UW Cardio

The charge nurse is assisting with a nonemergent cardioversion for a client with SVT. Which action by the primary nurse would cause the charge nurse to intervene? A. Administers a 1 time dose of IV midazolam B. Disengages the "sync" function on the defibrillator C. Places the defibrillator pads on upper right and lower left chest D. Turns off the client's oxygen and moves it away from the bed

ANS: B

The nurse is performing a cardiac assessment on a client. The nurse auscultates a loud blowing sound at the second intercostal space, right sternal border. How should the nurse document this finding? A. Arterial bruit B. Murmur heard at the aortic area C. Pericardial friction rub D. S3 gallop heard at the mitral area

ANS: B

A client is diagnosed with heart failure has an 8-hour urine output of 200 mL. WHat is the nurse's first action? A. Auscultate the client's breath sounds B. Encourage the client to increase fluid intake C. Report the findings to the HCP D. Start an IV line for diuretic administration

ANS: A

A client with a BP of 250/145 is admitted for hypertensive crisis. The HCP prescribes a continuous IV infusion of nitroprusside sodium. Which of these is the priority goal in initial management of hypertensive crisis? A. Decrease MAP by no more than 25% B. Keep BP at or below 120/80 C. Maintain hr of 60-100/min D. Maintain urine output of at least 30 mL/hr

ANS: A

A nurse cares for a client after cardiac catheterization. During assessment of the groin site, the nurse notices that the dressing is saturated with blood and a small trickle leaks down the client's lef. What should the nurse do first? A. Apply direct manual pressure at and above the skin puncture site. B. Call the HCP to report active bleeding C. Check the peripheral pulse distal to the catheterization site D. Place a new pressure dressing over the catheterization site

ANS: A

The nurse is assessing for the presence of JVD on a newly admitted client with a history of HF. Which is the best position for the nurse to place the client when observing for JVD? A. HOB 45 degree angle B. HOB 60 degree angle C. HOB 90 degree angle D. HOB flat

ANS: A

The nurse is caring for a client who has been admitted to the hospital for an acute exacerbation of heart failure. BP is 104/62, pulse is 96, respirations are 22 and O2 sat is 91%. Which of these findings supports the diagnosis of acute heart failure exacerbation? A. BNP 1382 pg/mL B. Flat jugular veins when seated at a 45-degree angle C. Sodium 150 mEq/L D. Urine output greater than 100 mL/hr

ANS: A BNP is secreted in response to ventricular stretch and wall tension when cardiac filling pressures are elevated. The BNP level is used to differentiate dyspnea of heart failure from dyspnea of noncardiac etiology. The level of circulating BNP correlates with both severity of left ventricular filling pressure elevation and mortality. A normal BNP level is <100 pg/mL. The nurse would expect a high BNP in a client exhibiting symptoms of acute decompensated heart failure.

The nurse is caring for a client who just had aortic valve replacement surgery. Which assessment information is most important to report to the HCP? A. Chest tube output of 175 mL in past hour B. INR of 1.5 C. Temperature of 100.3 F D. Total urine output of 85 mL over past 3 hours

ANS: A Chest drainage >100mL/hr should be reported to the HCP. Large losses of blood may indicate a compromise of the surgical suture site and may require repair. The client can quickly become hemodynamically unstable and may require a return to surgery or transfusion of blood products.

The nurse is caring for a client with newly diagnosed infective endocarditis (IE). Which assessment finding by the nurse is the highest priority to report to the HCP? A. Pain and pallor in one foot B. Pain in both knees C. Splinter hemorrhages in the nail beds D. Temperature of 102.2 F

ANS: A In IE, The vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications. These include the following: 1. Stroke-paralysis on one side 2. Spinal cord ischemia-paralysis of both legs 3. Ischemia to the extremities- pain, pallor, and cold foot or arm 4. Intestinal infarction-abdominal pain 5. Splenic infarction-left upper quadrant pain The nurse or the client (if at home) should report these manifestations immediately to the HCP.

A critical care nurse is caring for a newly admitted client with acute aortic dissection. Which prescription should the nurse prioritize while awaiting surgical revision of the client's aortic dissection? A. Administer IV labetalol to maintain blood pressure within prescribed parameters B. Initiate and maintain strict bed rest and a low-stimulation environment C. Monitor bilateral lower extremity peripheral pulse strength D. Prepare the client's consent form for surgical repair of the aorta

ANS: A Maintaining normal pressure in the aorta decreases the risk of aortic rupture. This is achieved with beta blocker which lower BP and HR.

A client with myocardial infarction (MI) underwent successful revascularization with stent placement, is now chest pain free, and will be attending cardiac rehabilitation as an outpatient. The client is embarrassed to talk to the healthcare provider (HCP) about resuming sexual relations after an MI. What teaching should the nurse initiate with this client? A. If the client is able to climb 2 flights of stairs without symptoms, the client may be ready for sexual activity if approved by the HCP. B. Inform the client that medications such as sildenafil or tadalafil are available as prescriptions from the HCP. C. It will be 6 months before the heart is healthy enough for sexual activity. D. The client will be ready for sexual activity after completion of cardiac rehabilitation.

ANS: A Sexual counseling is important for cardiac clients, yet can be difficult for clients and HCPs to discuss and is often neglected. Clients' concern about resumption of sexual activity can prove to be more stressful than would be the activity itself. The nurse should encourage clients to discuss concerns with the HCP; in general, if a client can walk 1 block or climb 2 flights of stairs without symptoms, the client can resume sexual activity safely.

A home health nurse is visiting a client with CHF. The nurse observes that the client is having trouble answering questions due to breathlessness and cough. What action should the nurse take first? A. Auscultate breath sounds B. Check for peripheral edema C. Measure the client's VS D. Review the client's weight log over the past several days

ANS: A The nurse should start assessment based on the ABCs. This client is at risk for acute decompensation heart failure and pulmonary edema. Pulmonary edema is an acute life-threatening situation in which the lung alveoli become filled with serosanguinous fluid. Auscultation may include crackles, wheezes, and rhonchi if the fluid has moved into the lungs. The next priority is for the nurse to measure VS. This would identify if the client's heart rate or respiratory rate is elevated and if the O2 sat is compromised.

A client with aortic stenosis is scheduled for surgery in 2 weeks. The client reports episodes of angina and passing out twice at home. Which would be the best response by the nurse to explain the appropriate activity for this client at this time? A. "Avoid strenuous activity before the surgery." B. "Continue to exercise, even if angina occurs. It will strengthen your heart muscles." C. "Take short walks 3 times a day." D. "There are no activity restrictions unless angina occurs."

ANS: A left ventricle cant pump enough to meet the body's demand due to stenosis.

The nurse is preparing to administer medications after assessing a client with a myocardial infarction. Based on the collected data, temp 98.4, BP 126/81, Pulse 49, resp. 16, which of the following prescribed medications are appropriate for the nurse to administer? SATA A. Aspirin B. Atorvastatin C. Docusate sodium D. Lisinopril E. Metoprolol

ANS: A, B, C, D The nurse would hold the metoprolol due to the low HR of the patient.

The nurse is preparing to administer 40 mg of IV furosemide. Prior to administering the medication, the nurse should assess which parameters? SATA A. BP B. BUN C. Liver enzymes D. Potassium E. WBC

ANS: A, B, D

The nurse is preparing to discharge a client who developed heart failure after a MI. Based on the discharge data the nurse plans to include which topics during teaching? SATA A. daily weighing B. How to take own pulse C. Need for monthly INR D. Need to increase foods high in potassium E. Reduction of sodium in diet F. Use of home oxygen

ANS: A, B, E

The nurse is reviewing discharge instructions on home management for a client with peripheral arterial disease. Which statements indicate a correct understanding of the instructions? SATA A. "I will apply moisturizing lotion on my legs everyday." B. "I will elevate my legs at night when I'm sleeping." C. "I will keep my legs below heart level when sitting." D. "I will start walking outside with my neighbor." E. " I will use a heating pad to promote circulation."

ANS: A, C, D

The nurse is teaching a client diagnosed with Raynaud phenomenon about ways to prevent recurrent episodes. Which instructions should the nurse include? SATA A. Avoid excessive caffeine B. immerse hands in cold water C. Practice yoga or tai chi D. Refrain from using tobacco products E. Wear gloves when handling cold objects

ANS: A, C,D,E Raynaud phenomenon is a vasospastic disorder resulting in an episodic vascular response related to cold temps or emotional stress. It most commonly affects women age 15-40. Vasospasms induce a characteristic color change in the appendages. When vasoconstriction occurs, the affected appendage initially turns white from decreased perfusion, followed by a bluish-purple appearance due to cyanosis. Clients usually report numbness and coldness during this stage. When blood flow is subsequently restored, the affected area becomes reddened and clients experience throbbing or aching pain, swelling, and tingling. Acute vasospasms are treated by immersing the hands in warm water. Client teaching includes: wearing gloves when handling cold objects, dress in warm layers, avoid extreme and abrupt changes in weather, avoid vasoconstricting drugs, avoid excessive caffeine intake, refrain from use of tobacco products, implement stress management strategies.

A client is hospitalized with worsening CHF. Which clinical manifestations does the admitting nurse most likely assess in this client? SATA A. Crackles on auscultation B. Dry mucous membranes C. Increased jugular venous distention D. Rhonchi on auscultation E. Skin "tenting" F. 3+ pitting edema of the lower extremities

ANS: A, C,F Clients with a diagnosis of chronic CHF experience clinical manifestations of both right-sided and left-sided failure. Crackles are discontinuous, adventitious lung sounds usually heard on inspiration and indicate the presence of pulmonary congestion in this client. Increased JVD reflects in an increase in pressure and volume in the systemic circulation, resulting in elevated central venous pressure (CVP) in this client. Although dependent pitting edema of the extremities can be associated with other conditions, it is related to fluid retention in this client.

A cardiac catheterization was performed on a client 2 hours ago. The catheter was inserted into the left femoral artery. What signs of potential complications should the nurse report immediately to the HCP? SATA A. Bleeding at the catheterization site B. Client lying down and quietly watching television C. Client taking only sips of fluids D. Left foot remarkably cooler than right foot E. Urine output of 100 mL since the procedure

ANS: A, D Bleeding at the puncture site indicates that a clot has not formed at the insertion site. This is an arterial bleed as a catheterization was done via the femoral artery. Arterial bleeds can lead to hypovolemic shock and death if not treated immediately. Reduced warmth in the lower extremity of the insertion site is a sign of decreased perfusion to the extremity and can result in tissue necrosis of the affected area.

A client with severe vomiting and diarrhea has a blood pressure of 90/70 and a pulse of 120. IV fluids of 2-liter NS were administered. Which parameters indicate that adequate rehydration occurred? SATA A. Capillary refill is less than 3 seconds B. Pulse pressure is narrowed C. Systolic BP only drops when standing D. Urine output is 360 mL in 4 hours E. Urine specific gravity is 1.020

ANS: A, D, E

What clinical symptoms might the nurse expect to find in a client with a central venous pressure (CVP) of 24 mmHg? SATA A. Crackles in lungs B. Dry mucous membranes C. Hypotension D. JVD E. Pedal edema

ANS: A, D, E CVP is a measure of right ventricular preload and reflects fluid volume problems. The normal CVP is 2-8 mmHg. An elevated CVP can indicate right ventricular failure or fluid volume overload.

The nurse is planning discharge teaching for a client who just received a permanent pacemaker. Which topics should the nurse include? SATA A. Avoid MRI scans B. Do not place cell phones directly over the pacemaker C. Notify airport security when traveling D. Perform shoulder ROM exercises E. Refrain from using microwave ovens

ANS: A,B,C

A client comes to the ED for the second time with SOB and substernal pressure that radiates to the jaw. The nurse understands that angina pectoris may be precipitated by with of these factors? SATA A. Amphetamine use B. Cigarette smoking C. Cold exposure D. Deep sleep E. Sexual intercourse

ANS: A,B,C,E Angina pectoris is defined as a chest pain brought on by myocardial ischemia. Any factor that increases oxygen demand or decreases oxygen supply to cardiac muscle may cause angina, include the following: 1. Physical exertion: increase heart rate and reduces diastole. 2. Intense emotion: initiates the sympathetic nervous system and increases cardiac workload 3. Temperature extremes: Usually cold exposure and hypothermia ; occasionally hyperthermia 4. Tobacco use and second hand smoke inhalation: replaces oxygen with carbon monoxide; nicotine causes vasoconstriction and catecholamine release. 4. Stimulants: increase heart rate and cause vasoconstriction 5. Coronary artery narrowing: decreases blood flow to myocardium

A client with suspected moderate to large pericardial effusion is admitted for monitoring. The nurse performs a head -to-toe assessment. Which of these findings indicate likely cardiac tamponade and require immediate intervention? SATA A. Blood pressure of 90/70 mmHg B. Bounding peripheral pulses C. Decreased breath sounds on left side D. Distant heart tones E. JVD

ANS: A,D,E Pericardial effusion is a buildup of fluid in the pericardium. Tamponade, a serious complication of pericardial effusion, develops as the effusion increases in volume and results in compression of the heart. The heart struggles to contract effectively against the fluid, and cardiac output can decrease drastically. This life-threatening complication requires an emergency pericardiocentesis (a needle inserted into the pericardial sac to remove fluid). Signs and symptoms of cardiac tamponade include: 1. Hypotension with narrowed pulse 2. Muffled or distant heart tones 3. JVD 4. Pulsus paradoxus 5. Dyspnea, tachypnea 6. tachycardia 6.

A nurse is making initial client rounds at the beginning of the shift. Which client should the nurse see first? A. 36-year-old with endocarditis who has a temp of 100.6, chills, malaise, and a heart murmur. B. 40-year-old client with pericardial effusion who has BP of 84/64 and JVD C. 67-year-old client admitted for pneumonia with new onset a fib, who has a BP of 130/90 and a hr of 110 D. 70-year-old client with advanced heart failure who is receiving IV diuretics, has a BP 80/60 and is watching TV

ANS: B

An experienced RN is mentoring a new nurse in the telemetry unit. Which assessment technique by the new nurse requires intervention by the RN? A. Nurse carefully auscultates for heart murmurs at Erb's point B. Nurse palpates bilateral carotid arteries simultaneously to assess for symmetry C. Nurse places client int semi-fowlers position to assess for JVD D. Nurse positions client supine to assess the point of maximal impulse

ANS: B

The clinic nurse is providing instructions to a client who will be wearing a Holter monitor for the next 24 hours. Which instructions are important to review with the client? A. How to transmit the readings over the phone B. Keep a diary of activities and any symptoms experienced C. Refrain from exercising while wearing the monitor D. The monitor may be removed only when bathing

ANS: B A Holter monitor continuously records a client's electrocardiogram rhythm for 24-48 hours. Electrodes are placed on the client's chest and a portable recording unit is kept with the client. At the end of the prescribed period, the client returns the unit to the HCP office. The data can then be recalled, printed, and analyzed for any abnormalities. Client instructions include the following: 1. Keep a diary of activities and any symptoms experienced while wearing the monitor so that these may later be correlated with any recorded rhythm disturbances 2. Do not bathe or shower during the test period 3. Engage in normal activities to stimulate conditions that may produce symptoms that the monitor can record

The nurse is caring for a client who had a large anterior wall MI 24 hours ago. Which finding is most important to report to the HCP? A. Nausea and vomiting B. New S3 heart sound C. Occasional unifocal PVCs D. Temp of 100.4 F

ANS: B A large anterior wall MI can affect the pumping ability of the left ventricle, putting the client at risk for developing heart failure and cardiogenic shock. The development of pulmonary congestion on X-Ray, auscultation of a new S3 heart sound, crackles on auscultation of breath sounds, or JVD can signal heart failure and should be reported immediately to the HCP.

A client comes to the ED with severe dyspnea and a cough. VS are temp 99.2 F, BP 108/70, HR 88 and resp 24. The client has a history of COPD and CHF. Which diagnostic test will be most useful to the nurse in determining if this is an exacerbation of heart failure? A. ABGs B. BNP C. CK-MB D. CXR

ANS: B BNP is a peptide that causes natriuresis. BNPs are made, stored, and released primarily by the ventricles due to the increased blood volume and higher levels of extracellular fluid (fluid overload) that accompany heart failure. Elevation of BNP >100pg/mL helps to distinguish cardiac from respiratory causes of dyspnea.

A client with peripheral arterial disease is visiting the health clinic. The nurse completes a health assessment. Which statement by the client indicates a priority need for follow-up teaching? A. "I always take my simvastatin in the evening." B. "I prop my legs up in the recliner and use a heating pad when my feet are cold C. " I've been walking on my treadmill at home for 15 minutes each day." D. "I've noticed that I don't have much hair on my lower legs anymore."

ANS: B Clients with PAD have decreased sensations from nerve ischemia or coexisting diabetes mellitus. They should never apply direct heat to the extremity due to the risk for a burn wound. Wound healing is impaired in these clients. Swelling in the extremities (edema) can result from venous stasis, these clients are asked to elevate their extremities during rest. However, the client with PAD usually do not have swelling, but rather a decreased blood supply . The extremities should not be elevated above the level of the heart because extreme elevation further impedes arterial blood flow to the feet.

The nurse is admitting a client with heart failure-related fluid overload. Which action should the nurse complete first? A. Administer oxygen B. Assess the client's breath sounds C. Initiate cardiac monitoring D. Insert a peripheral IV catheter

ANS: B The client being admitted for heart failure-related fluid overload is likely to have dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. The assessment phase of the nursing process must come before intervention and should be prioritized using the ABCs. Therefore, the nurse should first assess the client's breath sounds. Rales or "crackles" may be auscultated in the lungs as a result of pulmonary congestion.

The telemetry nurse reports the cardiac rhythms of 4 clients to the medical unit nurse assigned to care for them. The nurse should assess the client with which rhythm first? A. A-fib with a pulse of 76 in a client prescribed rivaroxaban B. Bradycardia in a client with a demand pacemaker set at 70/min C. First-degree atrioventricular block in a client prescribed atenolol D. Sinus tachycardia in a client with gastroenteritis and dehydration

ANS: B The pacemaker is failing to capture.

The nurse is preparing to perform a cardioversion in a client in SVT that has been unresponsive to drug therapy. The client has become hemodynamically unstable. Which step is most important in performing cardioversion? A. Charge the defibrillator B. Push the synchronize button C. Sedate the patient D. select energy level

ANS: B The synchronizer switch must be turned on when cardioversion is planned. The synchronize circuit in the defibrillator is programmed to deliver a shock on the R wave of the QRS complex on the ECG. This allows the unit to sense this client's rhythm and time the shock to avoid having it occur during the T-wave. A shock during the T wave could cause this client to go into a more lethal rhythm (V-tach, V-fib). If this client becomes pulseless, the synchronize function should be turned off and the nurse should proceed with defibrillation.Synchronized cardioversion is indicated for V-tach with a pulse, SVT, and A fib with a rapid ventricular response.

The nurse is caring for a client with acute pericarditis. Which clinical finding would require immediate intervention by the nurse? A. Client reports chest pain that is worse with deep inspiration. B. Distant heart tones and JVD C. ECG showing ST-elevation in all leads D. Pericardial friction rub auscultated at the left sternal border

ANS: B SIgns of cardiac tamponade

The nurse receives handoff of care report on 4 clients. Which client should the nurse see first? A. Client with Afib who reports feeling palpitations and has an irregular pulse of 122. B. Client with liver cirrhosis who reports bleeding from an IV insertion site and has a platelet count of 48,000. C. Client with pericarditis whose BP decreased from 122/70 to 98/68 over the past hour D. Client with pneumonia whose WBC has increased from 14,000 8 hours ago to 30,000

ANS: C

The nurse responds to a call for help from another staff member. Upon entering the client's room, The nurse observes a UAP performing chest compressions on an unconscious adult client while another nurse is calling for the emergency response team. What action by the arriving nurse is the priority? A. Ask the UAP to stop compressions and check for a pulse B. Establish additional IV access with large bore IVs C. Obtain the defibrillator and apply the pads to the client's chest D. Prepare to administer 100% O2 with a bag valve mask

ANS: C

The nurse provides discharge instructions to a client who was hospitalized for DVT that is now resolved. Which of the following instructions should the nurse include to prevent the reoccurrence of DVT? SATA A. "Do not take car rides longer than 4 hours for at least 3-4 weeks." B. "Drink plenty of fluids everyday and limit caffeine and alcohol intake." C. "Elevate legs on a footstool when sitting and dorsiflex the feet often." D. "Resume your walking program as soon as possible after getting home." E. "Sit in a cross-legged position for 5-10 minutes to improve circulation."

ANS: B, C, D A DVT is a blood clot formed in large veins, generally of the lower extremities. Risk factors for DVT include venous stasis , blood hypercoagulability , and endothelial damage. Therefore, discharge teaching for a client with resolved DVT emphasizes interventions to promote blood flow and venous return to prevent reoccurrence. Interventions to prevent DVT reoccurrence include: 1. Obtain adequate fluid intake and limit caffeine and alcohol intake to avoid dehydration because dehydration increases the risk for blood coagulability. 2. Elevate the legs when sitting and dorsiflex the feet often to reduce edema and promote venous return. 3. Resume an exercise program and change positions frequently to promote venous return. 4. Stop smoking to prevent endothelial damage and vasoconstriction. 5. Avoid restrictive clothing, which interferes with circulation and promotes clotting. 6. Consult with a dietitian if overweight; excessive weight increases venous insufficiency by compressing large pelvic vessels.

The registered nurse (RN) is providing discharge instructions to a client who has had coronary artery bypass grafting (CABG). Which teaching is correct? SATA A. No sexual activity for at least 6 weeks postoperatively B. Notify health care provider (HCP) of redness, swelling, or drainage at the incision site C. Refrain from lifting objects weighing >5 lb (2.26 kg) until approved by the HCP D. Take a shower daily without soaking chest and leg incisions. E. Use lotion on incision sites with dressing changes if the area is dry

ANS: B, C, D The RN providing discharge instruction for a client recovering from a CABG should include the following guidelines: 1. Explain the need for modification of cardiac risk factors, including smoking cessation, weight reduction, maintaining a healthy diet, increasing activity levels through exercise. 2. Encourage a daily shower as a bath could introduce microorganisms into the surgical incision sites. Surgical incisions are washed gently with mild soap and water and pat dry. The incisions should not be soaked or have lotions or creams applied as this could introduce pathogens 3. Explain that light housework may begin in 2 weeks, but there is to be no lifting of any object weighing >5 lb without approval of the HCP. Lifting, carrying, and pushing heavy objects are isometric activities. Heart rate and BP increase rapidly during isometric activities, which should be limited until approved by the HCP, generally about 6 weeks after discharge. Guide the client to gradually resume activity and possibly participate in a cardiac rehab program 4. Clarify no driving 4-6 weeks or until the HCP approves 5. If the client is able to walk a block or climb 2 flights of stairs without symptoms, it is safe to return to sexual activity 6. Notify the HCP if the following symptoms occur: Chest pain or SOB that doesn't subside with rest; fever >101 F; redness, drainage, or swelling at the incision sites

Which interventions should the nurse include when caring for a client who has had endovascular repair of an abdominal aortic aneurysm? SATA A. Assess abdominal incision every 4 hours B. Check for bleeding at groin puncture sites C. Measure chest tube drainage D. Monitor fluid intake and urine output E. Palpate and monitor peripheral pulses

ANS: B, D, E monitor urine because the AAA can cause urinary retention or renal problems, It is repaired through the femoral artery and monitor peripheral pulses to check perfusion

A client is in suspected shock state from major trauma. Which parameters best indicate the adequacy of peripheral perfusion?SATA A. Apical pulse B. Capillary refill C. Lung sounds D. Pupillary response E. Skin color and temperature

ANS: B, E

The nurse is admitting a client with a diagnosis of right-sided HF resulting from pulmonary hypertension. What clinical manifestations are most likely to be assessed? SATA A. Crackles in lung bases B. Increased abdominal girth C. JVD D. Lower extremity edema E. Orthopnea

ANS: B,C,D

The nurse is inspecting the legs of a client with a suspected lower-extremity DVT. Which of the following clinical manifestations should the nurse expect? SATA A. Blue, cyanotic toes B. Calf pain C. Dry, shiny, hairless skin D. Lower leg warmth and redness E. Unilateral leg edema

ANS: B,D,E Although clients with DVT may have no symptoms, typical clinical manifestations include unilateral edema, localized pain or tenderness to touch, warmth, erythema, and occasionally low grade fever. Recognition of a potential DVT is critical because the thrombus can dislodge from the vessel and cause life-threatening pulmonary embolism.

The client is scheduled to have a cardiac catheterization. Which of the following findings would cause the nurse to question the safety of the test proceeding? SATA A. Elevated serum C-reactive protein level B. History of previous allergic reaction to IV contrast C. Prolonged PR interval on ECG D. Received metformin today for type 2 DM E. Serum creatinine of 2.5 mg/dL

ANS: B,D,E Cardiac catheterization involves injection of IV iodinated contrast to assess for obstructed coronary arteries. Potential complications of IV iodinated contrast include: Allergic reaction, lactic acidosis (caused when metformin is administered), contrast-induced nephropathy.

A client with CAD is being seen in the clinic for a follow-up examination. During medication reconciliation, the nurse identifies which reported medication as requiring further investigation? A. 10 mg isosorbide dinitrate twice daily B. 20 mg atorvastatin once daily C. 500 mg naproxen twice daily D. 2,000 mg fish oil once daily

ANS: C

The nurse is caring for a client who 30 minutes ago, underwent an ablation procedure for SVT in the cardiac cath lab. The client has a dressing over the femoral insertion site with a small amount of blood oozing. Which action by the nurse causes the charge nurse to intervene? A. Applies pressure above the femoral insertion site B. Assesses bilateral pedal pulses frequently C. Assists client to sit on the side of the bed to use the urinal D. Reports client chest pain of 2 on a scale of 0-10 to health care provider

ANS: C

The nurse on a med surg unit enters a room, finds a client unresponsive with no pulse, and starts 2 minutes of CPR. The nurse receives and attaches an automated external defibrillator, but no shock is advised. Which action should the nurse perform next? A. Check for a carotid pulse for at least 10 minutes B. Provide rescue breaths at a rate of 10-12 /min C. Resume chest compressions at a rate of 100/min D. Use the jaw-thrust maneuver to assess the airway

ANS: C

Which client is in need of follow-up education by the nurse? A. Client with PAD who insists on dangling leg over the side of the bed when sleeping. B. Client with Raynaud's phenomenon who routinely soaks hands in warm water before going out. C. Client with venous leg ulcer who refuses to wear elastic compression stockings during the day. D. Post surgical client who points and flexes feet when lying in bed

ANS: C

The nurse should plan to teach which client about the need for prophylactic antibiotics prior to dental procedures? A. Client who had a large anterior wall MI with subsequent heart failure B. Client who had a mitral valvuloplasty repair C. Client with a mechanical aortic valve replacement D. Client with mitral valve prolapse with regurgitation

ANS: C Certain individuals should receive prophylactic antibiotics prior to dental procedures to prevent infective endocarditis. These include the following: 1. prosthetic heart valve or prosthetic material used to repair heart valve 2. Previous history of IE 3. Some forms of congenital heart disease (unrepaired cyanotic congenital defect, repaired congenital defect with prosthetic material or device for 6 months after the procedure, repaired congenital defect with residual defects at the site or adjacent to the site of a prosthetic patch or device) 4. Cardiac transplantation recipients who develop heart valve disease

A client with mitral valve prolapse has been experiencing occasional palpitations, lightheadedness, and dizziness. The health care provider prescribes a beta blocker. What additional teaching should the nurse include for this client? A. Avoid aerobic exercise B. Ensure you receive antibiotics prior to dental work C. Stay well hydrated and avoid caffeine D. Wear a medical alert bracelet

ANS: C Clients with MVP may have palpitations, dizziness, and lightheadedness. Chest pain can occur but its etiology is unknown in this client population. It may be a result of abnormal tension on the papillary muscles. Chest pain that occurs in MVP does not typically respond to antianginal treatment such as nitrates. Beta blockers may be prescribed for palpitations and chest pain. Client teaching for MVP includes the following: 1. Adopt healthy eating habits and avoid caffeine as it is a stimulant and may exacerbate symptoms 2. Check ingredients of over-the-counter medications or diet pills for stimulants such as caffeine or ephedrine as they can exacerbate symptoms 3. Reduce stress and avoid alcohol use

The nurse is providing community health screening . Which of the following clients should be referred to a health care provider for further evaluation? A. 30-year-old athlete with a heart rate of 50/min B. 45-year-old client with a BMI of 35 and a finger stick glucose of 150 C. 55-year-old client missing all the hair on the lower legs and failing the pinprick test D. 80-year-old client with a BP of 150/90

ANS: C Failure of a pinprick testing indicates peripheral neuropathy. Loss of hair on the lower extremities indicates poor perfusion. The combination of these suggests peripheral arterial disease, likely from undiagnosed diabetes mellitus and atherosclerosis. Nearly 1/3 of clients diagnosed with diabetes will already have complications from years of uncontrolled hyperglycemia. Diabetes dramatically accelerates the buildup of plaque on the arterial walls when blood glucose levels are uncontrolled.

A client is seen following a motor vehicle collision. An IV infusion of 1 L of NS solution was administered before arrival at the hospital. The IV line is now infusing at 200 mL/hr. Which assessment finding alerts the nurse to the development of hypovolemic shock? A. JVD B. MAP 65 mmHg C. Urine output <0.5mL/kg/hr D. Warm flushed skin

ANS: C Hypovolemic shock most commonly occurs from blood loss but can occur in any condition that reduces intravascular volume. Hypovolemia is classified as either an absolute or a relative fluid loss. Reduced intravascular volume results in decreased venous return, decreased stroke volume and cardiac output, inadequate tissue perfusion, and impaired cellular metabolism.

A client with heart failure has gained 5 lb over the last 3 days. The nurse reviews the client's blood laboratory results. Based on this information, what medication administration does the nurse anticipate? Laboratory Results Sodium 126, Potassium 4.8, and Calcium 9.0. A. 0.45% sodium chloride IV B. Calcium gluconate C. Furosemide D. Sodium polystyrene sulfonate

ANS: C In heart failure, cardiac output is reduced because the heart is unable to pump blood adequately. This reduction in cardiac output reduces perfusion to the vital organs, including the kidneys. Decreased renal blood flow triggers the kidneys to activate the renin-angiotensin system as a compensatory mechanism, which increases blood volume by increasing water resorption in the kidneys. This compensatory mechanism results in fluid volume excess and dilutional hyponatremia. Dilutional hyponatremia can be treated with fluid restriction , loop diuretics and ACE inhibitors. Furosemide works to resolve hyponatremia by promoting free water than sodium excretion allowing for hemoconcentration and increased sodium levels.

A client comes to the ED with a crushing, substernal chest pain. Temp is 98.6 F, BP is 173/84, and pulse is 92, and resps are 24. Oxygen sat is 95% on room air. What is the nurse's next priority action? A. Attach defibrillator pads to the client's chest B. Check the lipid profile laboratory results C. Obtain a 12-lead ECG D. Prepare to administer a heparin drip

ANS: C It is very important to rapidly diagnose and treat the client with chest pain and a potential MI to preserve cardiac muscle. Initial interventions in emergency management of chest pain are as follows: 1. assess ABCs 2. Position pt upright, unless contraindicated 3. Apply O2 if pt is hypoxic 4. Obtain baseline VS including O2 sat 5. Auscultate heart and lungs 6. Obtain a 12-lead EKG 7. Insert 2 large bore IV catheters 8. Assess pain using PQRST method 9. Medicate for pain as prescribed 10. initiate ECG monitoring 11. Obtain baseline blood work 12. Obtain portable CXR 13. Assess for contraindications to antiplatelet and anticoagulation therapies 14. Administer aspirin unless contraindicated

A client is 48 hours post abdominal aneurysm repair. Which assessment by the nurse is cause for greatest concern? A. Diminished breath sounds in bilateral lung bases B. Hypoactive bowel sounds in all 4 quadrants C. Urinary output of 90mL in the past 4 hours D. warm extremities with 1+bilateral pedal pulses

ANS: C Renal perfusion status is monitored closely in a client who has had abdominal aneurysm repair. Hypotension, dehydration, prolonged aortic clamping during surgery, blood loss, or embolization can lead to decreased renal perfusion and potential kidney injury. The nurse should routinely monitor the client's BUN and creatinine levels as well as urine output. Urine output should be at least 30 mL/hr. THis client should have an output of at least 120 mL of urine in a 4 hour period.

A client admitted to the cardiac care unit with markedly elevated blood pressure and heart failure is receiving a continuous infusion of nitroprusside. Thirty minutes later, the client appears pale with cold, clammy skin and reports being lighthearted. Which is the priority nursing action? A. Auscultate the client's lungs B. Check the client's capillary refill C. Measure the client's blood pressure D. Review the client's ECG

ANS: C Sodium nitroprusside is a highly potent vasodilator (both venous and arteriolar). Venous dilation reduces preload and arterial dilation reduces afterload. Sodium nitroprusside is commonly used in hypertensive emergencies and for conditions in which blood pressure control is of utmost importance (ie., aortic dissection, acute hypertensive heart failure). Nitroprusside begins to act within 1 minute and can produce a sudden and drastic drop in blood pressure if not monitored properly. Therefore, the client's blood pressure should be monitored closely (every 5-10 mins). This client's lightheadedness and cold clammy skin are likely due to hypotension. Nitroprusside metabolizes to cyanide, and clients with renal disease can occasionally develop fatal cyanide toxicity.

A client with newly diagnosed chronic heart failure is being discharged home. Which statement(s) by the client indicate a need for further teaching by the nurse? SATA A. "I don't plan on eating any more frozen meals." B. "I plan to take my diuretic pill in the morning." C. "I will weigh myself at least every other day." D. "I'm going to look into joining a cardiac rehabilitation program." E. "Ibuprofen works best for me when I have pain."

ANS: C, D Client and family education is important for those with heart failure to prevent/minimize exacerbations, decrease symptoms, prevent target organ damage and improve quality of life. The use of any NSAIDS is contraindicated as they contribute to sodium retention, and therefore fluid retention. To monitor the client's fluid status, clients are instructed to weigh themselves daily, at the same time, with the same amount of clothing, and on the same scale. Weights should be recorded to allow for day-to-day comparisons to help identify early signs of fluid retention.

The nurse in the oral surgery clinic reviews a client's medical record prior to surgery. Which will the nurse immediately report to the oral surgeon? SATA A. Client is on a calorie restricted diet for obesity B. Creatinine is 1.3 C. History of congenital heart disease D. INR of 2.5 E. Presence of prosthetic valve

ANS: C,D,E

A 62-year-old client was admitted to the telemetry unit after having an acute myocardial infarction 3 days ago. The client reports to the nurse that the left calf is very tender and feels warm to the touch. Which assessment by the nurse is the priority? A. Ask the client how long the leg has been tender and warm B. Assess the ECG for any ectopic beats C. Check VS including pulse oximetry D. Complete neurovascular assessment on lower extremities

ANS: D

A client develops sinus bradycardia with blood pressure of 90/40 mmHg and a heart rate of 46/min. Which of the following actions should the nurse take? A. Give scheduled dose of metoprolol 50 mg orally B. Instruct client to cough forcefully C. Place client in reverse Trendelenburg position D. Prepare to administer atropine 0.5 mg intravenous (IV) push

ANS: D

A client in the ED is admitted with a diagnosis of rule out MI. Which laboratory test should the nurse monitor to determine if the client has had an MI? A. D-dimer test B. Low-density Lipoprotein C. Myoglobin D. Troponin

ANS: D

A nurse in the ICU is caring for a post operative cardiac transplant client. What intervention is most important to include in the plan of care? A. Apply sequential compression devices to prevent DVT B. Assist the Client to change positions slowly to prevent hypotension C. Encourage coughing and deep breathing to prevent pneumonia D. Use careful hand washing and aseptic technique to prevent infection

ANS: D

The client was diagnosed 6 months ago with hypertension and had a recent ED visit for a TIA. The client's BP today is 170/88. What teaching is priority for the nurse to discuss with this client? A. Decreasing sodium intake B. Decreasing stress levels at work and home C. Increasing activity level D. Taking BP meds as prescribed

ANS: D

The nurse is assessing a client with a possible diagnosis of PAD. Which client statement is consistent with the diagnosis? A. "At the end of the day my shoes and socks are tight." B. "I have a slow-healing sore right above my ankle." C. "My legs ache when I stand for extended periods ." D. "When I sit down to rest and elevate my legs, the pain increases."

ANS: D

The nurse reviews laboratory data for a client admitted to the ED with chest pain. What serum value requires the most immediate action by the nurse? A. Glucose 200 B. Hct 38% C. Potassium 3.4 D. Troponin 0.7

ANS: D A troponin value of 0.7 indicates cardiac muscle damage and should be the priority and immediate focus of the nurse.

A client with heart failure is started on furosemide. The laboratory results are shown in the exhibit (Sodium 134, potassium 3.4, chloride 108, magnesium 0.9). The nurse is most concerned about which condition? A. Atrial fibrillation B. Atrial flutter C. Mobitz II D. Torsades de pointes

ANS: D Hypomagnesemia causes a prolonged QT interval that increases the client's susceptibility to ventricular tachycardia. Torsades de pointes is a type of polymorphic ventricular tachycardia coupled with a prolonged QT interval; it is a lethal cardiac arrhythmia that leads to decreased cardiac output and can quickly develop into ventricular fibrillation. It needs to be treated with IV mag sulfate.

The nurse has just completed discharge teaching for a client who had aortic valve replacement with a mechanical heart valve. Which statement by the client indicates that teaching has been effective? A. "I'm glad that I can continue taking my gingko biloba." B. "I will increase my intake of leafy green vegetables." C. "I will start applying vitamin E to my chest incision after showering." D. "I will shave with an electric razor from now on."

ANS: D Mechanical prosthetic valves are more durable than biological valves but require long-term anticoagulation therapy due to the increased risk of thromboembolism. The client should be taught ways to reduce the risk of bleeding.

A client with chest pain is diagnosed with acute pericarditis by the HCP. The nurse explains that the pain will improve with which of the following? A. Coughing and deep breathing B. Left lateral position C. Pursed-lip breathing D. Sitting up and leaning forward

ANS: D Pain is typically relieved by sitting up and leaning forward . This position reduces pressure on the inflamed parietal pericardium, especially during lung inflation. Treatment include a combination of NSAIDS plus colchicine.

The cardiac care unit has standing instructions that the HCP should be notified of an abnormal mean arterial pressure (MAP). The nurse will need to notify the HCP about which client? A. A client from the cardiac catheterization lab with a BP of 102/58. B. A client just admitted from the emergency department with a BP of 150/72. C. A client with a BP of 92/50 who just received a dose of nitroglycerin D. A client with heart failure on metoprolol with a BP of 106/42.

ANS: D The MAP refers to the average pressure within the arterial system felt by the vital organs. A normal MAP is between 70-105 mmHg. If the map falls below <60 mmHg, vital organs may be underperfused and can become ischemic. MAP can be calculated using the formula Systolic BP+(diastolic BPX2)/3. The client with the BP of 106/42 has a MAP of 63 mmHg, in the abnormal range. The nurse should report this to the HCP and monitor the client closely.

A nurse is discussing discharge education with a client after his 5th hospitalization for pulmonary edema caused by his congestive heart failure. Which of the following statements indicates that further teaching is required? A. "I should supplement my potassium intake." B. "I should weigh myself daily." C. "Moderate exercise may be helpful in my condition." D. "Potato chips are an acceptable snack in moderation."

ANS: D The client is likely dealing with some level of denial regarding his diagnosis of CHF. Glossing over the importance of salt avoidance is missing an important opportunity to help them avoid further hospitalizations for the same condition.

A client with chronic heart failure calls the clinic to report a weight gain of 3 lb over the last 2 days. Which information is most important for the nurse for the nurse to ask this client? A. Diet recall for this current week B. Fluid intake for the past 2 days C. Medications and dosages taken over the past 2 days D. Presence of SOB, coughing or edema

ANS: D The client with CHF is at risk for exacerbations that may require hospitalization. Clients should be instructed to report a weight gain of 3 lb in 2 days or >5 lb in a week. The priority for the nurse on the phone is to ascertain if the client is experiencing any physiological symptoms such as coughing, SOB, or edema. These could indicate fluid overload. This information can help the nurse direct the client to come in for further assessment, follow a protocol to make changes in medications/dosages, or restrict fluids.

The nurse is assigned to the following clients. Which client does the nurse assess/identify as being at greatest risk for the development of a DVT? A. A 25-year old client with abdominal pain who smokes cigarettes and takes oral contraceptives. B. A 55- year-old ambulatory client with exacerbation of chronic bronchitis and hematocrit of 56%. C. A 72-year old client with a fever who is 2 days post coronary stent placement. D. An 80-year-old who is 4 days postoperative from repair of a fractured hip.

ANS: D Venous thromboembolism includes both DVT and PE. DVT is the most common form and occurs most often (80%) in the proximal deep veins of the lower extremities. Virchow's triad describes the 3 most common theories behind the pathophysiology of the venous thrombosis: venous stasis, endothelial damage, and hypercoagulability of blood.

After a prolonged surgical procedure, the client reports unilateral leg pain. Which client assessment finding is most concerning? A. Client rates leg pain as "7". B. Negative homan sign C. Prominent varicose veins bilaterally D. Right calf is 4 cm larger than left calf

ANS: D can indicate DVT

The nurse is caring for a client diagnosed with a DVT one day ago. Which action by the client would require an immediate intervention by the nurse? A. Ambulates through the hallway several times per day B. Applies a warm compress to the site of inflammation C. Elevates the limb above the level of the heart while in bed D. Massages the affected leg to reduce pain and swelling

ANS: D massaging the site may trigger and embolism

A client comes to the ED in acute decompensated heart failure. The client is very anxious, with a respiratory rate of 30/min and pink, frothy sputum. After placing the client on oxygen via nasal cannula, which of these actions is the next priority? A. Administer digoxin 0.25 mg B. Administer furosemide 40 mg IV Push C. Initiate dopamine infusion at 5 mcg/kg/min D. Obtain blood sample for ABG

ANS:B This client is exhibiting signs of pulmonary edema, a life-threatening condition. In the presence of acute left ventricular failure, pulmonary vasculature overload causes increased pulmonary venous pressure that forces fluid out of the vascular space into the pulmonary interstitium and, if untreated, into the alveoli. Clinical manifestations of pulmonary edema include: 1. A history of orthopnea and/or paroxysmal nocturnal dyspnea 2. Anxiety/restlessness 3. Tachypnea, dyspnea, and use of accessory muscles 4. Frothy, blood-tinged sputum 5. Crackles on auscultation The priority of care is to improve oxygenation by reducing pulmonary pressure and congestion. Diuretics are prescribed to remove excess fluid in pulmonary edema.

A client is being discharged after receiving an implantable cardioverter defibrillator. Which statement by the client indicates that teaching has been effective? A. "I'm not worried about the device firing now because I know it won't hurt." B. "I will let my daughter fix my hair until my HCP says I can do it." C. "I will look into public transportation because I won't be able to drive again. " D. "I will notify my travel agent that I can no longer travel by plane."

Ans: B Clients are instructed to refrain from lifting the affected arm above the shoulder to prevent dislodgement of the lead wire on the endocardium.

A 62-year-old client is scheduled for open abdominal aneurysm repair. What key assessment should be made by the nurse preoperatively? A. Assess and compare blood pressure in each arm B. Assess character and quality of peripheral pulses C. Assess for presence or absence of hair on lower extremities D. Assess for presence of bowel sounds

Ans: B The nurse should pay attention to peripheral pulses, renal and neurological status. A decreased or absent pulse with cool, pale, mottled, or painful extremity postoperatively can indicate embolization or graft occlusion. Graft occlusion may may require reoperation.

The nurse is assessing a 70 year old client with a long history of type 2 DM for sudden, severe nausea, diaphoresis, dizziness and fatigue in the ED. Which hospital protocol would be most appropriate to follow initially? A. Food poisoning B. Influenza C. Myocardial infarction D. Stroke

Ans: C Early recognition and treatment of heart attack are critical. Women, the elderly, and client's with a history of diabetes may not have the classic heart attack symptoms of dull chest pain with radiation down the left arm. Instead, they can present with "atypical" symptoms such as nausea, vomiting, belching, indigestion, diaphoresis, dizziness, and fatigue.

A nurse is caring for a client on the first day postop after having minimally invasive direct coronary artery bypass (MIDCAB) grafting. The client thought that this surgery was supposed to have a much easier recovery and asks the nurse why it was so painful to take deep breaths. What is the best response by the nurse? A "I am sorry you have so much pain. I'll go get your pain medication right now." B. "Let me call the HCO to see if we can increase the dose of your pain medicine." C. "Take deep breaths while splinting your chest with a pillow, and use your incentive spirometer every 2 hours. This will help your recovery." D. "The overall recovery time is expected to be shorter, but initial postop pain can actually be higher with MIDCAB because the incisions are made between the ribs."

Ans: D