BN Ch 81 Cardiovascular Disorders

Question 1

A test is used to assess the severity of symptomatic and asymptomatic cardiac disease.

Answer 1

Stress Test

Question 2

________edema is a type of edema formed when a finger pressed on a swollen area leaves an indention that lasts longer than normal.

Answer 2

Pitting

Question 3

_________, one of the symptoms of CHF, refers to the presence of albumin in the urine.

Answer 3

Albuminuria

Question 4

_________ monitoring is a special kind of monitoring used when the heart pressures are increased.

Answer 4

Hemodynamic

Question 5

________refers to an inflammation of the sac surrounding the heart, which may be caused by infection, allergy, malignancy, trauma, or some other nonspecific problem.

Answer 5

Pericarditis

Question 6

_____ angina is a type of angina pain that does not respond to therapy and is so persistent that the client cannot work.

Answer 6

Intractable

Question 7

Extremities are blanched and cold,perspire and feel numb and prickly.

Answer 7

Raynaud phenomenon

Question 8

Groups of small dialated blood vessels treated with scleropathy.

Answer 8

Telangiectasia

Question 9

First sign is cramps in the calf muscles, brought on by excercise, which disappears with rest.

Answer 9

Burger disease

Question 10

Dark, tortuous superficial veins that become more prominent when the person stands and appear as dark protrusions.

Answer 10

Varicose veins

Question 11

Why would the nurse take the client’s apical pulse before administering any digitalis preparation to the client?

Answer 11

• Before administering any digitalis preparation, the nurse should take the client’s apical pulse for 1 full minute.
• The nurse should not give the medication if the pulse is less than 60 beats/min and should report such a finding immediately.
• Low pulse may indicate overdigitalization.

Question 12

Why would a nurse ask a client if they are allergic to shellfish or iodine before performing any test using radiopaque dye?

Answer 12

• The nurse must ask the client if he or she is allergic to shellfish or iodine before performing any test, such as an angiocardiogram, that involves injection of a radiopaque dye into the client’s vessel.
• If the client is allergic to shellfish or iodine, the dye could cause a severe anaphylactic reaction.

Question 13

What are the nursing interventions when caring for a client who is scheduled to undergo cardiac catheterization?

Answer 13

• The nurse should inform the client who is scheduled to undergo cardiac catheterization that the procedure is not painful but could be uncomfortable.
• The nurse should also warn the client about a sensation of warmth and a “fluttering” in the heart as the catheter passes through the blood vessels.
• The nurse should get a signed informed consent from the client and make sure that the client has nothing by mouth (NPO) for at least 6 hours before the procedure.

Question 14

What are the criteria for selection of clients for thrombolytic therapy?

Answer 14

• If thrombolytic therapy is to be administered to a client, the nurse should ensure that the client has not undergone or experienced a recent surgery, an organ biopsy, cardiopulmonary resuscitation, strokes, bleeding abnormalities, intracranial neoplasm, recent head injury, pregnancy, or allergy to streptokinase.

Question 15

What are the important preoperative considerations required for a client who is scheduled for cardiac surgery?

Answer 15

• As part of preoperative care for a client who is scheduled for cardiac surgery, the nurse should ensure that the client consumes good nutrition, has extra oxygen for the body (which has been deprived of an adequate oxygen supply), follows the prescribed vitamin therapy, practices deep breathing, and has undergone the appropriate routine tests and procedures.

Question 16

What do neck vein distention and muffled heart sounds indicate in a client with an implanted pacemaker?

Answer 16

• Neck distention or muffled heart sounds indicate cardiac tamponade in a client who has had a pace-maker implanted.
• The nurse should assess for these signs.
• These are serious and must be brought to the healthcare provider’s notice.

Question 17

Why is it important not to touch the client or the client’s bed during electrical defibrillation?

Answer 17

• It is important that the healthcare provider and others attending the client during electrical defibrillation not touch the client or the client’s bed, because doing so could result in a shock or an injury.

Question 18

A nurse’s role when caring for a client with a cardiovascular disorder includes data collection, nursing diagnosis, planning and implementation, teaching and prevention, and evaluation.

A client arrives at the healthcare facility complaining of a recurring chest pain. The initial interview reveals that the client has a positive family history of cardiovascular disorders. Diagnosis indicates hyperlipidemia. The healthcare provider suggests that an angiocardiogram be performed on the client.

a. Which nursing interventions would the
nurse pertorm when caring for a client
undergoing an angiocardiogram?

Answer 18

The following nursing interventions are involved when caring for a client who is undergoing an angiocardiogram:
* Ensure that the client does not consume any breakfast before the procedure.
* Ensure that the client has received a sedative 30 to 60 minutes before the test.
* Ensure that the groin area is prepared for insertion.
* Ask the client to void before the test.
* Be alert for a possible allergic reaction to the
dye during or after the procedure.
* Watch for signs of a delayed reaction after
returning to the room, such as rapid pulse, diaphoresis, shakiness, skin rash, or drop in blood pressure.
* If the client’s femoral site is used for insertion, instruct the client not to bend the leg or flex the hip for up to 8 hours.
* Closely observe the insertion site for bleeding.
* Monitor the vital signs to check for hemorrhage.

Question 19

A nurse’s role when caring for a client with a
cardiovascular disorder includes data collec-
tion, nursing diagnosis, planning and implementation, teaching and prevention, and
evaluation.

A client arrives at the healthcare facility complaining of a recurring chest pain. The initial interview reveals that the client has a positive family history of
cardiovascular disorders. Diagnosis indicates
hyperlipidemia. The healthcare provider suggests that an angiocardiogram be performed on the client.

Which assessment findings are important
in determining cardiovascular disorders?

Answer 19

The following are the important assessment findings in determining cardiovascular disorders:
* Changes in the rate, quality, and rhythm of the pulse
* Rise or fall in blood pressure or central venous pressure
* Edema, especially in the feet and ankles
* Weight gain due to excess fluid in the tissues
* Difficulty breathing and the presence of a
cough, often due to pulmonary edema
* Cyanosis, due to a lack of oxygen in the blood
or a circulatory disorder
* Clubbing of the fingers
* Needing to squat to breathe
* Pain
* Fatigue, for no apparent reason
* Intermittent claudication, which denotes a
decrease in blood supply to the legs and feet

Question 20

A nurse’s role when caring for a client with a cardiovascular disorder includes data collection, nursing diagnosis, planning and implementation, teaching and prevention, and evaluation.

A client arrives at the healthcare facility
complaining of a recurring chest pain.
The initial interview reveals that the
client has a positive family history of
cardiovascular disorders. Diagnosis indicates
hyperlipidemia. The healthcare provider
suggests that an angiocardiogram be
performed on the client.

Which instructions would the nurse
include in the client teaching plan for the
prevention of cardiovascular disorders?

Answer 20

The nurse should include the following instruc- tions in the client teaching plan for the preven- tion of cardiovascular disorders:
* Stop smoking and avoid smoking’s harmful effects.
* Reduce sodium (salt) intake.
* Maintain weight within standard guidelines.
* Avoid foods high in animal fats and cholesterol.
* Avoid foods that contain caffeine: coffee, cola drinks, tea, chocolate.
* Exercise regularly and moderately.
* Avoid crossing the legs at the knees when
sitting.
* Have both feet comfortably touch the floor
when sitting.
* For a few minutes in the morning and
evening, elevate the feet.
* Avoid constrictive garments, especially around
the legs, arms, and waist.
* Wear properly fitted shoes.
* Avoid and minimize environmental stress and
anxiety-producing factors. Learn ways to
handle stress effectively.
* Follow medication regimens for prescribed
medications.
* Get plenty of rest and relaxation. Learn
relaxation techniques if necessary.

Question 21

A client arrives at a healthcare facility
complaining of pain in the left arm. The
initial interview reveals that the client has a
recurring feeling of paleness and feels faint.
Further assessment reveals that the client is
dyspneic and experiences a tightening, vise-
like, choking sensation in the chest along
with indigestion.

a. Which condition do these symptoms
indicate?

Answer 21

The symptoms indicate that the client has angina pectoris.

Question 22

A client arrives at a healthcare facility
complaining of pain in the left arm. The
initial interview reveals that the client has a
recurring feeling of paleness and feels faint.
Further assessment reveals that the client is
dyspneic and experiences a tightening, vise-
like, choking sensation in the chest along
with indigestion.

Which instructions would the nurse
include in the client teaching plan for the
prevention of client’s disorder?

Answer 22

The nurse should include the following instructions in the client teaching plan for the prevention of angina pectoris:
* Use medications properly. Take them at the same time every day. Do not stop or change dosages without your healthcare provider’s approval.
* Do not expose nitroglycerin to sunlight or moisture. Keep nitroglycerin in its original container. Purchase a fresh supply every
3 months.
* Check with your healthcare provider before taking any nonprescription medications. They may cause harmful side effects when combined with the cardiac medications.
* Make necessary lifestyle adjustments. Determine what you can and cannot do. Try to determine things that bring on attacks, so that you can curtail such activities.
* Stop smoking.
* Regular exercise and maintenance of an ideal
weight help prevent the disease’s progression.
* If nitroglycerin is working effectively, the client will feel a tingling sensation on the
tongue.
* Keep cholesterol within the 150 to 200 mg/dL
range.

Question 23

A client arrives at a healthcare facility complaining of difficulty in breathing and nausea. During the assessment, the nurse observes the following in the client: cold and clammy skin; cyanosis; rapid, thready, and irregular pulse; drop in blood pressure and body temperature.

a. Which condition do these symptoms
indicate?

Answer 23

The symptoms indicate that the client is likely to be experiencing a myocardial infarction

Question 24

A client arrives at a healthcare facility complaining of difficulty in breathing and nausea. During the assessment, the nurse observes the following in the client: cold and clammy skin; cyanosis; rapid, thready, and irregular pulse; drop in blood pressure and body temperature.

Which nursing interventions would the
nurse perform when caring for this client?

Answer 24

The nursing interventions that the nurse should perform when caring for the client with myocar- dial infarction include the following:
* Frequently measured vital signs
* Electronic cardiac monitoring
* Input/output and daily weight measures
* Careful observation for restlessness, dyspnea,
or chest pain
* Assessment for signs of CHF
* Assessment of skin color
Medications to promote pain relief and improve the heart’s functioning
* Emotional support and stress reduction
* Monitoring of diet, intravenous fluids, or total
parenteral nutrition (TPN)
* Allowing the client to use a commode at the
bedside for a bowel movement, if possible
(in preference to a bedpan).
* Assisting the client with isometric (muscle-
setting) exercises
* Applying thromboembolic (antiembolism)
stockings, as prescribed by the healthcare
provider
* Placing all necessary items within the client’s
reach and making sure the call light is
available
* Performing physical care
* After giving the bath and before making the
bed, allowing the client to rest for awhile

Question 25

A client arrives at a healthcare facility complaining of difficulty in breathing and nausea. During the assessment, the nurse observes the following in the client: cold and clammy skin; cyanosis; rapid, thready, and irregular pulse; drop in blood pressure and body temperature.

Which instructions would the nurse include in the client and family teaching plan?

Answer 25

The instructions that the nurse should include in the client teaching plan are the following:
* Instruct clients and their families about patterns of healthy living and how to recognize emotional and physical stress.
* If the client is taking antihypertensive drugs, emphasize the necessity of taking prescribed medications even if the client feels well.
* Discuss potential side effects when teaching.
* Include teaching about signs and symptoms
that require immediate medical help.
* Carefully and completely document this
teaching.

Question 26

A client arrives at a healthcare facility complaining of difficulty in breathing and nausea. During the assessment, the nurse observes the following in the client: cold and clammy skin; cyanosis; rapid, thready, and irregular pulse; drop in blood pressure and body temperature.

Which points would the nurse include in
the rehabilitation plan for this client?

Answer 26

The points that the nurse should include in the rehabilitation plan for the client include the following:
* In the healthcare facility, a gradual increase in the client’s activity level as ordered by the healthcare provider
* Exercise tolerance test and exercise progression
* Graded exercise program with monitoring of
tolerance based on blood pressure and pulse
* Emotional support and counseling
* Stress management
* Sexual counseling
* Lifestyle changes, if any
* Risk factor management
* Dietary changes, such as a low-fat diet for
hyperlipidemia or weight control
* Smoking cessation
* Hypertension control
* Medication and compliance as ordered

Question 27

A client arrives at a healthcare facility complaining of chills and loss of appetite. During the assessment, the nurse observes that the client has a low-grade fever. The diagnosis indicates bacterial endocarditis.

a. Which assessment findings are important
in determining bacterial endocarditis in a
client?

Answer 27

The assessment findings that are important in determining bacterial endocarditis in a client include a brownish tinge on the client’s face; tiny, reddish-purple spots on the client’s skin and mucous membranes; perspiring; weight loss; and anemia.

Question 28

A client arrives at a healthcare facility complaining of chills and loss of appetite. During the assessment, the nurse observes that the client has a low-grade fever. The diagnosis indicates bacterial endocarditis.

Which groups of clients are most susceptible to bacterial endocarditis?

Answer 28

Clients with damaged heart valves, rheumatic fever, or heart defects are most susceptible to bacterial endocarditis

Question 29

A client arrives at a healthcare facility complaining of chills and loss of appetite. During the assessment, the nurse observes that the client has a low-grade fever. The diagnosis indicates bacterial endocarditis.

Which nursing interventions are involved
When caring for this client?

Answer 29

The nursing interventions involved when caring for a client with bacterial endocarditis include the following: make the client as comfortable as possible and conserve the client’s energy; note the client’s pulse rate and quality frequently; and closely observe for any fluctuation in the client’s body temperature.

Question 30

A nurse has been caring for a client with thrombophlebitis. The client complains of a sudden, sharp chest pain. The nurse reports the client’s symptom to the healthcare provider. A diagnostic test reveals a blood clot traveling to the lungs, causing obstruction of a small vessel.

a. What does the client’s diagnosis indicate?

Answer 30

The client’s diagnosis indicates that the client has pulmonary embolism.

Question 31

A nurse has been caring for a client with thrombophlebitis. The client complains of a sudden, sharp chest pain. The nurse reports the client’s symptom to the healthcare provider. A diagnostic test reveals a blood clot traveling to the lungs, causing obstruction of a small vessel.

Which signs and symptoms should the nurse monitor for in this client?

Answer 31

The nurse should monitor for the following signs and symptoms when caring for a client with pulmonary embolism: sudden, sharp chest pain; breathing difficulty; violent cough; bloody sputum; cyanosis; and shock.

Question 32

A nurse has been caring for a client with
thrombophlebitis. The client complains of a
sudden, sharp chest pain. The nurse reports
the client’s symptom to the healthcare
provider. A diagnostic test reveals a blood clot
traveling to the lungs, causing obstruction of
a small vessel.

Which nursing interventions would
the nurse perform when caring for this
client?

Answer 32

The nursing interventions involved when caring for a client with pulmonary embolism include administering oxygen, providing complete bed rest in a high semi-Fowler position, administering continuous intravenous anticoagulation therapy with heparin, and providing pain relief with the use of intravenous morphine.

Question 33

A 30-year-old female client arrives at the
health care facility complaining of numb
and prickly hands. When assessing the
client, the nurse understands that the client
is undergoing emotional stress and observes
that their hands are blanched and perspiring.
The healthcare provider suspects that the
client has developed Raynaud phenomenon.

a. Which symptoms would the nurse moni-
tor for to assess Raynaud phenomenon in
this client?

Answer 33

To assess Raynaud phenomenon in the client, the nurse should monitor for the following symp- toms: the fingernails develop a blue coloration along with being painful, the skin looks tight and shiny, the nails become deformed, and the fingertips develop gangrene.

Question 34

A 30-year-old female client arrives at the
health care facility complaining of numb
and prickly hands. When assessing the
client, the nurse understands that the client
is undergoing emotional stress and observes
that their hands are blanched and perspiring.
The healthcare provider suspects that the
client has developed Raynaud phenomenon.

Which instructions would a nurse give this
client when caring for them?

Answer 34

When caring for the client with Raynaud phenomenon, the nurse should offer the following instructions: avoid chilling at all times; always wear warm clothing outdoors in winter; avoid emotional upsets and tension; and avoid smoking.