NUR257 EXAM 3 EXAM 2024-2025, Exams of Nursing

Download NUR257 EXAM 3 EXAM 2024-2025 and more Exams Nursing in PDF only on Docsity! 1 | P a g e NUR257 EXAM 2 EXAM 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS|FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST |GUARANTEED PASS|LATEST UPDATE The nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing _________________ (hypokalemia, hyponatremia, hyperuricemia) as a result of the prescribed medication, the nurse focuses on monitoring the client for _________________ (ventricular arrhythmia, joint swelling, nausea) . hypokalemia, ventricular arrhythmia The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately? Ability to sleep through the night Persistent cough Weight loss Increased appetite Persistent cough The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Decreased urinary output Dyspnea on exertion Tachycardia Hypotension Dyspnea on exertion 2 | P a g e A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? The client says his rings have become tight and are difficult to remove. The client says that he has been urinating less frequently at night. The client says he is short of breath when ambulating. The client says he has been hungry in the evening. The client says his rings have become tight and are difficult to remove. A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? Ibuprofen Warfarin Amlodipine Digoxin immune FAB Digoxin immune FAB The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide? BNP of 100 Potassium level of 3.1 Sodium level of 135 Hemoglobin of 12 Potassium level of 3.1 A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs? Decreased renal blood flow causes the renin-angiotensin-aldosterone system to decrease secretion of aldosterone and antidiuretic hormone. Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Low blood pressure triggers the baroreceptors to decrease sympathetic nervous system stimulation. Increased renal blood flow causes the renin-angiotensin-aldosterone system to increase aldosterone secretion. Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)? Ethacrynic acid Chlorothiazide Spironolactone Bumetanide Spironolactone A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure? Complete blood count (CBC) 5 | P a g e acute pulmonary edema. cardiogenic shock. acute pulmonary edema. A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered? A chest x-ray An echocardiogram An electrocardiogram A ventriculogram An echocardiogram A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? The pericardial space is eliminated with scar tissue and thickened pericardium. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber? atrial fibrillation rhythm urine output of 300 mL in eight hours heart rate of 55 beats per minute blood pressure of 125/80 heart rate of 55 beats per minute A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Notify the health care provider. Administer potassium. Check the client's potassium level. Calculate the client's intake and output. Check the client's potassium level. The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client? defibrillator cardiac pacemaker 6 | P a g e intra-aortic balloon pump hypothermia-hyperthermia machine intra-aortic balloon pump The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? Right atrial function Left ventricular function Left atrial function Right ventricular function Left ventricular function A nurse reviews the client's medical record and reads in the progress notes that the client has decreased left ventricular function. What assessment will validate the diagnosis? orthopnea bibasilar rales cleared with coughing resting bradycardia increased appetite orthopnea A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? Observe for mist in the endotracheal tube. Call for a chest x-ray. Attach a pulse oximeter probe and obtain values. Listen for breath sounds over the epigastrium. Call for a chest x-ray. A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? echocardiogram cardiac ultrasound electrocardiogram cardiac catheterization echocardiogram What disease process(es) contributes to chronic heart failure? Select all that apply. Pulmonary insufficiency Valvular disease Pancreatic disease 7 | P a g e Renal failure Tachyarrhythmias Tachyarrhythmias Valvular disease Renal failure A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? Jugular venous distention Pedal edema Pulmonary congestion Nausea Pulmonary congestion The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? decreased left ventricular pumping increased left atrial contractility increased right atrial resistance decreased right ventricular elasticity decreased left ventricular pumping The nurse recognizes which symptom as a classic sign of cardiogenic shock? Increased urinary output Hyperactive bowel sounds High blood pressure Restlessness and confusion Restlessness and confusion The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? decreased peripheral perfusion to the extremities decreased left ventricular workload decreased renal perfusion decreased right ventricular workload decreased left ventricular workload The nurse is performing an initial assessment of a client diagnosed with heart failure. The nurse also assesses the client's sensorium and LOC. Why is the assessment of the client's sensorium and LOC important in clients with heart failure? Clients with heart failure are susceptible to overstimulation of the sympathetic nervous system. The most significant adverse effect of medications used for heart failure treatment is altered LOC. Heart failure ultimately affects oxygen transportation to the brain. Decreased LOC causes an exacerbation of the signs and symptoms of heart failure. 10 | P a g e Assessing for peripheral edema Assessing the client's vital signs every 4 hours Weighing the client daily at the same time each day Checking the client's lungs for crackles during every shift Weighing the client daily at the same time each day The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? ascites nocturia inadequate cardiac output hepatomegaly inadequate cardiac output A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? Increase in CVP Absence of cough Decrease in blood pressure Decrease in central venous pressure (CVP) Decrease in central venous pressure (CVP) A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of pulmonary embolism. myocardial infarction. pneumonia. pulmonary edema. pulmonary embolism. The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? Notify the health care provider of the chest pain. Hold any further treatment until the client's blood pressure increases. Wait ten minutes after the second tablet to assess pain. Administer the third sublingual nitroglycerin tablet. Administer the third sublingual nitroglycerin tablet. 11 | P a g e A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention? Titrate oxygen therapy. Administer pain medication. Assess for jugular vein distention. Assess the surgical incisional area. Titrate oxygen therapy. The nurse is caring for a client with a history of heart failure and a sudden onset of tachypnea. What is the nurse's priority action? Report a decrease in urine output. Assess pulse oximetry reading. Elevate the head of the bed. Notify the family of a change in condition. Elevate the head of the bed. The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided and left-sided heart failure? resting bradycardia weight loss warm extremities ascites ascites Which feature is the hallmark of systolic heart failure? Limited activities of daily living (ADLs) Basilar crackles Low ejection fraction (EF) Pulmonary congestion Low ejection fraction (EF) The pathophysiology of pericardial effusion is associated with all of the following except: Inability of the ventricles to fill adequately. Increased venous return. Atrial compression. Increased right and left ventricular end-diastolic pressures. Increased venous return. Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates 12 | P a g e transferring the client to the intensive care unit? The client is in the early stage of right-sided heart failure. The client is going into cardiogenic shock. The client is experiencing heart failure. The client shows signs of aneurysm rupture. The client is going into cardiogenic shock. A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? Flexion contractures Vasculitis nausea and vomiting Enlargement of joints nausea and vomiting A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition? Acute pulmonary edema Progressive heart failure Cardiogenic shock Pulmonary hypertension Acute pulmonary edema A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? Myocardial ischemia Ineffective right ventricular contraction Cystic fibrosis Pulmonary embolus Myocardial ischemia Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Encourage the client to ambulate in room Titrate milrinone rate slowly before discontinuing Monitor blood pressure frequently Teach the client about safe home use of the medication Monitor blood pressure frequently 15 | P a g e metoprolol furosemide dopamine enalapril dopamine The nurse is assisting in the care of a client who is receiving cardiopulmonary resuscitation (CPR). For which reason will the client be prescribed to receive amiodarone during the resuscitation efforts? Correct metabolic acidosis. Treat pulseless ventricular tachycardia. Reduce the development of torsade de pointes. Prevent the development of hypotension. Treat pulseless ventricular tachycardia. The nurse is discussing cardiac terms with a client who was doing some reading on the Internet. What is the correct response for the nurse when the client asks what affects stroke volume? Stroke volume depends on kidney and lung functions. Stroke volume is affected by the electrocardiogram intervals. Stroke volume is similar to your blood pressure. Stroke volume is affected by temperature and heart rate. Stroke volume is affected by temperature and heart rate. A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Increased pulmonary artery diastolic pressure Decreased mean pulmonary artery pressure Increase in the cardiac index Decreased central venous pressure Increased pulmonary artery diastolic pressure 16 | P a g e A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium. The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure? nocturia fatigue irregular pulse pedal edema fatigue What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? Duration of symptoms There is a marked limitation of physical activity. The client is unable to carry out any physical activity. The level of physical activity each allows The level of physical activity each allows A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition? "I should try not to drink too much during the daytime." "I should lie on my side with my knees bent when sleeping." "I need to ice my leg every 2 hours for about 20 minutes." "I need to do my leg exercises five times or more every hour." "I need to do my leg exercises five times or more every hour." A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)? Bleeding and infection Bleeding and wound dehiscence Thrombosis and infection Evisceration Bleeding and infection 17 | P a g e A client who recently had a myocardial infarction develops pericarditis and complains of chest pain rated 6 (on a scale of 0-10) with deep breathing. Which ordered pro re nata medications is most appropriate for the nurse to administer? Morphine sulfate 6 mg IVP every 2-4 hours Fentanyl 2 mg intravenous pyelogram (IVP) every 2-4 hours Acetaminophen 650 mg PO every 4 hours Ibuprofen 800 mg PO every 8 hours Ibuprofen 800 mg PO every 8 hours The nurse instructs a client recovering from mechanical valve replacement surgery. Which client statement indicates that teaching has been effective? "I can play soccer in a week or two." "I will not drive until informed by my health care provider." "I have a low risk of developing an infection in my heart." "I will not need to take anticoagulant medication every day." "I will not drive until informed by my health care provider." A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? Assess the client for bleeding and notify the health care provider of the results. Notify the next nurse on afternoon shift to hold the evening dose of warfarin. Notify the health care provider to request an increase in the warfarin dose. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. Assess the client for bleeding and notify the health care provider of the results. The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? low urine output secondary to left ventricular dysfunction fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) pitting edema, chest discomfort, and nonspecific ST-segment elevation lethargy, anorexia, and heart failure fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) We have an expert-written solution to this problem! A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure? Orthopnea, nausea, pedal edema Distended jugular veins, pedal edema, nausea 20 | P a g e Dyspnea Fatigue lasting more than 1 month Uncontrolled restlessness Constant chest pain Constant chest pain A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant? The patient's has an enlarged liver and edematous abdomen. The patient reports chest pain after eating a large meal. The patient has jugular vein distention and 3+ pedal edema. The patient reports shortness of breath when walking. The patient reports shortness of breath when walking. A nurse is teaching a client about valve replacement surgery. Which statement by the client indicates an understanding of the benefit of an autograft replacement valve? "The valve is mechanical, and it will not deteriorate or need replacing." "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? Chronic pain Impaired gas exchange Risk for infection Impaired memory Risk for infection A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider? 2.6 3.4 3.0 3.8 3.8 21 | P a g e A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? Balloon percutaneous valvuloplasty Placement of an autograft valve Antibiotic therapy Placement of a xenograft valve Balloon percutaneous valvuloplasty A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing? Review the client's most recent warfarin blood levels. Assess the client's apical pulse. Review the client's international normalized ratio (INR). Assess the client's radial pulse. Review the client's international normalized ratio (INR). The nurse is teaching a client diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without resorting to taking medications. What should the nurse teach the client? To eat a small meal before taking nitroglycerin To drink a glass of milk before taking nitroglycerin To rest and relax before taking nitroglycerin To engage in 15 minutes of light exercise before taking nitroglycerin To rest and relax before taking nitroglycerin A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? Gradually work up to strenuous activity. Avoid all physical and emotional stress. Alternate active periods with rest periods. Include isometric exercises in the daily routine. Alternate active periods with rest periods. A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? Severe staphylococcal infection Rheumatic fever Medullary sponge kidney Croup 22 | P a g e Rheumatic fever The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? Syncope Dizziness Extra heart sound Fatigue Extra heart sound A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client? symptoms to report of worsening tachycardia related to atrial fibrillation foods to limit (green leafy vegetables) while taking warfarin the high risk for complications if she becomes pregnant while taking warfarin instructions for using the rhythm method the high risk for complications if she becomes pregnant while taking warfarin A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scarring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? dilated restrictive arrhythmogenic right ventricular hypertrophic hypertrophic The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? "Can I take the antibiotics as a pill now?" "I have to call my doctor so I can get antibiotics before seeing the dentist." "I need a referral to a dietician to understand a low-sodium diet." "If I quit smoking, it will help the endocarditis." "I have to call my doctor so I can get antibiotics before seeing the dentist." A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it 25 | P a g e Heterograft A nurse is assessing a client with aortic stenosis. What type of murmur will the nurse expect to hear? high-pitched and blowing. low-pitched, rumbling during diastole. loud and rough during systole. low-pitched and blowing. loud and rough during systole. A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has a new onset of hypertrophic cardiomyopathy (HCM). What will be included on the plan of care? beginning a weight reduction diet establishing a daily exercise program an insertion of an implantable cardiac defibrillator teaching about heart transplantation surgery an insertion of an implantable cardiac defibrillator A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease? "The client may have to wear antiembolism stocking to help with venous return." "The client with mitral valve prolapse probably had no health symptoms." "The client needs premium insurance to cover the cost of medications." "The client's religion may prohibit the client from seeking medical attention." "The client with mitral valve prolapse probably had no health symptoms." A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure? Orthopnea, nausea, pedal edema Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) Dyspnea, distended jugular veins, orthopnea Distended jugular veins, pedal edema, nausea Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis? Serum cardiac antigens Complete blood count Positive blood culture Immunosuppressant assay Positive blood culture 26 | P a g e A young parent brings a 4-year-old child to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The parent states the child has been healthy until about 3 weeks ago, when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis? Group A beta-hemolytic strep Staphylococcus aureus Epstein-Barr virus Streptococcus viridians Group A beta-hemolytic strep Which of the following clinical manifestations would the nurse expect to find in the client diagnosed with aortic regurgitation? Systolic pressure is lower in the lower extremities Decrescendo systolic murmur Visible neck vein pulsations Pulse pressure shortens Visible neck vein pulsations A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble? low-pitched diastolic murmur at the apex quick, sharp strokes that suddenly collapse mitral click high-pitched blowing sound at the apex quick, sharp strokes that suddenly collapse What is the most common cause of mitral stenosis? Congestive heart failure Degenerative stenosis Rheumatic endocarditis Myocardial infarction Rheumatic endocarditis The nurse is caring for a five-client assignment on a cardiac unit. In caring for which client would the nurse be most correct to assess for an effusion? A client with chest pain A client with chest trauma A client with aortic stenosis A client with mitral valve prolapse A client with chest trauma 27 | P a g e A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? Nifedipine Vancomycin Cyclosporine Verapamil Cyclosporine Which mitral valve condition generally produces no symptoms? Regurgitation Stenosis Prolapse Infection Prolapse The nursing instructor is teaching a class on thrombophlebitis. What should the nurse tell the students about the inflammatory response in thrombophlebitis? The inflammatory response is caused by accumulated waste products in the blocked vessel. The inflammatory response is caused by an excess for fibrin in the blocked vessel. The inflammatory response is caused by the irritation of the clot. The inflammatory response is caused by the irritation of blood trying to flow through the vessel. The inflammatory response is caused by accumulated waste products in the blocked vessel. A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? Splinter hemorrhages seen under the fingernails Patterns of petechiae on the chest Erythematosus modules on the pads of the fingers Red or purple macules found on the palms of the hands Red or purple macules found on the palms of the hands A client comes into the emergency department reporting 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 diagnosis? Rheumatic fever Mitral valve stenosis Pericarditis Cardiomyopathy Pericarditis A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate: infective endocarditis. 30 | P a g e A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings? "I placed the patient in a semi-Fowler's position and started an NPO diet." "I told the patient that this is a normal complication and to take deep breaths." "I anticipated this complication and I will call the health care provider right now." "I instructed the patient to do coughing and deep breathing and I will reassess in 30 minutes." "I anticipated this complication and I will call the health care provider right now." A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A client with hypertrophic cardiomyopathy A client with a history of repaired ventricular septal defect A client 1 day post coronary stent placement A client 4 days postoperative after mitral valve replacement A client 4 days postoperative after mitral valve replacement The nurse is caring for a client with manifestations of dilated cardiomyopathy. When planning care, which consideration would the nurse make? Assess abdominal girth daily. Assist client to bathroom every 2 hours. Instruct client to avoid strenuous activity. Place bed in a high or semi-high Fowler's position as needed. Place bed in a high or semi-high Fowler's position as needed. The nurse is admitting a client with infective endocarditis (IE). What questions will the nurse ask to explore known risk factors associated with IE? Select all that apply. Did you have a recent eye examination? Do you have any tattoos? Do you smoke marijuana? Did you have a pacemaker insertion? Are you injecting any drugs? Did you have a pacemaker insertion? Do you have any tattoos? Are you injecting any drugs? The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)? Ventricular tachycardia Sinus dysrhythmia First-degree atrioventricular block Atrial fibrillation Atrial fibrillation 31 | P a g e The nurse is teaching a client with an atrial septal defect (ASD) about atrial fibrillation. What risk factor will the nurse include with the teaching? stroke cardiomegaly splenomegaly heart failure stroke The nurse is caring for a client with cardiogenic shock in an critical care unit and the family is asking about the intra-aortic balloon pump (IABP). What will the nurse explain is the premise of using IABP? The IABP is acting as the heart to pump blood through the body. The IABP is another machine used in the intensive care unit to keep the kidneys working. The IABP is helping to circulate oxygen to the body tissue. The IABP is reducing the workload of the heart during the shock period. The IABP is reducing the workload of the heart during the shock period. A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate: cardiomyopathy. thrombophlebitis. Buerger's disease. pericarditis. cardiomyopathy. Which type of cardiomyopathy is associated with syncope? Restrictive Dilated Arrhythmic Hypertrophic Hypertrophic A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? scleroderma chronic alcohol use disorder previous myocardial infarction heredity chronic alcohol use disorder The medical plan of treatment for chronic mitral regurgitation would include medications to reduce afterload, such as: Diuretics 32 | P a g e Anticoagulants. Angiotensin-converting enzyme (ACE) inhibitors. Vasodilators. Angiotensin-converting enzyme (ACE) inhibitors. Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis? greater incidence of a history of repaired congenital heart defects higher rate of tuberculosis increased use of prosthetic valve replacements increase in IV drug use increased use of prosthetic valve replacements The nurse is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis? complete blood count blood cultures transesophageal echocardiogram urinalysis blood cultures A client is diagnosed with cardiomyopathy. Which symptoms that are specific to cardiomyopathy will the nurse instruct the client to report to the health care provider? Select all that apply. Weight gain of 5 lbs. (2.3 kg) in one week Swollen lymph nodes Petechiae on the roof of the mouth Persistent cough Shortness of breath at rest Persistent cough Shortness of breath at rest Weight gain of 5 lbs. (2.3 kg) in one week A client with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which assessment data obtained by the nurse should be immediately communicated to the health care provider? A palpable thrill felt over the left anterior chest A loud systolic murmur all across the precordium Crackles audible throughout the lungs 4+ peripheral edema in both legs Crackles audible throughout the lungs A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response? 35 | P a g e blood pressure nausea temperature lung congestion A client has been diagnosed with heart failure. What is the major nursing outcome for the client? Sleep 8 hours per night. Reduce the workload on the heart. Maintain a healthy diet. Walk 30 minutes three times a week. Reduce the workload on the heart. Which is a key diagnostic indicator of heart failure? Brain natriuretic peptide (BNP) Blood urea nitrogen (BUN) Creatinine Complete blood count (CBC) Brain natriuretic peptide (BNP) A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? Dyspnea Jugular venous distention Cough Pulmonary congestion Jugular venous distention The diagnosis of heart failure is usually confirmed by which of the following? Ventriculogram Electrocardiogram (12-lead) Echocardiogram Chest x-ray Echocardiogram When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating paroxysmal nocturnal dyspnea. hyperpnea. orthopnea. dyspnea upon exertion. orthopnea 36 | P a g e what are modifiable risk factors? influence severity and onset of 5/10 leading causes of death What are 5 kinds of disease influenced by modifiable risk factors? 1) heart disease 2) stroke 3) diabetes 4) some cancers 5) liver disease Health and wellness are influenced by what 4 factors? 1) diet 2) physical activity 3) smoking 4) body weight What are the 4 kinds of external factors? 1) social, economic, health policies, politics 2) social/community networks/support 3) individual lifestyle factors 4) age, sex, biological and genetic factors What are health disparities? the acknowledgment that some population groups have a higher prevalence of chronic diseases than others What does obesity depend on? race, ethnicity, and income What ethnic group is cancer not going down for? American Indian Women What ethnic groups are most at risk to get diabetes? blacks and Hispanics What are health disparities influenced by? genetics, lifestyle, and environment What are phenolic compounds? biologically active components of food What are phenolic compounds linked to? 37 | P a g e 1) immune function, anti-oxidant and anti-inflammatory effects 2) chronic disease reduction What do phenolic compounds give food? color, flavor, aroma, texture Macronutrients Carbs, Fats, Protein What does fiber decrease? Energy density What does a high fiber intake lead to? lower body weight and less weight gain overtime What does low vitamin D intake lead to? decreased calcium absorption What are the 7 risk nutrients? 1) Vitamin A 2) Vitamin E 3) Choline 4) Potassium 5) Sodium 6) Magnesium 7) Iron Vitamin A/E fat-soluble vitamins with strong antioxidant functions What does a deficiency of Choline lead to? Fatty liver and muscle deterioration What do high sodium levels do? decrease vasodilation and raise blood pressure What do high potassium levels do? increase vasodilation What does a magnesium deficit do? Elict a calcium-activated inflammatory cascade What do low iron levels lead to? 40 | P a g e What are the two kinds of obesity? metabolic obesity and hedonic obesity (related to neuroendocrine regulatory system) metabolic obesity set points shifts and stabilizes at higher weight hedonic obesity homeostatic signals over ridden by food hyper-responsiveness; neuroconnection Biological body fat accumulation is secondary to what? Hypertrophy and hyperplasia What are the effects of obesity? 1) adipocytes can lead to chronic inflammation and insulin resistance 2) low self-esteem, depression, discrimination, and social stigma 3) shorter life expectancy Where is fat stored? In adipocytes in the form of triglycerides What are the 5 kinds of treatment plans used to treat obesity 1) eat to reduce caloric intake, incorporate physical activity 2) medical nutrition therapy 3) cognitive behavioral therapy for weight management 4) bariatric surgery 5) pharmacology Medical nutrition therapy calorie deficit, meal replacements, low carb/fat diets Cognitive Behavioral Therapy setting realistic goals, caloric deficit, meal plan, skill development, problem solving techniques What are bariatric surgery patients at risk for? micronutrient deficiencies Pharmacotherapy the application of drugs for weight loss; medications + lifestyle modifications cardiovascular disease Disease related to the heart and blood vessels what is CVD associated with? 41 | P a g e atherosclerosis what are 2 important factors in the progression of CVD? hyperlipidemia and hypertension What does cardiovascular disease consist of? 1) coronary heart disease 2) cerebral vascular disease 3) peripheral arterial disease Atherosclerosis plaque formation begins when fat deposits to become part of the tissue that form over injured arterial wall cells What are the physiological effects of atherosclerosis? Reduced blood flow, vessels lose flexibility and the heart has to work harder leading to higher blood pressure, decline in organ function, inability to preform activities of daily living What is the #1 cause of death in US adults? Cardiovascular Disease What are the risk factors for CVD? dyslipidemia, high blood pressure, lifestyle factors, obesity, diabetes, inflammation, and infection dyslipidemia high LDL/triglycerides and low HDL Metabolic Syndrome (Syndrome X) metabolic conditions increased blood pressure, high triglycerides, large waistline, low HDL, elevated fasting blood sugar Which ethnic groups are at a higher risk of metabolic syndrome? African Americans and Asians How does metabolic syndrome arise? Central Adiposity and insulin resistance What are the effects of metabolic syndrome? increased risk of CVD, type II diabetes, stroke, fatty liver disease, chronic kidney disease, obstructive sleep apnea, PCOS, cognitive decline/dementia, general proinflammatory and prothrombic state What are the 3 factors that screen for metabolic syndrome? waist circumference, fasting lipid profile, blood pressure 42 | P a g e Diabetes Mellitus disease associated with abnormally high levels of blood glucose What test is used to screen for DM? Hemoglobin A1C test Hemoglobin A1C test percentage of blood sugar attached to the hemoglobin What are signs of DM? excessive thirst, urination, weight loss, fatigue, blurry vision, slow healing wounds/cuts How many US adults have DM and how many US adults have prediabetes? DM: 25.6 million prediabetes: 79 million Type I Diabetes (Juvenile Diabetes) minimal/no production of insulin by the pancreas which destroys the beta cells of the pancreas; usually a genetic factor What attacks the body's pancreas to contribute to diabetes? autoantibodies Type II Diabetes defective production of insulin and insulin resistance in which insulin secretion increases--associated with overweight and obesity What are signs of Type II diabetes? Acanthosis nigricans, hypertension, dyslipidemia Prediabetes Blood glucose levels are marginally elevated and vascular changes occuf What are risk factors for prediabetes? low HDL, high trig, CVD Cancer a group of disease in which genes malfunction resulting in unregulated cell growth and tumor formation carcinogenesis the process by which normal cells are transformed into cancer cells Stages of Cancer 45 | P a g e metformin decrease glucose release by liver and increase uptake by muscles How do Action antihyperglycemic drugs work? 1) stimulate pancreas to produce more insulin 2) increase response to insulin at cell receptor sites 3) Decrease glucose released by the liver 4) Reduce digestion of polysaccharides 5) Increase glucose excretion by kidneys Why do younger children have an increased risk for respiratory infections? smaller airway diameter, shorter respiratory tract, short and open eustachian tube nursing diagnoses for respiratory infections ineffective breathing pattern, ineffective airway clearance, risk for infection, activity tolerance pt goals for respiratory infection have adequate oxygen, demonstrate effective clearance of secretions, have effective respirations s/s of respiratory tract infection fever, poor feeding and anorexia, vomiting, diarrhea, abdominal pain, nasal blockage, nasal discharge, cough, respiratory sounds, sore throat, HA, nuchal rigidity prevention measures for respiratory infection use of tissues when coughing/sneezing, proper disposal of used tissues, frequent handwashing, don't share cups what is included in a respiratory assessment? rate, depth and ease of breathing, labored breathing: onset, at rest or w/ exertion, rhythm, temperature, nose: drainage, color, consistency, amount, mouth: mm, moisture, color, throat: color, moisture, "spots" soreness, chest: movement equal, retractions, cough: harsh, dry, wet, continuous, lung sounds: wheezes, crackles, stridor, skin coloration: cyanosis, pale, flushed, chest pain, impact on feeding tx of ear infection ATB, tylenol/ibuprofen, external application of warm pad. Myringotomy w/ tympanostomy tubes, encourage fluid intake, soft diet, lie w/ affected ear down, antipyretics/analgesics importance of humidification loosens secretions and soothe the cough, reduce irritants (smoke, dust, chemical fumes) importance of finishing medication 46 | P a g e if pt doesn't finish medication then some of the bacteria will still remain alive, it will grow stronger and then mutliply, making the sickness harder to tx pain interventions for a child with penumonia raise HOB, have child lay on affected side to splint chest and reduce discomfort caused by pleural rubbing. This also increases the blood flow to the affected areas asthma cause: intrinsic (stress) or extrinsic (environment). Sx: hacking cough, SOB, audible and auscultated wheezes, restless/apprehensive, cyanosis, use of accessory resp muscles, nasal flaring, dyspnea. Dx: PFT, peak expiratory flow, exercise challenges triggers allergens, smoke, exercise, environmental temps asthma tx management: control home environment, allergen testing, and avoid, encourage exercise. Rx: preventative and rescue medications (corticosteroids, bronchodilators), allergen control, monitor peak flow, annual flu vaccination, penumonia vaccination assess for croup inspiratory stridor, suprasternal retractions, restlessness, low grade fever, hoarseness, "barking" "seal- like" cough albuterol Bronchodilator; rescue inhaler SE of albuterol tremor, HA, dizziness, insomnia, cough, hoarseness nasopharyngitis "common cold"; tx the symptoms; viral related; managed at home treatment for nasopharyngitis if bacterial: PCN, erythrmycin, enourage fluids liberally. Group A beta-hemolytic strep nasopharyngitis caused by Group A beta-hemolytic strep RSV respiratory syncytial virus; begins as URI, rhinnorhea, low grade fever, wet cough, eye drainage- advances with sx of respiratory distress who is at risk for RSV? 47 | P a g e usually in children under 1 y/o, can occur in older than 1 y/o if they have a serious debilitating illness epiglottitis A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction. cause: H. influenza, strep, penumonia. abrupt onset, sore throat, acute onset of drooling, "croaking" sound on inspiration, fever, tachypnea, tripod position. Caution in visual inspection of throat. Dx: lateral neck xray, possible intubation or tracheostomy. IV, ATB, corticosteroids to lower edema, cool mist O2 tripod position An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward. a sign of respiratory distress; drooling is common treatment for a chocking infant lay infant face down, along your forearm. use thigh or lap for support. Hold the infant's chest in your hand and jaw with fingers. point infants head downwards, lower than the body. Give 5 quick forceful blows between the infants shoulder blades, use palm of free hand. cystic fibrosis inherited autosomal recessive trait, increased viscosity of exocrine mucous gland secretions causing obstruction in bronchioles, pancreas. salty sweat. Sx: newborn-meconium ileus. other sx: large, bulky, smelly, frothy stools due to GI involvement, FTT, delayed puberty, sterility. Respiratory sx: tenacious mucus, recurrent respiratory infections, digital clubbing, drug resistance is problem tx goals of CF prevent/minimize pulmonary complciations, ensure adequate nutrition, encourage physical activity, promote quality of life therapeutic management of CF GI: pancreatic enzymes with each feeding nutrition: high protein, high calorie, high fluid, high Na+, monitor weight, growth and development, supplemental tube feedings if unable to maintain weight Resp: chest PT (flutter vest), humidifier, O2 PRN, hydration, prevent from infxn, ATB PRN, bronchodilator, exercise as tolerated, monitor blood glucose medications for CF airway clearance therapies, positive expiratory pressure, high frequency chest compressions, percussion and postural drainage, bronchodilator, recombinant human deoxyribonuclease, nebulized hypertonic saline test for CF sweat chloride test >60 mEq= CF assessment and goals for gastroenteritis