Podcast
Questions and Answers
Which clinical manifestation is more commonly observed in women experiencing a heart attack compared to men?
Which clinical manifestation is more commonly observed in women experiencing a heart attack compared to men?
- Heartburn
- Chest pain or tightness
- Sweating
- Jaw pain (correct)
A client with chronic stable angina, despite medication, reports increased frequency and intensity of chest pain. What is the most appropriate initial nursing intervention?
A client with chronic stable angina, despite medication, reports increased frequency and intensity of chest pain. What is the most appropriate initial nursing intervention?
- Obtain a 12-lead ECG and administer sublingual nitroglycerin. (correct)
- Administer oxygen at 2 L/min via nasal cannula.
- Notify the healthcare provider for possible admission.
- Encourage the client to rest and reassess pain in 15 minutes.
A client with heart failure is prescribed a potassium-wasting diuretic. What focused education should the nurse prioritize related to potential complications?
A client with heart failure is prescribed a potassium-wasting diuretic. What focused education should the nurse prioritize related to potential complications?
- Maintaining regular follow-up appointments with a cardiologist.
- Limiting fluid intake to 1500 mL per day.
- Adhering to a strict low-sodium diet.
- Monitoring for muscle weakness and cardiac arrhythmias. (correct)
A client with a history of aortic stenosis is scheduled for a dental procedure. Which prophylactic medication is the most important for the nurse to confirm is prescribed?
A client with a history of aortic stenosis is scheduled for a dental procedure. Which prophylactic medication is the most important for the nurse to confirm is prescribed?
A nurse is caring for a client post-surgical valve replacement with a mechanical valve. What laboratory value is most essential to monitor?
A nurse is caring for a client post-surgical valve replacement with a mechanical valve. What laboratory value is most essential to monitor?
A client with heart failure has been prescribed spironolactone. What specific dietary instruction should the nurse provide?
A client with heart failure has been prescribed spironolactone. What specific dietary instruction should the nurse provide?
A client with a history of chronic heart failure presents to the emergency department with acute dyspnea and frothy sputum. What is the priority nursing intervention?
A client with a history of chronic heart failure presents to the emergency department with acute dyspnea and frothy sputum. What is the priority nursing intervention?
A client with left-sided heart failure is prescribed digoxin. What assessment finding would warrant withholding the medication and notifying the healthcare provider?
A client with left-sided heart failure is prescribed digoxin. What assessment finding would warrant withholding the medication and notifying the healthcare provider?
A patient has been newly diagnosed with Crohn's disease. Which of the following instructions would the nurse give to ensure the best possible outcome and reduce the risk of disease exacerbation?
A patient has been newly diagnosed with Crohn's disease. Which of the following instructions would the nurse give to ensure the best possible outcome and reduce the risk of disease exacerbation?
A nurse is planning care for a client with ulcerative colitis experiencing frequent diarrhea. Which intervention is most important to include in the plan of care?
A nurse is planning care for a client with ulcerative colitis experiencing frequent diarrhea. Which intervention is most important to include in the plan of care?
A client with hepatitis B is being discharged. Which instruction requires further clarification?
A client with hepatitis B is being discharged. Which instruction requires further clarification?
A nurse is educating a client with diverticulitis about dietary management. Which food choice indicates the best understanding of dietary recommendations during an acute episode?
A nurse is educating a client with diverticulitis about dietary management. Which food choice indicates the best understanding of dietary recommendations during an acute episode?
A client is admitted with suspected hepatic encephalopathy. Which assessment finding is most indicative of this complication?
A client is admitted with suspected hepatic encephalopathy. Which assessment finding is most indicative of this complication?
A client with ulcerative colitis is prescribed sulfasalazine. What instructions should the nurse prioritize to ensure the client's safety and adherence?
A client with ulcerative colitis is prescribed sulfasalazine. What instructions should the nurse prioritize to ensure the client's safety and adherence?
What distinguishes Crohn's disease from ulcerative colitis in terms of the location and characteristics of the inflammation?
What distinguishes Crohn's disease from ulcerative colitis in terms of the location and characteristics of the inflammation?
A nurse completing discharge teaching for a patient with acute cholecystitis should prioritize which instructions?
A nurse completing discharge teaching for a patient with acute cholecystitis should prioritize which instructions?
A nurse is providing education to a patient who underwent a colonoscopy after being diagnosed with colorectal cancer. What statement indicates the patient needs further teaching?
A nurse is providing education to a patient who underwent a colonoscopy after being diagnosed with colorectal cancer. What statement indicates the patient needs further teaching?
Which laboratory finding is most indicative of acute liver damage?
Which laboratory finding is most indicative of acute liver damage?
A client with cirrhosis and ascites is scheduled for paracentesis. What nursing intervention is most important immediately following the procedure?
A client with cirrhosis and ascites is scheduled for paracentesis. What nursing intervention is most important immediately following the procedure?
Which nursing instruction should the nurse prioritize when educating the patient about home care? Select all that apply.
Which nursing instruction should the nurse prioritize when educating the patient about home care? Select all that apply.
Which of the following symptoms would lead the nurse to believe that the patient is experiencing Angina?
Which of the following symptoms would lead the nurse to believe that the patient is experiencing Angina?
A client newly diagnosed with heart failure demonstrates an understanding of sodium-restricted diet teaching when they select which meal?
A client newly diagnosed with heart failure demonstrates an understanding of sodium-restricted diet teaching when they select which meal?
A patient experiencing high fever with abdominal pain of three plus days should...
A patient experiencing high fever with abdominal pain of three plus days should...
A patient is experiencing symptoms of Hepatitis. Which foods should he/she avoid?
A patient is experiencing symptoms of Hepatitis. Which foods should he/she avoid?
Your patient with cirrhosis asks how to redue hepatic encephalopathy. Which of the following options should the nurse include in the teaching?
Your patient with cirrhosis asks how to redue hepatic encephalopathy. Which of the following options should the nurse include in the teaching?
Which of the following is considered a non-modifiable risk factor for coronary artery disease?
Which of the following is considered a non-modifiable risk factor for coronary artery disease?
While caring for the patient experiencing discomfort and pain from cholecystitis, the nurse should include which of the following interventions?
While caring for the patient experiencing discomfort and pain from cholecystitis, the nurse should include which of the following interventions?
A provider orders the following for the acute Chrohn's exacerbation client: low-fiber diet, ambulate 3x daily, administer anti-diarrheal medication after each loose stool, and 0.9 NS at 125 mL/hr. Which order should the nurse question?
A provider orders the following for the acute Chrohn's exacerbation client: low-fiber diet, ambulate 3x daily, administer anti-diarrheal medication after each loose stool, and 0.9 NS at 125 mL/hr. Which order should the nurse question?
A 55 year old obese male presents to the emergency room with fatigue and unexpected weight loss. He reports noticing dark black pieces in his stool over the last few weeks. Which of the following assessment questions is most important for the nurse to ask the patient?
A 55 year old obese male presents to the emergency room with fatigue and unexpected weight loss. He reports noticing dark black pieces in his stool over the last few weeks. Which of the following assessment questions is most important for the nurse to ask the patient?
A client with a history of Hepatitis C should be encouraged to avoid which activity?
A client with a history of Hepatitis C should be encouraged to avoid which activity?
A nurse is providing care to a 67 year old client with a recent diagnosis of heart failure. The client reports to the nurse, "I've never had to worry about my weight before, but now the doctor is telling me I have to weigh myself every day. I don't understand why. I feel fine!" What is the nurse's best response?
A nurse is providing care to a 67 year old client with a recent diagnosis of heart failure. The client reports to the nurse, "I've never had to worry about my weight before, but now the doctor is telling me I have to weigh myself every day. I don't understand why. I feel fine!" What is the nurse's best response?
The nurse admits a patient to the emergency room exhibiting right upper quadrant pain, nausea, and rebound tenderness and guarding. Her vital signs are as follows: HR 110, BP 150/88, RR 24, oral temperature 101.8. Based on this data, the nurse should prepare to:
The nurse admits a patient to the emergency room exhibiting right upper quadrant pain, nausea, and rebound tenderness and guarding. Her vital signs are as follows: HR 110, BP 150/88, RR 24, oral temperature 101.8. Based on this data, the nurse should prepare to:
The nurse is providing pre-op teaching to a client with end stage liver disease to prepare him for a colectomy. Due to the liver disease diagnosis, what clinical intervention should the nurse anticipate providing to the client?
The nurse is providing pre-op teaching to a client with end stage liver disease to prepare him for a colectomy. Due to the liver disease diagnosis, what clinical intervention should the nurse anticipate providing to the client?
The nurse is caring for a client and observes the following lab values: serum albumin 2.5 g/dL, total bilirubin 3.5 mg/dL, AST 150 u/L, ALT 175 u/L. The nurse anticipates that the client will:
The nurse is caring for a client and observes the following lab values: serum albumin 2.5 g/dL, total bilirubin 3.5 mg/dL, AST 150 u/L, ALT 175 u/L. The nurse anticipates that the client will:
A nurse is completing a health history with a newly admitted client who is reporting black, tarry stools. Which medication is the nurse most concerned about?
A nurse is completing a health history with a newly admitted client who is reporting black, tarry stools. Which medication is the nurse most concerned about?
A nurse is educating a post-operative client with a history of tobacco abuse about increasing their nutritional intake to promote wound healing. Which statement indicates that the client requires additional teaching?
A nurse is educating a post-operative client with a history of tobacco abuse about increasing their nutritional intake to promote wound healing. Which statement indicates that the client requires additional teaching?
A nurse is monitoring a client recently diagnosed with acute Hepatitis. The client's labs indicate that the jaundice, dark urine, and pruritus are decreasing, but they are now confused, irritable, and exhibit asterixis. The nurse is most concerned about:
A nurse is monitoring a client recently diagnosed with acute Hepatitis. The client's labs indicate that the jaundice, dark urine, and pruritus are decreasing, but they are now confused, irritable, and exhibit asterixis. The nurse is most concerned about:
Flashcards
Atherosclerosis
Atherosclerosis
Hardening and stiffening of the arteries, reducing blood flow.
Angina
Angina
Chest pain or discomfort caused by reduced blood flow to the heart.
Medical Management Goal for CAD/Angina
Medical Management Goal for CAD/Angina
Goal is to reduce risk/incidence of clots and decrease heart workload.
Why use Beta Blockers?
Why use Beta Blockers?
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ACE Inhibitors & ARBs
ACE Inhibitors & ARBs
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Crohn's Disease
Crohn's Disease
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Ulcerative Colitis
Ulcerative Colitis
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Diverticulitis
Diverticulitis
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Diverticulitis Diet
Diverticulitis Diet
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Risk Factors for Colorectal Cancer
Risk Factors for Colorectal Cancer
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Hepatitis Diet
Hepatitis Diet
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Hepatitis C Transmission
Hepatitis C Transmission
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Priority nursing action for hepatitis
Priority nursing action for hepatitis
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Immediate treatment/priority nursing actions
Immediate treatment/priority nursing actions
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Assessment for cholecystitis
Assessment for cholecystitis
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Study Notes
- The provided content is a review for Exam 2, covering Chronic Health Alterations, specifically Cardiac (Parts 1 and 2) and Gastrointestinal (GI) & Hepatitis topics.
Key Points for Coronary Artery Disease (CAD) and Angina
- Addresses modifiable and non-modifiable risk factors
- Discusses the pathophysiology of atherosclerosis and its manifestations
- Chronic angina needs to be distinguished from myocardial infarction (MI) through clinical manifestations
Diagnostics and Labs for CAD/Angina
- Includes CBC, cardiac enzymes, coagulation studies, and lipid panels
- Diagnostic approach starts with the least invasive methods moving to more invasive
- Diagnostic procedures include cardiac stress tests (treadmill or chemical) and angiography
- Nursing management involves client education and care before and after angiography
Medications for CAD and Angina
- The goal is reducing the incidence of clots and decreasing the heart's workload
- Common drugs include statins, anti-platelet aggregates, and vasodilators like Nitro
- For Nitro: administer sublingually every 5 minutes, up to 3 doses; call 911 if pain persists after the first dose
- Beta Blockers, Calcium Channel Blockers, ACE inhibitors, or ARBs are also used
Education for Medications
- Focus on the mechanism of action
- Instruct regarding when to notify the provider
- Explain what labs to monitor
Beta Blockers
- Reduce excessive sympathetic stimulation that worsens heart failure
- Increase diastolic filling time by slowing heart rate
- Prevent cardiac remodeling, crucial in heart failure with reduced ejection fraction (HFrEF)
Calcium Channel Blockers
- Dihydropyridines like Amlodipine are preferred for heart failure
- Non-dihydropyridines (Diltiazem, Verapamil) can worsen HFrEF
- Reduce afterload, decreasing the pressure against which the heart must pump
ACE Inhibitors & ARBs
- A first-line treatment for HFrEF (ejection fraction ≤40%)
- Reduce preload and afterload
- Prevent cardiac hypertrophy, improving long-term outcomes
- Reduce fluid overload by promoting sodium excretion
Discharge Education for CAD/Chronic Angina
- Diet should be reviewed. Recommendations include: -Fats -Cholesterol -Red meat -Salt intake -Omega 3s -Complex Carbs (Fiber)
- Exercise
- Smoking cessation
Valvular Heart Disease
- Clinical manifestations resemble heart failure
- Could be asymptomatic for years, with fatigue as the first sign
- Diagnostics involve EKG, CXR, and Echocardiogram
- Medication goals focus on reducing the heart's workload and fluid volume
- Surgical management includes valve replacement with mechanical or biologic valves
- Mechanical valves require long-term anticoagulation due to thromboembolism risk -Biologic valves do not require long-term anticoagulation but don't last as long
- Monitor coagulation labs (PT/PTT/INR)
Heart Failure
- Distinguish between Right- vs Left-Side Heart Failure -Left: Pulmonary Congestion -Right: Venous back-up
- Diagnostics use Echo, CXR, Stress Test, Angiography, and BNP
- First-line medication goals reduce workload and increase contractility
- Education includes K+ wasting diuretics and monitoring potassium
GI Conditions
Crohn’s Disease
- Affects all layers of the bowel from mouth to anus
- Presents with skip lesions and deep ulcerations
- Leads to 5-6 loose stools/day and malabsorption of nutrients
- Surgery not curative
Ulcerative Colitis
- Affects only the mucosa and submucosa of the large intestine
- Spreads uniformly
- Presents with diarrhea (>20 stools/day), liquid, bloody, and mucous
- Surgery is curative
- Diagnostic tools: colonoscopy and barium enema, labs
Common treatment for IBD
- Medications
- Nutrition and supplementation
- Call 911 for high fever and sudden abdominal pain/dehydration
- Education: small frequent meals and rest periods
Diverticulitis
- Outpouching from decreased fiber, slow stool transit time, and increased pressure
- Fever, LLQ pain, or mid-abdominal cramping may appear
- Complications include perforation
- Diagnostics: abdominal XR, CT
- Management: fluids, NPO, NG tube for suction, pain control
- High or low fiber diet depends on when to have it; avoid nuts and seeds, especially during flare-ups
Colorectal Cancer
- Risk factors include high BMI, alcohol/tobacco use, T2DM, and IBD > 10 years
- General manifestation is fatigue, unexpected weight loss
- Specific Manifestations: abdominal pain or distention, altered bowel habits, red/black stool
- Screening starts at age 45-75, earlier if high risk -Annual FOBT -Sigmoidoscopy: every 5 years -Colonoscopy: every 10 years
- Medical Management: chemo, radiation, surgery
- Nursing: intake/output, pain management, diet and fluid status, NGT
Hepatitis
- Low fat and moderate protein intake is recommended
- Encourage activity
- Educate when to call 911: changes in mental status, weight loss, high fever
- Smaller frequent meals
- Limiting fats
Cholecystitis
- RUQ colicky pain that can radiate to the back
- Pain increase after eating a large meal
- Possible N/V and jaundice
- Promote bed rest in Semi-Fowler's; avoid laying flat
- Diet should avoid fatty foods and heavy alcohol use
- Bland foods with probiotics, whole grains, fruits, and lean meat are encouraged
- Monitor VS, skin turgor, pain, abdominal assessment, daily weight, Intake/output
Test-Taking Strategies
- Do not read into the provided data but be aware that what is provided is important
- Look for words in the question like "Immediate"
- Determine if the question is a positive or negative query
- Answer based only on the information provided
- Eliminate, and re-read the question before final selection
Hypovolemia Question
- Clinical Judgement: Notice/Interpret/Respond: Client is compensating for hypovolemia
- Hypotension and elevated heart rate indicate client needs blood transfusion (Priority)
Cardiac Question #1
- The priority intervention for a client experiencing stable angina is to Administer sublingual nitroglycerin, as prescribed
Cardiac Question #2
- Administering oxygen takes priority when a client presents to you in respiratory distress
Cardiac Question #3
- Patients with aortic stenosis should avoid nitroglycerin. It can lead to syncope, and worsening prefusion
Cardiac Question #4
- Daily weight gain is an easy indicator of excess fluid retention
GI Question #1
- The priority action is fluid resuscitation due to significant diarrhea and dehydration
GI Question #2
- The priority action is administering lactulose, to reduce the hand tremors
GI Question #3
- Clients with Crohns should have a diet in low dairy and low fats to avoid diarrhea and inflammmation
GI Question #4
- Educate pregnant clients not to share the bathroom in order to avoid disease transmission
Exam Details
- Exam 2 takes place on Wednesday, March 26 at 10:00 am ET for both sections
- The Exam consists of 50 questions, and you will have 75 minutes to complete the exam
- Exam download will be available by Tuesday, March 25.
- Covered in Module 6,7 and 8
- Post-exam review will follow at 1:00 pm on March 26.
What to Include in your Study Materials
- PDFs and available Study Guides
- Homework
- Kaplan Videos and Case studies
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