Question 1

The nurse would assess closely for signs of right-sided heart failure which include (select all that apply):

Accepted Answer

Indicators of right-sided heart failure are distended jugular veins, anorexia, abdominal distention from ascites, liver enlargement with right upper quadrant pain, and edema of feet and ankles.

Question 2

The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can:

Accepted Answer

Herbal remedies such as ginkgo, garlic, angelica, and red clover can increase (potentiate) the action of the Coumadin.

Question 3

The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times?

Accepted Answer

Diuretics should be scheduled for morning administration to avoid causing the patient nocturia.

Question 4

The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask?

Accepted Answer

Patients with endocarditis are put on a protocol of prophylactic antibiotics for any invasive procedure. The dentist and physician should be contacted before the extraction.

Question 5

The nurse caring for a patient recovering from a myocardial infarction (MI) teaches which method to avoid the Valsalva maneuver during a bowel movement?

Accepted Answer

Mouth breathing will lessen the severity of straining and will decrease the effect of the Valsalva maneuver on intrathoracic pressure.

Question 6

During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure?

Accepted Answer

Left ventricular failure; the first is signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough.

Question 7

A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?

Accepted Answer

The CK-MB is elevated when there is infarcted myocardial muscle. The elevated white count, low sodium, and ESR are nonspecific.

Question 8

What is the difference between primary and secondary hypertension?

Accepted Answer

Secondary hypertension is a consistently elevated blood pressure that is caused by another disorder, such as renal disease, diabetes, or Cushing syndrome.

Question 9

What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient?

Accepted Answer

The goal for a post-MI rehabilitation walking program is typically to gradually increase endurance and cardiovascular fitness. Walking 2 miles in less than 60 minutes is a reasonable and safe goal for such patients after 12 weeks.

Question 10

The nurse reminds the patient that the National Heart, Lung, and Blood Institute recommends a lipid study every _________ years.

Accepted Answer

The National Heart, Lung, and Blood Institute recommend a lipid study every 5 years for all Americans, but especially for the older adult.

Question 11

How should the nurse advise a patient with an international normalized ratio (INR) of 5.8?

Accepted Answer

The INR that is desired should be maintained between 2 and 3. A reading of 5.8 puts the patient at risk for hemorrhage. The patient should stop taking the anticoagulant and contact the physician for further instruction.

Question 12

The nurse is treating a patient who has had a pacemaker inserted for the correction of atrial fibrillation. Which diagnostic test is no longer available to the patient because of the implanted device?

Accepted Answer

Because of the large magnets in the MRI cabinet, the pacemaker may be reset to a fixed mode and interfere with the functioning of the pacemaker.

Question 13

The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot?

Accepted Answer

A positive Homans sign for deep vein thrombosis (DVT) is a report of pain when the affected leg is flexed and the foot is dorsiflexed.

Question 14

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include:

Accepted Answer

The pain often radiates down the left inner arm to the little finger and also upward to the shoulder and jaw.

Question 15

Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)?

Accepted Answer

Avoid marked changes in eating habits, such as dramatically increasing foods high in vitamin K (e.g., broccoli, spinach, kale, greens). Limit alcohol intake to small amounts.

Question 16

The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention?

Accepted Answer

Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; and cold extremities. The legs in a dependent position will decrease venous return and ease the pulmonary edema.

Question 17

The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young
Adults who have minimal risk factors for cardiovascular disease is related to which factor(s)?

Accepted Answer

Cardiomyopathy caused by cocaine abuse is seen more frequently than ever before. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues.

Question 18

The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for:

Accepted Answer

The hazards of cigarette smoking and its relationship to Buerger disease are the primary focus of patient teaching. None of the palliative treatments are effective if the patient does not stop smoking. Nowhere are the cause and effect of smoking so dramatically seen as with Buerger disease.

Question 19

The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause:

Accepted Answer

Heart failure can result from rapid infusion of intravenous fluids in older adults.

Question 20

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?

Accepted Answer

Suggestion of a stasis ulcer in the making is an edematous, dry scaly area on the medial surface of the lower leg that has a darker pigmentation (rubor). Cool hairless limbs with absent or weak pedal pulses are indicative of arterial insufficiency.

Quiz 47: Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder

The nurse would assess closely for signs of right-sided heart failure which include (select all that apply) :