heart to promote venous return
A standard of nursing practice associated with the care of a client with deep vein thrombosis includes which of the following?
Walking as much as feasible
What teaching components should the nurse include in a care plan for a client with chronic venous insufficiency
Apply compression stocking during the day
Because a client with a left mastectomy experienced secondary lymphedema, the nurse includes which of the following in the care plan?
Elevate the head of the bed,Notify the physician of the situation
client with a deep vein thrombosis experiences acute chest pain and dyspnea. The nurse should perform which of the following?
What ethnic group has the highest risk for CAD?
A 45 year old depressed male with a high stress job
What individual would a nurse identify as having the highest risk for CAD?
Tofu , Walnuts, and Tuna Fish
When providing nutritional counseling for patients at risk for CAD, which of the following foods would the nurse encourage patients to include in their diet?
What antilipemic medication would a nurse question an order in a patient with cirrhosis of the liver?
I can take up to five tablets every three minutes for chest pain
After teaching a patient with chronic stable angina about nitroglycerin, the nurse would recognize need for further teaching if the patient states
Ashen skin, Diaphoresis, Nausea and Vomiting, and S3 or S4 heart sounds
The nurse would assess a patient with complaints of chest pain for what clinical manifestations associated with a MI
Oxygen, Nitro, ASA, and morphine
When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of
Canned chicken noodle soup
When evaluating a patients knowledge regarding a low sodium, low fat cardiac diet. The nurse recognizes additional teaching is needed when they select
Discussed along with other physical activities
The nurse is providing teaching to a patient recovering from an MI. Discussion regarding resumption of sexual activity should be
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?
A patient was admitted to the ER 24 hours earlier with complaints of chest pain that were subsequently attributed to ST segment elevation MI (STEMI). What complication of MI should the nurse anticipate?
Pathologic Q wave
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. What ECG change is most indicative of prolonged or complete coronary occlusion?
Acute myocardial infraction
What is percutaneous coronary intervention (PCI) most clearly indicated?
Anorexia and nausea
The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure. The nurse would become concerned with the possibility of digitalis toxicity if the patient reported
Withhold the dose and report the potassium level
The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/l, and glucose 106 mg/dl. The nurse should
The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin 0.125 mg IVP. An ampule containing 0.25 mg/ml is available. How many milliliters should be drawn up?
The priority assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be
Choosing intervention to promote comfort and prevent suffering
A male patient with a long standing history of HF has recently qualified for hospice care. Which of the following measure should the nurse now prioritize when providing care for this patient?
Hypotension and tachycardia
The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include
A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to
Drugs to treat erectile dysfunction
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid
Abdomen, anterior lateral aspect
The nurse is caring for a patient with a diagnosis of deep vein thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Levenox). What injection sites should the nurse use to administer this medication safely?
Pinch the skin between the thumb and forefinger before inserting the needle
The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. The nurse should do which of the following to administer this medication correctly?
The nurse is admitting a 68 year old preoperative patient with a suspected abdominal aortic aneurysm. The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which of the following medications?
Cerebral or pulmonary emboli
The nurse is caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed?
The nurse is reviewing the lab test results for a 68 year old patient whose warfarin (Coumadin) therapy was terminate during the preoperative period. The nurse concludes that the patient is the most stable condition for surgery after noting the INR results?
Pain and swelling in lower extremity
The nurse would determine that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noting what during a routine sift assessment?
The nurse is caring for a patient with a recent history of DVT. The patient now needs to undergo surgery for appendicitis. The nurse is reviewing the laboratory results for this patient before administering an ordered dose of vitamin K. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is?
This medication will help prevent blood clots forming in your legs until your activity, such as walking, returns to normal
A postoperative patient asks the nurse why the physician ordered daily administration of enoxaparin (Lovenox). What reply is most appropriate?
Prothrombin time (PT)
The nurse is caring for a preoperative patient who has an order for vitamin K by Sub -Q injection. The nurse should verify that which of the following laboratory studies is abnormal before administering the dose?
Teaching the patient the correct use of compression stockings
What is a priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)?
While you're still lying in bed in the morning, put on your stockings
A patient with varicose veins has been prescribed compression stockings. How should the nurse teach the patient to use these?
Remove the patient's IV catheter
Assessment of a patient's peripheral intravenous site reveals that phlebitis has developed over the past several hours. What intervention should the nurse implement first?
Is relieved by nitro
The nurse suspects stable angina rather than MI pain in the patient who reports chest pain that
Exercise stress test
A patient admitted to the hospital for elevation of chest pain has no abnormal serum cardiac markers 4 hours after the onset of pain. A noninvasive diagnostic test that can differentiate angina from other types of chest pain is
Has had no relief of the pain with rest or position change
A 52 year old man is admitted to the emergency department with severe chest pain. The nurse suspects an MI on finding that the patient
10 to 14 days
The point in healing process of the myocardium following an infract where early scar tissue results in an unstable heart wall is
Uses continuous cardiac monitoring
To detect and treat the most common complication of MI, the nurse
CK-MB enzyme elevations that peak 18 hours after the infarct
In the patient with chest pain, unstable angina can be differentiated from an MI by
Myocardial infraction associated with prolonged and complete coronary thrombosis
A second 12 lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST segment elevation. The nurse recognizes that this finding indicates a
Loosening the internal mammary artery from the chest wall and attaching it to a coronary artery distal to a steonosis
The nurse explains to the patient who is to undergo a coronary artery bypass graft that the procedure most often involves
Acute intensive drug therapy
Collaborative care of the patient with a non-St-segment elevation myocardial infraction (NSTEMI) differs from that of a patient with ST-segment elevation myocardial infraction (STEMI) in that NSTEMI is more frequently treated with
A decrease in the responsiveness of the patient
During treatment with tissue plasminogen activator (tPA) for a patient with a STEMI, the nurse is most concerned on finidng
Continues to have chest pain
The nurse recognizes that fibrinolytic therapy for the treatment of an MI has not been successful when the patient
Increased pulmonary hydrostatic pressure
The pathophysiologic mechanism that results in the pulmonary edema of left sided heart failure is
Bubbling crackles and tachycardia
A physical assessment finding that the nurse would expect to be present in the patient with acute left sided heart failure is
The use of two or more pillows to help breathing during sleep
The nurse assesses the patient with chronic biventricular heart failure for paroxysmal nocturnal dyspnea by questioning the patient regarding
A patient with chronic heart failure has atrial fibrillation and an LV ejection fraction of 18%. To decrease the risk of complications from these conditions, the nurse anticipates the administration of
b-type natriuretic peptide (BNP) levels
The diagnostic test that is most useful in differentiating dyspnea related to pulmonary effects of heart failure from dyspnea related to pulmonary disease is
The classic ischemic pain of PAD is known as
Non-healing ischemic ulcers and Gangrene
Two serious complications of PAD that frequently lead to lower limb amputation are
Surgery for PAD is indicated when the patient has limb pain during
I will need to have frequent blood tests to evaluate the effect of oral anticoagulant I will be taking
Following teaching about medications for PAD, the nurse determines that additional instruction is necessary when the patient says
Keep legs and feet warm, Walk at least 30 min/day to the point of discomfort, Inspect lower extremities for pulses, temperature, and any swelling
A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion. Appropriate teaching for the patient includes instructions to
Modifications will reduce the risk of other atherosclerotic conditions such as stroke
When teaching the patient with PAD about modifying risk factors associated with the condition
A loss of palpable pulses and numbness and tingling of the feet
During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experience's
Maintain bed rest until edema is relieved and anticoagulation is established
To help prevent embolization of the thrombus in a patient with VTE, the nurse teaches the patient to
The purpose of the heparin is to prevent growth of the clot or formation of new clots where the circulation is slowed
The patient with VTE is receiving therapy with heparin and asks the nurse whether the drug will dissolve the clot on her leg. The best response by the nurse is
The nurse teaches the patient with any venous disorder that the best way to prevent venous stasis and increase venous return is to
The most important measure in the treatment of venous stasis ulcers is
Occurs when demand for myocardial oxygen exceeds the supply
Chronic Stable Angina
The clinical manifestation of reversible myocardial ischemia
Primary reason for a decrease in supply of oxygen in the heart muscle is narrowing of the arteries caused by
Chronic Stable Angina
Chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms
Ischemia is occurring, but no symptoms are noted
Occurs only while lying down and is relieved by standing or sitting
Frequently associated with migraine and Raynaud's phenomenon
Goal is to decrease oxygen demand or increase oxygen supply
Planning of care for angina
Give as soon as Heart Attack is suspected
First line therapy in treatment of angina episode
Nitrates (short acting)
After one pill or metered spray under tongue. If no pain relief in 5 minutes
Isordil and Imdur
Long acting Nitrates
Side effect of Nitrates
Take for relief of nitrate headache
Preferred drugs to manage angina
Side effects of Beta Blockers
Who should avoid Beta Blockers
Causes smooth muscle dilation
Calcium Channel Blocker
Calcium Channel Blockers
C's Procardia, Clan, Cardizem
Monitor when taking Calcium channel blockers
Photophobia, Nausea/Vomiting, Halo's
Signs and Symptoms of Digoxin toxicity
Used in treatment of angina with patients who are high risk for cardiac event
Gold Standard diagnostic study for angina
Emergency, an manifestation of Acute Coronary Syndrome
New chest pain, chest pain at rest, worsening pattern of chest pain
Manifestations of Unstable Angina
Fatigue, anxiety, shortness of breath, indigestion, and back pain
Warning signs for women with unstable angina
Inability of the heart to pump blood effectively. Left Ventricle loses the ability to generate enough pressure to eject blood forward.
Systolic Heart Failure
Inability of the ventricles to relax and fill during diastole
Diastolic Heart Failure
Left Sided failure
LV dysfunction, blood backs up to LA and into the pulmonary veins
Right Sided failure
Back up of blood into RA and venous circulation
Dry hacking cough
Often the First sign of chronic heart failure
Decrease Preload and Afterload
Reduces preload and afterload, dilates both the pulmonary and systemic blood vessels, works by decreasing 02 demands
Decreases hear rate, contractility, oxygen demand. Increases CO
Beta Adrenergic Blockers (Coreg, Toprol XL)
Beta Adrenergic Blockers
Decreases the effect of SNS on heart (adrenalin) Fight or Flight
Abnormal accumulation of fluid in aveoli and interstital spaces in lungs
Extremity becomes pale when elevated and turns red when dependent and blood begins to flow better
Gravity is your friend in
Nonatherosclerotic, segmental, inflammatory disorder in young men. Strong relationship with smoking.
Episodic vasoapatic disorder of small cutaneous arteries. Young women with color changes in hands. White, REd, and Blue
A blood clot in the larger deeper veins of the body. Most often Iliac or Femoral veins
Deep Vein Thrombosis (DVT) Venous Thromboembolism (VTE)
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