412 HF + CAD Practice Questions

The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply

edema ascites anasarca

A nurse is caring for a patient with a history of chronic stable angina who complains of chest pain. Which factor is true of ischemia related to angina?

It will be relieved by rest, nitroglycerin, or both.

Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

Apply the patch to a nonhairy, nonfatty area of the upper torso or arms.

The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the pt into bed. Based on this finding, what should the nurse to first?

Assess RESPIRATORY status

A patient is taking metoprolol and hydrochlorothiazide. What finding indicates the med is effective?

Lowers the blood pressure

A nurse is caring for a patient diagnosed with heart failure who experiences fatigue. What could be the reason for fatigue?

Impaired perfusion to vital organs

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:

Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.

The nurse has provided dietary teaching of a 2 gram sodium diet to a patient with heart failure. Which statement by the patient indicates a need for further teaching?

"Bread is a good food choice because it has a very low salt content."

Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn't understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:

"Cardiac rehabilitation is not a cure but can help restore you to many of your former activities."

The nurse is performing medication teaching to a patient who has been prescribed sublingual (SL) nitroglycerin (NTG) tablets. Which statement by the patient indicates a need for further education?

"I can take as many tablets as needed until the pain goes away, five minutes apart.

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement?

"I can take up to five tablets every three minutes for relief of my chest pain.

A nurse provides discharge instructions to a patient with chronic heart failure related to dietary restrictions. Which statements made by the patient indicates understanding of the teaching?

"I should not use salt."

The nurse has been teaching a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates an adequate understanding?

"I will change my lifestyle to reduce activities that increase my stress." explanation: Health-promoting behaviors for those at risk for CAD include: - improving physical activity i.e. brisk walking (3-5 miles/hr for at least 30 mins 5+ times a week) - reducing total fat and saturated fat intake - stopping all tobacco use - altering patterns that are conducive to stress

The home care nurse visits a 73-year-old Hispanic woman with chronic heart failure. Which clinical manifestations, if assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)?

- Severe dyspnea - blood-streaked, frothy sputum - anxiety - pallor, cyanosis, clammy and cold skin, - use of accessory muscles - RR > 30 breaths per minute - orthopnea, wheezing, and coughing - Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs

Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults?

- Systolic murmur - Diminished pedal pulses - Decreased maximal heart rate - Increased recovery time from activity

Homocysteine

- a protein amino acid - High levels may indicate an increased risk for CAD - not used to diagnose myocardial infarction.

Myoglobin

- a protein found in skeletal and cardiac muscle - a sensitive indicator of early myocardial injury but is not specific for cardiac muscle - peaks and returns to normal in 3 to 15 hours

Preload

- the amount of stretch of the cardiac muscle fibers at the end of diastole - The volume of blood in the ventricle at the end of diastole determines the preload

Creatine kinase

-a serum cardiac marker for myocardial injury, but lacks specificity for myocardial damage. - Serum levels peak at 18 hrs - levels return to normal within 24 - 36 hrs

Beta Blockers

-reduce heart rate -decrease myocardial contractility -slow conduction

A patient with atrial fibrillation is due for a first dose of digoxin (Lanoxin) 125 mcg intravenous (IV) push. Available is a vial containing 0.25 mg/mL. How many milliliters should the nurse draw up to administer the dose?

0.5 mL

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)?

1. Administer ordered morphine sulfate. 2. Position patient in a semi-Fowler's position. 3. Instruct patient on the use of relaxation techniques. 4. Use a calm, reassuring approach while talking to patient.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)?

1. Left ventricular function is documented. 2. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge 3. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?

A change in the pattern of her pain - may indicated increasing severity of CAD

A patient with a history of left-sided heart failure arrives in the emergency department with complaints of extreme shortness of breath and a persistent cough with pink frothy sputum. On auscultation of the heart, the nurse notes aS3 gallop. The nurse recognizes those symptoms as being caused by:

Acute pulmonary edema

A patient with a history of left-sided heart failure arrives in the emergency department with complaints of extreme shortness of breath and a persistent cough with pink frothy sputum. On auscultation of the heart, the nurse notes aS3 gallop. The nurse recognizes those symptoms as being caused by:

Acute pulmonary edema Explanation:

Which of the following terms describes the force against which the ventricle must expel blood?

Afterload

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)?

Anorexia, N/V, blurred vision

The nurse notes that the patient was taking clopidogrel (Plavix) at home. The nurse knows that this medication belongs to which drug class?

Antiplatelet

An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient?

Accurately weigh the patient, and report and record the readings. Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water

A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first?

Assist the patient to a sitting position with arms on the overbed table. The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation.

Which condition most commonly results in CAD?

Atherosclerosis

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?

Atrial dysrhythmias STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage

The nurse is caring for a patient with manifestations of left-sided heart failure. What is the priority nursing intervention?

Auscultate lung sounds explanation: excess fluid leads to pulmonary congestion

A patient with chronic stable angina has received a prescription for nitroglycerin (Nitrolingual). The nurse tells the patient that orthostatic hypotension is an important side effect of this drug. To prevent complications associated with the side effect, what should the nurse include in the patient's teaching?

Avoid sudden changes in position after taking nitroglycerin to prevent falls Explanation: Nitrates cause vasodilatation, which in turn causes peripheral pooling of blood. On changing position suddenly (from recumbent to erect posture), there is a sudden drop of blood pressure, which is known as orthostatic hypotension. This decreases the blood supply to the brain, which may lead to dizziness and falling. Headaches and flushing are not associated with orthostatic hypotension. If there is no tingling sensation on administering the drug, then the medication may be expired or ineffective.

The nurse is caring for a patient who has been diagnosed with paroxysmal nocturnal dyspnea. Which complaint would the nurse expect this patient to report?

Awakening from sleep with feelings of suffocation

A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?

Bathroom privileges + self care activities

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure?

Blood Pressue - hypotension = adverse effect

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first?

Blood Pressure

Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death?

Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:

Check the client status and lead placement Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient?

Choose interventions to promote comfort and prevent suffering.

A nurse is assessing a 15-year-old patient who has a BMI over 30. What is the first change in the coronary artery that could make the patient susceptible to coronary artery disease?

Development of fatty streaks in the smooth muscles of the endothelium

A 67-year-old patient has coronary artery disease (CAD). Which question should the nurse ask to assess a need for additional teaching?

Did you have any recent weight gain?

The patient's laboratory results reveal a potassium level of 2.6 mEq/L. The nurse should notify the health care provider and withhold which scheduled medication?

Digoxin (Lanoxin) Explanation: Hypokalemia is the most significant risk factor for digoxin toxicity. The dose should be held and the health care provider should be notified with a plan to provide additional potassium supplementation. Potassium should be administered, not held, in the patient with hypokalemia.

When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:

Dissolve any potential clots

To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse:

Distal to the catheter insertion Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?

Does the pain get worse when you breath in? Chest pain is assessed by using the standard pain assessment parameters.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid?

Drugs to treat erectile dysfunction -- risk for severe hypotension / death

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

ECG The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction.

A patient is suspected of having heart failure. The nurse recognizes that which diagnostic tests are commonly used to make this diagnosis? Select all that apply.

ECG echocardiogram Chest xray

Which of the following diagnostic tests is preferred for evaluating heart valve function?

Echocardiogram b/c it allows the visualization of the valves as they open and close

An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse caring for the patient understands that this condition has occurred as a result of a chronic condition. What could be the cause of the cardiac dilation?

Elevated pressure in the ventricles

A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first:

GIVE MORPHINE Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.

Direct-acting vasodilators have which of the following effects on the heart rate?

HR increases in response to decreased BP r/t vasodilation

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: Headache High blood pressure Shortness of breath Stomach cramps

Headache Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.

Which of the following assessments would be an important finding for a patient with arterial disease?

Intermittent claudication w/ exercise r/t progression of atherosclerosis and altered tissue perfusion to the extremities

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

Myocardial Infarction Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is normal).

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating?

Oxygen, nitroglycerin, aspirin, and morphine

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?

Protamine Sulfate The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur.

Which lab test should the RN monitor when pt is receiving warfarin sodium therapy?

Prothrombin Time (PT)

The nurse notices that a patient with pulmonary edema experiences shortness of breath while lying down. What is the most likely reason for the development of orthopnea in this patient?

Pulmonary congestion

A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?

Review the intake and output records for the last 2 days Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight.

After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, weight gain, peripheral edema, and heart rate of 108/minute. What should the nurse suspect is happening?

Right Sided HF Explanation: An MI is a primary cause of heart failure . The JVD, weight gain, peripheral edema, and increased HR are manifestations of right-sided HF

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening?

Right-Sided HF

The nurse prepares to administer digoxin (Lanoxin) 0.125 mg to an 82-year-old man admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication?

Serum Potassium levels

A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to:

Start an IV

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication?

Sublingual NTG Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries

Symptoms of right-sided heart failure are caused by:

Systemic venous congestion

A patient admitted to the emergency department is diagnosed with acute decompensated heart failure manifesting as pulmonary edema. Which clinical manifestations should the nurse observe in this patient? Select all that apply.

dyspnea rapid HR frothy, blood-tinged sputum

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)?

Take meds as prescribed Explanation: The goal for the patient with chronic heart failure is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies, such as alternating activity with rest, will help the patient meet this goal

A70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed for her to continue at home. Which response by the nurse is accurate?

The medication prevents blood clots from forming in your heart."

A patient with heart failure and atrial fibrillation asks why an anticoagulant (heparin) has been prescribed. What explanation should the nurse provide?

To dissolve the atrial thrombus that may lead to stroke Explanation: In atrial fibrillation, the formation of thrombus is common in the atria, which may further form emboli and lead to a stroke. Therefore, anticoagulants are administered.

A nurse is caring for a patient with chest pain that began 10 days ago. Which serum cardiac marker should the nurse review to determine if a myocardial infarction occurred 10 days ago?

Troponin Explanation: Troponin is a serum cardiac marker that is detectable in the blood up to 2 weeks after myocardial injury and is used to diagnose a MI. Troponin has two subtypes: cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI). Serum levels of cTnT and cTnI begin to increase 4 to 6 hours after the onset of myocardial injury, peak at 10 to 24 hours, and return to normal over 10 to 14 days.

Which of the following blood tests is most indicative of cardiac damage?

Troponin 1 Levels Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.

Which of the following diagnostic studies most likely would confirm a myocardial infarction?

Troponin T levels

Auscultation of a patient's heart reveals the presence of a murmur. What is this assessment finding a result of?

Turbulent blood flow across a heart valve

A patient is scheduled to receive a dose of digoxin (Lanoxin). The morning laboratory results are as follows: sodium 145 mEq/L, potassium 3.2 mEq/L, chloride 98 mEq/L, and glucose 78 mg/dL. What is the priority nursing action?

Withhold the dose and report the potassium level

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next?

Withhold the dose and report the potassium level Explanation: The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes them more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the K+ level. The health care provider may prescribe the digoxin to be given once the potassium level has been treated and decreases to within normal range

If a patient has decreased cardiac output caused by fluid volume deficit and marked vasodilation, the regulatory mechanism that will increase the blood pressure by improving both of these is

activation of the renin-angiotensin-aldosterone system

The nurse recognizes the need for more frequent monitoring of electrolytes when a patient prescribed digitalis (Lanoxin) receives

any form of diuretic

Thrombolytic drugs

are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.

When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of

baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate.

An important nursing responsibility for a patient having an invasive cardiovascular diagnostic study is

checking the peripheral pulses and percutaneous site.

Chest X-ray

determines size of the heart

A nurse has identified a group of people who are at risk for developing coronary artery disease. To prevent atherosclerosis, the nurse advises a reduction in salt consumption. How does salt consumption increase the risk of developing atherosclerosis?

it causes water retention

BNP

lab that indicated heart failure when elevated

A nurse is caring for a patient with a dry cough who is not responding to conventional medical treatment. On auscultation the nurse finds S3 and S4 heart sounds, crackles, and an increased heart rate in this patient. Which condition is most likely affecting the patient?

left sided heart failure

The nurse is preparing the patient with HF to go home. The RN should instruct the patient to

monitor weight daily

The drug used in the management of a patient with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is

morphine

A compensatory mechanism involved in congestive heart failure that leads to inappropriate fluid retention and additional workload of the heart is

neurohormonal response

A patient experiences left ventricular failure. Which manifestation of this condition does the nurse recognize?

orthopnea

The nurse teaches a pt with COPD to assess for s/s of right sided heart failure. What s/s should be included?

peripheral edema

A patient is diagnosed with heart failure. The nurse identifies that which factors may influence the patient's cardiac output? Select all that apply.

preload HR myocardial contractility

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient?

reduce preload

A physician orders aspirin for a pt who has experiences a transient ischemic attack (TIA). The RN should teach the pt that the Dr ordered this med to:

reduce the chance of blood clot formation

The nurse is assessing a patient with valvular heart disease. The patient has not experienced any symptom of heart failure. How should the nurse classify this patient according to the American College of Cardiology/American Heart Association (ACC/AHA) stages of heart failure?

stage b

Holter Monitor

worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor