M5a/b: Cardiac <3 (CHA)

assessing angina:

"Where is the pain (or prodromal symptoms)? Can you point to it?" "Can you feel the pain anywhere else?" "How would you describe the pain?" "Is it like the pain you had before?" "Can you rate the pain on a 0-10 scale, with 10 being the most pain?" "When did the pain begin?" "How long does it last?" "What brings on the pain?" "What helps the pain go away?" "Do you have any other symptoms with the pain?"

Troponin T and I are considered cardiac biomarkers and are more specific for cardiac muscle injury than CK-MB because .....

*CK-MB can also be elevated with severe skeletal muscle injury where as the TnT & Tn1 are not.

Myoglobin is not very useful in determining the acute phase of an MI

*but it is useful to rule out an MI

Silent ischemia

*objective evidence of ischemia (such as electrocardiographic changes with a stress test), but patient reports no pain

Variant angina (also called Prinzmetal's angina)

*pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

Stable angina

*predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

Intractable or refractory angina

*severe incapacitating chest pain

The nurse observes the cardiac rhythm (see above) for a client who is being admitted with a myocardial infarction. Which should the nurse do first?

-check pulse

The health care provider prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. What should the nurse do to ensure safe administration of this drug? 1. Use an infusion pump for the medication. 2. Take the blood pressure every 4 hours. 3. Monitor urine output hourly. 4. Obtain serum potassium levels daily.

1. Use an infusion pump for the medication.

A client is scheduled for a cardiac catheterization. The nurse should do which preprocedural tasks? Select all that apply. 1. Verify the client has stopped taking anticoagulants if instructed by the health care provider. 2. Check for iodine sensitivity. 3. Verify that written consent has been obtained. 4. Withhold food and oral fluids before the procedure. 5. Insert a urinary drainage catheter.

1. Verify the client has stopped taking anticoagulants if instructed by the health care provider. 2. Check for iodine sensitivity. 3. Verify that written consent has been obtained.

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The physician diagnoses acute coronary syndrome. The client arrives on the unit with stable vital signs does not report pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order? Group of answer choices 1. carvedilol 2. digoxin 3. furosemide 4. dobutamine

1. carvedilol

A nurse is caring for a client admitted to the telemetry unit 4 days post coronary artery bypass graft (CABG) surgery. Which elements should the nurse monitor? Select all that apply. 1. electrocardiogram (EKG) 2. level of consciousness 3. BUN and serum creatinine 4. visitors entering the client's room 5. pain management

1. electrocardiogram (EKG) 2. level of consciousness 3. BUN and serum creatinine 5. pain management

A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to: 1. weigh daily 2. take blood pressure daily 3. keep a daily record of urine output 4. have a serum potassium level drawn weekly

1. weigh daily

A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this client's preoperative teaching plan? Select all that apply. 1. "If you have a hearing aid, you will need to remove it prior to leaving for the procedure." 2. "If you have chest pain during this procedure, please tell the staff when or if this should occur." 3. "The stitches at your right groin will be able to be removed in 7 to 10 days following the procedure." 4. "You will be given general anesthesia and will be asleep for throughout this procedure." 5. "You will need to remain flat during the procedure and for 3 to 6 hours after the procedure." 6. "You will need to keep your right leg in a flexed position for 1 to 2 hours following the procedure."

2. "If you have chest pain during this procedure, please tell the staff when or if this should occur." 5. "You will need to remain flat during the procedure and for 3 to 6 hours after the procedure."

A client with a history of cardiac disease has just returned to the cardiac unit post-cardiac catheterization at the femoral site. Which interventions would be included for this client? Select all that apply. Group of answer choices 1. Maintain NPO for 2 to 4 hours. 2. Check the pulse distal to the catheter insertion site. 3. Ensure that the client is kept flat in bed immediately after the procedure. 4. Administer antiarrhythmic medications. 5. Monitor heart rate and rhythm

2. Check the pulse distal to the catheter insertion site. 3. Ensure that the client is kept flat in bed immediately after the procedure. 5. Monitor heart rate and rhythm

A client with deep vein thrombosis has an I.V. infusion of heparin infusing at 1,500 units/hour. The concentration in the bag is 25,000 units/500 ml. How many milliliters of solution should the nurse document as intake from this infusion for an 8-hour shift? Record your answer using a whole number.

240

A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain? 1. 30 minutes to 1 hour 2. 2 to 3 hours 3. 4 to 6 hours 4. 12 to 18 hours

3. 4 to 6 hours

Which is an expected outcome for a client on the second day of hospitalization after a myocardial infarction (MI)? 1. The client continues to have severe chest pain. 2. The client can identify risk factors for MI. 3. The client participates in a cardiac rehabilitation walking program. 4. The client can perform personal self-care activities without pain.

3. The client participates in a cardiac rehabilitation walking program.

A client is admitted to the emergency department after reporting acute chest pain radiating down the left arm. The client appears anxious, dyspneic, and diaphoretic. Which laboratory studies would the nurse anticipate? Select all that apply. 1. hemoglobin and hematocrit (HCT) 2. serum glucose 3. creatine kinase (CK) 4. troponin T and troponin I 5. myoglobin 6. blood urea nitrogen (BUN)

3. creatine kinase (CK) 4. troponin T and troponin I 5. myoglobin

A nurse is awaiting the arrival of a client from the emergency department with a diagnosis of anterior wall myocardial infarction. In caring for this client, the nurse would be alert for which signs and symptoms of left-sided heart failure? Select all that apply. 1. jugular vein distention 2. hepatomegaly 3. dyspnea 4. crackles 5. tachycardia 6. skin tenting

3. dyspnea 4. crackles 5. tachycardia

A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply. 1. ascites 2. jugular vein distention 3. orthopnea 4. cough 5. hepatomegaly 6. crackles

3. orthopnea 4. cough 6. crackles

The nurse is caring for a group of clients on a medical-surgical nursing unit. Which task(s) could the nurse delegate to unlicensed assistive personnel (UAP)? Select all that apply. 1. Assess pedal pulses on a client who just returned from a cardiac angiogram 2. Administer oxygen via nasal cannula to a client with a saturation of 89%. 3. Administer acetaminophen to a client with a pain level of "5" out of "10." 4. Obtain vital signs for a client admitted yesterday. 5. Obtain intake and outputs on a client experiencing heart failure.

4. Obtain vital signs for a client admitted yesterday. 5. Obtain intake and outputs on a client experiencing heart failure.

The nurse is caring for a client diagnosed with a myocardial infarction (MI) 2 days ago. The nurse identifies a systolic murmur at the apex during their assessment. What is the nurse's priority action? A Assess for changes in vital signs. B Document the findings. C Evaluate heart sounds with the client leaning forward. D Notify the physician.

A Assess for changes in vital signs.

When preparing a client for a cardiac angiogram what actions should the nurse take? Select all that apply. A Determine if the client has an allergy to iodine or shellfish B Inform the client that an IV will be started before the procedure. C Remind the client to have nothing to eat or drink 6 hours before the procedure. D Explain to the client that they will be on bedrest for a period of time following the procedure. E Explain that the client will be intubated during this procedure.

A Determine if the client has an allergy to iodine or shellfish B Inform the client that an IV will be started before the procedure. C Remind the client to have nothing to eat or drink 6 hours before the procedure. D Explain to the client that they will be on bedrest for a period of time following the procedure.

The nurse is caring for a client who just underwent cardiac catheterization through a femoral access site. Which nursing interventions should the nurse include in the care plan for the next 8 hours? Select all that apply. A Frequently assess gauze dressing over the femoral access site. B Allow the client to sit upright for meals. C Perform frequent neurovascular checks to the affected extremity. D Monitor the vital signs every 8 hours. E Keep the affected extremity straight. F Allow use of the bedside commode immediately following the procedure.

A Frequently assess gauze dressing over the femoral access site. C Perform frequent neurovascular checks to the affected extremity. E Keep the affected extremity straight.

The nurse is managing a client following a cardiac catherization through the left groin. During the immediate post-cardiac catheterization period, the nurse prioritizes which of the following interventions? Select all that apply. A Monitor vital signs and neurovascular assessments frequently. B Assess all peripheral pulses frequently. C Instruct the client to keep the right leg straight during the recovery period. D Assist the client in using the urinal or bedpan during the immediate recovery period. E Assess for swelling, bruising or pain at the catheter insertion site. F Monitor the dressing to the left groin frequently for any signs of bleeding.

A Monitor vital signs and neurovascular assessments frequently. D Assist the client in using the urinal or bedpan during the immediate recovery period. E Assess for swelling, bruising or pain at the catheter insertion site. F Monitor the dressing to the left groin frequently for any signs of bleeding.

The nurse is providing education to a client and their family about the intensive care unit (ICU), as they plan for a coronary artery bypass graft (CABG) surgery. What priority information should the nurse tell the family regarding the ICU hospitalization? Select all that apply. A The client will remain in the ICU for the first few days, but will be transferred to a different unit prior to discharge. B The client will be sedated and sleep most of the time while in the intensive care unit. C There may be multiple wires, monitors and alarms in the intensive care unit. D The nurse will assess your pain and help manage it using a variety of techniques, including medication. E There will be other healthcare professionals that will see you in the ICU, such as respiratory therapy and physical therapy.

A The client will remain in the ICU for the first few days, but will be transferred to a different unit prior to discharge. C There may be multiple wires, monitors and alarms in the intensive care unit. D The nurse will assess your pain and help manage it using a variety of techniques, including medication. E There will be other healthcare professionals that will see you in the ICU, such as respiratory therapy and physical therapy.

A client who underwent cardiac surgery has been prescribed morphine sulfate 2 mg intravenously for pain. The morphine sulfate is packaged as 10 mg/2 ml. How many mL will the nurse administer? Record your answer using one decimal place. A. 0.4 B. 0.5 C. 2 D. 1

A. 0.4

A nurse is caring for a client admitted to the telemetry unit 4 days post coronary artery bypass graft (CABG) surgery. Which of the following assessment data warrants immediate intervention by the nurse? Select all that apply. A EKG tracing shows sinus rhythm with an occasional PVC B Chest tube drainage of 125 ml in the past hour C Patient complains of incisional pain 4/10, especially with inhalation. D Vital signs show a mean arterial pressure of 50 mmHg. E Increased confusion and irritability

B Chest tube drainage of 125 ml in the past hour D Vital signs show a mean arterial pressure of 50 mmHg. E Increased confusion and irritability

The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty. Which of the following data received during report is of greatest concern to the nurse? A The client received versed (Midazolam) and fentanyl during the procedure. B The cardiac catherization nurse stated they "needed to apply additional pressure to the groin site after closing the incision." C The client required 2L of oxygen after sedation was given. D This mornings labs included Hgb 10.5 g/dL, Platelet 180,000/mL, and WBC 14,000/mL

B The cardiac catherization nurse stated they "needed to apply additional pressure to the groin site after closing the incision."

The nurse is caring for a post-cardiac catherization client Which medication should a nurse have on hand when removing an arterial sheath after cardiac catheterization? A heparin B atropine C protamine D adenosine

B atropine

A nurse is assigned to care for a group of cardiac clients. Which client should the nurse address first? A the client admitted with unstable angina pectoris who has questions about taking nitroglycerin at home. B the female client who suffered an acute myocardial infarction (MI) who is complaining of jaw and shoulder discomfort C the client who had a pacemaker inserted yesterday and who is complaining of incisional pain D the client who underwent a CABG and has had 25 ml of chest tube drainage in the past hour.

B the female client who suffered an acute myocardial infarction (MI) who is complaining of jaw and shoulder discomfort

The nurse in the intensive care unit is giving a report to the nurse in a cardiac step-down unit about a client who had coronary artery bypass surgery. Which of the following is the most effective way to assure essential information about the client is reported? A Give the report face-to-face with both nurses in a quiet room. B Audiotape the report for future reference and documentation. C Give bedside report with both nurses present, using a standardized reporting form. D Document essential transfer information in the client's electronic health record.

C Give bedside report with both nurses present, using a standardized reporting form.

The nurse is caring for a group of clients on a cardiac unit. Which client should the nurse see first? A a client with a history of sinus tachycardia who is to receive a beta-blocker B a client with stable angina who took one sublingual nitroglycerine 30 minutes ago C a client with a placement of a coronary artery stent who just returned from the cardiac cath lab. D a client with new diagnosis of atrial fibrillation who has a heart rate of 90.

C a client with a placement of a coronary artery stent who just returned from the cardiac cath lab.

metabolic syndrome

These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels

Unstable angina (also called preinfarction angina or crescendo angina)

*symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin

If the myoglobin is negative

*then there has not been any cardiac tissue damage/injury

MI Cardiac Enzymes

*troponin T (TnT) and troponin I (TnI) *creatine phosphokinase - MB (CK-MB) *myoglobin

Framingham Heart Study

including age, gender, total cholesterol, HDL cholesterol, smoking status, systolic blood pressure, and need for antihypertensive medication.