Nokea
The nurse is teaching the client newly diagnosed with chronic stable angina. Which instructions on measures to prevent future angina should the nurse incorporate? Select all that apply.
- A. Increase isometric arm exercises to build endurance.
- B. Wear a facemask when outdoors in cold weather.
- C. Take nitroglycerin before a stressful event even if pain free.
- D. Perform most exertional activities in the morning.
- E. Take a daily laxative to avoid straining with bowel movements.
- F. Discontinue use of all tobacco products if you use these.
Correct Answer: B;C;F
Rationale: The nurse should instruct: B) Wearing a facemask in cold weather to prevent vasoconstriction; C) Taking nitroglycerin prophylactically to improve coronary blood flow; F) Discontinuing tobacco to reduce vasoconstriction. Isometric exercises, morning exertion, and daily laxatives are not recommended as they may increase cardiac workload or cause other issues.
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The nurse is admitting the client with a new diagnosis of persistent atrial fibrillation with rapid ventricular response. The client has been in atrial fibrillation for more than 2 days and has had no previous cardiac problems. Which initial interventions should the nurse anticipate? Select all that apply.
- A. Ablation of the AV node
- B. Immediate cardioversion
- C. Oxygen 2 liters per nasal cannula
- D. Heparin intravenous (IV) infusion
- E. Amiodarone IV infusion
- F. Diltiazem IV infusion
Correct Answer: C;D;E;F
Rationale: The nurse should anticipate: C) Oxygen to enhance tissue oxygenation due to decreased cardiac output; D) Heparin to prevent thromboembolism from atrial stasis; E) Amiodarone for pharmacological cardioversion; F) Diltiazem to slow ventricular response. Ablation and cardioversion are considered only if medications fail or after ruling out atrial clots.
The clinic nurse is teaching the client at risk for developing arteriosclerosis. The nurse should teach the client that the dietary therapy to decrease homo-cysteine levels includes eating foods rich in which nutrient?
- A. Monosaturated fats
- B. B complex Vitamins
- C. Vitamin C
- D. Calcium
Correct Answer: B
Rationale: Homocysteine interferes with the elasticity of the endothelial layer in blood vessels. Foods rich in B-complex vitamins, especially folic acid, have been found to lower serum homocysteine levels. Monosaturated fats, Vitamin C, and Calcium do not have a direct effect on homocysteine levels.
The client asks the nurse what can be done to alleviate the pain and discomfort associated with varicose veins. Which response by the nurse is best?
- A. “Dangle your legs off the side of the bed as often as possible to alleviate the pain.”
- B. “There isn’t much you can do about the pain except have surgery to remove the veins.”
- C. “You should wear long pants to hide bulging veins; this will help your self-confidence.”
- D. “Wear elastic stockings to promote venous return; these will also help reduce discomfort.”
Correct Answer: D
Rationale: The best response to alleviate pain and discomfort associated with varicose veins includes application of elastic stockings and elevating the lower extremities. These promote venous return. Dangling legs, surgery as the only option, or wearing long pants do not address the pain effectively.
The cardiac monitor of the client diagnosed with Prinzmetal’s angina shows a prolonged PR interval of 0.32 seconds. Which prescribed medication should the nurse question administering to the client?
- A. Isosorbide mononitrate 20 mg oral daily
- B. Amlodipine 10 mg oral daily
- C. Nitroglycerin 0.4 mg sublingual prn
- D. Atenolol 50 mg oral daily
Correct Answer: D
Rationale: Atenolol (Tenormin), a beta blocker, blocks stimulation of beta1 (myocardial)-adrenergic receptors, causing a reduction in BP and HR. A side effect of the medication is a prolongation of the PR interval (normal PR interval is 0.12 to 0.20 second). Continued use of the drug can result in heart block. The nurse should question administering atenolol. Other medications do not prolong the PR interval.
The client is discovered to have a popliteal aneurysm. Because of the aneurysm, the nurse should closely monitor the client for which associated problem?
- A. Thoracic outlet syndrome
- B. Ischemia in the lower limb
- C. Pulmonary embolism
- D. Raynaud’s phenomenon
Correct Answer: B
Rationale: A popliteal aneurysm (located in the space behind the knee) may cause ischemia in the leg distal to the aneurysm due to thrombus forming inside the aneurysm and potential emboli. Other options are unrelated to popliteal aneurysms.