Cardiovascular MEDSURG Flashcards
A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize?
A. Increasing fluids to maintain BP
B. Stopping medication if dizziness persists
C. Taking medication first thing in the morning
D. Rising slowly from a lying or sitting position
D. Rising slowly from a lying or sitting position
Patients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these patients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Patient should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse’s scope of practice.
The nurse is caring for an 84-year-old man who has just returned from the OR after inguinal hernia repair. The OR report indicates that the patient received large volumes of IV fluids during surgery and the nurse recognizes that the patient is at risk for left-sided heart failure. What signs and symptoms would indicate left-sided heart failure? A. Dependent edema B. Right upper quadrant pain C. Jugular vein distention D. Bibasilar fine crackles
D. Bibasilar fine crackles
Bibasilar fine crackles are a sign of alveolar fluid, a sequela of left ventricular fluid, or pressure overload. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.
A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks “about a pack of beer” every day. The nurse notes what nonmodifiable risk factor for hypertension? A. A family history of hypertension B. Hyperlipidemia C. Closer adherence to medical regimen D. Excessive alcohol intake
A. A family history of hypertension
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
The nurse is caring for a 68-year-old patient the nurse suspects has digoxin toxicity. In addition to physical assessment, the nurse should collect what assessment datum? A. Potassium level B. Peripheral pulses C. Skin turgor D. White blood cell count
A. Potassium level
The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. Skin turgor, white cell levels, and peripheral pulses are not normally affected in cases of digitalis toxicity.
The nurse is performing an initial assessment of a client diagnosed with HF. The nurse also assesses the patient’s sensorium and LOC. Why is the assessment of the patient’s sensorium and LOC important in patients with HF?
A. Decreased LOC causes an exacerbation of the signs and symptoms of HF.
B. The most significant adverse effect of medications used for HF treatment is altered LOC.
C. Patients with HF are susceptible to overstimulation of the sympathetic nervous system.
D. HF ultimately affects oxygen transportation to the brain.
D. HF ultimately affects oxygen transportation to the brain.
As the volume of blood ejected by the heart decreases, so does the amount of oxygen transported to the brain. Sympathetic stimulation is not a primary concern in patients with HF, although it is a possibility. HF affects LOC but the reverse is not usually true. Medications used to treat HF carry many adverse effects, but the most common and significant effects are cardiovascular.
A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?
A. Obesity and high intake of sodium and saturated fat
B. Metabolic syndrome and smoking
C. Diabetes and use of oral contraceptives
D. Renal disease and coarctation of the aorta
A. Obesity and high intake of sodium and saturated fat
Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.
A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged, uncontrolled hypertension is at risk for developing what health problem? A. Right ventricular hypertrophy B. Glaucoma C. Anemia D. Renal failure
D. Renal failure
When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.
A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?
A. “The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.”
B. “Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up.”
C. “Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly.”
D. “Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure.”
D. “Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure.”
Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.
Which assessment would be most appropriate for a patient who is receiving a loop diuretic for HF? A. Monitor for hypotension B. Assess the patient for hyperkalemia C. Monitor liver function studies D. Assess the patient's vitamin D intake
A. Monitor for hypotension
Diuretic therapy increases urine output and decreases blood volume, which places the patient at risk of hypotension. Patients are at risk of losing potassium with loop diuretic therapy and need to continue with potassium in their diet; hypokalemia is a consequent risk. Liver function is rarely compromised by diuretic therapy and vitamin D intake is not relevant.
A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? A. Chest pain B. Bleeding at the implantation site C. Bradycardia D. Malignant hyperthermia
B. Bleeding at the implantation site
Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.
The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patient's stroke volume. The nurse recognizes that afterload is increased when there is what? A. Venous vasodilation B. Venous vasoconstriction C. Arterial vasoconstriction D. Arterial vasodilation
C. Arterial vasoconstriction
Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.
The nurse is creating a plan of care for a patient with acute coronary syndrome. What nursing action should be included in the patient’s care plan?
A. Have patient maintain supine positioning when in bed.
B. Perform chest physiotherapy, as indicated.
C. Facilitate daily arterial blood gas (ABG) sampling.
D. Administer supplementary oxygen, as needed.
D. Administer supplementary oxygen, as needed.
Oxygen should be administered along with medication therapy to assist with symptom relief. Administration of oxygen raises the circulating level of oxygen to reduce pain associated with low levels of myocardial oxygen. Physical rest in bed with the head of the bed elevated or in a supportive chair helps decrease chest discomfort and dyspnea. ABGs are diagnostic, not therapeutic, and they are rarely needed on a daily basis. Chest physiotherapy is not used in the treatment of ACS.
The nurse has entered a patient’s room and found the patient unresponsive and not breathing. What is the nurse’s next appropriate action?
A. Illuminate the patient’s call light.
B. Activate the Emergency Response System (ERS).
C. Palpate the patient’s carotid pulse.
D. Begin performing chest compressions.
B. Activate the Emergency Response System (ERS).
After checking for responsiveness and breathing, the nurse should activate the ERS. Assessment of carotid pulse should follow and chest compressions may be indicated. Illuminating the call light is an insufficient response.
The nurse overseeing care in the ICU reviews the shift report on four patients. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock?
A. The patient admitted with acute renal failure
B. The patient admitted following a stroke
C. The patient admitted with malignant hypertension
D. The patient admitted following an MI
D. The patient admitted following an MI
Cardiogenic shock may occur following an MI when a large area of the myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients with acute renal failure are at risk for dysrhythmias and patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an MI is at the greatest risk for development of cardiogenic shock when compared with the other listed diagnoses.
The nurse overseeing care in the ICU reviews the shift report on four patients. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock?
A. The patient admitted with acute renal failure
B. The patient admitted following a stroke
C. The patient admitted with malignant hypertension
D. The patient admitted following an MI
Selected Answer: D.
The patient admitted following an MI
Cardiogenic shock may occur following an MI when a large area of the myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. While patients with acute renal failure are at risk for dysrhythmias and patients experiencing a stroke are at risk for thrombus formation, the patient admitted following an MI is at the greatest risk for development of cardiogenic shock when compared with the other listed diagnoses.
