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Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder?
- A. Increase the dose of aspirin for better therapy.
- B. Take medication at the same time each day.
- C. Report to health care provider cuts that do not stop bleeding with direct pressure.
- D. No restrictions for food or drink.
- E. Report for prescribed blood tests (PTT, INR, CBC, blood sugar).
Correct Answer: B,C
Rationale: Aspirin should not be used with anticoagulant therapy because it will increase bleeding. Gums, nosebleeds, excessive bruising, and cuts that do not stop bleeding with direct pressure should be reported to the health care provider. Alcohol and dark green and yellow vegetables should be avoided because they contain vitamin K. Normal blood tests for anticoagulant therapy are PTT, INR, and PT.
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What is the patient goal of the walking exercise program designed for the rehabilitation of a patient who had a myocardial infarction (MI) 3 weeks ago?
- A. Walk 2 miles in less than 60 minutes after 12 weeks.
- B. Jog mile in less than 30 minutes after 12 weeks.
- C. Fast walk' 1 mile in less than 20 minutes after 12 weeks.
- D. Walk 1 mile in 15 minutes without dyspnea after 12 weeks.
Correct Answer: A
Rationale: The goal of the 12-week walking program is that the patient can walk 2 miles in less than 60 minutes.
The nurse identifies the 'lub' sound of the 'lub/dub' of the cardiac cycle as the sound of which event?
- A. AV valves closing.
- B. closure of the semilunar valves.
- C. contraction of the papillary muscles.
- D. contraction of the ventricles.
Correct Answer: A
Rationale: The lub is the first sound of a low pitch heard when the AV valves close.
The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse reinforces which instruction?
- A. Good job! Continue with your low fat diet.
- B. These levels are borderline: you still aren't eating properly.
- C. The dietician will need to talk to you about lowering your cholesterol a lot more.
- D. Your cholesterol level needs to be lowered a great deal to improve your survival chances.
Correct Answer: A
Rationale: Total cholesterol of less than 200 is desirable. The higher the number of HDLs the better. A high number of LDLs puts the patient at risk for heart disease.
During a health interview by the home health nurse, which patient report suggests left-sided heart failure?
- A. I have to sleep in my recliner and I have this hacking cough.'
- B. I have no appetite and I have lost $3 \mathrm{lb}$ in the last week.'
- C. I have to urinate every 2 hours, even during the night.'
- D. I go barefoot most of the time because my feet are so hot.'
Correct Answer: A
Rationale: Left ventricular failure is often among the first of 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.
The older adult patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse should reinforce which instruction?
- A. Continue to take nitroglycerin sublingually at 5-minute intervals until the pain is relieved.'
- B. If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals, call your health care provider and come to the hospital.'
- C. When nitroglycerin is not relieving the pain, lie down and rest.'
- D. Use oxygen at home to relieve pain when nitroglycerin is not successful.'
Correct Answer: B
Rationale: Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the health care provider. Nitroglycerin administered sublingually usually relieves angina symptoms but does not relieve the pain from an MI. Administering nitroglycerin more than three times will probably not relieve the pain.