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CARDIOVASCULAR DISORDERS
The nurse advises a client recovering from a myocardial infarction to decrease fat and sodium intake. Which foods should the nurse instruct the client to avoid? Select all that apply. a) Soft drinks b) Oatmeal c) Pepperoni pizza d) Bacon e) Apple juice f) Cheese - ANS - A. Soft drinks C. Pepperoni pizza D. Bacon F. Cheese Foods high in sodium include cheese, processed meats such as pepperoni and bacon, and soft drinks. Bacon and cheese also have a high fat content.
A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? a) Increased myocardial contractility. b) Dilated coronary arteries. c) Decreased electrical conductivity in the heart. d) Decreased cardiac arrhythmias. - ANS - A. Increased myocardial contractility. Digoxin is a cardiac glycoside with positive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increases output of blood from the left ventricle. Digoxin does not dilate coronary arteries. Although digoxin can be used to treat arrhythmias and does decrease the electrical conductivity of the myocardium, these are not primary reasons for its use in clients with heart failure and pulmonary edema. What is the most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program? a) Walking increases high-density lipoprotein (HDL) level. b) Walking aids in weight reduction. c) Walking decreases venous congestion.
The client who suffered an acute MI who is complaining of constipation should be addressed first. If the client strains at stool after an MI, the vagal response may be stimulated, causing bradycardia thereby provoking arrhythmias. After addressing the MI client with constipation, the nurse should promptly address the pain-relief needs of the client who had a pacemaker inserted the previous day. The nurse should delegate answering the call light to the ancillary personnel. She may also delegate some of the discharge preparation, such as packing the client's belongings. Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? a) Whole wheat bread. b) Apples. c) Beef tenderloin. d) Tomato juice. - ANS - D. Tomato juice. Canned foods and juices such as tomato juice are typically high in sodium and should be avoided in a sodium-restricted diet. Canned foods and juices in which sodium has been removed or limited are available. The client should be taught to read labels carefully. Apples and whole wheat breads are not high in sodium. Beef tenderloin would have less sodium than canned foods or tomato juice.
A client with heart failure has bilateral +4 edema of the right ankle that extends up to midcalf. The client is sitting in a chair with the legs in a dependent position. Which of the following goals is the priority? a) Maintain body temperature. b) Decrease venous congestion. c) Maintain normal respirations. d) Prevent injury to lower extremities. - ANS - B. Decrease venous congestion. Decreasing venous congestion in the extremities is a desired outcome for clients with heart failure. The nurse should elevate the client's legs above the level of the heart to achieve this goal. The client is not demonstrating difficulty breathing or being cold. The nurse should prevent injury to the swollen extremity; however, this is not the priority. A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client presentation increases the likelihood of a cardiovascular disorder? a) Irritability b) Urinary frequency
During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses don't routinely give antibiotics during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures. A nurse knows that the major clinical use of dobutamine is to: a) treat hypertension. b) prevent sinus bradycardia. c) increase cardiac output. d) treat hypotension. - ANS - C. increase cardiac output Dobutamine increases cardiac output for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery. Physicians may use epinephrine hydrochloride, another catecholamine agent, to treat sinus bradycardia. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension. They don't use catecholamine agents to treat hypertension because catecholamine agents may raise blood pressure.
A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply. a) Jugular vein distention b) Cough c) Crackles d) Hepatomegaly e) Ascites f) Orthopnea - ANS - B. Cough C. Crackles F. Orthopnea Left-sided heart failure produces primarily pulmonary signs and symptoms, such as orthopnea, cough, and crackles. Right-sided heart failure primarily produces systemic signs and symptoms, such as ascites, jugular vein distention, and hepatomegaly. What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock? a) Cardiac pacemaker
As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia. The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: a) Clean the incisional area with an antiseptic. b) Place soiled dressings in a waterproof bag before disposing of them. c) Observe careful hand-washing procedures. d) Use prepackaged sterile dressings to cover the incision. - ANS - C. Observe careful hand-washing procedures. Many factors help prevent wound infections, including washing hands carefully, using sterile prepackaged supplies and equipment, cleaning the incisional area well, and disposing of soiled dressings properly. However, most authorities say that the single most effective measure in preventing wound infections is to wash the hands carefully before and after changing dressings. Careful hand washing is also important in reducing other infections often acquired in hospitals, such as urinary tract and respiratory tract infections.
During surgery, a client develops sinus bradycardia. The physician orders atropine sulfate. Which dose and route should the nurse use? a) 2 mg I.V. b) 0.6 mg I.M. c) 2 mg I.M. d) 1 mg I.V. - ANS - D. 1 mg I.V. To reverse arrhythmias, bradycardia, or sinus arrest, the usual adult dosage of atropine is 0.5 to 1 mg I.V. every 3 to 5 minutes as needed. The drug isn't administered I.M. for the treatment of bradycardia. A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? a) A client 4 days postoperative after mitral valve replacement b) A client 1 day post coronary stent placement c) A client with hypertrophic cardiomyopathy d) A client with a history of repaired ventricular septal defect - ANS - A. A client 4 days postoperative after mitral valve replacement Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired
a) Ask the physician if the client can take fewer pills each day. b) Come to the client's house each morning to prepare the daily allotment of medications. c) Teach a family member to fill a medication compliance aid once per week so the client can independently take his medications. d) Ask the client's family to take turns coming to the house at each administration time to assist the client with his medications. - ANS - C. Teach a family member to fill a medication compliance aid once per week so the client can independently take his medications. The nurse should intervene by asking a family member to fill a compliance aid each week with the client's weekly supply of medications in the appropriate time slots. Family members can't be expected to come to the client's house four times each day to administer medications. The physician shouldn't change the dosing regimen just for convenience. The home care nurse can't visit the client each morning to prepare the daily medication regimen. The nurse is discussing medications with a client with hypertension who has a prescription for furosemide daily. The client needs further education when stating which of the following? a) "I need to be sure to also take the potassium supplement that the doctor prescribed along with my furosemide." b) "I know I should not drive after taking my furosemide."
c) "I should be careful not to stand up too quickly when taking furosemide." d) "I should take the furosemide in the morning instead of before bed."
- ANS - B. "I know I should not drive after taking my furosemide." Furosemide is a diuretic often prescribed for clients with hypertension or heart failure; the drug should not affect a client's ability to drive safely. Furosemide may cause orthostatic hypotension, and clients should be instructed to be careful when changing from supine to sitting to standing. Diuretics should be taken in the morning if possible to prevent sleep disturbance due to the need to get up to void. Furosemide is a loop diuretic that is not potassium-sparing; clients should take potassium supplements as prescribed and have their serum potassium levels checked at prescribed intervals. When a client has a troponin level of 0.9 ng/mL, which of the following nursing interventions should be implemented? a) Apply oxygen at 2 L/minute per nasal cannula b) Document the finding as the only action c) Notify the healthcare provider d) Encourage the client to ambulate - ANS - C. Notify the healthcare provider
b) Skin temperature. c) Pain in extremity. d) Nail bed color. e) Nausea. - ANS - B. Skin temperature. C. Pain in extremity. D. Nail bed color. Maintaining circulation is critical in individuals with peripheral vascular disease. Skin and nail bed color and temperature will reveal the degree to which the extremity is receiving blood flow. Clients with peripheral vascular disease also usually have a certain amount of pain, especially when the oxygen demand becomes greater than oxygen supply, such as with walking or exercising. Fluid intake and reports of nausea are unrelated to peripheral circulation. The most common site of aneurysm formation is in the: a) descending aorta, beyond the subclavian arteries. b) ascending aorta, around the aortic arch. c) abdominal aorta, just below the renal arteries. d) aortic arch, around the ascending and descending aorta. - ANS - C. abdominal aorta, just below the renal arteries
About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries. A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders from the health care provider should the nurse verify before implementing? a) Metoprolol 5 mg IV push. b) Prepare for a pulmonary artery catheter insertion. c) Call for urine output < 30 mL/hr for 2 consecutive hours. d) Titrate dobutamine to keep systolic BP > 100. - ANS - A. Metoprolol 5 mg IV push. Metoprolol is indicated in the treatment of hemodynamically stable patients with an acute MI to reduce cardiovascular mortality. Cardiogenic shock causes severe hemodynamic instability and a beta blocker will further depress myocardial contractility. The metoprolol should be discontinued. The decrease in cardiac output will impair perfusion to the kidneys. Cardiac output, hemodynamic measurements, and appropriate interventions can be determined with a PA catheter. Dobutamine will improve contractility and increase the cardiac output that is depressed in cardiogenic shock.
d) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol." - ANS - B. "Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina). A client is receiving cilostazol for peripheral arterial disease, causing intermittent claudication. The nurse determines this medication is effective when the client reports which of the following: a) "My toes are turning grayish black in color." b) "I am having fewer aches and pains." c) "I am able to walk further without leg pain." d) "I do not have headaches anymore." - ANS - C. "I am able to walk further without leg pain."
Cilostazol is indicated for management of intermittent claudication. Symptoms usually improve within 2 to 4 weeks of therapy. Intermittent claudication prevents clients from walking for long periods. Cilostazol inhibits platelet aggregation induced by various stimuli and improving blood flow to the muscles and allowing the client to walk long distances without pain. Peripheral arterial disease causes pain mainly of the leg muscles. "Aches and pains" do not specify exactly where the pain is occurring. Headaches may be a side effect of this drug, and the client should report this information to the health care provider. Peripheral arterial disease causes decreased blood supply to the peripheral tissues and may cause gangrene of the toes; the drug is effective when the toes are warm to the touch and the color of the toes is similar to the color of the body. The plan of care for a client with hypertension taking propranolol hydrochloride should include: a) Measuring partial thromboplastin time weekly to evaluate blood clotting status. b) Instructing the client to notify the physician of irregular or slowed pulse rate. c) Instructing the client to discontinue the drug if nausea occurs.
