cardio 3

The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided? 1."I will eat enough daily fiber to prevent straining at stool." 2."I will try to exercise vigorously to strengthen my heart muscle." 3."I will drink 3000 to 3500 mL of fluid daily to promote good kidney function." 4."Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels."

"I will eat enough daily fiber to prevent straining at stool." Standard home care instructions for a client with this problem include, among others, lifestyle changes such as decreased alcohol intake, avoiding activities that increase the demands on the heart, instituting a bowel regimen to prevent straining and constipation, and maintaining fluid and electrolyte balance. Consuming 3000 to 3500 mL of fluid and exercising vigorously will increase the cardiac workload.

Diagnostic results of a patient reveal an ejection fraction (EF) of 32%. The nurse recognizes that the finding may be indicative of what conditions? Select all that apply.

-Systolic failure -Mixed systolic and diastolic failure

What are the interventions for shock?

-fluids -O2

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? 1. "I will sit down before I put the nitroglycerin under my tongue." 2. "I will check my pulse rate before I take any nitroglycerin tablets." 3. "I will put the nitroglycerin patch on as soon as I get any chest pain." 4. "I will remove the nitroglycerin patch before taking sublingual nitroglycerin."

1. "I will sit down before I put the nitroglycerin under my tongue." The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin. Although the nurse should check blood pressure before giving nitroglycerin, patients do not need to check the pulse rate before taking nitrates.

The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1. 50 to 100 joules 2. 150 to 300 joules 3. 300 to 350 joules 4. 350 to 400 joules

1. 50 to 100 joules

A team of nurses are reviewing the similarities and differences between the different classifications of shock. Which subclassifications of distributive shock should the nurses identify? Select all that apply. 1. Anaphylactic 2. Hypovolemic 3. Cardiogenic 4. Septic 5. Neurogenic

1. Anaphylactic 4. Septic 5. Neurogenic The varied mechanisms leading to the initial vasodilation in distributive shock provide the basis for the further subclassification of shock into three types: septic shock, neurogenic shock, and anaphylactic shock. Hypovolemic and cardiogenic shock are not subclassifications of distributive shock.

The intensive care nurse is responsible for the care of a client who is in shock. What cardiac signs or symptoms would suggest to the nurse that the client may be experiencing acute organ dysfunction? Select all that apply. 1. Drop in systolic blood pressure of greater than or equal to 40 mm Hg from baselines 2. Hypotension that responds to bolus fluid resuscitation 3. Exaggerated response to vasoactive medications 4. Serum lactate greater than 4 mmol/L 5. Mean arterial pressure (MAP) of less than 65 mm Hg

1. Drop in systolic blood pressure of greater than or equal to 40 mm Hg from baselines 4. Serum lactate greater than 4 mmol/L 5. Mean arterial pressure (MAP) of less than 65 mm Hg Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure <90 mm Hg or MAP <65 mm Hg, drop in systolic blood pressure >40 mm Hg from baselines, or serum lactate >4 mmol/L. An exaggerated response to vasoactive medications and an adequate response to fluid resuscitation would not be noted.

The nurse is caring for a client in intensive care unit whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. Which assessments and interventions should the nurse prioritize? 1. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration 2. Reviewing medications, performing a focused cardiovascular assessment, and providing client education 3. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema 4. Routine monitoring of vital signs, monitoring the peripheral intravenous site, and providing early discharge instructions

1. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on the dosage. When vasoactive medications are given, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated), not "routinely." Vasoactive medications should be given through a central, not peripheral, venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. High doses can cause vasoconstriction, which increases afterload and thus increases cardiac workload. Because this effect is undesirable in clients with cardiogenic shock, dopamine doses must be carefully titrated. Reviewing medications and laboratory findings, monitoring urine output, assessing for peripheral edema, performing a focused cardiovascular assessment, and providing client education are important nursing tasks, but they are not specific to the administration of IV vasoactive drugs.

Which is the MOST appropriate action for the nurse to take before administering digoxin? 1. Monitor potassium level 2. Assess blood pressure 3. Evaluate urinary output 4. Avoid giving with thiazide diuretic

1. Monitor potassium level Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.

Three main factors affect SV

1. Preload 2. Contractility 3. Afterload

The nurse in intensive care unit is admitting a 57-year-old client with a diagnosis of possible septic shock. The nurse's assessment reveals that the client has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurse's analysis of these data should lead to which preliminary conclusion? 1. The client is in the compensatory stage of shock. 2. The client is in the progressive stage of shock. 3. The client will stabilize and be released by tomorrow. 4. The client is in the irreversible stage of shock.

1. The client is in the compensatory stage of shock. In the compensatory stage of shock, the blood pressure remains within normal limits. Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to maintaining adequate cardiac output. Clients display the often-described "fight or flight" response. The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract to the brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool and clammy, and bowel sounds are hypoactive. In progressive shock, the blood pressure drops. In septic shock, the client's chance of survival is low and he will certainly not be released within 24 hours. If the client were in the irreversible stage of shock, his blood pressure would be very low and his organs would be failing.

A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? 1. implantable cardioverter defibrillator 2. pacemaker 3. atropine 4. epinephrine

1. implantable cardioverter defibrillator

Which comorbid conditions are causes for concern for patients who may need to take a beta blocker medication?Select all that apply. 1. Asthma 2. AV block 3. Diabetes 4. Hypertension 5. Benign prostatic hypertrophy (BPH)

1.Asthma Beta blockers can cause bronchoconstriction, so patients who have underlying disorders, such as asthma, should not take these drugs. 2.AV block beta blockers slow the heart rate, patients with AV block should not take these drugs. 3. Diabetes Beta blockers can impede early recognition of insulin-induced hypoglycemia and can block glycogenolysis, so patients with diabetes should not take these drugs.

A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? 1. Chest pain 2. Bleeding at the implantation site 3. Malignant hyperthermia 4. Bradycardia

2. Bleeding at the implantation site Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.

Routine laboratory monitoring in clients taking beta blockers should include: 1. Sodium 2. Glucose 3. Thyrotropin 4. Creatine phosphokinase

2. Glucose

A client has just completed an information session about measures to minimize the progression of coronary artery disease (CAD). Which statement indicates an initial understanding of lifestyle alterations? 1. I should take daily medication for life. 2. I should eat a diet that is low in fat and cholesterol. 3. I should continue to smoke to keep the metabolic rate high. 4. I should begin to exercise if diet is not sufficient to achieve weight loss.

2. I should eat a diet that is low in fat and cholesterol A diet that is low in fat and cholesterol helps slow the progression of CAD. This must be accompanied by regular exercise and cessation of smoking. If these measures are effective, the client may not need daily medication.

The nurse is assisting in caring for the client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. The nurse prevents dislodgement of the pacing catheter by implementing which intervention? 1. Limiting movement and abduction of the left arm 2. Limiting movement and abduction of the right arm 3. Assisting the client to get out of bed and ambulate with a walker 4. Having the physical therapist do active range of motion to the right arm

2. Limiting movement and abduction of the right arm In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgment. The nurse helps prevent this complication by limiting the client's activities.

An older client with ischemic heart disease has experienced an episode of dizziness and shortness of breath. The nurse reviews the plan of care and notices documentation of decreased cardiac output, dyspnea, and syncopal episodes. The nurse plans to take which important action? 1. Monitor oxygen saturation levels. 2. Place the client on a cardiac monitor. 3. Measure blood pressure every 4 hours. 4. Check capillary refill at least once per shift.

2. Place the client on a cardiac monitor. The client with decreased cardiac output should be placed on continuous cardiac monitoring so myocardial perfusion and presence of dysrhythmias can be most accurately assessed. Other cardiovascular data should be collected at least every 2 hours initially.

The nurse is evaluating a client's response to cardioversion. Which observation would be of highest priority to the nurse? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level of consciousness

2. Status of airway Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection

Which of the following is a contraindication for digoxin administration? 1. Blood pressure of 140/90 2. Heart rate above 80 3. Heart rate below 60 4. Respiratory rate above 20

3. Heart rate below 60 The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.

The nurse has reinforced home care instructions to a client who had a permanent pacemaker inserted. Which educational outcome has the greatest impact on the client's long-term cardiac health? 1. Knowledge of when it is safe to resume sexual activity 2. The ability to take an accurate pulse in either the wrist or neck 3. An understanding of the importance of proper microwave oven usage 4. An understanding of why vigorous arm and shoulder movement must be avoided initially

2. The ability to take an accurate pulse in either the wrist or neck Clients with permanent pacemakers must be able to accurately take their pulse in the wrist and/or neck. The client needs to identify any variation in the pulse rate or rhythm and immediately report the variation to the health care provider. Clients can safely operate microwave ovens, radios, electric blankets, lawn mowers, leaf blowers, and cars (proper grounding must be ensured if the client is to operate electrical items). Sexual activity is not resumed until 6 weeks after surgery. The arms and shoulders should not be moved vigorously for 6 weeks after insertion. The remaining options do not have the same impact on long-term cardiac health as does the correct option.

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient? 1. The patient may have had a myocardial infarction. 2. The patient had a vagal response. 3. The patient was anxious about being constipated. 4. The patient may have an abdominal aortic aneurysm.

2. The patient had a vagal response.

A nurse suspects that a client has digoxin toxicity. The nurse should assess for: 1. hearing loss 2. vision changes. 3. decreased urine output 4. gait instability.

2. vision changes

The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient? 1. Start lifting the arm above the shoulder right away to prevent chest wall adhesion. 2. Avoid cooking with a microwave oven. 3. Avoid exposure to high-voltage electrical generators. 4. Avoid walking through store and library antitheft devices.

3. Avoid exposure to high-voltage electrical generators. High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1.Call a code. 2.Call the health care provider. 3.Check the client's status and lead placement. 4.Press the recorder button on the electrocardiogram console.

3. Check the clients status and lead placement. Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

The nurse is caring for a client whose worsening infection places the client at high risk for shock. Which assessment finding would the nurse consider a potential sign of shock? 1. Elevated systolic blood pressure 2. Elevated mean arterial pressure (MAP) 3. Shallow, rapid respirations 4. Bradycardia

3. Shallow, rapid respirations A symptom of shock is shallow, rapid respirations. Systolic blood pressure drops in shock, and MAP is less than 65 mm Hg. Bradycardia occurs in neurogenic shock; other states of shock have tachycardia as a symptom. Infection can lead to septic shock.

A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? 1. Bundle of His 2. Purkinje fibers 3. Sinoatrial (SA) node 4. Atrioventricular (AV) node

3. Sinoatrial (SA) node The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity.

The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements? SATA 1. "I should limit my fluids while taking this medication." 2. "It is okay to keep taking my ginseng." 3. "If I have nausea, it means I must stop the medication." 4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."

4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."

The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating? 1. 5-10 lbs 2. 10-15 lbs 3. 15-20 lbs 4. 20-25 lbs

4. 20-25 lbs

The clinic nurse is obtaining cardiovascular data on a client. The nurse prepares to check the client's apical pulse and places the stethoscope in which position? 1. Midsternum equal with the nipple line 2. At the midaxillary line on the left side of the chest 3. At the midline of the chest just below the xiphoid process 4. At the midclavicular line at the fifth left intercostal space

4. At the midclavicular line at the fifth left intercostal space The heart is located in the mediastinum. Its apex or distal end points to the left and lies at the level of the fifth intercostal space. A stethoscope should be placed in this area to pick up heart sounds most clearly. The other options are incorrect because they do not represent the anatomical positioning of the heart's apex.

The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? 1. Administer atropine 0.5 mg 2. Administer epinephrine 3. Defibrillate with 360 joules 4. Begin cardiopulmonary resuscitation (CPR)

4. Begin cardiopulmonary resuscitation (CPR)

A nurse is monitoring a client who is taking Carvedilol (Coreg CR). Which of the following assessment made by the nurse would warrant a possible complication with the use of this medication? 1. Baseline blood pressure of 160/100 mm hg followed by a blood pressure of 120/70 mm hg after 3 doses. 2. Baseline heart rate of 97 bpm followed by a heart rate of 62 bpm after 3 doses. 3. Complaints of nightmares and insomnia. 4. Complaints of dyspnea.

4. Complaints of dyspnea Complaints of dyspnea is a sign of bronchospasm which is one of the serious complication of beta blockers. Options 1 and 2 shows a decrease in the blood pressure and heart rate which are expected in this therapy. Option 4 is a side effect of this medication.

The nurse is assigned to assist with caring for a client after cardiac catheterization. The nurse should plan to maintain bed rest for this client in which position? 1. High-Fowler's position 2. Lateral (side-lying) position 3. Head elevation of 45 degrees 4. Head elevation of no more than 30 degrees

4. Head elevation of no more than 30 degrees After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for the prescribed time period. The client may turn from side to side. The client is placed in the supine position and the head of the bed is not elevated to more than 30 degrees to keep the affected leg straight at the groin and prevent arterial occlusion. Bathroom privileges are not allowed during the immediate postcatheterization period. For the high-Fowler's position, the head of the bed is elevated 90 degrees.

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? 1. Oxygen saturation decreased from 96% to 91%. 2. Pulse rate increased from 80 to 104 beats per minute. 3. Blood pressure decreased from 140/86 to 112/72 mm Hg. 4. Respiratory rate increased from 16 to 19 breaths per minute.

4. Respiratory rate increased from 16 to 19 breaths per minute. Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.

A patient is being treated for hypothyroidism. She isalso taking digoxin (Lanoxin) for chronic heart failure. Which of the following factors places the patient at risk for digoxin toxicity? 1. impaired renal function 2. impaired liver function 3. tachycardia 4. decreased metabolic rate

4. decrease metabolic rate A client who is being treated for hypothyroidism has a decreased metabolic rate. A decreased metabolic rate places the client at risk for digitalis toxicity.

Which test is performed before an ABG is drawn?

Allen test

What is the formula used to calculate cardiac output?

Cardiac output = heart rate × stroke volume. SV = the volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction

Before ambulating the client for the first time after administration of captopril, the nurse should monitor for:

Hypotension