Exam 2 - Practice Questions (CV, IV fluids) Flashcards
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which of the following data is necessary to collect if the patient is experiencing chest pain?
a) Blood pressure in the left arm
b) Sound of the apical pulses
c) Pulse rate in upper extremities
d) Description of the pain
d)
Description of the pain
Explanation:
If the patient is experiencing chest pain, a history of its location, frequency, and duration is necessary, as is a description of the pain, if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the patient and measures vital signs. The nurse may measure BP in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.
The nurse is caring for a patient who has undergone peripheral arteriography. How should the nurse assess the adequacy of peripheral circulation?
a) By checking for cardiac dysrhythmias
b) By hemodynamic monitoring
c) By checking peripheral pulses
d) By observing the patient for bleeding
c)By checking peripheral pulses Explanation: Peripheral arteriography is used to diagnose occlusive arterial disease in smaller arteries. The nurse observes the patient for bleeding and cardiac dysrhythmias and assesses the adequacy of peripheral circulation by frequently checking the peripheral pulses. Hemodynamic monitoring is used to assess the volume and pressure of blood in the heart and vascular system
During the auscultation of a patient’s heart sounds, the nurse notes an S4. The nurse recognizes that an S4 is associated with which of the following?
a) Hypertensive heart disease
b) Diseased heart valves
c) Turbulent blood flow
d) Heart failure
a) Hypertensive heart disease Explanation:
Auscultation of the heart requires familiarization with normal and abnormal heart sounds. An extra sound just before S1 is an S4 heart sound, or atrial gallop. An S4 sound often is associated with hypertensive heart disease. A sound that follows S1 and S2 is called an S3 heart sound or a ventricular gallop. An S3 heart sound is often an indication of heart failure in an adult. In addition to heart sounds, auscultation may reveal other abnormal sounds, such as murmurs and clicks, caused by turbulent blood flow through diseased heart valves.
Which of the following terms is used to describe the ability of the heart to initiate an electrical impulse?
a) Conductivity
b) Automaticity
c) Excitability
d) Contractility
b)Automaticity
Explanation:
Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.
When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured, the measurement obtained is referred to as which of the following?
a) Pulmonary artery wedge pressure
b) Pulmonary artery pressure
c) Cardiac output
d) Central venous pressure
a)Pulmonary artery wedge pressure Explanation:
When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary artery until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure. Central venous pressure is measured in the right atrium. Pulmonary artery pressure is measured when the balloon tip is not inflated. Cardiac output is determined through thermodilution involving injection of fluid into the pulmonary artery catheter.
Age-related changes associated with the cardiac system include which of the following? Select all that apply.
a) Increased size of the left atrium
b) Increase in the number of SA node cells
c) Myocardial thinning
d) Endocardial fibrosis
a)Increased size of the left atrium, d)Endocardial fibrosis
Explanation: Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening
Decreased pulse pressure reflects which of the following?
a) Reduced stroke volume
b) Reduced distensibility of the arteries
c) Elevated stroke volume
d) Tachycardia
a)Reduced stroke volume
Explanation: Decreased pulse pressure reflects reduced stroke volume and ejection velocity or obstruction to blood flow during systole. Increased pulse pressure would indicate reduced distensibility of the arteries, along with bradycardia
The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing?
a) BP changes; 148/80 mm Hg to 166/90 mm Hg
b) Heart rate changes; 78 bpm to 112 bpm
c) Dizziness and leg cramping
d) ST-segment changes on the ECG
d)
ST-segment changes on the ECG
Explanation:
During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; BP; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the patient experiences signs of myocardial ischemia. Further diagnostic testing, such as a cardiac catheterization, may be warranted if the patient develops chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias or ST-segment changes on the ECG during the stress test. The other findings would not warrant the testing to be stopped.
The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient’s CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following?
a) Hypervolemia
b) Excessive blood loss
c) Left-sided heart failure (HF)
d) Overdiuresis
a)Hypervolemia Explanation:
The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.
The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which of the following questions?
a) “What was your morning blood sugar reading?”
b) “Are you allergic to shellfish?”
c) “Are you having chest pain?”
d) “When was the last time you ate or drank?”
b)“Are you allergic to shellfish?”
Explanation:
Radiopaque contrast agents are used to visualize the coronary arteries. Some contrast agents contain iodine, and the patient is assessed before the procedure for previous reactions to contrast agents or allergies to iodine-containing substances (e.g., seafood). If the patient has a suspected or known allergy to the substance, antihistamines or methylprednisolone (Solu-Medrol) may be administered before the procedure. Although the other questions are important to ask the patient, it is most important to ascertain if the patient has an allergy to shellfish.
A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education?
a) Taking the patient’s BP with the patient sitting on the edge of the bed with feet dangling b)Obtaining the supine measurements prior to the sitting and standing measurements
c) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)
d) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR
c)Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)
Explanation:
The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.
The nurse is caring for a patient in the ED who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse understands that this finding is most suggestive of which of the following?
a) Heart failure
b) Pulmonary edema
c) Ventricular hypertrophy
d) Myocardial infarction
a)Heart failure
Explanation:
A BNP level greater than 100 pg/mL is suggestive of HF. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of HF in settings such as the ED. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the clinician correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of HF.
The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include?
a) “If any discharge occurs at the puncture site, call 911 immediately.”
b) “Contact your primary care provider if you develop a temperature above 102°F.”
c) “Do not bend at the waist, strain, or lift heavy objects for the next 24 hours.”
d) “You can take a tub bath or a shower when you get home.”
c)“Do not bend at the waist, strain, or lift heavy objects for the next 24 hours.” Explanation:
The nurse should instruct the patient to complete the following: If the artery of the groin was used, for the next 24 hours, do not bend at the waist, strain, or lift heavy objects; the primary provider should be contacted if any of the following occur: swelling, new bruising or pain from your procedure puncture site, temperature of 101°F or more. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The patient should not drive to the hospital.
The nurse is caring for a patient in the ICU diagnosed with coronary artery disease (CAD). Which of the following assessment data indicates the patient is experiencing a decrease in cardiac output?
a) Reduced pulse pressure and heart murmur
b) Disorientation, 20 mL of urine over the last 2 hours
c) Elevated jugular venous distention (JVD) and postural changes in BP
d) BP 108/60 mm Hg, ascites, and crackles
Correct Response: b)
Disorientation, 20 mL of urine over the last 2 hours
Explanation:
Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.
The nurse is caring for a patient with an intra-arterial BP monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which of the following?
a) Catheter-related bloodstream infections (CRBSI)
b) Pneumothorax
c) Air embolism
d) Hemorrhage
a)Catheter-related bloodstream infections (CRBSI)
Explanation:
CRBSIs are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air.
hen teaching a patient with rheumatic carditis and a history of recurrent rheumatic fever, which of the following statements made by the patient indicates that teaching has been successful?
a) “I will avoid any kind of activity.”
b) “I will take nonsteroidal anti-inflammatory medication (NSAIDs) every day.”
c) “I may have to take prophylactic antibiotics for up to 10 years.”
d) “I will avoid milk, yogurt and other dairy products.”
c) “I may have to take prophylactic antibiotics for up to 10 years.”
Explanation:
Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of antibiotic coverage (e.g., penicillin G intramuscularly (IM) every 4 weeks, penicillin V orally twice a day (BID), sulfadiazine orally daily, or erythromycin orally BID. Patients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Steroids are prescribed to suppress the inflammatory response and aspirin to control the formation of blood clots around heart valves. Activities that require minimal activity are recommended to reduce the work of the myocardium and counteract the boredom of weeks of bed rest.
Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis?
a) Administer supplemental oxygen.
b) Elevate the patient’s head.
c) Maintain the patient on bed rest.
d) Administer a prescribed antipyretic.
c) Maintain the patient on bed rest.
Explanation:
The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. Bed rest also helps decrease myocardial damage and the complications of myocarditis. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient’s head to promote maximal breathing potential.
A patient with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the patient for which of the following manifestations?
a) Anorexia and confusion
b) Tachypnea and dyspnea
c) Abdominal pain and diarrhea
d) Edema and orthopnea
a) Anorexia and confusion
Explanation:
Patients with RCM have increased sensitivity to digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity. The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system (CNS) disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision).
A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve?
a) “The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged.”
b) “The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged.”
c) “The valve is mechanical, and it will not deteriorate or need replacing.”
d) “The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged.”
b) “The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged.”
Explanation:
Autografts (i.e., autologous valves) are obtained by excising the patient’s own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient’s own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.
A nurse reviewing a patient’s echocardiogram report reads the following statements: “The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring.” The nurse knows these manifestations are indicative of which type of cardiomyopathy?
a) Hypertrophic
b) Arrhythmogenic right ventricular cardiomyopathy
c) Restrictive
d) Dilated
a) Hypertrophic
Explanation:
In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in size and mass, especially along the septum. It often affects nonadjacent areas of the ventricle. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole. The coronary arteriole walls are also thickened, which decreases the internal diameter of the arterioles. The narrow arterioles restrict the blood supply to the myocardium, causing numerous small areas of ischemia and necrosis. The necrotic areas of the myocardium ultimately fibrose and scar, further impeding ventricular contraction. Because of the structural changes, HCM had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
An asymptomatic patient questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which of the following is the most appropriate nursing response?
a) Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.
b) Avoid any type of exercise.
c) Avoid strenuous cardiovascular exercise.
d) Continue the exercise routine but take ample rest after exercising.
a) Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.
Explanation:
Exercise is not limited until mild symptoms develop. Once symptoms of heart failure develop, the patient needs to restrict his or her activity level to minimize symptoms. It is not important for an asymptomatic patient to avoid exercise and to take ample rest after exercise.
A nurse is conducting a heath history on a patient with a primary diagnosis of mitral stenosis. Which of the following disorders reported by the patient is the most common cause of mitral stenosis?
a) Congestive heart failure
b) Atrial fibrillation
c) Myocardial infarction
d) Rheumatic endocarditis
d) Rheumatic endocarditis
Explanation:
Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.
The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse?
a) Fatigue
b) Syncope
c) Dizziness
d) Extra heart sound
d) Extra heart sound
Explanation:
Often, the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapsed.
A nurse is teaching a patient about an upcoming surgery to separate fused cardiac leaflets. Which of the following is the correct term used to describe this surgery?
a) Chordoplasty
b) Commissurotomy
c) Annuloplasty
d) Valvuloplasty
b) Commissurotomy
Explanation:
Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve’s outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.
A patient comes to the clinic with complaints of fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which of the following preventable diseases?
a) Pericarditis
b) Cardiomyopathy
c) Rheumatic fever
d) Mitral stenosis
c) Rheumatic fever
Explanation:
Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease
A patient comes into the emergency room complaining about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which of the following diagnoses?
a) Mitral valve stenosis
b) Pericarditis
c) Cardiomyopathy
d) Rheumatic fever
b) Pericarditis
Explanation:
The primary symptom of pericarditis is pain, which is assessed by evaluating the patient in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexion, extension, or rotation of the spine, including the neck; by movements of shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.
A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions?
a) Decrease the amount of acidic beverages and fruits.
b) A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions?
c) Decrease the amount of sodium and saturated fat.
d) Eliminate caffeine and alcohol
d) Eliminate caffeine and alcohol
Explanation:
To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to avoid caffeine and alcohol. The nurse encourages the patient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine, and epinephrine, which may produce dysrhythmias and other symptoms. The nurse also explores possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.
patient is admitted with aortic regurgitation. Which of the following medication classifications are contraindicated since they can cause bradycardia and decrease ventricular contractility?
a) Calcium channel blockers
b) Ace inhibitors
c) Beta blockers
d) Nitrates
a) Calcium channel blockers
Explanation:
The calcium channel blockers diltiazem (Cardizem) and verapamil (Calan, Isoptin) are contraindicated for patients with aortic regurgitation as they decrease ventricular contractility and may cause bradycardia
A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications?
a) Bleeding and wound dehiscence
b) Thrombosis and infection
c) Evisceration
d) Bleeding and infection
d) Bleeding and infection
Explanation:
Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.
The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?
a) Have you recently vacationed outside of the United States?
b) Do you live with any domesticated animals in your home?
c) Do you have a family history of endocarditis?
d) Have you been to the dentist recently?
d) Have you been to the dentist recently?
Explanation:
Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a patient has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator [ICD]), bacteremia can cause bacterial endocarditis.
The nurse is assessing a patient admitted with infective endocarditis. Which of the following manifestations would the nurse expect to find?
a) Involuntary muscle movements of the extremities
b) Small painful lesions on the pads of the fingers and toes
c) Bruising on the palms of the hands and soles of the feet
d) Raised red rash on the trunk and face
b) Small painful lesions on the pads of the fingers and toes
Explanation:
Primary presenting symptoms of infective endocarditis are fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes.
Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community?
a) Provide prophylactic antibiotics to individuals with a family history of rheumatic fever.
b) Encourage susceptible groups in the community to receive immunizations with streptococcal vaccine.
c) Educate individuals of the community about the importance of monitoring temperature when infections occur.
d) Teach individuals of the community to seek medical treatment for streptococcal pharyngitis.
d) Teach individuals of the community to seek medical treatment for streptococcal pharyngitis.
Explanation:
Prevention of acute rheumatic fever is dependent upon effective antibiotic treatment of streptococcal pharyngitis. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Education about monitoring temperature will not decrease the incidence of rheumatic fever.
A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient’s diagnosis?
a) Chest x-ray
b) Echocardiogram
c) CT scan
d) Cardiac cauterization
b) Echocardiogram
Explanation:
Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.
A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0–10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer?
a) Morphine sulfate 6 mg IVP every 2–4 hours
b) Ibuprofen (Motrin) 800 mg po every 8 hours
c) Fentanyl 2 mg intravenous pyelogram (IVP) every 2–4 hours
d) Acetaminophen (Tylenol) 650 mg per os (po) every 4 hours
b) Ibuprofen (Motrin) 800 mg po every 8 hours
Explanation:
Pain associated with pericarditis is caused by inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.
A patient with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which of the following assessment data obtained by the nurse should be immediately communicated to the health care provider?
a) The patient has 4+ peripheral edema in both legs.
b) The patient has crackles audible throughout the lungs.
c) The patient has a palpable thrill felt over the left anterior chest.
d) The patient has a loud systolic murmur all across the precordium.
b) The patient has crackles audible throughout the lungs.
Explanation:
Acute mitral regurgitation, resulting from a myocardial infarction, usually manifests as severe congestive heart failure. Dyspnea, fatigue and weakness are the most common symptoms. Palpitations, shortness of breath on exertion and cough from pulmonary congestion also occur. Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and need immediate interventions, such as diuretics.
A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking?
a) Thromboangiitis obliterans
b) Dyspnea
c) Orthopnea
d) Intermittent claudication
d) Intermittent claudication
Explanation:
Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient’s subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger’s disease.
A patient in the emergency department states, “I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though.” Based on this statement, which priority assessment should the nurse complete?
a) Attempt to palpate the dorsalis pedis and posterior tibial pulses.
b) Assess for unilateral swelling and tenderness of either leg.
c) Ask about any skin color changes that occur in response to cold.
d) Check for the presence of tortuous veins bilaterally on the legs.
a) Attempt to palpate the dorsalis pedis and posterior tibial pulses.
Explanation:
Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. A thorough assessment of the patient’s skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.
Which of the following observations regarding ulcer formation on the patient’s lower extremity indicates to the nurse that the ulcer is a result of venous insufficiency?
a) Is very painful to the patient, even though superficial
b) Is deep, involving the joint space
c) Is very painful to the patient, even though superficial
d) Size is large and superficial
d)
Size is large and superficial
Explanation:
Ulcerations are in the area of the medial or lateral malleolus (gaiter area) and are typically large, superficial, and highly exudative. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color.
The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following?
a) Vasospasm
b) Diuresis
c) Slowed heart rate
d) Depression of the cough reflex
a) Vasospasm
Explanation:
Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke or chew tobacco must be fully informed of the effects of nicotine on circulation and be encouraged to stop.
A patient in the ED has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, which symptoms will it be most important for the nurse to ask about?
a) Abdominal swelling and tenderness
b) Changes in bowel and bladder habits
c) Back or lumbar pain
d) Hoarse voice and difficulty swallowing
d) Hoarse voice and difficulty swallowing
Explanation:
Symptoms are dyspnea, the result of pressure of the aneurysm sac against the trachea, a main bronchus, or the lung itself; cough, frequently paroxysmal and with a brassy quality; hoarseness, stridor, or weakness or complete loss of the voice (aphonia), resulting from pressure against the laryngeal nerve; and dysphagia (difficulty in swallowing) due to impingement on the esophagus by the aneurysm.
A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm?
a) Dissecting
b) Anastomotic
c) Saccular
d) False
b) Anastomotic
Explanation:
An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.
A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, “What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?”
a) 30
b) 40
c) 20
d) 50
d) 50
Explanation:
Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced
Pentoxifylline (Trental) is a medication used for which of the following conditions?
a) Thromboemboli
b) Hypertension
c) Elevated triglycerides
d) Claudication
d) Claudication
Explanation:
Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental
In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent?
a) 40
b) 50
c) 20
d) 30
b) 50
Explanation:
The distal outflow vessel must be at least 50% patent for the graft to remain patent
Which of the following are risk factors for venous disorders of the lower extremities?
a) Pacing wires
b) Trauma
c) Obesity
d) Surgery
c) Obesity
Explanation:
Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Patients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other patients at high risk include those who are obese or older adults and women taking oral contraceptives.
Which of the following medications classify lyses and dissolve thrombi?
a) Anticoagulant
b) Factor XA inhibitors
c) Platelet inhibitors
d) Fibrinolytic
d) Fibrinolytic
Explanation:
Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of patients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do not lyse or dissolve thrombi
A patient admitted to the medical surgical unit with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are needed. Which response by the nurse is accurate?
a) “Administration of two anticoagulants decreases the risk of recurrent venous thrombosis.”
b) “The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect.”
c) “Lovenox will dissolve the clot, and Coumadin will prevent any more clots from occurring.”
d) “Because of the potential for a pulmonary embolism, it is important for you to have at least two anticoagulants.”
b) “The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect.”
Explanation:
Oral anticoagulants, such as warfarin, are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).
A patient is receiving enoxaparin (Lovenox) and warfarin (Coumadin) therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin (Lovenox) can be discontinued?
a) The patient’s K+ level is 3.5.
b) The patient’s activated partial thromboplastin time (aPPT) is half of the control value.
c) The patient’s international normalized ratio (INR) is 2.5.
d) The patient’s prothrombin time (PT) is 0.5 times normal.
c) The patient’s international normalized ratio (INR) is 2.5.
Explanation:
Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)
