NURX211 Health Differences Across The Life Span 1

*3) Lunch meats are processed meats and salt is used in the curing process. 4) Boiled eggs do not have sodium unless it is added to the egg after the boiling process. *5) Potato chips are processed and salt is used in the processing. Cardiovascular Problems Which information should be included in the discharge plan for a patient receiving an angiotensin converting enzyme (ACE) inhibitor for blood pressure control? "You may experience an increased appetite." "You may experience dehydration." "You may experience constipation." "You may experience cough." - answer-1) Angiotensin converting enzyme (ACE) inhibitors do not generally increase appetite. Because absorption of an ACE inhibitor is hindered by food, it should be administered 1 hour before a meal. 2) ACE inhibitors are less likely to cause dehydration than are other medications used to control blood pressure. 3) ACE inhibitors occasionally cause gastrointestinal side effects, including both diarrhea and constipation, but this is not common. *4) A cough is the most common side effect of an ACE inhibitor. It usually resolves within 1 to 4 days after therapy is begun, and the patient should be urged to continue taking the medication with this knowledge. Cardiovascular Problems While assessing a child's radial pulse, the RN notes a pattern of one strong beat followed by one weak beat. The RN knows this indicates which cardiac condition? Cardiac insufficiency Aortic stenosis Myocardial weakness Ineffective heart action - answer-1) Cardiac insufficiency has a water hammer pulse, which is very forceful and bounding, as in patent ductus arteriosus. 2) Aortic stenosis has a dicrotic pulse, which is a double radial pulse for every apical beat. *3) Myocardial weakness has a pulsus alternans, which is a pulse of one strong beat and one weak beat. 4) Ineffective heart action has a thready pulse, which is a pulse that is weak and usually rapid. Cardiovascular Problems An RN is caring for a patient with a history of chronic obstructive pulmonary disease (COPD). The patient has oxygen therapy at 2 L/min, per nasal cannula, and reports increasing dyspnea with activity, and dry cough with occasional hemoptysis. How should the RN revise the plan of care? Auscultate the lungs more frequently to assess for crackles. Increase oxygen to 6 L/minute by nasal cannula. Administer furosemide (Lasix) to decrease blood pressure. Assess blood pressure for increase in systolic pressure. - answer-*1) Cor pulmonale is a complication of pulmonary hypertension caused by COPD. 2) An increase of the oxygen to 6 L/min per nasal cannula with activity, and an increase in oxygen may be appropriate to relieve pulmonary hypertension, but this is too high for a nasal cannula. A patient with COPD requiring 6 liters would need further evaluation by the health care provider. 3) Furosemide may be appropriate if the patient has signs of cor pulmonale, but at this time, that is not evident. 4) Pulmonary hypertension cannot be measured with blood pressure cuff. Cardiovascular Problems During morning assessment, the RN auscultates an extra heart sound that is high pitched and blowing, during the systolic phase. Which condition would the RN most likely suspect? Mitral regurgitation Congestive heart failure Aortic stenosis Dilated cardiomyopathy - answer-*1) Mitral valve prolapse (MVP) often presents with an extra heart sound, referred to as a mitral click. This is often the first and only sign of MVP. The systolic click is an early sign that a valve leaflet is ballooning into the left atrium. A murmur may also be heard. 2) Although congestive heart failure (CHF) may produce extra heart sounds, they do not sound like a click. A systolic click is not a common finding in CHF. 3) Aortic stenosis presents with a loud, rough systolic murmur that can be heard over the aortic area and can radiate to other areas such as the carotid arteries and apex of the left ventricles. The murmur is a low pitched sound. 4) Dilated cardiomyopathy (DCM) is significant dilation of the ventricles without hypertrophy. Physical exam may reveal extra heart sounds (S3, S4) and a possible murmur. Clicking is not a finding in DCM. Cardiovascular Problems A patient with a family history of stroke is getting their yearly physical at the health care provider's office. The provider has ordered some laboratory tests. As the RN is completing venipuncture to obtain the specimen, the patient asks "The doctor ordered a new test called a C-reactive protein (CRP). What is that for?" What is the RN's best response? "The test can evaluate if you have any active infections in your body." "The test can evaluate if you have a risk for developing cancer." "The test is a marker used to evaluate your risk for cardiac issues." "The test can evaluate how well you metabolize cholesterol." - answer-1) Although the CRP may be elevated in individuals that have infection, the test is used to evaluate if inflammation is present, not infection. 2) CRP is not a tumor marker, it is an inflammatory marker. *3) CRP is a known inflammatory marker for cardiovascular risk, including acute coronary events and stroke. 4) CRP does not evaluate how the body metabolizes cholesterol. Cardiovascular Problems An RN notes that a patient who experienced a heart attack 3 days earlier is easily fatigued. Upon assessment, the RN finds an elevated serum Troponin T level, blood pressure 123/70, heart rate 120 beats per minute, a dry cough, and a weight gain of 2 pounds since admission. Which initial action by the RN is most appropriate? Encourage the patient to cough and breathe deeply. Administer nitroglycerine and call the health care provider. Plan for frequent rest periods between activities. Review intake and output for the last 24 hours. - answer-1) These actions will clear mucous from the airways. It does not affect pulmonary edema. 2) The patient is not reporting chest pain, troponin levels are expected to be increased 3 days after a heart attack. This is therefore a normal BP. 3) This is an appropriate intervention, but it will not correct the underlying cause of the dyspnea. More assessment data is needed. *4) More assessment data is needed to determine the underlying cause of the dyspnea. Heart failure is a common complication following a heart attack with damage to the left ventricle. Signs of heart failure include fatigue, edema, weight gain, S3 heart sound, crackles in the lungs, tachycardia, dyspnea, intake greater than output, weight gain greater than 3 lb per week. Cardiovascular Problems An older patient recovering from a myocardial infarction is being discharged from the acute care setting. The charge RN should assign the patient to which staff member? An LPN/LVN with 10 years of experience in cardiac rehabilitation An RN with 2 months of experience in an extended care facility and 1 year of experience in pediatrics Unlicensed assistive personnel (UAP) with 4 years of experience in the intensive care unit An LPN/LVN with 5 years of experience in a medical surgical unit - answer-1) Assessment, teaching, and evaluation should not be delegated. *2) The RN will need to ensure that discharge planning and discharge teaching needs have been met. Assessment, teaching, and evaluation should not be delegated. 3) See 1). 4) See 1). Cardiovascular Problems A patient with heart failure has a classification of II, according to the New York Heart Association. The RN determines which of the following activities to be possible for the patient to perform and still remain symptom free? Completing a 5K marathon Completing a 5-minute nap Completing a 5-minute walk Completing a 5-course meal - answer-1) This is significant physical activity; the patient will have symptoms. *2) This can be performed at rest. 3) This is moderate physical activity; the patient may have symptoms. 4) This is an ordinary physical activity that is performed for an extended period; the patient will have symptoms. Cardiovascular Problems The RN notes that the patient's ankle-brachial index (ABI) result in the left leg is 0.39. Which finding does this data reflect? Venous thromboembolism, causing venous dilation Cardiomyopathy, causing decreased cardiac output Atherosclerosis, causing arterial narrowing Normal finding for ABI - answer-1) ABI does not assess the venous system. 2) ABI does not assess cardiac output or cardiomyopathy. *3) ABI compares arm blood pressure to leg blood pressure. 0.39 is a low (abnormal) result which indicates peripheral artery disease. Peripheral artery disease is a narrowing of the arteries in the patient's legs, often times caused by atherosclerosis. 4) The result of 0.39 is not a normal finding. A normal result would be 1.0. Respiratory Problems Which measures should the RN implement in the plan of care for a child with asthma? (Select all that apply.) Schedule the child for allergy skin testing. Educate the child and parent on how to use a metered dose inhaler (MDI) Have the child complete peak flow rate monitoring monthly. Encourage the child to drink fluids, but avoid milk and milk products. Administer the child's cough suppressants as ordered by the physician. - answer-*1) Therapy for children with asthma involves planning for skin testing and hyposensitization to identified allergens that may cause an asthma attack. *2) MDIs and nebulizers are used to treat children with asthma when they are having bronchospasm. 3) Children with asthma should complete peak flow rate monitoring daily.