Cardiovascular

Which confirmatory test would the nurse anticipate for a client with a tentative diagnosis of Hodgkin disease?

Lymph node biopsy. The diagnosis depends on the identification of characteristic histological features of an excised lymph node. A bone scan is a diagnostic device to assess bony metastasis of cancers. CT scans identify the extent of the of the disease in the abdominal and thoracic cavities. The radioactive iodine uptake study is not indicated for Hodgkin disease; it is used be radiotherapy or diagnosis of thyroid diseases.

Which potential cause of dysrhythmia would the nurse consider when assessing a client who has sinus tachycardia? Select all that apply. - Anxiety - Caffeine - Exercise - Anemia - Hypothermia

Anxiety, Caffeine, Exercise, and Anemia Causes of sinus tachycardia: sympathetic, fear or pain (for ex. anxiety), use of stimulants (caffeine), exercise, anemia, hypovolemia, heart failure, and fever. Hypothermia will cause sinus bradycardia.

Which action will the nurse take first when a client w/ peripheral arterial disease returns to the nursing unit after a femoral angiogram?

Assess the client's affected leg. The most common complication of femoral angiogram is bleeding at the arterial access site, and the nurse will first assess the leg pulses, temp, and color for adequate perfusion. An oral temp will be obtained, but infection is not a common problem post-angiogram, and fever would not be expected. A general anesthetic is not used; therefore, voiding, usually is not a concern. The head of the bed after femoral angiogram usually can be elevated to about 30 degrees, although the head may need to be lowered if bleeding at the femoral site occurs.

Which lymph nodes would the nurse expect to be affected first when a client is dx w/ Hodgkin disease? - Cervical - Axillary - Inguinal - Mediastinal

Cervical Painless enlargement of the cervical lymph nodes often is the first sign of Hodgkin disease, a malignant lymphoma of unknown etiology. Axillary node enlargement occurs after cervical lymph node enlargement. Inguinal node enlargement occurs later. Mediastinal node involvement follows as the disease progresses.

Which clotting factor would a nurse explain is deficient to the parents of a child newly diagnosed with hemophilia A? - Factor II - Factor XII - Factor IX - Factor VIII

Factor VIII Hemophilia type A, the most common type of hemophilia, is from a deficiency of Factor VIII. Factors II and XII are part of the clotting cascade, but they are not associated with hemophilia. Factor IX is associated with hemophilia type B.

Which type of shock is associated with a ruptured abdominal aneurysm? - Vasogenic shock - Neurogenic shock - Cardiogenic shock - Hypovolemic shock

Hypovolemic shock When an abdominal aneurysm ruptures, hypovolemic shock ensues b/c fluid volume depletion occurs as the heart continues to pump blood out of the ruptured vessel. Vasogenic shock results from humoral or toxic substances acting directly on the blood vessel, causing vasodilation. Neurogenic shock results from decreased neuromuscular tone, causing decreased vasoconstriction. Cardiogenic shock results from a decreased in cardiac output.

Which information would the nurse include when explaining the purpose of a thallium scan to the client who has a history of chest pain?

It assesses myocardial ischemia and perfusion. Thallium imaging is used to assess myocardial ischemia or necrotic muscle tissue related to angina or myocardial infarction. Necrotic or scar tissue does not extract the thallium isotope, leading to cold spots. Action of the heart valves is available from an echocardiogram. Visualization of the ventricular systole and diastole is also determined by an echocardiogram. Identifying the adequacy of cardiac conduction is determined by an electrocardiogram.

Which factor is the likely cause of the laboratory result when arterial blood gases done on a client who is being resuscitated after cardiac arrest show a low pH? - Ketoacidosis - Irregular heartbeat - Lactic acid production - Sodium bicarbonate administration

Lactic acid production Lactic acid production Cardiac arrest causes decrease tissue perfusion, which result in anaerobic metabolism and lactic acid production. Fat-forming ketoacidosis occur in diabetes. An irregular heartbeat doesn't cause acidosis. Sodium bicarbonate causes alkalosis, not acidosis.

Which term would the nurse use to document a drop in bp when a client moves rapidly from a lying to a standing position?

Orthostatic hypotension Orthostatic hypotension specifically refers to an abnormally low bp that occurs when an individual assumes a standing position. Orthostatic hypotension is also known as postural hypotension. May be result of: internal bleeding, fluid depletion, or loos of neurovascular control preventing vasoconstriction from regulating bp. Vasomotor instability occurs during menopause and results in hot flashes and night sweats.

Which part of the electrocardiogram (ECG) represents depolarization of the ventricles? - P wave - T wave - PR interval - QRS interval

QRS interval Atrial and ventricular depolarization and repolarization are represented on the ECG as a series of waves: the P wave followed by the QRS complex and the T wave. The QRS represents ventricular depolarization. The P wave occurs with depolarization of the atria. The T wave represents ventricular repolarization. the PR interval represents depolarization of the atria and of the atrioventricular node.

Which condition would the nurse conclude that the client is experiencing when the monitor shows a PQRST wave for each beat, indicated a rate of 120 beats/ minute, and the rhythm is regular?

The presence of a P wave before each QRS complex indicated a sinus rhythm. A heart rate >100 beats/ minutes indicates tachycardia. Atrial fibrillation causes an irregular rhythm, and P waves are not identifiable. Ventricular fibrillation is irregular and shows no PQRST configurations. A first-degree atrioventricular block patter has a prolonged PR interval and is regular.

Which information will the nurse include when explaining to a client with atrial tachycardia how the use of the Valsalva maneuver may decrease the client's heart rate?

The vagus nerve is stimulated. Inhaling and forcing the diaphragm and chest muscles against a closed glottis increase intrathoracic pressure, which affects the vagus nerve and slows the heart. Although the glottis closes, this does not interrupt the dysrhythmia. Thoracic pressure increases, not decreases, during the Valsalva maneuver. Although the respiratory patter is interrupted briefly, this does not interrupt the dysrhythmia

Which statement by wife of a client receiving hemodialysis who undergoes surgery to create an arteriovenous fistula indicates that further teaching is required? - "I must touch the shunt several times a day to feel for the bruit" - I have to take his bp every day in the arm with the fistula" - He will have to be very careful at night not to lie on the arm with the fistula" - We really should check the fistula every day for signs of redness and swelling"

"I have to take his bp every day in the arm with the fistula" Taking the bp in the affected arm may injure the fistula. The presence of a bruit indicates that the circulation is not obstructed by a thrombus. Hemorrhage can occur in a matter of minutes if the cannula is dislodges. It is correct that the patient shouldn't lie on the arm with the fistula. Redness and swelling are signs of infection, which is a complication of cannulization.

In what order does normal cardiac conduction occur through the heart? - Bundle of His - Sinoatrial node - Purkinje fibers - Bundle branches - Atrioventricular (AV) node

1. Sinoatrial node 2. Atrioventricular (AV) node 3. Bundle of His 4. Bundle branches 5. Purkinje fibers The cardiac cycle begins with an impulse generated from a small concentrated area of pacemaker cells high in the right atria called the sinus or sinoatrial node. The impulse quickly reaches the AV node located in the area called the AV junction, b/w the atria and the ventricles. Here the impulse is slowed to allow time for ventricular filling during relaxation or ventricular diastole. The electrical impulse then is conducted rapidly through the bundle of HIS to the ventricles via the left and right bundle branches, finally terminating in tiny fibers called Purkinje fibers that reach the myocardial muscle cells or myocytes.

Which intervention would the nurse perform when caring for a client in the ED reporting chest pain? Select all that apply. - Providing oxygen - Assessing VS - Obtaining a 12-lead EKG - Drawing blood for cardiac enzymes - Auscultating heart sounds - Administering nitroglycerin

All of the above. The nurse would provide oxygen to a client with chest pain, as the heart may be getting insufficient oxygen as a result of occluded coronary vessels. The nurse would also assess the client's VS, obtain a 12-lead EKG, and auscultate heart sounds to determine rhythm changes related to cardiac ischemia. The nurse would need to draw blood for evaluation of cardiac enzymes. Changes in the levels of these enzymes (including troponin, creatine kinase, and myoglobin) can indicate damage to heart tissue. Nitroglycerin is administered to promote coronary vasodilation.

How would the nurse describe heart failure to a client? - A cardiac condition caused by inadequate circulating blood volume - An acute state in which the pulmonary circulation pressure decreases - An inability of the heart to pump blood in proportion to metabolic needs - A chronic state in which the systolic bp drops below 90 mm Hg

An inability of the heart to pump blood in proportion to metabolic needs. As the heart fails, cardiac output decreases; eventually the decrease will reach a level that prevents tissues from receiving adequate oxygen and nutrients. The heart will be unable to pump blood in proportion to metabolic needs. Heart failure is related to an increased, not decreased, or inadequate, circulating blood volume. When the pulmonary pressure increases capillary fluid is forced into the alveoli; the condition may be acute or chronic. The bp may decrease with heart failure, but a systolic bp below 90 mmHg can occur in healthy clients or be caused by many other diagnoses.

Which condition unrelated to cardia disease is the major cause of right ventricular failure? - Hypovolemic shock - Chronic kidney disease - Chronic obstructive pulmonary disease (COPD) - Systematic inflammatory response syndrome (SIRS)

COPD COPD causes destruction of capillary beds around the alveoli, interfering with blood flow through the lungs from the right side of the heart and causing pulmonary hypertension. As the heart continues to strain against this resistance, right ventricular failure eventually results. Hypovolemic shock will not cause stress on the right side of the heart. Chronic kidney disease and the resulting fluid retention cause stress on the left side of the heart and left ventricular failure. SIRS may be associated with septic shock and high output heart failure, but it doesn't cause right ventricular failure.

Which finding will the nurse expect when caring for a client who is in hypovolemic shock? - Slow HR - Cool skin temp - Bounding radial pulses - increased urine output

Cool skin temp Shunting of blood to vital organs such as the heart and brain occurs in hypovolemic shock, leading to cool skin b/c of decreased skin perfusion. tachycardia, not bradycardia (slow HR), occurs as a compensatory mechanism in hypovolemic shock. the pulses in hypovolemic shock are weak and thready b/c of decreased bp. Urine output will decrease b/c of decreased kidney perfusion in hypovolemic shock.

Which likely cause would a nurse suspect is responsible for a drop in bp after a client sustains multiple internal injuries in a motor vehicle accident and the bp suddenly drops from 134/90 to 80/60 mm Hg? - Reduction in the circulating blood volume Diminished vasomotor stimulation to the arterial wall - Vasodilation resulting from diminished vasoconstrictor tone - Cardiac decompensation resulting from electrolyte imbalance

Reduction in the circulating blood volume The client's history of traumatic injury and the sudden change in bp is most consistent with hypovolemic shock (reduction in the circulating blood volume), which is evidenced by decreased bp and a decreased pulse pressure. Diminished stimulation to the arterial wall is the result of low bp. Vasodilation resulting from diminished vasoconstrictor tone is a description of neurogenic shock, which is unlikely in this situation. Although electrolyte imbalances can precipitate cardiac decomopensation, cardiogenic shock is unlikely in this situation.