Cardiac-Vascular Nursing Flashcards

A patient's supine position during examination reveals jugular veins that are enlarged from the base of the neck to the angle of the jaw. This result suggests:

Answer: Increased central venous pressure

Distended jugular veins, especially when visible from the base of the neck to the angle of the jaw in a supine position, are a classic clinical sign of elevated central venous pressure (CVP). Increased CVP indicates higher pressure in the right atrium and vena cava, often associated with conditions like right-sided heart failure or fluid overload.

The cardiac-vascular nurse gives the following instructions to a patient who has intermittent claudication:

Answer: Walk as tolerated

For patients with intermittent claudication, a symptom of peripheral artery disease (PAD), supervised exercise programs, particularly walking, are a cornerstone of treatment. Walking as tolerated helps improve collateral circulation, reduce symptoms, and enhance functional capacity, making it a recommended instruction.

A cardiac-vascular nurse gives an individual who experienced a myocardial infarction a review of suggested exercises. The client claims, "What I do or don't do is unimportant. Either I grow better, or I pass away." This assertion shows:

Answer: Feelings of loss of control

The patient's statement, 'What I do or don't do is unimportant. Either I grow better, or I pass away,' indicates a belief that their actions have no influence on their health outcome. This reflects a sense of helplessness and a profound feeling of loss of control over their health situation, rather than acceptance or an internal locus of control.

A patient receiving outpatient cardiac rehabilitation for ten weeks still shows signs of despair. The cardiac-vascular nurse includes the following in the discharge plan she creates:

Answer: A referral for counseling and possible medication

Persistent signs of despair after ten weeks of cardiac rehabilitation suggest the patient may be experiencing clinical depression, which is common following a myocardial infarction. The most appropriate intervention for ongoing despair is a referral for professional psychological counseling and evaluation for antidepressant medication, as these are evidence-based treatments for depression.

The cardiac-vascular nurse notices a pattern of excessive calorie intake on Monday, Wednesday, and Friday nights after studying the patient's four-week diet history. The patient claims that their spouse has recently begun attending a nearby university for a night class on those evenings. According to the patient's diet history:

Answer: An individual coping behavior

The pattern of excessive calorie intake specifically on nights when the spouse is absent suggests a personal response to the spouse's absence, possibly due to loneliness, stress, or boredom. This indicates an individual coping behavior, where the patient uses food to manage emotions or fill a void, rather than a family-wide issue or lack of dietary knowledge.

The following ejection fraction of a patient who underwent percutaneous, transluminal coronary angioplasty four weeks ago is 30%. The patient makes a follow-up appointment. An examination demonstrates mild pedal edema and clean lungs upon auscultation. Digoxin (Lanoxin), furosemide (Lasix), enalapril maleate (Vasotec), and aspirin are the patient's current meds. The patient claims to have put on 5 lbs (2.27 kg) in the last two days. The first step taken by the cardiac-vascular nurse is to:

Answer: Inquire about the patient's medication compliance

A 5-pound weight gain in two days, coupled with mild pedal edema, strongly indicates fluid retention, which is a common sign of worsening heart failure. Given the patient is prescribed a diuretic (furosemide) and other heart failure medications, the nurse's immediate priority is to assess medication compliance, as non-adherence is a frequent cause of decompensation.

A patient in a research study says they no longer want the medication as the cardio-vascular nurse gets ready to give them an experimental heart medication. The patient is informed by the nurse that:

Answer: He or she has a right to refuse the medication and to withdraw from the study

Patients participating in research studies have fundamental ethical and legal rights, including the right to informed consent and the right to withdraw from the study at any time. The nurse's role is to uphold these rights and ensure the patient's autonomy is respected without coercion. Therefore, informing the patient of their right to refuse and withdraw is the most appropriate and ethical response.