Med surg cardiovascular review

A client having an implantable cardioverter- defibrillator asks the nurse, "What should I do if I feel a shock and am alone?" What is the best response by the nurse? "Lie down and call 911." "Continue previous activity." "Chew an aspirin tablet." "Take an extra dose of your antiarrhythmic medication."

Lie down and call 911

The nurse is reinforcing education for a client with hypertension. What statement made by the client indi- cates that further education is required? "I will apply methods to reduce stress in my life." "I don't have to take my antihypertensives if I am feeling well." "I will reduce the cholesterol and salt intake in my diet." blood pressure routinely at "I will measure my blood pressure routinely at home."

"I don't have to take my antihypertensives if I am feeling well."

The nurse is reinforcing discharge instructions for a client who received a mechanical heart valve. Whata statement made by the client indicates to the nurse that instructions are understood? A.I will have to take life long anti-coagulant therapy B. My valve will Have be replaced in 10 years C. I will not be able to exercise or participate in previous activities D. I will have to be on immune suppressant therapy for the duration of my life

"I will have to take lifelong anticoagulation therapy." R: Although mechanical heart valves (MHV) are more durable than tissue valves, they are more thrombogenic. Consequently, patients with MHV require long-term anticoagulation with vitamin K antagonists, such as warfarin.

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse (RN) and expects which interventions to be scribed? Select all that apply. 1. Administering oxygen 2. Inserting a foley catheter 3. Administering furosemide 4. Administering morphine sulfate intra- venously 5. Transporting the client to the coronary care unit 6. Placing the client in a low-Fowler's side- lying position

1,2,3,4 Pulmonary edema is a life-threatening event that can result from severe heart failure. During pulmonary edema the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high-Fowler's position to ease the work of breathing. Furose- mide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to accurately measure output. Intra- venously administered morphine sulfate reduces venous return (preload), decreases anxiety, and reduces the work of breath- ing. Transporting the client to the coronary care unit is not priority intervention. In fact, this may not be necessary at all if the client's response to treatment is successful.

The primary health care provider (PHCP) is going to perform carotid massage on a client with rapid rate atrial fibrillation. Which interventions should the nurse anticipate? Select all that apply. 1. The client should be placed on a. cardiac monitor. 2. The PHCP massages the carotid artery for a full minute. 3. The head should be turned toward the side to be massaged. 4. Rhythm strips should be obtained before. during, and after the procedure. 5. Monitor the vital signs, cardiac rhythm, and level of consciousness after the procedure.

1,4,5 Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly ter- minate a tachydysrhythmia. The other maneuvers are the Val- salva maneuver of inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm. The client's head should be turned away from the side to be massaged in order to provide better access to the carotid artery. The PHCP or cardiologist will massage only one carotid artery for a few seconds to determine whether a change in car- diac rhythm occurs. The client needs to be on a cardiac monitor throughout the procedure and obtain rhythm strips before during and after the procedure

A 24-year-old man seeks medical attention for complaints of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. Next, the nurse should check the client's medical history for which item? 1. Smoking history 2. Recent exposure to allergens 3. History of recent insect bites 4. Familial tendency toward peripheral vascular disease

1. Smoking history The mixture of arterial and venous manifestations (dlaudication and phlebitis, respectively) in the young male dient suggests thromboangiitis obliterans (Buerger's disease). This is a relatively uncommon disorder characterized by inflam- mation and thrombosis of smaller arteries and veins. This disorder is typically found in young men who smoke. The cause is unknown but is suspected to have an autoimmune component.

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

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

The nurse is monitoring a client following cardio- version. Which observations should be of highest priority to the nurse? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level consciousness

2 satatus of airway Nursing responsibilities after cardioversion include ment of vital signs and level of consciousness, and dysrhythmia maintenance of a patent airway, oxygen administration, assess detection. Airway is the priority.

A postcardiac surgery client with a blood urea nitro- gen (BUN) level of 45 mg/dL (16.2 mmol/L) and a serum creatinine level of 2.2 mg/dL (193.6 mcmol/L) has a total 2-hour urine output of 25 mL. The nurse understands that the risk for which condition? 1. Hypovolemia 2. Acute kidney injury 3. Glomerulonephritis 4. Urinary tract infection

2. Acute kidney injury The client who undergoes cardiac surgery is at risk for acute kidney injury from poor perfusion, hemolysis, Iow ardiac output, or vasopressor medication therapy. Kidney iniury is signaled by a decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. The client need medications to increase renal perfusion and could may need peritoneal dialysis or hemodialysis. Test-Taking Strategy: Focus on the subject, postoperative labo- ratory values. The question provides no evidence of any infection, the So eliminate options 3 and 4 first. Noting the laboratory values postope in the question will assist with eliminating option

To use an external cardiac defibrillator on a client which action should be performed to check the cardiac rhythm? 1. Holding the defibrillator paddles firmly against the chest 2. Applying the adhesive patch electrodes to the from the client skin and moving away 3. Applying standard electrocardiographic monitoring leads to the client and observing the rhythm 4. Connecting standard electrocardiographic electrodes to a transtelephonic monitoring device

2. Applying the adhesive patch electrodes to from the clients skin and miving away. The nurse or rescuer puts two large adhesive patch electrodes on the client's chest in the usual defibrillator posi- tion. The nurse stops cardiopulmonary resuscitation and orders anyone near the client to move away and not touch the client. The defibrillator then analyzes the rhythm which may take up to 30 seconds. The machine then indicates if it is necessary to defibrillate. Although automatic external defi- brillation can be done transtelephonically, it is done through the use of patch electrodes (not standard electrocardiographic electrodes) that interact via telephone lines to a base station that controls any actual defibrillation. It is not necessary hold defibrillator paddles against the client's chest with device.

A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds expecting to hear which breath sounds bilaterally? 1. Rhonchi 2. Crackles 3. Wheezes 4. Diminished breath sounds

2. Crackles Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Wheezes, rhonchi, and diminished breath sounds are not associated with pulmonary edema.

The nurse has reinforced instructions to the client with Raynaud's disease about self-management of the disease process. The nurse determines that the client needs further teaching if the client makes which statement? 1. Smoking cessation is very importan 2. Moving to a warmer climate should help 3. Sources of caffeine should be eliminated from the diet 4. Taking nifedipine as prescribed with decrease vessel spasm

2. Moving to a warmer climate should help Raynaud's disease responds favorably to the elimina- tion of nicotine and caffeine. Medications such as calcium chan- nel blockers may inhibit vessel spasm and prevent symptoms. Avoiding exposure to cold through a variety of means is very important. However, moving to a warmer climate may not nec- essarily be beneficial because the symptoms could still occur with the use of air conditioning and during periods of cooler weather.

The nurse is checking the neurovascular status of a client who returned to the surgical nursing unit four hours ago after undergoing an aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema, The pedal pulse is and unchanged data, the nurse should from admission. Based palpable on this make which determination about the client's neurovascular status? 1. Moderately impaired, and the surgeon should be called 2. Normal, caused by increased blood flow through the leg 3. Slightly deteriorating, and should be moni- tored for another hour 4. Adequate from an arterial approach, but venous complications are arising

2. Normal caused by increased blood flow through the leg An expected outcome of surgery is warmth, redness, and edema in the surgical extremity caused by increased blood flow. Options 1, 3, and 4 are incorrect.

The nurse is caring for a client on a cardiac mon- itor who is alone in a room at the end of the hall. The client has a short burst of ventricular tachycar- dia (VT), followed by ventricular fibrillation (VF). The client suddenly loses consciousness. Which intervention should the nurse do first? 1. Go to the nurse's station quickly and call a code. 2. Run to get a defibrillator from an adjacent nursing unit. 3. Call for help and initiate cardiopulmonary resuscitation (CPR). 4. Start oxygen by cannula at 10 L/minute and lower the head of the bed.

3 call for help and initiate CPR When ventricular fibrillation occurs, the nurse remains with the client and initiates CPR until a defibrillator is available and attached to the client. Options 1, 2, and 4 are incorrect.

The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse should expect to note which specific characteristic of this condition? 1. Dyspnea 2. Hacking cough 3. Dependent edema 4. Crackles on lung auscultation

3 dependent edema Right-sided heart failure is characterized by signs of systemic congestion that occur as a result of right ventricular failure, fluid retention, and pressure buildup in the venous sys- tem. Edema develops in the lower legs and ascends to the thighs and abdominal wall. Other characteristics include jugu- lar (neck vein) congestion, enlarged liver and spleen, anorexia and nausea, distended abdomen, swollen hands and fingers, polyuria at night, and weight gain. Left-sided heart failure pro- duces pulmonary signs. These include dyspnea, crackles on lung auscultation, and a hacking cough.

A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and short- ness of breath, and the client is visibly anxious. Which is a life-threatening complication that could be occurring? 1. Pneumonia 2. Pulmonary edema 3. Pulmonary embolism 4. Myocardial infarction

3. Pulmonary embolism Pulmonary embolism is a life-threatening compli- cation of deep vein thrombosis and thrombophlebitis. Chest pain is the most common symptom which is sudden in onset and may be aggravated by breathing. Other signs and symp- toms include dyspnea, cough, diaphoresis, and apprehension.

A client is diagnosed with pulmonary edema and having pink, frothy sputum, and crackles in both lungs. What nursing intervention should be provided at this time? Select all that apply. Administer morphine sulfate as ordered. Administer furosemide as ordered Place the legs in a dependent position Administer oxygen as ordered. Place the client in high Fowler position.

Administer morphine sulfate as ordered Administer oxygen as ordered Place the client in high Fowler position

A client is wearing a continuous cardiac monitor which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. The nurse should do which action first? 1. Call a code blue. 2. Check the client status and lead placement. 3. Call the primary health care provider (PHCP). 4. Press the recorder button on the ECG console.

Check the client status and lead placement 2 Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displace- ment. Checking of the client and equipment is the first action by the nurse.

The nurse is preparing to ambulate a postoperative client after cardiac surgery. The nurse plans to do which to enable the client to best tolerate the ambulation? 1. Provide the client with a walker. 2. Remove the telemetry equipment. 3. Encourage the client to cough and deep breathe. 4. Premedicate the client with an analgesic before ambulating.

Premedicate the client with analgesic before ambulating 4 Rationale: The nurse should encourage regular use of pain nedication for the first 48 to 72 hours after cardiac surgery because analgesic will promote rest decrease Myocardio oxygen consumption caused by pain and allow better participation in activities such as coughing and deep breathing and ambulation

A client is preparing to have an angiocardiagram in the morning. What data should the nurse obtain in preparation for this test? Ask if the client has crutches or a cane to use after the test. Ask if the client has a family member that had this test. Ask if the client has received a yearly flu shot. Ask if the client is allergic to shellfish or iodine.

d. Ask if the client is allergic to shellfish or iodine.