MedSurg Adult Health Cardio Questions

A nurse is providing discharge instructions for a client with angina who has a prescription for sublingual nitroglycerin tablets. The nurse should teach the client that the nitroglycerin sublingual tablets have lost their potency when: 1. Sublingual tingling is experienced. 2. The tablets are more than three months old. 3. The pain is unrelieved, but facial flushing is increased. 4. Onset of relief is delayed, but the duration of relief is unchanged.

2 Nitroglycerin tablets are affected by light, heat, and moisture. Loss of potency can occur after three months, reducing the drug's effectiveness in relieving pain. A new supply should be obtained routinely. Experiencing sublingual tingling indicates the tablets have retained their potency. Unrelieved pain with an increase of facial flushing and delayed relief with the duration of relief remaining the same do not necessarily indicate loss of potency.

When a client has a myocardial infarction, one of the major manifestations is a decrease in the conductive energy provided to the heart. When assessing this client, the nurse is aware that the existing action potential is in direct relationship to the: 1. Heart rate 2. Refractory period 3. Pulmonary pressure 4. Strength of contraction

4 A direct relationship exists between the strength of cardiac contractions and the electrical conductions through the myocardium. The heart rate is related to factors such as sinoatrial (SA) node function, partial pressures of oxygen and carbon dioxide, and emotions. Refractory period is when the heart is at rest, not when it is contracting. Pulmonary pressure does not influence action potential; it becomes elevated in the presence of left ventricular failure.

A client has a synchronous pacemaker inserted. The nurse observes spikes on the monitor at a regular rate that are not followed by myocardial activity. What conclusion should the nurse make about the pacemaker based on this data? 1. Loss of battery power 2. Functioning as expected 3. Failure to stimulate the heart 4. Ignoring the client's heartbeat

3 If pacemaker spikes are present, the pacemaker is firing appropriately but the lack of resulting QRS complexes indicates that it is not stimulating or "capturing" the heart. Loss of battery power is indicated by a slowing or irregular heart rate. Each pacemaker spike should be followed by a QRS complex. A fixed or asynchronous pacemaker is designed to work independently of the client's intrinsic rhythm.

A client is admitted to the hospital for an emergency cardiac catheterization. What is the most common adaptation that the client is most likely to complain about after this procedure? 1. Fear of dying 2. Skipped heartbeats 3. Pain at the insertion site 4. Anxiety in response to intensive monitoring

3 Pain at the arterial puncture site is attributable to entry and cannulation of the artery and is a common complaint after a cardiac catheterization. Fear of dying might occur during the precatheterization period. Although skipped heartbeats may occur during the procedure because of trauma to the conduction system, usually it does not continue after the procedure. Although some clients may be anxious, many feel safe when receiving ongoing monitoring.

A client has edema in the lower extremities during the day, which disappears at night. With which medical problem does the nurse conclude this clinical finding is consistent? 1. Pulmonary edema 2. Myocardial infarction 3. Right ventricular heart failure 4. Chronic obstructive lung disease

3 Right ventricular heart failure causes increased pressure in the systemic venous system, which leads to a fluid shift into the interstitial spaces. Because of gravity, the lower extremities are first affected in an ambulatory client. Pulmonary edema results in severe respiratory distress and peripheral edema. Myocardial infarction itself does not cause peripheral edema. Pulmonary disease will not result in varying degrees of edema.

A client is admitted with a higher than expected red blood cell (RBC) count. What physiological alteration does the nurse expect will result from this clinical finding? 1. Increased serum pH 2. Decreased hematocrit 3. Increased blood viscosity 4. Decreased immune response

3 Viscosity, a measure of a fluid's internal resistance to flow, is increased as the number of red cells suspended in plasma increases. The number of cells does not affect the blood pH. The hematocrit will be higher. RBCs do not affect immunity.

A nurse is assessing a client with cardiogenic shock. Which clinical findings should the nurse expect? Select all that apply. 1. Pallor 2. Nausea 3. Tachycardia 4. Narrow pulse pressure 5. Decreased respirations

1, 3, 4 Pale skin, tachycardia, and narrow pulse pressure are signs of cardiogenic shock. Nausea and decreased respirations are not expected with cardiogenic shock.

A nurse suggests that a client with right ventricular failure should: 1. Take a hot bath before bedtime 2. Avoid emotionally stressful situations 3. Avoid sleeping in an air-conditioned room 4. Exercise daily until the pulse rate exceeds 100 beats per minute

2 Stressful situations increase the body's oxygen demands. Clients with a low cardiac reserve cannot tolerate extremes of temperature; a hot bath increases the body's oxygen demands. Hot, humid weather is detrimental for those with heart disease; these individuals should use an air conditioner. The heart of a client with low cardiac reserve cannot tolerate a pulse rate this high.

A client has serially decreasing blood pressures after surgery. Which mechanisms involved in the regulation of blood pressure should the nurse consider? Select all that apply. 1. Dilation of arterioles to increase peripheral resistance. 2. Activation of regulators that control renal angiotensin II. 3. Release of vasodilators, for example antidiuretic hormone. 4. Increase of left ventricular stroke volume to maintain blood volume. 5. Enervation of the sympathetic nervous system to constrict arterioles.

2, 4, 5 When the kidney senses a decreased circulating blood volume, angiotensin I is released, which produces angiotensin II, a powerful vasoconstrictor; also, it stimulates the adrenal cortex to release aldosterone, which causes active reabsorption of sodium and water. Baroreceptors in the aortic arch and carotid sinus respond to altered arterial pressure, initiating events that ultimately stimulate peripheral vasoconstriction, thus increasing cardiac output. Alpha1-adrenergic receptors are located in vascular smooth muscles and, when stimulated, cause vasoconstriction of the blood vessels. Arterioles will constrict, not dilate, to increase peripheral resistance. Antidiuretic hormone (vasopressin) will cause vessels to constrict, not dilate.

A client is admitted to the hospital for a heart transplant. Which preoperative intervention is most important for the nurse to implement before the surgery? 1. Describe the surgical procedure in detail 2. Provide specific information about the future discharge plans 3. Explain that only the chest and groin will be clipped or shaved 4. Arrange for visits by nurses from the postanesthesia and surgical intensive care units

4 Clients should be familiar with staff members on these units and hear from them what will be experienced. Most clients do not want or need a detailed description of the surgery. Although discharge plans should be mentioned, they are not the primary focus at this time. Specifics about the discharge plan will depend on the client's needs at the time of discharge. The client's whole body may be shaved or clipped and prepped.

A 75-year-old client has a baseline blood pressure of 140/90 mm Hg. The nurse obtains a sitting blood pressure in the client's left arm, and the reading is 160/100 mm Hg. What action should the nurse take next? 1. Advise the client to restrict fluid and sodium intake, then begin to develop a teaching plan for the client. 2. Contact the primary health care provider immediately to report the blood pressure reading. 3. Record the findings, recognizing that the result is expected for an older adult. 4. Take the blood pressure in the right arm, and then take the blood pressure in both arms while the client is standing.

4 Further assessment is necessary before the nurse can plan a course of action. Advising the client to restrict fluid and sodium intake is not an initial nursing action; further assessment is the priority. The nurse must gather more data before consulting with the health care practitioner. This is not an expected blood pressure for an older adult; both systolic and diastolic pressures are elevated.

A client comes to the clinic complaining of weight loss, fatigue, and a low-grade fever. Physical examination reveals a slight enlargement of the cervical lymph nodes. Which question is most appropriate for the nurse to ask initially when assessing for possible causes for the fever? 1. "Are you sexually active?" 2. "Do you have a sore throat?" 3. "Have you been exposed to anyone with an infection recently?" 4. "When did it first become evident to you that you had a fever?"

4 The length of time a low-grade fever is present, together with a history of night sweats and other physical findings, is valuable information in assisting the health care provider in making a diagnosis. Sexual activity is not immediately relevant to the presenting signs and symptoms; more should be explored about the temperature itself before investigating causes of the temperature. Whether the client had a sore throat is not immediately relevant to the presenting signs and symptoms; more should be explored about the temperature increase itself before investigating its causes. Exposure to someone with an infection is not immediately relevant to the presenting signs and symptoms; more should be explored about the temperature increase itself before investigating its causes.