Disorders
When developing a teaching plan for a 64-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on
SELECT ALL
age, weight, gender, cholesterol level, activity levels.
What is weight, cholesterol level, & activity level
WHY?????
Modifiable factors
ADD OR LOSE
300 points
A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger’s disease). When the nurse is developing a discharge teaching plan for the patient, which outcome has the highest priority for this patient?
a. Cessation of all tobacco use
b. Control of serum lipid levels
c. Maintenance of appropriate weight
d. Demonstration of meticulous foot care
ANS: A
Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger’s disease. Other therapies have limited success in treatment of this disease.
A patient who has recently started taking pravastatin (Pravachol) & niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the health care provider?
a. Generalized muscle aches and pains
b. Dizziness when changing positions quickly
c. Nausea when taking the drugs before eating
d. Flushing and pruritus after taking the medications
ANS: A
WHY???
Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed.
When admitting a patient with a non–ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?
Place the patient on the heart monitor.
The nurse obtains a blood pressure of 176/83 mm Hg for a patient. What is the patient’s mean arterial pressure (MAP)?
114 mm Hg
MAP = (SBP + 2 DBP)/3
The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient?
a. Patient admitted with a large acute myocardial infarction.
b. Patient being discharged after an exacerbation of heart failure.
c. Patient who had a mitral valve replacement with a mechanical valve.
d. Patient being treated for rheumatic fever after a streptococcal infection.
ANS: C
Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.
DOUBLE YOUR POINTS
A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?
a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath.
ANS: D
The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.
The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to
a. increase the dietary intake of high-potassium foods.
b. make an appointment with the dietitian for teaching.
c. check the blood pressure (BP) with a home BP monitor at least once a day.
d. move slowly when moving from lying to sitting to standing.
ANS: A
The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.
During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would expect to find
a. substernal chest pressure.
b. a new regurgitant murmur.
c. a pruritic rash on the chest.
d. involuntary muscle movement.
ANS: B
New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse immediately would assess which item based on priority?
1.Anxiety level of the client and family
2.Presence of a Medic-Alert card for the client to carry
3.Knowledge of restrictions of postdischarge physical activity
4.Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver
4.
The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.
A 46-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?
a. Sitting at the work counter, rather than standing, is recommended.
b. Exercise, such as walking or jogging, can cause recurrence of varicosities.
c. Elastic compression stockings should be applied before getting out of bed.
d. Taking an aspirin daily will help prevent clots from forming around venous valves.
ANS: C
Elastic compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended for the patient who had just had sclerotherapy.
GAIN 500 OR LOSE 500
Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output?
1. Angina Pectoris
2. Dilated Cardiomyopathy
3. Left-sided heart failure
4. Right-sided heart failure
4
Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.
The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include
a. limit dietary sources of potassium.
b. take the hydrochlorothiazide before bedtime.
c. notify the health care provider if nausea develops.
d. skip the digoxin if the pulse is below 60 beats/minute.
ANS: C
Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.
In which of the following types of cardiomyopathy does cardiac output remain normal?
1. Dilated
2. Hypertrophic
3. Obliterative
4. Restrictive
2. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. All of the rest decrease cardiac output.
DOUBLE JEOPARDY
A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?
Auscultate for a pericardial friction rub.
The patient’s symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient’s symptoms.
DOUBLE JEOPARDY
Exceeding what level of serum cholesterol level significantly increases the risk of coronary artery disease?
Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels
DOUBLE YOUR POINTS
OR
LOSE THEM
A patient who had a mitral valve replacement with a prosthetic mechanical valve and is ready for discharge home. Which information should the healthcare provider include in the discharge teaching for this patient? Select all that apply.
B,C,D,E
To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review?
BNP
A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse describe this type of pain?
A. Stable angina
B. Unstable angina
C. Variant angina
D. Nonanginal pain
ariant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.
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?
Right atrium
The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.
Which of the following symptoms might a client with right-sided heart failure exhibit?
A Adequate urine output
B Polyuria
C Oliguria
D Polydipsia
Option C:
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Options A, B, and D: Adequate urine output, polyuria, and polydipsia aren’t associated with right-sided heart failure.
GAIN 1000 POINTS
OR
LOSE 1000 POINTS
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A Lower back pain, increased BP, decreased RBC, increased WBC
B Severe lower back pain, decreased BP, decreased RBC, increased WBC
C Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
B
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not increase. The WBC count increases as cells migrate to the site of injury.
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient?
A. Reduce preload.
B. Decrease afterload.
C. Increase contractility.
D. Promote vasodilation.
A. Reduce preload.
Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.
Which valve must blood pass through to go from the right atrium into the right ventricle?
Blood in the right atrium must pass through the tricuspid valve to enter the right ventricle. The mitral valve is between the left atrium and the left ventricle. The semilunar valves are located at the base of the aorta and the pulmonary trunk, also known as the aortic valve and pulmonary valve.
Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?
A Cardiomyopathy
B Coronary artery disease
C Myocardial infarction
D Pericardial Effusion
A
Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. Options B and C: Coronary artery disease and myocardial infarction are directly related to atherosclerosis. Option D: Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure.