Cardiovascular + Pulmonary

Question 1

The nurse is caring for a client with chronic, stable angina. The client takes the long-acting nitrate isosorbide mononitrate. Which client outcome indicates that the drug is effective?

1. Client is able to shower, dress, and fix hair without any chest pain
2. Client reports reduction in stress + anxiety
3. Client reports being able to sleep through the night
4. Client’s BP is 128/78 and the HR is 82.

Answer 1

1. Client is able to shower, dress, and fix hair without any chest pain

Long-acting nitrates are used to reduce the incidence of anginal attacks. Nitrates are effective if the client is able to do activities without the incidence of chest pain. The client should be taught to report any increase in chest pain and how to manage headaches, a common side effect of nitrates.

Question 2

A client had a thoracotomy 2 days ago to remove a lung mass and has a right chest tube attached to negative suction. Immediately after turning the client to the left side to assess the lungs, the nurse observes a rush of approximately 125 mL of dark bloody drainage into the drainage tubing and collection chamber. What is the appropriate nursing action?

First day post op: Chest drainage = 400 mL / 24 hrs

Second day post op: Chest drainage = 50 mL / 12 hrs

1. Document and continue to monitor drainage
2. Immediately clamp the chest tube
3. Notify the HCP
4. Request repeat hematocrit and hemoglobin levels

Answer 2

1. Document and continue to monitor drainage

Immediately following a thoracotomy, chest tube drainage (50-500 mL for the first 24 hours) is expected to be sanguineous (bright red) for several hours and then change to serosanguineous (pink) followed by serous (yellow) over a period of a few days.

A rush of dark bloody drainage from the chest tube when the client was turned following a period of minimal drainage is most likely related to retained blood due to a partial blockage in the tube. Bright red drainage indicates active bleeding and would be of immediate concern.

Question 3

The nurse should plan to teach which client about the need for prophylactic antibiotics prior to dental procedures?

1. Client had MI with secondary HF
2. Client with mitral vavuloplasty repair
3. Client with mechanical aortic valve replacement
4. Client with mitral valve prolapse with regurgitation

Answer 3

3. Client with mechanical aortic valve replacement

Certain individuals should receive prophylactic antibiotics prior to dental procedures to prevent infective endocarditis (IE). These include the following:

Prosthetic heart valve or prosthetic material used to repair heart valve
Previous history of IE

Some forms of congenital heart disease

Cardiac transplantation recipients who develop heart valve disease

Question 4

The nurse is caring for a client with newly diagnosed infective endocarditis (IE). Which assessment finding by the nurse is the highest priority to report to the health care provider (HCP)?

1. Pain and pallor in one foot
2. Pain in both knees
3. Splinter hemorrhages in the nail beds
4. Temperature of 39 C

Answer 4

1. Pain and pallor in one foot

Infective endocarditis will cause endocardium vegetation in the heart. These vegetations may break off and travel systemically throughout the body and embolize to various organs.

This includes:
Stroke, Spinal cord ischemia
Ischemia to extremities - pain pallor, cold foot/ arm
Intestinal infarction (abd pain)
Splenic infarction - left upper quadrant pain

Question 5

A client is 6 hours postoperative from hip surgery after receiving regional anesthesia and has epidural continuous anesthesia in place. Which is the most important reason for the nurse to contact the health care provider?

1. Client reports parethesia bilaterally since surgery
2. Fondaparinux prescribed for STAT admin
3. Lower extremity muscle strength is 3/5 bilaterally
4. Post op lab results show Hgb 9.9

Answer 5

2. Fondaparinux prescribed for STAT admin

Fondaparinux is an anticoagulent. This should be held until more than 6 hours after any surgery.