ATI: Cardiovascular and Hematology

Therapeutic Digoxin level

0.5 - 0.8 mg/mL Atrioventricular block, ventricular fibrillation and ventricular tachycardia are a few of the dysrhythmias occurring with toxic digoxin levels.

EKG changes: Hypocalcemia

A client who has hypocalcemia can have a *prolonged S-T interval and a prolonged Q-T interval, but not flattened T wave*

A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mm Hg, heart rate 102/min, respirations 22/min, and SpO2 95%. Which of the following actions should the nurse take?

Administer antihypertensive medications for blood pressure The nurse should administer antihypertensive medication for the elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall.

Ventricular Tachycardia

An irregular ventricular rate of 125/min with a *wide* QRS pattern

A nurse on a telemetry unit is caring for a client who has an irregular radial pulse. Which of the following ECG abnormalities should the nurse recognize as *atrial flutter*

Atrial rate of 300/min with QRS complex of 80/min The nurse should interpret this finding as atrial flutter, which indicates a *lack of conduction between the atria and the ventricles. The additional atrial beats are not conducting*

A nurse is assessing for *cardiac tamponade* on a client who had coronary artery bypass grafts. Which of the following actions should the nurse take?

Auscultate blood pressure for *pulsus paradoxus* The client who has cardiac tamponade will have pulsus paradoxus when *the systolic blood pressure is at least 10 mm Hg higher on expiration than on inspiration* This occurs because of the sudden decrease in cardiac output from the fluid compressing in the atria and ventricles

A nurse is completing an assessment for a client who has a history of *unstable angina*. Which of the following findings should the nurse expect?

Chest pain lasts longer than *15 minutes* The client who has unstable angina will have chest pain lasting longer than 15 minutes. This is due to the reduced blood flow in a coronary artery due to athersoclerotic plaque and thrombus formation causing partial arterial obstruction, or from an artery spasm

A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral arterial disease (PAD) Which of the following findings should the nurse expect?

Dry, pale skin with minimal body hair A client who has peripheral arterial disease can display dry, scaly, pale or mottled skin with minimal body hair because f narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities, which can lead to tissue damage.

A nurse is assessing a client who has *pericarditis*. Which of the following manifestations should the nurse expect?

Dyspnea with hiccups The client who has pericarditis will experience dyspnea, hiccups, and a nonproductive cough. These manifestations can indicate heart failure from pericardial compression due to constrictive pericarditis or cardiac tamponade

A nurse is monitoring a client who has heart failure relate to mitral stenosis. The client reports shortness of breath on exertion. Which of the following conditions should the nurse expect?

Increased pulmonary congestion Pulmonary congestion occurs due to right sided heart failure. Because of the defect in the mitral valve, the left atrial pressure rises, the left atrium dilates, there is an increase in pulmonary artery pressure, and hypertrophy of the right ventricle occurs. In this case, dyspnea is an indication of pulmonary congestion and right sided heart failure

Normal Sinus Rhythm

P waves occuring at *0.16* seconds before each QRS complex

A nurse is caring for a client who is postoperative following *vein ligation* and stripping for varicose veins. Which of the following actions should the nurse take?

Position the client supine with his legs elevated when in bed The nurse should elevate the client's leg *above his heart* to promote venous return by gravity. During discharge teaching, the nurse should reinforce the importance of periodic positioning of the legs above the heart. The nurse should instruct the client to wear *graduated compression stockings* for up to *one week* after surgery to promote venous return. Ambulate 5 to 10 minutes every hour while awake to prevent venous stasis. Discourage the client from sitting or standing for any duration to prevent venous stasis.

A nurse is caring for a client who has *heart failure* and whose telemetry reading displays a *flattening of the T wave*. Which of the following laboratory results should the nurse anticipate as the cause of this EKG change?

Potassium 2.8 mEq/L A flattened T wave or the development of a U wave is indicative of a low potassium level

A nurse is caring for a client who has *hemophilia* The client reports pain and swelling in a joint following an injury. Which of the following action should the nurse take?

Prepare for replacement of the missing clotting factor

A nurse is transfusing a unit of O-negative fresh frozen plasma to a client whose blood type is B positive. Which of the following actions should the nurse take?

Remover the unit of plasma immediately and start an IV infusion of normal saline solution A client who receives FFP that incompatible can experience a *hemolytic transfusion reaction* The nurse should stop the transfusion and infuse 0.9% sodium chloride solution with *new* tubing

A nurse is caring for a client who has a demand pacemaker inserted with the rate set at 72/min. Which of the following findings should the nurse expect?

Telemetry monitoring shows QRS complexes occurring at a rate of 74/min with no pacing spikes. The nurse should not expect pacer spikes when the client's pulse is greater than the set rate of 72/min because the intrinsic rate override the set rate of the pacemaker

If a client has a demand pacemaker and is experiencing premature ventricular complexes, what is this an indication of?

The nurse report when the client is displaying frequent premature ventricular complexes because this is a complication that can *indicate a lead wire is displaced in the ventricle*

A nurse is monitoring a client who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hours?

Ventricular dysrhythmias After an MI, the *electrical conduction* system of the heart can be irritable and prone to dysrhythmias. Ischemic tissue caused by the infarction can also interfere with the normal conduction patterns of the heart's electrical system.

Ventricular Ectopy or Premature Ventricular Contractions

Ventricular rate of 82/min with an atrial rate of 80/min

A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) to a client who has anemia. Which of the following actions should the nurse take first?

Witness the informed consent