Perfusion Weeks 1 & 2

A patient who has a history of pulmonary valve stenosis tells the healthcare provider, “I don’t have a lot of energy anymore, and both of my feet get swollen in the late afternoon.” Which of these problems does the healthcare provider conclude is the likely cause of these clinical findings?

• acute pericarditis

• peripheral artery disease

• deep vein thrombosis

• right ventricular heart failure

A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review?

• BUN

• sodium

• potassium

• troponin

A patient has been admitted to the cardiac unit with a diagnosis of right ventricular failure. Which of the following assessment findings would the healthcare provider expect to observe? is most likely to be observed by the healthcare provider?

• dyspnea and crackles

• peripheral edema and jugular vein distention

• fatigue and hemoptysis

• bradycardia and cyanosis

The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time?

• increased dose of digoxin

• furosemide (lasix)

• potassium chloride

• digoxin immune fab (DigiFab)

A patient is being assessed for possible heart failure. Which of these laboratory results will provide support this diagnosis?

• increased creatinine kinase

• decreased CRP

• increased BNP

• decreased sodium

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement?

• "I will replace my nitroglycerin supply every 6 months."

• "I can take up to five tablets every 3 minutes for relief of my chest pain."

• "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin."

• "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction? (select all that apply)

• flushing

• ashen skin

• diaphoresis

• nausea and vomiting

• S3 & S4 heart sounds

Answer explanation

During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.

When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating?

• oxygen, nitro, aspirin, and morphine

• oxygen, furosemide, nitro, and meperidine

• aspirin, nitroprusside, dopamine, and oxygen

• nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)

Answer explanation

The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. The other medications may be used later in the patient's treatment.

The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed?

• the conversation should be delegated to the physician

• discussed along with other physical activities

• avoided because it is embarrassing

• accomplished by providing the patient written material

Answer explanation

Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex as a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?

• dehydration

• paralytic ileus

• atrial dysrhythmias

• acute respiratory distress syndrome

Answer explanation

Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications