NUR 257 / NUR257 Exam 3 – Concepts of Aging and Chronic Illness in Nursing Review (Latest 2026/2027 Update) | Galen | Complete Study Guide | Verified Questions & Answers | 100% Correct Solutions | Grade A

NUR 257 / NUR257 Exam 3 – Concepts of Aging and Chronic Illness in Nursing Review (Latest 2026/2027 Update) | Galen | Complete Study Guide | Verified Questions & Answers | 100% Correct Solutions | Grade A Q: Insulin binding to its receptor on target cells results in Answer increased facilitated cellular diffusion of glucose. 3 multiple choice options Q: In the United States, more than ________ people have diabetes mellitus. Answer 34.2 million 3 multiple choice options Q: Which are microvascular complications of diabetes mellitus? (Select all that apply.) A. Cardiovascular disease B. Nephropathy C. Retinopathy D. Stroke E. Neuropathy Answer BC 3 multiple choice options Q: Diabetic neuropathy is thought to result from Answer decreased myoinositol transport. 3 multiple choice options Q: Which therapies would be appropriate for a patient with type 1 diabetes mellitus? (Select all that apply.) A. High-protein diet B. Oral hypoglycemic agents C. Carbohydrate counting D. Insulin E. Daily exercise Answer CDE 3 multiple choice options Q: A clinical finding consistent with a hypoglycemic reaction is Answer tremors. 3 multiple choice options Q: ________ is the most powerful predictor of developing type 2 diabetes mellitus. Answer Obesity 3 multiple choice options Q: The underlying pathogenic mechanism for type 1 diabetes is Answer pancreatic β-cell destruction. 3 multiple choice options Q: How is the principle of substituted judgement defined? Answer A surrogate makes a decision based on what they believe the person would have made if they were able to do so. 3 multiple choice options Q: An older client with Type II Diabetes Mellitus tells a nurse: "I don't know how I am going to continue with this blood sugar testing. I know it is important, but the strips are so expensive." The nurse formulates a response based on the what knowledge? Answer Diabetic testing supplies are covered by Medicare part B. 3 multiple choice options Q: What indicator is most helpful in evaluating long-term blood glucose management in patients with diabetes mellitus? Answer Glycosylated hemoglobin levels (HbA1c) 3 multiple choice options Q: The American Diabetes Association recommends a postprandial blood glucose level of ________ mg/dL for adults with diabetes. Answer less than 180 3 multiple choice options Q: In diabetic ketoacidosis, respiratory compensation may occur through a process of Answer respiratory alkalosis. 3 multiple choice options Q: A type of insulin that would be most appropriate for acute management of hyperglycemia is Answer regular. 3 multiple choice options Q: Type 2 diabetes mellitus is often associated with Answer nonketotic hyperosmolality. 3 multiple choice options Q: The breakdown of stored glycogen in the liver and muscles is called Answer glycogenolysis. 3 multiple choice options Q: When an older adult is considering long-term care insurance (LTCI), which is an important consideration? Answer Carefully scrutinize all exclusions before enrolling. 3 multiple choice options Q: An older client is pronounced brain dead, and the attorney-in-fact or surrogate named in her POA is opposed to organ donation; the law in the state allows a surrogate with a POA to make end-of-life decisions. Although the client failed to document it, family members state that the client wanted to be an organ donator. Given the law about a POA, what does the nurse expect the surrogate to do? Answer Provide consent. 3 multiple choice options Q: The underlying pathogenic mechanism for type 2 diabetes is Answer insulin resistance and β-cell dysfunction. 3 multiple choice options Q: Which are clinical findings usually associated with type 1 diabetes mellitus? (Select all that apply.) Weight gain A. Polyphagia B. Polyuria C. Obesity D. Polydipsia E. Weight gain Answer ABD 3 multiple choice options Q: Diabetes mellitus is the ________ leading cause of death and a major cause of disability in the United States. Answer seventh 3 multiple choice options Q: An older woman accompanies her husband to the geriatric clinic. The husband has been diagnosed with Alzheimer's disease and needs maximum assistance with activities of daily living (ADLs). The wife has made the decision to place her husband in a long-term care facility as she is no longer able to care for him. The wife expresses concern about the cost of the long-term care facility and the worry that all of their funds will be used to pay for the facility leaving no funds for her own care. The nurse formulates a response based on what understanding? Answer Only one half of combined value of household goods is used to determine eligibility for Medicaid. 3 multiple choice options Q: The older adult who diagnosed with type 2 diabetes mellitus has a sensory impairment and unstable blood sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar? Answer Has difficulty hearing conversations in crowded rooms 3 multiple choice options Q: Hyperglycemia is harder to detect in older adults due to which of the following? Answer There is a higher tolerance for elevated levels of circulating glucose in older adults. 3 multiple choice options Q: Which of the following statements is true about diabetes mellitus? Answer Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dL. 3 multiple choice options An older adult who is a non-Hispanic Caucasian has a fasting blood sugar level above 130 mg/dL. Which client assessment does the nurse use to confirm a high risk for diabetes mellitus in the client? Answer 68 years of age 3 multiple choice options Which factor is commonly associated with the development of cardiovascular comorbidities for those diagnosed with type 2? Answer Alcohol use 3 multiple choice options The nurse assists an older adult man who diagnosed with type 2 diabetes mellitus to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in 1 day? Answer Monitor blood glucose levels before and after walk. 3 multiple choice options An older adult man diagnosed with diabetes mellitus complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort? Answer Wear well-fitting shoes 3 multiple choice options The nurse recognizes which of the following signs and symptoms as an indication of hypothyroidism in an older adult? (Select all that apply.) A. Decrease in thyroid-stimulating hormone (TSH) and thyroxine (T4) B. Heat intolerance C. Gait disturbances D. Palpitations E. Decline in cognitive function CDE 3 multiple choice options When teaching a client about foods that do not increase blood glucose, which should the nurse include? Broccoli 3 multiple choice options Which laboratory results are goals for reducing a person's risk for diabetes and heart disease? High-density lipoprotein (HDL) over 35 mg/dL 3 multiple choice options The nurse teaches an older adult diagnosed with diabetes mellitus and prescribed metoprolol to recognize early clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in client teaching as the indicators this man is most likely to detect? (Select all that apply.) A. Confusion B. Anxiety C. Dizziness D. Diaphoresis E. Impaired vision F. Tachycardia BDF 3 multiple choice options Which is the best goal when planning nursing care for an older client diagnosed with diabetes mellitus? Facilitate self-management. 3 multiple choice options Which is the most likely reason that thyroid disorders are often difficult to diagnose in older adults? The classic symptoms may not be present in older adults. 3 multiple choice options The nurse is caring for a client diagnosed with hyperthyroidism. Which signs and symptoms indicate hyperthyroidism? (Select all that apply.) A. Heart failure B. Cold intolerance C. Sudden onset of symptoms D. Constipation E. Atrial fibrillation ACDE An older adult diagnosed with Type II DM who is being treated with insulin wants to increase his activity level and begin a walking program. What recommendations should the nurse provide to this client? The walking regimen needs to be done on a regularly scheduled basis. 3 multiple choice options Cerebral aneurysm is most frequently the result of subarachnoid hemorrhage. 3 multiple choice options ________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes. Nystagmus 3 multiple choice options Intracranial pressure normally ranges from ______ mm Hg. 0 to 15 3 multiple choice options Acceleration-deceleration movements of the head often result in polar injuries in which focal injuries occur in two places at opposite poles. 3 multiple choice options Manifestations of acute brain ischemia (Cushing reflex) are due primarily to sympathetic nervous system activation. 3 multiple choice options It is true that Bell palsy is a paralysis of the muscles innervated by the facial nerve. 3 multiple choice options The most important preventive measure for hemorrhagic stroke is blood pressure control. 3 multiple choice options It is true that epidural bleeding is characterized by a lucid interval immediately after injury. 3 multiple choice options The physiologic change most likely to lead to an increase in intracranial pressure is cerebral vasodilation. 3 multiple choice options Which are common causes of acquired parkinsonism? (Select all that apply.) A. Seizure disorder B. History of trauma C. History of intoxication D. Degeneration of dopaminergic neurons E. History of infection BCE 3 multiple choice options The most important determinant for prescribing therapy for acute stroke is ischemic versus hemorrhagic cause. 3 multiple choice options Which group of clinical findings indicates the poorest neurologic functioning? Assumes decorticate posture with light touch, no verbal response 3 multiple choice options A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of amyotrophic lateral sclerosis. 3 multiple choice options Risk factors for hemorrhagic stroke include acute hypertension. 3 multiple choice options Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to cerebral vasospasm. 3 multiple choice options ________ edema occurs when ischemic tissue swells because of cellular energy failure. Cytotoxic 3 multiple choice options Clinical manifestations of a stroke within the right cerebral hemisphere include left-sided muscle weakness and neglect. 3 multiple choice options The stroke etiology with the highest morbidity and mortality is intracranial hemorrhage. 3 multiple choice options In the acute phase of stroke, treatment is focused on stabilization of respiratory and cardiovascular function. 3 multiple choice options It is true that encephalitis is usually because of a viral infection in brain cells. 3 multiple choice options Rupture of a cerebral aneurysm should be suspected if the patient reports sudden, severe headache. 3 multiple choice options What type of seizure usually occurs in children and is characterized by brief staring spells? Absence 1 multiple choice option Seizures that involve both hemispheres at the outset are termed generalized. 3 multiple choice options Secondary injury after head trauma refers to brain injury resulting from the body's response to tissue damage. 3 multiple choice options The initial treatment of an individual experiencing a seizure is concentrated on maintaining an airway. 3 multiple choice options A severe complication of elevated intracranial pressure is brain herniation. 3 multiple choice options What self management skill would you not teach to an older adult client who has diabetes mellitus? The importance of eating fats and carbohydrates 3 multiple choice options Rugs on the floor is an extrinsic fall risk? True 1 multiple choice option Reduced vision is an extrinsic fall risk factor? False 1 multiple choice option Intrinsic fall risk includes cognitive impairment and effects of medications? True 1 multiple choice option Which of the following nursing interventions are suitable as a last resort treatment for gout? Colchicine by mouth. 3 multiple choice options Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? Improper assistive device use contributes to older adult falls. 3 multiple choice options The nurse administers an opioid analgesic to an older adult postop client. Which is most important intervention? Instruct the client to ask for help before getting up. 3 multiple choice options Arthritis of the knee may result in ligamentous weakness and instability causing the legs to give way or collapse. True 1 multiple choice option Evista and calcitonin is a medication that is used to prevent the development of osteoporosis and slow its progression. True 1 multiple choice option A patient has hypoglycemia and is hungry and shaky. What shows correct patient understanding in this situation. I will eat 3 graham crackers. 3 multiple choice options A new type 2 diabetes patient is receiving education from his nurse. What should be the nurse's priority in education? Create a plan for when you have hypoglycemic episodes 3 multiple choice options When educating a patient about diabetic foot care, what should be most important and included in the education? Make sure your shoes fit properly. 3 multiple choice options Glucose in the urine of a type 1 diabetic could cause the patient to be incontinent. True 1 multiple choice option Patient who typically has good control of their diabetes, has an A1C of 9.4%. What is best response from RN? Have you been doing something differently 3 multiple choice options If a patient with type 2 diabetes has a blood sugar of 44 the best action would be to offer the patient an apple. True 1 multiple choice option The RN is teaching a DM2 patient interventions for the plan of care, the RN should instruct them to strictly avoid carbs. False 1 multiple choice option What statement shows proper understanding on education of diabetic foot care. I will inspect my shoes for foreign objects before putting them on. 3 multiple choice options Insulin promotes glucose metabolism to produce energy. True 1 multiple choice option Antipsychotic drugs can cause the following in a diabetic patient. Select all that apply. A. Decreased appetite B. Insulin resistance C. Weight gain D. Hyperglycemia emergencies E. B-cell damage to the pancreas. BCDE 3 multiple choice options Type 1 diabetes is common in the aging adult. False 1 multiple choice option Patient is an older adult with pre-diabetes, you need to teach them which of the following? Select all that apply. A. Smoking cessation B. Keeping the low-density lipoprotein (LDL) level below 100mg/dl. C. Keeping the triglyceride level above 150 mg/dl D. Keeping the fasting blood sugar (FBS) below 126 mg/dl E. Maintaining her blood pressure (BP) at 130/80 mm Hg or less F. Maintaining a cholesterol level above 200mg/dl. ABDE 3 multiple choice options The first line of treatment for a newly diagnosed 85 year old with Type 2 diabetes would be metformin. False 1 multiple choice option Hyperglycemia in and older adult with type 2 diabetes could cause microvascular and macrovascular complications. True 1 multiple choice option The brain cannon store glucose. True 1 multiple choice option The following are true statements for diabetic patients who are taking corticosteroids. Select all that apply. A. Steroids stop glucose from being absorbed by muscle and fat and increase blood sugar. B. Taking steroids causes the liver to stop releasing sugar into blood stream. C. Reduces the body sensitivity to insulin. D. Steroid induced diabetes is more common in adults who are at risk for DM2. ACD 3 multiple choice options If a patient feels hungry and shaky, and has mild hypoglycemia, the nurse should give them 1mg of glucagon. False 1 multiple choice option Type 1 diabetes is considered an autoimmune disorder that occurs early in life. True 1 multiple choice option Which statement indicates that the patient will need more teaching about peripheral neuropathy and diabetes type 2? I can break in my shoes by wearing them all day. 3 multiple choice options Which indicates a need for further teaching for a new diabetic patient on weight control? I will exercise for 2 hours every day. 3 multiple choice options When educating a newly diagnosed diabetic patient, which indicates understanding about wearing the medic alert bracelet? If I become hypoglycemic, I could become unconscious. 3 multiple choice options Symptoms of a TIA resolve within 30-60 minutes 3 multiple choice options Symptoms of TIA Blurred vision, diplopia, blindness in one eye, tunnel vision, weakness, ataxia. The B in BEFAST Balance loss The E in BEFAST Eye sight changes The F in BEFAST Facial drooping The A in BEFAST Arm weakness The S in BEFAST Speech difficulty The T in BEFAST Time to call 911. Which dysrhythmia is thought to be associated with reentrant mechanisms? Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome) 3 multiple choice options A patient with forward effects of heart failure may present with which symptoms? (Select all that apply.) A. Aggression B. Stupor C. Confusion D. Impaired memory E. Mental fatigue CDE 3 multiple choice options Lusitropic impairment refers to impaired diastolic relaxation 3 multiple choice options A patient with heart failure who reports intermittent shortness of breath during the night is experiencing paroxysmal nocturnal dyspnea. 3 multiple choice options In which dysrhythmias should treatment be instituted immediately? Atrial fibrillation with a ventricular rate of 220 beats/minute 3 multiple choice options When assessing an individual during an acute asthma episode, you should expect to find which manifestations? (Select all that apply.) A. Foul-smelling sputum B. Feeling of chest tightness C. Coughing D. Use of accessory breathing muscles E. Expiratory wheezing BCDE 3 multiple choice options After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is associated with specific allergic triggers. 3 multiple choice options Obstructive disorders are associated with low expiratory flow rates 3 multiple choice options Copious amounts of foul-smelling sputum are generally associated with bronchiectasis. 3 multiple choice options All obstructive pulmonary disorders are characterized by resistance to airflow. 3 multiple choice options The nurse working in a long-term care facility completes morning assessment on a new postoperative client and notes a change in cognitive status from the previous day? The nurse recognizes which of the following as a precipitating factor for delirium? (Select all that apply.) A. Female gender B. History of dementia C. Poor sleep habits D. Poor nutrition E. Dehydration BCDE 3 multiple choice options Which assessment parameter should the nurse use to differentiate between delirium and depression in an older adult? Orientation 3 multiple choice options At 10 PM, an older adult resident attempts to climb over the bedrails. Which intervention should the nurse implement first? Talk to the resident about his behavior. 3 multiple choice options An older adult client diagnosed with dementia resides with an adult daughter. When the home care nurse visits, the daughter tearfully tells the nurse that her parent scratched her hand and cursed at her when she was attempting to provide care. She states, "I don't know why my partner hates me and wants to hurt me." How will the nurse respond to the client's daughter? "Let's try to figure out what your father was trying to say with his behavior." 3 multiple choice options Which of the following approaches to hygienic care is beneficial for a client diagnosed with dementia? Explain each step as you go and keep the client covered as much as possible while bathing. 3 multiple choice options An older adult arrives at the emergency department with a probable diagnosis of a hemorrhagic stroke. The nurse understands, based on the client's age, that the most likely cause is which one of the following? Uncontrolled hypertension 3 multiple choice options An older adult comes to the emergency department after falling at home, and reports "I can't walk without losing my balance." Which steps should the nurse implement for this client? Determine symptom onset or when the fall occurred. 3 multiple choice options Which of the following behavior modifications should the nurse instruct a client to accomplish to help reduce the risk factors for an occurrence of a stroke. (Select all that apply.) A. Avoid obesity. B. Control blood pressure. C. Increase the intake of green, leafy vegetables. D. Stop smoking. E. Increase physical activity. BDE 3 multiple choice options Which of the following statements is true about Parkinson disease (PD)? It is advised to take levodopa-carbidopa on an empty stomach. 3 multiple choice options Which of the following are common side effects of Parkinson’s disease (PD) and the medications used to treat it? (Select all that apply.) A. Dyskinesias B. Dystonia C. Sleep disorders D. Depression E. Nausea ABCD 3 multiple choice options When differentiating the characteristics of depression, delirium, and dementia, the nurse recognized which of the following as an indicator of delirium? Sudden onset 3 multiple choice options An older adult has a wound infection 5 days after a below-the-knee amputation brought about by diabetes mellitus. Which of the following is the nurse's priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult? Remove invasive devices as soon as possible. 3 multiple choice options The nurse recognizes which of the following displays may indicate hyperactive delirium? Nonpurposeful repetitive movements 3 multiple choice options An older adult is recovering from a bowel resection in the intensive care unit but remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium from developing in this client? Provide uninterrupted periods of rest and sleep. 3 multiple choice options An older adult is diagnosed to be in the early stage of Alzheimer’s disease. The diagnosis is made on the presence of which of the following outcomes? (Select all that apply.) A. Impaired judgement B. A decline from a previous level of functioning C. A gradual decline in cognitive abilities D. Easily frustrated E. Mild memory loss CE 3 multiple choice options The nurse in a rehabilitation center is caring for a client diagnosed with new-onset stroke with right-side hemiparesis. Which intervention should the nurse implement when caring for this client? Gives the client a dry erase board. 3 multiple choice options A new nurse in a long-term care facility is caring for a client diagnosed with Parkinson's disease (PD). The nurse should note that which one of the following actions is likely to be observed during the assessment? Resting hand tremors 3 multiple choice options An older adult comes to the emergency department after falling at home, and reports "I can't walk without losing my balance." Which steps should the nurse implement for this client? Determine symptom onset or when the fall occurred. 3 multiple choice options Which intervention to manage wandering in clients in a long-term care facility should be implemented? (Select all that apply.) A. Engaging the person in social interactions B. Close observation to identify the person’s individual patterns C. Providing enclosed pathways for walking D. Using physical restraints to prevent wandering to maintain safety E. Camouflaging doorways ABCE 3 multiple choice options A home health nurse is completing an admission on a client who recently experienced a transient ischemic attack (TIA). During the assessment, the client begins to report a severe headache and numbness in the left arm. Which action should the nurse take initially? Call 9-1-1. 3 multiple choice options After completing an admission assessment on a client who recently experienced a stroke, the nurse should choose which of the following nursing diagnoses as a priority? Altered cerebral perfusion 3 multiple choice options Which of the following statements is true about cognitive impairments in older adults? The Confusion Assessment Method (CAM) should be administered on admission to detect delirium. 3 multiple choice options Which of the following statements is true about dysarthria? A nasogastric tube may be necessary. 3 multiple choice options A 75 - year - old female with type 2 diabetes is admitted to the hospital for pneumonia . The nurse reviews her current medications and notices she is taking metformin , insulin , and a beta - blocker for hypertension . The client is experiencing decreased appetite and mild confusion . What should the nurse do first ? Assess the client's blood glucose levels 3 multiple choice options A 68 - year - old male with type 2 diabetes reports feeling increasingly fatigued and experiencing excessive thirst and frequent urination . His most recent blood glucose level is 350 mg / dL . Which of the following is the most important intervention for the nurse to implement ? Initiate fluid replacement therapy 3 multiple choice options A nurse is assessing a 72 - year - old client with diabetes who is admitted for an exacerbation of chronic obstructive pulmonary disease ( COPD ) . The client has a history of frequent falls . What is the priority assessment for this client ? Blood glucose levels 3 multiple choice options A 78 - year - old client with type 2 diabetes has a recent diagnosis of diabetic retinopathy . The nurse should explain that which of the following could contribute to the progression of this condition ? High blood pressure 3 multiple choice options A 75 - year - old client with type 2 diabetes and hypertension is being discharged after a hospitalization for a stroke . The nurse is discussing post - discharge medication management . Which of the following instructions should the nurse include in the teaching ? ' It is important to continue taking your diabetes medications as prescribed , even if your appetite decreases . " 3 multiple choice options A 65 - year - old client with type 1 diabetes is admitted with an acute infection . The nurse anticipates that the client may need an adjustment in insulin therapy . Which of the following explains why insulin adjustments may be necessary in this situation ? The body becomes more resistant to insulin during times of infection. 3 multiple choice options A 78 - year - old client is admitted with a diagnosis of acute ischemic stroke . The nurse observes the client is unable to move their right arm and has slurred speech . Which of the following interventions is the nurse's priority ? Monitor the client's vital signs 3 multiple choice options A 70 - year - old male who has just experienced a stroke is being assessed by the nurse . The client demonstrates right - sided weakness and aphasia . The nurse understands that these symptoms suggest the stroke is likely located in which area of the brain ? Left hemisphere 3 multiple choice options A 72 - year - old client who experienced stroke two weeks ago is being discharged from the hospital . The nurse is preparing discharge teaching for the family . Which statement by the family indicates the need for further teaching about stroke recovery ? " The client can resume driving now that the worst of the stroke is over . " 3 multiple choice options A 68 - year - old female with a history of hypertension and type 2 diabetes is admitted to the emergency department with symptoms of a stroke . The healthcare provider orders a CT scan . Which of the following is the primary reason the nurse should prepare the patient for this diagnostic test ? To determine if the stroke is ischemic or hemorrhagic 3 multiple choice options The nurse is caring for a 72 - year - old client who has had a stroke and is experiencing left - sided weakness . The nurse observes that the client is attempting to feed themselves but is using their right hand to grasp the utensils . Which action should the nurse take first ? Place the food closer to the client's left hand to encourage its use 3 multiple choice options A 72 - year - old client with mild cognitive impairment ( MCI ) expresses concern about their memory . They are worried that their forgetfulness may progress into Alzheimer's disease . The nurse explains that mild cognitive impairment is : A condition that can progress to Alzheimer's disease but not always 3 multiple choice options A 68 - year - old client with Parkinson's disease is prescribed carbidopa - levodopa . The nurse should inform the client that the medication : May take several weeks to show therapeutic effects 3 multiple choice options A nurse is caring for a 74 - year - old client with Parkinson's disease who has developed a soft , monotone voice and difficulty initiating speech . This condition is known as : Dysarthria 3 multiple choice options A 71 - year - old client with Parkinson's disease reports feeling " frozen " or unable to move at times . The nurse recognizes this as : Akinesia 3 multiple choice options A 72 - year - old client with COPD is being discharged after an exacerbation . Which statement by the client indicates a need for further teaching about oxygen therapy ? I will make sure to turn off my oxygen when I'm sleeping . 3 multiple choice options A 74 - year - old client with COPD prescribed an inhaled corticosteroid ( ICS ) and is receiving instructions from the nurse . Which of the following statements by the client indicates a need for further education regarding the use of the inhaler ? " If I miss a dose , I should double up on the next dose . " 3 multiple choice options A nurse is educating a 70 - year - old client with COPD about the importance of smoking cessation . The nurse should emphasize that smoking cessation is most beneficial in : Preventing further damage to the lungs and improving respiratory function 3 multiple choice options A 78 - year - old client with COPD is prescribed long - acting bronchodilators ( LABAs ) and inhaled corticosteroids ( ICS ) . Which of the following is an important consideration when using these medications ? The client should always use the bronchodilator before the corticosteroid inhaler . 3 multiple choice options A nurse is caring for an 80 - year - old client with COPD who is receiving oxygen therapy . The nurse should monitor the client closely for which potential complication associated with long - term oxygen therapy ? Oxygen toxicity 3 multiple choice options A 72 - year - old client with heart failure presents with edema , weight gain , and shortness of breath . The nurse should assess for which of the following symptoms as an early sign of worsening heart failure ? Decreased urine output and increased shortness of breath 3 multiple choice options A 76 - year - old client with atrial fibrillation ( AF ) is prescribed warfarin . The nurse should instruct the client to : Report any unusual bruising or bleeding immediately 3 multiple choice options A 73 - year - old client with a history of congestive heart failure ( CHF ) is prescribed digoxin . The nurse should monitor for which of the following symptoms that could indicate digoxin toxicity ? Nausea , vomiting , and visual disturbances 3 multiple choice options A nurse is preparing to administer a dose of furosemide ( Lasix ) to an 80 - year - old client with heart failure . Which of the following assessments should the nurse perform before administering the medication ? Potassium level 3 multiple choice options A 78 - year - old client with a history of COPD , cardiovascular disease ( CVD ) , diabetes mellitus ( DM ) , and Parkinson's disease is admitted to the hospital with increased shortness of breath and fatigue . The client is receiving multiple medications , including inhalers , beta - blockers , insulin , and carbidopa - levodopa . Which of the following actions should the nurse prioritize when developing the care plan for this client ? Assess the client's ability to safely perform activities of daily living ( ADLs ) due to Parkinson's disease 3 multiple choice options What self-management skills would you NOT teach to an older adult client who has diabetes mellitus the importance of eating fats and carbohydrates 3 multiple choice options A client with Type 2 diabetes is prescribed metformin. What is the most important instruction the nurse should give? avoid alcohol while on this medication. 3 multiple choice options Rugs on the floor is an Extrinsic fall risk true 1 multiple choice option Reduced vision is an Extrinsic fall risk factor false 1 multiple choice option Intrinsic Fall risk includes Cognitive impairment and effects of medicatons true 1 multiple choice option Which of the following nursing interventions are suitable as a last resort treatment for gout? colchicine by mouth 3 multiple choice options Which of the following is a true statement about assistive devices to aid older adults with impaired mobility? improper assistive device use contributes to older adult falls. 3 multiple choice options The nurse administers an opioid analgesic to an older adult postop client. Which is most important intervention? instruct the client to ask for help before getting up. 3 multiple choice options Arthritis of the knee may result in ligamentous weakness and instability causing the legs to give way or collapse. true 1 multiple choice option Evista and Calcitonin is a medication that is used to prevent the development of osteoporosis and slow its progression true 1 multiple choice option A patient has hypoglycemia and is hungry and shaky. What shows correct patient understanding in this situation. i will eat 3 graham crackers 3 multiple choice options A new type 2 diabetes patient is receiving education from his nurse. What should be the nurse's priority in education? create a plan for when you have hypoglycemic episodes 3 multiple choice options When educating a patient about diabetic foot care, what should be most important and included in the education? make sure you shoes fit properly 3 multiple choice options Glucose in the urine of a type 1 diabetic could cause the patient to be incontinent true 1 multiple choice option Patient who typically has good control of their diabetes, has an A1C of 9.4%. What is best response from RN? have you been doing something differently? 3 multiple choice options If a patient with type 2 diabetes has a blood sugar of 44 the best action would be to offer the patient and apple true 1 multiple choice option The RN is teaching a DM2 patient interventions for the plan of care, the RN should instruct them to strictly avoid carbs false 1 multiple choice option What statement shows proper understanding on education of Diabetic foot care. i will inspect my shoes for foreign objects before putting them on. 3 multiple choice options Insulin promotes glucose metabolism to produce energy true 1 multiple choice option Antipsychotic drugs can cause the following in a diabetic patient. Select all that apply A. decreased appetite B. insulin resistance C. weight gain D. hyperglycemia emergencies E. b-cell damage to the pancreas BCDE 3 multiple choice options Type 1 Diabetes is common in the aging adult false 1 multiple choice option Patient is an older adult with pre-diabetes, you need to teach them which of the following? (Select all that apply.) A. Smoking cessation B. Keeping the low-density lipoprotein (LDL) level below 100 mg/dL C. Keeping the triglyceride level above 150 mg/dL D. Keeping the fasting blood sugar (FBS) below 126 mg/dL E. Maintaining her blood pressure (BP) at 130/80 mm Hg or less F. Maintaining a cholesterol level above 200 mg/dL ABDE 3 multiple choice options The first line of treatment for a newly diagnosed 85 year old with Type 2 Diabetes would be metformin false 1 multiple choice option Hyperglycemia in and older adult with type 2 diabetes could cause microvascular and macrovascular complications. true 1 multiple choice option The brain cannot store glucose true 1 multiple choice option The following are true statements for diabetic patients who are taking corticosteroids: select all that apply A. Steroid induced diabetes is more common in adults who are at risk for DM2. B. taking steroids causes the liver to stop releasing sugar into blood stream C. Steroids stop glucose from being absorbed by muscle and fat, & increase BS D. reduces the body' sensitivity to insulin ACD If a patient feels hungry and shaky, and has mild hypoglycemia, the nurse should give them 1 mg of glucagon. false 1 multiple choice option Type 1 Diabetes is considered an autoimmune disorder that occurs early in life true 1 multiple choice option Which statement indicates that the patient will need more teaching about Peripheral Neuropathy and Diabetes Type 2? i can break in my shoes by wearing them all day 3 multiple choice options Which indicates a need for further teaching for a new diabetic patient on weight control i will exercise for 2 hours every day 3 multiple choice options When educating a newly diagnosed diabetic patient, which indicates understanding about wearing the MedicAlert Bracelet? If I become hypoglycemic, I could become unconscious 3 multiple choice options When an older adult has asthma that is not getting better with medications, it could be due to other health conditions. true 1 multiple choice option Pt complaints of increased shortness of breath, wheezing, and chest tightness over the past few days. Which is priority check oxygen saturation using a pulse oximeter. 3 multiple choice options RN is educating an older adult w asthma about using an inhaled corticosteroid. Which indicates a need for teaching? "I can stop taking the medication when my symptoms improve." 3 multiple choice options Pt w a history of asthma is prescribed a short-acting beta-agonist (SABA) inhaler. What correct teaching is needed? "Use the inhaler if you experience sudden shortness of breath or wheezing" 3 multiple choice options Pt w asthma who has increased dyspnea and wheezing despite using their prescribed medications. Which is most appropriate administer rescue inhaler as prescribed and notify the healthcare provider. 3 multiple choice options Pt w asthma asks why they are more susceptible to asthma exacerbations compared to younger individuals. Best response is immunity tends to weaken with age, & it's harder to fight resp infections 3 multiple choice options The common denominator in all forms of heart failure is : reduced cardiac output. 3 multiple choice options Asthma is categorized as a restrictive pulmonary disorder. false 1 multiple choice option COPD is an Obstructive Respiratory Disease true 1 multiple choice option Which of the following is a true statement about heart disease in older adults? Both excessive urination at night & decreased urination can be signs of HF 3 multiple choice options Patients with type 2 diabetes mellitus always require insulin therapy. false 1 multiple choice option A Hemoglobin A1c (HbA1c) level of 7.0% or lower is typically considered good control for a person with diabetes. true 1 multiple choice option Diabetic ketoacidosis (DKA) is more common in patients with type 2 diabetes than in those with type 1 diabetes. false 1 multiple choice option Patients with diabetes should avoid all carbohydrates to maintain normal blood sugar levels. false 1 multiple choice option A patient with diabetes should immediately treat any sign of hyperglycemia by eating a high carbohydrate snack. false 1 multiple choice option 80 yr old w history of COPD is admitted with pneumonia. Which assessment findings is most concerning to to RN? oxygen saturation of 88% on room air 3 multiple choice options Pt w increasing SOB. Which position would the nurse suggest to help the patient breathe more easily? High Fowler's position with pillows supporting the arms 3 multiple choice options COPD has a long-acting muscarinic antagonist (LAMA) inhaler. Which indicates a need for further teaching? this inhaler will help me during sudden episodes of breathlessness 3 multiple choice options For discharge instructions to an older patient w pneumonia. Which statement by the patient indicates an understanding? i should drink plenty of fluids to help thin the mucus in my lungs 3 multiple choice options 85yr old w emphysema & barrel chest, pursed-lip breathing, & resp rate of 24 breaths per minute. What is the priority? instruct the patient to practice pursed-lip breathing techniques. 3 multiple choice options 78yr old, history of HF with SOB, fatigue, & weight gain of 5lbs over 3 days. What is the RN's priority assessment? auscultate lung sounds for crackles. 3 multiple choice options 82yr old patient with A-fib is taking digoxin. RN knows to closely monitor for which signs of digoxin toxicity? bradycardia, nausea, and visual disturbances 3 multiple choice options 75-yr old newly diagnosed W/ CHF & RN is educating on lifestyle modifications. Which indicates a need for more teaching? "It’s okay to drink as much water as I want since it’s healthy." 3 multiple choice options 80 yr old w/ history of HTN is prescribed a thiazide diuretic. What diet education to prevent potential complications? "Increase your intake of foods high in potassium." 3 multiple choice options 85 yr old w S/S of MI. RN should monitor for which complication that is more common in older adults following an MI? atrial fibrillation 3 multiple choice options 78 yr old w/ dementia has UTI. She is more confused, restless, and disoriented than usual. What should the RN suspect Onset of delirium due to the UTI 3 multiple choice options 72 yr old w Parkinson's disease has been prescribed levodopa-carbidopa. What is the primary reason for this medication? to relieve tremors and muscle rigidity 3 multiple choice options A patient with Parkinson's disease has difficulty swallowing (dysphagia). What is the priority nursing diagnosis? risk for aspiration 3 multiple choice options RN is planning care for an older adult with Parkinson's disease who is at risk for falls. Which intervention is best? encourage the patient to use a walker at all times 3 multiple choice options A family member asks the RN how to best communicate with a loved one who has moderate Alzheimer's disease. What is best? "Use short, simple sentences and give one instruction at a time." 3 multiple choice options Pt w sudden severe headache described as the worst headache of my life, & confused. Why would RN suspect a hemorrhagic? sudden onset of severe headache with focal neurological deficits 3 multiple choice options 82 yr old w delirium returns to hospital after surgery. Which intervention is most appropriate to help reduce delirium? provide a clock and calendar and ensure familiar objects are in the room 3 multiple choice options A 90 yr old w/moderate Alzheimer's disease wanders frequently and attempts to leave the unit. What action should RN take place patient in room near the nurses' station and provide supervision 3 multiple choice options 85 yr old w/advanced dementia is becoming increasingly agitated and aggressive in evening. What action should RN take? provide a calming, quiet environment with reduced stimuli 3 multiple choice options 76yr old with mild cognitive impairment & recent pneumonia is suddenly confused w/ difficulty focusing. RN's best action reorient the patient to person, place, and time and assess for the causes 3 multiple choice options Pt w right-sided weakness, facial droop & difficulty speaking. Started 45 mins ago. What type of stroke is this? ischemic stroke 3 multiple choice options The primary cause of Hemorrhagic stroke is Low blood pressure false 1 multiple choice option The majority of Cerebrovascular events are Hemorrhagic in nature false 1 multiple choice option When a patient is taking warfarin post stroke, the most critical lab to monitor is INR. Target range is 2.0-3.0 true 1 multiple choice option When taking warfarin renal function must be monitored. It can impair renal function. true 1 multiple choice option The nurse notices that an older female nursing home resident is not eating and that her heart rate is faster than usual. Which should the nurse do to determine if pneumonia is a potential cause of the change in her status? Analyze sputum for color, texture, and volume. 3 multiple choice options An older has adult diagnosed with heart failure (HF) reports increasing dyspnea over 2 days. Which of the following should the nurse assess to help determine whether the client has adhered to prescribed therapy? (Select all that apply.) A. Compare current weight to baseline. B. Ask about bowel pattern. C. Determine coughing frequency. D. Check for peripheral edema. E. Assess diet over last 48 hours. F. Auscultate the lungs bilaterally. ADEF 3 multiple choice options A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (Select all that apply.) A. The actions of calcium channel blocker medications on hypertension B. The importance of adhering to pharmacological regimens for treatment of hypertension C. Discussion of smoking cessation techniques D. Techniques to incorporate more physical activity into the daily routine E. Strategies for reaching a healthy weight CDE 3 multiple choice options Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of heart failure (HF) in older adults? Control fluid balance. 3 multiple choice options An African American 58-year-old man in good health has a blood pressure at 120/73 mm Hg at his annual physical examination. Which of the following is the best goal for the nurse to use to assist him in maintaining his health and wellness into older age? Prevent cardiovascular disease. 3 multiple choice options Which of the following statements is true about cardiopulmonary disease in older adults? Mouth hygiene is essential to prevent and treat pneumonia. 3 multiple choice options An older man in a cardiac rehabilitation exercise class refuses to participate in the cool-down phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in client teaching to reinforce the importance of cooling down after exercising to this man? Baroreceptor function diminishes with age. 3 multiple choice options Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.) A. Stroke B. Familial hypercholesterolemia C. Atrial fibrillation D. Isolated systolic hypertension E. Renal insufficiency F. Cardiac disease ACEF 3 multiple choice options An older has adult diagnosed with COPD wants to perform self-care activities. Which instruction should the nurse include in client teaching to help achieve this goal? Bathe and eat slowly with periodic rest. 3 multiple choice options The nurse understands that heart disease’s modifiable risk factors include which of the following? (Select all that apply.) A. Hypertension B. Nicotine use C. Allergies D. Uncontrolled diabetes E. Obesity F. Macular degeneration ABDE 3 multiple choice options After an acute exacerbation of chronic obstructive pulmonary disease (COPD), the nurse prepares an older adult for discharge to home. Which is the most important client teaching for the nurse to include for the prevention of hospitalizations for exacerbations of COPD? Avoid sick people and wash hands. 3 multiple choice options A nurse measures an older adult's blood pressure on the right arm and notes a reading of 150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse? Measure the blood pressure in the left arm. 3 multiple choice options Which classic sign of an acute myocardial infarction (AMI) can be absent in an older man with an AMI? Crushing chest pain 3 multiple choice options Which condition is included in the diagnosis of chronic obstructive pulmonary disease (COPD)? Bronchial asthma 3 multiple choice options The patient usually understand others but speaks very slowly and uses minimal numbers of words. They often struggle to articulate a word and seem to have lost the ability to voluntarily control the movement of speech. Difficulty both verbally and in writing? Nonfluent (Broca's) Aphasia 3 multiple choice options The patient may not be able to speak, more often speaks easily with many long words, but the content does not make sense. Often having problems finding the correct word and substituting the incorrect word not realizing it? Fluent (Wenicke's) Aphasia 3 multiple choice options Cannot understand words of speak intelligibly. They use meaningless syllables repetitiously. Global Aphasia 3 multiple choice options The patient understands and speaks readily but may have severe word-finding difficulty. They are unable to remember crucial content words and has difficulty or is unable to name objects and use the correct nouns. Anomic Aphasia 3 multiple choice options The patient does not have the ability to articulate words, and has issues with muscle control needed for speech as a result of a stroke or neurological brain damage. Dysarthria 3 multiple choice options Cardia disease without associated limitations of physical activity. Asymptomatic Class 1 3 multiple choice options Slight limitation of physical activity, comfortable at rest, although an increase in activity may cause fatigue, palpitations, dyspnea, or anginal pain. Mild Heart Failure Class 2 3 multiple choice options The patient has limitations in physical activity, although comfortable at rest, ordinary walking or climbing of stairs can quickly trigger symptoms of fatigue, palpitations, dyspnea, or anginal pain. Substantial periods of bedrest are required. Moderate Heart Failure Class 3 3 multiple choice options The patient is almost always confined to bed with the inability to carry out any physical activity without having discomfort or severe symptoms. Some symptoms even occur at rest with chronic shortness of breath being common. Severe Heart Failure Class 4 3 multiple choice options Pt has a hx of PE with sudden onset of CP and SOB, what should you do? Raise the head of the bed and assess A patient with a spinal curve may have issues lying flat. This is new info what should you do with a pending surgery. Notify the surgical/anesthesia team. Assess the curve. Work with the surgical team on positioning. What valvular disorder is associated with pulmonary HTN and hemoptysis? Mitral valve stenosis indicative of pulmonary hypertension presenting with fatigue hemoptysis and SOB. Bacterial Endocarditis Treatment Antibiotic therapy until complete eradication achieved Patient starting an ACE-inhib or diuretics. What VS is a primary assessment? Blood pressure (both medications can affect bp, monitor for effectiveness and safety) Labs...pt should do what prior? Lipid profiles and lab work require at least 12 hr fasting time for accuracy. BNP can give preliminary diagnosis of heart failure. Cholesterol findings could lead to finds of atherosclerosis. High levels of CPK usually indicate some sort of stress or injury to your heart or other muscles. Mechanical valve education lifetime use of warfarin prophylactic antibiotics Anticoagulation therapy (warfarin: take as prescribed, monitor INR 2.5-3.5, no grapefruit juice), Dietary: Vit K can affect INR levels, no grapefruit juice, limit alcohol. Prevent infection: endocarditis risk (oral hygiene, prophylactic antibiotics) Recognize complications (blood clots, valve malfunction, signs of bleeding.) Cardiac stress test looks for what diseases CAD, arrhythmias, HF, Ischemic heart disease, valvular heart disease, cardiomyopathy, pulmonary HTN, peripheral artery disease. What do you do if during the stress test pt develops cp? Stop the test and assess the pt Frequency of cardiac labs for a MI? Serial labs are typically every 3 -4 hours when trending cardiac enzymes like troponin and CK MB. This normally runs for 12 hrs. What does pericarditis sound like? friction rub (like sandpaper rubbed on wood) What are the goals of intervention? Improve cardiac output and peripheral blood flow, increase activity tolerance and improve gas exchange, reduce anxiety. (cluster activities; legs down/monitoring edema)(slide 58) Heart failure what might you hear? Third and fourth heart sounds s3, s4. murmurs. crackles (rales) Dilated cardiomyopathy (DCM) is what (phys. Descipt. Of the heart) Muscle fibers have stretched heart chambers enlarged. (walls of the heart become thin and the heart gets larger) Can your HF intervention intervene with a persons job? Yes. Physical limitations, medication side effects, medical appointments, emotional and cognitive effects all affect a persons job. Cardiomyopathy related to young/athletes? Hypertrophic cardiomyopathy (HCM)(condition where heart muscles become abnormally thick, makes it hard for the heart to pump blood) is what we are seeing in young athletes who are falling out on the field. What do we expect to happen/treat cardiac tamponade? Cardiac tamponade is the restriction of heart function because of this fluid, resulting in decreased venous return and decreased CO. Cardinal signs of cardiac tamponade: falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds. Pulsus paradoxus, SOB, chest pain, engorged neck veins. Treatment: pericardiocentesis (removing the fluid from around the heart) Definitive test to treat endocarditis (ID ABX)? blood cultures are needed to verify abx type in treating endocarditis. Valvuloplasty can be done where? OR, or cathlab Myocarditis has what type of symptoms? flu-like s/s (signs of a viral infection; fatigue, dyspnea/SOB, syncope, palpitations, chest pain, indigestion.) Mech valve replacement and dental trx. Need what prophylactic? Prophylactic antibiotics are needed for dental treatments. Arrhythmia associated with mitral stenosis? atrial fibrillation (AFib) Mitral valve stenosis edu. To minimize symptoms? Avoid high-sodium foods, minimize stress, regular exercise (avoid overexertion), weight management, smoking cessation, endocarditis prevention (oral hygiene/ prophylactic abx), medications (diuretics, beta-blockers, CCB, anticoagulants, antiarrhythmic drugs), lifestyle adjustment, elevate head of bed (pillows), healthy diet, monitor fluid intake. Rheumatic heart disease is assoc. W/ what bacterial infection? If strep is not treated then you can develop rheumatic heart disease which leads to bacterial endocarditis. Heparin infusion you need 3 things...? IV pump, frequent aPTT bleeding assessments, heparin Which drug requires frequent coag testing (aptt and INR)? Warfarin DVT what can you delegate? VS monitoring, assisting with ADLs, compression socks, monitoring I&Os, report changes. Digoxin levels and VS needs? Digoxin levels need to be between 0.8-2.0 ng/mL, if digoxin parameters is unsafe hold and notify a provider. Check BP and HR before giving digoxin (hold if HR is 60bpm) Antidote to digoxin OD- DIGIBIND. No grapefruit with digoxin. Toxicity s/s: visual changes (yellow haze), nausea, anorexia, diarrhea, arrhythmias, fatigue/weakness. Milrinone is for HF watch for this adverse reaction? Decreases preload and afterload; causes hypotension and increased risk of dysrhythmias. Drugs and herbals that interfere with warfarin? St Johns Wort, NSAIDs, antiplatelets, anticoagulants, steroids, Vit K, garlic, ginko bilboa, antibiotics. aortic regurgitation backflows where? Blood flow backward from the body's main artery (aorta), into the lower left heart chamber (Left ventricle) during diastole ACE inhibitors (-prils) hold onto K, avoid what? limit potassium-rich foods (bananas, oranges, potatoes, and spinach, ect), potassium supplements, salt substitutes that contain potassium question to ask HF pt. (stairs) HF s/s: SOB during ADLs example from clinicals charted the pt was able to climb the stairs without SOB. electrolyte lab values Sodium 135-145 mEq/L. Potassium 3.5-5.0 mEq/L. Calcium 8.5-10.5 mg/L. Magnesium 1.3-2.1 mEq/L. Nonmodifiable things (cardiac diseases) age, gender, family history, genetics, ethnicity modifiable things (cardiac diseases) High BP, high cholesterol, smoking, physical inactivity, obesity, diet, diabetes management, stress Natrecor you have severe cardiac failure if you are on natrecor Spironolactone potassium sparing diuretic Can have HYPERkalemia as a side effect HCTZ interacts with this HF med ACE, ARB, CCB, Beta-blockers (may cause BP to drop too low) Spironolactone (severe potassium imbalances cardiac arrhythmias) HF exacerbation what would you assess first? Respiratory status first (ABCs) Post op extremity priority assessment pain circulation (5 p's) pain pulse pallor paresthesia paralysis (also check temp, swelling/edema, dressing/incision) Pt with HF and HTN on meds with new onset of cough. Prioritize what assessment Respiratory status Stable vs unstable angina Stable chest pain worse with activity and relieved with rest or goes away with medication. Unstable chest pain that doesn't resolve with rest or drugs, requires treatment at the hospital. Mitral valve stenosis progression s/s? fatigue, hemoptysis, dyspnea, SOB (this is a sign of pulmonary HTN) anxiety, palpitation, can cause AFIB. Where to listen to heart sounds Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB) A myocardial infarction happens where? A MI occurs when one of the main coronary arteries or one of the smaller branches is unable to deliver oxygen-rich blood to the main muscle layer of the heart (myocardium). Which of the following is the primary pacemaker for the myocardium? Sinoatrial node, (SA) node is the primary pacemaker of the heart; the atrioventricular (AV) node is the secondary pacemaker of the heart. Depolarization electrical activation of cell caused by influx of sodium into cell while potassium exits cell. Repolarization return of cell to resting state caused by reentry of potassium into cell while sodium exits. Treatment to restore the depolarization and repolarization effect action potential? Antiarrhythmic medications (sodium channel blockers, beta-blockers, potassium channel blockers, calcium channel blockers) Electrolyte management (potassium, calcium, magnesium can affect the action potential) Pacemaker or implantable cardioverter defibrillator defibrillation Nitro nitrate drug used in the treatment of angina a vasodilator expected side effect is headache due to increased blood flow to the brain. Diagnostic tests for cardiac assessments? CT, magnetic resonance angiography, (MRI prescreen is required for any MRI, previous surgeries, implanted objects...anything you were not born with. Electronic devices like pacemakers need to be reported to the provider. They can pull the serial number and determine if it is MRI safe. CTs will require contrast that needs an appropriate IV, a 20g at the AC or higher is preferred as the contrast is injected fast and needs a larger vein.) Cardiac catheterization invasive procedure used to diagnose structural and functional diseases of the heart and great vessels. (Include neuro checks following a heart cath, as it has a high time for stroke. S/S of stroke, slurred speech, one sided weakness, facial droop, ect. Contrast contains iodine, check for allergies iodine/shellfish. Peripheral vascular checks are important following procedure; pulses, color, temp, cap refill. Screen for arrhythmias, bed rest 2-6 hours. Observe cath site for bleeding/hematoma. Watch for drops in potassium.) LEVO-LEVOPHED norepinephrine drug used to treat low blood pressure and heart failure. Nursing management of pt with valvuloplasty/valve replacement? Frequent assessments with attention to neurologic, respiratory, and cardiovascular systems. Anticoagulation therapy is used for end stage heart failure is a life-long treatment. Prevention of infectious diseases of the heart? IV dressings (3 days or based off policy), assess- BUN and creatine, allergies and expect to give IV fluids to renal patients. ABX, oral hygiene, immunizations. Pulsus paradoxus is when you feel for a pulse radially and during the inhale you lose the pulse and it returns with the exhale this can be a sign of cardiac tamponade and CHF...often an emergency. Pharmacologic Stress Test This test is appropriate for patients with physical limitation. Medications such as adenosine, dipyridamole, regadenoson, or dobutamine are given intravenously through an IV line to cause the heart rate to climb to the target level or the same symptoms and EKG changes as the exercise test develop. The test is concluded after 85% of the target heart rate is achieved. Continuous ECG monitoring, BP and HR monitoring. NPO previous to the PST This tests for CAD and valvular disease Remove accumulated fluid and sodium Diuretics, (lasix) monitor serum K+ levels closely fluid restriction and possible sodium restriction Strict I&O and daily weights Decrease cardiac