Med Surge 2 Cardiac

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

Hypokalemia

A nurse is assessing a pt who has heart failure and is taking daily furosemide. The pt's apical pulse is weak and irregular. The nurse should identify these findings as manifestations of which electrolyte imbalance?

Hypokalemia. Furosemide can cause the loss of K, Na, Ca, and Mg.

A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate CPR

Unstable Angina

Increased frequency and severity and is not relieved by rest and NTG (nitroglycerine) Requires medical intervention

A nurse is monitoring a pt who has heart failure related to mitral stenosis. The client reports SOB on exertion. Which of the following conditions should the nurse expect?

Increased pulmonary congestion

A nurse is monitoring a pt who has heart failure related to mitral stenosis. The pt reports SOB on exertion. Which condition should the nurse expect?

Increased pulmonary congestion. This occurs due to right sided heart failure.

Sinus Arrhythmia/Dysrhythmia

Irregularity in the heart rhythm

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?

It is used to eliminate ventricular dysrhythmias.

A nurse is assessing a client who has FVO from a cardiovascular disorder. Which of the following manifestations should the nurse expect?

JVD, moist crackles, and an increased HR

A nurse is caring for a client following a stroke. Which of the following actions should the nurse take first?

Keep the client NPO due to risk for aspiration

A nurse is providing teaching about lifestyle changes o a pt who had an MI and has a new prescription for a beta blocker. Which of the following client statements indicates an understanding of teaching?

"Before taking my medication, I will count my radial pulse rate". A beta blocker will induce bradycardia. The client should take the pulse rate for 1min before self-admin.

ischemia

Lack of blood supply. Happens when you dont have percussion in the heart and oxygen flowing through out the body

A nurse is teaching a pt who has polycythemia vera about self-care measures. Which of the following interventions should the nurse include?

"Elevate your legs when sitting"

A nurse is providing teaching for a pt who has a prescription for a low sodium diet to manage HTN. Which statement indicates and understanding of the teaching?

"I can snack on fresh fruit".

A nurse is providing discharge teaching for a pt who has a new permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching?

"I should check my heart rate at the same time each day".

A nurse is teaching a client with heart disease about a low-cholesterol diet. Which statement indicates the teaching was effective

"I should remove the skin from poultry before eating it". The skin contains the greatest amount of fat.

A nurse is providing information to a client who is scheduled for an exercise EKG test. Which of the following statements indicates an understanding of the teaching?

"I will not drink coffee 4hrs prior to my test"

A nurse is caring for a client who is undergoing treatment for hypertension. Which of the following statements indicates that the client is adhering to the treatment plan?

"I would never have believed I could get used to enjoying my food without salt."

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?

"I'll keep a log of each time my ICD discharges."

A-fib EKG

"Irregularly irregular" - No discrete P waves and irregularly spaced QRS complexes

A nurse is providing discharge teaching for a client who has a newly inserted permanent pacemaker. Which of the following instructions should the nurse include in the teaching?

"Keep your cell phone 6in. away from your pacemaker when making a call"

A nurse is teaching a 70yo pt about risk factors for heart failure. The pt has mild asthma, DM, and CAD. Which of the following statements by the pt indicates an understanding of the teaching

"My coronary artery disease is a risk factor for heart failure"

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

"Spike" on the rhythm strip

A pt who just learned that he has variant (Prinzmetal's) angina asks the nurse how this type of angina compares with stable angina. How should the nurse reply?

"Variant angina can cause changes on your EKG."

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?

"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."

A nurse is preparing a pt for cardiac cath. Which info should the nurse give the pt pre procedure

"You'll have to lie flat for several hours after the procedure" "You'll receive medication to relax you before the procedure" "You'll have to keep your leg straight after the procedure"

The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse?

"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."

A nurse is assessing a pt who has an abdominal aortic aneurysm. Which of the following manifestations should the nurse expect?

Lower back discomfort

Digoxin toxicity

-Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision (think van Gogh), arrhythmias, AV block. -Can lead to hyperkalemia, which indicates poor prognosis.

The nurse knows that what PR interval presents a first-degree heart block?

0.24 seconds

Digoxin therapeutic range

0.5-0.8 ng/mL

A nurse is caring for a pt who is in hypovolemic shock. While waiting for a unit of blood, the nurse should admin

0.9% sodium chloride.

A nurse is reviewing the progress notes for a pt who has HF. The provider noted some improvement in the client's cardiac output. The nurse should understand that the cardiac output reflects what parameter?

The heart rate times the stroke volume

A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?

The need to have regular blood levels drawn

Cardiac Ablation

May be done more than once but each time it is done, more risks may occur especially for the elderly because it cause memory loss and stroke. Works by scarring or destroying tissue that triggers abnormal rhythm.

A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended?

Maze procedure

Classic Sign of A-fib

Missing P wave

Pacemaker and Nursing

Monitor PT, PTT, and CBC. Look for EKG changes, monitor SaO2, admin meds as prescribed

Dysrhythmia Nursing Care

Monitor and manage dysrhythmia, reduce anxiety, promote home and community care, education, continuing care

A nurse is planning care for a pt who is having a percutaneous transluminal coronary angioplasty (PTCA) with stent placement. Which of the following actions should the nurse anticipate in the post-procedure plan of care?

Monitor for bleeding. bleeding is a complication due to the admin of heparin during the procedure and the removal of the femoral sheath.

V-tach

3 or more PVCs in a row. Ventricle is beating independently, too rapidly, and ineffeciently

How to read HR in EKG

300 / (number of large squares in one R-R interval). This picture 300/4= 75BPM

A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as

90 bpm

LDL Lab

<100

Triglycerides

<150 mg/dL

Total blood cholesterol levels

<200

Sinus Tachycardia

>100 bpm

HDL Lab

>60 mg/dL

Types of Tachycardia

A fib, V tach, V fib

Holter Monitor

A small, portable continuous EKG unit worn by a patient for 24-48 hours. May go about daily life while wearing as long as you keep device dry. May need to keep diary of what you're doing when symptoms occur. TAKE OFF WHEN SHOWERING

A nurse is rewarming a client following coronary artery bypass graft (CABG) surgery. For which of the following complications of the rewarming process should the nurse monitor the client?

Acidosis. Metabolic acidosis associated with hypoxia can occur if a client is warmed too fast. Rewarming should occur no fast than 1C or 1.8F per hour.

A nurse is assessing a client who is 85yo. Which of the following findings should the nurse identify as a manifestation of MI?

Acute confusion. Other S/S: N/V, dyspnea, diaphoresis, anxiety, palpitations, fatigue

A nurse is assessing a pt who is 85yo. Which of the following findings should the nurse identify as a manifestation of MI?

Acute confussion

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

Administer an IV bolus of atropine.

A-fib Tx

Aims to reset the heart's rhythm to normal. Procedures to destroy small areas of heart tissue to prevent abnormal electrical signs and meds to control HR.

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?

Altered patterns frequently affect the heart's ability to pump blood effectively.

A-fib Medications

Anti-arrhythmic (Quinidine- OUTDATED; Dofetilide - Tikosyn; Propafenone - Rhythmol) and Blood Thinners (Warfarin) to prevent blood clot and stroke

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?

Anticoagulant

Clopidogrel-Plavix

Antiplatelet

The nurse is caring for a patient after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis?

Apply sequential pneumatic compression devices as prescribed. Prescribed to help prevent venous stasis and clotting complications such as deep vein thrombosis and pulmonary embolism. Patients should be discouraged to cross their legs. Pillows should not be used in the popliteal space to elevate the knees; rather, this should be avoided. Exercises, passive and active, should be encouraged

A nurse is examining the EKG of a pt who has frequent PVCs. Which of the following QRS changes should the nurse expect to see on the pt's EKG?

Much greater amplitude than the usual QRS complex. The QRS complexes unusually have greater amplitude in height and depth in pts wth PVCs.

A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response?

Assess the client and monitor leads.

A nurse is teaching a pt who has coronary artery disease about the difference between angina pectoris and MI. Which of the following manifestations should the nurse identify as indications of MI?

N/V, diaphoresis and dizzy, anxiety and feelings of doom

A nurse is examining the EKG of a client who is having an acute MI. The nurse should identify that the elevated ST segments on the EKG indicate which of the following alterations

Necrosis. This EKG reflects a clot at the site of injury, therefore the pt needs immediate revascularization of the artery

Monitor and Manage Dysrhythmia

Assess vitals, lightheaded, dizzy, fainting. If hospitalized, obtain 12-lead EKG with cont monitoring. "6-min walk test' with pt connected to EKG to monitor HR and activity

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

Atrial flutter

A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?

Atropine. Med of choice in treating sinus bradycardia.

Controlling Cholesterol

Avoid high fat, red meat, eggs, butter. Exercise! Dont smoke

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

Avoid undergoing magnetic resonance imaging (MRI).

A nurse is reviewing the medical record of a pt who has heart failure. Which of the following findings should the nurse expect?

BNP (B-type natriuretic peptide) lecel of 200pg/mL

Angina Pt Teaching

Balance activity with rest, follow exercise regime, avoid exercise in hot temps, emotional support, avoid OTCs that may increase HR or BP, stop tobacco, low fat high fiber diet

The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse?

Begin cardiopulmonary resuscitation (CPR)

The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate chest pain. What side effect should concern the nurse the most?

Blood pressure of 85/58. NTGs dilate vessels in the body that causes venous pooling of blood throughout the body.

Why can Lung Disease cause Dysrhythmias

Changing the O2 levels in the body, especially with COPD, can bring on dysrhythmias

Permanent Pacemaker

Check post insert for bleed or discharge, limit shoulder movement for up to 24hr, assist pt out of bed for 1st time, CXray done to check lead placement, pneumothorax complication

A nurse is completing an assessment for a pt who has a history of unstable angina. Which of the following findings should the nurse expect?

Chest pain lasts for longer than 15min

A nurse is teaching about a low-cholesterol diet to a client who had an MI. Which of the following meal selections by the client indicates an understanding of the teaching?

Chicken breast and corn on the cob

The nurse is preparing a male patient to have a 12-lead ECG performed. When prepping the skin the nurse notices that the patient has abundant chest hair. What is the most appropriate nursing

Clip the chest hair with the patient's permission prior to applying leads. Dont use alcohol because it can increase skin electrical impedance and hinder cardiac electrical signal

A-fib Predisposition

Clot formation because non-contracting atria contain stagnant blood

A nurse is caring for a pt who had a myocardial infarction 5 years. The pt has a sudden onset of SOB and begins coughing frothy, pink sputum. The nurse auscultates loud, bubbly sounds on inspiration. Which of the following adventitious breath sounds should the nurse document

Coarse crackles

The nurse knows that a pacemaker is the treatment of choice for what cardiac dysrhythmia?

Complete heart block

MI Nursing Interventions

O2 and meds, vitals, rest with HOB elevated, pain relief, I&O, position changes frequent for gas exchange

Ablation

Only tried if you tried meds and lifestyle changes first or if meds caused serious side effects.

Temporary Pacemaker

Outside the body, gloves worn when touching leads, 3 prongs needed, limit shoulder movement to ensure leads aren't misplaced

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

P wave

A-fib

Tolerable, may not be sensed by individual, rapid quivering of atria

Parts of EKG

P wave, QRS complex, T wave

To evaluate a client's spread of impulse through the intertribal and internal fibers, the nurse observes which part of the electrocardiogram waveform?

PR interval

T or F: Not all dysrhythmias cause chest pain

True

Bradycardia Requirement

Pacemaker to keep the heart at a healthy rate

A nurse is checking paradoxical blood pressure of a pt who has a possible cardiac tamponade. In what order should the nurse complete the following steps?

Palpate the blood pressure and inflate the cuff above the systolic pressure. Deflate the cuff slowly and listen for the first audible sounds. Identify the First BP sounds audible on expiration and then on inspiration Subtract the inspiration pressure from the expiatory pressure Inspect for JVD and notify the provider.

A nurse is caring for an older adult who had an acute MI. When assessing this pt, the nurse should identify that older adults are prone to complications of MI from poor tissue perfusion because of which age-related factor?

Peripheral vascular resistance increases

Pacemaker Complication

Pneumothorax, infection, dysthymia, dislocation of lead, device malfunction

V-fib

Ventricle is QUIVERING and not contracting. No blood flow from heart can cause cardiac arrest. Does not have a heart beat. CPR started IMMEDIATLY

A nurse is carding for a client who is postop following vein ligation and stripping for varicose veins. Which action should the nurse take?

Position the pt supine with legs elevated when in bed to promote venous return. During discharge, the nurse should reinforce the importance of periodic positioning of the legs above the heart

A nurse is caring for a pt with heart failure whose telemetry reading displays a flattening of the T wave. Which of the following lab tests should the nurse anticipate as the cause of this EKG change?

Potassium 2.8

Ablation Pre/Post Care

Pre: stop anticoagulant use 48-72s prior. Post: Apply pressure to decrease bleeding.

A nurse is monitoring a pt for reperfusion following a thrombolytic therapy to treat acute MI. Which indicator should the nurse identify to confirm reperfusion?

Ventricular dysrhythmias

A nurse is monitoring a pt for reperfusion following a thrombolytic therapy to treat acute MI. Which of the following indicators should the nurse identify to confirm reperfusion?

Ventricular dysrhythmias

A nurse is monitoring a pt who had an MI. What should be monitored for the first 24hrs?

Ventricular dysrhythmias

A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response?

Premature atrial complex

Angina S/S

Pressure-fullness/squeezing pain, pain extending to shoulder, SOB, FEELING OF DOOM due to O2 deprivation

A nurse is monitoring the EKG of a pt with hypocalcemia. Which of the following findings should the nurse expect?

Prolonged QT intervals.

To evaluate a client's ventricle depolarization the nurse observes which part of the electrocardiogram waveform?

QRS complex

A nurse is assessing a pt who has late-stage heart failure and is experiencing FVO. Which of the following findings should the nurse expect?

Weight gain of 1kg (2.2 lbs) in 1 day

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?

Question the client about alcohol and illicit drug use.

A nurse is assessing a pt who has an abdominal aortic aneurysm (AAA). Which of the following findings indicates that the AAA is expanding?

Report of sudden, severe back pain

The nurse cares for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which action should the nurse complete?

Request a digoxin level be ordered

Minimize Anxiety with Dysrhythmia

Stay with pt, maintain safety and security, discuss emotional responses, help pt develop a system to identify factors or irregularities, maximize pt control

Most common assessment finding with acute MI

Substernal chest pain

A nurse is showing a pt who has right sided heart failure an illustration of the heart. Which of the following blood vessels carry deoxygenated blood to the right atrium?

Superior vena cava

To evaluate a client's ventricle repolarization, the nurse observes which part of the electrocardiogram waveform?

T wave

A nurse is caring for a client who has a demand pacemaker inserted with a set rate of 72/min. Which of the following findings should the nurse expect?

Telemetry monitoring showing QRS complexes occurring at a rate of 74/min with no pacing spikes

The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason?

The defibrillator won't deliver a shock if the synchronizer switch is turned on.

A nurse is assessing a pt who has left sided heart failure. Which of the following findings should the nurse expect?

Crackles in the lung bases.

A client is prescribed quinine for treatment of moderate depression of depolarization. Which sign indicates the drugs' effectiveness in the client's treatment?

Decrease in cardiac contractility

Dysrhythmia Nursing Dx

Decreased cardiac output related to inadequate ventricular filling or altered HR

The nurse recognizes which as being true of cardioversion?

Defibrillator should be set to deliver a shock during the QRS complex.

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?

Delayed conduction, producing a prolonged PR interval

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?

Delayed conduction, producing a prolonged PR interval

A nurse is assessing a pt who has right sided heart failure. Which of the following findings should the nurse expect?

Dependent edema. Blood return from the venous system to the right atrium is impaired by a weakened right heart.

A nurse in a clinic is assessing the lower extremities and ankles of a pt who has a history of peripheral arterial disease. Which of the following findings should the nurse expect?

Dry, pale skin with minimal body hair

A nurse is preparing an in-service presentation about the management of MI. Death following MI is often a result of which complication?

Dysrhythmias

A nurse is preparing an in-service presentation about the management of myocardial infarction (MI). Death following MI is often a result of which complication?

Dysrhythmias

Pacemaker Post

EKG assess, CXR to find lead placement, skin assess, incision site assess, signs of ineffective coping, level of knowledge for pt and family

A-fib Medical Procedures

Electrical cardio version, catheter ablation, AV node ablation, left atrial appendage closure, Maze procedure. Medications and life style changes are tried first

Dysrhythmia Causes

Electrolyte imbalance (K, NA, Ca), Acid-Base imbalance, Cardiac disease/procedure/ stent, lung disease, activity intolerance

A nurse is examining the EKG of a client who has hyperkalemia. Which of the following EKG changes should the nurse expect?

Elevated ST segments

A nurse is caring for a pt who has severely elevated blood pressure. Which of the following findings should the nurse identify as a manifestation of HTN?

Epistaxis (nosebleed)

While participating in a community health fair, a nurse is providing information to a client who has a blood pressure of 150/90. Which action should the nurse take?

Give the client a written record of his BP to bring to his provider

Angina Tx

HOB up, pain assess, EKG, oxygen

A nurse is completing an assessment on a client. Which of the following findings should the nurse identify as a risk factor for CAD?

HTN, DM, hyperlipidemia, tobacco

The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia?

Heart rate of 42 beats per minute (bpm).

The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain?

a lack of oxygen in the heart muscle that causes the death of cells

Implantable Cardioverter Defibrillator (ICD)

an implanted, battery-operated device with rate-sensing leads; the device monitors cardiac impulses and initiates an electrical stimulus as needed to stop ventricular fibrillation or tachycardia. BEFORE CPR make sure pt is unresponsive and pulseless if they have an ICD in.

A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to

avoid caffeinated beverages.

PVC Tx

beta blockers, amiadarone, catheter cardiac ablation

Angina Pectoris

chest pain that results when the heart does not get enough oxygen

The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?

defibrillation

Coronary Artery Disease (CAD)

disease of the arteries surrounding the heart. Most prevalent CVD in adults

Statins

drugs used to lower cholesterol in the bloodstream

A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardigram as an indicator of sinus tachycardia?

heart rate of 118 bpm

HDL

high-density lipoprotein, excreted

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:

inherent rhythmicity of cardiac muscle tissue.

Sign of MI

inverted T wave

LDL

low-density lipoprotein deposited on artery wall

The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:

occur at a rate of more than six per minute

The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect?

pacemaker site infection

PVC (Premature Ventricular Contraction)

premature contraction of the ventricles, usually caused by anxiety or chemical inbalance. Chest Xray and Echo are always ordered.

Cardioversion

returning a heart to normal rhythm. Current delivery is SYNCHRONIZED with pt EKG

Ranexa

used to treat heart related chest pain. Typically it is used together with other medications when those are insufficient. Common side effects include constipation, headache, nausea, and dizziness. Serious side effects may include QT prolongation. Use is not recommended in those with liver cirrhosis.

Which clients are at risk for iron deficiencies

vegetarians, pregnant, overweight toddlers