Exam 3 Review

What effect does the nurse expect a Class IV drug to have on a client's cardiac conduction system? A. Slow the flow of calcium into the cell during depolarization to depress automaticity B. Stabilize membranes to decrease myocardial contractility C. Decrease heart rate and conduction velocity D. Lengthen the absolute refractory period and prolong repolarization

A Class IV antidysrhythmics slow the flow of calcium into the cell during depolarization, thereby depressing the automaticity of the sinoatrial (SA) and atrioventricular (AV) nodes, decreasing the heart rate, and prolonging the AV nodal refractory period and conduction. Calcium channel blockers, such as verapamil hydrochloride and diltiazem hydrochloride, are Class IV drugs. They are used to treat supraventricular tachycardia (SVT) and atrial fibrillation (AF) to slow the ventricular response.

Which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor? A. P wave B. PR segment C. QRS complex D. T wave

A Impulses from the sinus node move directly through atrial muscle and lead to atrial depolarization, which is reflected in a P wave on the electrocardiogram (ECG). Atrial muscle contraction should follow. The PR segment reflects impulses slowing down or being delayed in the AV node before proceeding to the ventricles. QRS complexes reflect ventricular depolarization and T waves reflect ventricular repolarization.

To determine if a client has a pulse deficit, what procedure would the nurse follow? A. Assess the apical and radial pulses for a full minute and calculate the difference. B. Check the client's blood pressure for a full minute and calculate the difference. C. Take the client's pulse rate while supine, then in a standing position. D. Assess the radial pulse for a minute, have the client rest, then check the radial pulse again.

A Pulse deficit is the difference between the apical and peripheral (e.g., radial) pulses. If the apical pulse differs from the radial pulse rate, a pulse deficit exists and indicates that the heart is not pumping adequately to achieve optimal perfusion to the body. The difference between systolic and diastolic pressures is the pulse pressure. When a client's blood pressure and pulse are taken first lying down and then sitting or standing, that is orthostatic vital signs.

Which beta-blocker drug approved for treating dysrhythmias is also a Class III antidysrhythmic drug? A. Sotalol B. Esmolol C. Propranolol D. Acebutolol

A Sotalol hydrochloride is an antidysrhythmic agent with both noncardioselective beta-adrenergic blocking effects (Class II) and action potential duration prolongation properties (Class III). IT is an oral agent that may be used for the treatment of documented ventricular dysrhythmias such as VT that are life threatening.

After calling for help, when the nurse finds a client in his or her room without a pulse, apneic and unconscious, which action should be taken next? A. Begin cardiac compressions. B. Establish IV access. C. Give supplemental oxygen. D. Defibrillate the client.

A The desired outcomes of collaborative care are to resolve VF promptly and convert it to an organized rhythm. Therefore, the priority is to defibrillate the client immediately according to ACLS protocol. If a defibrillator is not readily available, as would likely be the case in a client's room, high-quality CPR must be initiated and continued until the defibrillator arrives.

Which ECG strip pattern is evidence to the nurse that a client's temporary transvenous pacemaker has successfully depolarized the ventricles? A. A pacer spike followed by a QRS complex B. Two spikes followed by a QRS complex C. A pacer spike before and after the QRS complex D. No pacer spike but regular QRS complexes

A When a pacing stimulus is delivered to the heart, a spike (or pacemaker artifact) is seen on the monitor or ECG strip. When the pacer spike is followed by a QRS complex, this pattern indicates ventricular depolarization and is referred to as capture (the pacemaker successfully depolarized the ventricles).

Which action increases the effectiveness of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in controlling hypertension for African-American clients? A. The ARB or ACEI is given with a diuretic, beta blocker, or a calcium channel blocker. B. A much higher dose of ARB or ACEI is prescribed for an African-American client. C. The ARB or ACEI is combined with rigorous lifestyle modifications. D. Clients take the ARB or ACEI around the clock on an individu

A ACEIs and ARBs are not as effective in African Americans unless they are taken with diuretics or another drug category such as a beta blocker or calcium channel blocker.

Which relatively new therapy would be tried for clients with familial hypercholesterolemia or for those who are unable to reduce LDLs with existing therapies? A. PCSK9 inhibitors B. Nicotinic acid C. Lovaza (omega-3 ethyl esters) D. Combination drugs (e.g., Caduet)

A The Food and Drug Administration (FDA) ap-proved the drug class, PCSK9 inhibitors, for use in clients with familial hypercholesterolemia or for those who are unable to reduce LDLs with existing therapies. Nicotinic acid (niacin) may lower LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels and increase HDL-C levels but is poorly tolerated due to side effects. Lovaza (omega-3 ethyl esters) is approved by the FDA as an adjunct to diet to reduce TGs that are greater than 500 mg/dL. Caduet is used to decrease blood pressure while decreasing tri-glycerides (TGs), increasing HDL, and lowering LDL.

Which piece of equipment would the nurse recommend for a client to manage hypertension at home? A. Blood pressure monitoring device B. Stationary exercise bicycle C. Blood glucose monitoring device D. Kitchen food scale

A The nurse would teach the client to obtain an ambulatory BP monitoring (ABPM) device for use at home so the pressure can be checked daily. The nurse would also evaluate the client's and family's ability to use this device accurately and instruct the client to keep a record of blood pressure readings and report very low or high readings to the primary health care provider.

What drug would the nurse expect to be prescribed for a client with hypertension and for whom lifestyle modifications have failed to control blood pressure? A. Thiazide diuretic B. Calcium channel blocker C. Angiotensin-converting enzyme inhibitor D. Beta blocker

A Thiazide (low-ceiling) diuretics, such as hydro-chlorothiazide, inhibit sodium, chloride, and water reabsorption in the distal tubules while promoting potassium, bicarbonate, and magnesium excretion. Because of the low cost and high effectiveness of thiazide-type diuretics, they are usually the drugs of choice for clients with uncomplicated hypertension.

Which ECG waveforms and intervals are the normal measurements or positions? Select all that apply. A. PR interval 0.12-0.20 second B. QRS complex 0.6-0.10 second C. PR segment isoelectric line D. QT interval less than half of the R to R interval E. U wave follows T wave if present F. TP segment one block above isoelectric line

A, B, C, D, E All of these statements are correct except F. The TP segment should return to and be located on the isoelectric line.

Which signs and symptoms would the nurse expect to assess in a client with sinus tachycardia? Select all that apply. A. Fatigue B. Shortness of breath C. Decreased oxygen saturation D. Decreased blood pressure E. Anginal pain F. Widened QRS complexes

A, B, C, D, E For clients with sinus tachycardia, assess for fatigue, weakness, shortness of breath, orthopnea, decrease oxygen saturation, increased pulse rate, and decreased blood pressure. Also asses for restlessness and anxiety from decreased cerebral perfusion and for decreased urine output from impaired renal perfusion. The client may also have anginal pain and palpitations. The ECG pattern may show T-wave inversion or ST-segment elevation or depression (not wide QRS complexes) in response to myocardial ischemia.

Which features would the nurse recognize as indicating that a client had a venous ulcer? Select all that apply. A. No claudication or rest pain B. Ulcer located in the ankle area C. Brown pigmentation D. Very little granulation tissue present E. Ulcer bed is pink F. Pulses are present

A, B, C, E, F Characteristics of venous ulcers include: chronic nonhealing ulcer; no claudication or rest pain; moderate ulcer discomfort; client reports of ankle or leg swelling; location is the ankle area; brown pigmentation; the ulcer bed is pink; the ulcer is usually superficial, with uneven edges; granulation tissue present; ankle discoloration and edema; full veins when leg slightly dependent; no neurologic deficit; pulses present; and may have scarring from previous ulcers.

A nurse assesses a client who is recovering from a heart transplant. Which assessment findings would alert the nurse to the possibility of heart transplant rejection? (SATA) a. Shortness of breath b. Abdominal bloating c. New-onset bradycardia d. Increased ejection fraction e. Hypertension f. Fatigue

A, B, C, F Clinical findings of heart transplant reject include: SOB, fatigue, fluid gain, abdominal bloating, new-onset bradycardia, HYPOtension, afib/aflutter, decreased activity tolerance, and decreased EF.

A nurse assesses clients on a cardiac unit. Which clients would the nurse identify as at GREATEST risk for the development of acute pericarditis? (SATA) a. 36 year old woman with systemic lupus erythematosus (SLE) b. 42 year old man recovering from coronary artery bypass graft surgery c. 59 year old woman recovering from a hysterectomy d. 80 year old man with a bacterial infection of the respiratory tract e. 88 year old woman with a stage III sacral ulcer

A, B, D Acute pericarditis most commonly associated with acute exacerbations of systemic connective tissue disease, including SLE; with Dressler syndrome, or inflammation of the cardiac sac after cardiac surgery or a MI; and with infective organisms, including bacterial, viral, and fungal infections. Abdominal and reproductive surgeries and pressure injuries do not increase risk.

A nurse prepares to discharge a client who has heart failure. What questions would the nurse ask to ensure this client's safety prior to discharging home? a. Are your bedroom and bathroom on the first floor? b. What social support do you have at home? c. Will you be able to afford your oxygen therapy? d. What spiritual beliefs may impact your recovery? e. Are you able to accurately weigh yourself at home?

A, B, D, C & E??? To ensure safety upon discharge, the nurse would assess for structural barriers to functional ability, such as stairs. Nurse would assess pt's available social support (family, friends, home health services). Pt beliefs about and ability to adhere to meds and tx including daily weight would also be reviewed. Other q's do not specifically address pt safety upon discharge?

Where will the nurse place the leads on a client for a five-lead continuous monitoring system? Select all that apply. A. Right arm electrode just below the right clavicle B. Left arm electrode just below the left clavicle C. Right leg electrode not eh highest palpable rib, on the left midclavicular line D. Left leg electrode on the lowest palpable rib, on the left midclavicular line E. Fifth electrode placed to obtain one of the six chest leads F. Left arm electrode just above the left clavicle

A, B, D, E If the monitoring system provides five electrode cables, place the electrodes as follows: right arm electrode just below the right clavicle; left arm electrode just below the left clavicle; right leg electrode on the lowest palpable rib, on the right midclavicular line; left leg electrode on the lowest palpable rib, on the left midclavicular line; and fifth electrode placed to obtain one of the six chest leads.

Which causes would the nurse recognize as leading to increased atrial irritability and premature atrial contractions (PACs) in a client's myocardium? Select all that apply. A. Caffeine intake B. Anxiety C. Syncope D. Stress in life E. Infection F. Pulmonary hypotension

A, B, D, E The cause of atrial irritability that can lead to PACs include: stress; fatigue; anxiety; inflammation; infection; intake of caffeine, nicotine, or alcohol; and drugs such as epinephrine, sympathomimetics, amphetamines, digoxin, or anesthetic agents. PACs may also result from myocardial ischemia, hypermetabolic states, electrolyte imbalance, or atrial stretch.

Which important teaching points would the nurse discuss with a client who receives a new permanent pacemaker? Select all that apply. A. Report any pulse rate that is lower than the rate set on the pacemaker. B. Avoid sources of strong electromagnetic fields such as magnets. C. If the surgical incision is near the shoulder, be sure to perform daily range of motion. D. Carry a pacemaker identification card and wear a medical alert bracelet. E. Avoid tight clothing to prevent pressure over the pace

A, B, D, E The client would inform airport personnel of the pacemaker before passing through a metal detector and show them the pacemaker identification card. The metal in your pacemaker will trigger the alarm in the metal detector device. Instruct the client to avoid lifting the arm over the head or lifting more than 10 lb for the next 4 weeks because this could dislodge the pacemaker wire. Teach the client to report any pulse rate lower than that set on the pacemaker. Tell clients to avoid sources of strong electromagnetic fields, such as magnets and telecommunications transmitters. Carry a pacemaker identification card provided by the manufacturer and wear a medical alert bracelet at all times.

Which actions are essential nursing care for a client immediately after elective cardioversion? Select all that apply. A. Administer oxygen. B. Assess vital signs and level of consciousness. C. Provide sips of water or ice chips. D. Monitor for dysrhythmias. E. Maintain an open airway. F. Document the results of the cardioversion.

A, B, D, E, F Nursing care after cardioversion includes: maintaining a patent airway; administering oxygen; assessing vital signs and the level of consciousness; administering antidysrhythmic drug therapy, as prescribed; monitoring for dysrhythmias; assessing for chest burns from electrodes ; providing emotional support; and documenting the results of cardioversion. Sips of water and ice chips would not be provided until the client's gag reflex returned.

Which questions would the nurse use to assess a client's P wave on an ECG rhythm strip? Select all that apply. A. Do all P waves look similar? B. Are P waves present? C. Does one P wave follow each QRS complex? D. Are P waves occurring regularly? E. Are the P waves greater than 0.20 second? F. Are P waves smooth, rounded, and upright?

A, B, D, F Ask these five questions when analyzing P waves: Are P waves present?; Are the P waves occurring regularly?; Is there one P wave for each QRS complex?; Are the P waves smooth, rounded, and upright in appearance; or are they inverted?; and Do all P waves look similar?

Which actions would the nurse take when the monitor technician states that a client's telemetry ECG signal transmission is not very clear? Select all that apply. A. Ensure that the fee on each electrode is moist and fresh. B. Clean the skin and clip hairs if necessary. C. Abrade the skin by rubbing briskly with a rough washcloth. D. Make sure that the skin is free of lotion or any other substance. E. Clean the skin with povidone-iodine before applying electrodes. F. Check to be sure that electro

A, B, D, F The clarity of continuous ECG monitor recording is affected by skin preparation and electrode quality. To ensure the best signal transmission and decrease skin impedance, clean the skin and clip hairs if needed. Make sure that the area for electrode placement is dry. The gel on each electrode must be moist and fresh. Attach the electrode to the lead cable and then to the contact site. The contact site should be free of any lotion, tincture, or other substance that increases skin impedance. Electrodes cannot be placed on irritated skin or over scar tissue.

Which lifestyle changes would the nurse teach a client to help control hypertension? Select all that apply. A. Weight reduction if overweight or obese. B. Implement a healthy diet such as the DASH diet. C. Decrease smoking and nicotine use. D. Use relaxation techniques to decrease stress. E. Restrict sodium by not adding salt at the table. F. Increase activity by use of a structured exercise program.

A, B, D, F The nurse would teach all clients about lifestyle changes to help control hypertension including: restrict dietary sodium according to ACC/AHA guidelines (not adding table salt is often not enough); reduce weight if overweight or obese; implement a heart-healthy diet, such as the DASH diet; increase physical activity with a structured exercise program; abstain or de-crease alcohol consumption (no more than one drink a day for women and two drinks a day for men); stop smoking and tobacco use; and use relaxation techniques to reduce stress.

A nurse is assessing a client with left-sided heart failure. For which clinical manifestations would the nurse assess? (SATA) a. Pulmonary crackles b. Confusion c. Pulmonary hypotension d. Dependent edema e. Cough that worsens at night f. Jugular venous distension

A, B, E Left-sided HF occurs w/ decrease in contractility of heart or increase in afterload. Most signs will be in respiratory - crackles, confusion (decreased O2), and cough. RV HF = pulmonary hypotension, edema, and JVD.

A nurse evaluates laboratory results for a client with heart failure. Which results would the nurse expect? (SATA) a. Hematocrit: 32.8% b. Serum sodium: 130 mEq/L c. Serum potassium: 4.0 mEq/L d. Serum creatinine: 1.0 mg/dL e. Proteinuria f. Microalbuminuria

A, B, E, F Hematocrit of 32.8% is low (should be 42.6) indicating dilutional ratio of RBCs to fluid (too much fluid). Serum sodium low bc hemodilution. Microalbuminuria and proteinuria are present, indicating decerase in renal filtration. These are early warning signs of decreased compliance of heart. K levels normal, creatinine normal.

A nurse collaborates with assistive personnel to provide care for a client with congestive heart failure. Which instructions would the nurse provide to the AP when delegating care for this client? (SATA) a. Reposition the client every 2 hours b. Teach the client to perform deep-breathing exercises c. Accurately record intake and output d. Use the same scale to weigh the client each morning e. Place the client on oxygen if the client becomes short of breath

A, C, D The AP should reposition the client every 2 hours to improve oxygenation and prevent atelectasis. The AP can also accurately record intake/output, and use same scale to weigh pt each AM before breakfast. APs are not qualified to teach or asses the need for and provide O2 therapy.

Which nursing interventions promote a client's compliance with antihypertensive therapy? Select all that apply. A. Provide oral and written instructions related to all prescribed medications. B. Give the client a list of resources for finding additional information on prescribed drugs. C. Stress that suddenly stopping beta blockers can cause angina or heart attack. D. Suggest that the client have a home scale for weight monitoring. E. Advocate for medications that are taken three times a day for

A, C, D, F Health teaching is essential to help clients be-come successful in managing their BP. Pro-vide oral and written information about the indications, dosage, times of administration, side effects, and drug interactions for antihypertensives. Stress that medication must be taken as prescribed. Teach that suddenly stop-ping drugs such as beta blockers can result in angina (chest pain), myocardial infarction (MI), or rebound hypertension. Teach clients to obtain an ambulatory BP monitoring (ABPM) device and suggest having a scale in the home for weight monitoring. Remember that clients are more compliant with the plan of care when drugs are given once a day. Instruct clients to report unpleasant side effects of antihypertensive drugs so that another drug may be prescribed to minimize those side effects.

Which factors would the nurse note as increasing the risk for atherosclerosis with an older African-American client? Select all that apply. A. 20-year history of type 2 diabetes B. Nutrition includes three to four diet sodas per day C. Sedentary lifestyle D. 25 pounds overweight E. Father with history of colon cancer F. Grandmother died after heart attack

A, C, D, F Risk factors for atherosclerosis include: low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, diabetes mellitus, obesity, hypertension, sedentary lifestyle, smoking, stress, African American or Hispanic ethnicity, older adult, and diet high in saturated and trans fats, cholesterol, sodium, and sugar.

A nurse is caring for a client who was admitted with hypertrophic cardiomyopathy (HCM). What interprofessional care does the nurse anticipate providing? (SATA) a. Administering beta blockers b. Administering high-dose furosemide c. Preparing for a cardiac catheterization d. Loading the client on digitalis e. Instructing the client to avoid strenuous exercise f. Teaching the client how to use the CardioMEMS

A, C, E Management of obstructive HCM includes administering negative inotropic agents such as beta-adrenergic blocking agents (carvedilol) and calcium antagonists (verapamil). Vasodilators, diuretics, nitrates, and cardiac glycosides are contraindicated in pts with obstructive HCM. Strenuous exercise is also prohibited. Echo, radionuclide imaging, and angiocardiography during cardiac cath are performed to diagnose different cardiomyopathies. The CardioMEMS device is used with clients who have HF.

Which are nursing responsibilities for the care of a client with a newly implanted permanent pacemaker? Select all that apply. A. Assess the implantation site for bleeding, swelling, redness, tenderness, or infection. B. Administer short-acting sedatives as needed and prescribed. C. Monitor the ECG rhythm strip to ensure that the pacemaker is working correctly. D. Observe the overstimulation of the chest wall, which might cause pneumothorax. E. Assess that the implantation site dressing is clean

A, C, E, F After the procedure, monitor the ECG rhythm to check that the pacemaker is working correctly. Assess the implantation site for bleeding, swelling, redness, tenderness, and infection. The dressing over the site should remain clear and dry. The client should be afebrile and have stable vital signs. The electrophysiologist prescribes initial activity restrictions, which are then gradually increased. Observe for muscle contractions over the diaphragm that are synchronous with the heart rate. Pneumothorax is usually not a complication of pacemaker implantation. Sedative drug are often given to clients receiving transcutaneous pacing but not for permanent pacemaker insertion.

Which actions are responsibilities of the monitor technician? Select all that apply. A. Report client rhythm and significant changes to the nurse. B. Notify the health care provider of any pertinent changes. C. Print routine ECG strips for each monitored client. D. Apply battery-operated transmitter leads to clients. E. Watch the bank of cardiac monitors on a client care unit. F. Interpret rhythm strips for each monitored client.

A, C, E, F Most acute care facilities have monitor technicians who are specially educated in ECG monitoring and rhythm interpretation. Their responsibilities include: watching a bank of monitors on a unit; printing ECG rhythm stops routinely and as needed; interpreting rhythms; and reporting the client's rhythm and significant changes to the nurse. The nurse would be responsible for notifying the cardiac health care provider (HCP) of changes, and the nurse or a qualified AP would apply the leads to a monitored client.

Which control systems play an important role in maintaining a client's blood pressure? Select all that apply. A. The arterial baroreceptor system B. Elevated lipid levels C. Regulation of body fluid volume D. Dietary saturated fats and sodium E. Vascular autoregulation F. The renin-angiotensin-aldosterone system

A, C, E, F Stabilizing mechanisms exist in the body to exert overall regulation of systemic arterial pressure and to prevent circulatory collapse. Four control systems play a major role in maintaining blood pressure: the arterial baroreceptor system, regulation of body fluid volume, the renin-angiotensin-aldosterone system, and vascular autoregulation. Some elevated lipid levels contribute to development of atherosclerosis and arterial disease. A diet high in saturated fats and sodium is a risk factor for development of atherosclerosis.

Which assessment findings indicate to the nurse that a client has stage III peripheral arterial disease (PAD)? Select all that apply. A. Pain is described as numbness, burning, toothache-type pain. B. Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. C. Pain is relieved by placing the extremity in a dependent position. D. Ulcers and blackened tissue occur on the toes, forefoot, and heel. E. Pain usually occurs in the distal part of the extremity (toes, arch, foref

A, C, E, F Stage III peripheral arterial pain is also called rest pain. Key features include: pain while resting which commonly awakens the client at night; the pain is described as numbness, burning, or toothache-type pain; the pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel); and pain is relieved by placing the extremity in a dependent position. Muscle pain, cramping, or burning that occurs with exercise and is relieved with rest is a feature of stage II; and ulcers and blackened tissue occur on the toes, forefoot, and heel, which is characteristic of stage IV.

Which conditions would the nurse suspect when a client's telemetry ECG rhythm strip shows ST elevation of 1.5 mm (1.5 small blocks)? Select all that apply. A. Pericarditis B. Hypokalemia C. Myocardial infarction D. Ventricular hypertrophy E. Endocarditis F. Hyperkalemia

A, C, F ST elevation may indicate problems such as myocardial infarction, pericarditis, and hyperkalemia. ST depression is associated with hypokalemia, myocardial infarction, or ventricular hypertrophy. Endocarditis is an infection of the endocardium and usually affects the heart valves.

After teaching a client with congestive hear failure (CHF), the nurse assesses the client's understanding. Which client statements indicate a CORRECT understanding of the teaching related to nutritional intake. (SATA) a. I'll read the nutritional labels on food items for salt content b. I will drink at least 3 L of water each day c. Using salt in moderation will reduce the workload of my heart d. I will eat oatmeal for breakfast instead of ham and eggs e. Substituting fresh vegetables for canned

A, D, E Nutritional therapy for CHF focused on decreasing sodium and water retention to decrease heart workload. Pt taught to read labels, omit table salt and foods high in sodium (ham and canned foods), and limit water intake to a normal 2 L/day. Salt subs typically contain K so although not banned pt would have to have renal function and serum K monitored while using them - safer to avoid

A nurse assesses clients on a cardiac unit. Which client would the nurse identify as being at GREATEST risk for the development of left-sided heart failure? a. A 36 year old woman with aortic stenosis b. A 42 year old man with pulmonary hypertension c. A 59 year old woman who smokes cigarettes daily d. A 70 year old man who had a cerebral vascular accident

A. A 36 yer old woman with aortic stenosis Cause of LV failure include mitral or aortic valve disease, CAD, and HTN. Pulmonary HTN and chronic cig smoking are risk factors for RV failure. A CVA does not increase risk of HF.

While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next? a. Assess for symptoms of left-sided heart failure b. Document this as a normal finding c. Call the primary health care provider immediately d. Transfer the client to the intensive care unit

A. Assess for symptoms of left-sided heart failure The presences of an S3 gallop is an early diastolic filling sound indicative of increasing LV pressure and LV failure. The other actions are not warranted.

A nurse admits a client who is experiencing an exacerbation of heart failure. What action would the nurse take FIRST? a. Assess the client's respiratory status b. Draw blood to assess the client's serum electrolytes c. Administer intravenous furosemide d. Ask the client about current medications

A. Assess the client's respiratory status Assessment of respiratory and oxygenation status is the most important nursing intervention for the prevention of complications. Monitoring electrolytes, administering diuretics ad asking about current meds are important but not as important.

A nurse is teaching a client with heart failure who has been prescribed enalapril. Which statement would the nurse include in this client's teaching? a. Avoid using salt substitutes b. Take your medication with food c. Avoid using aspirin-containing products d. Check your pulse daily

A. Avoid using salt substitutes ACE inhibitors such as enalapril inhibit excretion of potassium. Hyperkalemia can be a life threatening side effect, and clients should be taught to limit potassium intake. Salt substitutes are composed of potassium chloride. ACE inhibitors do not need to be taken with food and have no impact on the pt's pulse rate. Aspirin is often prescribed with ACE inhibitors and is not contraindicated.

A nurse cares for an older adult client with heart failure. The client states, "I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die." What is the BEST response by the nurse? a. I can stay if you would like to talk more about this b. You are lucky to have such a devoted daughter c. It is normal to feel as though you are a burden d. Would you like to meet with the chaplain?

A. I can stay if you would to talk more about this Depression can occur in pts with HF, esp older adults. Having pt talk about feelings will help focus on actual problem. Open-ended statements allow pt to respond safely and honestly. Other options minimize pt concerns and do not allow nurse to obtain more information to provide pt centered care.

A nurse cares for a client with infective endocarditis. Which infection control precautions would the nurse use? a. Standard Precautions b. Bleeding Precautions c. Reverse isolation d. Contact isolation

A. Standard Precautions Pt w/ infective endocarditis does not pose a threat of transmitting the causative organism. Standard Precautions would be used; others not necessary.

A nurse cares for a client with right-sided HF. The client asks, "Why do I need to weigh myself every day?" How would the nurse respond? a. Weight is the best indication that you are gaining or losing fluid b. Daily weights will help us make sure that you're eating properly c. The hospital requires that all clients be weighed daily d. You need to lose weight to decrease the incidence of heart failure

A. Weight is the best indication that you are gaining or losing fluid Daily weights needed to document fluid retention or loss. 1 L of fluid = 2.2 lb (1 kg). Weight changes are the most reliable indicator of fluid loss or gain. The other responses do not address the importance of monitoring fluid retention/loss.

What is the first step when the nurse analyzes a client's ECG rhythm strip? A. Analyze the P waves B. Determine the heart rate C. Measure the QRS complex D. Assess for ST-segment elevation

B Analysis of an ECG rhythm strip requires a systematic approach using an eight-step method. The first step is to determine the heart rate. This is commonly accomplished by use of the 6-second strip method. Normal heart rate is 60-100 per minute. Less than 60 is bradycardia and more than 100 is tachycardia. Analyzing P waves is the 3rd step; measuring the QRS duration is 5th; and measuring the PR interval is the 4th step.

What is the priority action for the nurse when the monitor technician states that a client's telemetry monitor shows a rhythm that appears as a wandering of fuzzy baseline? A. Check to see if the client has a do-not-resuscitate order. B. Assess the client to differentiate artifact from an actual lethal rhythm. C. Immediately obtain a 12-lead ECG to assess the actual rhythm. D. Ask the assistive personnel (AP) to take a set of vital signs on the client.

B Artifact is interference seen on the monitor or rhythm strip, which may look like a wandering or fuzzy baseline. It can be caused by client movement, loose or defective electrodes, improper grounding, or faulty ECG equipment such as broken wires or cables. Some artifacts can mimic lethal dysrhythmias such as ventricular tachycardia (with toothbrushing) or ventricular fibrillation (with tapping on the electrode). Assess the client to differentiate artifact from actual lethal rhythms! Do not rely only on the ECG monitor.

Which procedure would the nurse provide teaching about to a client who has chronic atrial fibrillation and is at increased risk for a stroke, but is not a candidate for anticoagulation? A. Radiofrequency catheter ablation (RCA) B. Left arial appendage (LAA) occlusion C. Biventricular pacing D. Surgical maze procedure

B For clients who are at high risk for stroke and who are not candidates for anticoagulation, the left atrial appendage (LAA) occlusion device may be an option. The LAA is the most common site of blood clot development leading to the risk of stroke. Inserted percutaneously via the femoral vein, a device to occlude the LAA is delivered via a transseptal puncture. Radiofrequency catheter ablation (RCA) is an invasive procedure that may be used to destroy an irritable focus in atrial or ventricular conduction. Biventricular pacing is used with clients who have heart failure and conduction disorders. The surgical maze procedure is an open-chest surgical technique performed with coronary artery bypass grafting (CABG).

Which serum electrolyte would the nurse check after noting tall and peaked T waves on a client's ECG? A. Sodium B. Potassium C. Magnesium D. Chloride

B T waves may become tall and peaked; inverted (negative); or flat as a result of myocardial ischemia, potassium or calcium imbalances, medications, or autonomic nervous system effects.

How would the nurse best interpret the electrocardiogram (ECG) of a younger athletic client which shows sinus bradycardia with a rate of 54 beats/min? A. It is the body's attempt to compensate for a decreased stroke volume by decreasing heart rate. B. The sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning. C. The client has a rapid filling rate that lengthens diastolic filling time and leads to decreased cardiac output. D. This is a common finding i

B Well-conditioned athletes with bradycardia have a hyper effective heart in which the strong heart muscle provides an adequate stroke volume and a low heart rate to achieve a normal cardiac output. This is not a common finding in adults of all ages, but an indicator of dysrhythmia in older adults. Decreasing heart rate in most adults results in decreased cardiac output.

Which drug would the nurse expect the primary health care provider to prescribe for a client to decrease blood pressure, decrease triglycerides, increase high-density lipoprotein cholesterol (HDL-C), and lower low-density lipoprotein cholesterol (LDL-C)? A. Advicor B. Caduet C. Vytorin D. Ezetimibe

B Amlodipine and atorvastatin are combined as Caduet to decrease blood pressure while de-creasing triglycerides (TGs), increasing HDL-C, and lowering LDL-C. Vytorin (ezetimibe and simvastatin) is a combination of a selective inhibitor of intestinal cholesterol and statin used to treat elevated cholesterol. Ezetimibe is in a class of medications called cholesterol-lowering medications. It works by preventing the absorption of cholesterol in the intestine. Advicor is a combination of niacin XR and lovastatin used to lower cholesterol and triglyceride (fat) levels in the blood.

What is the nurse's best response when a client asks about the difference between arteriosclerosis and atherosclerosis? A. Arteriosclerosis is the sudden blockage of an artery while atherosclerosis is formation of plaque in arteries. B. Atherosclerosis is forming plaques in arteries but arteriosclerosis is thickening of arterial walls associated with aging. C. Arteriosclerosis is hardening of arterial walls while atherosclerosis involves permanent localized dilation of arteries D. Atherosclerosi

B Arteriosclerosis is a thickening, or hardening, of the arterial wall which is often associated with aging. Atherosclerosis is a type of arteriosclerosis that involves the formation of plaque within the arterial wall and is the leading contributor to coronary artery and cerebrovascular disease. A sudden blockage is an acute arterial occlusion. Permanent dilation of arteries occurs with an aneurysm. Clot formation in the deep veins is a deep vein thrombosis (DVT).

For which client would the nurse question the prescription of hydrochlorothiazide? A. Client with asthma B. Client with hypokalemia C. Client with hyperkalemia D. Client with chronic airway limitation

B Hydrochlorothiazide (HCTZ) is a thiazide di-uretic. The most frequent side effect associated with thiazide and loop diuretics is hypokalemia (low potassium level). Monitor serum potassium levels and assess for irregular pulse, dysrhythmias, and muscle weakness, which may indicate hypokalemia.

Which normal heart rates does the nurse expect to be initiated by the primary pacemaker of the heart (SA Node) in clients when the heart rate is regular? Select all that apply. A. 55 beats/min B. 62 beats/min C. 74 beats/min D. 86 beats/min E. 98 beats/min F. 110 beats/min

B, C, D, E The SA node is the heart's primary pacemaker. It can spontaneously and rhythmically generate electrical impulses at a rate of 60 to 100 beats/min and therefore has the greatest degree of automaticity (pacing function). Heart rates less than 60 beats/min are bradycardias and heart rates greater than 100 beats/min are tachycardias.

Which techniques would the nurse use when performing an initial cardiovascular assessment on a middle-aged client? Select all that apply. A. Check blood pressure on the dominant arm. B. Palpate all of the major pulse sites. C. Auscultate bruits in the radial and brachial arteries. D. Palpate and compare temperature differences in the lower extremities. E. Check the client for orthostatic hypotension. F. Perform bilateral but separate palpation on the carotid arteries.

B, C, D, E, F Because of the high incidence of hypertension in clients with atherosclerosis, assess the blood pressure in both arms. Palpate pulses at all the major sites on the body and note any differences. Palpate each carotid artery separately to prevent blocking blood flow to the brain! Also feel for temperature differences in the lower extremities and check capillary filling. Pro-longed capillary filling (>3 seconds in young to middle-aged adults; >5 seconds in older adults) generally indicates poor circulation. Many clients with vascular disease have a bruit in the larger arteries, which can be heard with a stethoscope or Doppler probe. A bruit is a turbulent, swishing sound, which can be soft or loud in pitch. It is heard as a result of blood trying to pass through a narrowed artery. A bruit is considered abnormal, but it does not indicate the severity of disease. Bruits often occur in the carotid, aortic, femoral, and popliteal arteries. Orthostatic hypotension is checked beca

A nurse prepares to discharge a client who has heart failure. Based on national quality measures, what actions would the nurse complete prior to discharging this client? (SATA) a. Teach the client about energy conservation techniques b. Ensure that the client is prescribed a beta blocker c. Document a discussion about advanced directives d. Confirm that a post-discharge nurse visit had been scheduled e. Consult a social worker for additional resources f. Care transition record transmitted to nex

B, C, D, F National quality measures aim to decrease HF readmission by proper prep for discharge. These measures include: 1. beta blocker prescribed for LV dysfunction at discharge; 2. post-discharge follow-up appt scheduled w/in 7 days of discharge w/ documentation of location, date, and time; 3. care transition record transmitted to next level of care w/in 7 days of discharge; 4. documentation of discussion of advance directives/advance care planning with a HCP; 5. documentation of execution of advance directives w/in the medical record; and 6. post-discharge eval of pt for symptom assessment and tx adherence within 72 hours of discharge (by phone, office visit, home visit)

Which statements about permanent pacemakers are accurate? Select all that apply. A. Permanent pacemakers are powered by lithium batteries that last over 20 years. B. Permanent pacemakers are available as pacemaker/defibrillator devices. C. Biventricular pacemakers allow synchronized depolarization of the ventricles. D. Permanent pacemakers are used to treat disorders such as complete heart block. E. A client with a new pacemaker should avoid lifting his or her arm over the head for at least 6 mo

B, C, D, F The average life of lithium batteries that power permanent pacemakers is 10 years. A biventricular pacemaker may be used to coordinate contractions between the right and left ventricles. The electrophysiologist implants the pulse generator in a surgically made subcutaneous pocket at the shoulder int he right or left subclavicular area, which may create a visible bulge. Permanent pacemaker insertion is performed to treat conduction, disorders that are not temporary, including complete heart block. Combination pacemaker/defibrillator devices are available. If the surgical incision is near either shoulder, advise the client to avoid lifting the arm over the head or lifting more than 10 lb for the next 4 weeks because this could dislodge the pacemaker wire.

Which instructions would the nurse give a client for following dietary recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA)? Select all that apply. A. Consume a dietary pattern that emphasizes intake of lean protein. B. Consume low-fat dairy products, poultry, and fish. C. Lower sodium intake to no more than 2400 mg/day. D. Engage in aerobic physical activity six to seven times a week. E. Limit intake of sweets and red meats. F. Eat legumes, tropic

B, C, E, F The ACC and AHA publish dietary recommendations for lowering LDL-C levels. These recommendations are based on the best current evidence from randomized controlled trials and include: consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; consume low-fat dairy products, poultry (without the skin), fish, legumes, non-tropical (e.g., canola) vegetable oils, and nuts; limit intake of sweets, sugar-sweetened beverages, and red meats; aim for a dietary pattern that includes 5% to 6% of calories from saturated fat; and limit trans fats.

When the nurse performs blood pressure screenings, which clients would be referred for further evaluation? Select all that apply. A. Diabetic client with blood pressure 118/76 mm Hg B. Client with heart disease and blood pressure 148/90 mm Hg C. Renal failure client with blood pressure of 180/90 mm Hg D. Client with no known health problems and blood pressure of 106/70 mm Hg E. Client with muscle cramping taking a statin drug with blood pressure 124/82 mm Hg F. COPD client with blood pressure 15

B, C, E, F The client with heart disease has stage 1 hypertension. The client with renal failure has very high blood pressure and stage 2 hypertension. The client taking the statin drug should be referred for a change in drug therapy because muscle cramps are a side effect of these drugs and this indicates that the client is not tolerating the statin. The client with COPD also has stage 2 hypertension (See Table 33.1). The diabetic client and the client with no known health problems both have normal blood pressure readings.

Which risk factors for atrial fibrillation would the nurse monitor for in client? Select all that apply. A. Peripheral vascular disease B. Hypertension C. Chronic obstructive pulmonary disease D. Diabetes mellitus E. Excessive alcohol intake F. Mitral valve disease

B, D, E, F Risk factors for atrial fibrillation include hypertension (HTN), previous ischemic stroke, transient ischemic attack (TIA) or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure, obesity, hyperthyroidism, chronic kidney disease, excessive alcohol use, and mitral valve disease. This dysrhythmia also increases with age.

Which descriptions are characteristics of Class III antidysrhythmic drugs? Select all that apply. A. Increase force of contraction B. Lengthen absolute refractory period C. Include hypertension as a side effect for some drugs D. Include bradycardia as a side effect for some drugs E. Prolong QT interval F. Prolong repolarization

B, D, F Class III antidysrhythmics lengthen the absolute refractory period and prolong repolarization and the action potential duration of ischemic cells. Class III drugs include amiodarone and ibutilide and are used to treat or prevent ventricular premature beats, VT, and VF. Bradycardia is a side effect with stall and amiodarone. Hypertension is not a side effect of these drugs.

A nurse assesses a client who has a history of heart failure. Which question would the nurse ask to assess the extent of the client's heart failure? a. Do you have trouble breathing or chest pain? b. Are you still able to walk upstairs without fatigue? c. Do you awake with breathlessness during the night? d. Do you have new-onset heaviness in your legs?

B. Are you still able to walk upstairs without fatigue? Pts with hx of HF generally have negative findings, such as SOB and fatigue. Nurse needs to determine whether pt's activity is same or worse, or whether pt identifies a decrease in activity level. Trouble breathing, chest pain, breathlessness at night, and peripheral edema are symptoms of HF but don't provide data that can determine extent of HF.

A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia would the nurse assess? a. Preventricular contractions b. Atrial fibrillation c. Symptomatic bradycardia d. Sinus tachycardia

B. Atrial fibrillation Afib is a clinical manifestation of mitral valve regurg/stenosis. PVCs and bradycardia are not associated with valvular problems but usually identified in pts with electrolyte imbalances, MI, and sinus node problems. Sinus tach is a manifestation of aortic regurg due to decrease in CO.

A nurse is providing discharge teaching to a client recovering from a heart transplant. Which statement would the nurse include? a. Use a soft-bristled toothbrush and avoid flossing b. Avoid large crowds and people who are sick c. Change positions slowly to avoid hypotension d. Check your heart rate before taking the medication

B. Avoid large crowds and people who are sick Heart transplant pts must take immunosuppressant therapy for rest of life. Nurse would teach pt to avoid crowds and sick ppl to reduce risk of becoming ill. Meds do not place pt at risk for bleeding, orthostatic hypotension, or changes in HR. Orthostatic hypotension from the denervated heart is generally only a problem in immediate postop period.

A nurse teaches a client with heart failure about energy conservation. Which statement would the nurse include in this client's teaching? a. Walk until you become short of breath, then walk back home b. Begin walking 200 feet a day three times a week c. Do not lift heavy weights for 6 months d. Eat plenty of protein to build your strength

B. Begin walking 200 feet a day three times a week A pt with HF would be taught to conserve energy and given an exercise plan. PT should begin walking 200-400 feet a day 3x a week. Pt should not walk until becoming SOB bc may not make it back home. Lifting restriction specific to pt after valve replacement. Protein helps build strength, not specific to HF.

A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" What is the BEST response by the nurse? a. The prosthetic valve places you at greater risk for a heart attack b. Blood clots form more easily in artificial replacement valves c. The vein taken from your leg reduces circulation in the leg d. The surgery left a lot of small clots in your heart and lungs

B. Blood clots form more easily in artificial replacement valves Synthetic valve prostheses and scar tissue provide surfaces on which platelets can aggregate easily and initiate the formation of clots. The other responses are inaccurate.

A nurse assesses a client with mitral valve stenosis. What clinical sign or symptom would alert the nurse to the possibility that the client's stenosis has progressed? a. Oxygen saturation of 92% b. Dyspnea on exertion c. Muted systolic murmur d. Upper extremity weakness

B. Dyspnea on exertion Dyspnea on exertion develops as the mitral valvular orifice narrows and pressure in the lungs increases. The other S&S do not relate.

A nurse assesses a client with pericarditis. Which assessment finding would the nurse expect to find? a. Heart rate that speeds up and slows down b. Friction rub at the left lower sternal border c. Presence of a regular gallop rhythm d. Coarse crackles in bilateral lung bases

B. Friction rub at the left lower sternal border PT with pericarditis may present with a pericardial friction rub at left lower sternal border. This sound is the result of friction from inflamed pericardial layers when they rub together. Other assessments not related.

After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client's understanding. Which client statement indicates a need for ADDITIONAL teaching? a. I'll be able to carry heavy loads after 6 months of rest b. I will have my teeth cleaned by my dentist in 2 weeks c. I must avoid eating foods high in vitamin K, like spinach d. I must use an electric razor instead of a straight razor to shave

B. I will have my teeth cleaned by my dentist in 2 weeks Pts with defective or repaired valves at high risk for endocarditis. Pt with valve surgery should avoid dental procedures for 6 months bc of risk for endocarditis. When undergoing mitral valve replacement surgery, the pt needs to be on anticoagulant therapy to prevent vegetation forming on the new valve. Pts on anticoagulant therapy would be instructed on bleeding precautions including using an electric razor. If pt is prescribed warfarin, the pt should avoid foods high in vitamin K. Pt recovering from open-heart valve replacements should not carry anything heavy for 6 months while the chest incision and muscle heal.

After administering the first dose of captopril to a client with heart failure, the nurse implements interventions to decrease complications. Which intervention is MOST important for the nurse to implement? a. Provide food to decrease nausea and aid in absorption b. Instruct the client to ask for assistance when rising from bed c. Collaborate with assistive personnel to bathe the client d. Monitor potassium levels and check for signs of hypokalemia

B. Instruct the client to ask for assistance when rising from bed Hypotension is a side effect of ACE inhibitors such as captopril. Pts with a fluid volume deficit should have their volume replaced or start at a lower dose of the drug to minimize this effect. The nurse would instruct the client to seek assistance before arising from bed to avoid injury from postural hypotension. ACE inhibitors do not need to be taken w/ food. Collab with AP to provide hygiene is not a priority. The pt would be encourage to complete ADLs as independently as possible. The nurse would monitor for hyperkalemia, not hypokalemia, especially if the pt has renal insufficiency secondary to HF.

A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure? a. I sleep with four pillows at night b. My shoes fit really tight lately c. I wake up coughing every night d. I have trouble catching my breath

B. My shoes fit really tight lately Signs of systemic congestion occur with right-sided HF. Fluid is retained, pressure builds in the venous system, and peripheral edema develops. Left-sided HF symptoms include respiratory symptoms - orthopnea, coughing, and difficulty breathing all could be results.

Which safety precaution must be taken before defibrillating a client with ventricular fibrillation (VF)? A. Make sure that the defibrillator is set on the synchronous mode. B. Be sure to hyperventilate the client before the defibrillation. C. Command all health care team members to stand clear of the client's bed. D. Disconnect the monitor leads to prevent electrical shocks to the client.

C Before defibrillation, loudly and clearly command all personnel to clear contact with the client and the bed and check to see they are clear before the shock is delivered. This safety measure prevents health care team members from receiving a shock when the client is defibrillated. Synchronous mode is used for cardioversion. Disconnection of the monitor leads would prevent assessing the effectiveness of the defibrillation shock. Hyperventilation of the client will not keep the health care team safe.

Which drug does the nurse prepare to administer to a client diagnosed with the dysrhythmia torsades de pointes? A. Calcium chloride B. Epinephrine C. Magnesium sulfate D. Adenosine

C Magnesium is used to treat the life-threatening ventricular tachycardia called torsades de pointes. Often a client with this dysrhythmia is hypomagnesemic which causes increased ventricular irritability. Adenosine treats PSVT; epinephrine increases atrial irritability and heart rate; and calcium chloride is used in cardiac resuscitation, arrhythmias, hypermagnesemia, calcium channel blocker overdose, and beta-blocker overdose.

Which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia? A. Clotting B. Fluid and electrolyte balance C. Perfusion D. Acid-base balance

C Perfusion is the priority concept for the client with dysrhythmias. It occurs when there is adequate arterial blood flow through the peripheral tissues (peripheral perfusion) and blood that is pumped by the heart to oxygenate major body organs (central perfusion). Perfusion is a normal physiologic process of the body; without adequate perfusion, cell death can occur. When a client has a dysrhythmia, often perfusion is inadequate. Clotting and fluid and electrolyte balance are interrelated concepts for dysrhythmias. Acid-base imbalance may be a result of inadequate perfusion.

To best perform a 12-lead ECG on a client, how does the nurse place the leads on the client? A. Four leads are placed on the limbs and four are placed on the chest. B. The negative electrode is placed on the left arm and the positive electrode is placed on the right leg. C. Four leads are placed on the limbs and six are placed on the chest. D. The negative electrode is placed on the right arm and the positive electrode is placed on the left leg.

C The 12-lead ECG provides 12 view os the electrical activity of the heart. There are six unipolar (or V) chest leads, determined by the placement of the chest electrode. The four limb electrodes are placed on the extremities which provide the 12 views. Positioning of the electrodes is crucial in obtaining an accurate ECG. Comparisons of ECGs taken at different times will be valid only when electrode placement is accurate and identical at each test. In many cases, a surgical marker is used to assure consistent placement of the leads.

Which would be the best method for the nurse to confirm a report from the monitor technician about the change in a monitored client's heart rate? A. Count QRS complexes in a 6-second strip and multiply by 10. B. Analyze the ECG rhythm strip using an ECG caliper. C. Assess the client's heart rate directly by checking the apical pulse. D. Request that the monitor technician run an ECG strip for a minute.

C The best and most direct method of checking the client for a change in heart rate is to assess the apical pulse for a full minute. All of the other repossess are indirect methods and do not include assessing the client which is the most important action in this situation.

What does the nurse determine is the client's heart rate when assessing a 6-second telemetry ECG strip with five QRS complexes? A. 30 beats/min, bradycardia B. 40 beats/min, bradycardia C. 50 beats/min, bradycardia D. 60 beats/min, normal

C The most common method is to count the number of QRS complexes in 6 seconds and multiple that number by 10 to calculate the rate for a full minute. This client has five QRS complexes in a 6-second strip. So, 5 times 10 equals 50 beats/min, which is a bradycardia.

Which condition is indicated when the nurse notes ST segment elevation or one to two small blocks on a client's ECG? A. Ventricular irritability B. Subarachnoid hemorrhage C. Myocardial injury or ischemia D. Malfunction of the SA node

C The normal ST segment begins at the isoelectric line. ST elevation or depression is significant if displacement is 1 mm (one small box) or more above or below the line and is seen in two or more leads. ST elevation may indicate problems such as myocardial infarction, pericarditis, and hyperkalemia. ST depression is associated with hypokalemia, myocardial infarction, or ventricular hypertrophy.

How does the nurse interpret a client's telemetry ECG strip that shows four successive premature ventricular contractions (PVCs)? A. The monitor is showing two PVC couplets in a row. B. This rhythm is ventricular asystole as seen in a dying heart. C. The client had an episode of nonsustained ventricular tachycardia (NSVT). D. The nurse must check the client for loose leads and artifact.

C Three or more successive PVCs in a row are usually canned non sustained ventricular tachycardia (NSVT). Two PVCs in a row make a couplet. Artifact appears as a fuzzy or wandering baseline. Ventricular asystole is generally described as a flat line although P waves may still be seen.

What would be the nurse's best action when a client reports dizziness when changing position from sitting to standing and a sudden dry cough after starting a prescription of captopril? A. Instruct the client to change positions slowly and take an over-the-counter cough syrup. B. Tell the client to take the drug at bedtime and use over-the-counter throat lozenges. C. Notify the primary health care provider immediately about these side effects. D. Teach the client to increase fluid intake to at le

C Captopril is an angiotensin-converting enzyme inhibitor (ACEI). Antihypertensive drugs all have the potential to cause hypotension. However, the most common side effect of this group of drugs is a nagging, dry cough. The nurse should immediately notify the primary health care provider of this finding. Clients must also be taught to report this problem as soon as possible. If a cough devel-ops, the drug is discontinued and the client is started on another drug therapy to control hypertension.

How does the nurse best interpret a client's low-density lipoprotein cholesterol (LDL-C) value which is greater than 190 mg/dL and does not respond to dietary intervention? A. The client should have total cholesterol and LDL-C testing repeated during the next routine examination. B. The client should be instructed to exercise 6 to 7 days per week to help bring the LDL-C level over time. C. The client should be evaluated for secondary causes of hyperlipidemia and treated with statin therapy becau

C Increased low-density lipoprotein cholesterol (LDL-C) ("bad" cholesterol) levels and low high-density lipoprotein cholesterol (HDL-C) ("good" cholesterol) indicate that a person is at an increased risk for atherosclerosis. For clients with elevated total cholesterol and LDL-C levels that do not respond adequately to dietary intervention, the primary health care provider prescribes a cholesterol-lowering agent, most likely a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or "statin" (e.g., lovastatin, simvastatin, atorvastatin), which would successfully reduce total cholesterol in most clients when used for an extended period.

What is the nurse's best explanation to a client for use of low-dose niacin to decrease LDL-C and very-low-density lipoprotein (VLDL) cholesterol levels? A. It will prevent muscle myopathies. B. It works well to prevent elevated blood pressure. C. It helps reduce side effects of flushing and feeling too warm. D. It will help prevent the undesirable side effect of hypokalemia.

C Low doses of niacin are recommended because many clients experience flushing and a very warm feeling all over with higher doses. Higher doses can also result in an elevation of hepatic enzymes. In statin-intolerant clients, niacin can be useful to help lower LDL cholesterol levels in combination with other drugs.

For which cardiac dysrhythmia(s) would an automatic external defibrillator (AED) instruct the nurse to immediately defibrillate an unconscious client at an outpatient clinic? Select all that apply. A. Paroxysmal supraventricular tachycardia B. Pulseless electrical activity C. Ventricular fibrillation D. Pulseless ventricular tachycardia E. Nonsustained ventricular tachycardia F. Atrial fibrillation with rapid ventricular reponse

C, D Defibrillation shocks are recommended by AEDs only for ventricular fibrillation and pulseless ventricular tachycardia.

Which nursing actions have priority when a client with acute supra ventricular tachycardia (SVT) is to be administered adenosine by the health care provider? Select all that apply. A. Have injectable beta-blocker drugs at the bedside. B. Give the drug slowly over 1-2 minutes. C. Ensure that emergency equipment is at the bedside. D. Follow the drug injection with a normal saline bolus. E. Monitor the client for bradycardia, nausea, and vomiting. F. Prepare for synchronized cardioversion after giv

C, D, E Adenosine is used to terminate the acute episode and is given rapidly (over several seconds) followed by a normal saline bolus. Side effects of adenosine include significant bradycardia with pauses, nausea, and vomiting. Beta blockers would not be given because they would cause increased bradycardia. The purpose of the drug is to terminate the dysrhythmia so cardioversion is not necessary.

Which criteria support the nurse's assessment that a client's ECG rhythm strip shows a normal sinus rhythm (NSR)? A. PR interval is 0.24 second B. Atrial and ventricular rates are 58 beats/min C. Atrial and ventricular rates are regular. D. P waves are present before every QRS complex. E. QRS duration is consistent at 0.08 second. F. Atrial and ventricular rates are 82 beats/min.

C, D, E, F Normal sinus rhythm (NSR) is the rhythm originating from the sinoatrial (SA) node (dominant pacemaker) that meets these ECG criteria: Rate: atrial and ventricular rates of 60 to 100 beats/min; Rhythm: atrial and ventricular rhythms regular; P waves: present, consistent configuration, one P wave before each QRS complex; PR interval: 0.12 to 0.20 second and constant; and QRS duration: 0.06 to 0.10 second and constant.

When would the telemetry unit nurse use temporary transcutaneous pacing for a client? Select all that apply. A. Only when a client's ECG shows a bradydysrhythmia and the client is asymptomatic. B. When a client's ECG strip shows atrial fibrillation with a rapid ventricular response. C. Only as a temporary emergency measure until invasive pacing method can be started. D. When a client is experiencing syncope, dizziness and fainting. E. Only until the client's heart rhythm returns to normal. F. Wh

C, E, F Transcutaneous pacing is used as an emergency measure to provide demand ventricular pacing in a profoundly bradycardia or asystolic client until invasive pacing can be used or the client's heart rate returns to normal. This method of pacing is painful and may require administration of pain and sedative medications for the client to tolerate the therapy. Transcutaneous pacing is used only as a temporary measure to maintain heart rate and perfusion until a more permanent method of pacing is used.

A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? a. I have been drinking more water than usual b. I am awakened by the need to urinate at night c. I must stop halfway up the stairs to catch my breath d. I have experienced blurred vision on several occasions

C. I must stop halfway up the stairs to catch my breath Pts with left-sided HF report weakness/fatigue while performing ADLs, as well as difficulty breathing, or "catching their breath". This occurs as fluid moves into the alveoli. Nocturia is often seen with right-sided heart failure. Thirst and blurred vision are not related to HF.

After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, "Why is this important?" How would the nurse respond? a. Rapid position changes can create shear and friction forces, which can tear out your internal vascular sutures b. Your new vascular connections are more sensitive to position changes, leading to increased intravascular pressure and dizziness c. Your new heart is not connected to the nervous system and is unable to respond to decre

C. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes Bc new heart is denervated, the baroreceptor and other mechanisms that compensate for BP drops caused by position changes do not function. This allows orthostatic hypotension to persist in postop period. Other statements false.

What does the nurse suspect when assessing a client's telemetry ECG strip and noting a wide distorted QRS complex of 0.14 second followed by a P wave? A. Delayed time of the impulse through the ventricles B. Problem with speed set on the ECG telemetry monitor C. Wide but normal complex with no cause for concern D. Premature ventricular complex followed by atrial contraction

D Premature ventricular complexes (PVCs), also called premature ventricular contractions, result from increased irritability of ventricular cells and are seen as early ventricular complexes followed by a pause. They appear as widened QRS complexes and sometimes the P waves follow the QRS complexes. They may be all the same shape (unifocal) or different shapes (multifocal). PVCs are common and increase with age.

Which definition best describes the electrophysiologic property called automaticity of myocardial pacemaker cells? A. The ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart. B. The ability to send an electrical stimulus from cell membrane to cell membrane. C. The ability of non pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells

D The electrophysiologic properties: automaticity, excitability, conductivity, and contractility. Automaticity (pacing function) is the ability of cardiac cells to generate impulse spontaneously and receptively. Excitability is the ability of non pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells. Conductivity is the ability to send an electrical stimulus from cell membrane to cell membrane. Contractility is the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart.

Which client assessment takes priority when the nurse begins his or her shift? A. Client with chronic atrial fibrillation and ventricular rate of 72 beats/min B. Client with sinus tachycardia and occasional premature atrial contractions (PACs) C. Client with paroxysmal supra ventricular tachycardia (PSVT) that terminated D. Client with atrial fibrillation and sustained rapid ventricular response

D The nurse would want to assess all four clients. However, the client with atrial fibrillation with sustained rapid ventricular repose is at highest risk for decreased cardiac output and development of symptoms. Therefore this client would need to be assessed first.

Which dysrhythmia does the nurse consider life threatening because it causes the ventricles to quiver and results in the absence of cardiac output for a client? A. Asystole B. Ventricular tachycardia C. Atrial fibrillation D. Ventricular fibrillation

D Ventricular fibrillation (VF) is a cardiac dysrhythmia that results from electrical chaos in the ventricles; impulses from many irritable foci fire in a totally disorganized manner so that ventricular contraction cannot occur; there is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully terminated within 3 to 5 minutes. Ventricular tachycardia and asystole are also life-threatening dysrhythmias. With atrial fibrillation there is loss of the atrial contribution to cardiac output, but the ventricles are usually still putting out adequate cardiac output.

When a client has been in atrial fibrillation for 3 days and is scheduled for an elective cardioversion, what priority teaching does the nurse provide to the client? A. Consume potassium-rich food sources such as bananas. B. Report muscle tremors or weakness to the health care provider. C. Get up slowly when getting out of bed or a chair. D. Watch for any sign of bleeding and report this to your health care provider.

D When the onset of AF is greater than 48 hours, the client must take anticoagulants for at least 3 weeks (or until the INR is 2 to 3) before the elective cardioversion to prevent clots from moving from the heart to the brain or lungs. Teaching the client to monitor for bleeding and reporting this to the primary health care provider (HCP) are essential when a client is prescribed an anticoagulant drug.

Which condition would the nurse suspect when a client has these findings (BP 200/130 mm Hg; sudden headache, blurred vision, and dyspnea)? A. Sustained hypertension B. Primary hypertension C. Secondary hypertension D. Malignant hypertension

D Hypertensive crisis (or malignant hypertension) is a severe type of elevated BP that rapidly progresses and is considered a medical emergency. A person with this health problem usually has symptoms such as morning head-aches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine). Clients are often in their 30s, 40s, or 50s with their systolic BP greater than 200 mm Hg.

What would the nurse suspect when assessing a client's lower extremities and finding decreased pedal pulses, skin that is cool to touch, loss of hair, and thickened toenails? A. Peripheral venous disease B. Raynaud's syndrome C. Deep vein thrombosis D. Peripheral arterial disease

D Specific findings for PAD depend on the severity of the disease. Assess for loss of hair on the lower calf, ankle, and foot; dry, scaly, dusky, pale, or mottled skin; and thickened toenails. With severe arterial disease, the extremity is cold and gray-blue (cyanotic) or darkened. Pallor may occur when the extremity is elevated.

What priority teaching would the nurse provide for a client who will be discharged with a prescription for atorvastatin? A. "Take over-the-counter ranitidine when you experience nausea or vomiting." B. "Go to the emergency department if you experience a nagging, nonproductive cough." C. "You can use acetaminophen if the drug causes mild to moderate headaches." D. "Immediately report any muscle cramping to your primary health care provider."

D Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. Therefore, they are contraindicated in clients with active liver disease or during pregnancy because they can cause muscle myopathies and marked decreases in liver function. Statins also have the potential for interactions with other drugs, such as warfarin, cyclosporine, and selected antibiotics. They are discontinued if the client has muscle cramping or elevated liver enzyme levels.

What are the priority nursing care concepts for clients with vascular problems? A. Perfusion and fluid balance B. Clotting and immunity C. Inflammation and perfusion D. Perfusion and clotting

D The priority care concepts for clients with vascular problems are perfusion and clotting. Inflammation is an interrelated concept for these clients.

What frequency of drug dosage therapy would the nurse advocate for an older client with hypertension who lives alone and is able to manage his or her self-care? A. Four times a day B. Three times a day C. Twice a day D. Once a day

D Research shows that clients, especially older adults, are more compliant with and able to manage self-care when drug dosages are prescribed once a day. The more frequently doses are scheduled, the more likely a client will be unable to follow the treatment regimen and miss doses of the prescribed drugs.

A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take? a. Initiate oxygen therapy b. Hold the next dose c. Instruct the client to drink water d. Administer PRN acetaminophen

D. Administer PRN acetaminophen The vasodilating fx of nitrates frequently cause pts to have headaches in the initial period of therapy. The nurse would inform the pt about this side effect and offer a mild analgesic, such as acetaminophen. The pt's headache is not related to hypoxia or dehydration so O2 or H2O would not help. The pt needs to take the med as prescribed to prevent angina; the med wouldn't be held.

A nurse teaches a client who is prescribed digoxin therapy. Which statement would the nurse include in this client's teaching? a. Avoid taking aspirin or aspirin-containing products b. Increase your intake of foods that are high in potassium c. Hold this medication if your pulse rate is below 80 beats/min d. Do not take this medication within 1 hour of taking an antacid

D. Do not take this medication within 1 hour of taking an antacid GI absorption of digoxin is erratic. Many meds, especially antacids, interfere with its absorption. Pts are taught to hold their digoxin for bradycardia; a heart rate of 80 beats/min is too high for this cut off. Potassium and aspirin have no impact on digoxin absorption.

A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side fo the neck. Which nonpharmacologic comfort measure would the nurse implement? a. Apply an ice pack to the client's chest b. Provide a neck rub, especially on the left side c. Allow the client to lie in bed with the lights down d. Sit the client up with a pillow to lean forward on

D. Sit the client up with a pillow to lean forward on Pain from acute pericarditis may worsen when pt lays supine. Nurse would position pt in a comfortable position, usually upright and leaning slight forward. An ice pack and neck rub will not relieve pain. Dimming lights will not help

A nurse teaches a client who has a history of heart failure. Which statement would the nurse include in this client's discharge teaching? a. Avoid drinking more than 3 quarts (3 L) of liquids each day b. Eat six small meals daily instead of three larger meals c. When you feel short of breath, take an additional diuretic d. Weigh yourself each day while wearing the same amount of clothing

D. Weigh yourself each day while wearing the same amount of clothing Pts with HF are instructed to weight themselves daily to detect worsening HF early and avoid complications. Other signs include increasing dyspnea, exercise intolerance, cold symptoms, and nocturia. Fluid overload increases symptoms of HF. The pt would be taught to eat a heart healthy diet, balance intake and output to prevent dehydration and overload, and take meds as prescribed. The most important discharge teaching is daily weights as this provides the best data related to fluid retention.

A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, "I know a transplant is my last chance, but I don't want to become a vegetable." How would the nurse respond? a. Would you like to speak with a priest or chaplain? b. I will arrange for a psychiatrist to speak with you c. Do you want to come off the transplant list? d. Would you like more information about advance directives?

D. Would you like more information about advance directives? Pt is verbalizing a real concern/fear about negative outcomes of surgery. This anxiety itself can have negative effects on the outcome because of SNS stimulation. The best action is to allow pt to verbalize concern and work toward positive outcome without making pt feel as though concerns are not valid. Pt needs to feel some control over future. Nurse personally provides care to address the pt's concerns instead of immediately calling for the chaplain or psychiatrist. Nurse would not jump to conclusions and suggest taking pt off transplant list, which is the best tx option.