zTest 1 N360 Flashcards
When the patient is being examined for venous thromboembolism (VTE) in the calf, what diagnostic test should the nurse expect to teach the patient about first?
Duplex ultrasound
? are positively charged ions. Examples include sodium (Na + ), potassium (K + ), calcium (Ca 2+ ), and magnesium (Mg 2+ ) ions.
Cations . Examples include sodium (Na + ), potassium (K + ), calcium (Ca 2+ ), and magnesium (Mg 2+ ) ions.
where is CVP measured
superior vena cava at entry to rt atria
In DM why would K be high
Insulin lets K into cell
While taking a patient’s blood pressure, a nurse notices that a carpal spasm occurs. To diagnose a possible cause for the carpal spasm, the nurse should expect the primary health care provider to prescribe which level?
Trousseau’s sign (carpal spasm when blood pressure cuff is inflated for a few minutes) is indicative of hypocalcemia. It does not occur with changes in sodium, potassium, or magnesium levels. The nurse should expect the primary health care provider to prescribe a calcium level be drawn.
Hyponatrimea starts below where
below 136
A nurse is caring for a patient with a central venous access device. The patient manifests symptoms of embolism, including chest pain, dyspnea, hypotension, and tachycardia. Which interventions should be included in the immediate management of this patient? Select all that apply.
Pulmonary embolism is a complication of central venous access devices. The nurse should start oxygen therapy to relieve dyspnea. The catheter should be clamped to prevent further formation of emboli. As the signs suggest air embolism, the patient is placed on the left side with the head down. Administering anticoagulants and normal saline are required if the catheter is occluded, and they do not help in relieving a pulmonary embolus. Text Reference - p. 311
When planning care for adult patients, the nurse concludes that which oral intake is adequate to meet the daily fluid needs of a stable patient?
Daily fluid intake and output is usually 2000 to 3000 mL. This is sufficient to meet the needs of the body and replace both sensible and insensible fluid losses. These would include urine output and fluids lost through the respiratory system, skin, and gastrointestinal tract.
S2 is what valves closing
aortic and pulmonary slamming shut (meanwhile tricuspid and mitral are silently opening up)
Are cations positive or negative
Positive
What intravenous (IV) solution may be used to pull fluid into the intravascular space after the paracentesis?
After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer’s, and 5% dextrose in 0.45% saline will not be effective for this action.
what is an ARB?
Angiotensin II Receptor Blockers
what drug increases stroke volume by improving contractility
digoxin
what shortens the QT interval
hypercalcemia
What does PQRST stand for (not ecg).
Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the area in which the patient felt the pain and if it radiated. The precipitating event (P) was going to the bathroom and having a bowel movement. The quality of the pain (Q) was “like before I was admitted,” although a more specific description may be helpful. Severity of the pain (S) was the “worst chest pain ever,” although an actual number may be needed. Timing (T) is supplied by the patient describing when the pain occurred and that the patient had had this pain previously.
what causes subacute endocarditis
strep or other less virulent bacteria
What is a normal level of troponin t?
.2
Does captopril lower HR
No
what follows sugar
Na
Which lab findings for myocarditis
Elevated Viral titers moderate leukocytosis elevated CRP
The nurse is teaching the family of a patient recently diagnosed with coronary artery disease (CAD). Which information on health promotion would the nurse include?
Dietary modifications should include a decrease in saturated fat and cholesterol, as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables) and fiber. A moderate physical activity program has to include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength on two days per week only. Text Reference - p. 736
what electrolyte triggers contraction
calcium
What INR do you need for surgery
1
if on warfarin do not encourage the consumption of
dark leafy veg. they are high in Vit K.
what is the inverse to Calcium
phosphorous
The lipid profile of a patient is indicative of hyperlipidemia. A nurse advises the patient to consume a diet rich in high-density lipoproteins based on what rationale?
High-density lipoproteins and low-density lipoproteins are vehicles for mobilization of fats. HDLs contain fewer lipids than proteins and mobilize lipids from the arteries to the liver for metabolism, thereby preventing the deposition of lipids on the vessel wall. LDLs have more lipid content than proteins and tend to deposit lipids in the arterial walls. HDLs prevent the deposition of lipids and do not directly alter the vessel wall or make it noncompliant. HDLs do not interfere with the production or breakdown of LDLs. Text Reference - p. 733
monitoring a postoperative patient for venous thromboembolism (VTE). Which are probable clinical findings in a person with VTE?
Venous distension deep reddish color tenderness to pressure over the involved vein
what hormone regulates Na
aldosterone
how does an ARB work?
Angiotensin II receptor blockers inhibit a substance that causes blood vessels to narrow (constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure. These medicines also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well. Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against. Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance.
? are substances whose molecules dissociate, or split into ions, when placed in water.
Electrolytes
What is the clinical use of a multiple gated acquisition (MUGA) scan?
It helps determine ejection fraction. A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20% is associated with a 50% mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy.
Amiodarone- look it up, it is a drug
Life-threatening ventricular arrhythmias unresponsive to less toxic agents.
A female patient with critical limb ischemia has had peripheral artery bypass surgery to improve her circulation. What care should the nurse provide on postoperative day 1?
Assist the patient with walking several times
Asystole
Bad, probably negative outcome, mostly don’t shock cause it wouldn’t help
What drug interrupts vasoconstriction and aldosterone
ARB
A patient is prescribed a statin drug to decrease levels of low-density lipoproteins and triglycerides. Which symptoms should the nurse teach the patient to be observant for?
rash, myopathy, rhabdomyolysis, gastro disturbances.
A nurse is identifying obese women at risk of developing coronary artery disease in a community for health care research. What are the appropriate criteria for the selection of at-risk women?
Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity where there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore, the criterion should be “waist circumference greater than 35 inches.” Text Reference - p. 732
normal osmolarity is betwn what
275-295, more than 295 is water deficient
diarrhea dumps acid or bicarb buffer
bicarb buffer
A nurse reviews the admission history of a 59-year-old female patient admitted to the hospital with deep venous thrombosis in the left leg. Which finding from the health history increases the risk for the patient to develop this complication?Select all that apply.
The risk for developing thromboembolic complications continues for several weeks postoperatively. The risk is related to possible vascular injury with the procedure, altered fluid status, increased coagulability, and lessened mobility during and after surgery. The recent left knee joint replacement surgery is significant. Estrogen, a hormone used for relief of menopausal discomfort, increases clotting factors and enhances coagulation. Medications such as lipid-lowering agents (simvastatin) and proton pump inhibitors (omeprazole) do not increase the risk for thrombosis. Not smoking eliminates a risk factor. The abdominal hysterectomy performed 10 years earlier is not a current risk factor.
What is a good bnp level
less than 100
s/s hypocalcemia
increased neuromuscular excitability
positive chvostek sign
positive trousseau sign
cramps
twitching
hyperactive reflexes
seizures
dysrhythmias
A patient presents with mild to moderate symptoms of thromboangiitis obliterans (Buerger’s disease). Which intervention is most important to include on the patient’s plan for treatment?
Buerger’s disease occurs most commonly in young adults who are chronic smokers. The patient has only mild to moderate symptoms of the disease. Therefore, the best way to treat is to advise the patient to quit smoking and not use any nicotine replacement products. The consumption of these products will worsen the symptoms, which may lead to a need for limb amputation. The patient can be prescribed IV iloprost to improve rest pain, promote healing of ulcerations, and decrease the need for amputation. No particular diagnostic tests are available to detect this disease. Diagnosis may be based on clinical symptoms, such as inflamed arteries, involvement of distal vessels, and presence of ischemic ulcerations. A daily walk is beneficial to reduce hypertension and prevent other cardiovascular disorders.
The primary health care provider prescribes warfarin (Coumadin) for a patient with venous thromboembolism. Which information should the nurse include in the patient’s discharge teaching plan?
Teaching for a patient prescribed warfarin includes avoiding any trauma or injury that might cause bleeding, such as contact sports. Routine laboratory monitoring is needed to assess the therapeutic effect of the medication and whether a change in drug dose is needed. Do not increase daily intake of dark leafy vegetables because these foods are high in vitamin K. Garlic may affect blood clotting. Instruct the patient to consult with the health care provider about the use of garlic supplements along with warfarin.
when does systole happen
between s1 and s2
Nausea and anorexia are signs of what overdose
digoxin
The patient had myocarditis and now is experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life?
Decrease preload and afterload Control heart failure by enhancing myocardial contractility The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process. Text Reference - p. 827
How much KCl per hour?
10mEq per hour
The nurse finds that a patient with a tumor of the adrenal glands is feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism?
A tumor of the adrenal glands may cause hypersecretion of aldosterone, resulting in hypernatremia. Hypernatremia should be treated with a diuretic (to promote excretion of excess sodium) and with sodium-free intravenous fluids such as 5% dextrose in water (to dilute the sodium concentration). Sodium intake should also be restricted. Conivaptan is administered when treating hyponatremia. Potassium supplements are needed in cases of hypokalemia. Text Reference - p. 293
A patient has a severe blockage in the left coronary artery. The nurse knows that the cardiac structures that are most likely to be affected by this blockage include which of these?
left atrium, left vent, interventricular septum
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression?
If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past three months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.
hypermagnesemia s/s
decreased neuromuscl excitation
diaphoresis,
diminished reflexes
hypotension
weakness
resp depression
bradycardia
dysrhythias
Cardiomyopathy. Which type has these Sx. dyspnea, Right HF, S3/4, emboli formation
restrictive
what supplies the av node and bundle of His
the right coronary artery.
A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure?
80mm/hg; Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore, if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120+ 2x60)/3 which is equal to 120+120/3 = 80 mm Hg. Text Reference - p. 690
Cardiomyopathy. Which type has these Sx. exertional dyspnea, syncope, angina, signs of HF, S4, sudden death which is usually the first sign
Hypertrophic
A diabetic patient is being discharged after distal peripheral bypass surgery below the knee. Which instructions should the nurse include when talking to the patient and caregiver before discharge?
Encourage supervised exercise training Teach the importance of foot care Instruct the patient to visit a podiatrist if required
s3 is heard in what cardio myopathy
Dilated Cardiomyopathy caused because blood flowing into ventricle when blood is still in there
The nurse is caring for a patient who survived sudden cardiac death (SCD) that was brought on by a lethal ventricular dysrhythmia. To reassure the patient, which tests should the nurse explain will be performed to monitor the effectiveness of drug treatment?
exercise stress testing 24 hr holter Signal averaged electrocardiogram Electrophysiological study under fluoroscopy Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies are most effective for them. This monitoring includes exercise stress testing, 24-hour Holter monitoring, signal-averaged electrocardiogram, and electrophysiological study done under fluoroscopy. Magnetic resonance imaging is not used to monitor for lethal dysrhythmias. Text Reference - p. 763
ref level of K
3.5-5
Common causes of dysrythmias
Alcohol ,acid base imbalance, tobacco, caffeine, herbal sups, near drowning, toxins, sepsis
When teaching a patient about physical activity guidelines following acute coronary syndrome, the nurse recommends isotonic (static) activities. What should isotonic activities require according to the FITT (frequency, intensity, type, and time) formula?
The FITT formula recommends isotonic activities that require a steady load on the heart, with careful attention not to increase the heart rate by more than 20 beats/minute over the resting heart rate, and that gradually increase in time and intensity. The FITT formula recommends limited isometric (dynamic) activities that rapidly increase the heart and blood pressure, but there is no FITT guideline that limits patients to stretching exercises only. Text Reference - p. 761
the nurse on a telemetry unit has just received change of shift report. which client should the nurse assess first?
client with new onset AFib
client in first degree heart block
client with new multifocal premature ventricular beats
client with new multifocal premature ventricular beats
The nurse understands that venous ulcers are characterized by which assessment findings?
delayed wound healing wounds proximal to the medial malleolus Lesions with delayed healing and located near or at the medial malleolus are classic findings associated with poor venous return and venous ulcers. A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. Venous ulcers have a bronze-brown pigmentation and cap refill is less than three seconds with venous disease. Well-defined edges are seen with arterial ulcers.
? are negatively charged ions.
Anions are negatively charged ions. Examples include bicarbonate (HCO3 − ), chloride (Cl − ), and phosphate (PO4 3− ) ions. Most proteins bear a negative charge and are thus anions.
What is a normal level of troponin i?
0.03
claudication
a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
what is normal CVP
2-8
S/s of hypokalemia?
weakness
abdom distenstion
polyuria
dysrhythmia
what supplies the av node and bundle of His
the right coronary artery.
Which symptom is indicative of lipodermatosclerosis?
In lipodermatosclerosis, the skin on the lower leg is scarred and leathery, with brown discoloration. A swollen, blue, painful leg, or phlegmasia cerulea dolens, is a rare complication that may develop in a patient in the advanced stages of cancer.
ref level of bicarb
22-26
How long does digoxin take to work
Many hours maybe 30….verify*****
give aspirin 30min prior to what and why
niacin, prevent flushing
The first heart sound is what valves closing
S1 which is Tricuspid and Mitral slamming shut
The first heart sound is what valves closing
S1 which is Tricuspid and Mitral slamming shut
While performing patient teaching regarding hypercalcemia, which statements are appropriate?
A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Weight-bearing exercise does enhance bone mineralization. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia.
A patient presents with claudication, pain in the legs and numbness of the feet. The patient is diagnosed with peripheral arterial disease (PAD). The nurse expects that what will be included in the patient’s treatment plan? 3 things
antiplatelet therapy exercise therapy nutritional therapy
A nurse is caring for a patient with malignant lung cancer who experiences weakness, lethargy, depressed reflexes, and bone pain. The nurse suspects the patient may have hypercalcemia. Which changes in the electrocardiogram indicate hypercalcemia? Select all that apply
Hypercalcemia may result from malignancies. Bone destruction due to tumor invasion may cause a release of calcium, leading to high levels of calcium in the blood. This causes altered transmembrane potentials affecting conduction time, and is manifested as a shortened ST segment and QT interval. An elongated ST segment and a prolonged QT interval are manifestations of hypocalcemia. A flattened or inverted T wave is a manifestation of hypokalemia. Text Reference - p. 299
A 68-year-old patient was admitted with abdominal pain, nausea, and severe diarrhea. Based on this information, the nurse assesses this patient for which primary acid-base imbalance?
Because gastric secretions are rich in hydrochloric acid, the patient with severe diarrhea will lose significant amounts of bicarbonate and is at increased risk for metabolic acidosis and a fall in pH. Metabolic alkalosis, respiratory alkalosis, and respiratory acidosis will not occur as a result of increased loss of bicarbonate.
What class of drug is captopril
ACE
ref level of Na
135-145
The nurse is reviewing the mechanisms of acid-base buffers in the body. The kidneys act as an acid-base buffer by which of these mechanisms? Select all that apply.
As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3- and eliminate excess H+. Thus the pH of the blood increases and the pH of the urine decreases. Text Reference - p. 303
what causes dilated cardiomyopathy
idiopathic, genetic, inflammation, toxins- alcohol, pregnancy as well NOT CAUSED by ischemia or HTN
It is especially important for the nurse to assess for which clinical manifestation(s) in a patient with primary hypoparathyroidism? Select all that apply.
Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Manifestations of low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek’s and Trousseau’s signs, and others. Anorexia and depressed reflexes are manifestations of hypercalcemia. Text Reference - p. 300
The nurse anticipates that the typical fluid replacement for the patient experiencing hypovolemic shock to be which of the following?
Isotonic saline (0.9% NaCl) may be used when a patient has experienced both fluid and sodium losses or as vascular fluid replacement in hypovolemic shock. The nurse would not administer 0.45% saline, 5% dextrose in 0.45% saline, or dextran, as these are not appropriate for fluid replacement in hypovolemic shock. Text Reference - p. 308
a relaxed heart is in what phase
diastole
Na is usually where
outside- NaCl really.
What is a medication used for pericarditis
a. Heparin
b. Prednison
c. ibuprofen
d. potassium chloride
heparin
A flattened or inverted T wave is a manifestation of
hypokalemia
patient has been ill for a week with the coxsackie B virus. Upon assessment, the nurse hears this heart sound, which was not present at the previous shift’s assessment. What is the correct identification of this heart sound?
The hallmark finding in acute pericarditis, which is commonly caused by the coxsackie B virus, is the pericardial friction rub. The rub is a scratching, grating, high-pitched sound believed to result from friction between the roughened pericardial and epicardial surfaces. Both third and fourth heart sounds are low-pitched and galloping. A murmur is a swooshing sound.
what drug decreases preload and pulmonary congestion= which ultimately lessens cardiac workload and increases CO
diuretic
A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure?
80mm/hg; Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore, if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120+ 2x60)/3 which is equal to 120+120/3 = 80 mm Hg. Text Reference - p. 690
The nurse preparing to administer a dose of potassium phosphate (Neutra-phos) would hold the medication after noting which laboratory value?
Calcium!. Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore, administration of phosphorus will reduce a patient’s already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.
normal EF is what ?
50-70%
Hypernatrimea starts where
Above 145
