(Med Surg II) Unit 6: Cardiovascular Study Guide

Dysrhythmias

Any disturbance or abnormality in a normal rhythmic pattern, specifically irregularity in the normal rhythm of the heart. Also called arrhythmia

A patient experienced intense chest pain, anxiety, and nausea. The admitting diagnosis is suspected myocardial infarction. When providing care for the patient in the emergency department, the nurse must understand what about a myocardial infarction? 1. It involves a critical reduction in blood supply to the myocardium. 2. There is a marked increase in cardiac output. 3. A sudden irregularity of cardiac contraction occurs. 4. There is a marked decrease in cardiac output.

1. It involves a critical reduction in blood supply to the myocardium.

The patient arrives in the emergency department with severe dyspnea, agitation, cyanosis, audible wheezes, and a cough with blood-tinged sputum. What is the priority nursing actions? 1. Obtained a blood sample for arterial blood gases 2. Administer oxygen 3. Auscultate lung sounds 4. Establish a peripheral IV

2. Administer oxygen

Which instruction would the nurse give to the patient for self-administration of nitrate medications? 1. Refrigerate the oral tablets and nitroglycerin patches until use 2. Apply patches in the morning and remove them at bedtime 3. A burning sensation on the tongue indicates on allergic reaction 4. Pain relief should occur after a minimum of two doses

2. Apply patches in the morning and remove them at bedtime

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

2. Status of airway

The nurse is caring for a patient who has right ventricular heart failure. After therapy, the nurses sees that the patient has lost 5 pounds of weight. Assuming that all the weight represents fluid loss, how much fluid has the patient lost?

- 1 L = 1 kg = 2.2 pounds - 2.2 lbs / 1 L = 5 lbs / x - x = 2.272 = 2.3 L 2.3 L

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 prescribed? Select all that apply. 1. Administering oxygen 2. Inserting a Foley catheter 3. Administering furosemide 4. Administering morphine sulfate intravenously 5. Transporting the client to the coronary care unit 6. Placing the client in a low-Fowler's side-lying position

1. Administering oxygen 2. Inserting a Foley catheter 3. Administering furosemide 4. Administering morphine sulfate intravenously

The nurse is providing patient teaching for a patient with Raynaud disease. Which information should be included? (Select all that apply.) 1. Avoid cold. 2. Warm hands and feet with heating pad. 3. Practice stress reduction techniques. 4. Comply with smoking cessation. 5. Limit caffeine intake.

1. Avoid cold. 3. Practice stress reduction techniques. 4. Comply with smoking cessation. 5. Limit caffeine intake.

Then patient with a history of heart failure tells the home health nurse, "Every night I sleep in this recliner chair." What will the nurse assess first? 1. Check for dependent edema in the lower extremities 2. Look at accessibility to the bedroom and bathroom 3. Assess ability to independently move and ambulate 4. Ask about compliance with low-sodium, low-fat diet

1. Check for dependent edema in the lower extremities

A patient receives a prescription for anticoagulant medication for treatment of arterial emboli. What dietary information should the nurse give? 1. Do not increase intake of dark green vegetables because of vitamin K 2. Take extra dairy products to ensure calcium intake and vitamin D 3. Eat fruits such as citrus and bananas that provide potassium 4. Avoid eating saturated fats by limiting use of butter, oils, and red meat

1. Do not increase intake of dark green vegetables because of vitamin K

The patient had a recent cardiac transplant. Which intervention is required for posttransplant care? 1. Immunosuppressive therapy 2. Pericardiocentesis 3. Percutaneous transluminal angioplasty 4. Contact isolation

1. Immunosuppressive therapy

A patient is admitted to the medical floor with a diagnosis of HF. Which assessment findings are consistent with the medical diagnosis? (Select all that apply.) 1. Increase in abdominal girth 2. Weight loss of 6 pounds in the past 2 weeks 3. Pitting edema 4. Nervous tremors 5. Night sweats

1. Increase in abdominal girth 3. Pitting edema

During a discharge teaching session, the young patient voices concern about her risk for heart disease because she has diabetes mellitus. Which self-care measures would the nurse teach the patient? Select all that apply. 1. Keep the blood glucose level under control 2. Monitor blood pressure at home: goal less than 120/80 mm Hg 3. Eat a low-fat diet rich and fruit and vegetables 4. Exercise 3 to 5 times a week for at least 30 minutes 5. Take low-dose aspirin once a day

1. Keep the blood glucose level under control 2. Monitor blood pressure at home: goal less than 120/80 mm Hg 3. Eat a low-fat diet rich and fruit and vegetables 4. Exercise 3 to 5 times a week for at least 30 minutes

The nurse is planning care for several patients who are scheduled to have diagnostic testing for cardiac disorders. Which patient will require post-procedural checks for peripheral, pulses, color, and sensation of the extremity every 15 minutes for 1 hour? 1. Needs cardiac catheterization to diagnose extent of atherosclerotic heart disease 2. Is scheduled for electrocardiogram to identify specific cardiac dysrhythmias 3. Requires chemically induced stress electrocardiogram for poor exercise tolerance 4. Must have positron emission tomography because of coronary artery disease

1. Needs cardiac catheterization to diagnose extent of atherosclerotic heart disease

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

1. The client would be placed on a cardiac monitor. 4. Rhythm strips would be obtained before, during, and after the procedure. 5. Vital signs, cardiac rhythm, and level of consciousness would be monitored the procedure.

Under what circumstances would the nurse expect to observe sinus tachycardia if the patient were on a cardiac monitor? 1. The patient has an untreated high fever 2. Patient demonstrates obstructive sleep apnea 3. Patient faints during a bowel movement 4. Health care provider performs carotid massage

1. The patient has an untreated high fever

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noting which signs/symptoms? Select all that apply. 1. Visual disturbances 2. Nausea and vomiting 3. Apical pulse rate of 63 beats/min 4. Serum digoxin level of 2.3 ng/mL 5. Serum potassium level of 3.9 mEq/L

1. Visual disturbances 2. Nausea and vomiting 4. Serum digoxin level of 2.3 ng/mL

The patient who had a myocardial infarction 2 weeks ago is now having frequent episodes of ventricular tachycardia. For this patient, what is the clinical significance of this dysrhythmia? 1. Warning sign for ventricular fibrillation 2. Expected finding at this stage 3. Reaction to a beta-adrenergic blocker 4. Treatment is given only for symptoms

1. Warning sign for ventricular fibrillation

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 important." 2. "Moving to a warmer climate would help." 3. "Sources of caffeine should be eliminated from the diet." 4. "Taking nifedipine as prescribed will decrease spasms in my blood vessels."

2. "Moving to a warmer climate would help."

The health care provider is considering tissue plasminogen activator (TPA) for a patient who is having an acute myocardial infarction. The wife suddenly rushes to the nurse and says, "We forgot to tell you something." Which disclosure is a contraindication for TPA? 1. "My husband is a Jehovah's Witness" 2. "My husband recently had a head injury" 3. "He forgot to take his insulin this morning" 4. "He had a small heart attack last year"

2. "My husband recently had a head injury"

What are the signs/symptoms of cardiac arrest? Select all that apply. 1. Pupil constriction 2. Absence of carotid pulse 3. Gasping respirations followed by apnea 4. Lethargic and difficult to arouse 5. Abrupt loss of consciousness 6. Pallor and cyanosis

2. Absence of carotid pulse 3. Gasping respirations followed by apnea 5. Abrupt loss of consciousness 6. Pallor and cyanosis

The nurse is discussing modifiable risk factors for cardiovascular disease with a 23-year-old patient who is currently asymptomatic. What does the nurse recommend? 1. Find out if any first-degree relatives had cardiovascular problems before the age of 50 2. Stop smoking, or consider greatly reducing the number of cigarettes smoked per day 3. Ask the healthcare provider for a cholesterol-lowering drug such as simvastatin 4. Monitor, weight and calorie intake to maintain a body mass index of 30

2. Stop smoking, or consider greatly reducing the number of cigarettes smoked per day

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication 4. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication

2. The development of audible expiratory wheezes

The patient's cardiac monitor shows a regular rhythm with a rate of 65 bpm, P waves proceed each QRS complex, QRS complexes are symmetrical and regularly spaced, and a normal T wave shows repolarization. What is the nurse's interpretation of the monitor display? 1. Vital signs should be immediately assessed 2. The monitor indicates a normal sinus rhythm 3. The monitor is showing a benign dysrhythmia 4. The patient should be assessed for chest pain

2. The monitor indicates a normal sinus rhythm

An 86-year-old patient is receiving an intravenous infusion at 83 mL/h via an electronic infusion pump. Why is it so vital that the IV lines of older adult patients be monitored carefully? 1. These patients do not become dehydrated very easily. 2. These patients are at an increased risk for developing fluid overload of the circulatory system. 3. These patients are at an increased risk for developing a venous infection. 4. Aging patients present an increased risk for developing thrombophlebitis in the peripheral system.

2. These patients are at an increased risk for developing fluid overload of the circulatory system.

A neighbor tells the nurse that he has indigestion that has lasted 60 minutes. He tried "taking nitroglycerin, but that didn't help." What should the nurse do first? 1. Tell the nurse to take an aspirin and then drive to the emergency department 2. Stay with the neighbor, assist him to remain calm, and call 911 3. Assess the neighbor's use of nitroglycerin and assess for other symptoms 4. Phone the neighbor's health care provider and ask for recommendations

3. Assess the neighbor's use of nitroglycerin and assess for other symptoms

When a patient returns to the unit following cardiac catheterization, which nursing activity should follow immediately after taking of vital signs? 1. Placing the patient in a warm bed and encouraging sleep 2. Providing the patient with fluids 3. Assessing the patient's peripheral pulses 4. Reapplying the patient's dressing where the dye was injected

3. Assessing the patient's peripheral pulses

For a patient with myocardial infarction, what symptom is the most important? 1. Diaphoresis 2. Palpitations 3. Pain 4. Shortness of breath

3. Pain

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium. Which statement made by the client reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a MedicAlert bracelet." 4. "I will take enteric coated aspirin for my headaches because it is coated."

4. "I will take enteric coated aspirin for my headaches because it is coated."

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine. Which statement made by the client indicates the need for further teaching? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store."

The patient had a percutaneous transluminal coronary angioplasty with stent placement. What type of medication is the patient most likely to be prescribed for at least 3 months? 1. Digitalis preparation 2. Diuretic 3. Opioid pain medication 4. Anticoagulant

4. Anticoagulant

A younger patient has had several blood pressure readings that are consistently staying around 130/80 mm Hg. What treatment and/or advice should be given to this patient? 1. Diuretics and low sodium diet 2. Beta-adrenergic blockers and weight loss 3. Angiotensin II receptor blocks and low fat diet 4. Lifestyle changes and routine health appointments

4. Lifestyle changes and routine health appointments

When a patient is receiving heparin therapy, what would be the nurse's most appropriate action? 1. Observe him for cyanosis. 2. Assess degree of edema in all extremities. 3. Give the injection intramuscularly. 4. Observe emesis, urine, and stools for blood.

4. Observe emesis, urine, and stools for blood.

Which physical assessment would the nurse perform to assist the health care provider in identifying atrial fibrillation? 1. Take a manual blood pressure on both arms 2. Compare bilateral peripheral pulses 3. Count the apical pulse for a full minute 4. Obtain help and check for a pulse deficit

4. Obtain help and check for a pulse deficit

Which psychosocial behaviors are more likely to be associated with increased cardiovascular symptoms? 1. Frequently in a hurry, and generally inpatient 2. Easy-going and usually enjoys life 3. Neat, organized, and pays attention to detail 4. Pessimistic and generally expresses negativity

4. Pessimistic and generally expresses negativity

The health care provider instructs the nurse to immediately report laboratory results to confirm the diagnosis of myocardial infarction. Which laboratory result should the nurse seek out first? 1. Creatinine phosphokinase 2. Creatine kinase 3. Troponin T 4. Troponin I

4. Troponin I (cardiac muscle specific)

Myocardial infarction (MI)

An occlusion of a major coronary artery or one of its branches; it is caused by atherosclerosis or an embolus resulting in necrosis of a portion of cardiac muscle

Ischemia

Decreased blood supply to a body organ or part, often marked by pain and organ dysfunction

Heart failure

Syndrome characterized by circulatory congestion due to the heart's inability to act as an effective pump; it should be viewed as a neurohormonal problem in which pathology progresses as a result of chronic release in the body of substances such as catecholamines (epinephrine and norepinephrine)

Ejection fraction (EF)

The fraction of blood pumped out of the left ventricle with each contraction, determined by dividing stroke volume by end-diastolic volume and expressed as a percentage.

A 75-year-old patient is diagnosed with heart failure. The nursing diagnosis of Activity Intolerance, related to dyspnea and fatigue, would be appropriate. What nursing intervention would be most appropriate for this diagnosis? 1. Plan frequent rest periods. 2. Allow the patient to shower. 3. Encourage the patient to perform all ADLs. 4. Encourage fluid intake of 3000 mL/day.

1. Plan frequent rest periods.

Which disorder of the cardiovascular system places the patient at highest risk for the potentially life-threatening condition of cardiac tamponade? 1. Pericarditis 2. Valvular heart disease 3. Buerger's disease 4. Endocarditis

1. Pericarditis

The nurse is caring for a patient who is on anticoagulant therapy. Which laboratory values are the most important to monitor? 1. Prothrombin time, International Normalized Ratio, and partial thromboplastin time 2. Blood glucose, potassium, sodium, calcium, and magnesium 3. Enzyme, creatinine kinase, creatinine phosphokinase, and myoglobin 4. B-type natriuretic peptide and troponins 1 and 2

1. Prothrombin time, International Normalized Ratio, and partial thromboplastin time (PT, INR, PTT)

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. The nurse would check the client's medical history for which finding next? 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 nurse is assessing a patient who had an embolectomy in the right lower extremity. Which assessment finding is cause for greatest concern? 1. Sudden absence of pulse in the affected extremity 2. Capillary refill in extremity is greater than 2 seconds 3. Affected extremity is erythematous and edematous 4. Patient reports a tingling sensation in extremity

1. Sudden absence of pulse in the affected extremity

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

2. Acute kidney injury

What is the primary goal of patient teaching after a myocardial infarction? 1. Explaining the disease process 2. Assisting the patient in developing a healthy lifestyle 3. Describing the precipitating causes and onset of pain 4. Educating the patient on causative factors that initiate cardiac vasoconstriction

2. Assisting the patient in developing a healthy lifestyle

The nurse is monitoring a patient who is waiting for diagnostic testing to determine if he has an aortic aneurysm. The patient suddenly reports severe chest pain. He becomes pale, weak, and confused. His pulse is 130 bpm and blood pressure is 85/50 mm Hg. What should the nurse do first? 1. Call the healthcare provider 2. Put the patient in a supine position 3. Assess pain and give opioid medication 4. Establish a patent peripheral IV

2. Put the patient in a supine position

A patient with a history of IV drug use is diagnosed with acute infective endocarditis. Which nursing intervention for this patient is most appropriate? 1. Early ambulation 2. Restricted activity for several weeks 3. Low-calorie diet 4. Dilution of blood by increased fluid intake

2. Restricted activity for several weeks

When providing patient teaching regarding coronary artery disease, the nurse can include which of the following when advising the patient about modifiable risk factors? (Select all that apply.) 1. Family history 2. Smoking 3. Cholesterol level 4. Obesity 5. Ethnicity

2. Smoking 3. Cholesterol level 4. Obesity

The nurse is caring for a client on a cardiac monitor who is alone in a room at the end of the hall. The client has a short burst of ventricular tachycardia (VT), followed by ventricular fibrillation (VF). The client suddenly loses consciousness. Which action would the nurse take 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/min and lower the head of the bed.

3. Call for help and initiate cardiopulmonary resuscitation (CPR).

A patient has Buerger disease. What is the most important aspect of patient compliance to decrease signs and symptoms of Buerger disease? 1. Low-fat diet 2. Weight loss 3. Cessation of tobacco use 4. Keeping extremities warm

3. Cessation of tobacco use

What is the best nursing action that will lessen the severity of a patient's orthostatic hypotension? 1. Turn him from side to side every 2 hours. 2. Limit times he will have to get in and out of the bed. 3. Change his position routinely, especially from horizontal to vertical. 4. Encourage him to move very slowly.

3. Change his position routinely, especially from horizontal to vertical.

A hospitalized client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions would the nurse take? Select all that apply. 1. Call a code blue. 2. Contact the client's family. 3. Check the client's pain level. 4. Check the client's blood pressure. 5. Administer a second nitroglycerin, 0.4 mg, sublingually.

3. Check the client's pain level. 4. Check the client's blood pressure. 5. Administer a second nitroglycerin, 0.4 mg, sublingually.

The home health nurse is reviewing the patient's laboratory results and sees the overall serum cholesterol level is 230 mg/dL. Based on the laboratory results, which patient education topic is the nurse most likely to review with the patient? 1. Importance of ambulation and mobility 2. Coping and stress reduction techniques 3. Dietary sources of fat and weight reduction 4. Methods to increase medication compliance

3. Dietary sources of fat and weight reduction

The nurse is assessing a patient and suspects the patient is experiencing thrombophlebitis in the lower leg. What symptoms would the nurse assess (Select all that apply.) 1. Numbness along a vein 2. Severe cramping 3. Edema of the extremity 4. Calf is warm to the touch 5. Pain in the effected extremity

3. Edema of the extremity 4. Calf is warm to the touch 5. Pain in the effected extremity

The nurse is caring for a postsurgical patient. Which intervention is the most important in preventing venous thrombosis in the legs? 1. Applying elastic compression stockings 2. Elevating the lower extremities 3. Ensuring early ambulation and mobility 4. Measuring the caps are circumference daily

3. Ensuring early ambulation and mobility

A patient is being discharged after receiving a permanent pacemaker. What is the best rationale to give to the patient about refraining from sports such as tennis, swimming, golf, and weight-lifting for the first 6-8 weeks? 1. "First, you have to be able to climb at least two flights of starts." 2. "Active sports will interfere with the pacemaker's fixed mode" 3. "These sports are too strenuous and rapidly increase the heart rate" 4. "The arm on the pacemaker side should not be lifted over the head"

4. "The arm on the pacemaker side should not be lifted over the head"

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level? 1. Thrombocyte count of 100,000 mm3 2. Prothrombin time (PT) of 21 seconds 3. International normalized ratio (INR) of 2.3 4. Activated partial thromboplastin time (aPTT) of 55 seconds

4. Activated partial thromboplastin time (aPTT) of 55 seconds

The health care provider is reviewing the 12-lead electrocardiogram and tells the nurse that the patient has a STEMI MI. Based on this information what is the priority intervention? 1. Administer beta-adrenergic blocker as prescribed 2. Transfer to the intensive care unit 3. Prepare patient for thrombolytic therapy 4. Administer oxygen at 2L/minute

4. Administer oxygen at 2L/minute

A patient is admitted with a diagnosis of possible aortic abdominal aneurysm. What is the most important factor to monitor as a possible complication? 1. Body temperature 2. Skin turgor 3. Respiratory rate 4. Blood pressure

4. Blood pressure

A patient is admitted to the hospital with a diagnosis of heart failure. Recently the patient's symptoms have been getting worse as a result of arteriosclerosis. In establishing a patient care plan, what is the primary goal of treatment? 1. Reduce the workload of the heart. 2. Promote rest for the heart. 3. Reduce fluid retention. 4. Reduce circulating blood volume.

1. Reduce the workload of the heart.

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

2. Normal, caused by increased blood flow through the leg

What is an ECG/EKG? When is it indicated

- records the electrical signals from the heart

Name the four heart chambers

- right atrium - right ventricle - left atrium - left ventricle

What are complications of stent placement surgery

- stent thrombosis - acute MI - emergency CABG - coronary spasm - possible dysrhythmias

What is the treatment for sinus bradycardia

- treat cause - pacemaker

Name the four valves of the heart

- tricuspid - pulmonary - mitral - aortic

What are complications of MI

- ventricular fibrillation - cardiogenic shock - heart failure - dysrhythmias - ventricular aneurysm - pericarditis - embolism - death

A patient presents with dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention. What does the nurse suspect the patient is experiencing? 1. Right-sided heart failure 2. Left-sided heart failure 3. Cardiac dysrhythmias 4. Valvular heart disease

1. Right-sided heart failure

Before administering a dose of digoxin to an assigned patient, the nurse observes that the patient's pulse rate is 52. What is the most appropriate nursing action? 1. Notify the charge nurse. 2. Recognize that these are signs of digoxin toxicity and withhold the dose. 3. Administer the medication. 4. Hold the medication and notify the health care provider.

4. Hold the medication and notify the health care provider.

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.

4. Premedicate the client with an analgesic before ambulating.

When caring for a patient whose health care provider has ordered furosemide (Lasix), what will the nurse recognize when the medication is having the desired effect? (Select all that apply.) 1. The patient becomes very thirsty. 2. The patient's resting heart rate slows. 3. The patient's blood pressure is reduced. 4. Production of urine is increased. 5. The patient's weight decreases

4. Production of urine is increased. 5. The patient's weight decreases

A 63-year-old patient present with fever, increased pulse, epistaxis, and joint involvement. Heart murmurs are auscultated. The patient has a history of inadequately treated childhood group A B-hemolytic streptococci pharyngitis. These findings and history are consistent with which medical diagnosis? 1. Cardiomyopathy 2. Angina 3. Left-sided heart failure 4. Rheumatic heart disease

4. Rheumatic heart disease

What is the best method to help a patient comply with dietary restrictions associated with atherosclerosis heart disease? 1. Tell him to avoid all foods that are high in fats 2. Remind him that total fat intake is 35% - 40% of total caloric intake 3. Tell him to eat 10-15 grams of soluble fiber every day 4. Teach him how to read the nutritional labels on food products

4. Teach him how to read the nutritional labels on food products

The patient experiences, dizziness and lightheadedness while trying to pass a bowel movement. An immediate pulse check shows 45 bpm that rapidly recovers to a regular rate of 70. What is the most probable cause of this episode of sinus bradycardia? 1. Digitalis toxicity 2. Endocrine disturbance 3. Intracranial tumor 4. Vagal stimulation

4. Vagal stimulation

What is the normal WBC?

5,000 - 10,000

What is the normal heart rate for an adult?

60 - 100 bpm

Sinus bradycardia

<60 bpm

Name the conduction system of the heart in order

SA node > AV node > bundle of HIS > purkinje fibers

MAP (mean arterial pressure)

The average pressure for the entire cardiac cycle MAP=Diastolic Pressure + 1/3 of the Pulse Pressure

What are the main purposes of heart valves?

To prevent backflow

What lab test is the most sensitive and specific for myocardial damage?

Troponin

A patient receives a diagnosis of angina pectoris, with no subsequent cardiac involvement. The health care provider prescribes nitroglycerin. What explanation would the nurse give to this patient about why this medication is given sublingually? 1. Superficial blood vessels promote rapid absorption of the medication. 2. Stomach acids destroy the medication. 3. Saliva helps break down the medication for absorption. 4. The medication is too rapidly absorbed in the stomach.

1. Superficial blood vessels promote rapid absorption of the medication.

A patient has a history of angina pectoris. To decrease the pain from angina pectoris, what should the patient do? 1. Take a cardiac glycoside at the first symptom of cardiac pain. 2. Avoid taking more than three or four nitroglycerin pills daily. 3. Take nitroglycerin sublingually three times daily. 4. Take nitroglycerin sublingually prophylactically before strenuous exercise.

1. Take a cardiac glycoside at the first symptom of cardiac pain.

Laboratory results show a low hemoglobin for a patient diagnosed with myocardial infarction. What is the first intervention that the nurse performed to address the laboratory result? 1. Obtain an order for an intramuscular iron supplement 2. Help the patient to order an iron-rich meal tray 3. Obtain an order for type and cross for blood transfusion 4. Check to see that oxygen is delivered as prescribed

4. Check to see that oxygen is delivered as prescribed

Which patient is the most likely candidate to meet the criteria for a cardiac transplant? 1. Has type one diabetes with end organ damage 2. Has heart disease stabilized by medication 3. Has a history of mental illness 4. Has inoperable coronary artery disease

4. Has inoperable coronary artery disease

What is BNP (B-type natriuretic peptide) test and what does an elevated level indicate?

- hormone secreted by the ventricles of the heart in response to ventricular expansion and pressure overload - shows how well the heart is working - a BNP level above 100 pg/mL indicates heart failure; the higher the BNP level the more severe the heart failure

What are some causes of ventricular tachycardia?

- hypoxemia - drug toxicity (digitalis quinidine) - electrolyte imbalance (potassium and magnesium) - bradycardia

Nursing interventions for heart failure

- monitor vital signs - monitor fluid status - assess lung sounds - monitor urinary output - assess edema - assess for signs and symptoms of pulmonary edema

What are symptoms of right sided heart failure (think right-sided Rita)

- nausea - abdominal distention - fatigue - peripheral venous pressure - ascites - enlarged liver and spleen - may be secondary to chronic pulmonary problems - distended jugular veins - anorexia and complaints of GI distress - weight gain - dependent edema (feet, ankles, sacrum, may progress up the legs into thighs external genitalia and lower trunk)

What are four modifiable risk factors of cardiovascular disease

- obesity - smoking - sedentary lifestyle - diabetes mellitus

What are the five P's for assessing arterial occlusion?

- pain - pallor - pulse - paresthesia - paralysis

Nursing interventions for angina pectoris

- promote comfort - promote tissue perfusion - promote rest - reduce anxiety - promote feelings of well-being - provide patient education

The different diagnostic test that are used to evaluate coronary function

- Diagnostic imaging - Cardiac catheterization and angiography - Electrocardiography - Cardiac monitors - Thallium scanning - Echocardiography - Positron emission tomography - MUGA scan - Laboratory tests

Signs and symptoms of thrombophlebitis in the lower leg

- Entire extremity may be pale, cold, and edematous - Area along vein may be erythematous and warm to touch - Patient may have Homan sign: Pain in calf on dorsiflexion - Superficial veins feel indurated (hard) and thready or cordlike and are sensitive to pressure - Extremities have difference in circumference - Pain - Edema

Homan's sign and how to perform it

- Pain in calf on dorsiflexion - forced dorsiflexion of the respective ankle in the suspected limb - has been found to be an unreliable sign, because it is not specific for DVT and appears in only 10% of patients with DVT

Name the diagnostic tests for an MI

- Troponin T (can be affected by skeletal and renal damage) - Troponin I (cardiac specific) - 12-lead ECG (ST segment elevation) - Chest x ray - Echocardiogram - PET scan - MUGA scan

What is the treatment of angina pectoris (medications and surgical interventions)

- antiplatelet - vasodilators - beta-blockers - calcium channel blockers - coronary artery bypass graft (CABG) - percutaneous transluminal angiography

What are nursing interventions for pacemaker placement surgery?

- closely monitor hear rate and rhythm - vital signs - level of consciousness - observe insertion site - side that pacemaker was place is immobilized for a specific amount of time - do not lift arm above head for 6 to 8 weeks

What are symptoms of left sided heart failure (think left-sided Larry)

- dyspnea - paroxysmal nocturnal dyspnea - cough - frothy blood tinged sputum - tachypnea - orthopnea - pulmonary crackles - radiographic evidence of pulmonary congestion with pleural effusoin - elevated pulmonary capillary wedge pressure - restlessness - confusion - tachycardia - fatigue - cyanosis

Name the three layers of the heart

- endocardium - myocardium - epicardium

What are causes of sinus tachycardia?

- exercise - anxiety - fever - shock - mediations - heart failure - excessive caffeine - recreational drugs - tobacco use

What are the two parts of cardiac rehabilitation

- exercise - education

What are four non modifiable risk factors for cardiovascular disease?

- gender - race - family history - age

Sinus tachycardia

100 - 150 bpm

What is the normal platelet count?

150,000 - 400,000

To use an external cardiac defibrillator on a client, which action would be performed to check the cardiac rhythm? 1. Holding the defibrillator paddles firmly against the chest 2. Applying the adhesive patch electrodes to the skin and moving away from the client 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 the skin and moving away from the client

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 would take 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

2. Check the client status and lead placement.

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

The patient is on the cardiac monitor undergoing a diagnostic procedure. Suddenly, the health care provider says, "The patient is having ventricular fibrillation." Which piece of equipment is the most vital? 1. Temporary pacemaker 2. Defibrillator 3. Bag-valve-mask 4. Crash cart

2. Defibrillator

What actions would the nurse expect to be used to treat heart failure? (Select all that apply.) 1. Cardiotonic drugs (digitalis) 2. Diuretic agents 3. Generous fluid intake 4. ACE inhibitors, beta-adrenergic blockers (carvedilol), nitrates 5. Oxygen therapy

2. Diuretic agents 4. ACE inhibitors, beta-adrenergic blockers (carvedilol), nitrates 5. Oxygen therapy

What is the most useful noninvasive diagnostic tool for evaluating the patient with heart failure? 1. Coronary angiography 2. Echocardiogram 3. Electrocardiogram 4. Thallium scanning

2. Echocardiogram

The patient has pulmonary edema and is prescribed furosemide. Which laboratory result is the most important for the nurse to monitor? 1. Complete blood count 2. Electrolytes 3. Coagulation studies 4. Serum lipids

2. Electrolytes

The nurse is planning to administer hydrochlorothiazide to a client. Which are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Hypokalemia, hyperglycemia, sulfa allergy 3. Hypokalemia, increased risk of osteoporosis 4. Hyperkalemia, hypoglycemia, penicillin allergy

2. Hypokalemia, hyperglycemia, sulfa allergy

The nurse is aware that the patient will benefit from the administration of streptokinase and tissue plasminogen activators when administered how long after admission for acute MI signs and symptoms? 1. In the first 24 hours 2. In the first 30 minutes to 1 hour 3. In the first 72 hours 4. In the second 6 hours after an MI

2. In the first 30 minutes to 1 hour

A patient has a diagnosis of hypertension. When providing discharge teaching what should the nurse include? (Select all that apply.) 1. Instruction in consuming a bland diet 2. Instruction to limit sodium intake to 2 g/day 3. Encouragement to begin a vigorous exercise program 4. Monitoring and keeping a record of blood pressure measurements at home 5. Education on continuing to take antihypertensive medications as prescribed

2. Instruction to limit sodium intake to 2 g/day 5. Education on continuing to take antihypertensive medications as prescribed

The nurse sees an older woman sitting in the waiting room, and she is crying, "My granddaughter was just diagnosed with infective endocarditis." Which therapy is the nurse most likely to explain to the grandmother? 1. Prosthetic valve replacement 2. Intensive antibiotic therapy 3. Complete bedrest 4. Anticoagulation therapy

2. Intensive antibiotic therapy

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 range of motion to the right arm

2. Limiting movement and abduction of the right arm

The nurse is caring for a patient who is 40 hours post-myocardial infarction. Which instructions should be given to the unlicensed assistive personnel (UAP)? 1. Assist the patient to ambulate in the hall three times 2. Check to see if the patient is too tired to get up 3. Encourage the patient to independently get out of bed 4. Help the patient get to the commode chair

4. Help the patient get to the commode chair

How many different types of atrioventricular blocks are there?

3 ; third degree needs pacemaker

The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse would 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

The health care provider tells the nurse the patient has occasional premature ventricular contractions (PVCs). Based on this information what would the nurse expect to observe when assessing the patient? 1. Shallow, rapid respiration with PVCs 2. Chest pain when the PVCs are occurring 3. Irregular rate and rhythm when palpating pulse 4. Blood pressure lower than 120/80 mm hg

3. Irregular rate and rhythm when palpating pulse

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available

3. Monitor for signs of bleeding.

The nurse hears in report that the patient with heart failure has 4+ pitting edema in the lower extremities. Based on this information, what is the priority assessment that the nurse will perform? 1. Check for edema in the sacrum 2. Weigh the patient 3. Observe respiratory effort 4. Observe for jugular vein distention

3. Observe respiratory effort

The nurse is caring for a patient who has peripheral arterial disease with burning pain in the right leg that occurs at rest which intervention will the nurse use? 1. Elevate the leg on a pillow 2. Use a covered ice compress 3. Place the leg in a dependent position 4. Encourage aerobic exercise for circulation

3. Place the leg in a dependent position

A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness 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

Which sign/symptom indicates to the nurse that a patient with endocarditis is experiencing a serious and common complication of the disease? 1. Fever and chills 2. Joint pains and aches 3. Sudden shortness of breath 4. Petechiae on neck and chest

3. Sudden shortness of breath

Isosorbide mononitrate is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a headache. Which action would the nurse suggest to the client? 1. Cut the dose in half. 2. Discontinue the medication. 3. Take the medication with food. 4. Contact the primary health care provider (PHCP).

3. Take the medication with food.

For which dysrhythmia would a pacemaker most likely be necessary? 1. Sinus tachycardia 2. Premature ventricular contractions 3. Third-degree heart block 4. Atrial fibrillation

3. Third-degree heart block

Which patient should be counseled about the risk of cardiomyopathy related to lifestyle choices? 1. High-risk sexual behavior 2. Poor intake of dietary fiber 3. Use of "crack" cocaine 4. Social consumption of alcohol

3. Use of "crack" cocaine

The nurse is caring for a patient with valvular heart disease. Which task should be assigned to the UAP? 1. Identify activities of daily living that cause fatigue 2. Check meal trays for high-sodium foods 3. Weigh the patient at the same time every day 4. Explain the plan for rest periods

3. Weigh the patient at the same time every day

A client is taking nicotinic acid for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid drinking alcohol." 2. "The medication needs to be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and are not a concern." 4. "Ibuprofen taken 30 minutes before the nicotinic acid will decrease the flushing."

4. "Ibuprofen taken 30 minutes before the nicotinic acid will decrease the flushing."

A 10-year-old patient is diagnosed with rheumatic fever. Of all the manifestations seen in rheumatic fever, which is most likely to lead to permanent complications? 1. Sydenham chorea 2. Erythema marginatum 3. Subcutaneous nodules 4. Carditis

4. Carditis

Where does supra ventricular tachycardia originate from

Atria

Which rhythm is when electrical activity in the atria is unorganized and causes the atria to fibrillate or quiver rather than contract?

Atrial fibrillation

What lab test indicates heart failure?

BNP

What lab test shows inflammation and is produced by the liver

CRP

What electrolyte is to maintain contraction for cardiac muscle?

Calcium

Systole is the phase of what

Contraction

What nursing interventions is the most important in preventing venous thrombosis in the legs?

Control pain and administer prescribed medications

What is the treatment for ventricular fibrillation?

Defibrillation

What is the advantage of placing a patient on a cardiac monitor?

Detect changes in cardiac rate and rhythm early

What is the treatment for sinus tachycardia?

Directed at cause

How do you chart or document regular heart sounds

HRRR

What is rheumatic heart disease?

Heart disease caused my rheumatic fever which arises from group A or B streptococcus infection

For what medication is PTT used to monitor

Heparin

What is the primary goal of treatment in a patient with a diagnosis of heart failure?

Improve the functionality and quality of life

What is the leading symptom of an MI

Pain

What is the nurse's role in diagnostic testing to evaluate coronary function

Prepare the patient physically for diagnostic procedures and to explain the examination to the patient

What is the pacemaker of the heart?

SA node

Where does sinus tachycardia orginate?

SA node

What is atherosclerosis

yellowish plaques of cholesterol, lipid, and cellular debris in the inner letters of the walls

What is the treatment for SVT

goal is to decrease hr - carotid sinus massage - vagal maneuver - adenosine - digoxin - calcium channel blockers - beta-blockers - cardioversion for persistent SVT - radiofrequency ablation

The muscle layer of the heart that is responsible for the heart's contraction is the __________

myocardium

Sinus rhythm

normal heart rhythm 60 - 100

Where does deoxygenated blood first come to the heart?

right atrium

Asystole

the absence of a heartbeat