Adult Theory -- Cardiovascular

B -- Indicators for a heart transplant include end-stage HF (Stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Diabetic patients who have well-controlled blood glucose levels may be candidates for heart transplant.

A 53 year old patient with Stage D HF and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. Because you have diabetes, you would not be a candidate for a heart transplant. b. The choice of a patient for a heart transplant depends on many different factors. c. Your heart failure has not reached the stage in which heart transplants are needed. d. People who have heart transplants are at risk for multiple complications after surgery.

D -- A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.

B -- The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow. The other assessment techniques also need to be corrected. However, they are not dangerous to the patient.

A RN is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse: a. presses on the skin over the tibia for 10 seconds to check for edema b. palpates both carotid arteries simultaneously to compare pulse quality c. documents a murmur heard along the right sternal border as a pulmonic murmur d. places the patient in the left lateral position to check for the point of maximal impulse

D

A client is prescribed hydrochlorothiazide for control of hypertension. What teaching should the nurse provide before the client begins therapy? a. "You may develop a slower pulse rate." b. "You may notice some swelling in your feet." c. "You may develop a nagging cough." d. "Your diet should include foods high in potassium."

B -- The nurse should expect to find the client with fatigue due to muscle weakness.

A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypokalemic? a. pitting edema b. fatigue c. dyspnea d. oliguria

B -- CVP is a measurement of the pressure in the right atria or ventricle at the end of diastole. An elevated CVP is indicative of heart failure.

A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect? a. decreased brain natriuretic peptide (BNP) b. elevated central venous pressure (CVP) c. increased pulmonary artery wedge pressure (PAWP) d. decreased specific gravity

C -- Blurred and yellow vision is an indication of dig toxicity.

A nurse in a clinic is caring for a client who has a prescription for digoxin. Which of the following statements indicates the client is experiencing digoxin toxicity? a. "I am gaining weight." b. "I am constipated." c. "My vision seems yellow." d. "My tongue is red and beefy."

A

A nurse in a clinic is caring for a client who has recently begun taking warfarin. The nurse is reviewing potential drug and food interaction risks and should instruct the client to avoid which of the following? a. cabbage b. green beans c. white beans d. cantaloupe

C

A nurse is admitting a client who has acute HF following myocardial infarction. The nurse recognizes that which of the following prescriptions by the provider requires clarification? a. Morphine sulfate 2 mg IV bolus every 2 hours prn pain b. Lab testing of serum potassium upon admission c. 0.9% NS IV at 125 ml/hr continuous d. Furosemide 40 mg IV bolus every 24 hours

B, C

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.) a. increased heart rate b. increased BP c. increased RR d. increased hematocrit e. increased temperature

B

A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider? a. splinter hemorrhages b. dyspnea c. fever d. clusters of petechiae in mouth

B - The client who has infective endocarditis and develops dyspnea, tachycardia, or a cough might be developing heart failure or experiencing pulmonary emboli, two complications of the infection.

A nurse is assessing a client who has infective endocarditis. Which of the following findings should be the priority for the nurse to report to the provider? a. splinter hemorrhages to the nails b. dyspnea c. fever d. clusters of petechiae in the mouth

D -- A hacking cough is a manifestation of left-sided heart failure that occurs due to pulmonary congestion.

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect? a. jugular venous distension b. abdominal distension c. dependent edema d. hacking cough

B -- Liver enlargement is a manifestation of right-sided HF.

A nurse is assessing a client who has right ventricular failure. Which of the following findings should the nurse expect? a. dry, hacking cough b. hepatomegaly c. dizziness d. crackles

A

A nurse is auscultating a client's heart sounds and hears an extra sound before what should be considered the first heart sound S1. The nurse should document this finding as which of the following heart sounds? a. the fourth heart sound (S4) b. A friction rub c. The third heart sound (S3) d. A split second heart sound S2

A -- It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? a. check the client's vital signs b. request a dietician consult c. suggest that the client rests before eating the meal d. request an order for an antiemetic

C -- Hypokalemia is an adverse effect of furosemide

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? a. hypervolemia b. hypertension c. hypokalemia d. hypoglycemia

C -- Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia.

A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following lab values should the nurse review before administering furosemide? a. bicarbonate b. carbon dioxide c. potassium d. phosphate

D -- Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digitalis toxicity.

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? a. "I can walk a mile a day." b. "I have had a backache for several days." c. "I am urinating more frequently." d. "I feel nauseated and have no appetite."

B -- The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints.

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? a. hypernatremia b. hyperuricemia c. hypercalcemia d. hyperchloremia

B

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take? a. Suggest that the client use a salt substitute. b. Obtain a 12-lead ECG. c. Advise the client to add citrus juices and bananas to her diet. d. Obtain a blood sample for a serum sodium level.

C -- With left sided HF, think of pulmonary symptoms.

A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition? a. anorexia b. weight gain c. breathlessness

A -- Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? a. fab antibody fragments b. flumazenil c. acetylcysteine d. naloxone

B -- A permanent pacemaker is a contraindication for MRI of the chest. The magnets in the machine can create electromagnetic interference and cause the pacemaker to malfunction.

A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify? a. serum cardiac enzymes b. MRI of the chest c. physical therapy d. low-sodium diet

A -- Left-sided heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations include hacking cough, frothy sputum, wheezing, fatigue, and weakness.

A nurse is caring for an older adult who has left-sided heart failure. Which of the following assessment findings should the nurse expect? a. frothy sputum b. dependent edema c. nocturnal polyuria d. jugular distension

B

A nurse is performing a cardiac assessment on a client and auscultates an S3 sound. The nurse should recognize that this sound represents which of the following heart conditions? a. atrial gallop b. ventricular gallop c. closure of mitral valve d. closure of pulmonary valve

A -- Digoxin is a cardiac glycoside medication used to improve myocardial contractility, increasing stroke volume and cardiac output in a client who has HF. During therapy, the nurse should closely monitor the client's potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias.

A nurse is planning to administer digoxin to a client who has heart failure. Which of the following lab results is the priority for the nurse to review prior to administering this medication? a. potassium b. hemoglobin c. creatinine d. blood urea nitrogen

C -- The client lies quietly on the left side with slight head elevation.

A nurse is preparing a client who is scheduled for an echocardiogram the following day. Which of the following instructions should the nurse include about the test? a. "It might cause slight discomfort in the chest area." b. "It takes about 5-10 minutes." c. "It requires lying quietly on one side." d. "It is best to have no food or beverages on the day of the test."

D -- Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? a. withholding the medication if the heart rate is above 100/min b. instructing the client to eat foods that are low in potassium c. measuring apical pulse rate for 30 seconds before administration d. evaluating the client for nausea, vomiting, and anorexia

A -- The nurse should encourage the client to stay as active as possible and to develop a regular exercise regimen. Clients who have heart failure who remain active appear to have improved outcomes. The client should try to walk at least three times per week and should slowly increase the amount of time walked over several months. Regular exercise strengthens the heart and cardiovascular system, thereby improving circulation and lowering blood pressure.

A nurse is providing discharge teaching to a client who has a new diagnosis of HF. Which of the following instructions should the nurse include in the teaching? a. exercise at least 3x per week b. Take diuretics early in the morning and before bedtime c. notify the provider of a weight gain of 0.5 (1 lb) in a week

D -- Exertion and anxiety can trigger the pain of angina, unless it is variant angina, which occurs at rest.

A nurse is providing teaching for a client who has a new diagnosis of angina pectoris. The nurse should give the client which of the following information about anginal pain? a. The pain usually lasts longer than 20 minutes. b. The pain often radiates to the jaw or neck. c. The pain persists with rest and organic nitrates. d. Exertion and anxiety can trigger the pain.

A - Nurse should monitor a client who has kidney impairment for oliguria. The nurse should monitor a client who has hypocalcemia for hyperactive deep tendon reflexes.

A nurse is reviewing a client's CBC findings and discovers that the client's platelet count is 9,000. The nurse should monitor the client for which of the following conditions? a. spontaneous bleeding b. oliguria c. hyperactive deep tendon reflexes d. infection

B -- A serum potassium below 3 mEg/L is a critical lab value. The nurse should report this finding immediately and monitor the client for dysrhythmias.

A nurse is reviewing the serum lab findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report immediately? A. Sodium 136 mEq/L B. Potassium 2.3 mEq/L C. Chloride 99 mEq/L D. Calcium 10 mg/dL

B -- The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening.

A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching? a. Apply a new transdermal patch once a week. b. Apply the transdermal patch in the morning. c. Apply the transdermal patch in the same location as the previous patch. d. Apply a new transdermal patch when chest pain is experienced.

C -- The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe.

A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? a. "Take this medication after each meal and at bedtime." b. "Take one tablet every 15 minutes during an acute attack." c. "Take one tablet at the first indication of chest pain." d. "Take this medication with 8 oz of water."

B

A nurse is teaching a middle-aged client about hypertension. Which of the following information should the nurse include in the teaching? a. "Reaching your goal BP will occur within 2 months." b. "Diuretics are the first type of medication to control hypertension." c. "Limit your alcohol consumption to three drinks a day.? d. "Plan to lower saturated fats to 10 percent of your daily calorie intake."

A -- Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain.

A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0-10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take? a. administer another nitroglycerin tablet b. initiate a peripheral IV c. call a Rapid Response Team d. Obtain an ECG

B -- A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient. The patient may receive a sedative drug before the procedure, but monitored anesthesia care is not used. Arterial pressure monitoring is not routinely used after the procedure to monitor BP. The patient is not immobile during cardiac catheterization and may be asked to cough or take deep breaths.

A patent is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that: a. it will be important to lie completely still during the procedure b. a flushed feeling may be noted when the contrast dye is injected c. monitored anesthesia care will be provided during the procedure d. arterial pressure monitoring will be required for 24 hrs after the test

D -- The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the medication, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high- potassium foods is inappropriate.

A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication? a. Check blood pressure (BP) in both arms before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls

C -- Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.

A patient who has chronic heart failure tells the nurse, I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating! The nurse will document this assessment finding as: a. orthopnea b. pulsus altemans c. paroxysmal nocturnal dyspnea d. acute bilateral pleural effusion

B -- Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many OTC medications can cause HTN, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

A patient with a history of hypertension treated with a diuretic and an angiotensin- converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Have you been consistently taking your medications? c. Have there been any recent stressful events in your life? d. Have you recently taken any antihistamine medications?

B -- Because noncompliance with antihypertensive therapy is common, the nurses initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first? a. Inform the patient about the reasons for a possible change in drug dosage. b. Question the patient about whether the medication is actually being taken. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.

B -- The patient will need to be on NPO for 6 hours preceding the TEE, so the nurse should place the patient on NPO status as soon as the order is received.

A transesophageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which action included in the standard TEE orders will the nurse need to accomplish first? a. start an IV line b. place the patient on NPO status c. administer O2 per nasal cannula d. give lorazepam (Ativan) 1 mg IV

D -- Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit.

After noting a pulse deficit when assessing a 74-year-old patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require a. emergent cardioversion b. a cardiac catheterization c. hourly BP checks d. ECG monitoring

D -- For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

After the nurse teaches the patient with stage 1 HTN about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient has 2 cups of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

C -- Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring are unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

An older patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for regular BP checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how self-monitor and record BPs at home. d. Inform the patient that ambulatory BP monitoring will be needed.

D -- The PMI should be felt at the intersection of the 5th intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with atherosclerosis or carotid artery disease.

During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to a. ask the patient about risk factors for atherosclerosis b. document that the PMI is in the normal anatomic location c. auscultate both the carotid arteries for the presence of a bruit d. assess the patient for symptoms of left ventricular hypertrophy

A -- The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems.

During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion

C -- The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective beta-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with beta-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patients most recent blood pressure (BP) reading is 158/91 mm Hg. b. The patients pulse has dropped from 68 to 57 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

D -- ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and beta-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The beta-adrenergic blockers are not used as initial therapy for new onset heart failure.

Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. beta blockers c. calcium channel blockers d. ACE inhibitors

C -- Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension.

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

A -- Nonselective beta-blockers block beta-1 and beta-2 adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. -Blockers will have no effect on the patients peptic ulcer disease or alcohol use. Beta-Blocker therapy is recommended after MI.

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of a. asthma. b. daily alcohol use. c. peptic ulcer disease. d. MI

A -- The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible AE. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to: a. increase the dietary intake of high-potassium foods. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) with a home BP monitor at least once a day. d. move slowly when moving from lying to sitting to standing.

B -- UAP can be educated in standardized lead placement for ECG monitoring. Assessment of patients who have had procedures where airway maintenance (transesophageal echocardiography) or bleeding (coronary angiogram) is a concern must be done by the registered nurse (RN). Patient teaching requires RN level education and scope of practice.

The nurse an UAP on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP? a. teaching a patient scheduled for exercise electrocardiography about the procedure b. Placing electrodes in the correct position for a patient who is to receive ECG monitoring c. Checking the catheter insertion site for a patient who is recovering from a coronary angiogram d. monitoring a patient who has just returned to the unit after a TEE

C -- Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction. Myoglobin rises in response to myocardial injury within 30 to 60 minutes. It is rapidly cleared from the body, thus limiting its use in the diagnosis of myocardial infarction. LDL cholesterol is useful in assessing cardiovascular risk but is not helpful in determining whether a patient is having an acute myocardial infarction. Creatine kinase (CK-MB) is specific to myocardial injury and infarction and increases 4 to 6 hours after the infarction occurs. It is often trended with troponin levels.

The nurse has received the lab results for a patient who developed chest pain 4 hours ago and may be having a MI. The most important lab result to review will be: a. myoglobin b. LDL cholesterol c. troponins T and I d. CK-MB

A -- The S1 signifies the onset of ventricular systole. S2 signifies the onset of diastole. A murmur occurring between these 2 sounds is a systolic murmur. The mitral area is the intersection of the left 5th intercostal space and the midclavicular line. The other responses describe murmurs heard at different landmarks on the chest and/or during the diastolic phase of the cardiac cycle.

The nurse hears a murmur between the S1 and S2 heart sounds at the patients left fifth intercostal space and midclavicular line. How will the nurse record this information? a. systolic murmur heard at mitral area b. systolic murmur heard at Erb's point c. diastolic murmur heard at aortic area d. diastolic murmur heard at the point of maximal impulse

C Calcium range: 8.7 - 10.2 Potassium range: 3.5-5

The nurse in the cardiac care clinic is reviewing serum electrolyte results on clients taking digoxin. Which client is at increased risk of digoxin toxicity? a. Ca 9.2 mg/dL b. Ca 10.3 mg/dL c. K 3.4 mEq/L d. K 4.8 mEq/L

B -- The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent farther neurologic damage.

The nurse is assessing a patient who has been admitted to the ICU with a hypertensive emergency. Which finding is most important to report to the HCP? a. Urine output over 8 hrs is 250 mL less than fluid intake b. the patient cannot move the left arm and leg when asked to do so c. tremors are noted in the fingers when the patient extends the arms d. the patient complains of a headache with pain at level 8/10

A, B Hypokalemia can potentiate dig toxicity. Dig will help irregular pulse rhythms. You want to reduce sodium intake, not potassium intake.

The nurse is caring for a client with chronic heart failure and atrial fibrillation receiving digitalis and furosemide. What should the nurse do to prevent complications of this drug combination? Select all that apply. a. Monitor serum potassium levels. b. Instruct the client on how to take their pulse. c. Hold the digitalis if the pulse rhythm is irregular. d. Educate the client about reduced potassium intake.

D -- Because the patients major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred, but are not as specific to evaluating this patients response.

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees

A -- The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

The nurse is reviewing the lab results for a patient who has recently been diagnosed with HTN. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.8 mg/dL b. Serum potassium of 4.5 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 96 mg/dL

C -- The elevation in troponin T and I indicates that the patient has had an acute MI. Further assessment and interventions are indicated. The other lab results are indicative of increased risk for coronary artery disease but are not associated with acute cardiac problems that need immediate intervention.

The nurse is reviewing the lab results for newly admitted patients on the CV unit. Which patient lab result is most important to communicate as soon as possible to the HCP? a. patient whose triglyceride level is high b. patient who has very low homocysteine level c. patient with increase in troponin T and troponin I level d. patient with elevated high-sensitivity CRP

A -- Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

The nurse just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed? a. a little swelling around my lips and face is okay b. the medication may not work as well if I take any aspirin c. the doctor may order a blood potassium level occasionally d. I will call the doctor if I notice that I have a frequent cough

A -- Dental procedures place the PT with a mitral valve at risk for IE. MI, infarction, immunizations and a family history of endocarditis are not risk factors

The nurse obtains a health hx from an older adult with a mechanical heart valve. Which question by the nurse helps identify a risk factor for infective endocarditis (IE)? a. "Have you had dental work done recently?" b. "Do you have a history of a heart attack?" c. "Is there a family hx of endocarditis?" d. "Have you had any recent immunizations?"

B -- The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patients alcohol intake is within guidelines and will not increase the hypertension risk.

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks a beer with dinner on most nights

B Sedentary lifestyle plays a huge role in BP issues.

The nurse obtains the following lifestyle information from a client newly diagnosed with elevated BP. Which finding is most important to address with the client? a. low dietary fiber intake b. no regular exercise c. drinks a beer with dinner every night d. weighs 8 lbs more than ideal weight

A -- The patient with chest pain may be experiencing acute MI, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain b. 52-year-old with a BP of 212/90 who has intermittent claudication c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria

C -- Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

B -- Nausea is a sign of dig toxicity.

The nurse plans to discharge a client for chronic HF who has prescriptions for digoxin and hydrochlorothiazide. Which instruction should the nurse include? a. Limit dietary intake of potassium. b. Notify the health care provider if nausea develops. c. Take the hydrochlorothiazide at bedtime. d. Take the digoxin if HR is under 60.

D -- The patient is instructed to keep a diary describing daily activities while Holter monitoring is being accomplished to help correlate any rhythm disturbances with patient activities. Patients are taught that they should not take a shower or bath during Holter monitoring and that they should continue with their usual daily activities. The recorder stores the information about the patients rhythm until the end of the testing, when it is removed and the data are analyzed.

The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. connect the recorder to a computer once daily b. exercise more than usual while the monitor is in place c. remove the electrodes when taking a shower or tub bath d. keep a diary of daily activities while the monitor is worn

C -- Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an as needed basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by further elevating the head of the bed.

The nurse working on the HF unit knows that teaching an older female patient with newly diagnosed HF is effective when the patient states that: a. she will take furosemide every day at bedtime b. the nitroglycerin patch is applied when any chest pain develops c. she will call the clinic if her weight goes from 124 to 128 pounds in a week d. an additional pillow can help her sleep if she is feeling short of breath at night

C -- LPN/LVN education and scope of practice include the correct use of common equipment such as automatic blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs.

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patients environment for adverse stimuli that might increase BP.

A

The standard policy on the cardiac unit states, Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg. The nurse will need to call the health care provider about the: a. postoperative patient with a BP of 116/42. b. newly admitted patient with a BP of 150/87. c. patient with left ventricular failure who has a BP of 110/70. d. patient with a myocardial infarction who has a BP of 140/86.

A -- Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best used for the higher-pitched sounds such as S1 and S2.

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the: a. bell of the stethoscope with the patient in the left lateral position b. diaphragm of the stethoscope with the patient in a supine position c. bell of the stethoscope with the patient sitting and leaning forward d. diaphragm of the stethoscope with the patient lying flat on the left side

D -- Increased levels of BNP are a marker for HF. The other lab results would be used to assess for MI (troponin) or risk for coronary artery disease (Hcy and LDL).

To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Troponin b. Homocysteine (Hcy) c. LDL d. B-type natriuretic peptide (BNP)

B -- The contrast dye used for the procedure is iodine based, so patients who have shellfish allergies will require treatment with medications such as corticosteroids and antihistamines before the angiogram. The other information is also communicated to the health care provider but will not require a change in the usual precardiac catheterization orders or medications.

When admitting a patient for cardiac catheterization and coronary angiogram, which information about the patient is most important for the nurse to communicate to the HCP? a. the patient's pedal pulses are 1+ b. the patient is allergic to shellfish c. the patient had a heart attack a year ago d. The patient has not eaten anything today.

B -- Murmurs are caused by turbulent blood flow, such as occurs when blood flows through a damaged valve. Relevant information includes the position in which the murmur is heard best (e.g., sitting and leaning forward), the timing of the murmur in relation to the cardiac cycle (e.g., systole, diastole), and where on the thorax the murmur is heard best. The other information is also important in the cardiac assessment but will not provide information that is relevant to the murmur.

When assessing a newly admitted patient, the nurse notes a murmur along the left sternal border. To document more information about the murmur, which action will the nurse take next? a. find the point of maximal impulse b. determine the timing of the murmur c. compare the apical and radial pulse rates d. palpate the quality of the peripheral pulses

B -- A bruit is the sound created by turbulent blood flow in an artery. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. A murmur is the sound caused by turbulent blood flow through the heart. Auscultating a bruit in an artery is not normal and indicates pathology.

When auscultating over the patient's abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a: a. thrill b. bruit c. murmur d. normal finding

D -- Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patients LDL level. Decreases in LDL will help reduce the patients risk for developing CAD.

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the: a. family hx of CAD b. increased risk associated with the patient's gender c. increased risk of CV disease as people age d. elevation of the patient's LDL

D -- The resting HR does not change with aging, so the decrease in HR requires further investigation. Bundle-branch block and slight increases in PR interval or QRS duration are common in older individuals because of increases in conduction time through the AV node, bundle of His, and bundle branches.

When receiving a 12-lead ECG for a healthy 79-year-old patient who is having an annual physical exam, what would be of most concern to the nurse? a. The PR interval is 0.21 seconds. b. The QRS duration is 0.13 seconds. c. There is a right bundle-branch block. d. The HR is 42 beats/minute.

D -- Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000 mg sodium diet. The other foods have minimal sodium and can be eaten without restriction.

When teaching the patient with newly diagnosed HF about a 2000 mg sodium diet, the nurse explains that foods to be restricted include: a. canned and frozen fruits b. fresh or frozen vegetables c. eggs and other high-protein foods d. milk, yogurt, and other milk products

D -- ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately. Increases in BP and heart rate (HR) are normal responses to aerobic exercise. Feeling tired is also normal as the intensity of exercise increases during the stress testing.

When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse? a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. BP increase from 134/68 to 150/80 d. newly inverted T waves on the ECG

C -- Labetalol decreases sympathetic nervous system activity by blocking both alpha and beta adrenergic receptors, leading to vasodilation and a decrease in HR, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne) to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

C -- Every antihypertensive med can cause orthostatic hypotension.

Which action should the nurse taken when giving the first dose of oral labetalol to a client with HTN? a. Tell the client to suck on hard candy for dry mouth. b. Instruct the client that headaches often occur with this medication. c. Ask the client to call for help before getting out of bed. d. Inform the client that their urine output will increase.

D -- Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency? a. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. b. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. c. Assist the patient up in the chair for meals to avoid complications associated with immobility. d. Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP) measurements.

C -- The nurse will need to teach the patient that the procedure is rapid and involves little risk. None of the other actions are necessary.

Which action will the nurse implement for a patient who arrives for a calcium- coring CT scan? a. insert an IV catheter b. administer oral sedative medications c. teach the patient about the procedure d. confirm that the patient has been fasting

B -- The BP is obtained in both arms, and the results of of the 2 arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2-3 mmHg per second.

Which action will the nurse in the HTN clinic take in order to obtain an accurate baseline BP for a new patient? a. deflate the BP cuff at a rate of 5-10 mmHg per second b. have the patient sit in a chair with the feet flat on the floor c. assist the patient to the supine position for BP measurements d. obtain 2 BP readings in the dominant arm and average the results

B -- Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life- threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

Which assessment finding for a patient who is receiving IV furosemide to treat stage 2 HTN is most important to report to the HCP? a. blood glucose level of 175 mg/dL b. blood potassium level of 3.0 mEq/L c. most recent BP reading of 168/94 mmHg d. orthostatic systolic BP decrease of 12 mmHg

B -- The goal for antihypertensive therapy for a patient with HTN and diabetes mellitus is a BP less than 130/80 mmHg. The BP of 102/60 may indicate overtreatment of the HTN and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patients treatment.

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of diabetes mellitus? a. 102/60 mm Hg b. 128/76 mm Hg c. 139/90 mm Hg d. 136/82 mm Hg

C -- BNP measure the degree of HF a patient is in. It should be less than 100.

Which diagnostic test will be most useful to the nurse in determining if a client admitted with acute dyspnea has HF? a. troponin b. 12-lead ECG c. B-natriuretic peptide d. arterial blood gas

C -- MRI is contraindicated for patients with implanted metallic devices such as pacemakers. The other information also will be reported to the health care provider but does not impact on whether or not the patient can have an MRI.

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent ventricular pacemaker. d. The patient took all the prescribed cardiac medications today.

D -- Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage blood pressure, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months once stable.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Increasing physical activity will control blood pressure (BP) for most patients. b. Most patients are able to control BP through dietary changes. c. Annual BP checks are needed to monitor treatment effectiveness. d. Hypertension is usually asymptomatic until target organ damage occurs.

D C-reactive protein is a lab test for pericarditis/endocarditis in order to show inflammation.

Which lab test should the nurse review to determine the effects of therapy for a client being treated for heart failure? a. troponin b. low density lipoprotein c. C-reactive protein d. Brain natriuretic peptide

A -- The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Collect a detailed diet history. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium

C -- The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. need to begin an aerobic exercise program several times weekly b. use of salt substitutes to replace table salt when cooking and at the table c. benefits and side effects of ACE inhibitors d. importance of making an annual appointment with the primary care provider

C -- The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patients home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care.

While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the water pill with the heart pill. When planning for the patient's discharge, the nurse will facilitate a: a. consult with a psychologist b. transfer to a long-term care facility c. referral to a home health care agency d. arrangements for around-the-clock care

C -- The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis.

While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates: a. decreased fluid volume b. jugular vein atherosclerosis c. increased right atrial pressure d. incompetent jugular vein valves

D -- When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not a clinically significant) finding. Obtaining vital signs and oxygen saturation is not warranted at this point. JVD is an expected finding when a patient performs the Valsalva maneuver because right atrial pressure increases. JVD that persists when the patient is sitting at a 30- to 45-degree angle or greater is significant. The nurse will document the JVD in the medical record if it persists when the head is elevated.

While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next? a. Document the finding in the patient's record b. obtain vital signs, including oxygen saturation c. have the patient perform the Valsalva maneuver d. observe for JVD with the patient upright at 45 degrees

D -- Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The nurse should simply document the finding in the admission assessment. Unless there are other abnormal findings (such as bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary.

While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? a. Teach the patient about aneurysms. b. Notify the hospital rapid response team. c. Instruct the patient to remain on bed rest. d. Document the finding in the patient chart.

D -- Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patients alcohol intake is not excessive.

he nurse is caring for a 70-year-old who uses hydrochlorothiazide (HydroDIURIL) and enalapril (Norvasc), but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen (Motrin) daily to treat osteoarthritis.