Bible week 2 questions

AA patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?

a. Platelet count is 42,000/μL.

b. Petechiae are present on the chest.

c. Blood pressure (BP) is 94/56 mm Hg.

d. Blood is oozing from the venipuncture site.

a. Platelet count is 42,000/μL.

A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

A. Apply pressure to needlestick sites for 10 min.

B. Assess core temperatures using a rectal thermometer.

C. Measure abdominal girth twice weekly.

D. Monitor for the presence of WBCs in the urine.

A. Apply pressure to needlestick sites for 10 min.

Which sign would the nurse expect to assess in the client diagnosed with immune thrombocytopenic purpura (ITP)?

1. Petechiae on the anterior chest, arms, and neck.

2. Capillary refill of less than three (3) seconds.

3. An enlarged spleen.

4. Pulse oximeter reading of 95%.

1. Petechiae on the anterior chest, arms, and neck.

Which order needs clarification? Sodium chloride IV

A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When re- viewing the health care provider's admission orders, which of the following orders is most important for the nurse to question?

a. Oxygen at 4 L/min per nasal cannula

b. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved

c. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours

d. IV nitroglycerin at 5mcg/min; increase by 5mcg/min every 3to 5 minutes Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.

c. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours

1. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?

a. Prothrombin time

b. Erythrocyte count

c. Fibrinogen degradation products

d. Activated partial thromboplastin time

d. Activated partial thromboplastin time

Patient comes into ER for suspected MI. What should be the 1st thing to do?

Oxygen - because intervention (do not put EKG - assessment)

Heparin purpose?

Not a clot buster but a blood thinner, prevent

Statin SE?

Muscle weakness

Digoxin toxicity

anorexia/halo, confusion, nausea

RHF

peripheral tissues, 3 lbs in 1-2 days or 3-5 lbs in 1 week

LHF

=pulmonary congestion, crackle, decrease cardiac output, cold extremities, decrease pulses, Paroxysmal nocturnal dyspnea

CABG (is coronary artery bypass surgery. If there is multi vessel coronary disease, more than 3 vessel blockage then they go for CABG Sx with CT Sx)

a. Numbness and cold extremities

b. Rehab -> Aspirin

c. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).

d. Postoperative care of a patient undergoing coronary artery by- pass graft (CABG) surgery includes monitoring for Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications.

Anginas

- untable angina treated with nitroglycerin

Chronic stable angina

ischemia → Few minutes, provoked by stress, relieved by nitroglycerin

Prinzmetal angina

coronary vasospasm → occurs at rest, triggered by environment, smoking or substance use

Unstable angina

ruptured of unstable plague → New, Chronic, lasts more than 10 minutes

What do you check before transfusion?

IV site and platelet count

Priority questions both has PCI (2 questions)

a. After receiving a change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first?

a. A 39-yr-old patient with pericarditis who is complaining of sharp, stabbing chest pain

b. A 56-yr-old patient with variant angina who is scheduled to receive nifedipine (Procardia)

c. A 65-yr-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge

d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

Thrombocytopenia (2 questions)

TTP, ITP, HIT → TTP

platelets forming arterioles and capillaries

Thrombocytopenia (2 questions)

Bleeding and clotting occur simultaneously

ITP acquired through thrombocytopenia

Post PCI care:

a. Monitoring for signs of recurrent angina (cardiac monitor)

b. Frequent assessment of VS (temp, P, cap refill), including HR and rhythm, LOC

c. Evaluation of the insertion site for signs of bleeding (asssess if oozing out, hematoma, bruising, or internal bleeding) -> flank pain

d. Neurovascular assessment of extremity used (check for stroke)

e. Maintenance of bed rest

Cardiac biomarkers

a. Troponin (4-6 hours)

b. CK-MB (6-8 hours)

c. Myoglobin (1-2 hours)

Complications post-MI

a. Dysrhythmia

b. HF

c. Pericarditis (leaning, pleural friction rub, dyspnea with hiccup)

d. Cardiogenic shock

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will

a. reduce heart palpitations.

b. prevent coronary artery plaque.

c. decrease coronary artery spasms.

d. increase contractile force of

c. decrease coronary artery spasms.

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?

a. Assign the patient to a private room.

b. Avoid intramuscular (IM) injections.

c. Use rinses rather than a soft toothbrush for oral care.

d. Restrict activity to passive and active range of motion.

b. Avoid intramuscular (IM) injections.

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/μL. Which action will the nurse include in the plan of care?

a. Prepare for platelet transfusion.

b. Discontinue the heparin infusion.

c. Administer prescribed warfarin (Coumadin).

d. Use low-molecular-weight heparin (LMWH).

b. Discontinue the heparin infusion.

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?

a. The platelet count is 52,000/μL.

b. The patient is difficult to arouse.

c. There are purpura on the oral mucosa

d. There are large bruises on the patient's back.

b. The patient is difficult to arouse.

A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?

a. Platelet count is 42,000/L.

b. Petechiae are present on the chest.

c. Blood pressure (BP) is 94/56 mm Hg.

d. Blood is oozing from the venipuncture site.

a. Platelet count is 42,000/L.

The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The laboratory test result most helpful in indicating myocardial damage will be

a. Myoglobin.

b. troponins T and I.

c. homocysteine (Hcy)

d. creatine kinase-MB (CK-MB).

b. troponins T and I.

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will

a. reduce heart palpitations.

b. prevent coronary artery plaque.

c. decrease coronary artery spasms.

d. increase contractile force of the heart.

c. decrease coronary artery spasms.

The nurse suspects that the patient with stable angina is experiencing a side effect of the prescribed drug metoprolol (Lopressor) if the

a. patient is restless and agitated.

b. blood pressure is 90/54 mm Hg.

c. patient complains about feeling anxious.

d. heart monitor shows normal sinus rhythm.

b. blood pressure is 90/54 mm Hg.

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for

a. decreased blood pressure and heart rate.

b. fewer complaints of having cold hands and feet.

c. improvement in the strength of the distal pulses.

d. participation in daily activities without chest pain.

d. participation in daily activities without chest pain.

After an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse evaluates the patient's response to the activity, which data would indicate that the exercise level should be decreased?

a. O2 saturation drops from 99% to 95%.

b. Heart rate increases from 66 to 98 beats/min.

c. Respiratory rate goes from 14 to 20 breaths/min.

d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

b. Heart rate increases from 66 to 98 beats/min.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Appropriate instructions for the patient include

a. limit dietary sources of potassium.

b. take the hydrochlorothiazide before bedtime.

c. notify the health care provider if nausea develops.

d. take the digoxin if the pulse is below 60 beats/min.

c. notify the health care provider if nausea develops.

The nurse is assessing a patient with myocarditis before giving the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider?

a. Leukocytosis

b. Irregular pulse

c. Generalized myalgia

d. Complaint of fatigue

b. Irregular pulse

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess 1st?

a. A 39-yr-old patient with pericarditis who is complaining of sharp, stabbing chest pain

b. A 56-yr-old patient with variant angina who is scheduled to receive nifedipine (Procardia)

c. A 65-yr-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge

d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

Which topic will the nurse plan to include in discharge teaching for a patient with heart failure with reduced ejection fraction (HFrEF)?

a. Need to begin an aerobic exercise program several times weekly

b. Use of salt substitutes to replace table salt when cooking and at the table

c. Importance of making an annual appointment with the health care provider

d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

Lab to report w benzapil?

K 3.0

Active MI meds

Oxygen

Nitro

Aspirin

Morphine

Dont give with ITP

NSAIDS

Pt refused n/a and takes digoxin?

Assess vitals

Heparin reversal?

Protamine sulfate

Left sided HF except:

JVD

Pt w/ ITP and platelet ct of 45k:

give corticosteroids

Adamts13 deficiency:

TTP

STEMI

ST elevation

Troponin shows

MI and how much damage

A-fib rhythm

irregular

Radio frequency ablation:

electrical energy that destroys conduction system areas

Implant of a radioactive device

Brachytherapy for breast cancer

Sign of ITP

petechiae

HF lab to order first

Echocardiogram

Report to provide if pt is receiving Warfarin

PT 45 seconds

Discharge ngn: Indicated and contraindicated

Contra: Preparing for the tournament

Everything else is indicated

Left HF

limit sodium

Right side

HT Urine output

Signs and symptoms hepatomegaly

[Fatigue. Nausea or lack of appetite.

Jaundice (yellowing of the skin & eyes).

Dark-colored urine & lightcolored stools.

Itchy skin (pruritis)

Enlarged spleen (splenomegaly)]

Use of aspirin

(162 to 325 mg of chewable aspirin)