BN Ch.81 Cardiovascular Disorders (Nursing Process)

Question 1

Explain the rationales for the following laboratory tests: CK, LDH, AST, troponin, lipid levels, and BNP.

Answer 1

• Enzymes; these diagnostic markers are released into the bloodstream when muscle damage occurs, as in myocardial infarction.
• The lab tests are done
  to measure the amount of the particular enzyme; the levels help determine what is wrong.
• Levels of these enzymes rise and fall at specific times

Question 2

Differentiate an angiocardiogram from an arteriogram, including nursing considerations for each procedure.

Question 3

Describe the role of the nurse during and after the following procedures: echocardiogram, ECG stress test, and an electrophysiology study.

Question 4

Identify nursing considerations before and after a cardiac catheterization.

Question 5

Identify the rationale for performing a PTCA.

Question 6

Compare and contrast the following surgical procedures: closed-heart surgery, open-heart surgery, heart valve replacement, and heart transplantation, including postoperative nursing interventions for each.

Question 7

Explain the role of each of the following conditions as they contribute to cardiovascular disease: arteriosclerosis, atherosclerosis, hypertension, and hypotension.

Question 8

Differentiate the following cardiac rhythm abnormalities: sinus tachycardia, sinus bradycardia, PVC, heart block, and fibrillation.

Question 9

Describe heart failure, including possible causes, signs and symptoms, diagnostic tests, treatment, and nursing care.

Question 10

Define and differentiate the following terms: edema, ascites, anasarca, dependent edema, pitting edema, nonpitting edema, and pulmonary edema.

Question 11

Define the following infectious and inflammatory heart disorders: myocarditis , endocarditis , and pericarditis .

Question 12

Identify four major causes of coronary artery disease.

Question 13

Describe three signs and symptoms for angina pectoris and myocardial infarction and nursing interventions for each condition.

Question 14

Differentiate the following disorders: thrombophlebitis, deep venous thrombosis, phlebitis, and embolism.

Question 15

Identify nursing considerations for each of the following conditions: intermittent claudication, Buerger disease, and Raynaud phenomenon.

Question 16

Identify the main causes and common complications of strokes.

Question 17

Identify nursing interventions that are important during the various phases of a stroke.

Question 18

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

Answer 18

Stress

Question 19

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

Answer 19

Pitting

Question 20

__________ one of the symptoms of CHE,
refers to the presence of albumin in the
urine.

Answer 20

Albuminuria

Question 21

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

Answer 21

Hemodynamic

Question 22

__________ 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 22

Pericarditis

Question 23

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

Answer 23

Intractable

Question 24

C

Answer 24

Raynaud phenomenon

Question 25

D

Answer 25

Telangiectasia

Question 26

A

Answer 26

Burger disease

Question 27

B

Answer 27

Varicose veins

Question 28

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

Answer 28

• 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 29

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

Answer 29

• 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 30

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

Answer 30

• 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 31

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

Answer 31

• 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
  • Allergy to streptokinase

Question 32

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

Answer 32

• 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
  • Has undergone the appropriate routine tests and procedures.

Question 33

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

Answer 33

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

Question 34

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

Answer 34

• 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 35

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 perform when caring for a client
undergoing an angiocardiogram?

Answer 35

• 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 36

Which assessment findings are important
in determining cardiovascular disorders?

Answer 36

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 37

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

Answer 37

The nurse should include the following instructions in the client teaching plan for the prevention 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
  • Chocolat.
  • 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
  • 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 38

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 38

The symptoms indicate that the client has angina pectoris.

Question 39

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

Answer 39

• 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 40

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 40

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

Question 41

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

Answer 41

The nursing interventions that the nurse should perform when caring for the client with myocardial 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 (anti embolism)
• 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 42

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

Answer 42

• 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 43

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

Answer 43

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 44

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 44

• 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
• Anemia

Question 45

Which groups of clients are most susceptible to bacterial endocarditis?

Answer 45

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

Question 46

Which nursing interventions are involved
when caring for this client?

Answer 46

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 47

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 47

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

Question 48

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

Answer 48

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 49

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

Answer 49

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 50

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 monitor for to assess Raynaud phenomenon in
this client?

Answer 50

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

Question 51

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

Answer 51

• 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
  • Avoid smoking