The document contains questions and answers related to cardiovascular nursing care. A client taking spironolactone was found to have a potassium level of 5.8 mEq/L, indicating hyperkalemia as a side effect of the medication. Instructions for a client taking quinidine sulfate include not chewing sustained-release capsules. A PR interval of 0.20 second on an ECG is a normal finding.
Case Study, Chapter 34, Management of Patients With Hematologic Neop.docxdrennanmicah
Case Study, Chapter 34, Management of Patients With Hematologic Neoplasms
1. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The patient has hypercalcemia. The patient’s uric acid level is elevated. The patient has orders for zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin. (Learning Objective 5)
a. What nursing management should the nurse provide the patient?
Explain the indication and action of the various medications ordered to treat the patient’s symptoms.
2. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation. (Learning Objective 3)
a. What laboratory results would you anticipate due to her ecchymosis and petechia?
Why would it be important to inspect her gums and teeth?
a. Why is her liver enlarged?
Case Study, Chapter 37, Management of Patients With HIV Infection and AIDS
1. The nurse is planning to provide education on HIV infection transmission and prevention strategies at a local senior center. (Learning Objectives 1 and 4)
a. What should the nurse include in the session considering the needs of the older population?
2. Sallie Jefferies, 28-year-old patient, is at the obstetric clinic for a pregnancy visit. The physician informs the patient that her HIV screen test is positive. The patient has no evidence of AIDS. The nurse provides patient education regarding what HIV is and what the clinical management entails. (Learning Objective 5)
a. What clinical management is recommended for the patient during the pregnancy to help decrease the risk of transmitting HIV to the unborn child?
The patient asks the nurse how zidovudine (Retrovir) will help her unborn child from getting HIV. How should the nurse respond?
What explanation about Retrovir should the nurse provide?
The patient asks the nurse if it will be safe to breast-feed her infant after the delivery. The nurse should provide what explanation?
a. The patient asks the nurse what testing schedule for the HIV antibody is needed after her baby is born. How should the nurse respond?
Case Study, Chapter 31, Assessment and Management of Patients With Hypertension
1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of .
MDC3 -3MAKE SURE TO ANSWER ALL THE FOLLOW CAREFULLY AND CORRECTLAbramMartino96
MDC3 -3
MAKE SURE TO ANSWER ALL THE FOLLOW CAREFULLY AND CORRECTLY WITH CAREFUL UNDERSTANDING
1. Which of the following assessment findings are consistent with aortic regurgitation?
Atrial fibrillation
Systolic click
Pitting edema
Blowing decrescendo diastolic murmur
2. The nurse receives an order to infuse heparin 1000 units/hr IV. The IV bag contains 25.000 units heparin in 500ml. D5W. Calculate the IV rate in ml/hr___ ( record as a whole number)
3. The nurse is assessing a client with severe anemia. Which clinical manifestation does the nurse expect to see in this clients?
Dyspnea with activity
Hypertension
Bradycardia
Warm flushed skin
4. A nurse is caring for a 19 year old male recently diagnosed with leukemia. Which of the following nursing interventions is appropriate for the client?
Strict hand hygiene to prevent infection
Fluid restriction
Low residual diet
Therapeutic phlebotomy
5. The nurse assesses a client and documents the following findings edema 2+ bilateral ankles brown pigmentation of lower extremity skin aching pain of lower extremities when standing that resolves with elevation and 2+pedal pulses. What condition does the client likely have?
Deep vein thrombosis
Venous insufficiency
Peripheral arterial disease
Raynaud disease
6. The nurse is caring for a 65 year old female who presented to the emergency department with shortness of breath and chest discomfort. The client has not been feeling well for the past few days and complains of a productive cough of blood tinged sputum. Laboratory an elevated brain natriuretic peptide (BNP) and chest x-ray reveals pulmonary congestion , Based on the assessment findings which of the following diagnosis are consistent with these findings?
Heart failure(left- sided)
Pulmonary embolism
Heart failure(right-sided)
Lung cancer
7. A nurse is performing discharge teaching for a client who was recently diagnosed with heart failure. Which of the following should be included in the client and family teaching? (SATA)
Medication teaching
Low sodium diet
Fluid restriction
Weekly weight
Symptoms to report to the provider
8. A 65 year old female presented to the emergency room with complaints of progressively worsening fatigue shortness of breath, and palpitations. Upon assessment heart rate is 150 beats per minute and irregular, and there is positive jugular vein distention heart tones reveal a high pitched holosystolic murmur. Which of the following disorders are consistent with these findings?
Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Mitral valve prolapse
9. Which of the following assessment findings is consistent with mitral valve prolapse?
Systolic click
Urinary frequency
Atrial fibrillation
Claudication
10. The nurse is caring for four clients on a post surgical unit . The nurse understands that monitoring the client for which post operative complication takes priority?
Constipation
Nausea
Urinary retention
Pneumonia
11. A nurse is caring for a client who was recently diagno ...
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Case Report: EPINEPHRINE OVERDOSE DUE TO INCORRECT ROUTE OF ADMINISTRATIONAnnisa Hayatunnufus
Case report assignment under the subject of Pharmacology that discusses the case of epinephrine overdose due to incorrect route of administration.
Created by: Annisa Hayatunnufus
Bachelor of Pharmacy
Management & Science University
Inhospital management of AIS slides'19.pptxAbushuMohammed
The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for reperfusion therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms.
Allergy Induced Acute Coronary Syndrome - Kounis Syndrome: Case Report.
Poster used in CMC MAC 2021.
OBJECTIVE: To discuss a rare occurrence of allergic reaction to NSAID causing Myocardial Infarction.
BACKGROUND: A 21-year-old obese female with no other comorbidities was referred to us with history of chest pain, generalized urticarial rashes and itch suddenly following Inj.IM Diclofenac, which was given for heel pain relief. She was hemodynamically stable, but tachypneic, orthopneic and was having bilateral basal crepitations. ECG revealed significant ST depression & T inversion in II,III,aVF and V2-V6 and ST elevation in aVR. CXR showed pulmonary edema. Diagnosed as ACS following anaphylaxis and loading dose was given along with IM adrenaline, antihistamines, and steroids. Echo revealed global hypokinesia of LV. Cardiac enzymes were elevated. Meanwhile, she had a prompt relief of chestpain, but dyspnea worsened and warranted NIV support. Repeat ECG revealed regression of ST changes correlating with chest pain relief. After 2 days of NIV, patient’s dyspnea improved and weaned from NIV. CAG revealed normal epicardial coronaries. Serial cardiac enzyme levels showed falling trend and ECG was completely normal with no significant ST-T changes. Pre-discharge, repeat echo showed persistence of global hypokinesia. 2weeks later, repeat echo showed dramatic improvement with normal LV systolic function suggesting recovery from myocardial stunning.
RESULTS: This qualifies for the diagnosis of MINOCA (Myocardial Infarction with No Obstructive Coronary Arteries). In the setting of allergic trigger, vasospasm or coronary hypersensitivity is the underlying mechanism- described as KOUNIS SYNDROME.
CONCLUSION: ECG changes and chest discomforts that occur in allergic reactions are not always secondary to distributive/anaphylactic shock. Sometimes heart could be the primarily affected organ by the allergic reaction as in this case. Although <200cases reported globally until 2017, it’s suspected to be frequently overlooked, hence likely to be more prevalent.
1. :Question -90
The clinic nurse is reviewing the assessment findings for a
client who has been taking spironolactone (Aldactone) for
treatment of hypertension. Which of the following, if noted
in the client ’s record, would indicate that the client is
?experiencing a side effect related to the medication
:Options
A potassium level of 3.2 mEq/L . 1
A potassium level of 5.8 mEq/L . 2
Client complaint of constipation . 3
Client complaint of dry skin . 4
:Answer
. 2
:Rationale
Spironolactone is a potassium-sparing diuretic. Side effects
include hyperkalemia, dehydration, hyponatremia, and
lethargy. Although the concern with most diuretics is
hypokalemia, this medication is potassium sparing, which
means that the concern with this medication is
hyperkalemia. Additional side effects include nausea,
vomiting, cramping, diarrhea, headache, ataxia,
.drowsiness, confusion, and fever
:Question -91
A nurse is providing instructions to the client with chronic
atrial fibrillation who is being started on quinidine sulfate.
:The nurse plans to instruct the client to
2. :Options
.Take the medication only on an empty stomach . 1
Open the sustained-release capsules and mix with . 2
applesauce if the medication is difficult to swallow. 3 .
.Wear a medical identification bracelet
Stop taking the prescribed digoxin (Lanoxin) when . 4
.this medication is started
:Answer
. 3
:Rationale
The client should be instructed to take quinidine sulfate
exactly as prescribed. The client should not chew the
sustained-release capsules or open the capsules and mix
them with food. The client should be instructed to wear a
medical identification bracelet or tag and to continue
taking digoxin as prescribed. Quinidine sulfate is
administered for atrial flutter or fibrillation only after the
client has been digitalized
.
:Question -92
A nurse is reviewing the electrocardiogram (ECG) rhythm
strip obtained on a client with a diagnosis of myocardial
infarction . The nurse notes that the PR interval is 0.20
:second . The nurse determines that this is
:Options
A normal finding . 1
Indicative of atrial flutter . 2
3. Indicative of impending reinfarction . 3
Indicative of atrial fibrillation . 4
:Answer
. 1
:Rationale
The PR interval represents the time it takes for the cardiac
impulse to spread from the atria to the ventricles . The
normal range for the PR interval is 0.12 to 0.20 second .
Options 2 , 3 , and 4 are incorrect
:Question -93
A nurse is documenting information in a client ’s chart
when the ECG telemetry alarm sounds and the nurse notes
that the client is in ventricular tachycardia (VT). The
nurse rushes to the client ’s bedside and performs which
?assessment first
:Options
Blood pressure . 1
Cardiac rate . 2
Respiratory rate . 3
Responsiveness of the client . 4
:Answer
. 4
:Rationale
VT is associated with a significant decrease in cardiac
output. Assessing for unresponsiveness determines whether
the client is affected by the decreased cardiac output .
Although options 1 , 2 , and 3 may be a component of the
4. assessment, the first action would be to determine
responsiveness of the client
.
:Question -94
A nurse in the medical unit is assigned to provide
discharge teaching to a client with a diagnosis of angina
pectoris. The nurse is discussing lifestyle changes that are
needed to minimize the effects of the disease process. The
client continuously changes the subject during the teaching
session. The nurse interprets that this client ’s behavior is
:most likely to indicate
:Options
An attempt to ignore or deny the need to make . 1
lifestyle changes
Boredom resulting from having already learned the . 2
material
Anxiety related to the need to make lifestyle changes . 3
Lack of understanding of the material provided at the . 4
teaching session and embarrassment about asking
questions
:Answer
. 1
:Rationale
Denial is a defense mechanism that allows the client to
minimize a threat that may be manifested by refusal to
discuss what has happened. Denial is a common early
reaction associated with chest discomfort, angina, or
5. myocardial infarction (MI). Anxiety usually is manifested
by symptoms of sympathetic nervous system arousal. No
data are provided in the question that would lead the
nurse to interpret the client ’s behavior as boredom or as
either understanding or not understanding the material
.provided at the teaching session
:Question -95
A nurse is reviewing the laboratory results for a client who
arrives at the health care clinic for follow-up assessment
after insertion of a mechanical prosthetic heart valve. The
international normalized ratio (INR) is analyzed because
the client has been taking warfarin sodium (Coumadin)
since discharge from the hospital. The nurse determines
that the INR range is appropriate if which of the following
?values is noted on the laboratory report
:Options
2.0 . 1
2.3 . 2
3.0 . 3
5.0 . 4
:Answer
. 3
:Rationale
The recommended INR range for oral anticoagulant
therapy is 2.0 to 3.0 , but this value may vary with the
goals of therapy . A recommended INR range with
mechanical prosthetic heart valve is 2.5 to 3.5 , and for
6. survivors of acute myocardial infarction (MI ) , 2.5 to 3.5
.
:Question -96
A clinic nurse is performing a cardiovascular assessment
on a client. In preparing to assess the client ’s apical pulse,
the nurse places the stethoscope over the heart ’s apex in
?which of the following positions
:Options
At the midline of the chest just below the xiphoid . 1
process
At the midclavicular line at the fifth left intercostal . 2
space
At the midaxillary line on the left side of the chest . 3
Mid-sternum, equal with the nipple line . 4
:Answer
. 2
:Rationale
The heart is located in the mediastinum. Its apex or distal
end points to the left and lies at the level of the fifth
intercostal space. A stethoscope should be placed in this
area to pick up heart sounds most clearly. The other
options are incorrect because they do not represent the
.anatomical positioning of the heart ’s apex
:Question -97
A nurse is caring for a client who has been hospitalized
with a diagnosis of angina pectoris. The client is receiving
7. oxygen via nasal cannula at 2 L/min . The client asks why
the oxygen is necessary . The nurse accurately explains
:that
:Options
.Oxygen has a calming effect . 1
Oxygen will prevent the development of any . 2
.thrombus
Oxygen dilates the blood vessels so they can supply . 3
more nutrients to the heart muscle. 4 . The pain of angina
pectoris occurs because of decreased oxygen supply to the
.heart
:Answer
. 4
:Rationale
The pain associated with angina results from ischemia of
myocardial cells. The pain often is precipitated by activity
that places more oxygen demand on heart muscle.
Supplemental oxygen will help to meet the added demands
on the heart muscle. Oxygen does not dilate blood vessels
or prevent thrombus formation and does not directly calm
.the client
:Question -98
A nurse is assisting in performing an arterial blood gas
analysis on a client. Which of the following is an
appropriate nursing action after the blood specimen is
?drawn
:Options
8. . Cover the site with a 4 × 4 gauze . 1
.Apply warm packs to the site . 2
Perform passive range of motion for the fingers of the . 3
.hand
.Apply pressure to the site . 4
:Answer
. 4
:Rationale
Pressure should be applied to the site after an arterial
blood gas specimen is drawn. The blood pressure in the
artery is higher than in the veins, so applying pressure to
the punctured artery is necessary to control bleeding.
Covering the site with gauze may protect the site but
would not control bleeding. Heat (by application of warm
packs) causes vasodilation, which would increase bleeding
.to the site. Exercise would increase circulation to the area
:Question -99
A client is admitted to the critical care unit with a
diagnosis of suspected myocardial infarction. The unit
nurse is reviewing the laboratory test results for this client.
Which of the following findings would most specifically
?(indicate the presence of a myocardial infarction (MI
:Options
Increased CK-MB . 1
Increased CK-MM . 2
(Increased blood urea nitrogen (BUN . 3
9. Decreased white blood cell (WBC) count . 4
:Answer
. 1
:Rationale
The MM fraction of creatine kinase (CK-MB) is specific
in determining the presence of MI. The CK-MM reflects
injury to skeletal muscle. The WBC count would most
likely be elevated in the client with an MI. The BUN is
.unrelated to this disorder
:Question -100
A nurse is caring for a client with a diagnosis of
myocardial infarction (MI). The client is experiencing
chest pain that is unrelieved by the administration of
nitroglycerin. The nurse administers morphine sulfate to
the client as prescribed by the physician. After
administration of the morphine sulfate, the nurse plans to
:monitor
:Options
Mental status . 1
Respirations and blood pressure . 2
Urinary output . 3
Temperature and blood pressure . 4
:Answer
. 2
:Rationale
Morphine sulfate is an opioid analgesic that may be
administered to relieve pain in a client with MI. Although
10. monitoring mental status is a component of the nurse ’s
assessment, it is not the priority after administration of
morphine sulfate. The nurse would monitor the client ’s
respirations and blood pressure. Signs of morphine toxicity
include respiratory depression and hypotension. Urinary
output is unrelated to the administration of this
medication. Monitoring the temperature also is not
.associated with the use of this medication
:Question -101
A client hospitalized with a diagnosis of myocardial
infarction calls for the unit nurse because she is
experiencing chest pain. The nurse administers a
sublingual nitroglycerin tablet as prescribed. The client,
who is receiving oxygen by nasal cannula, reports that her
chest pain is unrelieved by the nitroglycerin. Which of the
following is the next appropriate nursing action for this
?client
:Options
.Administer another nitroglycerin tablet . 1
.Increase the flow rate of oxygen . 2
.Contact the physician . 3
.Call the client ’s family . 4
:Answer
. 1
:Rationale
Nitroglycerin tablets are administered one tablet every 5
minutes , for a total of three tablets per episode of chest
11. pain , so long as the client maintains a systolic blood
pressure of 100 mm Hg or higher. Increasing the flow rate
of oxygen may be prescribed by the physician but would
not be the next nursing action. If three nitroglycerin
tablets did not relieve the client ’s chest pain, the physician
needs to be notified. It is premature to call the client ’s
.family
:Question -102
A client with a diagnosis of angina pectoris is hospitalized
for an angioplasty. The client returns to the nursing unit
after the procedure, and the nurse provides instructions to
the client regarding home care measures. Which of the
following statements if made by the client indicates an
?understanding of the instructions
:Options
I am so relieved that I can eat anything that I want” . 1
“ .to now
“ .I need to cut down on cigarette smoking” . 2
“ .I am so relieved that my heart is repaired” . 3
“ .I need to adhere to my dietary restrictions” . 4
:Answer
. 4
:Rationale
After angioplasty, the client needs to be instructed
regarding the specific dietary restrictions that must be
followed. Making the recommended dietary and lifestyle
changes will assist in preventing further atherosclerosis.
12. Abrupt closure of the artery can occur if the dietary and
lifestyle recommendations are not followed. Cigarette
smoking needs to be stopped. An angioplasty does not
repair the heart. Level of
:Question -103
A nurse is caring for a client with a diagnosis of
myocardial infarction (MI) and is assisting the client in
completing the diet menu. Which of the following
beverages would the nurse instruct the client to select from
?the menu
:Options
Coffee . 1
Tea . 2
Lemonade . 3
Cola . 4
:Answer
. 3
:Rationale
A client with a diagnosis of MI should not consume
caffeinated beverages. Caffeinated products can produce a
vasoconstrictive effect, leading to further cardiac ischemia.
Coffee, tea, and cola all contain caffeine and need to be
.avoided in the client with MI
:Question -104
A nurse is performing an admission assessment on a client
with a diagnosis of angina pectoris who takes nitroglycerin
for chest pain at home. During the assessment, the client
13. complains of chest pain. The nurse immediately asks the
?client which of the following questions
:Options
“ ?Are you having any nausea” . 1
“ ?Where is the pain located” . 2
“ ?Are you allergic to any medications” . 3
“ ?Do you have your nitroglycerin with you” . 4
:Answer
. 2
:Rationale
If a client complains of chest pain, the initial assessment
question would be to ask the client about the pain intensity
, location , duration , and quality . Although options 1 , 3 ,
and 4 all may be components of the assessment, none of
these questions would be the initial assessment question in
.this client
:Question -105
A nurse has provided dietary instructions to a client with
coronary artery disease. Which statement by the client
?indicates an understanding of the dietary instructions
:Options
.I need to substitute eggs and whole milk for meat” . 1
“
I should eliminate all cholesterol and fat from my” . 2
“ .diet
“ .I should use polyunsaturated oils in my diet” . 3
“ .I ’ll need to become a strict vegetarian” . 4
14. :Answer
. 3
:Rationale
The client with coronary artery disease should avoid foods
high in saturated fat and cholesterol such as eggs, whole
milk, and red meat. These foods contribute to increases in
low-density lipoproteins. The use of polyunsaturated oils is
recommended to control hypercholesterolemia. It is not
necessary to eliminate all cholesterol and fat from the diet.
.It is not necessary to become a strict vegetarian