Captopril (Capoten), furosemide (Lasix), and metoprolol (Toprol XL) areordered for a patient with systolic heart failure. The patient's BP 136/82 andHr 65. Prior to medication administration at 0900h, the nurse reviews the following lab tests: Sodium 140 mEq/L; Potassium 6.8 mEq/L; Chloride101 mEq/L; CO2 26 mEq/L; BUN 18 mg/dL; Creatinine 1.0 mg/dL; Hemoglobin 12 g/dL; and Hematocrit 37%. Which of the following should the nurse do first?
A. Administer the medication B. Call the physician C. Withhold the captopril D. Question the metoprolol doseThis is specific for this ACE due to Hyperkalemia
A patient with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The patient is taking warfarin (Coumadin). The expected outcome of this drug is to
A. Decrease circulatory overload B. Improve the myocardial workload C. Prevent thrombus formationD. Regulate cardiac rhythmWith pt with no hx of valve replacement : check the ejection fraction
A nurse is assessing a patient with heart failure. The nurse should assess the patient based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply.
a. Ventricular hypertrophy b. Parasympathetic nervous stimulationc. Renin-angiotensin-aldosterone system d. Jugular venous distention e. Sympathetic nervous stimulation
Which of the following sets of conditions is an indication that a patient with a history of left sided heart failure is developing pulmonary edema?
a. Distended jugular veins and wheezing b. Dependent edema and anorexia c. Coarse crackles and tachycardia d. Hypotension and tachycardia
The major goal of therapy for a patient with heart failure and pulmonary edema should be to
a. Increase cardiac output b. Improve respiratory status c. Decrease peripheral edema d. Enhance comfort
A patient with Aortic Stenosis (AS) complains of increasing dyspnea and dizziness. Identify the area where the nurse would place the stethoscope to assess a murmur from AS.
a. Best heard at the second intercostal space (ICS) at the right side of the sternumb. Heard best at the apex of the heart or the apical area
Identify the area where the nurse would place the stethoscope to assess a murmur from Mitral Stenosis (MS).
a. Best heard at the second intercostal space (ICS) at the right side of thesternumb. Heard best at the apex of the heart or the apical area
Identify the area where the nurse would place the stethoscope to assess a murmur from Aortic Regurgitation (AR
a. Best heard at the second intercostal space (ICS) at the right side of the sternumb. Heard best at the apex of the heart or the apical area
Identify the area where the nurse would place the stethoscope to assess a murmur from Mitral Regurgitation (MR)
a. Best heard at the second intercostal space (ICS) at the right side of thesternumb. Heard best at the apex of the heart or the apical area
HEART MURMURS: GRADING SYSTEMGrade I
Very soft murmurs
Heart murmurs: Grade II
Mild to moderately loud murmur
Heart Murmurs:GradeIII
Loud murmur that is easily heard once the stethoscope is placed on chest
Heart MurmursGrade IV
Very loud murmur. Thrill is more obvious
Heart MurmursGrade V
he murmur is so loud that it can be heard even with thestethoscope off the chest. The thrill is easily palpated
HEART SOUNDSS1 (Systole)
Closure of the mitral and tricuspid vales
Heart SoundsS2 (Diastole)
Closure of the aortic and pulmonic vales
Heart SoundsS3 is a sign of what
for CHF and > 35 y/o -always considered abnorma
Heart SoundsS4 is a sign of what
for LVH and considered a normal finding in some elderly
The nurse is assessing a 48-year-old patient with a history of smoking during a routine clinic visit. The patient, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings require further testing?
a. Heart rate 57 bpm b. SpO2 of 94% on room air c. Blood pressure 134/82 d. Ankle brachial index of 0.65Index is > 0.90
A common abnormal laboratory result associated with the development of peripheral vascular disease (PVD) is:
a. High serum calcium level b. High serum lipid levels c. Low serum potassium level d. Low serum lipid levels
A patient with Raynaud's phenomenon (digital vasoconstriction) is prescribeddiltiazem (Cardizem). An expected outcome is
a. Decreased heart rate b. Conversion to normal sinus rhythm c. Reduced episode of finger numbness d. Increased SpO2
A patient has chest pain rated 8/10. The 12-lead EKG shows ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this patient at this time
a. Monitor daily weights and urine output b. Permit unrestricted visitation by family and friends c. Provide patient education on medications and diet d. Reduce pain and myocardial oxygen demand
Troponin I and T (both do ??)
both increase rapidly within the first 12 hours after an MI
- Troponin I:
more cardiac-specific and is sensitive for small-volume myocardial damage and remains 192 hours (8 days) after an MI
=- Troponin t
remains 168 hours (7 days) and chronic renal failure muscle trauma, and rhabdomyolysis
A patient who is in hypovolemic shock has the following clinical signs: Hr 120 b/m, BP 80/55 mmHg, and urine output 20 mL/hr. After administering an IV fluid bolus, which of these signs if noted by the healthcare provider is the best indication of improve perfusion
a. Right atrial pressure increases b. Systolic blood pressure increases to 85 mm Hg c. Urine output increases to 30 mL/hd. Heart rate drop to 100 b/mUrine out put 30- 50 mL/h