Adult Health Exam 3

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." "A burning sensation after administration indicates that the nitroglycerin tablets are potent." "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses."

"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse? "Moderation is the key to everything." "Ask your physician to prescribe the new reverse lipid drug." "Increase the soy in your diet." "Exercise, keep your blood sugar in check, and manage your stress."

"Exercise, keep your blood sugar in check, and manage your stress."

The nurse is conducting client teaching about cholesterol levels. When discussing the client's elevated LDL and lowered HDL levels, the client shows an understanding of the significance of these levels by making what statement? "Increased LDL and decreased HDL increase my risk of coronary artery disease." "Increased LDL has the potential to decrease my risk of heart disease." "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls." "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."

"Increased LDL and decreased HDL increase my risk of coronary artery disease."

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? "When I finish the rehabilitation program I'll never have to worry about heart trouble again." "I won't be able to jog again even with rehabilitation." "Rehabilitation will help me function as well as I physically can." "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."

"Rehabilitation will help me function as well as I physically can."

Why do we monitor 12 leads?

- "picture in picture" view of the heart - (STEMI) ST elevated MI

Why do we monitor 18 leads?

- 3 posterior leads - reflect myocardial ischemia/injury

What lab monitoring is important for a pt with heart failure?

- BMP or CMP: imbalances & kidney function - CBC or H&H: long term anemia can cause heart failure - BNP: 0-100 - urinalysis: monitor kidney function - ABG: monitor respiratory acidosis

Why do we monitor 15 leads?

- additional leads are added to right side of chest - indicate right ventricular/left posterior ventricular infarction

Nursing intervention for tissue perfusion:

- drugs (ACE inhibitors, diurectics, vasodilators, digoxin, beta-blockers) - low sodium & fat die - fluid restrictions (weigh pt daily) - surgical interventions (VADs, cardiac support devices, myosplint).

Nursing intervention for activity intolerance:

- focus on improving gas exchange and tissue perfusion. - diuretics

Why do we monitor 3-5 leads?

- give a quick simple view and basic understanding of heart rhythm - Up to 7 different cardiac pictures - 5 Leads shows anterior wall of the left ventricle - Lead II (best atrial depolarization) - Lead V1 ( (best ventricular depolarization) - Artifact stuff can really mess up the results - always assess the patient and double check the leads **

What are the common risk factors for heart failure and how can a pt help mitigate their risk?

- hypertension - prior heart issues including heart attack - anemia - drug abuse - diabetes - obesity - chronic lung issues - right-sided heart failure

What leads to the development or right-sided heart failure?

- left-sided heart failure - heart attack of the right ventricle - pulmonary hypertension

What do pts need to know when going home with heart failure?

- medication adherence - adequate amounts of exercise - healthy diet (low sodium) & weight - tell signs of heart issues

Nursing intervention for gas exchage:

- oxygen and anything else that can be done to remove fluid and get the heart to work more effectively

What consideration should be in place to eliminate artifact?

- settle the pt - avoid shaking/chills - clean connections - interference - electronics/cell phones - environmental concerns - poor connects - lead

How does right-sided heart failure present?

- swelling in peripherals - edema - jugular vein distention - ascites - hepatomegaly

What leads to the development of left-sided heart failure?

- systolic heart failure: ventricle can't pump properly - increased preload: too much blood returning to the heart - increased afterload: too much blood leaving the heart increasing BP - decreased ejection fraction: inability to pump out enough blood w/ each beat - decreased tissue perfusion and blood backup

How does left-sided heart failure present?

- tachypnea - dyspnea - crackles - decreased urine output - cool extremities - signs of poor perfusion

What does pulmonary edema look like?

- tachypnea - tachycardia - dyspnea - crackles - pink, frothy sputum - decrease in O2 - labored breathing

What do pts need to report to their physician regarding heart failure?

- weight gain of 3 or more lbs in 2 days - decrease in activity tolerance for 2-3 days - cough lasting more than 3-5 days - excessive nighttime urination - development of dyspnea or angina at rest - increased edema

Each tiny box is reflective of how much time?

0.04 second

One large box is reflective of how much time?

0.20 second

What steps are important prior to/during lead placement and why?

1. debride 2. clip hair 3. connect leads to wires 4. peel backing off leads 5. is it sticky? 6. consider anatomic position 7. change position every 24 hr.

What are priority problems in pts with heart failure?

1. gas exchange 2. impaired tissue perfusion 3. activity intolerance

how many seconds do you have to respond to a pt experiencing asystole?

10 seconds

How many big boxes make a 3 second strip?

15 big boxes

How many big boxes make a 6 second strip?

30 big boxes

The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? 30 minutes to 1 hour after pain 2 to 3 hours after admission 4 to 6 hours after pain 12 to 18 hours after admission

4 to 6 hours after pain

A 1 second strip can be measured using how many big boxes?

5 big boxes

A nurse is assigned four clients with diagnoses that rule out myocardial infarction (MI) due to chest pain. Which client's test results best demonstrate the specific diagnosis of unstable angina (USA)? A 63-year-old client with elevated troponins and no elevation in the ST segment. A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins. A 54-year-old client with elevated creatine kinase myocardial band (CK-MB) and ST segment elevations in two contiguous leads on the electrocardiogram (ECG). A 48-year-old client with T wave inversions, ST elevation, and abnormal Q waves.

A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins.

A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. Absent P-waves Abnormal Q-waves T-wave hyperactivity and inversions ST-segment elevations U-wave elevations

Abnormal Q-waves T-wave hyperactivity and inversions ST-segment elevations

The nurse in the emergency department is caring for a client recently admitted with a likely myocardial infarction (MI). The nurse understands that the client's heart is pumping an inadequate supply of oxygen to the tissues. The nurse knows the client is at an increased risk for MI due to which factor? Arrhythmias Elevated B-natriuretic peptide (BNP) Use of thrombolytics Dehydration

Arrhythmias

A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen Assess blood pressure and administer aspirin It is not important to assess the client or to notify the physician Assess the client's physical history

Assess chest pain and administer prescribed drugs and oxygen

The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? Assess the client's mental and emotional status. Assess the skin of the client. Assess the characteristics of chest pain. Assess for any kind of drug abuse.

Assess the characteristics of chest pain.

A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at a rate of 150 bpm, with no discernible P waves. What does the nurse determine this rhythm to be? Atrial fibrillation Ventricular fibrillation Sinus tachycardia Nonparoxysmal junctional tachycardia

Atrial fibrillation

A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? Clonidine Amiloride Bumetanide Methyldopa

Clonidine

A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? Coronary artery disease Raynaud syndrome Cardiogenic shock Venous occlusive disease

Coronary artery disease

A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. Coronary artery disease Myocardial infarction Pancreatitis Tension pneumothorax Stroke

Coronary artery disease Myocardial infarction Stroke

A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? Diabetes, hypercholesterolemia, and heredity Diabetes, age, and gender Age, gender, and heredity Diabetes, hypercholesterolemia, and hypertension

Diabetes, hypercholesterolemia, and hypertension

The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. Elevated blood pressure Alcohol use Obesity Physical inactivity Increasing age Family history

Elevated blood pressure Alcohol use Obesity Physical inactivity

A client had a previous myocardial infarction and has been experiencing angina from occluded coronary arteries. What teaching should the nurse provide in the stable phase of the Trajectory Model of Chronic Illness? Encourage the family to support the client's exercise plan. Discuss aortocoronary bypass surgery techniques. Collaborate with health care providers for medication therapy. Encourage discussion of end-of-life preferences.

Encourage the family to support the client's exercise plan.

Which is a modifiable risk factor for coronary artery disease (CAD)? Increasing age Hyperlipidemia Male gender Family history

Hyperlipidemia

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. Hyperlipidemia Gender Obesity Race Tobacco use

Hyperlipidemia Obesity Tobacco use

Which is a modifiable risk factor for coronary artery disease (CAD)? Hypertension Gender Race Increasing age

Hypertension

A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply. Hypertension Coronary artery disease Heart failure Myocardial infarction Heart murmur

Hypertension Coronary artery disease Heart failure Myocardial infarction

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Decreased central venous pressure Increase in the cardiac index Increased pulmonary artery diastolic pressure Decreased mean pulmonary artery pressure

Increased pulmonary artery diastolic pressure

The nurse is caring for an adult client who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina? Ineffective breathing pattern related to decreased cardiac output Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) Impaired skin integrity related to CAD

Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)

The nurse is working with a client who has diagnoses of coronary artery disease and angina pectoris. During a clinic visit, the nurse learns that the client has only been taking the prescribed antiplatelet medication when the client experiences chest pain and fatigue. What nursing diagnosis is most relevant to this assessment finding? Acute pain related to myocardial ischemia Confusion related to mismanagement of drug regimen Ineffective health maintenance related to inappropriate medication use Ineffective role performance related to inability to manage medications

Ineffective health maintenance related to inappropriate medication use

A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? Initiate transcutaneous pacing Prepare for defibrillation Administer 1 mg of IV atropine Obtain a 12-lead ECG

Initiate transcutaneous pacing

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) It is relieved by rest and inactivity. It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. It subsides after taking nitroglycerin.

It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms.

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? Leads I, aVL, V5, and V6 Leads II, III, and aVF Leads V1 and V2 Leads V3 and V4

Leads V3 and V4

The nurse is caring for a client in the cardiac intensive care unit (CICU) after a myocardial infarction (MI). Which drug will the nurse administer that will decrease contractility? Digoxin Dopamine Dobutamine Metoprolol

Metoprolol

A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? Ineffective right ventricular contraction Myocardial ischemia Pulmonary embolus Cystic fibrosis

Myocardial ischemia

The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experienced a significant increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a client with CAD may result in which outcome? Development of an atrial-septal defect Myocardial ischemia Formation of a pulmonary embolism Release of potassium ions from cardiac cells

Myocardial ischemia

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? Pulmonary embolism Myocardial infarction (MI) Heart failure Pneumothorax

Pneumothorax

The nurse is educating a patient at risk for atherosclerosis. What nonmodifiable risk factor does the nurse identify for the patient? Stress Obesity Positive family history Hyperlipidemia

Positive family history

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? Preload is reduced. More blood returns to the heart. It increases myocardial oxygen consumption. It functions as a vasoconstrictor.

Preload is reduced.

A client reports chest pain and palpitations during and after jogging in the mornings. The client's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk? Protein-rich diet Liquid diet Smoking cessation Mild meals

Smoking cessation

A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina? Stable Variant Unstable Intractable

Stable

A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium.

The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart.

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy? The client demonstrates ability to tolerate more activity without chest pain. The client exhibits a heart rate above 100 beats/minute. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking. The client states that sublingual nitroglycerin usually relieves his chest pain.

The client demonstrates ability to tolerate more activity without chest pain.

The client asks the nurse why a stress test is needed. What statement best explains the rationale for the health care provider to order a cardiac stress test? The health care provider wants to identify if the heart failure is from coronary artery disease. The health care provider needs to evaluate everything. Heart failure is causing the client to be weak and tired. The stress test is the best diagnostic tool to monitor which stage of heart failure the client is experiencing.

The health care provider wants to identify if the heart failure is from coronary artery disease.

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? The patient has compromised left ventricular function. The patient has had angina longer than 3 years. The patient has at least a 70% occlusion of a major coronary artery. The patient has an ejection fraction of 65%.

The patient has at least a 70% occlusion of a major coronary artery.

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? Bounding pulse Weak pulse Thready pulse A pulse deficit

Thready pulse

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? To dilate coronary arteries To decrease workload of the heart To decrease homocysteine levels To prevent angiotensin II conversion

To decrease workload of the heart

The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why they have to take an aspirin every day if they don't have any pain. Which rationale for this intervention would be the best? To help restore the normal function of the heart To help prevent blockages that can cause chest pain or heart attacks To help the blood penetrate the heart more freely To help the blood carry more oxygen than it would otherwise

To help prevent blockages that can cause chest pain or heart attacks

The nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment? Whether the client and involved family members understand the role of genetics in the etiology of the disease Whether the client and involved family members understand dietary changes and the role of nutrition Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately Whether the client and involved family members understand the importance of social support and community agencies

Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately

The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? incomplete blockage of a major coronary artery a destroyed part of the heart muscle complete closure of an artery a lack of oxygen in the heart muscle cells

a lack of oxygen in the heart muscle cells

The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is below the optimal range. above the optimal range. within the optimal range. extremely high.

above the optimal range.

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? anterior. posterior. lateral. inferior.

anterior.

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? aspirin or acetaminophen. pentoxifylline or acetaminophen. aspirin or clopidogrel. penicillin V or erythromycin.

aspirin or clopidogrel.

The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? atherosclerosis diabetes mellitus myocardial infarction renal failure

atherosclerosis

The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. morphine atorvastatin enalapril aspirin sildenafil

atorvastatin enalapril aspirin

What is atrial fibrillation?

atrial rate of 350-600 bpm. ventricular rate of 120-200 bpm. P wave is not discernible. rhythm is irregular and usually rapid.

EKG leads should not be placed over what 3 areas and why?

bone major tendons or major muscle mass areas hair

What are the benefits of telehealth with recorders and implantable devices?

can be transmitted to provider immediately

Role of diuretics (furosemide, potassium sparing diuretics) on heart failure:

cuts down amount of blood volume circulating in the body, allows heart to handle rest of the blood in body without backing into lungs, less work on heart

The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output? BP 108/60 mm Hg, ascites, and crackles disorientation, 20 mL of urine over the last 2 hours reduced pulse pressure and heart murmur elevated jugular venous distention and postural changes in BP

disorientation, 20 mL of urine over the last 2 hours

Nursing intervention for pulmonary edema?

diuretics, stop fluids, give pt oxygen

The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? decrease anxiety enhance myocardial oxygenation administer sublingual nitroglycerin educate the client about his symptoms

enhance myocardial oxygenation

Where and what color leads would you place on the patient for a 5 lead image? *ON EXAM*

green (grass) - bottom right white (cloud) - top right brown (tree trunk) - middle red (fire) - bottom left black (smoke) - top left

The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? heart failure ventricular hypertrophy pulmonary edema myocardial infarction

heart failure

What is sinus tachycardia?

heart rate greater than 100 bpm. 100-180 bpm.

What is sinus bradycardia?

heart rate less than 60 bpm

The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as high. low. within normal limits. critically high.

high.

Role of Digoxin on heart failure:

improve contractility of the heart. narrow therapeutic range, can do more bad than good if long term use

How can we prevent pulmonary edema from developing?

make sure we giving appropriate amount of fluids & not overloading fluids

if pt is in asystole can you shock them?

no, because there is nothing to shock. instead, do compressions and push meds (epi pen) to get heart pumping again

What do you do if pt is flat lining (in asystole)?

not a straight line going straight across. make sure everything is hooked up right

12- lead EKG only have 10 electrodes, why? *ON EXAM*

placement allows for extra readings. can be portable and brought to the pts room

What is premature atrial contraction?

premature and abnormal looking P waves that differ from normal P waves

Role of ACE inhibitors and ARBs (lisinopril - ACE inhibitor; losartan - ARB) on heart failure:

prevents vasoconstriction caused by release of angiotensin 2. protects the heart & vessels from additional remodeling from damage

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin

prior intracranial hemorrhage

Role of Beta-Blockers (metoprolol & carvedilol) on heart failure:

slow the rate & force heart contractions, allows heart to not have to work as hard. Decreases BP

Why do we use holter monitors?

small, wearable device that records heart's rhythm. used to determine risk of irregular heartbeats (arrhythmias)

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? smoking cessation a protein-rich diet exercise avoidance antioxidant supplements

smoking cessation

What is the basic pathophysiology of heart failure?

state in which the heart is not longer able to pump blood at an adequate rate for the body or in order to do so the diastolic filling pressure is elevated

A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? streptokinase, aspirin, and morphine administration morphine administration, stress testing, and admission to the cardiac care unit serial liver enzyme testing, telemetry, and a lidocaine infusion sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

What is the main purpose of a 12-lead EKG?

to screen patients for possible cardiac ischemia. helps EMS and staff quickly identify pts with STEMI