22 - Cardiovascular Health Flashcards
A nurse assesses the lower extremities of an older adult and notes a small ulcer between the person’s great toe and second toe. The ulcer has well-defined edges and there is no bleeding; however, there is a small amount of necrotic tissue present. This wound is most likely a(n):
a. ) venous ulcer.
b. ) arterial ulcer.
c. ) pressure ulcer
d. ) surgical wound.
b.) arterial ulcer.
Arterial ulcers are often located between the toes. They usually present with well-defined edges, do not bleed, and have necrotic tissue. These features are not found in venous ulcers. Pressure ulcers develop from unrelieved pressure. There is no indication in the description that there is unrelieved pressure. There is no mention of surgery in the scenario above.
A nurse measures an older adult’s blood pressure on the right arm and notes a reading of 150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse?
a. ) Immediately contact the medical provider.
b. ) Measure the blood pressure in the left arm.
c. ) Measure the blood pressure in sitting and standing positions.
d. ) Document the findings in the medical record; elevated blood pressures are normal
in older adults.
b.) Measure the blood pressure in the left arm.
When an abnormal blood pressure reading is obtained, it is necessary to do two measurements, five minutes apart, confirmed in the contralateral arm.
Doing orthostatic measurements is not indicated in this situation. A blood pressure reading above 140/90 is considered abnormal for an older adult.
A nurse is auscultating an older patient’s heart and notes a systolic murmur (heard between the S1 and S2 heart sounds. The first action by the nurse is to:
a. ) question the patient about the presence of the murmur.
b. ) note it in the chart as this is always a normal finding for an older adult.
c. ) contact the medical provider as this is an abnormal finding.
d. ) immediately implement emergency interventions.
a.) question the patient about the presence of the murmur.
In normal aging, the heart valves separating the chambers thicken and stiffen as a result of lipid deposits and collagen cross-linking.
Mild systolic murmurs (between S1 and S2) are expected findings in the older adult. Aortic and mitral valves are those most commonly affected. If the nurse auscultates a systolic murmur in an asymptomatic older adult, he or she should ask about it. Most older adults will reply that they have had it for a while. If this is not the case, the person is referred to a cardiologist. If the new finding is accompanied by any significant signs or symptoms of distress, it is a medical emergency.
Diastolic murmurs (heard between S2 and S1) are always indicative of a serious problem in cardiac hemodynamics and these persons are followed closely by a cardiologist.
A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (Select all that apply.)
a. ) Learning how to read and interpret food labels
b. ) The sodium content of commonly consumed foods
c. ) Techniques to incorporate more physical activity into the daily routine
d. ) The actions of calcium channel blocker medications on hypertension
e. ) The importance of adhering to pharmacological regimens for treatment of hypertension
a.) Learning how to read and interpret food labels
b.) The sodium content of commonly consumed foods
c.) Techniques to incorporate more physical activity into the daily routine
Options A and B address dietary interventions to control hypertension. Option C addresses physical activity. These all involve lifestyle changes to control hypertension.
Options D and E are related to pharmacological treatment of hypertension.
An older patient with atrial fibrillation is prescribed warfarin for anticoagulation. Which of the following should the nurse include in the teaching plan? (Select all that apply.)
a. ) Frequent blood testing is required to assure that the level of anticoagulation is in the correct range.
b. ) Limit dietary intake of vitamin K.
c. ) Increase dietary intake of vitamin D and calcium.
d. ) Inform the medical provider if any antibiotics are ordered from any other provider.
e. ) Seek medical attention immediately if an injury is sustained.
a, b, d, e
a.) Frequent blood testing is required to assure that the level of anticoagulation is in the correct range.
b.) Limit dietary intake of vitamin K.
d.) Inform the medical provider if any antibiotics are ordered from any other provider.
e.) Seek medical attention immediately if an injury is sustained.
Frequent blood testing is required to check the level of anticoagulation. Vitamin K is an antidote to warfarin, so the patient must limit intake of vitamin K.
Warfarin interacts with most antibiotics. Since warfarin is an anticoagulant, the patient needs to seek medical attention if an injury is sustained due to risk of bleeding. Vitamin D and calcium are unrelated to warfarin.
An older person has sudden onset of a severe headache, left-sided facial drooping, and left arm numbness. The person’s daughter calls 911 and the person is transported to the emergency department. The first diagnostic test that will likely be performed is a(n):
a. ) electrocardiogram (ECG) to assess for atrial fibrillation
b. ) computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke.
c. ) international normalized ratio to determine level of anticoagulation.
d. ) lumbar puncture to assess for infection.
b.) computed axial tomography (CAT) scan to differentiate hemorrhagic from ischemic stroke.
The first diagnostic test that will be done is a CAT scan to differentiate hemorrhagic from ischemic stroke. If it is an ischemic stroke, tissue plasminogen activator (tPA) can be administered to dissolve the clot but must be done within 3 hours. Depending on the patient’s presentation, all of the other diagnostic tests may also be done following the CAT scan.
A homecare nurse visits an older female adult at home who has peripheral vascular disease to monitor her status. The nurse determines that the client needs additional teaching when the client states which of the following? (Select all that apply.)
a. ) “I need to try and elevate my legs above the level of my heart every time I sit down and all night.”
b. ) “I really need to try and avoid sitting in one position for a long period of time.”
c. ) “I know that I need to wear these compression stockings 24 hours a day.”
d. ) “I will wash my feet and legs with strong antibacterial soap twice daily.”
e. ) “I need to examine my feet daily for any cuts, sores, or openings.”
c.) “I know that I need to wear these compression stockings 24 hours a day.”
d.) “I will wash my feet and legs with strong antibacterial soap twice daily.”
Compression stockings are worn all day but need to be removed at bedtime. It is important to wash the feet and legs with mild soap and water frequently.
An older client is diagnosed with venous insufficiency of the lower extremities. The nurse expects the client to display which of the following signs and symptoms? (Select all that apply.)
a. ) Thin, shiny dry skin
b. ) Reddish brown discoloration of the skin of the legs
c. ) Pain when the legs are elevated
d. ) Varicose veins
e. ) Legs are cool to touch
b.) Reddish brown discoloration of the skin of the legs
d.) Varicose veins
A reddish brown discoloration of the lower extremities and varicose veins are present with venous insufficiency.
The other signs and symptoms are all associated with arterial insufficiency.
A nurse is caring for an older hospitalized patient who recently suffered a myocardial infarction (MI). The patient asks the nurse, “I didn’t even know that I had a heart attack. I did not have crushing chest pain like you see on television. Why didn’t I?” The best response by the nurse is:
a. ) “Older patients do not feel pain in the same way that younger patients do.”
b. ) “Oh, that is just television. Hardly anyone has crushing chest pain when he has a heart attack.”
c. ) “Older people often do not have the typical signs and symptoms when they have a heart attack.”
d. ) “Older people never have chest pain when they have a heart attack.”
c.) “Older people often do not have the typical signs and symptoms when they have a heart attack.”
Symptoms of an MI can be completely atypical in an older person, such as an unexplained fall, acute change in mental status, or extreme fatigue or dyspnea. Some older patients, however, do have the typical signs and symptoms. It is not true that older people do not feel pain.
An older adult who was diagnosed with atrial fibrillation asks a nurse, “I feel fine. I have no symptoms at all with this heart problem, yet I am now on a blood thinner medication, which I understand can by very dangerous. Is this really necessary?” The nurse formulates a response based on the understanding that:
a. ) Atrial fibrillation, while initially asymptomatic, will progress and become symptomatic.
b. ) the risk of stroke is very high for a person with atrial fibrillation.
c. ) untreated atrial fibrillation will likely cause a heart attack.
d. ) atrial fibrillation can cause coronary heart disease.
b.) the risk of stroke is very high for a person with atrial fibrillation.
The most serious complication of atrial fibrillation is stroke. Symptoms of atrial fibrillation, if they occur, are usually vague and do not worsen. While untreated atrial fibrillation can cause tachycardia as a compensatory mechanism, which can lead to myocardial ischemia, a heart attack from atrial fibrillation is not a common occurrence. Coronary heart disease can cause atrial fibrillation, not the reverse.
