When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:
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Solution
This combination promotes diuresis but decreases the risk of hypokalemia
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
Direct-acting vasodilators have which of the following effects on the heart rate?
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Solution
Heart rate increases
Heart rate increases in response to decreased blood pressure caused by vasodilation.
In order to prevent the development of tolerance, the nurse instructs the patient to:
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Solution
Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?
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Solution
“Apply the patch to a nonhairy, nonfatty area of the upper torso or arms.”
A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates.
Option B: Sites should be rotated to prevent skin irritation.
Option C: The drug should be continued if headache occurs because tolerance will develop.
Option D: Sublingual nitroglycerin should be used to treat chest pain.
A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:
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Solution
Decreased arterial blood flow secondary to vasoconstriction
Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.
A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?
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Solution
Creatine kinase (CK or CPK)
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.
Options B, C, and D: Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.
A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom is explained by which of the following statements?
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Solution
The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.
The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart’s having to beat faster to meet the body’s needs for oxygen.
A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?
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Solution
Maintaining cardiac monitoring
Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished by the MI monitoring.
A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:
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Solution
Myocardial scarring and perfusion
This scan detects myocardial damage and perfusion, an acute or chronic MI.
Option D: Specific ventricular function is tested by a gated cardiac blood pool scan.
To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:
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Solution
Distal to the catheter insertion
Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.