Adult Health Cardiac, Shock, Vascular System

The client in shock has the following vital signs: T 99.8°F, P 132 beats/min, R 32 breaths/min, and BP 80/58 mm Hg. Calculate the pulse pressure.__

22 mm Hg

_____: Removal of a clot (thrombus) from a blood vessel.

Thrombectomy

_____: The presence of a thrombus associated with inflammation; usually occurs in the deep veins of the lower extremities.

Thrombophlebitis

_____: A blood clot believed to result from an endothelial injury, venous stasis, or hypercoagulability.

Thrombus

_____: Toe systolic pressure divided by brachial (arm) systolic pressure; may be performed instead of or in addition to ankle-brachial index to determine arterial perfusion in the feet and toes.

Toe brachial pressure index (TBPI)

_____: A type of ventricular tachycardia that is related to a prolonged QT interval.

Torsades de pointes

_____: Temporary pacing that is accomplished through the application of two large external electrodes.

Transcutaneous pacing

_____: A form of echocardiography performed transesophageally (through the esophagus); an ultrasound transducer is placed immediately behind the heart in the esophagus or stomach to examine cardiac structure and function.

Transesophageal echocardiography (TEE)

_____: A new surgical procedure for patients with unstable angina and inoperable coronary artery disease with areas of reversible myocardial ischemia. After a single-lung intubation, a left anterior thoracotomy is performed and the heart is visualized. A laser is used to create 20 to 24 long, narrow channels through the left ventricular muscle to the left ventricle. The channels eventually allow oxygenated blood to flow from the left ventricle during diastole to nourish the muscle.

Transmyocardial laser revascularization

_____: A type of premature complex consisting of a repetitive three-beat pattern; usually occurs as two sequential normal complexes followed by a premature complex and a pause, with the same pattern repeating itself in triplets.

Trigeminy

_____: Serum lipid profile that includes the measurement of cholesterol and lipoproteins.

Triglycerides

_____: A myocardial muscle protein released into the bloodstream after injury to myocardial muscle. Because it is not found in healthy patients, any rise in values indicates cardiac necrosis or acute myocardial infarction.

Troponin

A client is prescribed lisinopril (Zestril) for control of hypertension. What health teaching will the nurse provide to this patient? (Select all that apply.) A) "This medication can cause increased potassium levels." B) "It is important to change positions slowly when you start this medication." C) "This medication may cause you to develop a persistent, non-productive cough." D) "To achieve maximum benefit of Zestril, your diet should include foods high in sodium." E) "Be sure to monitor your BP regularly while taking this medication."

ANS: A, B, C, E. Lisinopril (Zestril) is an ACE inhibitor which is known to cause orthostatic hypotension associated with vasodilation; thus changing positions slowly is important. Persistent, nagging cough is also common in this drug category. Because this medication is being used to modify BP, regular monitoring is important to assess effectiveness. Hyperkalemia is also associated with ACE Inhibitors especially for clients with diabetes mellitus and renal dysfunction. A high sodium diet is inappropriate for a client with hypertension and would adversely affect BP.

A client who is in the progressive stage of hypovolemic shock has all of the following signs, symptoms, or changes. Which ones does the nurse attribute to ongoing compensatory mechanisms? (Select all that apply.). A) Increasing pallor B) Increasing thirst C) Increasing confusion D) Increasing heart rate E) Increasing respiratory rate F) Decreasing systolic blood pressure G) Decreasing blood pH H) Decreasing urine output

ANS: A, B, D, E, H. Compensatory mechanisms attempt to maintain perfusion and gas exchange to vital organs. Thus these mechanisms shunt blood away from less vital organs and try to prevent further volume losses. The increasing pallor occurs because blood is shunted away from skin and mucous membranes to the heart, brain, liver, and lungs. Increasing thirst and decreasing urine output help to increase blood volume by stimulating the patient to drink and by preventing fluid loss through the urine. Increasing heart rate and respiratory rate work to maintain gas exchange to those selected organs that continue to be perfused. Increasing confusion indicates the compensatory mechanisms are failing and that the brain is not being adequately perfused. Decreasing systolic blood pressure also is an indication of worsening shock. Decreasing blood pH is not a compensatory action; it is an indication of inadequate gas exchange.

A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? (Select all that apply.) A) Peripheral edema. B) Crackles in both lungs C) Increased abdominal girth D) Ascites E) Tachypnea

ANS: A, C, D, E. Peripheral edema, increased abdominal girth, ascites, and tachypnea are all symptoms associated with right-sided heart failure due to the back up into the peripheral system. Crackles in the lungs are associated with left-sided heart failure.

The nurse is admitting a client with an ulcer on the right foot. Which statement made by the client indicates venous insufficiency? (Select all that apply.) A) "My ankles swell up all the time." B) "My leg hurts after I walk about a block." C) "My feet are always really cold." D) "My veins really stick out in my legs." E) "My ankles have been discolored for years."

ANS: A, D, E. Symptoms of venous insufficiency include ankle and leg swelling, ankle discoloration, and full veins with dependent positioning of the legs (Chart 36-4). Pain with ambulation would signal claudication and cold extremities would indicate poor arterial perfusion.

An 84-year-old client with heart failure presents to the emergency department with confusion, blurry vision, and an upset stomach. Which assessment data is most concerning to the nurse? A) Digoxin (Lanoxin) therapy daily. B) Daily metoprolol (Lopressor). C) Furosemide (Lasix) twice daily. D) Currently taking an antacid for upset stomach.

ANS: A. Confusion, blurry vision, and upset stomach are symptoms of Digoxin toxicity, which is common in older adults and requires immediate treatment. The other answers are important assessment data but do not indicate immediate connection to the client's presentation.

A client thought to be at risk for distributive shock is given a drug that constricts blood vessels. What effect does the nurse expect the drug to have on the client's mean arterial pressure (MAP)? A) Increased MAP without a change in vascular volume. B) Increased MAP by increasing vascular volume. C) Decreased MAP from widespread capillary leak. D) Decreased MAP by decreasing vascular volume.

ANS: A. Distributive shock occurs when blood volume is diverted from the vascular volume into other spaces but without being lost from the body. Drugs that constrict blood vessels, especially arterioles, can keep the remaining vascular volume in place and reduce the size of the capillary bed. These responses increase mean arterial pressure but do not expand the vascular volume.

A client is being discharged home following 5 days of acute care for treatment of a deep vein thrombosis. Which statement made by the client indicates a need for further teaching? A) "I will be going home on oral Heparin and warfarin." B) "I have an appointment for follow up care with my primary care provider." C) "I will avoid dark green leafy vegetables while taking warfarin." D) "I will report any signs of bleeding to my primary care provider."

ANS: A. Heparin is not an oral drug and a patient will not go home on both Heparin and Coumadin. These medications are overlapped in the hospital for at least 5 days because they work differently to anticoagulate. A follow-up appointment is appropriate following hospitalization and labs will most likely be assessed for warfarin maintenance. Dark green leafy vegetables contain Vitamin K which is the antidote for warfarin. Avoidance is appropriate. Following DVT, all patients will be discharged on anticoagulant therapy. All anticoagulants present a risk for bleeding. Prompt recognition and reporting of bleeding is an appropriate action.

A client diagnosed with atherosclerosis and hypertension has been newly prescribed a combination drug of amlodipine and atorvastatin (Caduet). Which statement by the client indicates a need for further teaching? A) "I will continue to take my amlodipine with the new medication." B) "I'll follow up with my nurse practitioner on a regular basis." C) "I need to quit smoking as soon as I possibly can." D) "I shouldn't drink grapefruit juice while on this drug."

ANS: A. The patient should not be taking amlodipine (Norvasc) and Caduet. Caduet is a combination drug that contains a statin as well as amlodipine (Norvasc). All other options are correct statements.

While performing an admission assessment on a client, the nurse assesses which of the following as risk factors for cardiovascular disease? (Select all that apply.) A) BMI of 22. B) Well-controlled diabetes mellitus. C) Exposure to second-hand cigarette smoke. D) BP of 128/54. E) History of repeated streptococcal tonsillitis. F) Family history of cardiovascular disease. G) Total cholesterol level is 140 mg/dl.

ANS: B, C, E, F. Diabetes mellitus is a risk factor even if it is well controlled. The client's wife exposes him to second-hand smoke which is a risk for CVD. Recurrent streptococcal infections are associated with valvular disease and place the client at risk for CVD. A primary relative with the disease is a major risk factor. A BMI of 22 is normal, as is a BP of 128/54, and a cholesterol level of 140 mg/dl.

A 48-year-old female client having an annual physical asks the nurse about her risk for developing a myocardial infarction (MI). The nurse discusses risk factors with the client. Which modifiable risk factors will the nurse assess to guide the client's teaching plan? (Select all that apply.). A) Older age B) Tobacco use C) Female D) High-fat diet E) Family history F) Obesity

ANS: B, D, F. Tobacco use, diet, and obesity are all considered modifiable risk factors and should be included in the plan of care.

During routine suctioning of a client with a tracheostomy, the client becomes diaphoretic, nauseous, and the heart rate decreases to 39 beats/minute. What is the nurse's best action at this time? A) Continue to clear the airway B) Stop suctioning the patient C) Administer atropine D) Call the heath care provider immediately

ANS: B. Removing the noxious stimuli causing the vagal response would be the first action. If this does not resolve the bradycardia, second action would be to administer atropine and call provider. Continuing to suction is not appropriate as this is the cause of the vagal episode.

The nurse assesses a client who had a coronary artery bypass graft yesterday. Which assessment finding will cause the nurse to suspect cardiac tamponade? A) Incisional pain with decreased urine output B) Muffled heart sounds with the presence of JVD C) Sternal wound drainage with nausea D) Increased blood pressure and decreased heart rate

ANS: B. Symptoms are part of Beck's Triad which are indicative of tamponade. Incisional pain is expected. While sternal wound drainage is a problem, it is not an indicator of cardiac tamponade. With tamponade, blood pressure will decrease and the heart rate will increase.

Which statement made by the client on the way to the catheterization lab requires an immediate action by the nurse? A) "My allergies are bothering me so I took some Benadryl last night before bed." B) "I was nervous last night but I still remembered to take my warfarin last night." C) "I sure am hungry. I haven't had anything to eat since I went to bed last night." D) "I don't know what I will do if they find a blockage in my heart."

ANS: B. Warfarin should be held prior to the procedure to avoid the risk of excessive bleeding. The nurse will need to call the provider immediately to determine if the cardiac catheterization will need to be rescheduled. Benadryl prior to the procedure is not contraindicated. This statement requires no action by the nurse. The statement in option C informs the nurse that the client has been NPO which is required prior to the heart catheterization. This statement in option D indicates mild anxiety associated with the medical procedure. Emotional support from the nurse is an appropriate response.

The nurse is assessing a client with chest pain. Which symptoms assessed by the nurse would be most indicative of myocardial infarction? (Select all that apply.) A) Substernal chest discomfort associated with exertion B) Chest pain that is relieved with rest C) Chest pain associated with ECG changes D) Chest pain relieved with nitroglycerin E) Chest pain relieved only by opioids F) Chest pain associated with shortness of breath G) Chest pain that lasts less than 10 minutes

ANS: C, E, F. Refer to chart 38-2. Pain associated with myocardial infarction is associated with ECG changes (dysrhythmias and ST elevation), is often only relieved by opioids and has associated symptoms such as shortness of breath and nausea. The options are associated with angina pain.

A client who recently had a heart valve replacement is preparing for discharge. What statement by the client indicates that the nurse will need to do additional health teaching? A) "I need to brush my teeth at least twice daily and rinse with water." B) "I will eat foods that are low in vitamin K, such as potatoes and iceberg lettuce." C) "I need to take a full course of antibiotics prior to my colonoscopy." D) "I will take my blood pressure every day and call if it is too high or low."

ANS: C. Antibiotics are only required prior to dental procedures. Good oral hygiene is the best prevention for endocarditis. The statement in option A is correct and shows the patient understands the need for oral hygiene. The patient with a mechanical valve will be on warfarin (Coumadin); thus, foods high in Vitamin K should be avoided. This statement is in option B is correct and shows the patient understands foods that are LOW in Vitamin K. This statement in option D is also correct and shows that the patient understands the importance of regular BP assessment as well as when to call the provider based on the assessment

With which client should the nurse remain alert for the possibility of sepsis and septic shock? A) 41-year-old man who sustained closed depression fractures on the face when hit with a baseball. B) 53-year-old woman who had an open abdominal hysterectomy 3 days ago to remove several large fibroid tumors. C) 67-year-old woman on chronic corticosteroid therapy who had several teeth extracted 2 days ago. D) 72-year-old man with severe allergies who is undergoing radiation therapy for early-stage prostate cancer.

ANS: C. Anyone taking corticosteroids on a chronic basis has some degree of reduced immunity. This client also had oral surgery to remove teeth. This does constitute a blood exposure to organisms in the mouth because the mouth cannot be sterilized. Also, she is older than 65 years, which also increases her risks. Although the woman with the abdominal surgery also had blood exposure, this was done under sterile surgical conditions and she has no other risk factors. The client with closed depression fractures has no risk factors. The man with prostate cancer, although at some risk because of age, is not placed at further risk by either his early-stage cancer or the radiation therapy.

The health care provider prescribes warfarin (Coumadin) for a client with atrial fibrillation. Which statement made by the client indicates additional education is needed? A) "I need to go to the clinical once a week to have my blood level checked." B) "If my stools turn black, I will be sure to call my healthcare provider" C) "I'm glad I do not need to change my diet. Salads are my favorite food." D) "I need to stop taking my herbal supplement"

ANS: C. Patients on Coumadin therapy need to avoid foods high in Vitamin K including green leafy vegetables; INR needs to be measured frequently; black stools are a sign of bleeding and should be reported; herbal medications interfere with functioning of coumadin.

The nurse is teaching a client with a newly diagnosed cardiovascular disorder. Which statement made by the client demonstrates health promotion? A) "My heart disease will go away when I cut down to one cigarette a day." B) "I'm glad I don't have to change my diet and continue to eat whatever I want." C) "I need to get at least 150 minutes of moderate exercise a week." D) "I finally have my blood pressure to a normal level of 150/85."

ANS: C. The statement in answer C shows that the client demonstrates health promotion. Answer A - This client needs additional education regarding smoking cessation. Certainly, decreasing cigarette smoking is helpful. However, any amount of smoking increases cardiovascular risk. A decrease in smoking will not cause heart disease to go away. Answer B - This patient requires further teaching regarding a healthy heart diet that is low in fat and sodium. Answer D - This client requires further teaching regarding normal blood pressure values.

A client in the telemetry unit is on a cardiac monitor. The monitor technician notices there are no ECG complexes and the alarm sounds. What is the first action by the nurse? A) Suspend the alarm. B) Call the emergency response team. C) Press the record button to get an ECG strip. D) Assess the client and check lead placement.

ANS: D. ALWAYS check the patient first. Cardiac monitors are a tool for assessment but they do not replace hands on nursing assessment.

The nurse is caring for a client with intermittent claudication pain related to peripheral arterial disease. Which statement made by the client indicates understanding of proper self-management? A) "I need to reduce the number of cigarettes that I smoke each day." B) "I will elevate my legs above the level of my heart." C) "I will use a heating pad to promote circulation." D) "I will start to exercise gradually, stopping when I have pain."

ANS: D. Gradual exercise can improve collateral circulation and decrease pain associated with intermittent claudication. Teach the client to walk until they have pain, then to stop and rest, only to resume walking again. This promotes collateral development. Complete abstinence from smoking is essential to prevent vasoconstriction. While maintaining warmth is good to promote vasodilation, use of a heating pad is not safe due to the decreased sensation that can occur. Elevation of the extremities may be beneficial to reduce swelling; however, they should not be elevated above the heart level.

A client with chronic heart failure presents to the ED with a new onset of atrial fibrillation. Which of the following medications would the nurse question? A) Lasix (furosemide) B) Toprol XL (metoprolol succinate) C) Cardizem (diltiazem) D) Corlanor (ivabradine)

ANS: D. Ivabradine is contraindicated in the presence of atrial fibrillation and should be stopped.

_____: In the electrocardiogram, the deflection that follows the T wave and may result from slow repolarization of ventricular Purkinje fibers. When present, it is of the same polarity as the T wave, although generally smaller. Abnormal prominence of the U wave suggests an electrolyte abnormality or other disturbance.

U wave

_____: A wound dressing constructed of gauze moistened with zinc oxide; used to promote venous return in the ambulatory patient with a stasis ulcer and to form a sterile environment for the ulcer. The boot is applied to the affected limb, from the toes to the knee, after the ulcer has been cleaned with normal saline solution and covered with an elastic wrap. The dressing hardens like a cast.

Unna boot

_____: Nonsurgical management of cardiac dysrhythmias that is intended to induce vagal stimulation of the cardiac conduction system, specifically the sinoatrial and atrioventricular nodes. Vagal maneuvers may be attempted to terminate supraventricular tachydysrhythmia.

Vagal maneuver

Which new assessment finding in a client being treated for hypovolemic shock indicates to the nurse that interventions are currently effective? A) Oxygen saturation remains unchanged. B) Core body temperature has increased to 99°F (37.2°C). C) The client correctly states the month and the year. D) Serum lactate and the serum potassium levels are declining.

ANS: D. Serum lactate levels and serum potassium levels both rise when shock progresses and more tissues are metabolizing under anaerobic conditions. A decline in both values indicates that the client is responding to the current interventions for hypovolemic shock. Oxygen saturation staying the same suggests that the shock is not progressing at this time but does not indicate the interventions are correcting shock. The increase in body temperature is not great enough to indicate improvement or worsening of shock. The fact that the client can correctly state the month and the year by itself does not indicate improvement because information is not provided about his or her earlier cognition or level of consciousness.

Which client would most likely be misdiagnosed for having a myocardial infarction? 1. A 55-year-old Caucasian male with crushing chest pain and diaphoresis. 2. A 60-year-old Native American male with an elevated troponin level. 3. A 40-year-old Hispanic female with a normal electrocardiogram. 4. An 80-year-old Peruvian female with a normal CK-MB at 12 hours.

ANSWER 3. 1. Crushing pain and sweating are classic signs of an MI and should not be misdiagnosed. 2. An elevated troponin level is a benchmark in diagnosing an MI and should not be misdiagnosed. 3. The clients who are misdiagnosed concerning MIs usually present with atypical symptoms. They tend to be female, be younger than 55 years old, be members of a minority group, and have normal electrocardiograms. 4. CK-MB may not elevate until up to 24 hours after onset of chest pain.

The home health nurse is assigned a client diagnosed with heart failure. Which should the nurse implement? Select all that apply. 1. Request a dietary consult for a sodiumrestricted diet. 2. Instruct the client to elevate the feet during the day. 3. Teach the client to weigh every morning wearing the same type of clothing. 4. Assess for edema in dependent areas of the body. 5. Encourage the client to drink at least 3,000 mL of fluid per day. 6. Have the client repeat back instructions to the nurse.

ANSWER: 1, 2, 3, 4, 6. 1. A dietitian can assist the nurse in explaining the sodium restrictions to the client as well as hidden sources of sodium. 2. This will help the client's body to return excess fluid to the heart for removal from the body by the kidneys. 3. The client should weigh himself/herself every morning in the same type of clothing (gown, underwear, jeans, etc.) and report a weight gain of 3 pounds in a week to the HCP. 4. The nurse should not assess for edema in the feet and lower legs, but if the client is in bed the lowest part of the body may be in the sacral area. Whichever area is dependent is where the nurse should look for edema. 5. The client should drink enough fluids to maintain body function, but 3,000 mL is excessive. 6. Whenever the nurse is instructing a client, the nurse should determine if the client heard and understood the instructions. Having the client repeat the instructions is one way of determining "hearing." Having the client return demonstrate is a method of determining understanding. TEST-TAKING HINT: The new NCLEX-RN test plan report states that "Select all that apply" questions may have five (5) to six (6) options, and one option must be correct but all may be correct. In order to answer a "Select all that apply" question each option is considered separately as a true/false question.

_____: Regurgitation of any heart valve.

Valvular regurgitation

_____: A type of angina caused by coronary vasospasm (vessel spasm); usually associated with elevation of the ST segment on an electrocardiogram obtained during anginal attacks.

Variant (Prinzmetal's) angina

_____: Distended, protruding veins that appear darkened and tortuous; common in patients older than 30 years whose occupations require prolonged standing. As the vein wall weakens and dilates, venous pressure increases and the valves become incompetent (defective). The incompetent valves enhance the vessel dilation, and the veins become tortuous and distended.

Varicose veins

_____: Decrease in diameter of blood vessels.

Vasoconstriction

_____: A sudden and transient constriction of a blood vessel.

Vasospasm

_____: System used to categorize antidysrhythmic agents according to their effects on the action potential of cardiac cells.

Vaughn-Williams classifcation

_____: Alteration of venous efficiency by thrombosis or defective valves; caused by prolonged venous hypertension, which stretches the veins and damages the valves, resulting in further venous hypertension, edema, and, eventually, venous stasis ulcers, swelling, and cellulitis.

Venous insufficiency

_____: A term that refers to both deep vein thrombosis and pulmonary embolism; obstruction by a thrombus.

Venous thromboembolism (VTE)

The client has just had a pericardiocentesis. Which interventions should the nurse implement? Select all that apply. 1. Monitor vital signs every 15 minutes for the first hour. 2. Assess the client's heart and lung sounds. 3. Record the amount of fluid removed as output. 4. Evaluate the client's cardiac rhythm. 5. Keep the client in the supine position.

ANSWER: 1, 2, 3, 4. 1. The nurse should monitor the vital signs for any client who has just undergone surgery. 2. A pericardiocentesis involves entering the pericardial sac. Assessing heart and lung sounds allows assessment for cardiac failure. 3. The pericardial fluid is documented as output. 4. Evaluating the client's cardiac rhythm allows the nurse to assess for cardiac failure, which is a complication of pericardiocentesis. 5. The client should be in the semi-Fowler's position, not in a flat position, which increases the workload of the heart. TEST-TAKING HINT: This is an alternate-type question that requires the test taker to select possibly more than one option as a correct answer.

_____: The complete absence of any ventricular rhythm. There are no electrical impulses in the ventricles and therefore no ventricular depolarization, no QRS complex, no contraction, no cardiac output, and no pulse, respirations, or blood pressure. The patient is in full cardiac arrest.

Ventricular asystole

_____: A cardiac dysrhythmia that results from electrical chaos in the ventricles; impulses from many irritable foci fire in a totally disorganized manner so that ventricular contraction cannot occur; there is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully terminated within 3 to 5 minutes.

Ventricular fibrillation (VF)

_____: An abnormal third heart sound that arises from vibrations of the valves and supporting structures and is produced during the rapid passive filling phase of ventricular diastole when blood flows from the atrium to a noncompliant ventricle. In patients older than 35 years, it is an early sign of heart failure or ventricular septal defect.

Ventricular gallop

Which signs/symptoms should the nurse assess in any client who has a long-term valvular heart disease? Select all that apply. 1. Paroxysmal nocturnal dyspnea. 2. Orthopnea. 3. Cough. 4. Pericardial friction rub. 5. Pulsus paradoxus.

ANSWER: 1, 2, 3. 1. Paroxysmal nocturnal dyspnea is a sudden attack of respiratory distress, usually occurring at night because of the reclining position, and occurs in valvular disorders. 2. This is an abnormal condition in which a client must sit or stand to breathe comfortably and occurs in valvular disorders. 3. Coughing occurs when the client with long-term valvular disease has difficulty breathing when walking or performing any type of activity. 4. Pericardial friction rub is a sound auscultated in clients with pericarditis, not valvular heart disease. 5. Pulsus paradoxus is a marked decrease in amplitude during inspiration. It is a sign of cardiac tamponade, not valvular heart disease. TEST-TAKING HINT: The test taker should notice that options "1," "2," and "3" are all signs/symptoms that have something to do with the lungs. It would be a good choice to select these three as correct answers. They are similar in description.

Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? Select all that apply. 1. Encourage a low-fat, low-cholesterol diet. 2. Instruct the client to walk 30 minutes a day. 3. Decrease the salt intake to two (2) g a day. 4. Refer to a counselor for stress reduction techniques. 5. Teach the client to increase fiber in the diet

ANSWER: 1, 2, 4, 5. 1. A low-fat, low-cholesterol diet will help decrease the buildup of atherosclerosis in the arteries. 2. Walking will help increase collateral circulation. 3. Salt should be restricted in the diet of a client with hypertension, not coronary artery disease. 4. Stress reduction is encouraged for clients with CAD because this helps prevent excess stress on the heart muscle. 5. Increasing fiber in the diet will help remove cholesterol via the gastrointestinal system. TEST-TAKING HINT: This is an alternate-type question where the test taker must select all interventions that are applicable to the situation. Coronary artery disease is a common disease, and the nurse must be knowledgeable about ways to modify risk factors.

_____: (1) Progressive myocyte (myocardial cell) contractile dysfunction over time; results from activation of the renin-angiotensin system caused by reduced blood flow to the kidneys, a common occurrence in low-output states; (2) after a myocardial infarction, permanent changes in the size and shape of the left ventricle due to scar tissue; such remodeling may decrease left ventricular function, cause heart failure, and increase morbidity and mortality.

Ventricular remodeling

_____: An abnormal heart rhythm that occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more.

Ventricular tachycardia (VT)

_____: The surgical excision of a portion of the hypertrophied ventricular septum to create a widened outflow tract in patients with obstructive hypertrophic cardiomyopathy.

Ventriculomyomectomy (ventricular septal myectomy)

_____: The occurrence of stasis of blood flow, endothelial injury, or hypercoagulability; often associated with thrombus formation.

Virchow's triad

The nurse identifies the concept of altered tissue perfusion related to a client admitted with atrial fibrillation. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's blood pressure and apical rate every four (4) hours. 2. Place the client on intake and output every shift. 3. Require the client to sleep with the head of the bed elevated. 4. Teach the patient to perform Buerger Allen exercises daily. 5. Determine if the client is on an antiplatelet or anticoagulant medication. 6. Assess the client's neurological status every shift and prn.

ANSWER: 1, 2, 5, 6. 1. The client should be monitored for any cardiovascular changes. 2. The client should be monitored for the development of heart failure as a result of increased strain on the heart from the atria not functioning as they should. 3. There is no evidence that the client requires to sleep in the orthopneic position. 4. Buerger Allen exercises are useful for clients who have peripheral artery disease but do not have an effect on atrial fibrillation. 5. Clients who have been diagnosed with atrial fibrillation are at risk for developing emboli from the stasis of blood in the atria. If an emboli breaks loose from the lining of the atria then it can travel to the lungs (right) or to the brain (left). 6. Clients who have been diagnosed with atrial fibrillation are at risk for developing emboli from the stasis of blood in the atria. If an emboli breaks loose from the lining of the atria then it can travel to the lungs (right) or to the brain (left). TEST-TAKING HINT: To answer "Select all that apply" questions the test taker should look at each option independently of the others. Each option becomes a true/false question.

The client is in ventricular fibrillation. Which interventions should the nurse implement? Select all that apply. 1. Start cardiopulmonary resuscitation. 2. Prepare to administer the antidysrhythmic adenosine IVP. 3. Prepare to defibrillate the client. 4. Bring the crash cart to the bedside. 5. Prepare to administer the antidysrhythmic amiodarone IVP.

ANSWER: 1, 3, 4, 5. 1. Ventricular fibrillation indicates the client does not have a heartbeat. Therefore, CPR should be instituted. 2. Adenosine, an antidysrhythmic, is the drug of choice for supraventricular tachycardia, not for ventricular fibrillation. 3. Defibrillation is the treatment of choice for ventricular fibrillation. 4. The crash cart has the defibrillator and is used when performing advanced cardiopulmonary resuscitation. 5. Amiodarone is an antidysrhythmic that is used in ventricular dysrhythmias. TEST-TAKING HINT: This is an alternate-type question that requires the test taker to possibly select more than one option. To receive credit, the test taker must select all correct options; partial credit is not given for this type of question.

The nurse is working with a group of new graduates on a medical-surgical unit. Which should the nurse explain about completing first morning rounds on clients? 1. Perform a "down and dirty" assessment on each client soon after receiving report. 2. Determine which client should have a bath and inform the unlicensed assistive personnel. 3. Give all the clients a wet wash to wash the face and a toothbrush and toothpaste. 4. Pick up any paper on the floor and get the room ready for morning physician rounds.

ANSWER: 1. 1. "Down and dirty" rounds include assessing each client for the main focus of the client's admission or any new issue that is reported from the shift report and assessing all lines and tubes going into or coming out of the client. Once this is done the nurse knows then that the client is stable and a full head-to-toe assessment can be done at a later time. 2. The UAP will determine when and how to accomplish the job; the nurse may assist the UAP by informing the UAP of situations which may impact the timing of the baths, but this is not the purpose of morning rounds. 3. This is the UAP's job. 4. This is not the purpose of morning rounds. TEST-TAKING HINT: Option "3" has the word "all," which could eliminate it from consideration because rarely does an "all" apply. Options "2" and "3" are doing the UAP's job and option "4" is the housekeeping's job.

The client diagnosed with an ST elevation myocardial infarction (STEMI) has developed 2+ edema bilaterally of the lower extremities and has crackles in all lung fields. Which should the nurse implement first? 1. Notify the health care provider (HCP). 2. Assess what the client ate at the last meal. 3. Request a STAT 12 lead electrocardiogram. 4. Administer furosemide IVP.

ANSWER: 1. 1. "Has developed" indicates a new issue; the nurse should notify the HCP of the assessment findings, which indicate that the client has developed heart failure. 2. What the client ate has no bearing on the new development of the clinical manifestations of heart failure. 3. A 12-lead ECG will not treat heart failure. 4. A diuretic may need to be administered but notifying the HCP is first. TEST-TAKING HINT: The test taker should read every word in the stem of the question; "has developed" indicates a newly occurring situation for the client. The nurse must notify the HCP when new issues occur in order to intervene before a failure to rescue issue occurs.

The client has chronic atrial fibrillation. Which discharge teaching should the nurse discuss with the client? 1. Instruct the client to use a soft-bristle toothbrush. 2. Discuss the importance of getting a monthly partial thromboplastin time (PTT). 3. Teach the client about signs of pacemaker malfunction. 4. Explain to the client the procedure for synchronized cardioversion.

ANSWER: 1. 1. A client with chronic atrial fibrillation will be taking an anticoagulant to help prevent clot formation. Therefore, the client is at risk for bleeding and should be instructed to use a soft-bristle toothbrush. 2. The client will need a regularly scheduled INR to determine the therapeutic level for the anticoagulant warfarin (Coumadin); PTT levels are monitored for heparin. 3. A client with symptomatic sinus bradycardia, not a client with atrial fibrillation, may need a pacemaker. 4. Synchronized cardioversion may be prescribed for new-onset atrial fibrillation but not for chronic atrial fibrillation. TEST TAKING HINT: In order to choose the correct answer for this question the test taker must recognize the disease process, then know what complications are possible, and finally the test-taker must know how the client can possibly be treated so that the complication does not occur.

The nurse has received shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease complaining of severe indigestion. 2. The client diagnosed with congestive heart failure who has 3+ pitting edema. 3. The client diagnosed with atrial fibrillation whose apical rate is 110 and irregular. 4. The client diagnosed with sinus bradycardia who is complaining of being constipated.

ANSWER: 1. 1. A complaint of indigestion could be cardiac chest pain. The nurse should assess this client because of the diagnosis of CAD and the word "severe" in the option. 2. Edema is expected for the client diagnosed with heart failure, and it is not life threatening. 3. An irregular heart rate is not life threatening, and 110 is abnormal but also not life threatening. 4. Constipation is not life threatening albeit uncomfortable. TEST-TAKING HINT: A first makes the test taker determine which client has the greatest need. Expected and not life-threatening issues do not require being a priority.

The client diagnosed with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this client? 1. Prepare for a pericardiocentesis. 2. Request STAT cardiac enzymes. 3. Perform a 12-lead electrocardiogram. 4. Assess the client's heart and lung sounds.

ANSWER: 1. 1. A pericardiocentesis removes fluid from the pericardial sac and is the emergency treatment for cardiac tamponade. 2. Cardiac enzymes may be slightly elevated because of the inflammatory process, but evaluation of these would not be ordered to treat or evaluate cardiac tamponade. 3. A 12-lead ECG would not help treat the medical emergency of cardiac tamponade. 4. Assessment by the nurse is not collaborative; it is an independent nursing action. TEST-TAKING HINT: "Collaborative" means another member of the health-care team must order or participate in the intervention. Therefore, option "4" could be eliminated as a possible correct answer.

The nurse is functioning in the role of medication nurse during a code. Which should the nurse implement when administering amiodarone for ventricular tachycardia? 1. Mix the medication in 100 mL of fluid and administer rapidly. 2. Push the amiodarone directly into the nearest IV port and raise the arm. 3. Question the physician's order because it is not ACLS recommended. 4. Administer via an IV pump based on mg/kg/min.

ANSWER: 1. 1. Amiodarone is administered during a code rapidly after being mixed in 100 mL of fluid. 2. Amiodarone is not pushed; lidocaine is administered by this method. Amiodarone is replacing the use of lidocaine during a code because of evidence-based practice. 3. Amiodarone is ACLS recommended. 4. Dopamine is administered via mg/kg/min. The time to calculate this kind of dosage is not taken until after the code is concluded and the client is placed on a vasopressor medication such as dopamine. TEST-TAKING HINT: The test taker should be knowledgeable of common medications and basic rules of administration.

The client is experiencing multifocal premature ventricular contractions. Which antidysrhythmic medication would the nurse expect the healthcare provider to order for this client? 1. Amiodarone. 2. Atropine. 3. Digoxin. 4. Adenosine.

ANSWER: 1. 1. Amiodarone suppresses ventricular ectopy and is the drug of choice for ventricular dysrhythmias. 2. Atropine decreases vagal stimulation and is the drug of choice for asystole. 3. Digoxin slows heart rate and increases cardiac contractility and is the drug of choice for atrial fibrillation. 4. Adenosine is the drug of choice for supraventricular tachycardia. TEST-TAKING HINT: This is a knowledge-based question, and the test taker must know the answer. The nurse must know what medications treat specific dysrhythmias.

The nurse on the telemetry unit has just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with myocardial infarction who has an audible S3 heart sound. 2. The client diagnosed with congestive heart failure who has 4+ sacral pitting edema. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 94%. 4. The client with chronic renal failure who has an elevated creatinine level

ANSWER: 1. 1. An S3 heart sound indicates left ventricular failure, and the nurse must assess this client first because it is an emergency situation. 2. The nurse would expect a client with CHF to have sacral edema of 4+; the client with an S3 would be in a more life-threatening situation. 3. A pulse oximeter reading of greater than 93% is considered normal. 4. An elevated creatinine level is expected in a client diagnosed with chronic renal failure. TEST-TAKING HINT: Because the nurse will be assessing each client, the test taker must determine which client is a priority. A general guideline for this type of question is for the test taker to ask "Is this within normal limits?" or "Is this expected for the disease process?" If the answer is yes to either question, then the test taker can eliminate these options and look for abnormal data that would make that client a priority.

The intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement? 1. Notify the health-care provider immediately. 2. Elevate the head of the client's bed. 3. Document this as a normal and expected finding. 4. Administer morphine intravenously

ANSWER: 1. 1. An S3 indicates left ventricular failure and should be reported to the health-care provider. It is a potential life-threatening complication of a myocardial infarction. 2. Elevating the head of the bed will not do anything to help a failing heart. 3. This is not a normal finding; it indicates heart failure. 4. Morphine is administered for chest pain, not for heart failure, which is suggested by the S3 sound. TEST-TAKING HINT: There are some situations in which the nurse must notify the healthcare provider, and the test taker should not automatically eliminate this as a possible correct answer. The test taker must decide if any of the other three options will help correct a life-threatening complication. Normal assessment concepts should help identify the correct option. The normal heart sounds are S1 and S2 ("lubb-dupp"); S3 is abnormal.

The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure? 1. An elevated B-type natriuretic peptide (BNP). 2. An elevated creatine kinase (CK-MB). 3. A positive D-dimer. 4. A positive ventilation/perfusion (V/Q) scan.

ANSWER: 1. 1. BNP is a specific diagnostic test. Levels higher than normal indicate congestive heart failure, with the higher the number, the more severe the CHF. 2. An elevated CK-MB would indicate a myocardial infarction, not severe CHF. CK-MB is an isoenzyme. 3. A positive D-dimer would indicate a pulmonary embolus. 4. A positive ventilation/perfusion (V/Q) scan (ratio) would indicate a pulmonary embolus. TEST-TAKING HINT: This question requires the test taker to discriminate among CHF, MI, and PE. If unsure of the answer of this type of question, the test taker should eliminate any answer options that the test taker knows are wrong. For example, the test taker may not know about pulmonary embolus but might know that CK-MB data are used to monitor MI and be able to eliminate option "2" as a possibility. Then, there is a 1:3 chance of getting the correct answer

The nurse identifies the concept of tissue perfusion as a client problem. Which is an antecedent of tissue perfusion? 1. The client has a history of coronary artery disease (CAD). 2. The client has a history of diabetes insipidus (DI). 3. The client has a history of chronic obstructive pulmonary disease (COPD). 4. The client has a history of multiple fractures from a motor-vehicle accident.

ANSWER: 1. 1. CAD narrows the arteries of the heart, causing the tissues not to be perfused, especially when an embolus or a thrombus occurs. 2. DI is a disease of the pituitary gland or the kidneys; it is not a perfusion issue. 3. COPD is an oxygenation issue, not a perfusion one. 4. Multiple fractures do not cause perfusion issues unless an interrelated issue occurs. TEST-TAKING HINT: The test taker should remember basic pathophysiology and the resulting problems associated with different pathology

The nurse is assisting with a synchronized cardioversion on a client in atrial fibrillation. When the machine is activated, there is a pause. What action should the nurse take? 1. Wait until the machine discharges. 2. Shout "all clear" and don't touch the bed. 3. Make sure the client is all right. 4. Increase the joules and redischarge.

ANSWER: 1. 1. Cardioversion involves the delivery of a timed electrical current. The electrical impulse discharges during ventricular depolarization and, therefore, there might be a short delay. The nurse should wait until it discharges. 2. Calling "all clear" and not touching the bed should be done prior to activating the machine to discharge the electrical current. 3. A pause is an expected event, and asking if the client is all right may worry the client unnecessarily. 4. Increasing joules and redischarging is implemented during defibrillation, not during synchronized cardioversion.

A client is being seen in the clinic to rule out (R/O) mitral valve stenosis. Which assessment data would be most significant? 1. The client complains of shortness of breath when walking. 2. The client has jugular vein distention and 3+ pedal edema. 3. The client complains of chest pain after eating a large meal. 4. The client's liver is enlarged and the abdomen is edematous.

ANSWER: 1. 1. Dyspnea on exertion (DOE) is typically the earliest manifestation of mitral valve stenosis. 2. Jugular vein distention (JVD) and 3+ pedal edema are signs/symptoms of right-sided heart failure and indicate worsening of the mitral valve stenosis. These signs would not be expected in a client with early manifestations of mitral valve stenosis. 3. Chest pain rarely occurs with mitral valve stenosis. 4. An enlarged liver and edematous abdomen are late signs of right-sided heart failure that can occur with long-term untreated mitral valve stenosis. TEST-TAKING HINT: Whenever the test taker reads "rule out," the test taker should look for data that would not indicate a severe condition of the body system that is affected. Chest pain, JVD, and pedal edema are late signs of heart problems

The client had open-heart surgery to replace the mitral valve. Which intervention should the intensive care unit nurse implement? 1. Restrict the client's fluids as ordered. 2. Keep the client in the supine position. 3. Maintain oxygen saturation at 90%. 4. Monitor the total parenteral nutrition

ANSWER: 1. 1. Fluid intake may be restricted to reduce the cardiac workload and pressures within the heart and pulmonary circuit. 2. The head of the bed should be elevated to help improve alveolar ventilation. 3. Oxygen saturation should be no less than 93%; 90% indicates an arterial oxygen saturation of around 60 (normal is 80 to 100). 4. Total parenteral nutrition would not be prescribed for a client with mitral valve replacement. It is ordered for clients with malnutrition, gastrointestinal disorders, or conditions in which increased calories are needed, such as burns. TEST-TAKING HINT: A client with a heart or lung problem should never have the head of the bed in a flat (supine) position; therefore, option "2" should be eliminated as a possible correct answer. The test taker must know normal values for monitoring techniques such as pulse oximeters and keep a list of normal values.

Which medical client problem should the nurse include in the plan of care for a client diagnosed with cardiomyopathy? 1. Heart failure. 2. Activity intolerance. 3. Powerlessness. 4. Anticipatory grieving.

ANSWER: 1. 1. Medical client problems indicate the nurse and the physician must collaborate to care for the client; the client must have medications for heart failure. 2. The nurse can instruct the client to pace activities and can teach about rest versus activity without a health care provider order. 3. This is a psychosocial client problem that does not require a physician's order to effectively care for the client. 4. Anticipatory grieving involves the nurse addressing issues that will occur based on the knowledge of the poor prognosis of this disease

The nurse is caring for a client diagnosed with coronary artery disease (CAD). Which should the nurse teach the client prior to discharge? 1. Carry your nitroglycerin tablets in a brown bottle. 2. Swallow a nitroglycerin tablet at the first sign of angina. 3. If one nitroglycerin tablet does not work in 10 minutes, take another. 4. Nitroglycerin tablets have a fruity odor if they are potent

ANSWER: 1. 1. Nitroglycerin tablets are dispensed in small brown bottles to preserve the potency. The client should not change the tablets to another container. 2. The tablets are placed under the tongue to dissolve and thereby work more rapidly. 3. The client is taught to take one (1) tablet every 5 minutes and if the angina is not relieved to call 911. 4. The tablets do not have a fruity odor; they sting when placed under the tongue if they are potent. TEST-TAKING HINT: The test taker should be knowledgeable of common medications and what to teach the client.

The client with coronary artery disease is prescribed a Holter monitor. Which intervention should the nurse implement? 1. Instruct the client to keep a diary of activity, especially when having chest pain. 2. Discuss the need to remove the Holter monitor during a.m. care and showering. 3. Explain that all medications should be withheld while wearing a Holter monitor. 4. Teach the client the importance of decreasing activity while wearing the monitor

ANSWER: 1. 1. The Holter monitor is a 24-hour electrocardiogram, and the client must keep an accurate record of activity so that the health-care provider can compare the ECG recordings with different levels of activity. 2. The Holter monitor should not be removed for any reason. 3. All medications should be taken as prescribed. 4. The client should perform all activity as usual while wearing the Holter monitor so the HCP can get an accurate account of heart function during a 24-hour period. TEST-TAKING HINT: In some instances, the test taker must be knowledgeable about diagnostic tests and there are no test-taking hints. The test taker might eliminate option "3" by realizing that, unless the client is NPO for a test or surgery, medications are usually taken.

The client's telemetry reading shows a P wave before each QRS complex and the rate is 78. Which action should the nurse implement? 1. Document this as normal sinus rhythm. 2. Request a 12-lead electrocardiogram. 3. Prepare to administer the cardiotonic digoxin PO. 4. Assess the client's cardiac enzymes.

ANSWER: 1. 1. The P wave represents atrial contraction, and the QRS complex represents ventricular contraction—a normal telemetry reading. A rate between 60 and 100 indicates normal sinus rhythm. Therefore, the nurse should document this as normal sinus rhythm and not take any action. 2. A 12-lead ECG should be requested for chest pain or abnormal dysrhythmias. 3. Digoxin is used to treat atrial fibrillation. 4. Cardiac enzymes are monitored to determine if the client has had a myocardial infarction. Nothing in the stem indicates the client has had an MI. TEST-TAKING HINT: The test taker must know normal sinus rhythm, and there are no testtaking hints to help eliminate incorrect options. The test taker should not automatically select assessment as the correct answer, but if the test taker had no idea of the answer, remember assessment of laboratory data is not the same as assessing the client

The client comes to the emergency department saying, "I am having a heart attack." Which question is most pertinent when assessing the client? 1. "Can you describe your chest pain?" 2. "What were you doing when the pain started?" 3. "Did you have a high-fat meal today?" 4. "Does the pain get worse when you lie down?"

ANSWER: 1. 1. The chest pain for an MI usually is described as an elephant sitting on the chest or a belt squeezing the substernal midchest, often radiating to the jaw or left arm. 2. This helps to identify if it is angina (resulting from activity) or MI (not necessarily brought on by activity). 3. Learning about a client's intake of a high-fat meal would help the nurse to identify a gallbladder attack. 4. This is a question the nurse might ask the client with reflux esophagitis.

The client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" Which response by the nurse is most appropriate? 1. "You are at risk of developing an infection in your heart." 2. "Your teeth will not bleed as much if you have antibiotics." 3. "This procedure may cause your valve to malfunction." 4. "Antibiotics will prevent vegetative growth on your valves."

ANSWER: 1. 1. The client is at risk for developing endocarditis and should take prophylactic antibiotics before any invasive procedure. 2. Antibiotics have nothing to do with how much the teeth bleed during a cleaning. 3. Teeth cleaning will not cause the valve to malfunction. 4. Vegetation develops on valves secondary to bacteria that cause endocarditis, but the client may not understand "vegetative growth on your valves"; therefore, this is not the most appropriate answer. TEST-TAKING HINT: The test taker should select an option that answers the client's question in the easiest and most understandable terms, not in medical jargon. This would cause the test taker to eliminate option "4" as a possible correct answer. The test taker should know antibiotics do not affect bleeding and so can eliminate option "2."

The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client? 1. Apical pulse rate of 110 and 4+ pitting edema of feet. 2. Thick white sputum and crackles that clear with cough. 3. The client sleeping with no pillow and eupnea. 4. Radial pulse rate of 90 and CRT less than three (3) seconds.

ANSWER: 1. 1. The client with CHF would exhibit tachycardia (apical pulse rate of 110), dependent edema, fatigue, third heart sounds, lung congestion, and change in mental status. 2. The client with CHF usually has pink frothy sputum and crackles that do not clear with coughing. 3. The client with CHF would report sleeping on at least two pillows, if not sleeping in an upright position, and labored breathing, not eupnea, which means normal breathing. 4. In a client diagnosed with heart failure, the apical pulse, not the radial pulse, is the best place to assess the cardiac status. TEST-TAKING HINT: In option "3," the word "no" is an absolute term and, usually, absolutes, such as "no," "never," "always," and "only," are incorrect because there is no room for any other possible answer. If the test taker is looking for abnormal data, then the test taker should exclude the options that have normal values in them, such as eupnea, pulse rate of 90, and capillary refill time (CRT) less than three (3) seconds.

The client diagnosed with a myocardial infarction asks the nurse, "Why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response? 1. "Your heart is damaged and needs about four (4) to six (6) weeks to heal." 2. "There is necrotic myocardial tissue that puts you at risk for dysrhythmias." 3. "Your doctor has ordered bedrest. Therefore, you must stay in the bed." 4. "Just because your chest doesn't hurt anymore doesn't mean you are out of danger."

ANSWER: 1. 1. The heart tissue is dead, stress or activity may cause heart failure, and it does take about six (6) weeks for scar tissue to form. 2. The nurse should talk to the client in layperson's terms, not medical terms. Medical terminology is a foreign language to most clients. 3. This is not answering the client's question. The nurse should take any opportunity to teach the client. 4. This is a condescending response, and telling the client that he or she is not out of danger is not an appropriate response. TEST-TAKING HINT: When attempting to answer a client's question, the nurse should provide factual information in simple, understandable terms. The test taker should select the answer option that provides this type of information

Which meal would indicate the client understands the discharge teaching concerning the recommended diet for coronary artery disease? 1. Baked fish, steamed broccoli, and garden salad. 2. Enchilada dinner with fried rice and refried beans. 3. Tuna salad sandwich on white bread and whole milk. 4. Fried chicken, mashed potatoes, and gravy.

ANSWER: 1. 1. The recommended diet for CAD is low fat, low cholesterol, and high fiber. The diet described is a diet that is low in fat and cholesterol. 2. This is a diet very high in fat and cholesterol. 3. The word "salad" implies something has been mixed with the tuna, usually mayonnaise, which is high in fat, but even if the test taker did not know this, white bread is low in fiber and whole milk is high in fat. 4. Meats should be baked, broiled, or grilled— not fried. Gravy is high in fat.

The nurse is told in report the client has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur? 1. Second intercostal space, right sternal notch. 2. Erb's point. 3. Second intercostal space, left sternal notch. 4. Fourth intercostal space, left sternal border.

ANSWER: 1. 1. The second intercostal space, right sternal notch, is the area on the chest where the aorta can best be heard opening and closing. 2. Erb's point allows the nurse to hear the opening and closing of the tricuspid valve. 3. The second intercostal space, left sternal notch, is the area on the chest where the pulmonic valve can best be heard opening and closing. 4. The fourth intercostal space, left sternal border, is another area on the chest that can assess the tricuspid valve.

The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a client with a mechanical valve replacement. The client's INR is 2.7. Which action should the nurse implement? 1. Administer the medication as ordered. 2. Prepare to administer vitamin K (AquaMephyton). 3. Hold the medication and notify the HCP. 4. Assess the client for abnormal bleeding.

ANSWER: 1. 1. The therapeutic range for most clients' INR is 2 to 3, but for a client with a mechanical valve replacement it is 2 to 3.5. The medication should be given as ordered and not withheld. 2. Vitamin K is the antidote for an overdose of warfarin, but 2.7 is within the therapeutic range. 3. This laboratory result is within the therapeutic range, INR 2 to 3, and the medication does not need to be withheld. 4. There is no need for the nurse to assess for bleeding because 2.7 is within the therapeutic range. TEST-TAKING HINT: The test taker has to know the therapeutic range for the INR to be able to answer this question correctly. The test taker should keep a list of normal and therapeutic laboratory values that must be remembered.

The nurse is transcribing the doctor's orders for a client with congestive heart failure. The order reads 2.5 mg of Lanoxin daily. Which action should the nurse implement? 1. Discuss the order with the health-care provider. 2. Take the client's apical pulse rate before administering. 3. Check the client's potassium level before giving the medication. 4. Determine if a digoxin level has been drawn.

ANSWER: 1. 1. This dosage is 10 times the normal dose for a client with CHF. This dose is potentially lethal. 2. No other action can be taken because of the incorrect dose. 3. No other action can be taken because of the incorrect dose. 4. No other action can be taken because of the incorrect dose.

The client with coronary artery disease asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse? 1. "Chest pain is caused by decreased oxygen to the heart muscle." 2. "There is ischemia to the myocardium as a result of hypoxemia." 3. "The heart muscle is unable to pump effectively to perfuse the body." 4. "Chest pain occurs when the lungs cannot adequately oxygenate the blood."

ANSWER: 1. 1. This is a correct statement presented in layman's terms. When the coronary arteries cannot supply adequate oxygen to the heart muscle, there is chest pain. 2. This is the explanation in medical terms that should not be used when explaining medical conditions to a client. 3. This explains congestive heart failure but does not explain why chest pain occurs. 4. Respiratory compromise occurs when the lungs cannot oxygenate the blood, such as occurs with altered level of consciousness, cyanosis, and increased respiratory rate. TEST-TAKING HINT: The nurse must select the option that best explains the facts in terms a client who does not have medical training can understand.

The nurse assessing the client with pericardial effusion at 1600 notes the apical pulse is 72 and the BP is 138/94. At 1800, the client has neck vein distention, the apical pulse is 70, and the BP is 106/94. Which action would the nurse implement first? 1. Stay with the client and use a calm voice. 2. Notify the health-care provider immediately. 3. Place the client left lateral recumbent. 4. Administer morphine intravenous push slowly.

ANSWER: 1. 1. This is a medical emergency; the nurse should stay with the client, keep him calm, and call the nurses' station to notify the health-care provider. Cardiac output declines with each contraction as the pericardial sac constricts the myocardium. 2. The client's signs/symptoms would make the nurse suspect cardiac tamponade, a medical emergency. The pulse pressure is narrowing, and the client is experiencing severe rising central venous pressure as evidenced by neck vein distention. Notifying the health-care provider is important, but the nurse should stay with the client first. 3. A left lateral recumbent position is used when administering enemas. 4. Morphine would be given to a client with pain from myocardial infarction; it is not a treatment option for cardiac tamponade.

The client diagnosed with pericarditis is being discharged home. Which intervention should the nurse include in the discharge teaching? 1. Be sure to allow for uninterrupted rest and sleep. 2. Refer the client to outpatient occupational therapy. 3. Maintain oxygen via nasal cannula at two (2) L/min. 4. Discuss upcoming valve replacement surgery.

ANSWER: 1. 1. Uninterrupted rest and sleep help decrease the workload of the heart and help ensure the restoration of physical and emotional health. 2. Occupational therapy addresses activities of daily living. The client should be referred to physical therapy to develop a realistic and progressive plan of activity. 3. The client with pericarditis is not usually prescribed oxygen, and 2 L/min is a low dose of oxygen that is prescribed for a client with chronic obstructive pulmonary disease (COPD). 4. Endocarditis, not pericarditis, may lead to surgery for valve replacement. TEST-TAKING HINT: A concept that the test taker must remember with any client being discharged from the hospital should be to alternate rest with activity to avoid problems associated with immobility. If the test taker does not know the answer to a question, using basic concepts is the best option.

The client is diagnosed with acute pericarditis. Which sign/symptom warrants immediate attention by the nurse? 1. Muffled heart sounds. 2. Nondistended jugular veins. 3. Bounding peripheral pulses. 4. Pericardial friction rub.

ANSWER: 1. 1. Acute pericardial effusion interferes with normal cardiac filling and pumping, causing venous congestion and decreased cardiac output. Muffled heart sounds, indicative of acute pericarditis, must be reported to the health-care provider. 2. Distended, not nondistended, jugular veins would warrant immediate intervention. 3. Decreasing quality of peripheral pulses, not bounding peripheral pulses, would warrant immediate intervention. 4. A pericardial friction rub is a classic symptom of acute pericarditis, but it would not warrant immediate intervention. TEST-TAKING HINT: This is a priority setting question, the test taker should determine if the data provided is abnormal or expected for the the disease process. If so, then the test taker can consider the option as being the correct answer. If the data is within normal limits aor expected for the disease process then the option is not a priority.

Which data would cause the nurse to question administering digoxin to a client diagnosed with congestive heart failure? 1. The potassium level is 3.2 mEq/L. 2. The digoxin level is 1.2 mcg/mL. 3. The client's apical pulse is 64. 4. The client denies yellow haze.

ANSWER: 2, 3, 4. 1. This potassium level is below normal levels; hypokalemia can potentiate digoxin toxicity and lead to cardiac dysrhythmias. 2. This digoxin level is within therapeutic range, 0.5 to 2 mcg/mL. 3. The nurse would question the medication if the apical pulse were less than 60. 4. Yellow haze is a sign of digoxin toxicity.

The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select all that apply. 1. Obtain a midstream urine specimen. 2. Attach the telemetry monitor to the client. 3. Start a saline lock in the right arm. 4. Draw a basal metabolic panel (BMP). 5. Request an order for a STAT 12-lead ECG.

ANSWER: 2, 3, 5. 1. A midstream urine specimen is ordered for a client with a possible urinary tract infection, not for a client with cardiac problems. 2. Anytime a nurse suspects cardiac problems, the electrical conductivity of the heart should be assessed. 3. Emergency medications for heart problems are primarily administered intravenously, so starting a saline lock in the right arm is appropriate. 4. This serum blood test is not specific to assess cardiac problems. A BMP evaluates potassium, sodium, glucose, and more. 5. A 12-lead ECG evaluates the electrical conductivity of the heart from all planes

The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement? Select all that apply. 1. Administer morphine intramuscularly. 2. Administer an aspirin orally. 3. Apply oxygen via a nasal cannula. 4. Place the client in a supine position. 5. Administer nitroglycerin subcutaneously

ANSWER: 2, 3. 1. Morphine should be administered intravenously, not intramuscularly. 2. Aspirin is an antiplatelet medication and should be administered orally. 3. Oxygen will help decrease myocardial ischemia, thereby decreasing pain. 4. The supine position will increase respiratory effort, which will increase myocardial oxygen consumption; the client should be in the semi-Fowler's position. 5. Nitroglycerin, a coronary vasodilator, is administered sublingually, not subcutaneously. TEST-TAKING HINT: This is an alternate-type question that requires the test taker to select all options that are applicable. The test taker must identify all correct answer options to receive credit for a correct answer; no partial credit is given. Remember to read the question carefully—it is not meant to be tricky.

Which interventions should the nurse discuss with the client diagnosed with coronary artery disease? Select all that apply. 1. Instruct the client to stop smoking. 2. Encourage the client to exercise three (3) days a week. 3. Teach about coronary vasodilators. 4. Prepare the client for a carotid endarterectomy. 5. Eat foods high in monosaturated fats.

ANSWER: 2, 3. 1. Smoking is the one risk factor that must be stopped totally; there is no compromise. 2. Exercising helps develop collateral circulation and decrease anxiety; it also helps clients to lose weight. 3. Clients with coronary artery disease are usually prescribed nitroglycerin, which is the treatment of choice for angina. 4. Carotid endarterectomy is a procedure to remove atherosclerotic plaque from the carotid arteries, not the coronary arteries. 5. The client should eat polyunsaturated fats, not monosaturated fats, to help decrease atherosclerosis.

The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select all that apply. 1. Notify the health-care provider of a weight gain of more than one (1) pound in a week. 2. Teach the client how to count the radial pulse when taking digoxin, a cardiac glycoside. 3. Instruct the client to remove the saltshaker from the dinner table. 4. Encourage the client to monitor urine output for change in color to become dark. 5. Discuss the importance of taking the loop diuretic furosemide at bedtime.

ANSWER: 2, 3. 1. The client should notify the HCP of weight gain of more than two (2) or three (3) pounds in one (1) day. 2. The client should not take digoxin if the radial pulse is less than 60. 3. The client should be on a low-sodium diet to prevent water retention. 4. The color of the urine should not change to a dark color; if anything, it might become lighter and the amount will increase with diuretics. 5. Instruct the client to take the diuretic in the morning to prevent nocturia. TEST-TAKING HINT: This is an alternative-type question—in this case, "Select all that apply." If the test taker missed this statement, it is possible to jump at the first correct answer. This is one reason that it is imperative to read all options before deciding on the correct one(s). This could be a clue to reread the question for clarity. Another hint that this is an alternative question is the number of options. The other questions have four potential answers; this one has five. Numbers in an answer option are always important. Is one (1) pound enough to indicate a problem that should be brought to the attention of the health-care provider?

The client is in complete heart block. Which intervention should the nurse implement first? 1. Prepare to insert a pacemaker. 2. Administer atropine, an antidysrhythmic. 3. Obtain a STAT electrocardiogram (ECG). 4. Notify the health-care provider.

ANSWER: 2. 1. A pacemaker will have to be inserted, but it is not the first intervention. 2. Atropine will decrease vagal stimulation and increase the heart rate. Therefore, it is the first intervention. 3. A STAT ECG may be done, but the telemetry reading shows complete heart block, which is a life-threatening dysrhythmia and must be treated. 4. The HCP will need to be notified but not prior to administering a medication. The test taker must assume the nurse has the order to administer medication. Many telemetry departments have standing protocols. TEST-TAKING HINT: The test taker must select the intervention that should be implemented first and will directly affect the dysrhythmia. Medication is the first intervention, and then pacemaker insertion. The test taker should not eliminate an option because the test taker thinks there is not an order by a health-care provider

The client is admitted to the medical unit to rule out carditis. Which question should the nurse ask the client during the admission interview to support this diagnosis? 1. "Have you had a sore throat in the last month?" 2. "Did you have rheumatic fever as a child?" 3. "Do you have a family history of carditis?" 4. "What over-the-counter (OTC) medications do you take?"

ANSWER: 2. 1. A sore throat in the last month would not support the diagnosis of carditis. 2. Rheumatic fever, a systemic inflammatory disease caused by an abnormal immune response to pharyngeal infection by group A beta-hemolytic streptococci, causes carditis in about 50% of people who develop it. 3. Carditis is not a genetic or congenital disease process. 4. This is an appropriate question to ask any client, but OTC medications do not cause carditis. TEST-TAKING HINT: This is a knowledge-based question, but the test taker could eliminate option "4," realizing this is a question to ask any client, and the stem asks which question will support the diagnosis of carditis.

Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning diet? 1. "I will not eat more than six (6) eggs a week." 2. "I should bake or grill any meats I eat." 3. "I will drink eight (8) ounces of whole milk a day." 4. "I should not eat any type of pork products."

ANSWER: 2. 1. According to the American Heart Association, the client should not eat more than three (3) eggs a week, especially the egg yolk. 2. The American Heart Association recommends a low-fat, low-cholesterol diet for a client with coronary artery disease. The client should avoid any fried foods, especially meats, and bake, broil, or grill any meat. 3. The client should drink low-fat milk, not whole milk. 4. Pork products (bacon, sausage, ham) are high in sodium, which is prohibited in a low-salt diet, not a low-cholesterol, low-fat diet. TEST-TAKING HINT: The test taker must be knowledgeable of prescribed diets for specific disease processes. This is mainly memorizing facts. There is no test-taking hint to help eliminate any of the options.

_____: Tissue transplanted (grafted) from another species; for example, a heart valve transplanted from a pig to a human.

Xenograft

The 45-year-old male client diagnosed with essential hypertension has decided not to take his medications. The client's BP is 178/94, indicating a perfusion issue. Which question should the nurse ask the client first? 1. "Do you have the money to buy your medication?" 2. "Does the medication give unwanted side effects?" 3. "Did you quit taking the medications because you don't feel bad?" 4. "Can you tell me why you stopped taking the medication?"

ANSWER: 2. 1. Although this might be the cause of noncompliance, actual side effects of antihypertensive medications may be more likely. Evidence indicates that the side effect of erectile dysfunction is a major reason of noncompliance for males. 2. This is a mild way of introducing the subject of side effects to a client not wishing to admit the medication causes unwanted effects. It opens the door to more probing assessment questions. The nurse should bring up the subject in order to allow the client to be forthcoming with the issues of why he is not taking his medication. 3. This would be the second question to ask if the client denies any problems with side effects. 4. Although in this case the nurse can ask "why" because it is an interview question and not therapeutic conversation being requested in the stem, a more direct question will open the conversation up better. TEST-TAKING HINT: To answer this question the test taker must remember that all medications have potential side effects. Antihypertensive medications can cause erectile dysfunction in males, frequently resulting in noncompliance with the medication regimen. The issue is a psychological as well as a physiological one.

The nurse is developing a nursing care plan for a client diagnosed with congestive heart failure. A nursing diagnosis of "decreased cardiac output related to inability of the heart to pump effectively" is written. Which short-term goal would be best for the client? 1. The client will be able to ambulate in the hall by date of discharge. 2. The client will have an audible S1 and S2 with no S3 heard by end of shift. 3. The client will turn, cough, and deep breathe every two (2) hours. 4. The client will have a SaO2 reading of 98% by day two (2) of care.

ANSWER: 2. 1. Ambulating in the hall by day of discharge would be a more appropriate goal for an activity-intolerance nursing diagnosis. 2. Audible S1 and S2 sounds are normal for a heart with adequate output. An audible S3 sound might indicate left ventricular failure, which could be life threatening. 3. This is a nursing intervention, not a short-term goal, for this client. 4. A pulse oximeter reading would be a goal for impaired gas exchange, not for cardiac output. TEST-TAKING HINT: When reading a nursing diagnosis or problem, the test taker must be sure that the answer selected addresses the problem. An answer option may be appropriate care for the disease process but may not fit with the problem or etiology. Remember, when given an etiology in a nursing diagnosis, the answer will be doing something about the problem (etiology). In this question the test taker should look for an answer that addresses the ability of the heart to pump blood.

Which client would the nurse suspect of having a mitral valve prolapse? 1. A 60-year-old female with congestive heart failure. 2. A 23-year-old male with Marfan's syndrome. 3. An 80-year-old male with atrial fibrillation. 4. A 33-year-old female with Down syndrome.

ANSWER: 2. 1. Congestive heart failure does not predispose the female client to having a mitral valve prolapse. 2. Clients with Marfan's syndrome have lifethreatening cardiovascular problems, including mitral valve prolapse, progressive dilation of the aortic valve ring, and weakness of the arterial walls, and they usually do not live past the age of 40 because of dissection and rupture of the aorta. 3. Atrial fibrillation does not predispose a client to mitral valve prolapse. 4. A client with Down syndrome may have congenital heart anomalies but not mitral valve prolapse. TEST-TAKING HINT: The test taker could eliminate options "1" and "3" based on knowledge that these are commonly occurring cardiovascular problems, and the nurse should know that possible complications of these problems do not include mitral valve prolapse.

The nurse is administering morning medications. Which medication should be administered first? 1. The cardiac glycoside medication, digoxin, to a client diagnosed with heart failure and who has 2+ edema of the feet. 2. The sliding scale insulin to a client with a fasting blood glucose of 345 mg/dL who is demanding breakfast. 3. The loop diuretic, furosemide, to a client with a 24-hour intake of 986 mL and an output of 1,400 mL. 4. The ARB medication to a client whose blood pressure was reported by the unlicensed assistive personnel as 142/76.

ANSWER: 2. 1. Digoxin is a routine medication that will be administered at 0900 in most hospitals. 2. The client intends on eating breakfast and this is a scheduled medication for before meals. 3. This client is showing that the diuretic is doing what it should do. This medication will be given at 0900. 4. This is a slightly abnormal blood pressure but is in acceptable range for someone prescribed an ARB, angiotensin receptor blocker. The medication can be administered at 0900. TEST-TAKING HINT: The test taker should be knowledgeable of common medications and the basic rules of administration.

What is the priority problem in the client diagnosed with congestive heart failure? 1. Fluid volume overload. 2. Decreased cardiac output. 3. Activity intolerance. 4. Knowledge deficit.

ANSWER: 2. 1. Fluid volume overload is a problem in clients with congestive heart failure, but it is not priority because, if the cardiac output is improved, then the kidneys are perfused, which leads to elimination of excess fluid from the body. 2. Decreased cardiac output is responsible for all the signs/symptoms associated with CHF and eventually causes death, which is why it is the priority problem. 3. Activity intolerance alters quality of life, but it is not life threatening. 4. Knowledge deficit is important, but it is not priority over a physiological problem

The health-care provider has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with congestive heart failure. Which discharge instructions should the nurse include? 1. Instruct the client to take a cough suppressant if a cough develops. 2. Teach the client how to prevent orthostatic hypotension. 3. Encourage the client to eat bananas to increase potassium level. 4. Explain the importance of taking the medication with food.

ANSWER: 2. 1. If a cough develops, the client should notify the health-care provider because this is an adverse reaction and the HCP will discontinue the medication. 2. Orthostatic hypotension may occur with ACE inhibitors as a result of vasodilation. Therefore, the nurse should instruct the client to rise slowly and sit on the side of the bed until equilibrium is restored. 3. ACE inhibitors may cause the client to retain potassium; therefore, the client should not increase potassium intake. 4. An ACE inhibitor should be taken one (1) hour before meals or two (2) hours after a meal to increase absorption of the medication. TEST-TAKING HINT: If the test taker knows that an ACE inhibitor is also given for hypertension, then looking at answer options referring to hypotension would be appropriate.

Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction? 1. Midepigastric pain and pyrosis. 2. Diaphoresis and cool, clammy skin. 3. Intermittent claudication and pallor. 4. Jugular vein distention and dependent edema.

ANSWER: 2. 1. Midepigastric pain would support a diagnosis of peptic ulcer disease; pyrosis is belching. 2. Diaphoresis (sweating) is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this, in turn, leads to cold, clammy skin. 3. Intermittent claudication is leg pain secondary to decreased oxygen to the muscle, and pallor is paleness of the skin as a result of decreased blood supply. Neither is an early sign of MI. 4. Jugular vein distension (JVD) and dependent edema are signs/symptoms of congestive heart failure, not of MI. TEST-TAKING HINT: The stem already addresses chest pain; therefore, the test taker could eliminate option "1" as a possible answer. Intermittent claudication, option "3," is the classic sign of arterial occlusive disease, and JVD is very specific to congestive heart failure. The nurse must be able to identify at least two or three signs/symptoms of disease processes.

Which client problem has priority for the client with a cardiac dysrhythmia? 1. Alteration in comfort. 2. Decreased cardiac output. 3. Impaired gas exchange. 4. Activity intolerance.

ANSWER: 2. 1. Not every cardiac dysrhythmia causes alteration in comfort; angina is caused by decreased oxygen to the myocardium. 2. Any abnormal electrical activity of the heart causes decreased cardiac output. 3. Impaired gas exchange is the result of pulmonary complications, not cardiac dysrhythmias. 4. Not all clients with cardiac dysrhythmias have activity intolerance. TEST-TAKING HINT: Option "2" has the word "cardiac," which refers to the heart. Therefore, even if the test taker had no idea what the correct answer was, this would be an appropriate option. The test taker should use medical terminology to help identify the correct option

Which potential complication should the nurse assess for in the client with infective endocarditis who has embolization of vegetative lesions from the mitral valve? 1. Pulmonary embolus (PE). 2. Cerebrovascular accident. 3. Hemoptysis. 4. Deep vein thrombosis.

ANSWER: 2. 1. Pulmonary embolus would occur with an embolization of vegetative lesions from the tricuspid valve on the right side of the heart. 2. Bacteria enter the bloodstream from invasive procedures, and sterile platelet-fibrin vegetation forms on heart valves. The mitral valve is on the left side of the heart and, if the vegetation breaks off, it will go through the left ventricle into the systemic circulation and may lodge in the brain, kidneys, or peripheral tissues. 3. Coughing up blood (hemoptysis) occurs when the vegetation breaks off the tricuspid valve in the right side of the heart and enters the pulmonary artery. 4. Deep vein thrombosis is a complication of immobility, not of a vegetative embolus from the left side of the heart. TEST-TAKING HINT: If the test taker does not know the answer, knowledge of anatomy may help determine the answer. The mitral valve is on the left side of the heart and any emboli would not enter the lung first, thereby eliminating options "1" and "3" as possible correct answers.

The client with coronary artery disease is prescribed transdermal nitroglycerin, a coronary vasodilator. Which behavior indicates the client understands the discharge teaching concerning this medication? 1. The client places the medication under the tongue. 2. The client removes the old patch before placing the new. 3. The client applies the patch to a hairy area. 4. The client changes the patch every 36 hours.

ANSWER: 2. 1. The client does not understand how to apply this medication; it is placed on the skin, not under the tongue. 2. This behavior indicates the client understands the discharge teaching. 3. The patch needs to be in a nonhairy place so it makes good contact with the skin. 4. The patch should be changed every 12 or 24 hours but never every two (2) hours. It takes two (2) hours for the patch to warm up and begin delivering the optimum dose of medication.

The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina? 1. Put a nitroglycerin tablet under the tongue. 2. Stop the activity immediately and rest. 3. Document when and what activity caused angina. 4. Notify the health-care provider immediately.

ANSWER: 2. 1. The client should take the coronary vasodilator nitroglycerin sublingually, but it is not the first intervention. 2. Stopping the activity decreases the heart's need for oxygen and may help decrease the angina (chest pain). 3. The client should keep a diary of when angina occurs, what activity causes it, and how many nitroglycerin tablets are taken before chest pain is relieved. 4. If the chest pain (angina) is not relieved with three (3) nitroglycerin tablets, the client should call 911 or have someone take him to the emergency department. Notifying the HCP may take too long. TEST-TAKING HINT: The question is asking which action the client should take first. This implies that more than one of the answer options could be appropriate for the chest pain, but that only one is done first. The test taker should select the answer that will help the client directly and quickly—and that is stopping the activity.

The client diagnosed with congestive heart failure is complaining of leg cramps at night. Which nursing interventions should be implemented? 1. Check the client for peripheral edema and make sure the client takes a diuretic early in the day. 2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. 3. Determine if the client has gained weight and instruct the client to keep the legs elevated. 4. Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.

ANSWER: 2. 1. The client with peripheral edema will experience calf tightness but would not have leg cramping, which is the result of low potassium levels. The timing of the diuretic will not change the side effect of leg cramping resulting from low potassium levels. 2. The most probable cause of the leg cramping is potassium excretion as a result of diuretic medication. Bananas and orange juice are foods that are high in potassium. 3. Weight gain is monitored in clients with CHF, and elevating the legs would decrease peripheral edema by increasing the rate of return to the central circulation, but these interventions would not help with leg cramps. 4. Ambulating frequently and performing legstretching exercises will not be effective in alleviating the leg cramps. TEST-TAKING HINT: The timing "at night" in this question was not important in answering the question, but it could have made the test taker jump at option "1." Be sure to read all answer options before deciding on an answer. Answering this question correctly requires knowledge of the side effects of treatments used for CHF

The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure? 1. Perform passive range-of-motion exercises. 2. Assess the client's neurovascular status. 3. Keep the client in high Fowler's position. 4. Assess the gag reflex prior to feeding the client.

ANSWER: 2. 1. The client's right leg should be kept straight to prevent arterial bleeding from the femoral insertion site for the catheter used to perform the catheterization. 2. The nurse must make sure that blood is circulating to the right leg, so the client should be assessed for pulses, paresthesia, paralysis, coldness, and pallor. 3. The head of the bed should be elevated no more than 10 degrees. The client should be kept on bedrest, flat with the affected extremity straight, to help decrease the chance of femoral artery bleeding. 4. The gag reflex is assessed if a scope is inserted down the trachea (bronchoscopy) or esophagus (endoscopy) because the throat is numbed when inserting the scope. A catheter is inserted in the femoral or brachial artery when performing a cardiac catheterization. TEST-TAKING HINT: The nurse should apply the nursing process when determining the correct answer. Therefore, either option "2" or option "4" could possibly be the correct answer. The test taker then should apply anatomy concepts—where is the left femoral artery? Neurovascular assessment is performed on extremities.

The client with infective endocarditis is admitted to the medical department. Which health-care provider's order should be implemented first? 1. Administer intravenous antibiotic. 2. Obtain blood cultures times two (2). 3. Schedule an echocardiogram. 4. Encourage bedrest with bathroom privileges.

ANSWER: 2. 1. The nurse must obtain blood cultures prior to administering antibiotics. 2. Blood cultures must be done before administering antibiotics so that an adequate number of organisms can be obtained to culture and identify. 3. An echocardiogram allows visualization of vegetations and evaluation of valve function. However, antibiotic therapy is a priority before diagnostic tests, and blood cultures must be obtained before administering medication. 4. Bedrest should be implemented, but the first intervention should be obtaining blood cultures so that antibiotic therapy can be started as soon as possible. TEST-TAKING HINT: The test taker must identify the first of the HCP's orders to be implemented. "Infective" should indicate that this is an infection, which requires antibiotics, but the nurse should always assess for allergies and obtain cultures prior to administering any antibiotic.

Which intervention should the nurse implement when administering a loop diuretic to a client diagnosed with coronary artery disease? 1. Assess the client's radial pulse. 2. Assess the client's serum potassium level. 3. Assess the client's glucometer reading. 4. Assess the client's pulse oximeter reading

ANSWER: 2. 1. The nurse should always assess the apical (not radial) pulse, but the pulse is not affected by a loop diuretic. 2. Loop diuretics cause potassium to be lost in the urine output. Therefore, the nurse should assess the client's potassium level, and if the client is hypokalemic, the nurse should question administering this medication. 3. The glucometer provides a glucose level, which is not affected by a loop diuretic. 4. The pulse oximeter reading evaluates peripheral oxygenation and is not affected by a loop diuretic. TEST-TAKING HINT: Knowing that diuretics increase urine output would lead the test taker to eliminate glucose level and oxygenation (options "3" and "4"). In very few instances does the nurse assess the radial pulse; the apical pulse is assessed.

The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first? 1. Call a code immediately. 2. Assess the client for a pulse. 3. Begin chest compressions. 4. Continue to monitor the client.

ANSWER: 2. 1. The nurse should call a code if the client does not have vital signs. 2. The nurse must first determine if the client has a pulse. Pulseless ventricular tachycardia is treated as ventricular fibrillation. Stable ventricular tachycardia is treated with medications. 3. Chest compression is only done if the client is not breathing and has no pulse. 4. Ventricular tachycardia is a potentially lifethreatening dysrhythmia and needs to be treated immediately

The client is one (1) day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first? 1. Medicate the client with intravenous morphine. 2. Assess the client's chest dressing and vital signs. 3. Encourage the client to turn from side to side. 4. Check the client's telemetry monitor.

ANSWER: 2. 1. The nurse should medicate the client as needed, but it is not the first intervention. 2. The nurse must always assess the client to determine if the chest pain that is occurring is expected postoperatively or if it is a complication of the surgery. 3. Turning will help decrease complications from immobility, such as pneumonia, but it will not help relieve the client's pain. 4. The nurse, not a machine, should always take care of the client. TEST-TAKING HINT: The stem asks the nurse to identify the first intervention that should be implemented. Therefore, the test taker should apply the nursing process and select an assessment intervention. Both options "2" and "4" involve assessment, but the nurse— not a machine or diagnostic test—should always assess the client

The client diagnosed with a myocardial infarction (MI) is being discharged. Which discharge instruction(s) should the nurse teach the client? 1. Call the health care provider (HCP) if any chest pain happens. 2. Discuss when the client can resume sexual activity. 3. Explain the pharmacology of nitroglycerin tablets. 4. Encourage the client to sleep with the head of the bed elevated.

ANSWER: 2. 1. The word "any" makes this a wrong option. The nurse should teach the client what to do if chest pain occurs. Take one nitroglycerin tablet every 5 minutes times three (3), and if not relieved call 911. 2. The nurse should make sure the client is aware of when sexual activity can be safely resumed. 3. The client needs to know how to take nitroglycerin but not the pharmacology of how the medication works. 4. The client can sleep in any position of comfort. TEST-TAKING HINT: The test taker should recognize certain words such as "any," "all," "never," or "always." These absolutes will determine if an option is incorrect or correct.

The nurse is preparing to administer a beta blocker to the client diagnosed with coronary artery disease. Which assessment data would cause the nurse to question administering the medication? 1. The client has a BP of 110/70. 2. The client has an apical pulse of 56. 3. The client is complaining of a headache. 4. The client's potassium level is 4.5 mEq/L

ANSWER: 2. 1. This blood pressure is normal and the nurse would administer the medication. 2. A beta blocker decreases sympathetic stimulation to the heart, thereby decreasing the heart rate. An apical rate less than 60 indicates a lower-than-normal heart rate and should make the nurse question administering this medication because it will further decrease the heart rate. 3. A headache will not affect administering the medication to the client. 4. The potassium level is within normal limits, but it is usually not monitored prior to administering a beta blocker. TEST-TAKING HINT: If the test taker does not know when to question the use of a certain medication, the test taker should evaluate the options to determine if any options include abnormal data based on normal parameters. This would make the test taker select option "2" because the normal apical pulse in an adult is 60 to 100.

The charge nurse is making shift assignments. Which client would be most appropriate for the charge nurse to assign to a new graduate who just completed orientation to the medical floor? 1. The client admitted for diagnostic tests to rule out valvular heart disease. 2. The client three (3) days post-myocardial infarction being discharged tomorrow. 3. The client exhibiting supraventricular tachycardia (SVT) on telemetry. 4. The client diagnosed with atrial fibrillation who has an INR of five (5).

ANSWER: 2. 1. This client requires teaching and an understanding of the preprocedure interventions for diagnostic tests; therefore, a more experienced nurse should be assigned to this client. 2. Because this client is being discharged, it would be an appropriate assignment for the new graduate. 3. Supraventricular tachycardia (SVT) is not life threatening, but the client requires intravenous medication and close monitoring and therefore should be assigned to a more experienced nurse. 4. A client with atrial fibrillation is usually taking the anticoagulant warfarin (Coumadin), and the therapeutic INR is 2 to 3. An INR of 5 is high and the client is at risk for bleeding. TEST-TAKING HINT: The test taker must realize that a new graduate must be assigned the least critical client. Remember, teaching is a primary responsibility of the nurse; physical care is not always the criterion that should be used when making client assignments.

The nurse identifies the concept of perfusion for a client diagnosed with congestive heart failure. Which assessment data support this concept? 1. The client has a large abdomen and a positive tympanic wave. 2. The client has paroxysmal nocturnal dyspnea. 3. The client has 2+ glucose in the urine. 4. The client has a comorbid condition of myocardial infarction.

ANSWER: 2. 1. This indicates ascites, which can happen in heart failure but does not necessarily do so; it can also be liver failure or another issue. 2. Dyspnea occurring at night when the client is in a recumbent position indicates that the cardiac muscle is not able to compensate for extra fluid returning to the heart during sleep. 3. This could indicate diabetes but not heart failure. 4. The client is at risk for heart failure as a result of the MI, but it does not happen with all MI clients and does not support the diagnosis. TEST-TAKING HINT: The test taker should read the stem of the question carefully. It is asking for assessment data to support the client is in heart failure. Three of the answer options give assessment data; therefore, option "4" can be eliminated. Only one of the other three gives an option that only occurs with heart failure.

Which assessment data would the nurse expect to auscultate in the client diagnosed with mitral valve insufficiency? 1. A loud S1, S2 split, and a mitral opening snap. 2. A holosystolic murmur heard best at the cardiac apex. 3. A midsystolic ejection click or murmur heard at the base. 4. A high-pitched sound heard at the third left intercostal space.

ANSWER: 2. 1. This would be expected with mitral valve stenosis. 2. The murmur associated with mitral valve insufficiency is loud, high pitched, rumbling, and holosystolic (occurring throughout systole) and is heard best at the cardiac apex. 3. This would be expected with mitral valve prolapse. 4. This would be expected with aortic regurgitation. TEST-TAKING HINT: This is a knowledge-based question and there is no test-taking hint to help the test taker rule out distracters

Which intervention should the nurse implement with the client diagnosed with dilated cardiomyopathy? 1. Keep the client in the supine position with the legs elevated. 2. Discuss a heart transplant, which is the definitive treatment. 3. Prepare the client for coronary artery bypass graft. 4. Teach the client to take a calcium channel blocker in the morning.

ANSWER: 2. 1. Most clients with dilated cardiomyopathy prefer to sit up with their legs in the dependent position. This position causes pooling of blood in the periphery and reduces preload. 2. Without a heart transplant, this client will end up in end-stage heart failure. A transplant is the only treatment for a client with dilated cardiomyopathy. 3. A bypass is the treatment of choice for a client with occluded coronary arteries. 4. Calcium channel blockers are contraindicated in clients with dilated cardiomyopathy because they interfere with the contractility of the heart.

The client is exhibiting sinus bradycardia, is complaining of syncope and weakness, and has a BP of 98/60. Which collaborative treatment should the nurse anticipate being implemented? 1. Administer a thrombolytic medication. 2. Assess the client's cardiovascular status. 3. Prepare for insertion of a pacemaker. 4. Obtain a permit for synchronized cardioversion.

ANSWER: 3. 1. A thrombolytic medication is administered for a client experiencing a myocardial infarction. 2. Assessment is an independent nursing action, not a collaborative treatment. 3. The client is symptomatic and will require a pacemaker. 4. Synchronized cardioversion is used for ventricular tachycardia with a pulse or atrial fibrillation. TEST-TAKING HINT: The key to answering this question is the adjective "collaborative," which means the treatment requires obtaining a health-care provider's order or working with another member of the health-care team. This would cause the test taker to eliminate option "2" as a possible correct answer.

The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse? 1. The client is keeping the affected extremity straight. 2. The pressure dressing to the right femoral area is intact. 3. The client is complaining of numbness in the right foot. 4. The client's right pedal pulse is 3+ and bounding

ANSWER: 3. 1. After PTCA, the client must keep the right leg straight for at least six (6) to eight (8) hours to prevent any arterial bleeding from the insertion site in the right femoral artery. 2. A pressure dressing is applied to the insertion site to help prevent arterial bleeding. 3. Any neurovascular assessment data that are abnormal require intervention by the nurse; numbness may indicate decreased blood supply to the right foot. 4. A bounding pedal pulse indicates that adequate circulation is getting to the right foot; therefore, this would not require immediate intervention. TEST-TAKING HINT: This question requires the test taker to identify abnormal, unexpected, or life-threatening data. The nurse must know that a PTCA is performed by placing a catheter in the femoral artery and that internal or external bleeding is the most common complication.

The client is exhibiting ventricular tachycardia. Which intervention should the nurse implement first? 1. Administer amiodarone , an antidysrhythmic, IVP. 2. Prepare to defibrillate the client. 3. Assess the client's apical pulse and blood pressure. 4. Start basic cardiopulmonary resuscitation.

ANSWER: 3. 1. Amiodarone is the drug of choice for ventricular tachycardia, but it is not the first intervention. 2. Defibrillation may be needed, but it is not the first intervention. 3. The nurse must assess the apical pulse and blood pressure to determine if the client is in cardiac arrest and then treat as ventricular fibrillation. If the client's heart is beating, the nurse would then administer lidocaine. 4. CPR is only performed on a client who is not breathing and does not have a pulse. The nurse must establish if this is occurring first prior to taking any other action. TEST-TAKING HINT: When the stem asks the test taker to select the first intervention, all answer options could be plausible interventions, but only one is implemented first. The test taker should use the nursing process to answer the question and select the intervention that addresses assessment, which is the first step in the nursing process.

The elderly client has coronary artery disease. Which question should the nurse ask the client during the client teaching? 1. "Do you have a daily bowel movement?" 2. "Do you get yearly chest x-rays (CXRs)?" 3. "Are you sexually active?" 4. "Have you had any weight change?"

ANSWER: 3. 1. Bowel movements are important, but they are not pertinent to coronary artery disease. 2. Chest x-rays are usually done for respiratory problems, not for coronary artery disease. 3. Sexual activity is a risk factor for angina resulting from coronary artery disease. The client's being elderly should not affect the nurse's assessment of the client's concerns about sexual activity. 4. Weight change is not significant in a client with coronary artery disease. TEST-TAKING HINT: Remember, if the client is described with an adjective such as "elderly," this may be the key to selecting the correct answer. The nurse must not be judgmental about the elderly, especially about issues concerning sexual activity.

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)? 1. Creatine kinase (CK-MB). 2. Lactate dehydrogenase (LDH). 3. Troponin. 4. White blood cells (WBCs).

ANSWER: 3. 1. CK-MB elevates in 12 to 24 hours. 2. Lactic dehydrogenase (LDH) elevates in 24 to 36 hours. 3. Troponin is the enzyme that elevates within 1 to 2 hours. 4. WBCs elevate as a result of necrotic tissue, but this is not a cardiac enzyme. TEST-TAKING HINT: The test taker should be aware of the words "cardiac enzyme," which would eliminate option "4" as a possible answer. The word in the stem is "first." This question requires the test taker to have knowledge of laboratory values.

The client has an implantable cardioverter defibrillator (ICD). Which discharge instructions should the nurse teach the client? 1. Do not lift or carry more than 23 kg. 2. Have someone drive the car for the rest of your life. 3. Carry the cell phone on the opposite side of the ICD. 4. Avoid using the microwave oven in the home.

ANSWER: 3. 1. Clients should not lift more than 5 to 10 pounds because it puts a strain on the heart; 23 kg is more than 50 pounds. 2. There may be driving restrictions, but the client should be able to drive independently. 3. Cell phones may interfere with the functioning of the ICD if they are placed too close to it. 4. Microwave ovens should not cause problems with the ICD.

The nurse is discussing the importance of exercise with the client diagnosed with coronary artery disease. Which intervention should the nurse implement? 1. Perform isometric exercises daily. 2. Walk for 15 minutes three (3) times a week. 3. Do not walk outside if it is less than 40˚F. 4. Wear open-toed shoes when ambulating.

ANSWER: 3. 1. Isometric exercises are weight lifting-type exercises. A client with CAD should perform isotonic exercises, which increase muscle tone, not isometric exercises. 2. The client should walk at least 30 minutes a day to increase collateral circulation. 3. When it is cold outside, vasoconstriction occurs, and this will decrease oxygen to the heart muscle. Therefore, the client should not exercise when it is cold outside. 4. The client should wear good, supportive tennis shoes when ambulating, not sandals or other open-toed shoes. TEST-TAKING HINT: The test taker should be aware of adjectives such as "isometric," which makes option "1" incorrect, and "open-toed," which makes option "4" incorrect.

The client diagnosed with a myocardial infarction is on bedrest. The unlicensed assistive personnel (UAP) is encouraging the client to move the legs. Which action should the nurse implement? 1. Instruct the UAP to stop encouraging the leg movements. 2. Report this behavior to the charge nurse as soon as possible. 3. Praise the UAP for encouraging the client to move the legs. 4. Take no action concerning the UAP's behavior.

ANSWER: 3. 1. Leg movement is an appropriate action, and the UAP should not be told to stop encouraging it. 2. This behavior is not unsafe or dangerous and should not be reported to the charge nurse. 3. The nurse should praise and encourage UAPs to participate in the client's care. Clients on bedrest are at risk for deep vein thrombosis, and moving the legs will help prevent this from occurring. 4. The nurse should praise subordinates for appropriate behavior, especially when it is helping to prevent life-threatening complications. TEST-TAKING HINT: This is a management question. The test taker must know the chain of command and when to report behavior. The test taker could eliminate options "1" and "2" with the knowledge that moving the legs is a safe activity for the client. When having to choose between options "3" and "4," the test taker should select doing something positive, instead of taking no action. This is a management concept.

The client diagnosed with pericarditis is complaining of increased pain. Which intervention should the nurse implement first? 1. Administer oxygen via nasal cannula. 2. Evaluate the client's urinary output. 3. Assess the client for cardiac complications. 4. Encourage the client to use the incentive spirometer.

ANSWER: 3. 1. Oxygen may be needed, but it is not the first intervention. 2. This would be appropriate to determine if the urine output is at least 30 mL/hr, but it is not the first intervention. 3. The nurse must assess the client to determine if the pain is expected secondary to pericarditis or if the pain is indicative of a complication that requires intervention from the health-care provider. 4. Using the incentive spirometer will increase the client's alveolar ventilation and help prevent atelectasis, but it is not the first intervention. TEST-TAKING HINT: The test taker must apply the nursing process when determining the correct answer and select the option that addresses the first step in the nursing process—assessment.

The client has just received a mechanical valve replacement. Which behavior by the client indicates the client needs more teaching? 1. The client takes prophylactic antibiotics. 2. The client uses a soft-bristle toothbrush. 3. The client takes an enteric-coated aspirin daily. 4. The client alternates rest with activity

ANSWER: 3. 1. Prophylactic antibiotics before invasive procedures prevent infectious endocarditis. 2. The client is undergoing anticoagulant therapy and should use a soft-bristle toothbrush to help prevent gum trauma and bleeding. 3. Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) interfere with clotting and may potentiate the effects of the anticoagulant therapy, which the client with a mechanical valve will be prescribed. Therefore, the client should not take aspirin daily. 4. The client should alternate rest with activity to prevent fatigue to help decrease the workload of the heart. TEST-TAKING HINT: The stem asks the test taker to identify which behavior means the client does not understand the teaching. Therefore, the test taker should select the distracter that does not agree with the condition. There is no condition for which alternating rest with activity would not be recommended.

The client with pericarditis is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which teaching instruction should the nurse discuss with the client? 1. Explain the importance of tapering off the medication. 2. Discuss that the medication will make the client drowsy. 3. Instruct the client to take the medication with food. 4. Tell the client to take the medication when the pain level is around "8."

ANSWER: 3. 1. Steroids, such as prednisone, not NSAIDs, must be tapered off to prevent adrenal insufficiency. 2. NSAIDs will not make clients drowsy. 3. NSAIDs must be taken with food, milk, or antacids to help decrease gastric distress. NSAIDs reduce fever, inflammation, and pericardial pain. 4. NSAIDs should be taken regularly around the clock to help decrease inflammation, which, in turn, will decrease pain. TEST-TAKING HINT: The test taker must remember NSAIDs and steroids cause gastric distress to the point of causing peptic ulcer disease. These medications are administered for a variety of conditions and diseases.

Which preprocedure information should be taught to the female client having an exercise stress test in the morning? 1. Wear open-toed shoes to the stress test. 2. Inform the client not to wear a bra. 3. Do not eat anything for four (4) hours. 4. Take the beta blocker one (1) hour before the test.

ANSWER: 3. 1. The client should wear firm-fitting, solid athletic shoes. 2. The client should wear a bra to provide adequate support during the exercise. 3. NPO decreases the chance of aspiration in case of emergency. In addition, if the client has just had a meal, the blood supply will be shunted to the stomach for digestion and away from the heart, perhaps leading to an inaccurate test result. 4. A beta blocker is not taken prior to the stress test because it will decrease the pulse rate and blood pressure by direct parasympathetic stimulation to the heart.

The female client is diagnosed with rheumatic fever and prescribed penicillin, an antibiotic. Which statement indicates the client needs more teaching concerning the discharge teaching? 1. "I must take all the prescribed antibiotics." 2. "I may get a vaginal yeast infection with penicillin." 3. "I will have no problems as long as I take my medication." 4. "My throat culture was positive for a streptococcal infection."

ANSWER: 3. 1. The full course of antibiotics must be taken to help ensure complete destruction of streptococcal infection. 2. Antibiotics kill bacteria but also destroy normal body flora in the vagina, bowel, and mouth, leading to a superinfection. 3. Even with antibiotic treatment for rheumatic fever, the client may experience bacterial endocarditis in later years and should know this may occur. 4. A throat culture is taken to diagnose group A beta-hemolytic streptococcus and is positive in 25% to 40% of clients with acute rheumatic fever. TEST-TAKING HINT: The question is asking the test taker to identify which statement indicates the client does not understand the teaching; this is an "except" question. The test taker can ask which statement indicates the teaching is effective and choose the one option that is not appropriate.

The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first? 1. Administer sublingual nitroglycerin. 2. Obtain a STAT electrocardiogram (ECG). 3. Have the client sit down immediately. 4. Assess the client's vital signs.

ANSWER: 3. 1. The nurse must assume the chest pain is secondary to decreased oxygen to the myocardium and administer a sublingual nitroglycerin tablet, which is a coronary vasodilator, but this is not the first action. 2. An ECG should be ordered, but it is not the first intervention. 3. Stopping all activity will decrease the need of the myocardium for oxygen and may help decrease the chest pain. 4. Assessment is often the first nursing intervention, but when the client has chest pain and a possible MI, the nurse must first take care of the client. Taking vital signs would not help relieve chest pain. TEST-TAKING HINT: Whenever the test taker wants to select an assessment intervention, be sure to think about whether that intervention will help the client, especially if the client is experiencing pain. Do not automatically select the answer option that is assessment.

The nurse is administering morning medications to clients on a telemetry unit. Which medication would the nurse question? 1. Furosemide IVP to a client with a potassium level of 3.6 mEq/L. 2. Digoxin orally to a client diagnosed with rapid atrial fibrillation. 3. Enalapril orally to a client whose BP is 86/64 and apical pulse is 65. 4. Morphine IVP to a client complaining of chest pain and who is diaphoretic.

ANSWER: 3. 1. The potassium level is within normal range; this medication would not be questioned. 2. Digoxin is given to clients with rapid atrial fibrillation to slow the heart rate; this medication would not be questioned. 3. Enalapril, an ACE inhibitor, will lower the blood pressure even more. The nurse should hold the medication and notify the HCP that the medication is being held. 4. This would be the first medication to be administered because it indicates a potential cardiac muscle perfusion issue. TEST-TAKING HINT: The test taker should recognize normal values and results in order to recognize abnormals. A normal result can rule out an answer in "Which do you assess first?" or "Which would the nurse question?" An abnormal value indicates a need for some action on the part of the nurse

The client who has had a myocardial infarction is admitted to the telemetry unit from intensive care. Which referral would be most appropriate for the client? 1. Social worker. 2. Physical therapy. 3. Cardiac rehabilitation. 4. Occupational therapy

ANSWER: 3. 1. The social worker addresses financial concerns or referrals after discharge, which are not indicated for this client. 2. Physical therapy addresses gait problems, lower extremity strength building, and assisting with transfer, which are not required for this client. 3. Cardiac rehabilitation is the most appropriate referral. The client can start rehabilitation in the hospital and then attend an outpatient cardiac rehabilitation clinic, which includes progressive exercise, diet teaching, and classes on modifying risk factors. 4. Occupational therapy assists the client in regaining activities of daily living and covers mainly fine motor activities. TEST-TAKING HINT: The test taker must be familiar with the responsibilities of the other members of the health-care team. If the test taker had no idea which would be the most appropriate referral, the word "cardiac," which means "heart," should help the test taker in deciding that this is the most sensible option because the client had a myocardial infarction, a "heart attack."

The telemetry nurse is unable to read the telemetry monitor at the nurse's station. Which intervention should the telemetry nurse implement first? 1. Go to the client's room to check the client. 2. Instruct the primary nurse to assess the client. 3. Contact the client on the client call system. 4. Request the nursing assistant to take the crash cart to the client's room.

ANSWER: 3. 1. The telemetry nurse should not leave the monitors unattended at any time. 2. The telemetry nurse must have someone go assess the client, but this is not the first intervention. 3. If the client answers the call light and is not experiencing chest pain, then there is probably a monitor artifact, which is not a life-threatening emergency. After talking with the client, send a nurse to the room to check the monitor. 4. The crash cart should be taken to a room when the client is experiencing a code. TEST-TAKING HINT: When the test taker sees the word "first," the test taker must realize that more than one answer option may be a possible intervention but that only one should be implemented first. The test taker should try to determine which intervention directly affects the client.

The client shows ventricular fibrillation on the telemetry at the nurse's station. Which action should the telemetry nurse implement first? 1. Administer epinephrine IVP. 2. Prepare to defibrillate the client. 3. Call a STAT code. 4. Start cardiopulmonary resuscitation (CPR).

ANSWER: 3. 1. There are many interventions that should be implemented prior to administering medication. 2. The treatment of choice for ventricular fibrillation is defibrillation, but it is not the first action. 3. The nurse must call a code that activates the crash cart being brought to the room and a team of health-care providers that will care for the client according to an established protocol. 4. The first person at the bedside should start cardiopulmonary resuscitation (CPR), but the telemetry nurse should call a code so that all necessary equipment and personnel are at the bedside. TEST-TAKING HINT: The test taker must realize that ventricular fibrillation is life threatening and immediate action must be implemented. Remember, when the question asks "first," all options could be appropriate interventions but only one should be implemented first.

The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement? 1. Notify the health-care provider. 2. Document that the pericarditis has resolved. 3. Ask the client to lean forward and listen again. 4. Prepare to insert a unilateral chest tube.

ANSWER: 3. 1. These assessment data are not life threatening and do not warrant notifying the HCP. 2. The nurse should attempt to hear the friction rub in multiple ways before documenting that it is not heard. The nurse does not determine if pericarditis has resolved. 3. Having the client lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard. 4. Chest tubes are not the treatment of choice for not hearing a friction rub.

The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse? 1. The client's BP is 110/70 and pulse is 90. 2. The client's groin dressing is dry and intact. 3. The client refuses to keep the leg straight. 4. The client denies any numbness and tingling.

ANSWER: 3. 1. These vital signs are within normal limits and would not require any immediate intervention. 2. The groin dressing should be dry and intact. 3. If the client bends the leg, it could cause the insertion site to bleed. This is arterial blood and the client could bleed to death very quickly, so this requires immediate intervention. 4. The nurse must check the neurovascular assessment, and paresthesia would warrant immediate intervention, but no numbness and tingling is a good sign. TEST-TAKING HINT: "Warrants immediate intervention" means the nurse should probably notify the health-care provider or do something independently because a complication may occur. Therefore, the test taker must select an answer option that is abnormal or unsafe. In the data listed, there are three normal findings and one abnormal finding.

The charge nurse is making assignments for clients on a cardiac unit. Which client should the charge nurse assign to a new graduate nurse? 1. The 44-year-old client diagnosed with a myocardial infarction. 2. The 65-year-old client admitted with unstable angina. 3. The 75-year-old client scheduled for a cardiac catheterization. 4. The 50-year-old client complaining of chest pain.

ANSWER: 3. 1. This client is at high risk for complications related to necrotic myocardial tissue and will need extensive teaching, so this client should not be assigned to a new graduate. 2. Unstable angina means this client is at risk for life-threatening complications and should not be assigned to a new graduate. 3. A new graduate should be able to complete a preprocedure checklist and get this client to the catheterization laboratory. 4. Chest pain means this client could be having a myocardial infarction and should not be assigned to a new graduate. TEST-TAKING HINT: "New graduate" is the key to answering this question correctly. What type of client should be assigned to an inexperienced nurse? The test taker should not assign the new graduate a client who is unstable or at risk for a life-threatening complication.

The charge nurse is making shift assignments for the medical floor. Which client should be assigned to the most experienced registered nurse? 1. The client diagnosed with congestive heart failure who is being discharged in the morning. 2. The client who is having frequent incontinent liquid bowel movements and vomiting. 3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood pressure of 94/62. 4. The client who is complaining of chest pain on inspiration and a nonproductive cough.

ANSWER: 3. 1. This client is stable because discharge is scheduled for the following day. Therefore, this client does not need to be assigned to the most experienced registered nurse. 2. This client is more in need of custodial nursing care than care from the most experienced registered nurse. Therefore, the charge nurse could assign a less experienced nurse to this client. 3. This client is exhibiting signs/symptoms of shock, which makes this client the most unstable. An experienced nurse should care for this client. 4. These complaints usually indicate muscular or pleuritic chest pain; cardiac chest pain does not fluctuate with inspiration. This client does not require the care of an experienced nurse as much as does the client with signs of shock. TEST-TAKING HINT: When deciding on an answer for this type of question, the test taker should reason as to which client is stable and which has a potentially higher level of need.

The client's telemetry reading is normal sinus. Which should the nurse implement? 1. Take the client's apical pulse and blood pressure. 2. Prepare to administer amiodarone IVPB. 3. Continue to monitor. 4. Place oxygen on the client via a nasal cannula.

ANSWER: 3. 1. This strip indicates normal sinus rhythm; there is no need for further action based on the strip. 2. This strip indicates normal sinus rhythm; there is no need for further action based on the strip. 3. This strip indicates normal sinus rhythm; there is no need for further action based on the strip. The nurse should continue to monitor the client. 4. This strip indicates normal sinus rhythm; there is no need for further action based on the strip. TEST-TAKING HINT: The test taker should recognize normal values and results in order to recognize abnormals. A normal result can rule out an answer in a "which do you assess first" question; an abnormal value automatically elevates the need to see that client before another one.

The nurse is caring for clients on a cardiac floor. Which client should the nurse assess first? 1. The client with three (3) unifocal PVCs in one (1) minute. 2. The client diagnosed with coronary artery disease who wants to ambulate. 3. The client diagnosed with mitral valve prolapse with an audible S3. 4. The client diagnosed with pericarditis who is in normal sinus rhythm.

ANSWER: 3. 1. Three (3) unifocal PVCs in one (1) minute is not life threatening. 2. The client wanting to ambulate is not a priority over a client with a physiological problem. 3. An audible S3 indicates the client is developing left-sided heart failure and needs to be assessed immediately. 4. A client in normal sinus rhythm will not be a priority over someone with a potentially lifethreatening situation.

The nurse is assessing the client diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective? 1. The client's peripheral pitting edema has gone from 3+ to 4+. 2. The client is able to take the radial pulse accurately. 3. The client is able to perform ADLs without dyspnea. 4. The client has minimal jugular vein distention.

ANSWER: 3. 1. Pitting edema changing from 3+ to 4+ indicates a worsening of the CHF. 2. The client's ability to take the radial pulse would evaluate teaching, not medical treatment. 3. Being able to perform activities of daily living (ADLs) without shortness of breath (dyspnea) would indicate the client's condition is improving. The client's heart is a more effective pump and can oxygenate the body better without increasing fluid in the lungs. 4. Any jugular vein distention indicates that the right side of the heart is failing, which would not indicate effective medical treatment. TEST-TAKING HINT: When asked to determine whether treatment is effective, the test taker must know the signs and symptoms of the disease being treated. An improvement in the signs and symptoms indicates effective treatment.

The nurse is admitting a client diagnosed with coronary artery disease (CAD) and angina. Which concept is priority? 1. Sleep, rest, activity. 2. Comfort. 3. Oxygenation. 4. Perfusion.

ANSWER: 4. 1. Activity intolerance is a result of lack of perfusion of the cardiac muscle, but the priority is to get the muscle perfused. 2. Pain does not kill anyone; the reason behind the pain could. In the case of chest pain the cardiac muscle is not being perfused, which causes the pain. 3. The problem is not having enough oxygen available to the body but that the oxygen is not being perfused to the cardiac muscle. 4. The cardiac muscle is not perfused when there is a narrowing of the arteries caused by CAD or when an embolus or a thrombus occludes the artery. Adequate perfusion will supply oxygen to the cardiac muscle, allow for increased activity, and decrease pain. TEST-TAKING HINT: The test taker should remember basic pathophysiology to answer this priority question. The other three interrelated concepts are based on the issue of tissue perfusion.

The nurse and an unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP? 1. Assist the client to go down to the smoking area for a cigarette. 2. Transport the client to the intensive care unit (ICU) via a stretcher. 3. Provide the client going home dischargeteaching instructions. 4. Help position the client who is having a portable x-ray done.

ANSWER: 4. 1. Allowing the UAP to take a client down to smoke is not cost effective and is not supportive of the medical treatment regimen that discourages smoking. 2. The client going to the ICU would be unstable, and the nurse should not delegate to a UAP any nursing task that involves an unstable client. 3. The nurse cannot delegate teaching. 4. The UAP can assist the x-ray technician in positioning the client for the portable x-ray. This does not require judgment. TEST-TAKING HINT: The test taker must be knowledgeable about the individual state's Nurse Practice Act regarding what a nurse may delegate to unlicensed assistive personnel. Generally, the answer options that require higher level of knowledge or ability are reserved for licensed staff.

The client is being evaluated for valvular heart disease. Which information would be most significant? 1. The client has a history of coronary artery disease. 2. There is a family history of valvular heart disease. 3. The client has a history of smoking for 10 years. 4. The client has a history of rheumatic heart disease.

ANSWER: 4. 1. An acute myocardial infarction can damage heart valves, causing tearing, ischemia, or damage to heart muscles that affects valve leaflet function, but coronary heart disease does not cause valvular heart disease. 2. Valvular heart disease does not show a genetic etiology. 3. Smoking can cause coronary artery disease, but it does not cause valvular heart disease. 4. Rheumatic heart disease is the most common cause of valvular heart disease. TEST-TAKING HINT: The test taker could rule out option "1" because of knowledge of anatomy: Coronary artery disease has to do with blood supply to heart muscle, whereas the valves are a part of the anatomy of the heart

The nurse is teaching a class on valve replacements. Which statement identifies a disadvantage of having a biological tissue valve replacement? 1. The client must take lifetime anticoagulant therapy. 2. The client's infections are easier to treat. 3. There is a low incidence of thromboembolism. 4. The valve has to be replaced frequently

ANSWER: 4. 1. An advantage of having a biological valve replacement is that no anticoagulant therapy is needed. Anticoagulant therapy is needed with a mechanical valve replacement. 2. This is an advantage of having a biological valve replacement; infections are harder to treat in clients with mechanical valve replacement. 3. This is an advantage of having a biological valve replacement; there is a high incidence of thromboembolism in clients with mechanical valve replacement. 4. Biological valves deteriorate and need to be replaced frequently; this is a disadvantage of them. Mechanical valves do not deteriorate and do not have to be replaced often. TEST-TAKING HINT: This is an "except" question. The test taker might reverse the question and ask, "Which is an advantage of a biological valve?"—which might make answering the question easier

Which nursing diagnosis would be priority for the client diagnosed with myocarditis? 1. Anxiety related to possible long-term complications. 2. High risk for injury related to antibiotic therapy. 3. Increased cardiac output related to valve regurgitation. 4. Activity intolerance related to impaired cardiac muscle function.

ANSWER: 4. 1. Anxiety is a psychosocial nursing diagnosis, which is not a priority over a physiological nursing diagnosis. 2. Antibiotic therapy does not result in injury to the client. 3. Myocarditis does not result in valve damage (endocarditis does), and there would be decreased, not increased, cardiac output. 4. Activity intolerance is priority for the client with myocarditis, an inflammation of the heart muscle. Nursing care is aimed at decreasing myocardial work and maintaining cardiac output. TEST-TAKING HINT: If the test taker has no idea which is the correct answer, then "myo," which refers to muscle, and "card," which refers to the heart, should lead the test taker to the only option which has both muscle and heart in it, option "4."

The telemetry nurse notes a peaked T wave for the client diagnosed with congestive heart failure. Which laboratory data should the nurse assess? 1. CK-MB. 2. Troponin. 3. BNP. 4. Potassium.

ANSWER: 4. 1. CK-MB is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme. 2. Troponin is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme. 3. Beta-type natriuretic peptide (BNP) is elevated in clients with congestive heart failure, but it does not affect the electrical activity of the heart. 4. Hyperkalemia will cause a peaked T wave; therefore, the nurse should check these laboratory data.

Which population is at a higher risk for dying from a myocardial infarction? 1. Caucasian males. 2. Hispanic females. 3. Asian males. 4. African American females.

ANSWER: 4. 1. Caucasian males have a high rate of coronary artery disease, but they do not delay seeking health care as long as some other ethnic groups. The average delay time is five (5) hours. 2. Hispanic females are at higher risk for diabetes than for dying from a myocardial infarction. 3. Asian males have fewer cardiovascular events, which is attributed to their diet, which is high in fiber and omega-3 fatty acids. 4. African American females are 35% more likely to die from coronary artery disease than any other population. This population has significantly higher rates of hypertension and it occurs at a younger age. The higher risk of death from an MI is also attributed to a delay in seeking emergency care—an average of 11 hours.

The male client is diagnosed with coronary artery disease (CAD) and is prescribed sublingual nitroglycerin. Which statement indicates the client needs more teaching? 1. "I should keep the tablets in the dark-colored bottle they came in." 2. "If the tablets do not burn under my tongue, they are not effective." 3. "I should keep the bottle with me in my pocket at all times." 4. "If my chest pain is not gone with one tablet, I will go to the ER."

ANSWER: 4. 1. If the tablets are not kept in a dark bottle, they will lose their potency. 2. The tablets should burn or sting when put under the tongue. 3. The client should keep the tablets with him in case of chest pain. 4. The client should take one tablet every five (5) minutes and, if no relief occurs after the third tablet, have someone drive him to the emergency department or call 911. TEST-TAKING HINT: This question is an "except" question, requiring the test taker to identify which statement indicates the client doesn't understand the teaching. Sometimes the test taker could restate the question and think which statement indicates the client understands the teaching.

The nurse has written an outcome goal "demonstrates tolerance for increased activity" for a client diagnosed with congestive heart failure. Which intervention should the nurse implement to assist the client to achieve this outcome? 1. Measure intake and output. 2. Provide two (2)g sodium diet. 3. Weigh the client daily. 4. Plan for frequent rest periods.

ANSWER: 4. 1. Measuring the intake and output is an appropriate intervention to implement for a client with CHF, but it does not address getting the client to tolerate activity. 2. Dietary sodium is restricted in clients with CHF, but this is an intervention for decreasing fluid volume, not for increasing tolerance for activity. 3. Daily weighing monitors fluid volume status, not activity tolerance. 4. Scheduling activities and rest periods allows the client to participate in his or her own care and addresses the desired outcome. TEST-TAKING HINT: With questions involving nursing diagnoses or goals and outcomes, the test taker should realize that all activities referred to in the answer options may be appropriate for the disease but may not be specific for the desired outcome

The client who has just had a percutaneous balloon valvuloplasty is in the recovery room. Which intervention should the Post Anesthesia Care Unit nurse implement? 1. Assess the client's chest tube output. 2. Monitor the client's chest dressing. 3. Evaluate the client's endotracheal (ET) lip line. 4. Keep the client's affected leg straight.

ANSWER: 4. 1. Percutaneous balloon valvuloplasty is not an open-heart surgery; therefore, the chest will not be open and the client will not have a chest tube. 2. This is not an open-heart surgery; therefore, the client will not have a chest dressing. 3. The endotracheal (ET) tube is inserted if the client is on a ventilator, and this surgery does not require putting the client on a ventilator. 4. In this invasive procedure, performed in a cardiac catheterization laboratory, the client has a catheter inserted into the femoral artery. Therefore, the client must keep the leg straight to prevent hemorrhaging at the insertion site. TEST-TAKING HINT: If the test taker knows that the word "percutaneous" means "via the skin," then options "1" and "2" could be eliminated as possible correct answers.

The client is diagnosed with pericarditis. Which are the most common signs/symptoms the nurse would expect to find when assessing the client? 1. Pulsus paradoxus. 2. Complaints of fatigue and arthralgias. 3. Petechiae and splinter hemorrhages. 4. Increased chest pain with inspiration.

ANSWER: 4. 1. Pulsus paradoxus is the hallmark of cardiac tamponade; a paradoxical pulse is markedly decreased in amplitude during inspiration. 2. Fatigue and arthralgias are nonspecific signs/symptoms that usually occur with myocarditis. 3. Petechiae on the trunk, conjunctiva, and mucous membranes and hemorrhagic streaks under the fingernails or toenails occur with endocarditis. 4. Chest pain is the most common symptom of pericarditis, usually has an abrupt onset, and is aggravated by respiratory movements (deep inspiration, coughing), changes in body position, and swallowing. TEST-TAKING HINT: The test taker who has no idea what the answer is should apply the testtaking strategy of asking which body system is affected. In this case, it is the cardiac system, specifically the outside of the heart. The test taker should select the option that has something to do with the heart, which is either option "1" or option "4."

The nurse enters the room of the client diagnosed with congestive heart failure. The client is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first? 1. Sponge the client's forehead. 2. Obtain a pulse oximetry reading. 3. Take the client's vital signs. 4. Assist the client to a sitting position.

ANSWER: 4. 1. Sponging dry the client's forehead would be appropriate, but it is not the first intervention. 2. Obtaining a pulse oximeter reading would be appropriate, but it is not the first intervention. 3. Taking the vital signs would be appropriate, but it is not the first intervention. 4. The nurse must first put the client in a sitting position to decrease the workload of the heart by decreasing venous return and maximizing lung expansion. Then, the nurse could take vital signs and check the pulse oximeter and then sponge the client's forehead. TEST-TAKING HINT: In a question that asks the nurse to set priorities, all the answer options can be appropriate actions by the nurse for a given situation. The test taker should apply some guidelines or principles, such as Maslow's hierarchy, to determine what will give the client the most immediate assistance.

Which laboratory data confirm the diagnosis of congestive heart failure? 1. Chest x-ray (CXR). 2. Liver function tests. 3. Blood urea nitrogen (BUN). 4. Beta-type natriuretic peptide (BNP).

ANSWER: 4. 1. The CXR will show an enlarged heart, but it is not used to confirm the diagnosis of congestive heart failure. 2. Liver function tests may be ordered to evaluate the effects of heart failure on the liver, but they do not confirm the diagnosis. 3. The BUN is elevated in heart failure, dehydration, and renal failure, but it is not used to confirm congestive heart failure. 4. BNP is a hormone released by the heart muscle in response to changes in blood volume and is used to diagnose and grade heart failure.

The nurse enters the client's room and notes an unconscious client with an absence of respirations and no pulse or blood pressure. The concept of perfusion is identified by the nurse. Which should the nurse implement first? 1. Notify the health care provider. 2. Call a rapid response team (RRT). 3. Determine the telemetry monitor reading. 4. Push the Code Blue button.

ANSWER: 4. 1. The HCP will be notified but the first action is to call for the Code Blue team and initiate CPR. 2. A Rapid Response Team is called to prevent an arrest situation from occurring. This client is in an arrest situation. 3. The client has clinical signs of death; CPR must be initiated and the code team notified. 4. The first action is to immediately notify the code team and initiate CPR per protocol. TEST-TAKING HINT: The test taker should remember "If in stress do not assess." The nurse has enough information given in the stem of the question to initiate an action. The question asks for a first; all of the options may be implemented but only one is first

Which intervention should the nurse implement when defibrillating a client who is in ventricular fibrillation? 1. Defibrillate the client at 50, 100, and 200 joules. 2. Do not remove the oxygen source during defibrillation. 3. Place petroleum jelly on the defibrillator pads. 4. Shout "all clear" prior to defibrillating the client.

ANSWER: 4. 1. The adult client should be defibrillated at 360 joules. 2. The oxygen source should be removed to prevent any type of spark during defibrillation. 3. The nurse should use defibrillator pads or defibrillator gel to prevent any type of skin burns while defibrillating the client. 4. If any member of the health-care team is touching the client or the bed during defibrillation, that person could possibly be shocked. Therefore, the nurse should shout "all clear." TEST-TAKING HINT: The test taker should always consider the safety of the client and the health-care team. Options "2" and "3" put the client at risk for injury during defibrillation.

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication? 1. The client's apical pulse is 64. 2. The client's calcium level is elevated. 3. The client's telemetry shows occasional PVCs. 4. The client's blood pressure is 90/58.

ANSWER: 4. 1. The apical pulse is within normal limits— 60 to 100 beats per minute. 2. The serum calcium level is not monitored when calcium channel blockers are given. 3. Occasional PVCs would not warrant immediate intervention prior to administering this medication. 4. The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out. TEST-TAKING HINT: The test taker must know when to question administering medications. The test taker is trying to select an option that, if the medication is administered, would cause serious harm to the client.

The nurse is caring for a client who suddenly complains of crushing substernal chest pain while ambulating in the hall. Which nursing action should the nurse implement first? 1. Call a Code Blue. 2. Assess the telemetry reading. 3. Take the client's apical pulse. 4. Have the client sit down.

ANSWER: 4. 1. The client has not arrested. The nurse might call the rapid response team (RRT) but not a code blue. 2. The client is in distress; the nurse should implement a procedure that will alleviate the distress. 3. The client is in distress; the nurse should implement a procedure that will alleviate the distress. 4. The client began to have a problem during physical exertion. Stopping the exertion should be the first action taken by the nurse. TEST-TAKING HINT: The test taker should remember "If in stress do not assess." The nurse has enough information given in the stem of the question to initiate an action. The question asks for a first. All of the options may be implemented but only one is first.

The unlicensed assistive personnel (UAP) tells the primary nurse that the client diagnosed with coronary artery disease is having chest pain. Which action should the nurse take first? 1. Tell the UAP to go take the client's vital signs. 2. Ask the UAP to have the telemetry nurse read the strip. 3. Notify the client's health-care provider. 4. Go to the room and assess the client's chest pain.

ANSWER: 4. 1. The client with CAD who is having chest pain is unstable and requires further judgment to determine appropriate actions to take, and the UAP does not have that knowledge. 2. The UAP could go ask the telemetry nurse, but this is not the first action. 3. The client's HCP may need to be notified, but this is not the first intervention. 4. Assessment is the first step in the nursing process and should be implemented first; chest pain is priority

The client who is one (1) day postoperative coronary artery bypass surgery is exhibiting sinus tachycardia. Which intervention should the nurse implement? 1. Assess the apical heart rate for one (1) full minute. 2. Notify the client's cardiac surgeon. 3. Prepare the client for synchronized cardioversion. 4. Determine if the client is having pain.

ANSWER: 4. 1. The telemetry reading is accurate, and there is no need for the nurse to assess the client's heart rate. 2. There is no reason to notify the surgeon for a client exhibiting sinus tachycardia. 3. Synchronized cardioversion is prescribed for clients in acute atrial fibrillation or ventricular fibrillation with a pulse. 4. Sinus tachycardia means the sinoatrial node is the pacemaker, but the rate is greater than 100 because of pain, anxiety, or fever. The nurse must determine the cause and treat appropriately. There is no specific medication for sinus tachycardia. TEST-TAKING HINT: The test taker must use the nursing process to determine the correct option and select an option that addresses assessment, the first step of the nursing process. Because both option "1" and option "4" address assessment, the test taker must determine which option is more appropriate. How will taking the apical pulse help treat sinus tachycardia? Determining the cause for sinus tachycardia is the most appropriate intervention.

The client is three (3) hours post-myocardial infarction. Which data would warrant immediate intervention by the nurse? 1. Bilateral peripheral pulses 2+. 2. The pulse oximeter reading is 96%. 3. The urine output is 240 mL in the last four (4) hours. 4. Cool, clammy, diaphoretic skin

ANSWER: 4. 1. This pulse indicates the heart is pumping adequately. Normal pulses should be 2+ to 3+. 2. A pulse oximeter reading of greater than 93% indicates the heart is perfusing the periphery. 3. An output of 30 mL/hr indicates the heart is perfusing the kidneys adequately. 4. Cold, clammy skin is an indicator of cardiogenic shock, which is a complication of MI and warrants immediate intervention.

According to the 2010 American Heart Association Guidelines, which steps of cardiopulmonary resuscitation for an adult suffering from a cardiac arrest should the nurse teach individuals in the community? Rank in order of performance. 1. Place the hands over the lower half of the sternum. 2. Look for obvious signs of breathing. 3. Begin compressions at a ratio of 30:2. 4. Call for and AED immediately. 5. Position the victim on the back.

ANSWER: In order of performance: 5, 2, 4, 1, 3 5. The victim is positioned on the back for assessment and for the rescuer to be able to begin cardiopulmonary resuscitation. 2. Although we now perform a quick look to determine if the victim is breathing there is no longer a "look, listen, feel" step. The victim may not be breathing at all or may be having agonal respirations. 4. For adults the rescuer should immediately call for an AED or 911. Research has proven the faster that defibrillation is performed the better the chance of survival for the victim. 1. Compressions are initiated immediately because the victim will have some residual oxygen in the lungs. Breathing is not initiated unless there is a barrier device available. 3. The compression rate is 30:2.

_____: A polyester mesh jacket that is placed over the ventricles to provide support and to avoid overstretching the myocardial muscle in the patient with heart failure; reduces heart muscle hypertrophy and assists with improvement of ejection fraction.

Acorn cardiac support device

_____: The sudden blockage of an artery, typically in the lower extremity, in the patient with chronic peripheral arterial disease.

Acute arterial occlusion

_____: A disorder, including unstable angina and myocardial infarction, that results from obstruction of the coronary artery by ruptured atherosclerotic plaque and leads to platelet aggregation, thrombus formation, and vasoconstriction.

Acute coronary syndrome (ACS)

_____: The pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels; the amount of resistance is directly related to arterial blood pressure and blood vessel diameter.

Afterload

_____: Metabolism without oxygen.

Anaerobic cellular metabolism

_____: The widespread reaction that occurs in response to contact with a substance to which the person has a severe allergy (antigen); characterized by blood vessel and bronchiolar smooth muscle involvement causing widespread blood vessel dilation, decreased cardiac output, and bronchoconstriction; results in cell damage and the release of large amounts of histamine, severe hypovolemia, vascular collapse, decreased cardiac contraction, and dysrhythmias, and causes extreme whole-body hypoxia.

Anaphylaxis

_____: Generalized edema.

Anasarca

_____: A permanent localized dilation of an artery (to at least 2 times its normal diameter) that forms when the middle layer (media) of the artery is weakened, stretching the inner (intima) and outer (adventitia) layers. As the artery widens, tension in the wall increases and further widening occurs, thus enlarging the aneurysm.

Aneurysm

_____: A surgical procedure performed to excise an aneurysm.

Aneurysmectomy

_____: Literally, "strangling of the chest"; a temporary imbalance between the ability of the coronary arteries to supply oxygen and the demand for oxygen by the cardiac muscle. As a result, the patient experiences chest discomfort.

Angina pectoris

_____: A ratio derived by dividing the ankle blood pressure by the brachial blood pressure; this calculation is used to assess the vascular status of the lower extremities. To obtain the ABI, a blood pressure cuff is applied to the lower extremities just above the malleoli. The systolic pressure is measured by Doppler ultrasound at both the dorsalis pedis and posterior tibial pulses. The higher of these two pressures is then divided by the higher of the two brachial pulses.

Ankle-brachial index (ABI)

_____: Completely lacking oxygen.

Anoxic

A client with septic shock is to receive dopamine at 18 mcg/kg/min. The client's weight is 154 pounds. How many mcg/min does the nurse administer?__

Answer: 1260 mcg/min

The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? (Select all that apply). A) Truncal obesity. B) Hypercholesterolemia. C) Elevated homocysteine levels. D) Glucose intolerance. E) Client taking losartan (Cozaar).

Answer: A, B, D, E. Truncal obesity related to large waist size (excessive abdominal fat causing central obesity)—40 inches (102 cm) or greater for men, 35 inches (89 cm) or greater for women—is a sign of metabolic syndrome. Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol)—HDL-C less than 45 mg/dL (1.17 mmol/L) for men or less than 55 mg/dL (1.42 mmol/L) for women—or taking an anticholesterol drug is a sign of metabolic syndrome. Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome. Blood pressure greater than 130/85 mm Hg or taking antihypertensive medication indicates metabolic syndrome.Although elevated homocysteine levels may predispose to atherosclerosis, they are not part of metabolic syndrome.

When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction (MI)? (Select all that apply). A) Oxygen. B) Morphine sulfate. C) Nitroglycerin. D) Naloxone. E) Acetaminophen. F) Verapamil (Calan, Isoptin)

Answer: A, B. Administering oxygen will increase available oxygen for the ischemic myocardium during the acute phase of an MI. Morphine is also needed to reduce oxygen demand, preload, pain, and anxiety, and nitroglycerin is used to reduce preload and chest pain.Naloxone is a narcotic antagonist that is used for over dosage of opiates, not for MI. Acetaminophen may be used for headache related to nitroglycerin. Because of negative inotropic action, calcium channel blockers such as verapamil are used for angina, not for MI.

A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply). A) Limited alcohol intake. B) Reduced potassium intake. C) Tobacco cessation. D) Decreased magnesium intake. E) Regular exercise program.

Answer: A, C, E. Clients who have hypertension should limit alcohol intake. Low potassium intake is associated with hypertension. Tobacco use exacerbates hypertension. Low magnesium intake is associated with hypertension. regular exercise program will help reduce blood pressure.

Which clients are at immediate risk for hypovolemic shock? (Select all that apply). A) Unrestrained client in a motor vehicle collision (MVC) B) Construction worker C) Athlete D) Surgical intensive care unit (SICU) client E) 85-year-old with gastrointestinal (GI) virus

Answer: A, D, E. Clients who are immediate risk for hypovolemic shock include: the unrestrained client in a (MVC), the SICU client, and the 85-year-old client with GI virus. The client who is unrestrained in a MVC is prone to multiple trauma and bleeding. Surgical clients are at high risk for hypovolemic shock owing to fluid loss and hemorrhage. Older adult clients are prone to shock, especially if a gastrointestinal virus is present that results in fluid losses.Unless injured or working in excessive heat, the construction worker and the athlete are not at risk for hypovolemic shock. They may, however, be at risk for dehydration.

A client is exhibiting signs and symptoms of early shock. What is important for the nurse to do to support the psychosocial integrity of the client? (Select all that apply). A) Ask family members to stay with the client. B) Call the health care provider. C) Increase IV and oxygen rates. D) Remain with the client. E) Reassure the client that everything is being done for him or her.

Answer: A, D, E. To support the psychosocial integrity of a client in early shock, the nurse would have a familiar person nearby to comfort the client. The nurse would also remain with the client and offer genuine support to reassure the client that everything is being done for her.The health care provider would be notified, and increasing IV and oxygen rates may be needed, but these actions do not support the client's psychosocial integrity.

The client with which laboratory result is at risk for hemorrhagic shock? A) International normalized ratio (INR) 7.9 B) Partial thromboplastin time (PTT) 12.5 seconds C) Platelets 170,000/mm3 (170 × 109/L) D) Hemoglobin 8.2 g/dL (82 mmol/L)

Answer: A. A client with a prolonged INR of 7.9 places a client at risk for hemorrhagic shock. Prolonged INR indicates that blood takes longer than normal to clot and increases the risk for bleeding.PTT of 12.5 seconds is low and puts this client at risk for clotting. A platelet value of 170,000/mm3 (170 × 109/L) is normal and poses no risk for bleeding. Although a hemoglobin of 8.2 g/dL (82 mmol/L) is low, the client could have severe iron deficiency or could have received medication affecting the bone marrow.

A client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care? A) "My leg might turn very white after the surgery." B) "I must be concerned if my foot turns blue." C) "I must report a fever or any drainage." D) "Warmness, redness, and swelling are expected."

Answer: A. A need for further postoperative teaching about arterial revascularization is needed when the client says that "my leg might turn very white after the surgery." Pallor is one of the signs of decreased perfusion along with increased pain, poikilothermia, paresthesia, pulselessness, and paralysis.The foot turning blue is a sign of poor perfusion. Fever or drainage would indicate an infection. Warmness, redness, and swelling indicate reperfusion, which is a good sign.

A client recovering from an open reduction of the femur suddenly feels light-headed, with increased anxiety and agitation. Which key vital sign differentiates a pulmonary embolism from early sepsis? A) Temperature. B) Pulse. C) Respiration. D) Blood pressure.

Answer: A. A postoperative client's temperature may differentiate pulmonary embolism from early sepsis when the client complains of feeling light-headed and anxious. A sign of early sepsis is low-grade fever.Both early sepsis and thrombus may cause tachycardia(pulse), tachypnea(respiration), and hypotension (blood pressure).

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition? A) Absence of adventitious breath sounds. B) Presence of a nonproductive cough C) Decrease in respiratory rate at rest D) SaO2 86% on room air

Answer: A. Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving. A moist, productive cough usually accompanies pulmonary edema. However, the presence of a nonproductive cough does not indicate that the problem is resolving. The respiratory rate usually decreases while at rest. It is not an indicator of effective treatment. This value is below the expected reference range. It is not an indicator of effective treatment.

A client is admitted to the hospital with two of the systemic inflammatory response syndrome variables: temperature of 95°F (35°C) and high white blood cell count. Which intervention from the sepsis resuscitation bundle does the nurse initiate? A) Broad-spectrum antibiotics B) Blood transfusion C) Cooling baths D) NPO status

Answer: A. From the sepsis resuscitation bundle the nurse initiates broad-spectrum antibiotics within 1 hour of establishing diagnosis.A blood transfusion is indicated for low red blood cell count or low hemoglobin and hematocrit. Transfusion is not part of the sepsis resuscitation bundle. Cooling baths neither are indicated because the client is hypothermic nor are this part of the sepsis resuscitation bundle. NPO status neither is indicated for this client nor is it part of the sepsis resuscitation bundle.

A nurse is caring for a client following insertion o f a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? A) "I can't get rid of these hiccups." B) "I have a headache." C) "I feel dizzy when I stand." D) "My incision site stings."

Answer: A. Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation. Headache is not a complication of the insertion procedure. However, it might be related to other disease processes. Dizziness is not a complication of the insertion procedure and is expected initially as the client adjusts to the pacemaker. Pain or stinging at the incision site is not a complication of the insertion procedure. However, the client should monitor the pacemaker insertion site for manifestations of infection.

The client with which problem is at highest risk for hypovolemic shock? A) Esophageal varices. B) Kidney failure. C) Arthritis and daily acetaminophen use. D) Kidney stone.

Answer: A. The client with esophageal varices is at highest risk for hypovolemic shock. Esophageal varices are caused by portal hypertension where the portal vessels are under high pressure. With this high pressure, the portal vessels are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock.As the kidneys fail, fluid is typically retained, causing fluid volume excess, not hypovolemia. Arthritis and daily acetaminophen use do not cause GI bleeding and hypovolemia. Nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen may predispose the client to gastrointestinal (GI) bleeding and hypovolemia. Although a kidney stone may cause hematuria, massive blood loss or hypovolemia generally does not occur.

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? A) Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL. B) Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL. C) Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL. D) Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL

Answer: A. The expected reference range of cholesterol is less than 200 mg/dL, HDL above 45 mg/dL for men and above 55 mg/dL for women, and LDL less than 130 mg/dL.

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? A) Elevate the head of the client's bed. B) Initiate seizure precautions. C) Tell the client to report vision changes. D) Start a peripheral IV.

Answer: A. The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation. The nurse should initiate seizure precautions because the client is at risk for seizures. However, this is not the first action the nurse should take. The nurse should tell the client to report vision changes because the client is at risk for blurred vision. However, this is not the first action the nurse should take. The nurse should initiate an IV to provide access for medication administration to reduce the client's blood pressure. However, this is not the first action the nurse should take.

The nurse reviews the medical record of a client with hemorrhagic shock, which contains the following information:Physical Assessment FindingsDiagnostic FindingsPulse 140 beats/min and threadyABG respiratory acidosisBlood pressure 60/40 mm HgLactate level 63 mg/dL(7 mmol/L)Respirations 40/min and shallow. All of these provider prescriptions are given for the client. Which does the nurse carry out first? A) Notify anesthesia for endotracheal intubation. B) Give Plasmanate 1 unit now. C) Give normal saline solution 250 mL/hr. D) Type and crossmatch for 4 units of packed red blood cells (PRBCs).

Answer: A. The nurse must first notify anesthesia for endotracheal intubation for this client with hemorrhagic shock. Establishing an airway is the priority in all emergency situations.Although administering Plasmanate and normal saline, and typing and cross matching for 4 units of PRBCs are important actions, airway always takes priority.

After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first? A) The client with acute coronary syndrome who has a 3-pound (1.4 kg) weight gain and dyspnea B) The client with percutaneous coronary angioplasty who has a dose of heparin scheduled C) The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 beats/min D) A client who has first-degree heart block, rate 68 beats/min, after having an inferior myocardial infarction

Answer: A. The nurse needs to first assess the client with acute coronary syndrome with dyspnea and weight gain. These are symptoms of left ventricular failure and pulmonary edema. This client needs prompt intervention.A scheduled heparin dose does not take priority over dyspnea; it can be administered after the client with dyspnea is taken care of. The client with a pacemaker and a normal heart rate is not in danger. First-degree heart block is rarely symptomatic, and the client has a normal heart rate.

The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of which medication because it raises an index of suspicion as to the worsening of the client's HF? A) Ibuprofen (Motrin) B) Hydrochlorothiazide (HydroDIURIL) C) NPH insulin D) Levothyroxine (Synthroid)

Answer: A. The nurse questions an 82-year-old client with exacerbation of heart failure if the client is taking ibuprofen. Long-term use of nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client's HF.A diuretic may be used in the treatment of HF and hypertension. Although diabetes may be a risk factor for cardiovascular disease, it does not directly cause HF. In proper doses, Synthroid replaces thyroid hormone for those with hypothyroidism. It does not cause HF.

A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? A) Dyspnea on exertion. B) Pericardial rub. C) Tracheal deviation. D) Weight loss.

Answer: A. The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output. The nurse should identify that a pericardial rub is an expected manifestation of pericarditis. The nurse should identify that tracheal deviation is an expected manifestation of a tension pneumothorax. The nurse should identify that weight gain is an expected manifestation of dilated cardiomyopathy. Weight gain is due to ventricular compromise and fluid retention.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A) Vagal stimulation. B) Administration of atropine IV. C) Delivery of a precordial thump. D) Defibrillation.

Answer: A. The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole. The nurse should identify that atropine is used to treat bradydysrhythmias. Supraventricular tachycardia does not require atropine. The nurse should identify that a precordial thump is used for witnessed ventricular tachycardia if a defibrillator is unavailable. Supraventricular tachycardia does not require a precordial thump. The nurse should identify that cardioversion, rather than defibrillation, is used to treat supraventricular tachycardia. Defibrillation is used to treat ventricular fibrillation or pulseless ventricular tachycardia.

A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching? A) "This is a big warning; I must modify my lifestyle or I am at risk for having a heart attack." B) "Angina is just a temporary interruption of blood flow to my heart." C) "I need to tell my wife I've had a heart attack." D) "Because this was temporary, I will not need to take any medications for my heart."

Answer: A. The statement by the client that unstable angina being a big warning and needing to alter his lifestyle shows that the client understands the teaching. Health promotion efforts are directed toward controlling or altering modifiable risk factors for CAD, which will then lower the risk of unstable angina and/or MI.Although anginal pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin, lipid-lowering agents, antianginals, or antihypertensives.

The unlicensed assistive personnel (UAP) is concerned about a postoperative client with blood pressure (BP) of 90/60 mm Hg, heart rate of 80 beats/min, and respirations of 22 breaths/min. What does the supervising nurse do? A) Compare these vital signs with the last several readings. B) Request that the surgeon see the client. C) Increase the rate of intravenous fluids. D) Reassess vital signs using different equipment.

Answer: A. The supervising nurse will take the vital sign trends into consideration. A BP of 90/60 mm Hg may be normal for this client.Calling the surgeon is not necessary at this point, and increasing IV fluids is not indicated. The same equipment must be used when vital signs are taken postoperatively.

The nurse is caring for a client with peripheral arterial disease (PAD). For which symptoms does the nurse assess? A) Reproducible leg pain with exercise B) Unilateral swelling of affected leg C) Decreased pain when legs are elevated D) Pulse oximetry reading of 90%

Answer: A. The symptom the nurse assesses the client with PAD is reproducible leg pain with exercise. Claudication (leg pain with ambulation due to ischemia) is reproducible in similar circumstances.Unilateral swelling is typical of venous problems such as deep vein thrombosis. With PAD, pain decreases with legs in the dependent position. Pulse oximetry readings reflect the amount of oxygen bound to hemoglobin. PAD results from atherosclerotic occlusion of peripheral arteries.

A nurse is caring for a postoperative client 1 hr following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? A) Urine output of 20 mL/hr. B) Severe pain with coughing. C) Increase in temperature from 36.8° C (98.2° F) to 37.5° C (99.5° F). D) Serosanguineous drainage on dressing.

Answer: A. Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture. Coughing is painful after an aortic aneurysm repair. However, it is not a manifestation of shock. This temperature is within the expected reference range and is not a manifestation of shock. Serosanguineous drainage 1 hr postoperative is expected and is not a manifestation of shock. Serosanguineous drainage should decrease over the first few days and discontinue after day 5.

A nurse is caring for a client who was admitted for treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? A) Review serum electrolyte values. B) Obtain client's current weight. C) Check the client's urine output. D) Determine the time of the last digoxin dose.

Answer: A. Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia. B) The nurse should obtain the client's current weight to determine fluid loss from diuretic therapy. However, the nurse should take another action first. C) The nurse should check the client's urine output to determine fluid loss from diuretic therapy. However, the nurse should take another action first. D) The nurse should determine the time of the last digoxin dose in order to evaluate when the next dose is due. However, the nurse should take another action first.

Which characteristics place women at high risk for myocardial infarction (MI)? (Select all that apply). A) Premenopausal. B) Increasing age. C) Family history. D) Abdominal obesity. E) Breast cancer.

Answer: B, C, D. Increasing age is a risk factor, especially after 70 years. Family history is a significant risk factor in both men and women. Also, a large waist size and/or abdominal obesity are risk factors for both metabolic syndrome and MI.Premenopausal women are not at higher risk for MI, and breast cancer is not a risk factor for MI.

Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)? (Select all that apply). A) Sharp, inspiratory chest pain B) Dyspnea. C) Dizziness. D) Extreme fatigue. E) Anorexia.

Answer: B, C, D. Many women who experience an MI present with dyspnea, light-headedness and dizziness, and fatigue.Sharp, pleuritic pain is more consistent with pericarditis or pulmonary embolism. Anorexia is neither a typical nor an atypical sign of MI.

The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock? (Select all that apply). A) Bradycardia. B) Cool, diaphoretic skin. C) Crackles in the lung fields. D) Respiratory rate of 12 breaths/min. E) Anxiety and restlessness. F) Temperature of 100.4*F (38.0*C)

Answer: B, C, E. The client with shock has cool, moist skin. Because of extensive tissue necrosis, the left ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles in the lung fields due to poor tissue perfusion. A change in mental status, anxiety, and restlessness are also expected.All types of shock (except neurogenic) present with tachycardia, not bradycardia. Due to pulmonary congestion, a client with cardiogenic shock typically has tachypnea. A respiratory rate of 12 breaths/minute is within normal limits. Cardiogenic shock does not present with low-grade fever. Fever would be more likely to occur in pericarditis.

How does the nurse recognize that a positive outcome has occurred when administering plasma protein fraction (Plasmanate)? A) Urine output 20 to 30 mL/hr for the last 4 hours B) Mean arterial pressure (MAP) 70 mm Hg C) Albumin 3.5 g/dL (5.0 mcmol/L) D) Hemoglobin 7.6 g/dL (76 mmol/L)

Answer: B. A MAP of 70 mm Hg means that a positive outcome has occurred when plasma protein fraction (Plasmanate) has been administered. Plasmanate expands the blood volume and helps maintain MAP greater than 65 mm Hg, and a desired outcome in shock.Urine output needs to be 0.5 mL/kg/hr, or greater than 30 mL/hr. Albumin levels reflect nutritional status, which may be poor in shock states due to an increased need for calories. Plasmanate expands blood volume by exerting increasing colloid osmotic pressure in the bloodstream, pulling fluid into the vascular space and does not improve an abnormal hemoglobin.

Which problem in the clients below best demonstrates the highest risk for hypovolemic shock? A) Client receiving a blood transfusion B) Client with severe ascites C) Client with myocardial infarction D) Client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

Answer: B. A client with severe ascites best demonstrates the problem with the highest risk for hypovolemic shock. Fluid shifts from vascular to intraabdominal may cause decreased circulating blood volume and poor tissue perfusion.The client receiving a blood transfusion does not have as high a risk as the client with severe ascites. Myocardial infarction results in tissue necrosis in the heart muscle, but no blood or fluid losses occur. Owing to excess antidiuretic hormone secretion, the client with SIADH will retain fluid and therefore is not at risk for hypovolemic shock.

Which laboratory result is seen in late sepsis? A) Decreased serum lactate B) Decreased segmented neutrophil count C) Increased numbers of monocytes D) Increased platelet count.

Answer: B. A decreased segmented neutrophil count is indicative of late sepsis. The segmented neutrophils (segs) may no longer be elevated because prolonged sepsis may have exceeded the bone marrow's ability to keep producing and releasing new mature neutrophils.Serum lactate is increased, not decreased, in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis. Late in sepsis, platelets may decrease due to consumptive coagulopathy.

A client comes to the emergency department with chest discomfort. Which action does the nurse perform first? A) Administers oxygen therapy. B) Obtains the client's description of the chest discomfort C) Provides pain relief medication D) Remains calm and stays with the client

Answer: B. A description of the chest discomfort must be obtained first, before further action can be taken.Neither oxygen therapy nor pain medication is the first priority in this situation. An assessment is needed first. Remaining calm and staying with the client are important but are not matters of highest priority.

A nurse is preparing a client for coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure? A) Hemoglobin 14.4 g/dL. B) Previous allergic reaction to shellfish. C) History of peripheral arterial disease. D) Urine output 200 mL/4 hr

Answer: B. A hemoglobin level of 14.4 g/dL is within the expected reference range. The contrast medium used is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine. This procedure involves access through large arteries or veins into the heart and is not affected by peripheral arterial disease. An output of 200 mL in 4 hr is within the expected reference range.

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome? A) Hourly urine output 10 to 12 mL/hr B) Blood pressure 90/60 mm Hg and mean arterial pressure 70 mm Hg C) Blood glucose 245 mg/dL (13.6 mmol/L) D) Serum creatinine 3.6 mg/dL (318 mcmol/L)

Answer: B. A positive outcome of a Dopamine infusion started on a client with septic shock is a blood pressure of 90/60 mm Hg and a mean arterial pressure of 70 mm Hg. Dopamine improves blood flow by increasing peripheral resistance, which increases blood pressure.Urine output less than 30 mL/hr or 0.5 mL/kg/hr and elevations in serum creatinine indicate poor tissue perfusion to the kidney and are a negative consequence of shock, not a positive response. Although a blood glucose of 245 mg/dL (13.6 mmol/L) is an abnormal finding, dopamine increases blood pressure and myocardial contractility, not glucose levels.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? A) Continue to monitor the heparin infusion as prescribed. B) Stop the heparin infusion. C) Request a prothrombin time (PT). D) Increase the heparin infusion flow rate by 2 mL/hr.

Answer: B. An aPTT of 96 seconds indicates excessive heparin. Therefore, the nurse should take corrective action. The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury. The nurse should monitor PT for a client who is taking an oral anticoagulant. However, it is not necessary to request a PT before taking any corrective action. An aPTT of 96 seconds indicates excessive heparin. Therefore, the nurse should not increase the heparin infusion.

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? A) Ask if the client has had a recent infection. B) Inquire about the presence or absence of claudication. C) Explore the client's family history of peripheral vascular disease. D) Note the presence or absence of pain at the ulcer site.

Answer: B. Both arterial and venous ulcers have the potential to become infected. Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not. Family history is important, but it does not help to differentiate between arterial and venous ulcers. Both arterial and venous ulcers cause varying degrees of pain or discomfort.

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? A) A 1-inch (2.5 cm) backup of blood in the IV tubing B) Facial drooping C) Partial thromboplastin time (PTT) 68 seconds D) Report of chest pressure during dye injection

Answer: B. During and after thrombolytic administration, facial drooping may indicate intracranial bleeding, including changes in neurologic status.A 1-inch (2.5 cm) backup of blood in the IV tubing may be related to IV positioning. If heparin is used, PTT reflects a therapeutic value which is 1½ to 2½ times the control. Reports of chest pressure during dye injection or stent deployment are considered an expected result of the procedure.

A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A) Dyspnea with exertion. B) Weight gain of 0.9 kg (2 lb) in 24 hr. C) Increase of 10 mm Hg in systolic blood pressure. D) Dizziness when rising quickly.

Answer: B. Dyspnea with exertion is a nonurgent finding that is expected for a client who has heart failure. Although the client should report it, there is another finding the client should report immediately. When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately. An increase of 10 mm Hg in systolic blood pressure is a nonurgent finding. Although the client should report the increase in blood pressure, there is another finding the client should report immediately. Dizziness when rising quickly is a nonurgent finding that is expected for a client who is taking medications to treat heart failure. Although the client should report it, there is another finding the client should report immediately.

A nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? A) "I have had chest pain a couple of times since I saw my doctor in the office last week." B) "I smoked a cigarette this morning to calm my nerves about having this procedure." C) "I didn't take my heart pills this morning because the doctor told me not to." D) "I'm still hungry after the bowl of cereal I ate at 7 a.m."

Answer: B. Episodes of chest pain are not a contraindication to this test. Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test. The provider might withhold cardiovascular medications prior to this procedure to effectively monitor cardiovascular response to stress. It is not necessary for the client to be NPO prior to this procedure.

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? A) Jugular venous neck distention. B) Weak peripheral pulses. C) Increased abdominal girth. D) Dependent edema.

Answer: B. Jugular venous neck distention is a finding related to systemic congestion resulting from right-sided heart failure. Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure. Increased abdominal girth is a finding related to systemic congestion resulting from right-sided heart failure. Dependent edema is a finding related to systemic congestion resulting from right-sided heart failure.

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated? A) Localized erythema and edema B) Low-grade fever and mild hypotension C) Low oxygen saturation rate and decreased cognition D) Reduced urinary output and increased respiratory rate

Answer: B. Low-grade fever and mild hypotension in a postoperative client indicate very early sepsis. With treatment, the probability of recovery is high.Localized erythema and edema indicate local infection. A low oxygen saturation rate and decreased cognition indicate severe sepsis. Reduced urinary output and increased respiratory rate indicate active (not early) sepsis.

The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? A) Urine output of 1500 mL on the preceding day B) Crackles in the lung fields C) Pedal edema. D) Expectoration of yellow sputum

Answer: B. Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields.A urine output of 1500 mL is normal. Edema is a sign of right ventricular heart failure. Yellow sputum indicates the presence of white blood cells and possible infection.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of amyocardial infarction (MI)? A) Myoglobin. B) Creatine kinase-MB. C) Homocysteine. D) C-reactive protein.

Answer: B. Myoglobin is elevated following an MI. However, it is not specific to the cardiac muscle and is elevated with skeletal muscle injury. Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury. Homocysteine is always present in the blood. An increased level might indicate a risk factor for the development of cardiovascular disease. C-reactive protein increases soon after the beginning of an inflammatory process, such as rheumatoid arthritis, and is not specific to cardiac muscle.

A nurse is teaching a client who is starting to take an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify his provider if he experiences which of the following adverse effects of this medication? A) Tendon pain. B) Persistent cough. C) Frequent urination. D) Constipation.

Answer: B. Tendonitis is an adverse effect of fluoroquinolone antibiotics. A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication. Frequent urination is an expected outcome of this medication. Constipation is an adverse effect of ACE inhibitors. However, the client does not need to discontinue use or report this to the provider.

A nurse is providing teaching for a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? A) "You will be able to stop taking immunosuppressants after 12 months." B) "You might no longer be able to feel chest pain." C) "Your level of activity intolerance will not change." D) "After 6 months, you will no longer need to restrict your sodium intake."

Answer: B. The client will remain on immunosuppressants for the remainder of his life to help prevent rejection of the heart. Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart. The client's activity tolerance should gradually improve as the healing process progresses. The client will need to permanently maintain a diet that is restricted in sodium and fat.

The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? A) Inferior wall. B) Anterior wall. C) Lateral wall. D) Posterior wall.

Answer: B. The client with an anterior wall MI is most carefully observed for the development of left ventricular failure. Due to the large size of the anterior wall, the amount of tissue infarction may be large enough to decrease the force of left ventricular contraction, leading to heart failure.The client with an inferior wall MI is most likely to develop right ventricular heart failure related to an occlusion of the right coronary artery. Clients with obstruction of the circumflex artery may experience a lateral wall MI and sinus dysrhythmias or a posterior wall MI and sinus dysrhythmias.

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present? A) PaCO2 58 mm Hg B) Lactate 81 mg/dL (9.0 mmol/L) C) Partial thromboplastin time 64 seconds D) Potassium 2.8 mEq/L (2.8 mmol/L)

Answer: B. The client with septic shock and a lactate level of 81 mg/dL (0.9 mmoL/L) indicates that severe tissue hypoxia is present. Poor tissue oxygenation at the cellular level causes anaerobic metabolism, with the by-product of lactic acid.Elevated partial pressure of carbon dioxide occurs with hypoventilation, which may be related to respiratory muscle fatigue, secretions, and causes other than hypoxia. Coagulation times reflect the ability of the blood to clot, not oxygenation at the cellular level. Elevation in potassium appears in septic shock due to acidosis, but this value is decreased and is not consistent with septic shock.

The nurse in the coronary care unit is caring for a group of clients who have had a myocardial infarction. Which client does the nurse see first? A) Client with normal sinus rhythm and PR interval of 0.28 second B) Client with third-degree heart block on the monitor C) Client with dyspnea on exertion when ambulating to the bathroom D) Client who refuses to take heparin or nitroglycerin

Answer: B. The client with the third-degree heart block needs to be seen first. Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved. This type of block usually requires pacemaker insertion.A normal rhythm with prolonged PR interval indicates first-degree heart block, which usually does not require treatment. The client with dyspnea on exertion when ambulating to the bathroom is not at immediate risk. The client's uncooperative behavior when refusing to take heparin or nitroglycerin may indicate fear or denial; he should be seen after emergency situations have been handled.

Prompt pain management with myocardial infarction is essential for which reason? A) The discomfort will increase client anxiety and reduce coping. B) Pain relief improves oxygen supply and decreases oxygen demand. C) Relief of pain indicates that the MI is resolving. D) Pain medication would not be used until a definitive diagnosis has been established.

Answer: B. The focus of pain relief is to improve oxygen supply and to reduce myocardial oxygen demand.Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain does not mean that the MI is resolving. Although it is used to be true that pain medication was not to be used for undiagnosed abdominal pain, this does not relate to MI.

A postoperative client is admitted to the intensive care unit (ICU) with hypovolemic shock. Which nursing action does the nurse delegate to an experienced unlicensed assistive personnel (UAP)? A) Obtain vital signs every 15 minutes. B) Measure hourly urine output. C) Check oxygen saturation. D) Assess level of alertness.

Answer: B. The nurse delegates to an experienced ICU UAP the measurement of hourly urine output on a client with hypovolemic shock. Monitoring hourly urine output is included in nursing assistant education and does not require special clinical judgment. The nurse will evaluate the results.Obtaining vital signs, monitoring oxygen saturation, and assessing mental status in critically ill clients requires the clinical judgment of the critical care nurse because immediate intervention may be needed.

A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon? A) Temperature 98.2°F (36.8°C) B) Chest tube drainage 175 mL last hour C) Serum potassium 3.9 mEq/L (3.9 mmol/L) D) Incisional pain 6 on a scale of 0 to 10

Answer: B. The nurse needs to report chest drainage over 150 mL/hr to the surgeon. Although some bleeding is expected after surgery, 175 mL per hour is excessive.Although hypothermia is a common problem after surgery, a temperature of 98.2°F (36.8°C) is a normal finding. Serum potassium of 3.9 mEq/L (3.9 mmol/L) is a normal finding. Incisional pain of 6 on a scale of 0-10 is expected immediately after major surgery; the nurse would administer prescribed analgesics.

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action does the nurse take first? A) Administer the antibiotic immediately. B) Ensure that blood cultures were drawn. C) Obtain signature for informed consent. D) Take the client's vital signs.

Answer: B. The nurse's first action when planning to administer an antibiotic to a newly admitted patent in septic shock is to ensure that blood cultures were drawn. Cultures must be taken to identify the organism for more targeted antibiotic treatment before antibiotics are administered. Antibiotics are not administered until after all cultures are taken.A signed consent is not needed for medication administration. Monitoring the client's vital signs is important, but the antibiotic must be administered within 1 to 3 hours, because timing is essential.

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? A) "My blood pressure shouldn't be high because I took my blood pressure medication this morning." B) "I took my warfarin last night according to my usual schedule." C) "My arthritis is really bothering me because I haven't taken my aspirin in a week." D) "I will check my blood sugar because I took a reduced dose of insulin this morning."

Answer: B. The provider might instruct the client to administer medications to treat high blood pressure to reduce the risk of hypertension. Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding. The provider might have the client discontinue over-the-counter medications, such as aspirin, prior to surgery to reduce the risk of bleeding. The provider might instruct a client who takes insulin to take a reduced dose in the morning of surgery to regulate blood glucose.

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? A) A client who consumes two 12-oz bottles of beer a day. B) A client who has diabetes mellitus. C) A client whose daily caloric intake consists of 25% fat. D) A client who has hypothyroidism.

Answer: B. Two 12-oz bottles of beer a day is considered moderate alcohol intake and does not place the client at risk for development of peripheral arterial disease. Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease. Twenty-five percent is within the recommended range for daily fat intake, and diet does not place the client at risk for development of peripheral arterial disease. Hypothyroidism is not a risk factor for developing peripheral arterial disease.

Which problem places a client at highest risk for sepsis? A) Pernicious anemia B) Pericarditis C) Post kidney transplant D) Client owns an iguana

Answer: C. A client with post kidney transplant is the highest risk for sepsis. This client will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms.Pernicious anemia is related to lack of vitamin B12, not to bone marrow failure (aplastic anemia), which would place the client at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the immune-suppressed kidney transplant client has a greater risk for infection, sepsis, and death.

What typical sign/symptom indicates the early stage of septic shock? A) Pallor and cool skin. B) Blood pressure 84/50 mm Hg. C) Tachypnea and tachycardia. D) Respiratory acidosis.

Answer: C. Early signs/symptoms of systemic inflammatory response syndrome include rapid respiratory rate, leukocytosis, and tachycardia. The early stage of septic shock precedes sepsis.In the early stage of septic shock, the client is usually warm and febrile. Hypotension does not develop until later in septic shock due to compensatory mechanisms. Respiratory alkalosis and not acidosis occurs early in shock because of an increased respiratory rate.

An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? A) No action is required; low blood pressure is normal for older adults. B) No action is required for postsurgical CABG clients. C) Assess pulmonary artery wedge pressure (PAWP). D) Give ordered loop diuretics.

Answer: C. In this situation, the nurse next needs to assess pulmonary wedge pressure (PAWP). Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation. Hypotension could cause the graft to collapse.Low blood pressure is not normal in older adults or postoperative clients. The cause of hypotension must be found and treated. Further action is needed to determine additional interventions. Hypotension could be caused by hypovolemia. Giving loop diuretics increases hypovolemia.

A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following client findings should the nurse report? A) Mediastinal drainage 100 mL/hr. B) Temperature 37.1° C (98.8° F). C) Blood pressure 160/80 mm Hg. D) Potassium 4.0 mEq/L.

Answer: C. Mediastinal drainage of up to 150 mL/hr is expected during this time. A body temperature within the expected reference range is desired following a CABG. The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites. A potassium level of 4.0 mEq/L is the desired goal in the postoperative period after CABG.

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A) Myelodysplastic syndrome. B) Guillain-Barré syndrome. C) Valvular disease. D) Ventricular depolarization

Answer: C. Myelodysplastic syndrome is a disorder of the bone marrow and is not a potential complication of endocarditis. Guillain-Barré syndrome is associated with certain bacterial and viral infections but is not a potential complication of endocarditis. Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium. Ventricular depolarization occurs during a normal cardiac cycle and is not a potential complication of endocarditis.

The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest? A) The need to increase activities slowly at home B) Planning and participating in a walking program C) Placing a chair in the shower for independent hygiene D) Consultation with social worker for disability planning

Answer: C. Placing a chair in the shower is an activity performed in Phase 1 cardiac rehabilitation. It begins with the acute illness and ends with discharge from the hospital. Phase 1 focuses on promoting rest and allowing clients to improve their activities of daily living based on their abilities.Phase 2 begins after discharge and continues through convalescence at home, including consultation with a social worker for long-term planning. It consists of achieving and maintaining a vital and productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress. Phase 3 refers to long-term conditioning, such as a walking program.

Which intervention provides safety during cardioversion? A) Setting the defibrillator at 220 joules B) Obtaining informed consent C) Setting the defibrillator to the synchronized mode D) Removing oxygen

Answer: C. Safety during cardioversion depends upon setting the defibrillator to the synchronized mode to avoid discharging the shock during the vulnerable period on the T wave. Unsynchronized cardioversion may cause ventricular fibrillation.Cardioversion is usually performed starting at a lower rate of 120-200 joules for biphasic machines. Although it is imperative to obtain informed consent, this does not improve the safety of the procedure. Oxygen would be turned off because it presents a safety issue; fire could result.

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? A) Keep the patch on 24 hr per day. B) Apply the new patch to the same site as the previous patch. C) Place the patch on an area of skin away from skin folds and joints. D) Replace the patch at the onset of angina.

Answer: C. The client should have a patch-free interval of 10 to 12 hr per day to prevent tolerance to the medication. Rotating the patch site can prevent skin irritation. The client should apply the patch to an area of intact skin that has enough room for the patch to fit smoothly. The nurse should emphasize that nitroglycerin patches offer ongoing prevention of angina attacks. The patches do not treat angina attacks because they do not take effect immediately.

A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? A) "This way you will not need to have a leg incision." B) "The surgeon prefers this approach because it is easier." C) "These arteries remain open longer." D) "The surgeon has chosen this approach because of your age."

Answer: C. The correct response by the nurse is that mammary arteries remain open and patent much longer than other grafts.Although no leg incision will be made with this approach, veins from the legs do not remain patent as long as the mammary artery graft does. Long-term patency, not ease of the procedure, is the primary concern. Age is not a determining factor in selection of these grafts.

The nurse is teaching a group of teens about prevention of heart disease. Which point is most important for the nurse to emphasize? A) Reduce abdominal fat. B) Avoid stress. C) Do not smoke or chew tobacco. D) Avoid alcoholic beverages.

Answer: C. The most important point for the nurse to emphasize when teaching a group of teens about heart disease prevention is not to smoke or chew tobacco. Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causing vasoconstriction, endothelial dysfunction, and thickening of the vessel walls. Smoking also increases carbon monoxide and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure.Teens are not likely to experience metabolic syndrome from obesity but are very likely to use tobacco. Avoiding stress is a less modifiable risk factor, which is less likely to cause heart disease in teens. The risk of smoking outweighs the risk of alcohol use.

An LPN/LVN is scheduled to work on the inclient "stepdown" cardiac unit. Which client does the charge nurse assign to the LPN/LVN? A) A 60-year-old who was admitted today for pacemaker insertion because of third-degree heart block and who is now reporting chest pain. B) A 62-year-old who underwent open-heart surgery 4 days ago for mitral valve replacement and who has a temperature of 100.8°F (38.2°C). C) A stable 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is stable and scheduled for discharge to a group home later today. D) A 69-year-old who had a stent placed 2 hours ago in the left anterior descending artery and who has bursts of ventricular tachycardia.

Answer: C. The nurse will assign a stable 66-year-old client with a prescription for a nitroglycerin patch to the LPN/LVN. The LPN/LVN scope of practice includes administration of medications to stable clients.Third-degree heart block is characterized by a very low heart rate and usually requires pacemaker insertion. The skills of the RN are needed to care for this client. Fever after surgery requires collaboration with the health care provider, which is more consistent with the role of the RN. The client with a recent stent placement and having bursts of ventricular tachycardia is unstable and is showing ventricular irritability. This client will need medications and monitoring beyond the scope of practice of the LPN/LVN.

The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action would be performed first? A) Assess coping skills. B) Assess for postoperative pain at the client's incision site. C) Monitor the heart rate for dysrhythmias. D) Monitor mental status.

Answer: C. The nurse would monitor the client's heart rate for dysrhythmias. Dysrhythmias are the leading cause of prehospital death.Assessing mental status, coping skills, or postoperative pain is not the priority for this client.

The nurse is caring for a client in the refractory stage of cardiogenic shock. Which intervention does the nurse consider? A) Admission to rehabilitation hospital for ambulatory retraining B) Collaboration with home care agency for return to home C) Discussion with family and provider regarding palliative care D) Enrollment in a cardiac transplantation program

Answer: C. When caring for a client in the refractory stage of cardiogenic shock the nurse considers discussing palliative care with the family and provider. In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care would be considered.Rehabilitation or returning home is unlikely. The client with sustained tissue hypoxia is not a candidate for organ transplantation.

Which problem places a person at highest risk for septic shock? A) Kidney failure. B) Cirrhosis. C) Lung cancer. D) 40% burn injury

Answer: D. A client with 40% burn injury is at highest risk for septic shock and possible death. The skin forms the first barrier to prevent entry of organisms into the body.Although the client with kidney failure has an increased risk for infection, his skin is intact, unlike the client with burn injury. Although the liver acts as a filter for pathogens, the client with cirrhosis has intact skin, unlike the burned client. The client with lung cancer may be at risk for increased secretions and infection, but risk is not as high as for a client with open skin.

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication? A) Metallic taste. B) Shortness of breath. C) Dry cough. D) Lightheadedness.

Answer: D. A metallic taste is not an adverse reaction to furosemide. Furosemide is used to manage shortness of breath secondary to heart failure. This is not an adverse reaction to this medication. A dry cough is not an adverse reaction to furosemide. Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.

The nurse is teaching a patient with a new permanent pacemaker. Which statement by the patient indicates a need for further discharge education? A) "I will be able to shower again soon." B) "I need to take my pulse every day." C) "I might trigger airport security metal detectors." D) "I no longer need my heart pills."

Answer: D. All prescribed medications, including heart medications, are still needed after the pacemaker is implanted.Once the wound from the surgery heals, the patient will be able to shower. The patient's pulse will have to be taken and recorded for 1 full minute at the same time each day. The metal in the pacemaker will trigger the alarm in metal detector devices. A card can be shown to authorities to indicate that the patient has a pacemaker.

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? A) Irregular pulse. B) Dependent edema. C) Persistent fatigue. D) Slurred speech.

Answer: D. An irregular pulse is an expected finding for a client who has atrial fibrillation and indicates the client is at risk for inadequate cardiac output. However, another finding is the priority. Dependent edema is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate circulation. However, another finding is the priority. Fatigue is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate cardiac output. However, another finding is the priority. The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching? A) "I will be awake during this procedure." B) "I will have a balloon in my artery to widen it." C) "I must lie still after the procedure." D) "My angina will be gone for good."

Answer: D. In this situation, further teaching is needed when the client states that angina will be gone after the PTCA. The client's angina may not be eliminated. Reocclusion is possible after PTCA.The client is typically awake, but drowsy, during this procedure. PTCA uses a balloon to widen the artery, and the client will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage.

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? A) "You are right. Work on your diet then." B) "You must find someplace to walk." C) "Walk around the edge of your apartment complex." D) "Where might you be able to walk?"

Answer: D. In this situation, the best response by the nurse is to ask the client where he or she might be able to walk. This calls for cooperation and participation from the client. Increased activity is imperative for this client.Telling the client to work on diet is an inappropriate response. Telling the client to find someplace to walk is too demanding to be therapeutic. Telling the client to walk around the apartment complex is domineering and will not likely achieve cooperation from the client.

Which finding in the history of a client with an abdominal aortic aneurysm (AAA) is a risk factor for aneurysm formation? A) Peptic ulcer disease. B) Deep vein thrombosis (DVT). C) Osteoarthritis. D) Marfan syndrome.

Answer: D. Marfan syndrome is a risk factor for cardiovascular disorders such as AAA. Marfan syndrome is a genetic connective tissue disorder. It occurs in middle-aged and older people, peaking in adults in their 50s and 60s. Men are more commonly affected than women.Peptic ulcer disease is not a risk factor for AAA formation. AAA is an arterial problem, so DVT is not a related risk. Osteoarthritis is related to overuse of joints, and does not present a risk for AAA.

To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? A) Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase B) Homocysteine and C-reactive protein C) Total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol D) Troponin

Answer: D. Positive findings for troponin is the most specific cardiac marker used to determine whether an MI has occurred.Alkaline phosphatase is often elevated in liver disease. Homocysteine and C-reactive protein are markers of inflammation, which may represent risk for MI, but they are not diagnostic for MI. Elevated cholesterol levels are risks for MI, but they do not validate that an MI has occurred.

The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? A) Substernal chest discomfort occurring at rest B) Chest pain brought on by exertion or stress C) Substernal chest discomfort relieved by nitroglycerin or rest D) Substernal chest pressure relieved only by opioids

Answer: D. Substernal chest pressure relieved only by opioids is typically indicative of MI.Substernal chest discomfort that occurs at rest is not necessarily indicative of MI, and it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.

The nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock? A) Hypotension. B) Bradypnea. C) Heart blocks. D) Tachycardia.

Answer: D. Tachycardia is an early symptom of shock. Heart and respiratory rates increased from the client's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart.Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal and not abnormally low. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock and are related to lack of oxygen to the heart.

Which nurse would be assigned to care for an intubated client who has septic shock as the result of a methicillin-resistant Staphylococcus aureus (MRSA) infection? A) The LPN/LVN who has 20 years of experience B) The new RN who recently finished orienting and is working independently with moderately complex clients C) The RN who will also be caring for a client who had coronary artery bypass graft (CABG) surgery 12 hours ago D) The RN with 2 years of experience in intensive care unit (ICU)

Answer: D. The RN with 2 years ICU experience would be assigned to care for an intubated client with septic shock due to a MRSA infection. This RN with current intensive care experience who is not caring for a postoperative client is an appropriate nurse to care for this client.Care of the unstable client with intubation and mechanical ventilation is not within the scope of practice for the LPN/LVN. A client who is experiencing septic shock is too complex for the new RN. Although the RN who is also caring for the post-CABG client is experienced, this assignment will put the post-CABG client at risk for MRSA infection.

The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed? A) Pulse 60 beats/min and regular B) Urinary frequency C) Incisional discomfort D) Respiratory rate 28 breaths/min

Answer: D. The activity should be terminated when the nurse notices the client's respiration rate of 28 breaths per minute. This indicates tachypnea and possibly tachycardia due to activity intolerance.Pulse 60 beats/min and regular is a normal finding. Urinary frequency may indicate infection or diuretic use, but not activity intolerance. Incisional pain with activity after surgery is anticipated. Pain medication would be available.

While caring for a client who has received recombinant tissue plasminogen activator (t-PA) for a large deep vein thrombus, the nurse becomes most concerned when the client develops which condition? A) Small amount of blood at the IV insertion site B) Heavy menstrual bleeding C) +1 pitting edema of the affected extremity D) Client stating that the year is 1967

Answer: D. The nurse becomes most concerned after a client receives t-PA for a large vein thrombus when the client states that the year is 1967. The most serious complication from thrombolytic therapy is intracerebral bleeding, manifested by changes in the level of consciousness.Thrombolytics such as t-PA dissolve clots. Even without this medication, a small amount of blood at the insertion site is not abnormal. Anticoagulants and thrombolytics may cause heavier-than-usual menstrual bleeding. Swelling is expected in the extremity with deep vein thrombosis.

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals she is 1 week postoperative following an open cholecystectomy. The nurse should recognize that which of the following interventions i s contraindicated? A) Administering oxygen at 2 L/min via nasal cannula. B) Administering IV morphine sulfate. C) Helping the client to the bedside commode. D) Assisting with thrombolytic therapy.

Answer: D. The nurse should administer supplemental oxygen to the client to increase myocardial tissue perfusion. The nurse should administer IV morphine to the client to relieve pain and reduce myocardial oxygen demand. Using a bedside commode is less stressful than using a bedpan, and most clients are allowed to use a commode following a myocardial infarction. The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

A nurse in an emergency room is assessing a client wh ohas a bradydysrhtymia. Which of the following findings should the nurse monitor for? A) Dry skin. B) Hypertension. C) Friction rub. D) Confusion.

Answer: D. The nurse should monitor a client who has a bradydysrhythmia for diaphoresis. The nurse should monitor a client who has a bradydysrhythmia for hypotension. The nurse should expect to hear a friction rub during cardiac auscultation on a client who has pericarditis. Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. The nurse should identify that which of the following findings indicates the medication is effective? A) Minimal bruising of extremities. B) Hemoglobin 14 g/dL. C) Decreased blood pressure. D) INR 2.0.

Answer: D. The nurse should recognize that minimal bruising or no bruising is desired. However, this is not evidence of effective warfarin therapy. The nurse should recognize that a hemoglobin level of 14 g/dL is within the expected reference range. However, this is not evidence of effective warfarin therapy. The nurse should recognize that decreased blood pressure is a manifestation of bleeding, which is an adverse effect of warfarin. The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

When caring for an obtunded client admitted with shock of unknown origin, which action does the nurse take first? A) Obtain IV access and hang prescribed fluid infusions. B) Apply the automatic blood pressure cuff. C) Assess level of consciousness and pupil reaction to light. D) Check the airway and respiratory status.

Answer: D. The nurse's first action when caring for an obtunded client admitted with shock is to check the client's airway and respiratory status. When caring for any client, determining airway and respiratory status is the priority.The airway takes priority over obtaining IV access, applying the blood pressure cuff, and assessing for changes in the client's mental status.

A client with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C); pulse 122 beats/min; blood pressure 86/48 mm Hg; respirations 24 breaths/min; urine output 20 mL for last 2 hours; skin cool and clammy. Which prescription order for this client does the nurse question? A) Dopamine (Intropin) 12 mcg/kg/min B) Dobutamine (Dobutrex) 5 mcg/kg/min C) Plasmanate 1 unit D) Bumetanide (Bumex) 1 mg IV

Answer: D. The prescription order the nurse questions is Bumetanide (Bumex0 1 mg IV). A diuretic such as bumetanide will decrease blood volume in a client who is already hypovolemic. This order must be questioned because this is not an appropriate action to expand the client's blood volume.The orders other than Bumetanide are appropriate for improving blood pressure in shock and do not need to be questioned.

_____: The flow of blood from the aorta back into the left ventricle during diastole; occurs when the aortic valve leaflets do not close properly during diastole and the annulus (the valve ring that attaches to the leaflets) is dilated or deformed.

Aortic regurgiatation

_____: Narrowing of the aortic valve orifice and obstruction of left ventricular outflow during systole.

Aortic stenosis

_____: The pulse located at the left fifth intercostal space in the midclavicular line in the mitral area (the apex of the heart). Also called the point of maximal impulse.

Apical impulse (point of maximal impulse, PMI)

_____: A form of cardiomyopathy that results from the replacement of myocardial tissue with fibrous and fatty tissue.

Arrhythmogenic right ventricular cardiomyopathy (dysplasia)

_____: The surgical procedure most commonly used to increase arterial blood flow in the affected limb of a patient with peripheral arterial disease.

Arterial revascularization

_____: A painful complication in the patient with peripheral arterial disease. Typically, the ulcer is small and round, with a "punched out" appearance and well-defined borders. Ulcers develop on the toes (often the great toe), between the toes, or on the upper aspect of the foot. With prolonged occlusion, the toes can become gangrenous.

Arterial ulcers

_____: Angiography of the arterial vessels; this invasive diagnostic procedure involves fluoroscopy and the use of a contrast medium and is performed when an arterial obstruction, narrowing, or aneurysm is suspected.

Arteriography

_____: A thickening, or hardening, of the arterial wall.

Arteriosclerosis

_____: A surgical opening into an artery.

Arteriotomy

_____: In the electrocardiogram, interference that is seen on the monitor or rhythm strip and may look like a wandering or fuzzy baseline; can be caused by patient movement, loose or defective electrodes, improper grounding, or faulty equipment.

Artifact

_____: An invasive nonsurgical technique in which a high-speed, rotating metal burr uses fine abrasive bits to scrape plaque from inside an artery while minimizing damage to the vessel surface.

Atherectomy

_____: A type of arteriosclerosis that involves the formation of plaque within the arterial wall; the leading contributor to coronary artery and cerebrovascular disease.

Atherosclerosis

_____: A cardiac dysrhythmia in which multiple rapid impulses from many atrial foci, at a rate of 350 to 600 times per minute, depolarize the atria in a totally disorganized manner, with no P waves, no atrial contractions, a loss of the atrial kick, and an irregular ventricular response.

Atrial fibrillation (AF)

_____: An abnormal fourth heart sound that occurs as blood enters the ventricles during the active filling phase at the end of ventricular diastole; may be heard in patients with hypertension, anemia, ventricular hypertrophy, myocardial infarction, aortic or pulmonic stenosis, and pulmonary emboli.

Atrial gallop

_____: In the cardiac conduction system, the area consisting of a transitional cell zone, the atrioventricular (AV) node itself, and the bundle of His. The AV node lies just beneath the right atrial endocardium, between the tricuspid valve and the ostium of the coronary sinus.

Atrioventricular (AV) junctional

_____: Angina that manifests itself as indigestion, pain between the shoulders, an aching jaw, or a choking sensation that occurs with exertion. Many women experience atypical angina.

Atypical angina

_____: Belonging to the person, such as a person's vein being moved from one part of the body to another.

Autogenous

_____: The ability of a cell to initiate an impulse spontaneously and repetitively; in cardiac electrophysiology, the ability of primary pacemaker cells (SA node, AV junction) to generate an electrical impulse.

Automaticity

_____: A peptide produced and released by the ventricles when the patient has fluid overload as a result of heart failure (HF).

B-type natriuretic peptide (BNP)

_____: Sensory receptors in the arch of the aorta and at the origin of the internal carotid arteries that are stimulated when the arterial walls are stretched by an increased blood pressure.

Baroreceptors

_____: Procedure that involves ventilating the patient who has stopped breathing, as well as giving chest compressions in the absence of a carotid pulse. Also known as cardiopulmonary resuscitation (CPR).

Basic Cardiac Life Support (BCLS)

_____: Surgical technique in heart transplantation in which the intact right atrium of the donor heart is preserved by anastomoses at the recipient's superior and inferior vena cavae.

Bicaval technique

_____: A type of premature complex that exists when normal complexes and premature complexes occur alternately in a repetitive two-beat pattern, with a pause occurring after each premature complex so that complexes occur in pairs.

Bigeminy

_____: The force of blood exerted against the vessel walls.

Blood pressure

_____: Slowness of the heart rate; characterized as a pulse rate less than 50 to 60 beats/min.

Bradycardia

_____: An abnormal heart rhythm characterized by a heart rate less than 60 beats/min.

Bradydysrhythmias

_____: Swishing sound in the larger arteries (carotid, aortic, femoral, and popliteal) that can be heard with a stethoscope or Doppler probe; may indicate narrowing of the artery and is usually associated with atherosclerotic disease.

Bruit

_____: The response of capillaries to the presence of biologic chemicals (mediators) that change blood vessel integrity and allow fluid to shift from the blood in the vascular space into the interstitial tissues.

Capillary leak syndrome

_____: In electrocardiography (ECG), the direction of electrical current flow in the heart. The relationship between the cardiac axis and the lead axis is responsible for the deflections seen on the ECG pattern.

Cardiac axis

_____: The most definitive but most invasive test in the diagnosis of heart disease; involves passing a small catheter into the heart and injecting contrast medium.

Cardiac catheterization

_____: A calculation of cardiac output requirements to account for differences in body size; determined by dividing the cardiac output by the body surface area.

Cardiac index

_____: Serum studies that include troponin, creatine kinase-MB, and myoglobin.

Cardiac markers

_____: The volume of blood ejected by the heart each minute; normal range in adults is 4 to 7 L/min.

Cardiac output (CO)

_____: The process of actively assisting the patient with cardiac disease to achieve and maintain a productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress. Phase 1 begins with the acute illness and ends with discharge from the hospital. Phase 2 begins after discharge and continues through convalescence at home. Phase 3 refers to long-term conditioning.

Cardiac rehabilitation

_____: In patients with some types of heart failure, the use of a permanent pacemaker alone or in combination with an implantable cardioverter-defibrillator to provide biventricular pacing.

Cardiac resynchronization therapy (CRT)

_____: Compression of the myocardium by fluid that has accumulated around the heart; this compresses the atria and ventricles, prevents them from filling adequately, and reduces cardiac output.

Cardiac tamponade

_____: Post-myocardial infarction heart failure in which necrosis of more than 40% of the left ventricle has occurred. Also called class IV heart failure.

Cardiogenic shock

_____: Enlarged heart.

Cardiomegaly

_____: A subacute or chronic disease of cardiac muscle; classified into four categories based on abnormalities in structure and function: dilated, hypertrophic, restrictive, and arrhythmogenic.

Cardiomyopathy

_____: Diversion of the blood from the heart to a bypass machine, where it is heparinized, oxygenated, and returned to the circulation through a cannula placed in the ascending aortic arch or femoral artery to provide oxygenation, circulation, and hypothermia during induced cardiac arrest for coronary artery bypass surgery. This process ensures a motionless operative field and prevents myocardial ischemia.

Cardiopulmonary bypass (CPB)

_____: A synchronized countershock that may be performed in emergencies for hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias that are resistant to medical therapies. The shock depolarizes a critical mass of myocardium simultaneously during intrinsic depolarization and is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart.

Cardioversion

_____: Serum lipid that includes high-density lipoproteins and low-density lipoproteins.

Cholesterol

_____: A fibrous thickening of the pericardium that prevents adequate filling of the ventricles and eventually results in cardiac failure; caused by chronic pericardial inflammation due to tuberculosis, radiation therapy, trauma, kidney failure, or metastatic cancer.

Chronic constrictive pericarditis

_____: Type of angina characterized by chest discomfort that occurs with moderate to prolonged exertion and in a pattern that is familiar to the patient.

Chronic stable angina (CSA)

_____: Changes in the tissue beds of the fingers and toes, with the base of the nail becoming spongy; results from chronic oxygen deprivation in the tissue beds.

Clubbing

_____: Circulation that provides blood to an area with altered tissue perfusion through smaller vessels that develop and compensate for the occluded vessels.

Collateral circulation

_____: The means of producing compensation. Also called adaptive mechanism.

Compensatory mechanism

_____: 64-slice diagnostic scan used to diagnose coronary artery disease in symptomatic patients.

Computed tomography coronary angiography (CTCA)

_____: The ability of a cell to transmit an electrical stimulus from cell membrane to cell membrane.

Conductivty

_____: Former term for left-sided heart failure. Categorized as either systolic heart failure or diastolic heart failure, which may be acute or chronic and mild to severe.

Congestive heart failure (CHF)

_____: A respiratory treatment that improves obstructive sleep apnea in patients with heart failure.

Continuous positive airway pressure (CPAP)

_____: The ability of a cell to contract in response to an impulse. In cardiac electrophysiology, the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, generating sufficient pressure to propel blood forward. Contractility is the mechanical activity of the heart.

Contractility

_____: A surgical procedure in which occluded coronary arteries are bypassed with the patient's own venous or arterial blood vessels or synthetic grafts.

Coronary artery bypass graft (CABG)

_____: Disease affecting the arteries that provide blood, oxygen, and nutrients to the myocardium; partial or complete blockage of the blood flow through the coronary arteries, causing ischemia and infarction of the myocardium, angina pectoris, and acute coronary syndromes. Also known as coronary heart disease or simply heart disease.

Coronary artery disease (CAD)

_____: A form of coronary artery disease that presents as diffuse plaque in the arteries of the donor heart in patients who have received a heart transplant.

Coronary artery vasculopathy (CAV)

_____: An enzyme specific to cells of the brain, myocardium, and skeletal muscle. Its appearance in the blood indicates tissue necrosis or injury, with levels following a predictable rise and fall during a specified period.

Creatinine kinase (CK)

_____: Bluish or darkened discoloration of the skin and mucous membranes; results from an increased amount of deoxygenated hemoglobin.

Cyanosis

_____: Presence of a thrombus associated with inflammation in the deep veins, usually in the legs. Compared with superficial thrombophlebitis, it presents a greater risk for pulmonary embolism.

Deep vein thrombophlebitis (deep vein thrombosis; DVT)

_____: An asynchronous countershock that depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit, allowing the sinus node to regain control of the heart.

Defibrillation

_____: The ability of a cell to respond to a stimulus by initiating an impulse

Depolarization (excitability)

_____: A pacemaker for the phrenic nerve to cause the diaphragm to contract (leading to inhalation). Also known as phrenic nerve pacing.

Diaphragmatic pacing

_____: The phase of the cardiac cycle that consists of relaxation and filling of the atria and ventricles; normally about two thirds of the cardiac cycle.

Diastole

_____: Heart failure that occurs when the left ventricle is unable to relax adequately during diastole, which prevents the ventricle from filling with sufficient blood to ensure adequate cardiac output.

Diastolic heart failure

_____: A reaction to therapy with digitalis derivatives (digoxin) that is identified by monitoring serum digoxin and potassium levels (hypokalemia potentiates digitalis toxicity). Signs of toxicity are nonspecific (anorexia, fatigue, changes in mental status). Toxicity may cause dysrhythmia, most commonly premature ventricular contractions.

Digoxin toxicity

_____: A type of cardiomyopathy that involves extensive damage to the myofibrils and interference with myocardial metabolism. There is normal ventricular wall thickness but dilation of both ventricles and impairment of systolic function.

Dilated cardiomyopathy (DCM)

_____: Increase in the diameter of blood vessels.

Dilation

_____: Dyspnea that is associated with activity, such as climbing stairs.

Dyspnea on exertion (DOE)

_____: A disorder of the heartbeat involving a disturbance in cardiac rhythm; irregular heartbeat.

Dysrhythmia

_____: A measurement tool used in analysis of an electrocardiographic (ECG) rhythm strip.

ECG caliper

_____: In cardiovascular assessment, the use of ultrasound waves to assess cardiac structure and mobility, particularly of the valves; a noninvasive, risk-free test that is easily performed at the bedside or on an ambulatory care basis.

Echocardiography

_____: Out of place

Ectopic

_____: Tissue swelling as a result of the accumulation of excessive fluid in the interstitial spaces.

Edema

_____: The percentage of blood ejected from the heart during systole.

Ejection fraction

_____: A graphic recording of the electrical current generated by the heart. The ECG provides information about cardiac dysrhythmias, myocardial ischemia, site and extent of myocardial infarction, cardiac hypertrophy, electrolyte imbalances, and effectiveness of cardiac drugs. It is a routine part of cardiovascular evaluation and is a valuable diagnostic test.

Electrocardiogram (ECG)

_____: In cardiovascular assessment, an invasive procedure performed in a catheterization laboratory during which programmed electrical stimulation of the heart is used to induce and evaluate lethal dysrhythmias and conduction abnormalities to permit accurate diagnosis and effective treatment. The study is used in patients who have survived cardiac arrest, have recurrent tachydysrhythmias, or experience unexplained syncopal episodes.

Electrophysiologic study (EPS)

_____: The occurrence of inflammation and thickening of the vein wall around a clot (thrombus).

Embolus

_____: A secretion produced by the endothelial cells when they are stretched.

Endothelin

_____: The repair of an abdominal aortic aneurysm using a stent made of flexible material; the stent is inserted through a skin incision into the femoral artery by way of a catheter-based system.

Endovascular stent graft

_____: Elevated blood pressure that is not caused by a specific disease. The major risk factor is a family history of hypertension. Also called primary hypertension.

Essential hypertension

_____: The ability of a cell to respond to a stimulus by initiating an impulse. Also called depolarization. In cardiac electrophysiology, it is the ability of non-pacemaker myocardial cells to respond to an electrical impulse generated from pacemaker cells and to depolarize.

Excitability

_____: In cardiovascular assessment, a test that assesses cardiovascular response to an increased workload. Exercise electrocardiography helps determine the functional capacity of the heart, screens for coronary artery disease, and identifies dysrhythmias that develop during exercise. It also aids in evaluating the effectiveness of antidysrhythmic drugs.

Exercise electrocardigraphy (exercise tolerance or stress test)

_____: Breathlessness or difficulty breathing that develops during activity or exertion.

Exertional dyspnea

_____: Originating outside the body.

Exogenous

_____: A surgical procedure in which an incision is made through the skin and subcutaneous tissues into the fascia of the affected compartment to relieve the pressure in and restore circulation to the affected area in the patient with acute compartment syndrome.

Fasciotomy

_____: Drug that targets the fibrin component of the coronary thrombosis; used to dissolve thrombi in the coronary arteries and restore myocardial blood flow; examples include tissue plasminogen activator, anisoylated plasminogen-streptokinase activator complex, and reteplase.

Fibrinolytic

_____: Sound created by the closure of the mitral and tricuspid valves (atrioventricular valves).

First heart sound (S1)

_____: Drugs that target the platelet component of the thrombus. They are administered intravenously to prevent fibrinogen from attaching to activated platelets at the site of a thrombus and are given to patients with acute coronary syndromes (especially unstable angina and non-Q-wave myocardial infarction). Examples include abciximab, eptifibatide, and tirofiban.

Glycoprotein (GP) IIb/IIIa inhibitors

_____: A general term for the inadequacy of the heart to pump blood throughout the body, causing insufficient perfusion of body tissues with vital nutrients and oxygen. Also called pump failure.

Heart failure

_____: Term referring to the number of times the ventricles contract each minute.

Heart rate (HR)

_____: A surgical procedure in which a heart from a donor with a comparable body weight and ABO compatibility is transplanted into a recipient less than 6 hours after procurement. It is the treatment of choice for patients with severe dilated cardiomyopathy and may be considered for patients with restrictive cardiomyopathy.

Heart transplantation

_____: The aggregation of platelets into "white clots" that can cause thrombosis, usually in the form of an acute arterial occlusion; occurs with heparin administration. Also called white clot syndrome.

Heparin-induced thrombocytopenia (HIT)

_____: A drug that has an increased risk for causing patient harm if given in error.

High-alert drug

_____: Part of the total cholesterol value that should be more than 45 mg/dL for men and more than 55 mg/dL for women; "good" cholesterol.

High-density lipoproteins (HDL's)

_____: Heart failure that occurs when cardiac output remains normal or above normal. It is usually caused by increased metabolic needs or hyperkinetic conditions such as septicemia (fever), anemia, and hyperthyroidism. This type of heart failure is different from left- and right-sided heart failure, which are typically low-output states, and is not as common as other types.

High-output heart failure

_____: A serum marker of inflammation and a common and critical component to the development of atherothrombosis.

Highly sensitive C-reactive protein (hsCRP)

_____: An essential sulfur-containing amino acid that is produced when dietary protein breaks down; elevated values (greater than 15 mmol/L) may be a risk factor for the development of cardiovascular disease.

Homocysteine

_____: The force of the weight of water molecules pressing against the confining walls of a space.

Hydrostatic pressure

_____: Increased arterial carbon dioxide levels.

Hypercapnia

_____: An elevation of serum lipid (fat) levels in the blood.

Hyperlipidemia

_____: A cardiovascular condition pertaining to people who have a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher or who take medication to control blood pressure; approximately 1 of every 5 Americans has hypertension.

Hypertension

_____: A severe elevation in blood pressure (greater than 180/120 mm Hg) that can cause damage to organs such as the kidneys or heart.

Hypertensive crisis

_____: A type of cardiomyopathy that involves disarray of the myocardial fibers and asymmetric ventricular hypertrophy; leads to a stiff left ventricle that results in diastolic filling abnormalities.

Hypertrophic cardiomyopathy (HCM)

_____: A reduction of oxygen supply to the tissues.

Hypoxia

_____: Hardening.

Induration

_____: Necrosis, or cell death.

Infarction

_____: A microbial infection (e.g., viruses, bacteria, fungi) involving the endocardium; previously called bacterial endocarditis.

Infective endocarditis

_____: Surgical procedure in which the surgeon inserts a filter device percutaneously into the inferior vena cava of a patient with recurrent deep vein thrombosis (to prevent pulmonary emboli) or pulmonary emboli that do not respond to medical treatment. The device is meant to trap emboli in the inferior vena cava before they progress to the lungs. Holes in the device allow blood to pass through, thus not significantly interfering with the return of blood to the heart.

Inferior vena cava filtration

_____: A type of myocardial infarction that occurs in patients with obstruction of the right coronary artery, causing significant damage to the right ventricle.

Inferior wall myocardial infarction

_____: Chronic peripheral arterial disease with obstruction at or above the common iliac artery, abdominal aorta, or profunda femoris artery. The patient experiences discomfort in the lower back, buttocks, or thighs after walking a certain distance. The pain usually subsides with rest.

Inflow disease

_____: A characteristic leg pain experienced by patients with chronic peripheral arterial disease. Typically, patients can walk only a certain distance before a cramping muscle pain forces them to stop. As the disease progresses, the patient can walk only shorter and shorter distances before pain recurs. Ultimately, pain may occur even at rest.

Intermittent claudication

_____: An intra-aortic counterpulsation device. It may be used as an invasive intervention to improve myocardial perfusion during an acute myocardial infarction, to reduce preload and afterload, and to facilitate left ventricular ejection. It is also used when patients do not respond to drug therapy with improved tissue perfusion, decreased workload of the heart, and increased cardiac contractility.

Intra-aortic balloom pump (IABP)

_____: In cardiac catheterization, the use of a flexible catheter with a miniature transducer that emits sound waves. Sound waves are reflected off the plaque and the arterial wall, creating an image of the blood vessel; used as an alternative to injecting a contrast medium into the coronary arteries.

Intravascular utrasonography (IVUS)

_____: System used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion. It directly measures pressures in the heart and great vessels.

Invasive hemodynamic monitoring

_____: Blockage of blood flow through a blood vessel resulting in a lack of oxygen. Prolonged severe ischemia can cause irreversible damage to tissue.

Ischemia

_____: Cell dysfunction or death from a lack of oxygen resulting from decreased blood flow in a body part.

Ischemic

_____: Having equal electric potentials, such as in the heart.

Isoelectric

_____: Enlargement of the jugular vein of the neck; caused by an increase in jugular venous pressure.

Jugular venous distention (JVD)

_____: In an ECG, the provider of one view of the heart's electrical activity.

Lead

_____: In electrocardiography, the imaginary line that joins the positive and negative poles of the lead systems.

Lead axis

_____: Inadequacy of the left ventricle of the heart to pump adequately; results in decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels; typical causes include hypertensive, coronary artery, or valvular disease involving the mitral or aortic valve. Most heart failure begins with failure of the left ventricle and progresses to failure of both ventricles.

Left-sided heart (ventricular) faiulre

_____: Fat, including cholesterol and triglycerides, that can be measured in the blood.

Lipid

_____: Part of the total cholesterol value that should be less than 130 mg/dL; "bad" cholesterol.

Low-density lipoproteins (LDLs)

_____: A severe type of elevated blood pressure that rapidly progresses, with systolic blood pressure greater than 200 mm Hg and diastolic blood pressure greater than 150 mm Hg (greater than 130 mm Hg when there are pre-existing complications).

Malignant hypertension

_____: An open chest surgical technique often performed with coronary artery bypass grafting for patients in atrial fibrillation with decompensation.

Maze procedure

_____: The arterial blood pressure (between 60 and 70 mm Hg) necessary to maintain perfusion of major body organs, such as the kidneys and brain.

Mean arterial pressure (MAP)

_____: Infection of the mediastinum.

Mediastinitis

_____: Physician incidents and all errors caused by members of the health care team or system that lead to patient injury or death.

Medical harm

_____: A collection of related health problems with insulin resistance as a main feature. Other features include obesity, low levels of physical activity, hypertension, high blood levels of cholesterol, and elevated triglyceride levels. Metabolic syndrome increases the risk for coronary heart disease. Also called syndrome X.

Metabolic syndrome

_____: The presence of very small amounts of albumin in the urine that are not measurable by a urine dipstick or usual urinalysis procedures. Specialized assays are used to analyze a freshly voided urine specimen for microscopic levels of albumin.

Microalbuminuria

_____: Surgical procedure that does not require cardiopulmonary bypass and may be used for patients with a lesion of the left anterior descending artery. Also known as "keyhole" surgery.

Minimally invasive direct coronary artery bypass (MIDCAB)

_____: Inability of the mitral valve to close completely during systole, which allows the backflow of blood into the left atrium when the left ventricle contracts; usually due to fibrosis and calcification caused by rheumatic disease. Also called mitral insufficiency.

Mitral regurgitation

_____: Thickening of the mitral valve due to fibrosis and calcification and usually caused by rheumatic fever. The valve leaflets fuse and become stiff, the chordae tendineae contract, and the valve opening narrows, preventing normal blood flow from the left atrium to the left ventricle. As a result, left atrial pressure rises, the left atrium dilates, pulmonary artery pressures increase, and the right ventricle hypertrophies.

Mitral stenosis

_____: Dysfunction of the mitral valve that occurs because the valvular leaflets enlarge and prolapse into the left atrium during systole; usually benign but may progress to pronounced mitral regurgitation.

Mitral valve prolapse (MVP)

_____: A factor in disease development that can be altered or controlled by the patient. Examples include elevated serum cholesterol levels, cigarette smoking, hypertension, impaired glucose tolerance, obesity, physical inactivity, and stress.

Modifiable risk factor

_____: In nuclear cardiology, cardiac blood pool imaging is a noninvasive test to evaluate cardiac motion and calculate ejection fraction by using a computer to synchronize the patient's electrocardiogram with pictures obtained by a gamma-scintillation camera. In multigated blood pool scanning, the computer breaks the time between R waves into fractions of a second, called "gates." The camera records blood flow through the heart during each gate. By analyzing information from multiple gates, the computer can evaluate ventricular wall motion and calculate ejection fraction (percentage of the left ventricular volume that is ejected with each contraction) and ejection velocity.

Multigated blood pool scanning

_____: The sequence of inadequate blood flow to body tissues, which deprives cells of oxygen and leads to anaerobic metabolism with acidosis, hyperkalemia, and tissue ischemia; this is followed by dramatic changes in vital organs and leads to the release of toxic metabolites and destructive enzymes.

Multiple organ dysfunction syndrome (MODS)

_____: Abnormal heart sound that reflects turbulent blood flow through normal or abnormal valves; murmurs are classified according to their timing in the cardiac cycle (systolic or diastolic) and their intensity depending on their level of loudness.

Murmurs

_____: Enlargement of the myocardium.

Myocardial hypertrophy

_____: Injury and necrosis of myocardial tissue that occurs when the tissue is abruptly and severely deprived of oxygen; usually caused by atherosclerosis of a coronary artery, rupture of the plaque, subsequent thrombosis, and occlusion of blood flow.

Myocardial infarction (MI)

_____: The use of radionuclide techniques in which radioactive tracer substances are used to view, record, and evaluate cardiovascular abnormalities; useful for detecting myocardial infarction and decreased myocardial blood flow and for evaluating left ventricular ejection.

Myocardial nuclear perfusion imaging (MNPI)

_____: The heart muscle.

Myocardium

_____: Electrical stimulation of tension splints in the heart to help the ventricle change to a more normal shape in the patient with heart failure; under investigation in Europe and the United States.

Myosplint

_____: Dizziness with an inability to remain in an upright position.

Near-syncope

_____: In electrocardiography, the flow of electrical current in the heart (cardiac axis) away from the positive pole and toward the negative pole.

Negative deflection

_____: Cardiac chest pain that occurs for the first time.

New-onset angina

_____: A drug prescribed for patients with angina. It increases collateral blood flow, redistributes blood flow toward the subendocardium, and causes dilation of the coronary arteries.

Nitroglycerin (NTG)

_____: Myocardial infarction in which the patient typically has ST and T-wave changes on a 12-lead ECG; this indicates myocardial ischemia.

Non-ST-segment elevation myocardial infarction (NSTEMI)

_____: Factor in disease development that cannot be altered or controlled by the patient. Examples include age, gender, family history, and ethnic background.

Nonmodifiabe risk factor

_____: Occurrence of three or more successive premature ventricular complexes.

Nonsustained ventricular tachycardia (NSVT)

_____: The rhythm originating from the sinoatrial node (dominant pacemaker), with atrial and ventricular rates of 60 to 100 beats/min and regular atrial and ventricular rhythms.

Normal sinus rhythm (NSR)

_____: An increase in body weight at least 20% above the upper limit of the normal range for ideal body weight, with an excess amount of body fat; in an adult, a body mass index greater than 30.

Obesity

_____: Shortness of breath that occurs when lying down but is relieved by sitting up.

Orthopnea

_____: A decrease in blood pressure (20 mm Hg systolic and/or 10 mm Hg diastolic) that occurs during the first few seconds to minutes after changing from a sitting or lying position to a standing position.

Orthostatic (postural) hypotension

_____: The most common type of transplantation procedure in which a diseased organ is removed and a donor organ is grafted in its place. For example, during heart transplantation, the surgeon removes the diseased heart and leaves the posterior walls of the patient's atria, which serve as the anchor for the donor heart; anastomoses are made between the recipient and donor atria, aorta, and pulmonary arteries.

Orthotopic

_____: Chronic peripheral arterial disease with obstruction at or below the superficial femoral or popliteal artery. The patient experiences burning or cramping in the calves, ankles, feet, and toes after walking a certain distance; the pain usually subsides with rest.

Outflow disease

_____: An increase in body weight for height compared with a reference standard (e.g., the Metropolitan Life height and weight tables) or 10% greater than ideal body weight. However, this weight may not reflect excess body fat, which in an adult is a body mass index of 25 to 30.

Overweight

_____: In the electrocardiogram, the deflection representing atrial depolarization.

P wave

_____: In the electrocardiogram, the interval measured from the beginning of the P wave to the end of the PR segment; represents the time required for atrial depolarization as well as impulse delay in the atrioventricular node and travel time to the Purkinje fibers.

PR interval

_____: In the electrocardiogram, the isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electrical impulse is traveling through the atrioventricular node, where it is delayed.

PR segment

_____: The number of packs of cigarettes per day multiplied by the number of years the patient has smoked; used in recording a patient's smoking history.

Pack-years

_____: A feeling of fluttering in the chest, an unpleasant awareness of the heartbeat, or an irregular heartbeat; may result from a change in heart rate or rhythm or from an increase in the force of heart contractions.

Palpitations

_____: An exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle (normal is 3 to 10 mm Hg); clinical conditions that may produce a paradoxical blood pressure include pericardial tamponade, constrictive pericarditis, and pulmonary hypertension.

Paradoxical blood pressure (paradoxical pulse; pulsus paradoxus)

_____: Abnormal splitting of the S2 heart sound heard in patients with severe myocardial depression; causes early closure of the pulmonic valve or a delay in aortic valve closure.

Paradoxical splitting

_____: In the patient with heart disease, difficulty breathing that develops after lying down for several hours and causes the patient to awaken abruptly with a feeling of suffocation and panic. Occurs because the heart is unable to compensate for the increased volume when blood from the lower extremities is redistributed to the venous system, which increases venous return to the heart. A diseased heart is ineffective in pumping the additional fluid into the circulatory system, and pulmonary congestion results.

Paroxysmal nocturnal dyspnea (PND)

_____: A form of supraventricular tachycardia that occurs when the rhythm is intermittent; it is initiated suddenly by a premature complex, such as a premature atrial complex, and terminated suddenly with or without intervention.

Paroxysmal supraventricular tachycardia (PSVT)

_____: A ventricular reconstructive procedure that involves removing a triangle-shaped section of the weakened heart in the left lateral ventricle to reduce the ventricle's diameter and decrease wall tension. Also known as heart reduction surgery and Batista procedure.

Partial left ventriculectomy (PLV)

_____: Pertaining to the feet.

Pedal

_____: Surgical procedure for hypertrophic cardiomyopathy (HCM) in which alcohol is injected into a target septal branch of the left anterior descending coronary artery to produce a small septal infarction. This procedure also widens the left ventricular outflow tract.

Percutaneous alcohol septal ablation

_____: A nonsurgical method of improving arterial flow by opening the vessel lumen and creating a smooth inner vessel surface. One or more arteries are dilated with a balloon catheter advanced through a cannula, which is inserted into or above an occluded or stenosed artery.

Percutaneous transluminal coronary angioplasty (PTCA, Percutaneous coronary intervention, PCI, percutaneous vascular intervention)

_____: Complication of pericarditis that occurs when the space between the parietal and visceral layers of the pericardium fills with fluid.

Pericardial effusion

_____: An abnormal sound that originates from the pericardial sac and occurs with the movements of the heart during the cardiac cycle; usually transient and a sign of inflammation, infection, or infiltration; may be heard in patients with pericarditis resulting from myocardial infarction, cardiac tamponade, or post-thoracotomy.

Pericardial friction rub

_____: Surgical excision of the pericardium (the sac around the heart).

Pericardiectomy

_____: Withdrawal of pericardial fluid through a catheter inserted into the pericardial space to relieve the pressure on the heart.

Pericardiocentesis

_____: Several 1- to 2-mm collections of tissue identified in the carotid arteries and along the aortic arch.

Peripheral chemoreceptors

_____: Any disorder that alters the natural flow of blood through the arteries and veins of the peripheral circulation.

Peripheral vascular disease (PVD)

_____: Pinpoint red spots on the mucous membranes, palate, conjunctivae, or skin.

Petechiae

_____: A form of echocardiography in which either dobutamine (increases heart's contractility) or adenosine (dilates coronary arteries) is given to the patient; usually used when patients cannot tolerate exercise.

Pharmacologic stress echocardiogram

_____: A tumor of the adrenal medulla, which can cause excessive secretion of catecholamines.

Pheochromocytoma

_____: Inflammation of a vein, which can predispose patients to thrombosis.

Phlebitis

_____: Presence of a thrombus in a vein without inflammation.

Phlebothrombosis

_____: Indentation of the skin; often occurs with edema.

Pitting

_____: A stabbing pain on taking a deep breath.

Pleuritic chest pain

_____: Cluster of nerves

Plexus

_____: In electrocardiography, the flow of electrical current in the heart (cardiac axis) toward the positive pole.

Positive deflection

_____: Symptoms, including pericardial and pleural pain, pericarditis, friction rub, elevated temperature and white blood cell count, and dysrhythmias, that occur in patients after cardiac surgery; may occur days to weeks after surgery and seems to be associated with blood that remains in the pericardial sac.

Postpericardiotomy syndrome

_____: Chest pain that occurs in the days or weeks before a myocardial infarction.

Pre-infarction angina

_____: The degree of myocardial fiber stretch at the end of diastole and just before contraction; determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart).

Preload

_____: In the electrocardiogram, an early complex that occurs when atrial tissue becomes irritable. This ectopic focus fires an impulse before the next sinus impulse is due, thus usurping the sinus pacemaker. The premature P wave from the atrial focus is early and has a shape different from that of the P wave generated from the sinus node.

Premature atrial complex (contraction) (PAC)

_____: In the electrocardiogram, an early complex that occurs when a cardiac cell or cell group other than the sinoatrial node becomes irritable and fires an impulse before the next sinus impulse is generated. After the premature complex, there is a pause before the next normal complex, which creates an irregularity in the rhythm.

Premature complex

_____: In the electrocardiogram, an early ventricular complex is followed by a pause that results from increased irritability of ventricular cells. The QRS complexes may be unifocal or uniform (of the same shape), or multifocal or multiform (of different shapes).

Premature ventricuar complexes (PVCs)

_____: Measurement of pressure in the left atrium using a balloon-tipped catheter introduced into the pulmonary artery. When the balloon at the catheter tip is inflated, the catheter advances and wedges in a branch of the pulmonary artery. The tip of the catheter is able to sense pressures transmitted from the left atrium, which reflect left ventricular end-diastolic pressure.

Pulmonary artery wedge pressure (PAWP)(pulmonary artery occlusive pressure, PAOP)

_____: The relocation of the patient's own pulmonary valve to the aortic position for aortic valve replacement (Ross procedure).

Pulmonary autographs

_____: The difference between the apical and peripheral pulses.

Pulse deficit

_____: The difference between the systolic and diastolic pressures.

Pulse pressure

_____: A type of pulse in which a weak pulse alternates with a strong pulse despite a regular heart rhythm; seen in patients with severely depressed cardiac function.

Pulsus alternans

_____: In the cardiac conduction system, the cells that make up the bundle of His, bundle branches, and terminal Purkinje fibers. These cells are responsible for the rapid conduction of electrical impulses throughout the ventricles, leading to ventricular depolarization and subsequent ventricular muscle contraction.

Purkinje cells

_____: In the electrocardiogram, the portion consisting of the Q, R, and S waves, representing ventricular depolarization.

QRS complex

_____: In the electrocardiogram, the time required for depolarization of both ventricles; measured from the beginning of the QRS complex to the J point (the junction at which the QRS complex ends and the ST segment begins).

QRS duration

_____: In the electrocardiogram, the time from the beginning of the QRS complex to the end of the T wave. It represents the total time required for ventricular depolarization and repolarization.

QT interval

_____: A type of premature complex consisting of a repetitive four-beat pattern; usually occurs as three sequential normal complexes followed by a premature complex and a pause, with the same pattern repeating itself in a four-beat pattern.

Quadrigeminy

_____: An invasive procedure that uses radiofrequency waves to abolish an irritable focus that is causing a supraventricular or ventricular tachydysrhythmia.

Radiofrequency catheter ablation

_____: A member of the health care team who works to help patients continue or develop hobbies or interests. Also called activity therapist.

Recreational therapist

_____: A hormone that is produced in the juxtaglomerular complex of the kidney and that helps regulate blood flow, glomerular filtration rate, and blood pressure. Renin is secreted when sensing cells (macula densa) in the distal convoluted tubule sense changes in blood volume and pressure

Renin

_____: A form of cardiomyopathy that restricts the filling of the ventricles; a type of lung disease that prevents good expansion and recoil of the gas exchange unit.

Restrictive cardiomyopathy

_____: Inflammatory lesions in the heart due to a sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic streptococci, which occurs in about 40% of patients with rheumatic fever. Inflammation results in impaired contractile function of the myocardium, thickening of the pericardium, and valvular damage. Also called rheumatic endocarditis.

Rheumatic carditis

_____: The inability of the right ventricle to empty completely, resulting in increased volume and pressure in the systemic veins and systemic venous congestion with peripheral edema.

Right-sided heart (ventricular) failure

_____: Dusky red discoloration of the skin.

Rubor

_____: The third heart sound; an early diastolic filling sound that indicates an increase in left ventricular pressure and may be heard on auscultation in patients with heart failure.

S3 gallop

_____: In the electrocardiogram, the line (normally isoelectric) representing early ventricular repolarization. It occurs from the J point to the beginning of the T wave.

ST segment

_____: Myocardial infarction in which the patient typically has ST elevation in two contiguous leads on a 12-lead ECG; this indicates myocardial infarction/necrosis.

ST-elevation myocardial infarction (STEMI)

_____: A granulomatous disorder of unknown cause that can affect any organ but most often involves the lung.

Sarcoidosis

_____: The injection of a sclerosing agent via a catheter, usually in an endoscopic procedure, to stop variceal bleeding.

Sclerotherapy

_____: Elevated blood pressure that is related to a specific disease (e.g., kidney disease) or medication (e.g., estrogen).

Secondary hypertension

_____: Systemic infection.

Sepsis

_____: The type of shock that occurs when large amounts of toxins and endotoxins produced by bacteria are released into the blood, causing a whole-body inflammatory reaction.

Septic shock

_____: The whole-body response to poor tissue oxygenation. Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a life-threatening emergency.

Shock

_____: In the cardiac conduction system, the primary pacemaker of the heart; located close to the epicardial surface of the right atrium near its junction with the superior vena cava. It can spontaneously and rhythmically generate electrical impulses at a rate of 60 to 100 beats/min.

Sinoatrial (SA) node (sinus node)

_____: A variant of normal sinus rhythm that results from changes in intrathoracic pressure during breathing; heart rate increases slightly during inspiration and decreases slightly during exhalation. Atrial and ventricular rates are between 60 and 100 beats/min, and atrial and ventricular rhythms are irregular.

Sinus arrhythmia

_____: A cardiac dysrhythmia caused by a decreased rate of sinus node discharge, with a heart rate that is less than 60 beats/min.

Sinus bradycardia

_____: A cardiac dysrhythmia caused by an increased rate of sinus node discharge, with a heart rate that is more than 100 beats/min.

Sinus tachycardia

_____: Black longitudinal line or small red streak on the distal third of the nail bed; seen in patients with infective endocarditis.

Splinter hemorrhage

_____: In patients with venous insufficiency, discoloration of the skin along the ankles, which may extend up to the calf.

Stasis dermatitis

_____: In patients with long-term venous insufficiency, ulcer formed as a result of edema or minor injury to the limb; typically occurs over the malleolus.

Stasis ulcers

_____: The amount of blood ejected by the left ventricle during each heartbeat.

Stroke volume (SV)

_____: A form of tachycardia that involves the rapid stimulation of atrial tissue at a rate of 100 to 280 beats/min. It is most often due to a re-entry mechanism in which one impulse circulates repeatedly throughout the atrial pathway, re-stimulating the atrial tissue at a rapid rate.

Supraventricular tachycardia (SVT)

_____: A state of partial blood vessel constriction caused when nerves from the sympathetic division of the autonomic nervous system continuously stimulate vascular smooth muscle.

Sympathetic tone

_____: Transient loss of consciousness (blackouts), most commonly caused by decreased perfusion to the brain.

Syncope

_____: The phase of the cardiac cycle that consists of the contraction and emptying of the atria and ventricles.

Systole

_____: Heart failure that results when the heart is unable to contract forcefully enough during systole to eject adequate amounts of blood into the circulation.

Systolic heart failure (systolic ventricular dysfunction)

_____: In the electrocardiogram, the deflection that follows the ST segment and represents ventricular repolarization.

T wave

_____: An excessively fast heart rate; characterized as a pulse rate greater than 100 beats/min.

Tachycardia

_____: An abnormal heart rhythm with a rate greater than 100 beats/min.

Tachydysrhythmias

_____: Vascular lesions with a red center and radiating branches. Also called spider angiomas, spider nevi, or vascular spiders.

Telangiectasias (spider angiomas)

_____: In electrocardiography (ECG), the use of a battery-powered transmitter system for monitoring an ambulatory patient; allows freedom of movement within a certain radius without losing transmission of the ECG.

Telemetry

_____: A nonsurgical intervention for cardiac dysrhythmia that provides a timed electrical stimulus to the heart when either the impulse initiation or the intrinsic conduction system of the heart is defective.

Temporary pacing

Which are risk factors that are known to contribute to atherosclerosis-related diseases? (Select all that apply). A) Low-density lipoprotein cholesterol (LDL- of 160 mg/dL (4.14 mmol/L). B) Smoking. C) Aspirin (acetylsalicylic acid [ASA]) consumption D) Type 2 diabetes. E) Vegetarian diet.

Answer: A, B, D. Risk factors that contribute to atherosclerosis-related diseases include LDL-C of 160 mg/dL (4.14 mmol/L), smoking, and type 2 diabetes. Having an LDL-C value of less than 100 mg/dL (2.59 mmol/L) is optimal. 100 to 129 mg/dL (2.59 to 3.34 mmol/L) is near or less than optimal. LDL-C 130 to 159 mg/dL (3.37 to 4.12 mmol/L) is borderline high. The client with a LDL-C of 160 mg/dL (4.14 mmol/L) is advised to modify diet and exercise. Smoking is a modifiable risk factor and needs to be avoided or terminated. Diabetes is a risk factor for atherosclerotic disease.ASA is used as prophylaxis for atherosclerotic disease/coronary artery disease to prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent atherosclerosis. Vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.

The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the client's last appointment. Which actions by the client indicate that teaching has been effective? (Select all that apply). A) Has maintained a low-sodium, no-added-salt diet B) Has lost 3 pounds (1.4 kg) since last seen in the clinic C) Cooks food in palm oil to save money D) Exercises once weekly E) Has cut down on caffeine

Answer: A, B, E. Teaching about hypertension has been effective when the nurse notes that the client has been on a low-sodium, no-added salt diet, has lost 3 pounds (1.4 kg) since the last clinic visit, and has cut down on caffeine. Clients with hypertension need to consume low-sodium foods and would avoid adding salt. Weight loss can result in lower blood pressure. Caffeine promotes vasoconstriction, thereby elevating blood pressure.Although palm oil may be cost-saving, it is higher in saturated fat than canola, sunflower, olive, or safflower oil. The goal is to exercise three times and not once weekly.

The nurse is caring for a patient who has developed a bradycardia. Which possible causes does the nurse investigate? (Select all that apply) A) Bearing down for a bowel movement B) Possible inferior wall myocardial infarction (MI) C) Patient stating that he just had a cup of coffee. D) Patient becoming emotional when visitors arrived E) Diltiazem (Cardizem) administered 1 hour ago

Answer: A, B, E. Valsalva maneuvers such as bearing down for a bowel movement or gagging may cause excessive vagal (parasympathetic) stimulation to the heart leading to decreased rate of sinus node discharge. Bradycardia may result from carotid sinus massage, vomiting, suctioning, ocular pressure, or pain. Inferior wall MI is a cause of bradycardia and heart block. Calcium channel blockers such as diltiazem may cause bradycardia.Caffeine intake results in an increased heart rate. Stress, such as an emotional encounter, can result in tachycardia.

The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? (Select all that apply). A) Chest discomfort or pain. B) Tachycardia. C) Expectorating thick, yellow sputum. D) Sleeping on back without a pillow. E) Fatigue.

Answer: A, B, E. When caring for a client with heart failure, the nurse needs to assess for chest discomfort or pain, tachycardia, and fatigue. Decreased tissue perfusion with heart failure may cause chest pain or angina. Tachycardia may occur as compensation for or as a result of decreased cardiac output. Fatigue is a symptom of poor tissue perfusion in clients with heart failure.Presence of a cough or dyspnea results as pulmonary venous congestion ensues. Clients with acute heart failure have dry cough and, when severe, pink, frothy sputum. Thick, yellow sputum is indicative of infection. Position for sleeping isn't a symptom. Clients usually find it difficult to lie flat because of dyspnea symptoms.

The nurse is caring for a patient with heart rate of 143 beats/min. For which manifestations does the nurse observe? (Select all that apply). A) Palpitations. B) Increased energy. C) Chest discomfort. D) Flushing of the skin. E) Hypotension.

Answer: A, C, E. Tachycardia is a heart rate greater than 100 beats/min; the patient with a tachydysrhythmia may have palpitations, chest discomfort (pressure or pain from myocardial ischemia or infarction), restlessness and anxiety, pale cool skin, and syncope ("blackout") from hypotension. Chest discomfort and palpitations may occur because decreased time for diastole results in lower perfusion through the coronary arteries to the myocardium. Hypotension results from decreased time for ventricular filling, secondary to shortened diastole, and therefore reduced cardiac output and blood pressure. Reduced cardiac output and possible development of heart failure will cause fatigue.In this situation, the patient will have pale, cool skin and not flushing of the skin. Also, reduced cardiac output and possible development of heart failure will cause fatigue and not increased energy.

The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? (Select all that apply). A) Blurred vision. B) Tachycardia. C) Fatigue. D) Serum digoxin level of 1.5 ng/ml (1.92 nmol/L). E) Anorexia.

Answer: A, C, E. The signs and symptoms of digoxin toxicity that the nurse notifies the provider include: blurred vision, fatigue, and anorexia. Changes in mental status, especially in older adults, may also occur.Sinus bradycardia and not tachycardia is a sign of digoxin toxicity. A serum digoxin level between 0.8 and 2.0 (1.02 and 2.56 nmol/L) is considered normal and is not a symptom.

A patient admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action does the nurse take next? A) Prepare for defibrillation. B) Establish IV access. C) Place an oral airway and ventilate. D) Start cardiopulmonary resuscitation (CPR).

Answer: A. Defibrillating is the priority next action before any other resuscitative measures, according to advanced cardiac life support protocols.After immediate defibrillation, establish IV access, place an oral airway, and ventilate. CPR will be started after unsuccessful defibrillation.

The nurse is caring for a patient with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention? A) Defibrillation B) Cardiopulmonary resuscitation (CPR). C) Administration of epinephrine D) Administration of oxygen

Answer: A. Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt. Therefore, this intervention is not used.If drug therapy fails to restore effective rhythm, CPR is initiated. Epinephrine is used to increase heart rate in asystole. Hypoxia may be a cause of cardiac arrest, so the administration of oxygen would be appropriate.

The nurse discusses the importance of restricting sodium in the diet for a client with heart failure. Which statement made by the client indicates that the client needs further teaching? A) "I need to avoid eating hamburgers." B) "I must cut out bacon and canned foods." C) "I won't put the salt shaker on the table anymore." D) "I need to avoid lunchmeats but may cook my own turkey."

Answer: A. Further teaching about restricting sodium in the diet for a client with heart failure is needed when the client says, "I need to avoid eating hamburgers." Cutting out beef or hamburgers made at home is not necessary, but fast-food hamburgers are to be avoided owing to higher sodium content.Bacon, canned foods, lunchmeats, and processed foods are high in sodium, which promotes fluid retention, and must be avoided. The client correctly understands that adding salt to food must be avoided.

Which laboratory finding is consistent with acute coronary syndrome (ACS)? A) Troponin 3.2 ng/mL (3.2 mcg/L). B) C-reactive protein 13 mg/dL (130 mg/L) C) Triglycerides 400 mg/dL (4.52 mmol/L) D) Lipoprotein-a 18 mg/dL (0.64 mcmol/L)

Answer: A. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).Normal C-reactive protein would be less than 1 mg/dL (10 mg/L). This tests for risk for coronary artery disease (CAD), not ACS. Normal triglycerides would be 35-135 mg/dL (0.40-1.50 mmol/L) for females and 40-160 mg/dL (0.45-1.81 mmol/L) for males. This tests for risk for CAD, not ACS. Normal lipoprotein-a is less than 30 mg/dL (1.07 mcmol/L). This also tests for risk for CAD, not ACS.

Which patient is appropriate for the cardiac care unit charge nurse to assign to the float RN from the medical-surgical unit? A) The 64-year-old patient admitted for weakness who has a sinus bradycardia with a heart rate of 58 beats/min B) The 71-year-old patient admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min C) The 88-year-old patient admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min D) The 92-year-old patient admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

Answer: A. The 64-year-old has a stable, asymptomatic bradycardia, which usually requires monitoring but no treatment unless the patient develops symptoms and/or the slow heart rate causes a decrease in cardiac output. This patient can be managed by a nurse with less cardiac dysrhythmia training.The 71-year-old is unstable and requires immediate intervention for dyspnea and tachycardia. The 88-year-old is displaying symptoms of myocardial injury (elevated troponin) and unstable blood pressure and needs immediate attention and medications. The 92-year-old is experiencing a dysrhythmia that could deteriorate into ventricular tachycardia and requires immediate intervention by a telemetry nurse.

A client who is suffering from dyspnea on exertion and congestive heart failure (CHF) will most likely report which symptom during the health history? A) Fatigue. B) Swelling of one leg. C) Slow heart rate. D) Brown discoloration of lower extremities.

Answer: A. The CHF client with dyspnea on exertion will most likely report fatigue during the health history. Although fatigue in itself is not diagnostic of heart disease, many people with heart failure are limited by leg fatigue during exercise. Fatigue that occurs after mild activity and exertion usually indicates inadequate cardiac output (due to low stroke volume) and anaerobic metabolism in skeletal muscle.Unilateral swelling is more typical with a local finding such as deep vein thrombosis, not a systemic problem such as heart failure. Tachycardia, rather than bradycardia, develops with heart failure and decreased cardiac output. Brown discoloration of the lower extremities is indicative of long-standing venous stasis, such as occurs with varicose veins.

The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? A) "I will call the provider if I have a cough lasting 3 or more days." B) "I will report to the provider weight loss of 2 to 3 pounds (0.9 to 1.4 kg) in a day." C) "I will try walking for 1 hour each day." D) "I should expect occasional chest pain."

Answer: A. The client understands the discharge teaching about when to seek medical attention when the client says: "I will call the provider if I have a cough lasting 3 or more days." Cough, a symptom of heart failure, is indicative of intra-alveolar edema; it is important to notify the provider if this occurs.The client would call the provider for weight gain of 3 pounds (1.4 kg) in a week or 1-2 pounds (0.45 to 0.9 kg) overnight. The client would begin by walking 200 to 400 feet (61 to 123 meters) per day. Chest pain is indicative of myocardial ischemia and worsening of heart failure. The provider must be notified if this occurs.

Which client has the highest risk for cardiovascular disease? A) Man who smokes and whose father died at 49 of myocardial infarction (MI) B) Woman with abdominal obesity who exercises three times per week C) Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L) D) Man who is sedentary and reports four episodes of strep throat

Answer: A. The client who has the highest risk for cardiovascular disease is the man who smokes and whose father died at 49 years of age of MI. Smoking is a major risk factor for MI, and family history is a stronger risk factor than hypertension, obesity, diabetes, or sudden cardiac death.Although abdominal obesity is a risk factor, exercising three times weekly is not. Diabetes is a major risk factor for MI, but an HDL cholesterol of 75 mg/dL (1.94 mmol/L) is in the optimal range of greater than 55 mg/dL (1.42 mmol/L). Sedentary lifestyle is a risk factor but is not a major risk. Frequent strep infections may be associated with valvular disease rather than coronary artery disease.

The nurse is assigned to all of these clients. Which client would be assessed first? A) The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago B) The client admitted with hypertensive crisis who has a nitroprusside (Nipride) drip and blood pressure of 149/80 mm Hg C) The client with peripheral vascular disease who has a left leg ulcer draining purulent yellow fluid D) The client who had a right femoral-popliteal bypass 3 days ago and has ongoing edema of the foot

Answer: A. The client who would be assessed first is the client who had a PTA of the right femoral artery 30 minutes ago. This client must have checks of vascular status and vital signs every 15 minutes in the first hour after the procedure.The client admitted with hypertensive crisis has stabilized and is not in need of immediate assessment. The client with peripheral vascular disease is the most stable and can be seen last. The client who had a right femoral-popliteal bypass is not in need of immediate assessment and can be assessed after the PTA client is seen.

A client has undergone an embolectomy for acute arterial occlusion after creation of a lower arm arteriovenous fistula for dialysis. Which finding does the nurse report to the primary health care provider (PCP) immediately? A) Swelling and tenseness in the affected area B) Incisional pain and tenderness at the surgical site C) Pink, mobile fingers D) An order for heparin infusion

Answer: A. The finding the nurse immediately reports to the PCP when caring for a postoperative embolectomy client who had an acute arterial occlusion after creation of a lower arm arteriovenous fistula for dialysis is swelling and tenseness in the affected arm. Compartment syndrome may develop after an embolectomy, with swelling of skeletal muscle fibers causes increasing pain, swelling, and tenseness. A fasciotomy may be needed to preserve the limb.Incisional pain is expected. Pink fingers and mobility are normal physical assessment findings. Heparin may be prescribed to maintain patency of the vessel after clot removal.

The nurse caring for a client who has had abdominal aortic aneurysm (AAA) repair would be most alarmed by which finding? A) Urine output of 20 mL over 2 hours B) Blood pressure of 106/58 mm Hg C) Absent bowel sounds D) +3 pedal pulses

Answer: A. The nurse caring for a client who had an AAA repair would be most alarmed with the client's urine output of 20 mL over 2 hours. Complications post AAA stent repair include bleeding, which may manifest as signs of hypovolemia and oliguria.Reduction of systolic blood pressure to 100 to 120 mm Hg is appropriate. Paralytic ileus may be a complication of AAA repair, but is not a priority over decreased urine output (think ABCs). +3 pedal pulses is a normal physical assessment finding.

The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer? A) Heparin. B) Atropine. C) Dobutamine. D) Magnesium sulfate.

Answer: A. The nurse plans to administer heparin in addition to the antidysrhythmic. AF is the loss of coordinated atrial contractions that can lead to pooling of blood, resulting in thrombus formation. The patient is at high risk for pulmonary and systemic embolism. Heparin and other anticoagulants (e.g., enoxaparin [Lovenox], warfarin [Coumadin], and novel oral anticoagualants, when nonvalvular, such as dabigatran [Pradaxa], rivaroxaban [Xarelto], apixaban [Eliquis], or edoxaban [Savaysa]) are used to prevent thrombus development in the atrium, leading to the risk of embolization (i.e., stroke).Atropine is used to treat bradycardia and not rapid heart rate associated with AF. Dobutamine is an inotropic agent used to improve cardiac output; it may cause tachycardia, thereby worsening atrial fibrillation. Although electrolyte levels are monitored in clients with dysrhythmia, magnesium sulfate is not used unless depletion is noted.

After receiving change-of-shift report about these four clients, which client would the nurse assess first? A) A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular contractions (PVCs) B) A 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% C) A 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths D) A 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, heart rate 104 beats/min

Answer: A. The nurse would first assess the 46-year-old with aortic stenosis on digoxin and now has new-onset frequent PVCs. The PVCs may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity must be done and the primary health care provider notified about the dysrhythmia.The 55-year-old is stable and can be assessed after the client with aortic stenosis. The 68-year-old may be assessed after the client with aortic stenosis. This type of pain is expected in pericarditis. Tachycardia is expected in the 79-year-old because rejection will cause signs of decreased cardiac output, including tachycardia. This client may be seen after the client with aortic stenosis.

Which statement reflects correct cardiac physical assessment technique? A) Auscultate the aortic valve in the second intercostal space at the right sternal border. B) Evaluate for orthostatic hypotension by moving the client from a standing to a reclining position. C) Palpate the apical pulse over the third intercostal space in the midclavicular line. D) Assess for carotid bruit by auscultating over the anterior neck.

Answer: A. The statement that shows correct cardiac physical assessment technique is to auscultate the aortic valve in the second intercostal space at the right sternal border.Orthostatic hypotension is measured when a person moves from a reclining to a standing position. The apical pulse is palpated over the fifth intercostal space in the midclavicular line. A bruit is assessed by auscultating the carotid artery in the neck.

A client who is to undergo cardiac catheterization must be taught which essential information by the nurse? A) "Monitor the pulses in your feet when you get home." B) "Keep your affected leg straight for 2 to 6 hours." C) "Do not take your blood pressure medications on the day of the procedure." D) "Take your oral hypoglycemic with a sip of water on the morning of the procedure."

Answer: B . The client undergoing cardiac catheterization must be taught to keep the affected leg straight for 2 to 6 hours after the test. The client will remain in bed and the affected leg kept straight for 2 to 6 hours after the procedure, depending on the type of vascular closure device used, to allow the arterial puncture to heal well and prevent bleeding.The nurse monitors the pulses in the affected extremity until discharge, then teaches the client to contact the primary health care provider immediately if pallor, pain, paresthesia, or coolness of the extremity develops. The client may take regular medications except oral hypoglycemics. Blood pressure may be elevated due to anxiety before the procedure, so antihypertensive medications are taken. Oral hypoglycemics are taken with or before meals based on an anticipated rise in glucose after eating. They are not taken when the client is NPO for procedures or surgery.

The nurse administers amiodarone (Cordarone) to a patient with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? (Select all that apply). A) Respiratory rate. B) QT interval. C) Heart rate. D) Heart rhythm. E) Urine output.

Answer: B, C, D. Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore, monitoring of heart rate and rhythm is needed.Although it is always important to monitor respiratory rate and urine output, these assessments are not specific to amiodarone.

Which risk factors are known to contribute to atrial fibrillation? (Select all that apply). A) Use of beta-adrenergic blockers B) Excessive alcohol use C) Advancing age. D) High blood pressure. E) Palpitations.

Answer: B, C, D. Risk factors contributing to atrial fibrillation include excessive alcohol use, advancing age, and hypertension. Other risk factors involve previous ischemic stroke, transient ischemic attack or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure, mitral valve disease, obesity, and chronic kidney disease. The incidence of atrial fibrillation also occurs more often in those of European ancestry and African Americans.Beta-adrenergic blocking agents, which reduce heart rate, are used to treat atrial fibrillation. Palpitations are a symptom of atrial fibrillation, rather than a risk or a cause.

Which signs and symptoms are seen with suspected pericarditis? (Select all that apply). A) Squeezing, vise-like chest pain B) Chest pain relieved by sitting upright C) Chest and abdominal pain relieved by antacids D) Sudden-onset chest pain relieved by anti-inflammatory agents E) Pain in the chest described as sharp or stabbing

Answer: B, D, E. The chest pain of pericarditis is relieved when sitting upright or forward, may appear abruptly, and is relieved by anti-inflammatory agents. The inflammatory pain of pericarditis tends to be sharp, stabbing, and related to breathing.Squeezing, vise-like chest pain is characteristic of myocardial infarction. Chest and abdominal pain relieved by antacids is characteristic of peptic ulcer.

Which of these factors contribute to the risk for cardiovascular disease? (Select all that apply). A) Consuming a diet rich in fiber. B) Elevated C-reactive protein levels. C) Low blood pressure. D) Elevated high-density lipoprotein (HDL) cholesterol level E) Smoking

Answer: B, E. Factors that contribute to the risk for cardiovascular disease include elevated C-reactive protein levels and smoking. Elevation in C-reactive protein, suggestive of inflammation, is a risk factor for atherosclerosis and cardiac disease. Smoking cessation must also be emphasized. Smoking is a major modifiable risk factor for cardiovascular disease.A diet rich in fiber is not a risk factor for cardiovascular disease, but rather a desirable behavior. Hypertension, not low blood pressure, is a risk for cardiovascular disease. Elevated low-density lipoprotein cholesterol is a risk for atherosclerosis. Elevated HDL cholesterol is desirable and may be cardioprotective.

A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client? A) "Consume foods high in potassium." B) "Monitor for irregular pulse." C) "Monitor for muscle cramping." D) "Avoid grapefruit juice."

Answer: D. The nurse teaches the client who is taking verapamil to avoid grapefruit juice. Grapefruit juice must be avoided with calcium channel blockers, such as verapamil, because it can enhance the action of the drug.Foods high in potassium would be encouraged for clients taking diuretics, not calcium channel blockers such as verapamil. Bradycardia, not irregular pulse, is a typical side effect of verapamil. Muscle cramping may occur with statins, not with calcium channel blockers.

How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? A) Ejection fraction is 25%. B) Client states that she is able to sleep on one pillow. C) Client was hospitalized five times last year with pulmonary edema. D) Client reports that she experiences palpitations.

Answer: B. A client with heart failure has had a positive outcome to metoprolol when she states that she is able to sleep on one pillow. Improvement in activity tolerance, less orthopnea, and improved symptoms represents a positive response to beta blockers such as metoprolol.An ejection fraction of 25% is well below the normal of 50% to 70% and indicates poor cardiac output. Repeated hospitalization for acute exacerbation of left-sided heart failure does not demonstrate a positive outcome. Although metoprolol decreases the heart rate, palpitations are defined as the feeling of the heart beating fast in the chest. This is not a positive outcome.

The nurse in a coronary care unit interprets information from hemodynamic monitoring. The client has a cardiac output of 2.4 L/min. Which action would be taken by he nurse? A) No intervention is needed; this is a normal reading. B) Collaborate with the primary health care provider to administer a positive inotropic agent. C) Administer a STAT dose of metoprolol (Lopressor). D) Ask the client to perform the Valsalva maneuver.

Answer: B. A positive inotropic agent will increase the force of contraction (stroke volume [SV]), thus increasing cardiac output (CO). Recall that SV × HR = CO (heart rate [HR]). Normal cardiac output is 4 to 7 L/min.No intervention is needed because this is a normal reading. The beta blocker metoprolol (Lopressor) has side effects of bradycardia and decreased contractility, so cardiac output would be further reduced. The Valsalva maneuver, or bearing down, will decrease the heart rate and thus cardiac output.

After a cardiac catheterization, the client needs to increase his or her fluid intake for which reason? A) NPO status will cause the client to be thirsty. B) The dye causes an osmotic diuresis. C) The dye contains a heavy sodium load. D) The pedal pulses will be more easily palpable.

Answer: B. After a cardiac catheterization, the client needs to increase fluid intake because the dye used causes osmotic diuresis. The dye is osmotically heavy, causing increased urine output, possible decreased blood flow to the kidney, and renal impairment.Although the client may report thirst while NPO, the reason to increase fluids is related to osmotic diuresis from the contrast medium. The contrast medium is iodinated and does not contain a heavy sodium load. Although maintaining fluid volume may make pulses more obvious, this is not the reason to encourage fluids.

Which statement by the client with a recent cardiovascular diagnosis indicates maladaptive denial? A) "I don't know how I am going to change my lifestyle." B) "I don't need to change. It hasn't killed me yet." C) "I don't think it is as bad as the doctors say." D) "I will have to change my diet and exercise more."

Answer: B. An example of maladaptive denial to a recent cardiovascular diagnosis is when the client says that change is not needed, because "it hasn't killed me yet." This type of denial is a defense mechanism that enables the client to cope with threatening circumstances. He or she may deny the current cardiovascular condition, may state that it was present but is now absent, or may be excessively cheerful. Denial becomes maladaptive when the client is noncompliant or does not adhere to the interdisciplinary plan of care.Not knowing how to change indicates that the client is overwhelmed, not in denial. Not thinking it is that bad indicates denial, but not maladaptive denial. Changing diet and exercising more indicate a willingness to change.

A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? A) The client's ability to understand medication teaching B) The risk for hypotension C) The potential for bradycardia D) Liver function tests

Answer: B. At the start of therapy with lisinopril, the nurse needs to consider the risk for hypotension. Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.Although desirable, ability to understand teaching is not essential. ACE inhibitors are vasodilators and do not affect heart rate. Renal function, not liver function, may be altered by ACE inhibitors.

Which medication, when given in heart failure, may improve morbidity and mortality? A) Dobutamine (Dobutrex) B) Carvedilol (Coreg) C) Digoxin (Lanoxin) D) Bumetanide (Bumex).

Answer: B. Carvedilol when given to clients in heart failure may improve morbidity and mortality. Beta-adrenergic blocking agents such as carvedilol reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure. This category of pharmacologic agents improves morbidity, mortality, and quality of life.Dobutamine and digoxin are inotropic agents used to improve myocardial contractility but have not been directly associated with improving morbidity and mortality. Bumetanide is a high-ceiling diuretic that promotes fluid excretion, and does not improve morbidity and mortality.

The nurse receives a report that a patient with a pacemaker has experienced loss of capture. Which situation is consistent with this? A) The pacemaker spike falls on the T wave. B) Pacemaker spikes are noted, but no P wave or QRS complex follows. C) The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip. D) The patient demonstrates hiccups.

Answer: B. Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode.Pacemaker spikes falling on the T wave indicate improper sensing. A heart rate of 42 beats/min with no pacemaker spikes seen on the rhythm strip indicates failure to pace or sense properly. Demand pacing would cause the pacemaker to intervene with electrical output when the heart rate falls below the set rate. Although the set rate is not given, this heart rate indicates profound bradycardia. Hiccups may indicate stimulation of the chest wall or diaphragm from wire perforation.

When administering furosemide (Lasix) to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels? A) Increase red meat in the diet. B) Consume melons and baked potatoes. C) Add several portions of dairy products each day. D) Try replacing your usual breakfast with oatmeal or Cream of Wheat.

Answer: B. Melons and baked potatoes are foods high in potassium.Red meat is high in saturated fat and is to be consumed sparingly. Dairy products are high in calcium. Cereals are fortified with iron. Oatmeal contains fiber but not potassium.

The nurse is teaching a client the precautions to take while on warfarin (Coumadin) therapy. Which statement made by the client demonstrates that teaching has been effective? A) "I can use an electric razor or a regular razor." B) "Eating foods like green beans won't interfere with my Coumadin therapy." C) "If I notice I am bleeding a lot, I should stop taking Coumadin right away." D) "When taking Coumadin, I may notice some blood in my urine."

Answer: B. Teaching about the precautions of warfarin has been effective when the client says "that eating foods like green beans won't interfere with my Coumadin therapy." Vitamin K is not found in foods such as green beans, so these foods will not interfere with the anticoagulant effects of Coumadin.Warfarin "thins" the blood, so the risk for cutting oneself and bleeding is very high with the use of a regular razor. The client needs to use an electric razor. Clients must apply pressure to bleeding wounds and must seek medical assistance immediately. They do not need to discontinue warfarin therapy. Blood in the urine of a client taking warfarin therapy is not a side effect. The client must notify the primary health care provider immediately if this occurs.

The home health nurse visits a client with heart failure who has gained 5 pounds (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? A) Assess the client for peripheral edema. B) Auscultate the client's posterior breath sounds. C) Notify the health care provider about the client's weight gain. D) Remind the client about dietary sodium restrictions.

Answer: B. The action the home care nurse takes first is to auscultate the heart failure client's posterior breath sounds. Because the client is at risk for pulmonary edema and hypoxemia, the breath sounds must be assessed.Assessment of edema may be delayed until after breath sounds are assessed. After a full assessment, the nurse must notify the health care provider. After physiologic stability is attained, then ask the client about behaviors that may have caused the weight gain, such as increased sodium intake or changes in medications.

The nurse is caring for a client with dark-colored toe ulcers and blood pressure (BP) of 190/100 mm Hg. Which nursing action does the nurse delegate to the LPN/LVN? A) Assess leg ulcers for evidence of infection. B) Administer a clonidine patch for hypertension. C) Obtain a request from the health care provider for a dietary consult. D) Develop a plan for discharge, and assess home care needs.

Answer: B. The action the nurse delegates to the LPN/LVN caring for a client with dark-colored toe ulcers and a BP of 190/100 mmHg is to administer a clonidine patch for hypertension. Administering medication is within the scope of practice for the LPN/LVN.The RN is responsible for physical assessments, making referrals for other services, and developing the plan of care for the hospitalized client.

Which client is best to assign to an LPN/LVN working on the telemetry unit? A) Client with heart failure who is receiving dobutamine (Dobutrex) B) Client with dilated cardiomyopathy who uses oxygen for exertional dyspnea C) Client with pericarditis who has a paradoxical pulse and distended jugular veins D) Client with rheumatic fever who has a new systolic murmur

Answer: B. The best client to assign to the LPN/LVN working on the telemetry unit is the client with dilated cardiomyopathy who uses oxygen for exertional dyspnea. This client is the most stable. Administration of oxygen to a stable client is within the scope of LPN/LVN practice.The client with heart failure is receiving an intravenous inotropic agent, which requires monitoring by the RN. The client with pericarditis is displaying signs of cardiac tamponade and requires immediate lifesaving intervention. The client with a new-onset murmur requires assessment and notification of the primary health care provider, which is within the scope of practice of the RN.

Which client would the charge nurse assign to a graduate RN who has completed 2 months of orientation to the coronary care unit? A) Client with a new diagnosis of heart failure who needs a pulmonary artery catheter inserted B) Client who has just arrived after a coronary arteriogram and has vital signs requested every 15 minutes C) Client with acute electrocardiographic changes who is requesting nitroglycerin for left anterior chest pain D) Client who has many questions about the electrophysiology studies (EPS) scheduled for today

Answer: B. The client returning from a coronary arteriogram who requires vital signs and checks of the insertion site every 15 minutes. This client is within the scope of practice of a newly licensed RN.An experienced critical care nurse is needed to assist with insertion of a pulmonary artery catheter for hemodynamic monitoring. A client with electrocardiographic changes is potentially unstable, so the experienced nurse will need to monitor the electrocardiogram, administer nitroglycerin, and identify additional interventions as needed. The experienced critical care nurse needs to provide extensive teaching about the invasive procedure of EPS. The newly licensed nurse just off orientation may not have the depth of knowledge to perform this teaching independently.

Which client has pain most consistent with myocardial infarction (MI) requiring notification of the health care provider? A) Client with abdominal pain and belching B) Client with pressure in the mid-abdomen and profound diaphoresis C) Client with dyspnea on exertion (DOE) and inability to sleep flat who sleeps on four pillows D) Client with claudication and fatigue

Answer: B. The client with pain most consistent with an MI is the client with pressure in the mid-abdomen and profound diaphoresis. Typical symptoms of MI include chest pain or pressure, ashen skin color, diaphoresis, and anxiety.Although atypical cardiac pain can be perceived in the abdomen, abdominal pain and belching are more typical of peptic ulcer. DOE and orthopnea are typical problems for clients with heart failure. Claudication (pain in the legs with exercise or at rest) is symptomatic of peripheral arterial occlusive disease.

The nurse is caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A) Defibrillate the patient at 200 joules. B) Check the patient for a pulse. C) Cardiovert the patient at 50 joules. D) Give the patient IV lidocaine.

Answer: B. The nurse needs to first assess the patient to determine stability before proceeding with further interventions. If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone.If the patient is pulseless or nonresponsive, the patient is unstable and defibrillation is used and not cardioversion. Also, if the patient is pulseless, lidocaine may be given after defibrillation.

Which statement about diagnostic cardiovascular testing is correct? A) Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism. B) An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. C) Holter monitoring allows periodic recording of cardiac activity during an extended period of time. D) The left side of the heart is catheterized first and may be the only side examined.

Answer: B. The correct statement about diagnostic cardiovascular testing is that an alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. Intravascular ultrasonography (IVUS) is performed when a flexible catheter with a miniature transducer is inserted at the distal tip to view the coronary arteries. The transducer emits sound waves, which reflect off the plaque and the arterial wall to create an image of the blood vessel. It is another option besides using the medium injection method of diagnostic cardiovascular testing.Lethal, not nonlethal, dysrhythmias are a complication of diagnostic cardiovascular testing. Holter monitoring allows periodic recording of cardiac activity during short periods of time. Several parts of the heart are examined during diagnostic cardiovascular testing and not just the left side of the heart.

The nurse is caring for a patient with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Toprol). Which monitoring is essential when administering the medication? A) ST segment. B) Heart rate. C) Troponin. D) Myoglobin

Answer: B. The monitoring of the patient's heart rate is essential. The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand.ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI, but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS, but does not address needed monitoring related to metoprolol.

An RN and an LPN/LVN, both of whom have several years of experience in the intensive care unit, are caring for a group of clients. Which client is most appropriate for the RN to assign to the LPN/LVN? A) A client with pulmonary edema who requires hourly monitoring of pulmonary artery wedge pressures B) A client who was admitted with peripheral vascular disease and needs assessment of the ankle-brachial index C) A client who has intermittent chest pain and requires teaching about myocardial nuclear perfusion imaging D) A client with acute coronary syndrome who has just been admitted and needs an admission assessment

Answer: B. The most appropriate client the RN assigns to the LPN/LVN is the client admitted with peripheral vascular disease who needs assessment of the ankle-brachial index. The scope of practice of the LPN/LVN includes taking blood pressure in the arm and lower extremity. This information will be given to the nurse for assessment.The scope of practice for the LPN/LVN does not include interpretation of hemodynamic monitoring results. The scope of practice of the RN includes providing client education. The LPN/LVN may reinforce that teaching. The role of the professional nurse is to perform assessment and develop the plan of care. The LPN/LVN may implement the plan.

All of this information is obtained by the nurse who is admitting a client for a coronary arteriogram. Which information is most important to report to the primary care provider before the procedure begins? A) The client has had intermittent substernal chest pain for 6 months. B) The client develops wheezes and dyspnea after eating crab or lobster. C) The client reports that a previous arteriogram was negative for coronary artery disease. D) The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate.

Answer: B. The most important information the nurse needs to report to the primary health care provider before a coronary arteriogram is that the client develops wheezes and dyspnea after eating crab or lobster. The contrast agent injected into the coronary arteries during the arteriogram is iodine-based. The client with a shellfish allergy is likely to have an allergic reaction to the contrast and must be medicated with an antihistamine or a steroid before the procedure.The reason the client is having the procedure is to determine whether atherosclerotic plaque obstructing the coronary arteries is the underlying cause of the chest pain. The intermittent substernal chest pain does not need to be reported to the provider. The provider does not need information about the previous arteriogram at this time. It is appropriate to know that, but does not change the current need for the procedure. The nurse will palpate the distal pulses after the procedure. The pulses can be assessed with a Doppler device and marked in ink. Therefore, this information is not needed before the procedure is performed.

A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription? A) Serum sodium level of 135 mEq/L (135 mmol/L) B) Serum potassium level of 2.8 mEq/L (2.8 mmol/L) C) Serum creatinine of 1.0 mg/dL (88.4 mcmol/L) D) Serum magnesium level of 1.9 mEq/L (0.95 mmol/L)

Answer: B. The nurse is concerned with the serum potassium level of 2.8 mEq/L (2.8 mmol/L) in a heart failure client taking furosemide. Furosemide is a loop diuretic and clients taking this drug must be monitored for potassium deficiency from diuretic therapy.A serum sodium level of 135 mEq/L (135 mmol/L) is a normal value. Heart failure may cause renal insufficiency, but a serum creatinine of 1.0 mg/dL (88.4 mcmol/L) represents a normal value. A diuretic may deplete magnesium, but a serum magnesium level of 1.9 mEq/L (0.95 mmol/L) represents a normal value.

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? A) Calcium 8.5 mEq/L (4.25 mmol/L) B) Potassium 3.0 mEq/L (3.0 mmol/L) C) Magnesium 2.1 mEq/L (1 mmol/L) D) International normalized ratio (INR) of 1.0

Answer: B. The nurse needs to contact the primary health care provider when a potassium level of 3.0 mEq/L (3.0 mmol/L) is noticed on a client admitted with heart failure. Normal potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Hypokalemia may predispose to the client to dysrhythmia, especially if the client is taking digitalis preparations.A normal calcium level is 8.5 to 10.5 mEq/L (4.25 to 5 mmol/L). A normal magnesium level is 1.7 to 2.4 mEq/L (0.85 to 1.2 mmol/L). INR of 1.0 reflects a normal value.

When caring for a client with an abdominal aortic aneurysm (AAA), the nurse suspects dissection of the aneurysm when the client makes which statement? A) "I feel my heart beating in my abdominal area." B) "I just started to feel a tearing pain in my belly." C) "I have a headache. May I have some acetaminophen?" D) "I have had hoarseness for a few weeks."

Answer: B. The nurse suspects dissection of an AAA when the client says that "I just started to feel a tearing pain in my belly." Severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs, is indicative of impending rupture of AAA.The sensation of feeling the heartbeat in the abdomen is a symptom of AAA but not of dissection or rupture. Headache may be benign or indicative of cerebral aneurysm or increased intracranial pressure. Hoarseness, shortness of breath, and difficulty swallowing may be symptoms of thoracic aortic aneurysm.

The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet? A) Less than 30% of the daily caloric intake should be derived from proteins. B) Use canola oil rather than palm oil. C) Consume 10 mg of fiber daily. D) Work toward lowering your high-density lipoprotein (HDL) cholesterol levels.

Answer: B. The nurse teaches the client who has had MI to use canola oil rather than palm oil. Palm oil is higher in saturated fats and needs to be avoided. Nontropical vegetable oils would be encouraged, e.g., canola.Less than 30% of daily calories need to come from fats. Clients would be encouraged to consume 30 g of dietary fiber daily. A higher HDL cholesterol level (good cholesterol) is more desirable. Clients need to strive to reduce low-density lipoprotein cholesterol (bad cholesterol) when elevated.

A client who has been admitted for the third time this year for heart failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? A) Calls the family to lift the client's spirits B) Considers further assessment for depression C) Sedates the client to decrease myocardial oxygen demand D) Tells the client that things will get better

Answer: B. The nurse's best response to the client when he/she says it isn't worth it anymore and I want it all to end is to consider further assessment for depression. This client is at risk for depression because of the diagnosis of heart failure, and further assessment must be done.Calling the family to help distract the client does not address the core issue. Sedation is inappropriate in this situation because it ignores the client's feelings. Telling the client that things will get better may give the client false hope, and ignores the client's feelings.

Which teaching is essential for a patient who has had a permanent pacemaker inserted? A) Avoid talking on a cell phone. B) Avoid operating electrical appliances over the pacemaker. C) Avoid sexual activity. D) Do not take tub baths.

Answer: B. The patient needs to avoid operating electrical appliances directly over the pacemaker site because this may cause the pacemaker to malfunction.It is not necessary to avoid a telephone or a cell phone, but the patient would keep cellular phones at least six inches (15 centimetres) away from the generator and with the handset on the ear opposite the side of the generator. Radio transmitter towers, arc welding, and strong electromagnetic fields may pose a hazard. No hazard exists with sexual activity. Bathing and showering are permitted.

For a client with an 8-cm abdominal aortic aneurysm, which problem must be addressed immediately to prevent rupture? A) Heart rate 52 beats/min B) Blood pressure (BP) 192/102 mm Hg C) Report of constipation D) Anxiety

Answer: B. The problem that must be addressed immediately to prevent rupture in a client with an 8-cm abdominal aneurysm is a BP of 192/102 mm Hg. Elevated blood pressure can increase the rate of aneurysmal enlargement and risk for early rupture.The nurse must consider the client's usual pulse. However, bradycardia does not pose a risk for aneurysm rupture. Straining at stool can elevate blood pressure and pose a risk for dissection. However, a potential problem would not be addressed before an actual problem. Anxiety may be benign or may be a symptom of something serious. However, the elevated blood pressure is an immediate risk.

The nurse is caring for a client with an arterial line. How does the nurse recognize that the client is at risk for insufficient perfusion of body organs? A) Right atrial pressure is 4 mm Hg. B) Mean arterial pressure (MAP) is 58 mm Hg. C) Pulmonary artery wedge pressure (PAWP) is 7 mm Hg. D) PO2 is reported as 78 mm Hg.

Answer: B. To maintain tissue perfusion to vital organs, the MAP must be at least 60 mm Hg. An MAP of between 60 and 70 mm Hg is necessary to maintain perfusion of major body organs such as the kidneys and brain.An arterial line will not measure atrial pressure, PAWP, or oxygenation. Normal right atrial pressure is 1 to 8 mm Hg. Normal PAWP is 4 to 12 mm Hg. A normal PO2 is greater than 75 mm Hg.

A client is receiving unfractionated heparin (UFH) by infusion. Of which finding does the nurse notify the primary health care provider (PCP)? A) Partial thromboplastin time (PTT) 60 seconds B) Platelets 32,000/mm3 (32 × 109/L) C) White blood cells 11,000/mm3 (11 × 109/L) D) Hemoglobin 12.2 g/dL (122 mmol/L)

Answer: B. When caring for a client receiving UFH, the nurse notifies the PCP of a platelet level of 32,000/mm3 (32 × 109/L). UFH can decrease platelet counts. The PCP must be notified if the platelet count is below 100,000 to 120,000/mm3 (100 to 120 × 109/L). Heparin-induced thrombocytopenia, an immune disorder, presents with platelets less than 150,000/mm3 (150 × 109/L).A 60-second PTT reflects a therapeutic value within 1.5 to 2 times the normal value. Mild leukocytosis (increased white blood cells) may be expected with deep vein thrombosis. A hemoglobin of 12.2 g/dL (122 mmol/L) reflects a normal reading.

Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? A) Serum potassium level of 3.2 mEq/L (3.2 mmol/L) B) Ejection fraction of 60% C) B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) D) Chest x-ray report showing right middle lobe consolidation

Answer: C. A BNP of 760 pg/ml (760 ng/dL) is consistent with a diagnosis of heart failure. BNP is produced and released by the ventricles when the client has fluid overload as a result of HF. A normal BNP value is less than 0-99 picograms per milliliter (pg/mL) or 0-99 nanograms per liter (ng/L).Hypokalemia (serum potassium level of 3.2 mEq/L [3.2 mmol/L]) may occur in response to diuretic therapy for HF, but may also occur with other conditions. It is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may indicate pneumonia.

Which waveform indicates proper function of the sinoatrial (SA) node? A) The QRS complex is present. B) The PR interval is 0.24 second. C) A P wave precedes every QRS complex. D) The ST segment is elevated.

Answer: C. A P wave is generated by the SA node and represents atrial depolarization and needs to be followed by a QRS complex. When the electrical impulse is consistently generated from the SA node, the P waves have a consistent shape in a given lead.The QRS complex represents ventricular depolarization. The PR interval represents time required for atrial depolarization and for the impulse delay in the atrioventricular node and travel time to the Purkinje fibers. Normal PR level is up to 0.20 seconds. Elevation of the ST segment indicates myocardial injury.

What teaching does the nurse include for a patient with atrial fibrillation who has a new prescription for warfarin? A) "It is important to consume a diet high in green leafy vegetables." B) "You would take aspirin or ibuprofen for headache." C) "Report nosebleeds to your provider immediately." D) "Avoid caffeinated beverages."

Answer: C. A nosebleed could be indicative of excessive dosing of warfarin. Warfarin is an anticoagulant and causes decreased ability for blood to clot.Green leafy vegetables are high in vitamin K, which may antagonize the effects of warfarin; these vegetables would be eaten in moderate amounts. Aspirin and nonsteroidal anti-inflammatory agents may prolong the prothrombin time and the international normalized ratio, causing predisposition to bleeding. These agents would be avoided. It is not necessary to avoid caffeine because this does not affect clotting; however, green tea may interfere with the effects of warfarin.

A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure? A) Ankle-brachial index B) Dye allergy. C) Pedal pulses. D) Gag reflex

Answer: C. After a client with PAD has had a PTA, it is essential for the nurse to assess for pedal pulses. Priority nursing care focuses on assessment for bleeding at the arterial puncture site and monitoring distal pulses to ensure adequate perfusion. Pulse checks must be assessed post procedure to detect improvement (stronger pulses) or complications (diminished or absent pulses).Ankle-brachial index is a diagnostic study used to detect the presence of PAD. This is not necessary after PTA, which is an intervention to treat PAD. It is imperative to assess for dye allergy before performing PTA. Gag reflex is checked after procedures affecting the throat (e.g., endoscopy, bronchoscopy). The femoral artery is generally the access site for PTA.

A 72-year-old client admitted with fatigue and dyspnea has elevated levels of all of these laboratory results. Which finding is consistent with acute coronary syndrome (ACS) and must be communicated immediately to the primary health care provider? A) White blood cell count B) Low-density lipoproteins C) Serum troponin I level. D) C-reactive protein

Answer: C. Elevation in serum troponin levels is associated with acute myocardial injury and indicates a need for immediate interventions such as angioplasty, anticoagulant administration, or administration of fibrinolytic medications.The white blood cell count does not reflect ACS. A mild leukocytosis (increase in white blood cells) may occur secondary to inflammation, but this does not constitute an emergency. Although elevated lipoproteins may have contributed to development of atherosclerosis, which is the cause of ACS, the results are not emergent. C-reactive protein indicates inflammation and is increased in people at risk for atherosclerosis and ACS, but it does not indicate an acute problem.

Which symptom reported by a client who has had a total hip replacement requires emergency action? A) Localized swelling of one of the lower extremities B) Positive Homans' sign C) Shortness of breath and chest pain D) Tenderness and redness at the IV site

Answer: C. Emergency action is needed when the postoperative total hip replacement client reports shortness of breath and cheat pain. Shortness of breath and chest pain indicate a possible pulmonary embolism (PE), which can be life threatening. Orthopedic procedures create high risk for deep vein thrombosis (DVT) and PE.Although localized swelling is a symptom of DVT, it is not emergent. Pain in the calf on dorsiflexion of the foot (positive Homans' sign) appears in only a small percentage of clients with DVT, and false-positive findings are common, so assessing for Homans' sign is not advised. Tenderness and redness at the IV site indicate phlebitis and are not emergent, but must be attended to after the emergency.

The nurse is assessing a client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? A) Friction rub auscultated at the left lower sternal border B) Pain aggravated by breathing, coughing, and swallowing C) Splinter hemorrhages D) Thickening of the endocardium

Answer: C. Splinter hemorrhages are indicative of infective endocarditis. Petechiae (pinpoint red spots) occur in many clients with endocarditis. Splinter hemorrhages appear as black longitudinal lines or small red streaks along the distal third of the nail bed.Friction rub in the left lower sternal border and pain aggravated by breathing, coughing, and swallowing are signs and symptoms indicative of chronic constrictive pericarditis. Thickening of the endocardium is indicative of rheumatic carditis.

A client's medical record shows these data:Physical Assessment FindingsDiagnostic Findings Provider PrescriptionsCrackles at basesPTT 55 secondsLovenox 40 mg twice dailyRight leg swellingPOSITIVE, D-dimerElevate right legRight calf painhCG negativeDoppler study right leg A) Human chorionic gonadotropin (hCG) negative B) Crackles at bases. C) Positive D-dimer (>0.5mg/L) D) Right leg swelling

Answer: C. The above finding that confirms the presence of thromboembolism is positive D-dimer (>0.5mg/L). A D-dimer test is a global marker of coagulation activation, and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is often used for the diagnosis of deep vein thrombosis when the client has few clinical signs, and stratifies clients into a high-risk category for reoccurrence.A negative hCG indicates that the client is not pregnant, removing risk for thromboembolism. This test does not confirm thromboembolism. Crackles may be present in a variety of conditions, including pneumonia, heart failure, and pulmonary embolism. Leg swelling may be related to injury and thromboembolism.

Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? A) Monitor pulse oximetry and cardiac rate and rhythm. B) Reassure the client that his distress can be relieved with proper intervention. C) Place the client in high-Fowler's position with the legs down. D) Ask a family member to remain with the client.

Answer: C. The best intervention to help the client with acute pulmonary edema to reduce anxiety and dyspnea is to place the client in high-Fowler's position with the legs down. High-Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.Monitoring of vital signs will detect abnormalities, but will not prevent them. Reassuring the client and a family member's presence may help alleviate anxiety, but dyspnea and anxiety resulting from hypoxemia secondary to intra-alveolar edema must be relieved.

When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? A) Auscultation of crackles B) Pedal edema. C) Weight loss of 6 pounds (2.7 kg) since the last visit D) Reports sucking on ice chips all day for dry mouth

Answer: C. The clinic nurse recognizes that the client has been compliant with fluid restrictions when the client has a weight loss of 6 pounds (2.7 kg) since the last visit. Weight loss in this client indicates effective fluid restriction and diuretic drug therapy.Lung crackles indicate intra-alveolar edema and fluid excess. Pedal edema indicates fluid excess. Sucking on ice chips indicates noncompliance with fluid restrictions. Alternative methods of treating dry mouth need to be explored.

A client recovering from cardiac angiography develops slurred speech. What does the nurse do first? A) Maintains NPO (nothing by mouth) until this resolves B) Calls in another nurse for a second opinion C) Performs a complete neurologic assessment and notifies the primary care provider D) Explains to the client and family that this is expected after sedation

Answer: C. The first action the nurse must do when a client recovering from a cardiac angiography develops slurred speech is to perform a complete neurologic assessment and notify the primary health care provider. Based on the assessment finding, the client probably is suffering a neurologic event, possibly a stroke. Neurologic changes such as visual disturbances, slurred speech, swallowing difficulties, and extremity weakness must be reported immediately for prompt intervention.Keeping the client NPO and waiting for symptoms to resolve are not appropriate. This assessment does not warrant a second opinion. Slurred speech is not expected after a cardiac angiography and sedation.

The client undergoing femoral popliteal bypass states that he is fearful he will lose the limb in the near future. Which response by the nurse is most therapeutic? A) "Are you afraid you will not be able to work?" B) "If you control your diabetes, you can avoid amputation." C) "Your concerns are valid; we can review some steps to limit disease progression." D) "What about the situation concerns you most?"

Answer: C. The most therapeutic response by the nurse to this client is "Your concerns are valid; we can review some steps to limit disease progression." It is important to validate the client's concern and offer needed information.Asking the client if he is afraid may identify fear but does not allow the client to discuss his specific concern. Controlling diabetes may help prevent amputation, but the nurse cannot state this with certainty. Asking the client about what concerns him the most is not as open-ended a question as the others. In addition, the client has already stated his concern.

A client with heart failure reports a 7.6-pound (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? A) Dietary consult. B) Sodium restriction. C) Daily weight monitoring. D) Restricted activity

Answer: C. The nurse expects that the primary health care provider will want the client's daily weights monitored. A sudden weight increase of 2.2 pounds (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight. It is possible for weight gains of up to 10 to 15 pounds (4.5 to 6.8 kg), or 4 to 7 L of fluid to occur before excess fluid accumulation (edema) is apparent.The weight change is most likely from excessive fluid, so a dietary consult, sodium restrictions, and restricted activity are not appropriate interventions.

The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client would the nurse question? A) Enalapril (Vasotec) B) Sodium nitroprusside (Nipride) C) Dopamine (Intropin) D) Labetalol (Normodyne)

Answer: C. The nurse would question the prescription for dopamine. Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure, and would not be used in hypertensive emergency.Enalapril, an angiotensin-converting enzyme inhibitor, may be used intravenously in hypertensive emergencies. Sodium nitroprusside, a direct-acting vasodilator, may be used intravenously to lower blood pressure quickly in hypertensive emergencies. Labetalol, an intravenous calcium channel blocker, is used in hypertensive emergencies when oral therapy is not feasible.

The client, a college athlete who collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response? A) "How does this make you feel?" B) "This can be caused by taking performance-enhancing drugs." C) "This may be caused by a genetic trait." D) "Just imagine how bad it would be if you weren't in good shape."

Answer: C. The nurse's best response is that this may be caused by a genetic trait. Hypertrophic cardiomyopathy is often transmitted as a single gene autosomal dominant trait.Exploring the client's feelings is important, but does not address the client's question. Hypertrophic cardiomyopathy is not caused by performance-enhancing drugs. Reminding the client that he or she is in good shape is not at all therapeutic and does not address the client's question.

Which nursing action may be delegated to an unlicensed assistive personnel (UAP) working on the medical unit? A) Determine the usual alcohol intake for a client with cardiomyopathy. B) Monitor the pain level for a client with acute pericarditis. C) Obtain daily weights for several clients with class IV heart failure. D) Check for peripheral edema in a client with endocarditis.

Answer: C. The nursing action that can be delegated to a UAP on the medical unit is to obtain daily weights for several clients with class IV heart failure. Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN.The role of the professional nurse is to perform assessments. Determining alcohol intake, monitoring pain level, and assessing for peripheral edema would not be delegated.

Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? A) The client ambulates around the nursing unit with a walker. B) The nurse monitors the client's pulse and blood pressure frequently. C) The nurse obtains a bedside commode before administering furosemide. D) The nurse returns the client to bed when the client becomes tachycardic.

Answer: C. The nursing intervention that can help the client admitted today with heart failure is to have a bedside commode available to the client before administering furosemide. Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand.Monitoring of vital signs will alert the nurse to increased energy expenditures but will not prevent them. Waiting until tachycardia occurs permits increased oxygen demand. The nurse must prevent this situation.

A patient with atrial fibrillation (AF) with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88 beats/min. For which additional therapy does the nurse plan? A) Synchronized cardioversion. B) Electrophysiology studies (EPS). C) ANticoagulation. D) Radiofrequency ablation therapy.

Answer: C. The patient's rhythm has stabilized but because of the risk for thromboembolism related to AF, anticoagulation is necessary.Cardioversion is not needed at this time. EPS are indicated for recurring, symptomatic dysrhythmia. Ablation therapy is ordered for recurring and symptomatic atrial fibrillation.

Which statement best reflects correct client education for a client with a blood pressure (BP) of 136/86 mm Hg? A) This blood pressure is good because it is a normal reading. B) This blood pressure indicates that the client has hypertension or high blood pressure. C) This blood pressure increases the workload of the heart; the client must consider modifying his or her lifestyle. D) This blood pressure seems a little low; the client must be further assessed for orthostatic hypotension.

Answer: C. The statement that best reflects correct client education about a BP of 136/86 mm Hg is that this blood pressure increases the workload of the heart so I need to consider modifying my lifestyle.Although not considered hypertension because the blood pressure is not greater than 140/90 mm Hg, it is consistent with increased risk for heart disease; the client requires further education. Hypertension is defined as blood pressure greater than 140/90 mm Hg. A blood pressure that exceeds 135/85 mm Hg increases the workload of the left ventricle and oxygen consumption of the myocardium. Orthostatic hypotension is defined as blood pressure less than 90/60 mm Hg.

Which teaching point does the nurse include for a client with peripheral arterial disease (PAD)? A) "Elevate your legs above heart level to prevent swelling." B) "Inspect your legs daily for brownish discoloration around the ankles." C) "Walk to the point of leg pain, then rest, resuming when pain stops." D) "Apply a heating pad to the legs if they feel cold."

Answer: C. The teaching point the nurse include for a client with PAD is walk to the point of leg pain, rest, and then resume when pain stops. Exercise may improve arterial blood flow by building collateral circulation. Instruct the client to walk until the point of claudication, stop and rest, and then walk a little farther.Elevating the legs in PAD decreases blood flow and increases ischemia. Brown discoloration around the ankles is characteristic of venous occlusive disease. Application of heat must be avoided in clients with PAD due to a lack of sensation and possible burns to the legs.

A patient's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? A) Normal sinus rhythm. B) Sinus bradycardia. C) Sinus tachycardia. D) Sinus rhythm with premature ventricular contractions.

Answer: C. These are the characteristics of sinus tachycardia.A normal sinus rhythm would have a heart rate of 60 to 100 beats/min. A heart rate of less than 60 beats/min would indicate sinus bradycardia. Early QRS intervals would indicate sinus rhythm with premature ventricular contractions.

Which sign/symptom is essential for the nurse to report to the primary health care provider (PCP) when caring for a client with Raynaud's phenomenon? A) Nifedipine (Procardia) administration caused the blood pressure to change from 134/76 to 110/68 mm Hg. B) The client's extremity became white, then red temporarily. C) The affected extremity becomes purple and cold. D) The client states that the digits are painful when they are white.

Answer: C. When caring for a client with Reynaud's phenomenon, it is essential for the nurse to report to the PCP an affected extremity that becomes purple and cold. Reynaud's phenomenon is described as painful vasospasms of arteries and arterioles in extremities, especially digits. This causes red-white-blue skin color changes on exposure to cold or stress. The cause is unknown, occurs more in women, and may be autoimmune because it is associated with many rheumatic diseases like systemic lupus erythematosus.Vasodilating drugs are administered as treatment and may lower the blood pressure, but this is not a significant drop. In severe cases, the attack lasts longer, and gangrene of the digits can occur. Pain, numbness, and cold are typical findings in Raynaud's phenomenon.

The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, with pink, frothy sputum, and crackles throughout the lung fields. The nurse reviews the medical record, which contains the following information: Physical Assessment Findings Diagnostic Findings Provider Prescriptions Crackles in all fieldsS3 presentOliguriaEjection fraction 30%BNP 560Sodium 130 mEq/L (130 mmol/L)Diagnosis: heart failureEnalapril 10 mg orally dailyHeparin 5000 units subcutaneously every 12 hoursFurosemide 40 mg IV dailyStrict I & O A) Enalapril. B) Heparin. C) Furosemide. D) Intake and output (I&O).

Answer: C. While caring for a client with acute heart failure, the ED nurse Administers Furosemide first. The client is displaying typical signs of acute pulmonary edema secondary to fluid-filled alveoli and pulmonary congestion. A diuretic will promote fluid loss.Although enalapril will promote vasodilation and decrease cardiac workload, the client is demonstrating signs of acute pulmonary edema secondary to intra-alveolar fluid. Heparin will prevent deep vein thrombosis secondary to immobility, but will not reduce fluid excess. Although all clients with congestive heart failure need to have daily weights and I & O monitored, this is not a priority. Removing fluid volume and treating dyspnea are matters of priority.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? A) The patient is semi-recumbent in bed. B) Chest leads are placed as for the previous ECG. C) The patient is instructed to breathe deeply through the mouth. D) The patient is instructed to lie still.

Answer: C. While obtaining a 12-lead ECG, remind the patient to be as still as possible in a semi-reclined position, breathing normally. Any repetitive movement will cause artifact and could lead to inaccurate interpretation of the ECG. Normal breathing is required or artifacts will be observed, perhaps leading to inaccurate interpretation of the ECG.Placing the patient in a semi-reclined position is correct and does not require the nurse to intervene. ECGs are valid when electrode placement is identical at each test. The patient must lie still to avoid artifacts and inaccurate interpretation of the ECG.

The nurse suspects that a client has developed an acute arterial occlusion of the right lower extremity based on which signs/symptoms? (Select all that apply). A) Hypertension. B) Tachycardia. C) Bounding right pedal pulses. D) Cold right foot. E) Numbness and tingling of right foot. F) Mottling of right foot and lower leg.

Answer: D, E, F. Signs/symptoms of acute arterial occlusion of the right lower extremity include cold right foot, numbness and tingling of the right foot, and mottling and tingling of the right foot. Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cool limb), and mottled color are characteristics of acute arterial occlusion.Hypertension presents risk for atherosclerosis, but not for acute arterial occlusion. The pulse rate does not indicate occlusion, but rather quality. Absence of pulse, rather than bounding pulse, is a symptom of acute arterial occlusion.

How does the nurse recognize that atropine has produced a positive outcome for the patient with bradycardia? A) The patient states he is dizzy and weak. B) The nurse notes dyspnea. C) The patient has a heart rate of 42 beats/min. D) The monitor shows an increase in heart rate.

Answer: D. An expected outcome after the administration of atropine is an increased heart rate. By definition, the bradydysrhythmia has resolved when the heart rate is greater than 60 beats/min.Dizziness and weakness indicate symptoms of decreased cerebral perfusion and intolerance to the bradydysrhythmia. Dyspnea indicates intolerance to the bradydysrhythmia. A heart rate of 42 beats/min after atropine has been given indicates that bradycardia is unresolved.

Which action does the nurse delegate to experienced unlicensed assistive personnel (UAP) working in the cardiac catheterization laboratory? A) Assess preprocedure medications the client took that day. B) Have the client sign the consent form before the procedure is performed. C) Educate the client about the need to remain on bedrest after the procedure. D) Obtain client vital signs and a resting electrocardiogram (ECG).

Answer: D. Checking vital signs and performing a 12-lead ECG can be delegated to the UAP.The primary health care provider will explain the catheterization procedure and have the client sign the consent form. Assessments and client teaching must be done by the RN.

The nurse is teaching a young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching? A) "I must stop taking my birth control pills." B) "I should drink lots of water so I don't get dehydrated." C) "I should exercise my legs when I have been sitting or standing for a long time." D) "If I wear pantyhose, I won't have to wear the stockings the hospital gives me."

Answer: D. Further teaching is needed about how to prevent venous thromboembolism when the client says that "If I wear pantyhose, I won't have to wear the stockings the hospital gives me." Wearing the graduated compression stockings is a type of prevention specific to the hospital setting. They are designed to prevent blood clots, unlike regular pantyhose.Discontinuation of birth control pills is a routine prevention for thromboembolism, but this prevention is not specific to the client's acute hospitalization. Drinking a lot of water, where the quantity is not specified, may not be indicated for this client. Exercise is a prevention that can be done outside the hospital.

The nurse is caring for a client with heart failure in the coronary care unit. The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? A) Determines the client's physical limitations B) Encourages alternate rest and activity periods C) Monitors and documents heart rate, rhythm, and pulses D) Positions the client to alleviate dyspnea

Answer: D. The ICU nurse's first action is to position the client to alleviate dyspnea. This action will help ease air hunger and anxiety. Administering oxygen therapy is also an important priority action.Determining the client's physical limitations is not a priority in this situation. Encouraging alternate rest and activity periods is not the immediate priority. Monitoring of heart rate, rhythm, and pulses is important, but is not the priority.

A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment result obtained the day after admission is the best indicator that the treatment has been effective? A) The client has diuresis of 400 mL in 24 hours. B) The client's blood pressure is 122/84 mm Hg. C) The client has an apical pulse of 82 beats/min. D) The client's weight decreases by 2.5 kg.

Answer: D. The best indicator that treatment is effective on a client with heart failure and problems of hypervolemia is the client's weight decreased by 5.5 pounds (2.5 kg) in one day. The best indicator of fluid volume gain or loss is daily weight. Because each kilogram represents approximately 1 liter, this client has lost approximately 2500 mL of fluid.Diuresis of 400 mL in 24 hours represents oliguria. Although a blood pressure of 122/84 mm Hg is a normal finding, alone it is not significant for relief of hypervolemia. Although an apical pulse of 82 beats/min is a normal finding, alone it is not significant to determine whether hypervolemia is relieved.

The professional nurse and the nursing student are caring for a group of clients with hypertension. Which problem identified by the nursing student correctly identifies the client at risk for secondary hypertension? A) Psychiatric disturbance. B) High sodium intake. C) Physical inactivity. D) Kidney disease.

Answer: D. The client who is most at risk for secondary hypertension is the client with kidney disease. Kidney disease is one of the most common causes of secondary hypertension.Psychiatric disturbance can exacerbate essential hypertension, but secondary hypertension is caused by a disease process or drugs. High sodium intake is a risk factor for essential hypertension, not for secondary hypertension, which is caused by disease states or medications. Physical inactivity is a risk factor for essential hypertension.

Which client who has just arrived in the emergency department does the nurse classify as emergent and needing immediate medical evaluation? A) A 60-year-old with venous insufficiency who has new-onset right calf pain and tenderness B) A 64-year-old with chronic venous ulcers who has a temperature of 100.1°F (37.8°C) C) A 69-year-old with a 40-pack-year cigarette history who is reporting foot numbness D) A 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic

Answer: D. The client who just arrived in the ED and needs immediate medical evaluation of the 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic. This client's history and clinical manifestations suggest possible aortic dissection. The nurse will immediately assess the client's blood pressure and plan for IV antihypertensive therapy, rapid diagnostic testing, and possible transfer to surgery.The 64-year-old is most stable and can be seen last. The 60-year-old and the 69-year-old would both be seen soon, but the 70-year-old client must be seen first.

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus those in women. Which information would be included? A) Men do not tend to report chest pain. B) Men are more likely than women to die after MI. C) Men more than women tend to deny the importance of symptoms. D) Women may experience extreme fatigue and dizziness as sole symptoms.

Answer: D. The differences in symptoms of MI in men versus women are that women may experience extreme fatigue and dizziness as sole symptoms. Women may have atypical symptoms, including absence of chest pain. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feeling an inability to "catch the breath" (dyspnea) are also common in heart disease. The client may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or vise-like.Men do report chest pain. Women have higher mortality from MI than men. Because of differences in symptoms, denial may occur more often in women.

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? A) Auscultate the client's precordium for murmurs. B) Teach the client about the reason for the TEE. C) Reassure the client that the test is painless. D) Validate that the client has remained NPO.

Answer: D. The essential nursing action the nurse must take is to validate that the client scheduled for a TEE has remained NPO. Owing to the risk for aspiration, the client must be NPO before the procedure.It is anticipated that the client with mitral stenosis may have an audible murmur, so auscultation is not essential at this time. Although teaching is important, the client could undergo the procedure without understanding the reason for the test. The client will have sedation during the test because it is uncomfortable.

The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which statement by the nurse reflects the most correct teaching? A) "This is a noninvasive test performed to assess your heart rhythm." B) "You will receive an injection of dobutamine (Dobutrex) and will walk on a treadmill to reveal whether you have coronary artery disease." C) "This is a painless test that is done to assess the structure of your heart using sound waves." D) "This test evaluates you for potentially fatal cardiac rhythms."

Answer: D. The most correct teaching about the purpose of EPS is when the nurse says that the test evaluates the potential for fatal cardiac rhythms. EPS are invasive tests performed to determine whether the client has lethal dysrhythmias and conduction abnormalities.A noninvasive test to assess the heart rhythm best describes the electrocardiogram. Injection of dobutamine (Dobutrex) followed by walking on a treadmill best describes an exercise stress test. Using sound waves to assess the structure of the heart best describes echocardiography.

The nurse is caring for a client with hemodynamic monitoring. Right atrial pressure is 8 mm Hg. The nurse anticipates which request by the primary health care provider? A) Saline infusion. B) Morphine sulfate. C) No treatment, continue monitoring. D) INtravenous furosemide.

Answer: D. The nurse expects that the primary health care provider will request intravenous furosemide be given to the client with a right atrial pressure of 8 mm Hg. Normal right atrial pressure is 0 to 5 mm Hg. The primary health care provider may prescribe furosemide, a diuretic, to reduce the fluid volume and right atrial pressure.Administering saline will increase the right atrial fluid balance and pressure. Morphine is indicated to reduce preload, measured by left ventricular end-diastolic pressure or left atrial pressure. Because this is an abnormal finding, the nurse must collaborate with the provider to decrease the right atrial pressure.

The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F (37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the nurse take? A) Give the digoxin; reassess the heart rate in 30 minutes. B) Give the digoxin; document assessment findings in the medical record. C) Hold the digoxin, and obtain a prescription for an additional dose of furosemide. D) Hold the digoxin, and obtain a prescription for a potassium supplement.

Answer: D. The nurse needs to hold the digoxin and get a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates digoxin toxicity.Furosemide decreases circulating blood volume and depletes potassium. There is no indication suggesting that the client has fluid volume excess at this time.

The nurse is caring for a patient on a telemetry unit who has a regular heart rhythm and rate of 60 beats/min; a P wave precedes each QRS complex, and the PR interval is 0.20 second. Additional vital signs are as follows: blood pressure 118/68 mm Hg, respiratory rate 16 breaths/min, and temperature 98.8°F (37°C). All of these medications are available on the medication record. What action does the nurse take? A) Administer atropine. B) Administer digoxin. C) Administer clonidine. D) Continue to monitor.

Answer: D. The nurse needs to take no action other than to continue monitoring because the patient is displaying a normal sinus rhythm and normal vital signs.Atropine is used in emergency treatment of symptomatic bradycardia. This patient has a normal sinus rhythm. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Clonidine is used in the treatment of hypertension; a side effect is bradycardia.

In teaching patients at risk for bradydysrhythmias, what information does the nurse include? A) "Avoid potassium-containing foods." B) "Stop smoking and avoid caffeine." C) "Take nitroglycerin for a slow heartbeat." D) "Use a stool softener."

Answer: D. The nurse will advise the client to use a stool softener. Patients at risk for bradydysrhythmias would avoid bearing down or straining during a bowel movement. The Valsalva maneuver associated with bearing down can cause bradycardia.Patients with renal failure and hyperkalemia are instructed to avoid potassium-containing foods; if risk for hypokalemia exists, such as with diuretic therapy, the patient is instructed to eat foods high in potassium. Smoking and caffeine increase heart rate; although all people would stop smoking, patients at risk for tachycardia, premature beats, and ectopic rhythms are instructed to stop smoking and avoid caffeine. Nitroglycerin is used to reduce oxygen demand in cardiac ischemia, not for bradycardia.

All of these client assignments have been made by the charge nurse. Which assignment is questionable? A) The RN with 3 years of experience caring for a client with a pulmonary embolism (PE) who is receiving heparin therapy B) The LPN/LVN with 5 years of experience caring for a client with leg ulcers who is awaiting nursing home placement C) The RN with 8 years of experience caring for a client with peripheral arterial disease (PAD) and a total cholesterol of 390 mg/dL (10.1 mmol/L) D) The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure (BP) is 210/150 mm Hg

Answer: D. The questionable assignment made by the charge nurse is assigning the LPN/LVN with 20 years' experience to care for a client with a headache whose BP is 210/150 mm Hg. The client with a headache and high blood pressure has unstable hypertension and is at risk for complications such as stroke, heart failure, or renal failure. This client must be assigned to an experienced RN, who can assess for end-organ damage and administer IV medications.A better assignment would be to assign the client with a headache to an RN and the client with PAD to the LPN/LVN. The RN with 3 years of experience has sufficient experience to provide care for a client with PE. The LPN/LVN can provide care for the client with leg ulcers, including dressing changes, if needed. The RN with 8 years of experience has sufficient knowledge to provide care for the client with PAD.

A client has been admitted to the hospital with chest pain radiating down the left arm. The pain has been unrelieved by rest and antacids. Which test result best confirms that the client sustained a myocardial infarction (MI)? A) C-reactive protein of 1 mg/dL (10 mg/L) B) HOmocysteine level of 13 mcmol/L. C) Creatine kinase (CK) of 125 units/L D) Troponin of 5.2 ng/mL (5.2 mcg/L)

Answer: D. The test results that best confirm that this client sustained a MI is a troponin of 5.2 ng/mL (5.2 mcg/L). The presence of elevated troponin indicates myocardial damage. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).A C-reactive protein level lower than 1 mg/dL (10 mg/L) is optimal for identifying inflammation and risk for heart disease. A homocysteine level lower than 12 mcmol/L is optimal, but elevation indicates risk, not myocardial damage. CK totals must be broken down into isoenzyme MB to evaluate for heart damage. Elevations in the CK total may be caused by stroke or skeletal muscle damage.

Which vascular assessment by the student nurse requires intervention by the supervising nurse? A) Measuring capillary refill in the fingertips B) Assessing pedal pulses by Doppler C) Measuring blood pressure in both arms D) Simultaneously palpating the bilateral carotids

Answer: D. The vascular assessment by the student that needs intervention by the supervisor nurse is simultaneously palpating the bilateral carotids. Carotid arteries are palpated separately because of the risk for inadequate cerebral perfusion and the risk for causing the client to faint.Prolonged capillary filling generally indicates poor circulation, and is an appropriate assessment. Many clients with vascular disease have poor blood flow. Pulses that are not palpable may be heard with a Doppler probe. Because of the high incidence of hypertension in clients with atherosclerosis, blood pressure is assessed in both arms.