Practice Perfusion NCLEX Questions, clinical

Practice Perfusion NCLEX Questions, clinical decision making practice questions, Inflammation NCLEX Questions, LPN to ADN Study Guide Leave the first rating Terms in this set (244) Science MedicineCardiology Save The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive highest priority?

• BP 110/62, atrial fibrillation with HR

82, bibasilar crackles

• Confusion, urine output 15mL over

the last 2 hours, orthopnea.

• SpO2 92 on 2 liters nasal cannula,

respirations 20, 1+ edema of lower extremities.

• Weight gain of 1kg in 3 days, BP

130/80, mild dyspnea with exercise.

• A low urine output and confusion are signs of

decreased tissue perfusion. Orthopnea is a sign of left-sided heart failure. Crackles, edema and weight gain should be monitored closely, but the levels are not as high a priority. With atrial fibrillation there is a loss of atrial kick, but the blood pressure and heart rate are stable

Which of the following is an expected outcome when a client is receiving an IV administration of furosemide?

• Increased blood pressure
• Increased urine output
• Decreased pain
• Decreased premature ventricular

contractions

• Furosemide is a loop diuretic that acts to

increase urine output. Furosemide does not increase blood pressure, decrease pain, or decrease arrhythmias The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease?

• a 32-year-old female with mitral

valve prolapse who quit smoking 10 years ago.

• a 43-year-old male with a family

history of CAD and cholesterol level of 158

• A 56-year-old male with an HDL of

60 who takes atorvastatin (Lipitor)

• A 65-year-old female who is

obese with an LDL of 188

• The woman who is 65-years-old, over weight

and has an elevated LDL is at greatest risk. Total cholesterol >200, LDL >100, HDL <40 in men, HDL <50 in women, men 45-years and older, women 55- years and older, smoking and obesity increase the risk of CAD. Atorvastatin is a medication to reduce LDL and decrease risk of CAD. The combination of postmenopausal, obesity and high LDL cholesterol places this client at greatest risk.

A 58-year-old female with a family history of CAD is being seen for her annual physical exam. Fasting lab

test results include: Total cholesterol

198; LDL cholesterol 120; HDL cholesterol 58; Triglycerides 148; Blood sugar 102; and C-reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medication and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse?

• "The labs indicate severe

hyperlipidemia and the medications will lower your LDL, along with a low-fat diet."

• "The triglycerides are elevated and

will not return to normal without these medications."

• "The CRP is elevated indicating

inflammation seen in cardiovascular disease, which can be lowered by the medications ordered."

• "The medications are not indicated

since your lab values are all normal."

• CRP is a marker of inflammation and is elevated

in the presence of cardiovascular disease. The high sensitivity CRP (hs-CRP) is the blood test for greater accuracy in measuring the CRP to evaluate cardiovascular risk. The family history, post- menopausal age, LDL above optimum levels and elevated CRP place the client at risk of CAD. Statin medications can decrease LDL, whereas statins and aspirin can reduce CRP and decrease the risk of MI and stroke.

An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual

because of:

• Left ventricular atrophy
• Irregular heartbeats
• Peripheral vascular occlusion
• Pacemaker placement
• In older adults who are less active and do not

exercise the heart muscle, atrophy can result.Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle.Decreased cardiac output, cardiac hypertrophy, and heart failure are examples of the chronic conditions that may develop in response to inactivity, rather than in response to the aging process. Irregular heartbeats are generally not associated with an older sedentary adult's lifestyle.Peripheral vascular occlusion or pacemaker placement should not affect response to stress.A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the

nurse would be that:

• The drug will have no effect on

insulin needs.

• The drug might cause

hypoglycemia.

• The drug could cause

hyperglycemia.

• The client should ask the physician

this question.

• The drug might cause hypoglycemia.

There is increased incidence of hypoglycemia with type I diabetes mellitus, because propranolol can inhibit glycogenolysis.