OMG did you hear the new girl is Anemic?
The clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?
a.
Infection
b.
Trauma
c.
Fluid overload
d.
Stress
c. Fluid overload
Rationale:
Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress.
The mother of a child with sickle cell disease should encourage fluid intake of 1 1/2 to 2 times the daily requirement to prevent dehydration
Nonselective beta blockers may be used to treat hypertension and what other condition?
A. Supraventricular dysrhythmias
B. Heart failure
C. Heart block
D. Chronic obstructive pulmonary disease (COPD)
A. Supraventricular dysrhythmias
**Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure, COPD, and heart block secondary to their negative inotropic effect (heart failure), blocking of bronchodilation (COPD), and negative chronotropic effects (heart block).
Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.)
Mental status changes
Agitation
Frequent falls
Sudden changes in GI function
Mental status changes
Agitation
Frequent falls
Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.
7) IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?
Vitamin K
Aminocaporic acid
Potassium chloride
Protamine sulfate
4.
The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.
Name the Cardio Selective Beta Blockers
Metoprolol
Atenolol
Nebivolol
Betaxolol
Acebutolol
Bisopolol
Esmolol
MANBABE!!!!!!!
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions?
a.
Bleeding tendencies
b.
Intake and output
c.
Peripheral sensation
d.
Bowel function
a. Bleeding tendencies
Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and Platelets. The client is at risk for bruising and bleeding tendencies.
The nurse knows which drug is an example of a cardioselective beta blocker?
A. Atenolol (Tenormin)
B. Sotalol (Betapace)
C. Propranolol (Inderal)
D. Labetalol (Normodyne)
A. Atenolol (Tenormin)
**At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.
THINK OF MANBABE (thing I sent in Groupchat)
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?
Left atrium
Right atrium
Right ventricle
Left ventricle
Right atrium
Rationale: 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.
The nurse is caring for a client who has been hospitalized with a diagnosis of angina pectoris. The client is receiving oxygen via nasal cannula at 2 L/min. The client asks why the oxygen is necessary. The nurse should provide which information to the client?
1.Oxygen has a calming effect.
2.Oxygen will prevent the development of any thrombus.
3.Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle.
4.The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.
4.
The pain associated with angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more oxygen demand on heart muscle. Supplemental oxygen will help to meet the added demands on the heart muscle. Oxygen does not dilate blood vessels or prevent thrombus formation and does not directly calm the client.
Cognitive Ability: Understanding
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Implementation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Client Education, Perfusion
Immediate Treatment of Myocardial Infarction Drugs
MORPHINE- reduces pain and anxiety, also a vasodilator and decreases the workload of the heart by reducing preload and afterload.
OXYGEN- to provide and improve oxygenation of ischemic myocardial tissue, enforced with bedrest to help reduce myocardial oxygen consumption.
NITROGLYCERIN- First-line of treatment for angina pectoris and acute MI, causes vasodilation and increases blood flow to myocardium
ASPRIN- Asprin prevents the formation of thromboxane A2 which causes platlets to aggregate and arteries to constrict.
BETA BLOCKERS- lowers the heart rate and BP by reducing the force of myocardial contraction which decreases the demand for oxygen.
When discussing appropriate food choices with a patient who has iron-deficiency anemia and follows a low-cholesterol diet, the nurse will encourage the patient to increase the dietary intake of
a.
eggs and muscle meats.
b.
nuts and cornmeal.
c.
milk and milk products.
d.
legumes and dried fruits
d. legumes and dried fruits
Rationale: Legumes and dried fruits are high in iron and low in fat and cholesterol.
When performing discharge instructions to a patient prescribed metoprolol (Lopressor), which statement by the nurse is correct?
A. "If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions."
B. "If you become dizzy, do not take your medication for 2 days and then restart on the third day."
C. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem."
D. "Increase your intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."
A. "If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions."
**Beta blockers have a negative chronotropic effect and could cause symptomatic bradycardia or heart block. The health care provider should be consulted before administering to a patient with bradycardia (heart rate
Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication?
Sublingual nitroglycerin
Cardiac glycosides
HMG-CoA reductase inhibitors
Morphine sulfate
Sublingual nitroglycerin
Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.
A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions?
1."I need to cut down on cigarette smoking."
2."I am so relieved that my heart is repaired."
3."I need to adhere to my dietary restrictions."
4."I am so relieved that I can eat anything I want to now."
3.
After angioplasty, the client needs to be instructed regarding the specific dietary restrictions that must be followed. Making the recommended dietary and lifestyle changes will assist in preventing further atherosclerosis. Abrupt closure of the artery can occur if the dietary and lifestyle recommendations are not followed. Cigarette smoking needs to be stopped. An angioplasty does not repair the heart.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Client Education, Perfusion
What are ACE Inhibitors and the most common side effect?
ACE Inhibitors are antihypertensive medications that block the conversion of angiotensin 1 to angiotensive 2 and inhibits the degradation og bradykinin
Most common side effect is A Cough Expected
A client is beginning a regimen of ferrous sulfate or iron. As you prepare to administer the medication, it is important for you to advise the client that
a.
Her urine will turn a dark orange
b.
Her bowel movements will be dark and tarry
c.
Her appetite will be diminished
d.
Her vision will become slightly blurred
b. Her bowel movements will be dark and tarry
When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important for the nurse to instruct the patient about which drug information?
A. Abrupt medication withdrawal may lead to a rebound hypertension.
B. Alcohol intake is encouraged for its vasodilating effects.
C. Hot baths and showers will help increase the therapeutic effects of this drug.
D. These medications may be taken with antacids to minimize gastrointestinal distress.
A. Abrupt medication withdrawal may lead to a rebound hypertension.
**Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should not be withdrawn abruptly, but should be tapered over 1 to 2 weeks. Antacids should not be taken with beta blockers because they may decrease absorption.
1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure?
Intake and output
Baseline peripheral pulse rates
Height and weight
Allergy to iodine or shellfish
4.
This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.
The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL, and fasting blood glucose level of 184 mg/dL. The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)?
1.Age
2.Hypertension
3.Hyperlipidemia
4.Glucose intolerance
4.
Hypertension, cigarette smoking, and hyperlipidemia are modifiable risk factors that are predictors of CAD. Glucose intolerance, obesity, and response to stress are contributing modifiable risk factors to CAD. Age greater than 40 years is a nonmodifiable risk factor. The nurse places priority on risk factors that can be modified. In this scenario, the abnormal value is the fasting blood glucose level, indicating glucose intolerance as the priority risk factor.
Cognitive Ability: Analyzing
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Health Promotion
How do Calcium Channel Blockers work?
they prevent calcium from entering cells of the heart and blood vessel walls. this helps to decrease the force of contraction of the muscle cells. This also results in relaxed blood vessels so the heart is receiving more oxygenated blood
The usual treatment for iron-deficiency anemia includes:
a.
Vitamin B12 injection
b.
Non-enteric-coated ferrous sulfate
c.
Enteric-coated or sustained-release ferrous sulfate
d.
Whole blood transfusion
b. Non-enteric-coated ferrous sulfate
The usual tx is 325 mg p.o. daily. enteric-coated and sustained rls formulas should be avoided, as they are poorly absorbed
Beta blockers are used to treat which conditions? (Select all that apply.)
A. Hypertension
B. Angina pectoris
C. Cardiac dysrhythmias
D. COPD
E. Raynaud's disease
A. Hypertension
B. Angina pectoris
C. Cardiac dysrhythmias
**Beta blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta blockers can exacerbate COPD because they block beta22 receptors and subsequent bronchodilation. Raynaud's disease may be treated with alpha, not beta, blockers.
2) A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?
"Have you ever had this pain before?"
"Can you describe the pain to me?"
"Does the pain get worse when you breathe in?"
"Can you rate the pain on a scale of 1-10, with 10 being the worst?"
3.
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. What type of angina should the nurse determine that the client is experiencing?
1.Stable
2.Variant
3.Unstable
4.Intractable
1.
Stable angina is triggered by a predictable amount of effort or emotion. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than in classic angina and tend to occur early in the day and at rest. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Intractable angina is chronic and incapacitating and is refractory to medical therapy.
Cognitive Ability: Understanding
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Pain, Perfusion
A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply:*
A. The patient reports seeing yellow-greenish halos and is vomiting.
B. The patient reports flushing and has enlargement of the gums.
C. The patient's heart rate is regular and 80 beats per minute.
D. The patient's Digoxin level is 3 ng/mL.
A and D