CARDIO - Myocardial Infarction & Peripheral Vascular Diseases

CARDIO - Myocardial Infarction & Peripheral Vascular Diseases

Multiple Choice

A nurse caring for a client in one room is told by another nurse that a second client has developed severe pulmonary edema. On entering the 2nd client’s room, the nurse would expect the client to be:

• Slightly anxious

• Mildly anxious

• Moderately anxious

• Extremely anxious

Multiple Choice

A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on digoxin (Lanoxin), a nurse checks the client’s most recent:

• Digoxin level

• Sodium level

• Potassium level

• Creatinine level

Multiple Choice

A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for:

• Hypovolemia

• UTI

• Glomerulonephritis

• Acute renal failure

Multiple Choice

A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?

• Encourage the client to cough and deep breathe.

• Premedicate the client with an analgesic.

• Provide the client with a walker.

• Remove telemetry equipment because it weighs down the hospital gown.

Multiple Choice

A client’s electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is:

• Normal sinus rhythm

• Sinus bradycardia

• Sinus tachycardia

• Sinus dysrhythmia

Multiple Choice

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because:

• It is uncomfortable for the client, giving a sense of impending doom.

• It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

• It is almost impossible to convert to a normal sinus rhythm.

• It can develop into ventricular fibrillation at any time.

Multiple Choice

A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for:

• Thrombocytopenia and weight gain

• Anorexia, nausea, and visual disturbances

• Diarrhea and hypotension

• Fatigue and muscle twitching

Multiple Choice

A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:

• Stable angina

• Unstable angina

• Variant angina

• Nonanginal pain

Multiple Choice

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following?

• Obtaining an infusion pump for the medication.

• Monitoring BP q4h.

• Monitoring urine output hourly.

• Obtaining serum potassium levels daily.

Multiple Choice

Aspirin is administered to the client experiencing an MI because of its:

• Antipyretic action

• Antithrombotic action

• Antiplatelet action

• Analgesic action

Multiple Choice

Which of the following is an expected outcome for a client on the second day of hospitalization after an MI?

• Has severe chest pain.

• Can identify risk factors for MI.

• Agrees to participate in a cardiac rehabilitation walking program.

• Can perform personal self-care activities without pain.

Multiple Choice

Which of the following reflects the principle on which a client’s diet will most likely be based during the acute phase of MI?

• Liquids as ordered

• Small, easily digested meals

• Three regular meals per day

• NPO

Multiple Choice

An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of:

• Left ventricular atrophy

• Irregular heartbeats

• Peripheral vascular occlusion

• Pacemaker placement

Multiple Select

Which of the following nursing diagnoses would be appropriate for a client with heart failure? Select all that apply.

• Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output.

• Activity intolerance related to increased cardiac output.

• Decreased cardiac output related to structural and functional changes.

• Impaired gas exchange related to decreased sympathetic nervous system activity.

• Acute pain related to inability to meet the oxygen demands.

Multiple Choice

Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema?

• Risk for infection related to stasis of alveolar secretions.

• Impaired skin integrity related to pressure.

• Activity intolerance related to pump failure.

• Constipation related to immobility.

Multiple Choice

Captopril may be administered to a client with HF because it acts as a:

• Vasopressor

• Volume expander

• Vasodilator

• Potassium-sparing diuretic

Multiple Choice

Furosemide is administered intravenously to a client with HF. How soon after administration should the nurse begin to see evidence of the drug’s desired effect?

• 5 to 10 minutes

• 30 to 60 minutes

• 2 to 4 hours

Multiple Choice

Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following a 2-gram sodium diet?

• Apples

• Tomato juice

• Whole wheat bread

• Beef tenderloin

Multiple Choice

The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects:

• Left atrial enlargement

• Left ventricular enlargement

• Right atrial enlargement

• Right ventricular enlargement

Multiple Choice

Which of the following arteries primarily feeds the anterior wall of the heart?

• Circumflex artery

• Internal mammary artery

• Left anterior descending artery

• Right coronary artery

Multiple Choice

The most important factor in regulating the caliber of blood vessels, which determines resistance to flow, is:

• Hormonal secretion

• Independent arterial wall activity.

• The influence of circulating chemicals

• The sympathetic nervous system

Multiple Choice

With peripheral arterial insufficiency, leg pain during rest can be reduced by:

• Elevating the limb above heart level.

• Lowering the limb so it is dependent.

• Massaging the limb after application of cold compresses.

• Placing the limb in a plane horizontal to the body.

Multiple Choice

Buerger’s disease is characterized by all of the following except:

• Arterial thrombosis formation and occlusion.

• Lipid deposits in the arteries.

• Redness or cyanosis in the limb when it is dependent.

• Venous inflammation and occlusion.

Multiple Choice

A significant cause of venous thrombosis is:

• Altered blood coagulation

• Stasis of blood

• Vessel wall injury

• All of the above

Multiple Choice

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for:

• At least 12 hours

• The first 24 hours

• 2-3 days

• 1 week

Multiple Choice

Mike, a 43-year old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike’s symptoms as being associated with peripheral arterial occlusive disease. The nursing diagnosis is probably:

• Alteration in tissue perfusion related to compromised circulation.

• Dysfunctional use of extremities related to muscle spasms.

• Impaired mobility related to stress associated with pain.

• Impairment in muscle use is associated with pain on exertion.

Multiple Choice

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for:

• Familial tendency toward peripheral vascular disease.

• Smoking history.

• Recent exposures to allergens.

• History of insect bites.

Multiple Choice

Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit?

• Vitamin K

• Aminocaproic acid

• Potassium chloride

• Protamine sulfate

Multiple Choice

A client who has been receiving heparin therapy also is started on warfarin sodium (coumadin). The client asks the nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin sodium:

• Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exhibit an anticoagulant effect.

• Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect.

• Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for it to begin.

Multiple Choice

A nurse has the order to begin administering warfarin sodium (Coumadin) to a client. While implementing this order, the nurse ensures that which of the following medications is available on the nursing unit as the antidote for Coumadin?

• Vitamin K

• Aminocaproic acid

• Potassium chloride

• Protamine sulfate

Multiple Choice

A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing an aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:

• Normal because of the increased blood flow through the leg.

• Slightly deteriorating and should be monitored for another hour.

• Moderately impaired, and the surgeon should be called.

• Adequate from the arterial approach, but venous complications are arising.

Multiple Choice

A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer, expecting to note that the ulcer:

• Has a pale colored base.

• Is deep, with even edges.

• Has little granulation tissue.

• Has brown pigmentation around it.

Multiple Choice

In preparation for the discharge of a client with arterial insufficiency and Raynaud’s disease, client teaching instructions should include:

• Walking several times each day as an exercise program.

• Keeping the heat up so that the environment is warm.

• Wearing a TED hose during the day.

• Using hydrotherapy for increasing oxygenation.

Multiple Choice

A client comes to the outpatient clinic and tells the nurse that he has had leg pains that begin when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for?

• An acute obstruction in the vessels of the legs.

• Peripheral vascular problems in both legs.

• Diabetes

Multiple Choice

Which of the following characteristics is typical of the pain associated with DVT?

• Dull ache

• No pain

• Sudden onset

• Tingling

Multiple Choice

Cancer can cause changes in what component of Virchow’s triad?

• Blood coagulability

• Vessel walls

• Blood flow

• Blood viscosity

Multiple Choice

Varicose veins can cause changes in what component of Virchow’s triad?

• Blood coagulability

• Vessel walls

• Blood flow

• Blood viscosity

Multiple Choice

Which technique is considered the gold standard for diagnosing DVT?

• Ultrasound imaging

• Venography

• MRI

• Doppler flow study

Multiple Choice

A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to an aneurysm?

• Pulsatile abdominal mass.

• Hyperactive bowel sounds in that area.

• Systolic bruit over the area of the mass.

• Subjective sensation of “heart beating” in the abdomen.

Multiple Choice

A nurse is caring for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse would inspect the surgical site most closely for signs of:

• Thrombosis and infection

• Bleeding and infection

• Bleeding and wound dehiscence.

• Wound dehiscence and evisceration.

Multiple Choice

A 68-year-old woman is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have any symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the nice lady, the nurse would most likely learn that the client’s childhood health history included:

• Chicken pox

• Poliomyelitis

• Rheumatic fever

• Meningitis

Multiple Choice

Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation?

• Exertional dyspnea

• Confusion

• Elevated creatine phosphokinase concentration

• Chest pain

Multiple Choice

The nurse expects that a client with mitral stenosis would demonstrate symptoms associated with congestion in the:

• Aorta

• Right atrium

• Superior vena cava

• Pulmonary circulation

Multiple Choice

Because a client has mitral stenosis and is a prospective valve recipient, the nurse preoperatively assesses the client’s past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client?

• Medication therapy

• Diet modification

• Activity restrictions

• Dental care

Multiple Choice

Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include a demonstration of the proper use of:

• A manual toothbrush

• An electric toothbrush

• An irrigation device

• Dental floss

Multiple Choice

A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication the nurse will constantly observe for is:

• Presence of heart murmur

• Systemic emboli

• Fever

• Congestive heart failure

Multiple Choice

Cholesterol, frequently discussed in relation to atherosclerosis, is a substance that:

• May be controlled by eliminating food sources.

• Is found in many foods, both plant and animal sources.

• All persons would be better off without because it causes the disease process.

• Circulates in the blood, the level of which usually decreases when unsaturated fats are substituted for saturated fats.

Multiple Choice

When teaching a client with a cardiac problem, who is on a high-unsaturated fatty-acid diet, the nurse should stress the importance of increasing the intake of:

• Enriched whole milk

• Red meats, such as beef

• Vegetables and whole grains

• Liver and other glandular organ meats

Multiple Choice

A 2-gram sodium diet is prescribed for a client with severe hypertension. The client does not like the diet, and the nurse hears the client’s request that the spouse “Bring in some good home-cooked food.” It would be most effective for the nurse to plan to:

• Call in the dietician for client teaching.

• Wait for the client’s family and discuss the diet with the client and family.

• Tell the client that the use of salt is forbidden, because it will raise BP.

• Catch the family members before they go into the client’s room and tell them about the diet.

Multiple Select

What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply.

• The RR intervals are relatively consistent.

• One P wave precedes each QRS complex.

• Four to eight complexes occur in a 6-second strip.

• The ST segment is higher than the PR interval.

• The QRS complex ranges from 0.12 to 0.2 seconds.

DONE!!!