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© Yes Your answer is correct! You selected Aspirin, Nitroglycerin, Morphine, and Oxygen, which are the four anticipated prescriptions for a patient experiencing chest pain, following the MONA protocol. Here's why each one is appropriate: 1. Morphine - Used to relieve chest pain and reduce myocardial oxygen demand, which can help decrease the workload on the heart. 2. Oxygen — Helps ensure adequate oxygen supply, especially if the patient is experiencing shortness of breath or has low oxygen saturation. 3. Nitroglycerin — A vasodilator that helps improve blood flow to the heart by dilating coronary arteries, relieving chest pain. 4. Aspirin — An antiplatelet medication that prevents blood clot formation and reduces the risk of further blockage in coronary arteries. Why the other options are incorrect: - Atropine is used for bradycardia (slow heart rate), but your patient has tachycardia, making it unnecessary. - Furosemide is a diuretic mainly used for fluid overload or heart failure, not acute chest pain management. Would you like a more detailed explanation on any of these treatments? O06 VM Ev The question is asking the nurse to determine the greatest risk factors based on the client's history. Key Points from the Client's History: - Smoking 1 pack/day for 40 years > Major risk factor for cardiovascular disease. - Diabetes mellitus > Increases risk for heart disease and stroke. - Obstructive sleep apnea > Can contribute to hypertension and cardiovascular issues. - Alcohol use (4 beers/day) > Increases risk for hypertension and heart disease. - Family history of coronary artery disease (CAD) > Genetic predisposition to heart conditions. - Symptoms: Shortness of breath, palpitations, dizziness, irregular heart rhythm (per EKG) > Indicates possible atrial fibrillation or another cardiac issue. Most Likely Conditions at Greatest Risk: 1. Stroke — The irregular heart rhythm (potentially atrial fibrillation) significantly increases the risk of stroke. 2. Heart Failure — Long-term smoking, diabetes, and alcohol use contribute to heart failure. Correct Answers: The nurse should identify that the client is at the greatest risk for developing stroke and heart failure. Would you like a breakdown of why the other options are less likely? Of VM Ev This question is asking you to differentiate between left-sided heart failure and right-sided heart failure based on assessment findings. Key Differences Between Left-Sided and Right-Sided Heart Failure: 1. Left-Sided Heart Failure (LHF) - Affects the lungs (because the left ventricle fails to pump blood effectively to the body, causing fluid buildup in the lungs). + Symptoms include: + Pulmonary congestion (crackles in lung sounds) - Dyspnea (shortness of breath) + Cough + Orthopnea (difficulty breathing when lying down) + Increased BNP (B-type natriuretic peptide, which rises when heart failure worsens) 2. Right-Sided Heart Failure (RHF) - Affects systemic circulation (since the right ventricle fails to pump blood to the lungs, causing fluid backup in the body). + Symptoms include: + Peripheral edema (swelling in legs and feet) - Jugular vein distension (JVD) - Hepatomegaly (enlarged liver) - Ascites (fluid in the abdomen) - Weight gain How to Categorize the Assessment Findings: Assessment Finding Left-Sided HF Right-Sided HF Heart assessment (irregular (can be present in both) rhythm, tachycardia) Neck vein assessment (Jugular x vein distension) BNP result (Elevated in both heart failures) Breath sounds (Crackles, fluid x buildup in lungs) Cough (Result of pulmonary x congestion) Final Answer: - Left-Sided Heart Failure: Heart assessment, BNP result, Breath sounds, Cough. « Right-Sided Heart Failure: Heart assessment, Neck vein assessment, BNP result. Would you like any further explanation on why each symptom fits? O06 VW Sv It looks like your answer was partially correct for distinguishing left-sided vs. right- sided heart failure. Let's go over the correct classification based on the diagnostic results. Reviewing the Assessment Findings: 1. Heart assessment (Tachycardia, abnormal heart sounds) . Both Left-Sided and Right-Sided Heart Failure + The heart is affected in both types of heart failure. 2. Neck vein assessment (Jugular vein distension, systemic congestion) » & Right-Sided Heart Failure + This is a classic sign of right-sided heart failure due to fluid backup in the venous system. 3. BNP result (Elevated levels due to heart failure) » © Both Left-Sided and Right-Sided Heart Failure + BNP is a marker of heart failure in general and can be elevated in both types. 4. Breath sounds (Crackles, pulmonary congestion) » © Left-Sided Heart Failure + Left heart failure leads to pulmonary congestion and fluid accumulation in the lungs. 5. Cough (Result of pulmonary fluid buildup) - © Left-Sided Heart Failure + This occurs due to fluid backup in the lungs from left-sided heart failure. What You May Have Missed: - Heart assessment should have been marked for both left-sided and right- sided failure. - BNP should have been marked for both left-sided and right-sided failure. Correct Classification: Assessment Finding Left-Sided HF Right-Sided HF Heart assessment Neck vein assessment BNP result Breath sounds Saag xs x x8) 8/8 Cough Final Takeaways: - Left-Sided HF > Pulmonary symptoms (crackles, cough, shortness of breath) - Right-Sided HF > Systemic congestion (JVD, peripheral edema, ascites) It looks like you were very close! Let me know if you need further clarification! Of VM Ev This question is assessing the client's understanding of the DASH (Dietary Approaches to Stop Hypertension) diet, which is designed to lower blood pressure and promote heart health. DASH Diet Key Principles: 1. Increase: - Fruits and vegetables (4-5 servings per day) + Whole grains (6-8 servings per day) + Low-fat dairy (2-3 servings per day) - Nuts, seeds, legumes (4-5 servings per week) + Lean protein (<2 servings per day) 2. Reduce: + Sodium intake (goal: less than 2,300 mg/day, ideally 1,500 mg) + Red meats and processed meats + Full-fat dairy - Added sugars and sugary beverages Evaluating the Client's Statements: - Correct Understanding: . “| understand that | need to eat 4 to 5 servings of vegetables a day.” + This aligns with DASH guidelines. . “| have to increase my consumption of nuts, seeds, and dry beans to eat 4 to 5 servings weekly.” + This is also correct per DASH recommendations. - Incorrect Understanding: - X "lam so glad | can still eat meat with every meal.” - DASH encourages limiting red meat and consuming lean proteins sparingly. . x “| always drink whole milk with every meal and at bedtime.” + Whole milk is high in saturated fat. DASH recommends low-fat or fat-free dairy instead. Final Takeaway: The correctly highlighted statements should be: - “Lunderstand that I need to eat 4 to 5 servings of vegetables a day.” - “| have to increase my consumption of nuts, seeds, and dry beans to eat 4 to 5 servings weekly.” Would you like any further explanation? Ob VW Sv This question asks about the adverse effects of ACE inhibitors (Angiotensin- Converting Enzyme inhibitors), which are commonly used to treat hypertension. Common Side Effects of ACE Inhibitors: 1. Persistent Dry Cough — Most notable adverse effect + Occurs due to increased bradykinin levels. - A frequent reason for discontinuation or switching to an ARB (angiotensin receptor blocker). 2. Angioedema (Serious but rare) + Swelling of the face, lips, tongue, and throat. - Requires immediate medical attention. 3. Hyperkalemia - Elevated potassium levels. + Can lead to cardiac complications. 4. Hypotension - Especially after the first dose. 5. Renal Impairment — Should be monitored in patients with kidney disease. Answer: The nurse should instruct the client to notify their provider if they experience persistent cough, as this is a common and notable adverse effect of ACE inhibitors. Why the Other Options Are Incorrect: + Tendon pain — More associated with fluoroquinolone antibiotics (not ACE inhibitors). - Frequent urination — Common with diuretics but not ACE inhibitors. - Constipation — Not a common side effect of ACE inhibitors. Final Answer: &% Persistent cough Would you like a further explanation on ACE inhibitors? Of VM Ev This question is assessing the nurse's response to heparin therapy complications, particularly in the setting of an elevated aPTT (activated partial thromboplastin time) and hematuria (blood in urine). Key Points: - Normal aPTT Range for Heparin Therapy: 30-40 seconds (baseline) + Therapeutic Range for Heparin: 1.5 to 2 times the normal value (typically 60-80 seconds). + The client's aPTT is 96 seconds, which is too high, indicating excessive anticoagulation and increased bleeding risk. - Hematuria is a sign of bleeding, which suggests heparin-induced over- anticoagulation. Answer Analysis: 1. Increase the heparin infusion flow rate by 2 mL/hr x + This would worsen the bleeding risk by further increasing the anticoagulation effect. 2. Continue to monitor the heparin infusion as prescribed x + This would be inappropriate because the aPTT is already too high and the patient has active bleeding. 3. Request a prothrombin time (PT) + PT is used to monitor warfarin (Coumadin) therapy, not heparin. The correct test for heparin is aPTT. 4. Stop the heparin infusion (Correct Answer) + Immediate action is to stop heparin to prevent further bleeding. + The provider should also be notified, and protamine sulfate (heparin antidote) may be administered if needed. Final Answer: &% Stop the heparin infusion. Would you like additional clarification? O06 VM Ev This question asks which client statement should prompt the nurse to contact the provider and consider rescheduling the exercise electrocardiography (stress test). Key Considerations for an Exercise ECG (Stress Test) - The test evaluates how the heart responds to physical exertion. - Contraindications for proceeding include: - Recent or worsening chest pain (indicates unstable angina or risk of Ml). + Smoking before the test (can increase heart rate and blood pressure, affecting results). + Not taking prescribed heart medications (can cause inaccurate test results). - Eating a heavy meal before the test (may cause discomfort but usually doesn't require rescheduling). Evaluating the Statements: 1. “I'm still hungry after the bowl of cereal | ate at 7 a.m.” . x Incorrect — Eating a small meal may not significantly impact the test. This does not require rescheduling. 2. "I didn't take my heart pills this morning because the doctor told me not to.” . x Incorrect — Some medications, such as beta-blockers, are intentionally withheld before stress tests to evaluate heart function without their effects. 3. “| have had chest pain a couple of times since | saw my doctor in the office last week.” . Correct — New or worsening chest pain suggests possible unstable angina, which can increase the risk of a cardiac event during the test. The provider should be contacted before proceeding. 4. “I smoked a cigarette this morning to calm my nerves about having this procedure.” . x Incorrect but concerning — Smoking can affect test results by increasing heart rate and blood pressure, but it does not automatically require rescheduling. Final Answer: &% “I have had chest pain a couple of times since | saw my doctor in the office last week.” Would you like further clarification on why certain options are correct or incorrect? O06 VW Sv Your answer is correct! The best assessment to differentiate between arterial ulcers and venous stasis ulcers is to inquire about the presence of claudication. Key Differences Between Arterial and Venous Ulcers: Feature Arterial Ulcers Venous Stasis Ulcers Location Toes, feet, lateral ankle Medial ankle, lower leg Pain Painful, worsens with activity or | Mild pain, relieved by elevation elevation Claudication Yes — pain in legs with walking, No - venous ulcers are not relieved by rest related to claudication Appearance Deep, round edges, necrotic Superficial, irregular edges, wet tissue, pale/dry wound bed with granulation tissue Skin Changes | Thin, shiny, cool skin, hair loss Thick, brownish, warm, swollen skin Pulses Weak/absent Present Why the Other Options Were Incorrect: 1. Exploring family history of peripheral vascular disease X + Family history is important but does not differentiate between arterial vs. venous ulcers. 2. Noting the presence/absence of pain + Both ulcer types can be painful. Arterial ulcers are typically more painful, but pain alone is not enough to differentiate them. 3. Asking about a recent infection 3 - Both arterial and venous ulcers can become infected, so this does not help distinguish between them. Final Takeaway: + Claudication (pain in legs during walking, relieved by rest) is a hallmark of arterial disease. - Venous ulcers do not cause claudication. Final Answer: &% Inquire about the presence of claudication. Great job! Let me know if you want further clarification. Of VW Sv This question is asking which postoperative finding in a patient 8 hours after a coronary artery bypass graft (CABG) should be reported to the provider. Normal vs. Concerning Post-CABG Findings: Finding Expected/Acceptable? | Reasoning Mediastinal drainage 100 mL/ XX Report Excessive bleeding; normal is hr <150 mL/hr for the first few hours, then should gradually decrease. >150 mL/hr may indicate hemorrhage. Blood pressure 160/80 mm Hg | XX Report Hypertension can stress the graft site and lead to bleeding or rupture. BP should be controlled postoperatively. Temperature 37.1°C (98.8°F) Acceptable Slight temperature elevation is normal post-op due to inflammation. Concern arises if >38.0°C (100.4°F). Potassium 4.0 mEq/L (3.5 - Acceptable Normal potassium levels help 5.0 mEq/L) prevent dysrhythmias post- CABG. Concern arises if <3.5 mEq/L or >5.0 mEq/L. Best Answer: The nurse should report blood pressure of 160/80 mm Hg because hypertension increases the risk of graft rupture, bleeding, and cardiac complications. Would you like more clarification on post-CABG care? O06 VM Ev This question asks which client statement requires further clarification before proceeding with coronary artery bypass graft (CABG) surgery. Key Considerations for Preoperative CABG Care: - Anticoagulants like warfarin should be held before surgery to prevent excessive bleeding. - Aspirin is often stopped 5-7 days prior to surgery to reduce bleeding risk (unless specifically allowed by the provider). - Blood pressure should be controlled before surgery, but taking antihypertensive medication as prescribed is expected. - Blood sugar management is crucial, and insulin doses are often adjusted. Evaluating the Statements: 1. “My arthritis is really bothering me because | haven't taken my aspirin ina week.” . Expected - Aspirin is typically stopped before surgery to reduce bleeding risk, so this is not concerning. 2. “My blood pressure shouldn't be high because | took my blood pressure medication this morning.” . Expected - Some antihypertensive medications are continued before surgery, so this statement does not require clarification. 3. “Il took my warfarin last night according to my usual schedule.” - & Incorrect (Requires Clarification) — Warfarin (Coumadin) is a blood thinner and should be stopped several days before major surgery to prevent excessive bleeding. + This requires immediate clarification and provider notification. 4. “| will check my blood sugar because | took a reduced dose of insulin this morning.” . Expected - Insulin doses are often adjusted preoperatively to prevent hypoglycemia while the patient is fasting. Final Answer: “I took my warfarin last night according to my usual schedule.” + Why? Warfarin should be held before CABG surgery to prevent bleeding complications. Would you like further clarification on anticoagulants before surgery? O06 VW Br This question asks which client is at risk for developing peripheral arterial disease (PAD). Key Risk Factors for Peripheral Arterial Disease (PAD): PAD is a condition where narrowed arteries reduce blood flow to the limbs, usually due to atherosclerosis. Major risk factors include: 1. Diabetes Mellitus — Increases the risk of atherosclerosis and poor circulation. . Smoking — A major risk factor for PAD due to its effect on blood vessels. . Hypertension — Causes arterial damage over time. 2 3 4. High Cholesterol — Leads to plaque buildup in arteries. 5. Obesity and Sedentary Lifestyle — Contribute to poor circulation. 6 . Excessive Alcohol Consumption — Can lead to high blood pressure and vascular issues. chatgpt.com 
