Adult Cardiac

Which of the following statements is wrong about central venous pressure (CVP) a. It increases in cases of hypovolemia b. It increases in cases of hypervolemia c. It increases in patients with right ventricular failure d. It can be measured using the proximal port of the pulmonary artery catheter

A

Youre caring for a patient in anaphylactic shock. What is NOT a typical medical treatment for this condition a. Diphenhydramine b. Epinephrine c. Corticosteroids d. IV furosemide

D

Diastolic pulmonary artery pressure normal value

4-12 (mmHg)

which sided coronary MI has a worse prognosis

left (dyspnea, tachycardia, htn)

Pulmonary vascular resistance normal value

<250

S3,s4 gallop on auscultation is indicative of _____ sided heart failure

Left

The volume of blood in millimeters ejected from each ventricle due to the contraction of the heart muscle which compresses the ventricles. It is influenced by three variables- preload, afterload. Contractility

Stroke volume SV

gold standard test for flow limiting coronary artery disease

coronary angiography

cardiac output/index abnormal high causes and treatments

causes: early septic shock, hypervolemia, hypertension tx: only if concerns are present

Fibrinolytic therapy can be started within _______ hours

12

Systolic pulmonary artery pressure normal value

15-30 (mmHg)

When caring for a client in late hypovolemic shock, which complication will the nurse anticipate? 1 Hypokalemia 2 Metabolic acidosis 3 Respiratory alkalosis 4 Decreased Pco2 levels

2

When a client with hypovolemic shock has a hematocrit value of 25%, which fluid therapy will the nurse prepare to infuse? 1 Lactated Ringer solution 2 Human serum albumin 5% 3 Packed red blood cells 4 High molecular weight dextran

3 (Blood replacement is needed to increase the oxygen-carrying capacity of the blood; the expected hematocrit for women is 37% to 47% and for men is 42% to 52%. The other three fluids will increase volume, but will not improve the oxygen-carrying capacity of the blood. Lactated Ringer solution does not increase the oxygen-carrying capacity of the blood. Serum albumin helps maintain volume but does not affect the hematocrit level. Although dextran does expand blood volume, it decreases the hematocrit because it does not replace red blood cells.)

Also known as systemic vascular resistance. SVR. Referee to the resistance to flow that the ventricle must overcome to eject blood. Increasing afterload May make it harder for the heart to eject blood.

Afterload

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure a. Acute anxiety b. Hypotension and tachycardia c. Peripheral edema and weight gain d. Paroxysmal nocturnal dyspnea

B

Which lab result would the nurse expect in the client diagnosed with DIC a. A decreased prothrombin time b. A decreased platelet count c. An increased white blood cell count d. A decreased PTT

B

A patient reports during a check up that he is experiencing chest pain and SOB with activities. Pain improves with rest. What is this a. Unstable angina b. Prinzmetal's angina c. Variant angina d. Stable angina

D

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction? 1 Aspirin 2 Atropine 3 Gabapentin 4 Epinephrine

1

BNP: <____ pg/mL = HF Unlikely >____ pg/mL = HF likely

100, 400

When a client is experiencing acute coronary syndrome, which factor would the nurse identify as the cause of the pain experienced by a client? 1 Arterial aneurysm 2 Heart muscle ischemia 3 Blocking of the coronary veins 4 Irritation of nerve endings in the cardiac plexus

2

myoglobin post MI rise: _____ peak: ______

2 hours, 3-15 hours

Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina? 1 Blood pressure 142/90 mm Hg 2 Report of chest pain when walking 3 Sinus bradycardia, rate 54 on monitor 4 Large Q waves on the electrocardiogram

3

Which finding on an electrocardiogram for a client complaining of chest pain indicates possible acute myocardial infarction? 1 Flattened T waves 2 Absence of P waves 3 Elevated ST segments 4 Disappearance of Q waves

3

Cardiac output normal value

4-8 (L/min)

Creatinine Kinase post MI rise: _______ peak: _________ baseline: ________

6 hours, 18 hours, 10-14 days

Mixed venous oxygen saturation normal value

60-80 (%)

Central venous oxygen saturation normal value

70 (%)

Mean arterial pressure normal value

70-100 (mmHg - at least 60)

The nurse is caring for a patient with systolic heart murmur. Which valve disorders are associated with a systolic murmur a. Aortic stenosis and mitral regurgitation b. Aortic and tricuspid stenosis c. Pulmonic and mitral regurgitation d. Pulmonic regurgitation and tricuspid stenosis

A

systemic vascular resistance abnormal low causes and treatments

causes: hypovolemia, hypotension, cardiogenic and hypovolemic shock tx: vasoconstrictors

Which of the following is NOT classified as an acute coronary syndrome a. Unstable angina b. Atherosclerosis c. Non ST segment elevation myocardial infarction d. ST segment elevation myocardial infarction

B

What is a key factor in describing any type of shock a. Hypoxemia b. Hypotension c. Vascular collapse d. Inadequate tissue perfusion

D

The average arterial pressure throughout one cardiac cycle, systole, and diastole. Influenced by cardiac output output and systemic vascular resistance (SVR).

Mean arterial pressure (MAP)

The amount of blood in the ventricles at the end of diastole. Reflects the patients fluid volume status. Filling pressures. Increase in preload May result in increase cardiac output.

Preload

central venous pressure normal value

2-6 (mmHg)

how long does the PT need to lay flat after a femoral artery percutaneous coronary intervention (PIC)

2-6 hours

Pulmonary capillary wedge pressure normal value

4-12 (mmHg)

A patient diagnosed with CHF has been prescribed Lasix in an effort to physiologically do what for the patient a. Reduce preload b. Decrease afterload c. Increase contractility d. Promote vasodilation

A

Ejection fraction: _____-____ = normal <____ = disease <_____ = severe disease

55-65, 45, 30

The amount of blood ejected by the heart every minute. It is a function of stroke volume and HR. Co=HRx SV

Cardiac output (CO)

Appropriate treatment modalities for the management of cardiogenic shock include: ___________________

Circulatory assist devices such as an intra-aortic balloon pump

The force of mechanical contraction of the heart. Poor contractility decreased stroke volume, thus decreasing cardiac output.

Contractility

Systolic murmurs happen with _____

Contraction

Pulmonary artery pressure abnormal high and treatments

causes: pulmonary HTN, R heart failure tx: inotropic, vasodilators, diuretics

pulmonary capillary wedge pressure abnormal high causes and treatments

causes: pulmonary HTN, cardiogenic shock, hypoxia, ARDS tx: inotropic, vasodilator, diuretics

A patient is being started on lisinopril. Nursing interventions during initial therapy with this medication must include: a. Monitoring blood pressure b. Monitoring intake and output c. Monitoring EKG d. Monitoring serum levels

A

When admitting a client with acute coronary syndrome (ACS) to the telemetry unit after cardiac catheterization and percutaneous intervention (PCI), which action would the nurse take first? 1 Attach the cardiac monitor. 2 Auscultate the heart sounds 3 Check the intravenous fluid rate. 4 Assess alertness and orientation.

1 (Because fatal dysrhythmias may occur in the first hours after myocardial infarction, cardiac monitoring is a priority. The nurse will also do auscultation of the heart, but changes in heart sounds are not expected with ACS and PCI. Checking the intravenous line for patency and correct infusion rate is also important, but would be done after establishing cardiac monitoring. Neurological status would be assessed, but changes in neurological status are not expected after PCI, which does not require general anesthesia.)

When caring for a client who presents to the emergency department with an ST-segment-elevation myocardial infarction (STEMI), which laboratory result will the nurse expect? 1 Decreased white blood cell count 2 Elevated serum troponins I and T 3 Decreased creatine kinase-MB (CK-MB) 4 Decreased B-type natriuretic peptide (BNP)

2 (Elevations of troponin I and T levels are indicative and specific for cardiac muscle damage as would occur with STEMI. White blood cell count would increase in the first days after myocardial infarction because of the inflammatory response associated with myocardial cell death. CK-MB is found in cardiac muscle and levels increase with myocardial cell death. BNP levels are not directly reflective of myocardial infarction, but might increase if the client develops heart failure as a complication of myocardial infarction.)

A client who had a myocardial infarction has runs of ventricular tachycardia. Which medication will the nurse prepare to administer? 1 Digoxin 2 Furosemide 3 Amiodarone 4 Norepinephrine

3 (Amiodarone decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias such as ventricular tachycardia. Digoxin slows and strengthens ventricular contractions; it will not rapidly correct ectopic beats. Furosemide, a diuretic, does not affect ectopic foci. Norepinephrine is a sympathomimetic and is not the medication of choice for ventricular irritability.)

Which nursing intervention would prevent septic shock in the hospitalized client? 1 Maintain the client in a normothermic state. 2 Administer blood products to replace fluid losses. 3 Use aseptic technique during all invasive procedures. 4 Keep the critically ill client immobilized to reduce metabolic demands.

3 (Septic shock occurs as a result of an uncontrolled infection, which may be prevented by using correct infection control practices. These include aseptic technique during all invasive procedures. Maintaining the client in a normothermic state, administering blood products, and keeping the critically ill client immobilized are not directly related to the prevention of septic shock.)

Which type of shock would the nurse monitor for in a client with a ruptured abdominal aortic aneurysm? 1 Obstructive 2 Neurogenic 3 Cardiogenic 4 Hypovolemic

4 (Hypovolemic shock occurs because of blood loss from the circulation when an abdominal aneurysm ruptures. Obstructive shock occurs from physical obstruction impeding the filling or outflow of blood, such as cardiac tamponade or pulmonary embolism. Neurogenic shock results from spinal cord or head injury, which cause vasodilation due to loss of sympathetic nervous system vasoconstrictor tone. Cardiogenic shock results from a decrease in cardiac output.)

Which diagnostic test is most important to obtain rapidly when caring for a client who has just arrived in the emergency department with possible acute coronary syndrome (ACS)? 1 Chest radiograph 2 Troponin T (cTnT) 3 Creatine kinase MB (CK-MB) 4 12-lead electrocardiogram (ECG)

4 (With acute coronary syndrome, ECG changes indicating myocardial injury and infarction occur within minutes. Because treatment for ACS usually involves actions to restore blood flow to the myocardium as rapidly as possible, it is essential that the ECG be done and evaluated immediately. The other tests are also appropriate but will be done after the ECG. Changes in the chest radiograph will occur if there is cardiac enlargement, pericardial effusion, or heart failure secondary to myocardial infarction. Troponin T will increase in an average of 4 to 6 hours with myocardial infarction. CK-MB starts to increase at about 6 hours after myocardial infarction.)

systemic vascular resistance normal value

800-1200

A 70 year old patient has a history of type 2 diabetes mellitus, and is admitted from the nursing home with pneumonia. What type of shock is this? a. Septic b. Neurogenic c. Cardiogenic d. Anaphylactic

A

A patient is treated in the ER for shock of unknown etiology. The first action by the nurse should be to: a. Check the blood pressure b. Obtain and oxygen saturation c. Attach a cardiac monitor d. Check level of consciousness

B

Intravenous NTG is ordered for a patient with acute pulmonary edema. The nurse will need to adjust the NTG if the patient develops _____ a. A drop in heart rate to 54 beats/min b. A systolic BP >90mmHg c. Any symptoms indicating cyanide toxicity d. An increased amount of ventricular ectopy

B

The most accurate assessment parameters to use to determine adequate tissue perfusion in a patient with MODs are: a. Blood pressure, pulse, and respirations b. Breath sounds, blood pressure, and body temperature c. Pulse pressure, level of consciousness, and pupillary response d. Level of consciousness, urine output, and skin color and temperature

D

Which client would be most at risk for developing disseminated intravascular coagulation (DIC) a. A 35 year old pregnant client with placenta previa b. A 42 year old client with a pulmonary embolus c. A 60 year old client receiving hemodialysis 3 days a week d. A 78 year old client with septicemia

D

what medication is NOT to be used with a right coronary artery MI with bradycardia

beta-blockers

systemic vascular resistance abnormal low causes and treatments

causes: distributive shock (anaphylaxis, sepsis) tx: fluid bolus, vasopressors, treat underlying cause

Central venous pressure abnormal low causes and treatments

causes: hypovolemia, peripheral vasodilation tx: fluid bolus, vasopressors

Sublingual nitroglycerin has been prescribed for a client with unstable angina. Which client response indicates that nitroglycerin is effective? 1 Pain subsides as a result of arteriole and venous dilation. 2 Pulse rate increases because the cardiac output has been stimulated. 3 Sublingual area tingles because sensory nerves are being triggered. 4 Capacity for activity improves as a response to increased collateral circulation.

1

The difference between normal oxygen consumption (V02) and VO2 during the low-DO2 state. The longer there is an imbalance between cellular oxygen supply and demand, the larger the oxygen debt becomes. The resulting oxygen debt must be repaid in order to maintain cellular function.

Oxygen debt

Aortic stenosis is heard on the ____

2nd ICS, RSB

Which term refers to a blowing sound created by turbulence caused by narrowing of arteries while assessing for carotid pulse? 1 Bruit 2 Ectropion 3 Entropion 4 Borborygmi

1

Which first-line medication would the nurse use to treat anaphylactic reactions? 1 Epinephrine 2 Norepinephrine 3 Dexamethasone 4 Diphenhydramine

1 (Epinephrine is the first-line medication for treating anaphylactic reactions. Norepinephrine is also used in treating anaphylactic reactions as a supportive medication. Diphenhydramine and dexamethasone are second-line medications for treating anaphylactic reactions.)

Which laboratory test is most important for the nurse to monitor when a client is admitted with acute coronary syndrome? 1 Troponin 2 Myoglobin 3 Homocysteine 4 Creatine kinase (CK)

1 (Troponins are released into circulation within 2 to 4 hours after myocardial infarction (MI) and are not found in healthy adults, so elevated troponin levels indicate myocardial necrosis. Although myoglobin is one of the first cardiac markers to increase after an MIMI, it lacks cardiac specificity. Elevation of homocysteine is a risk factor for coronary artery disease, but not an indicator of acute myocardial necrosis. CK levels, especially the creatine phosphokinase (MB) subunit, increase with myocardial necrosis within 3 to 6 hours, but are not as sensitive as troponin testing for acute myocardial necrosis.)

The mean arterial pressure (MAP) for a client who has a blood pressure of 180/95 mm Hg is _____ mm Hg. Record answer as a whole number.

123 [(2x95)+180/3]

Cardiac Index normal value

2.5-4 (L/min/m)

When a client with angina is scheduled to have a cardiac catheterization, which explanation would the nurse give about the purpose of the procedure? 1 To obtain the pressures in the heart chambers 2 To determine the existence of congenital heart disease 3 To visualize the disease process in the coronary arteries 4 To measure the oxygen content of various heart chambers

3 (Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization. Although pressures can be obtained, they are not the priority for this client; this assessment is appropriate for those with valvular disease. Determining the existence of congenital heart disease is appropriate for infants and young adults with cardiac birth defects. Measuring the oxygen content of various heart chambers is appropriate for infants and young children with suspected septal defects.)

The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication? 1 Headache 2 Tachycardia 3 Constipation 4 Hypotension

4 (Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure. This medication does not cause headaches; this medication may be used to relieve vascular headaches. This medication may cause bradycardia, not tachycardia. This medication may cause diarrhea, not constipation.)

Troponin post MI rise: _______ peak: _______ baseline: _______

4-6 hours, 10-24 hours, 10-14 days

Examples of medications with positive inotropic effect include all of the following EXCEPT: a. Dopamine b. Digoxin c. B-adrenergic blockers d. Dobutamine

C

Which of the following hemodynamic measures is used to estimate left ventricular preload a. Central venous pressure b. Invasive blood pressure c. Systemic vascular resistance d. Pulmonary artery wedge pressure

D

Most common valvular disease related dysrhythmia

Atrial fibrillation

mitral regurgitation is heard on the ____

Axilla

A nurse is caring for a patient diagnosed with an MI who is having chest pain. Which intervention should the nurse do first a. Administer morphine sulfate IM b. Apply oxygen via nasal canula c. Place the client in supine position d. Administer nitroglycerin subcutaneously

B

First sign of valvular heart disease

Murmur

Reflects the amount of oxygen extracted from the blood at the tissue level. It can be measured through evaluation of a blood sample, a venous oxygen saturation (SvO2). The venous oxygen saturation level reflects the amount of oxygenated blood returned to the heart. Normal Sv02 values are between 60% and 75%. When the value falls below normal, it means the tissues are extracting more oxygen than normal.

Oxygen consumption (VO2)

Mitral regurgitation and aortic stenosis are ____ murmurs

Systolic

NSTEMI = _________ occlusion, ST __________ STEMI = ___________ occlusion, ST __________

partial, depression, complete, elevation

cardiac output/cardiac index abnormal low causes and treatments

causes: MI, all socks except septic tx: fluid bolus, inotropic, treat MI cause

central venous pressure abnormal high causes and treatments

causes: R heart failure, tension pneumothorax, pulmonary HTN, pericardial tamponade tx: inotropic or vasodilator therapy

When assessing a client with cardiogenic shock, which clinical manifestations will the nurse expect to find? Select all that apply. One, some, or all responses may be correct. 1 Polyuria 2 Dyspnea 3 Diaphoresis 4 Tachycardia 5 Hypertension

2, 3, 4

preferred blood test to diagnose acute MI

troponin

gold standard test for MI

EKG (women are less likely than men to have abnormal EKG readings)

After the nurse teaches a group of women about coronary artery disease (CAD) and myocardial infarction (MI), which statement by the women indicates that the teaching has been effective? 1 Unusual fatigue is a common symptom of CAD in women. 2 Women usually have a more rapid recovery than men after MI. 3 Cardiac surgery is generally more successful in women than men. 4 High-density lipoprotein (HDL) levels increase after menopause.

1 (Studies indicate that women who have myocardial infarctions often experience unusual prodromal fatigue; also, during the prodromal period, women more commonly experience upper abdominal fullness instigated by exertion or emotional stress. Women report more disability than men after a cardiac event. Women have higher mortality and more complications than men after coronary artery bypass graft surgery. Low-density lipoprotein levels increase after menopause, increasing CAD risk.)

After insertion of a central venous catheter through the left subclavian vein, a client reports chest pain and dyspnea and has decreased breath sounds on the left side. Which action would the nurse take first? 1 Administer oxygen as prescribed. 2 Activate the Rapid Response Team. 3 Give the prescribed as needed morphine sulfate. 4 Assist the client to cough and deep breathe.

1 (The client's history of a subclavian vein central line insertion and sudden onset of pain, dyspnea, and decreased breath sounds suggest tension pneumothorax. The nurse will initially administer oxygen. The next action would be to activate the Rapid Response Team, because chest tube placement is likely to be needed to allow lung re-expansion. Morphine sulfate may be needed for pain control, but would not be the initial action. Coughing and deep breathing will not help with dyspnea caused by tension pneumothorax, although the client would be encouraged to cough and deep breathe once the chest tube is in place.)

A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess for which medication side effect? 1 Nausea 2 Delirium 3 Bradycardia 4 Hypotension

4 (The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure and resulting in decreased cardiac workload. Nausea is not a common side effect of intravenous nitroglycerin. Nitroglycerin does not cause delirium. Reflex tachycardia may occur with the decrease in blood pressure.)

Which of the following laboratory findings fits with a diagnosis of cardiogenic shock? a. Decreased liver enzymes b. Increased white blood cells c. Increased blood urea nitrogen and creatinine levels d. Decreased red blood cells, hemoglobin, and hematocrit

C

Which finding would the nurse expect when assessing a client diagnosed with hypovolemic shock? 1 Oliguria 2 Crackles 3 Dyspnea 4 Bounding pulse

1 (Urine output decreases to less than 20 to 30 mL/hr (oliguria) because of decreased renal perfusion secondary to a decreased circulating blood volume. Crackles are associated with pulmonary edema caused by cardiogenic shock, not hypovolemic shock. Dyspnea may be associated with hypervolemia, not hypovolemia, and also with pulmonary edema and respiratory disorders. Bounding pulse will occur with hypervolemia.)

The nurse will anticipate the need to administer which type of medication when a client with cardiogenic shock has an increased pulmonary artery wedge pressure reading of 30 mm Hg? 1 Vasopressor 2 Loop diuretic 3 Antidysrhythmic 4 Beta-adrenergic blocker

2 (Increased pulmonary artery wedge pressure indicates increased left ventricular preload; the nurse will anticipate the need to decrease preload by administration of a loop diuretic. A vasopressor would not decrease ventricular preload and vasopressors are not usually used in cardiogenic shock because they increase cardiac workload and oxygen demand. There is no indication that the client has a dysrhythmia and antidysrhythmic treatment is not indicated. A beta-adrenergic blocker would decrease cardiac output and likely increase left ventricular preload.)

After administering epinephrine to a client experiencing an anaphylactic reaction, which second-line medications would the nurse prepare to administer? Select all that apply. One, some, or all responses may be correct. 1 Dopamine 2 Norepinephrine 3 Dexamethasone 4 Diphenhydramine hydrochloride 5 Hydrocortisone sodium succinate

3, 4, 5 (Dexamethasone is a CORTICOSTEROID that is a second-line medication used in the treatment of anaphylaxis. Diphenhydramine hydrochloride is an ANTIHISTAMINE that is a second-line medication used in the treatment of anaphylaxis. Hydrocortisone sodium succinate is a CORTICOSTEROID that is a second-line medication used in the treatment of anaphylaxis. Dopamine and norepinephrine are VASOPRESSOR medications and are considered support medications in the treatment of anaphylaxis.)

To determine whether a client is experiencing acute coronary syndrome (ACS), which component of the electrocardiogram would the nurse analyze? 1 P wave 2 PR interval 3 QRS complex 4 ST segment

4 (Elevation or depression of the ST segment is indicative of ACS because of changes in cardiac electrical activity that occur with ischemia and injury. P wave changes are not used to diagnose ACS. Changes in the QRS complex do not occur with ACS. Changes in the PR interval are not diagnostic of ACS.)

Diastolic murmurs are heard with ______ or _____ valve ________ or ______ or ______ valve _______

Aortic, pulmonic, regurgitation, mitral, tricuspid, stenosis

The amount of oxygen delivered to the tissues. It is assessed through the evaluation of cardiac output and arterial oxygen content. Arterial oxygen content is a combination of hemoglobin levels, the percentage of hemoglobin saturated with oxygen, and the amount of oxygen dissolved in the plasma( partial pressure of oxygen in arterial blood [PaO2]

Oxygen delivery (DO2)

Which action will the nurse take when measuring a client's pulmonary artery wedge pressure (PAWP)? 1 Deflate the balloon as soon as the PAWP is measured. 2 Have the client bear down when measuring the PAWP. 3 Place the client in high-Fowler position to measure the PAWP. 4 Advance the catheter if a typical PAWP tracing is not obtained.

1 (Although the balloon must be inflated to measure the PAWP, it is deflated as soon as the PAWP is obtained to allow blood to continue to flow through the pulmonary artery. Bearing down will increase intrathoracic pressure and lead to an inaccurate PAWP reading. The client would be positions in a supine position at 0 to 45 degrees for PAWP measurement. Repositioning of the catheter may be done by the health care provider, but is not within the scope of nursing practice.)

Which finding will the nurse expect when caring for a client who is in hypovolemic shock? 1 Slow heart rate 2 Cool skin temperature 3 Bounding radial pulses 4 Increased urine output

2 (Shunting of blood to vital organs such as the heart and brain occurs inhypovolemic shock, leading to cool skin because of decreased skin perfusion. Tachycardia, not bradycardia (slow heart rate), occurs as a compensatory mechanism in hypovolemic shock. The pulses in hypovolemic shock are weak and thready because of decreased blood pressure. Urine output will decrease because of decreased kidney perfusion in hypovolemic shock.)

A client with an abdominal aortic aneurysm is suddenly pale and reports feeling light-headed and having abdominal pain. Which action would the nurse take first? 1 Assess the respiratory rate for hyperventilation. 2 Check the blood pressure for hypotension. 3 Administer the prescribed morphine for pain. 4 Inspect the abdomen for distension and firmness.

2 (The history of abdominal aortic aneurysm, with new symptoms of pallor, lightheadedness, and abdominal pain, suggests bleeding or dissection of the aneurysm. The nurse would first check blood pressure and report hypotension immediately to the health care provider, anticipating the need to give intravenous fluids and prepare the client for emergency surgery. The other actions are also appropriate after the nurse has obtained the blood pressure. Hyperventilation may cause lightheadedness. Treatment of pain is appropriate if the blood pressure is stable, but morphine would further lower blood pressure if the client is hypotensive. Inspection of the abdomen would help confirm a diagnosis of bleeding or dissection but would not be first action.)

Which information about a client who is being discharged 3 days after having an ST segment elevation myocardial infarction (STEMI) and coronary artery stent placement indicates that a home health referral may be needed at discharge? 1 ST segments have not yet returned to baseline. 2 Troponin T and Troponin I levels are still elevated. 3 Client reports frequently forgetting to take medications. 4 Pulse increases from 65 beats/minute to 75 beats/minute with exercise.

3 (Because clients are discharged on multiple medications after experiencing STEMI and stenting, the statement about forgetting to take medications indicates a need for home health assessment and interventions to ensure medication adherence. ST segments may not return to baseline for a few days after STEMI. Troponin levels remain elevated for 10 to 14 days post-STEMI. A pulse rate increase of 10 beats/minute is a normal response to exercise.)

Priority meds for cardiomyopathy

ACE inhibitors (lisinopril) ARB (Losartan) Beta-blocker (metoprolol)

Most common valvular disorders

Aortic stenosis, mitral regurgitation

mixed venous 02 saturation abnormal low causes and treatments

causes: increased 02 demand, decreased CO and hemoglobin tx: increase CO, 02, and hemoglobin

pulmonary vascular resistance abnormal high causes and treatments

causes: pulmonary HTN tx: vasodilators