CARDIAC EXAM
Ventricular bigeminy
-every other beat is a PVC -no P wave
EACH SMALL SQUARE IS
0.04 seconds
Atrial Tachycardia
HR: 140-250 bpm abnormal P WAVE regular rhythm
A patient is recovering from mechanical cardiac mitral valve replacement. What medication will be prescribed for long term therapy?
anticoagulants
A client is prescribed lisinopril after a myocardial infarction. The client asks about possible side effects of the drug. Which common side effects should the nurse include in the teaching? Select all that apply
-dry cough -hypotension
Premature Atrial Contraction
-irregular rhythm and premature abnormal P wave -client feels like they skipped a beat
The nurse is the emergency department is admitting a client with a right ventricular myocardial infarction. In caring for this client, the nurse should alert for which of the following signs and symptoms of right-sided heart failure?
-jugular venous distention -hepatomegaly -dependent edema
The client is admitted with a diagnosis of atrial fibrillation. Which interventions should the nurse implement? Select all that apply).
-monitor BP -determine antiplatelet/coagulation therapy - asses neuro status
Hyperkalemia
-peaked T waves -prolonged PR -Widened QRS
Atrial Flutter
-variable rhythm -NO PR wave -risk of stroke due to thrombus -Radiofrequency catheter ablation therapy uses electrical energy to burn areas of the conduction system
QRS INTERVAL time
0.06- 0.10 seconds
PR INTERVAL time
0.12-0.20 seconds
which finding is considered the highest risk factor for developing coronary atherosclerotic disease?
20 pack year smoking history
The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril. The charge nurse will need to intervene if the new RN tells the patient to
increase the dietary intake of high-potassium foods.
A patient who has experienced an MI and his wife identify to the nurse that they are nervous about resuming sexual activity after discharge, even though the doctor has stated that they may. What is the most appropriate advice to give the patient?
sexual activity is equivalent to walking two flights of stairs
You are working in the ED caring for a patient who was just admitted with crushing left anterior chest pain, possible angina or myocardial infarction. Which ordered nursing activity should you accomplish first?
Administer sublingual nitroglycerin
A patient who had knee surgery received IV ketorolac 30 minutes ago and continues to report pain at a level of 7 (0 to 10 scale). Which action is most effective for the nurse to take at this time
Administer the prescribed PRN IV morphine sulfate.
Two days following the insertion of a pacemaker, the patient calls the clinic stating that he "just doesn't feel right." What question does the nurse ask to best assess the functioning of the pacemaker?
Are you feeling weak and dizzy?"
A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. The patient's oxygen saturation is 96%, and recent laboratory results are all normal. Which action by the nurse is most appropriate?
Assess for bladder distention.
A 69-year old client comes to the ER with heart failure complicated by pulmonary edema. Upon admission, which should the nurse assess first?
Blood pressure
Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin?
Heparin prevents the development of new clots in the coronary arteries
A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first?
Check O2 sat
A patient is admitted to the postanesthesia care unit (PACU) with a blood pressure (BP) 122/72 mm Hg. Thirty minutes after admission, the BP is 114/62, with a pulse of 74 and warm, dry skin. Which action by the nurse is most appropriate?
Continue to take vital signs every 15 minutes
A patient who has just been transported from the operating room to the postanesthesia care unit (PACU) is shivering and has a temperature of 96.5° F (35.8° C). Which action should the nurse take next?
Cover the patient with a warm blanket
The nurse is reviewing the laboratory results for newly admitted patients on the cardiovascular unit. Which laboratory result is most important to communicate as soon as possible to the health care provider?
High troponin 1 level
A client with a diagnosis of symptomatic PVCs complains of dizziness & palpitations. The nurse obtains a rhythm strip. The strip shows the client in ventricular bigeminy. The nurse knows that these symptoms are associated with:
DECREASE CARDIAC OUTPUT (this causes the symptoms) which leads to decrease BP
A 67-year old patient was admitted 48 hours ago with an anterior myocardial infarction. He now has an intravenous infusion of Heparin running at 1100 units/hour. Also ordered is warfarin, 5mg p.o Q.D. Today, his partial thromboplastin time (PTT) is 80 and his INR is 2.6. The nurse should expect which of the following?
Discontinue heparin. Continue warfarin as it is at a therapeutic level.
A 57-year old woman develops a deep vein thrombosis two days post operatively. When taking her vital signs, the nurse finds a heart rate of 150, respirations 46 and blood pressure 100/60. The patient is restless and anxious. Of the following ordered activities, what is the nurse's best first action?
Elevate the head of bed and administer oxygen by nasal cannula
Ventricular Tachycardia
HR : >150 QRS is wide and distorted PR is not measurable
The nurse is reviewing the 12-lead electrocardiograph (ECG) for a healthy 74-yr-old patient who is having an annual physical examination. What finding is of most concern to the nurse?
HR is 41 bpm
Atropine
INCREASES HR
When should client stop exercising?
If HR is 20 bpm than resting rate
Which should be part of the discharge teaching for the patient with atrial fibrillation?
Importance of anticoagulant therapy
You are teamed with a practical nurse (LPN) in caring for a patient who has just returned to the unit after having had a cardiac catheterization with a femoral puncture. Which action by the LPN indicates that you need to intervene immediately
LPN assists patient to the bathroom
Patient has prescription for daily furosemide. Which assessment findings would indicate an adverse effect of this drug?
Muscle weakness, leg cramps, nausea & fatigue.
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient?
No regular physical exercise
You are providing care to a patient with a diagnosis of pericarditis. Upon assessment, you note that the patient is short of breath with chest tightness. Upon auscultating the client's heart sounds, you have increased difficulty hearing them from an earlier assessment and note narrowing pulse pressure in blood pressure reading. What is your best first action?
Notify physician
You are caring for an 83-year-old female patient with hypertension and is being treated with a diuretic and beta-blocker. You are aware that a major consideration in managing hypertension in the elderly is what?
Teach the use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension.
A 62-year-old patient is hospitalized with congestive heart failure exacerbation. On assessment, you note the patient has 2+ pitting edema in the lower extremities and crackles throughout the lung fields. His vital signs are: blood pressure 180/96; heart rate 95 bpm; respirations 16; temperature 98.6 F and oxygen saturation on room air is 90%. The patient is taking these medications: Lasix IV, Digoxin, Miralax and multivitamins. Which finding is the most concerning? A.Potassium level of 5.3. B. Patient states, "I've been up all-night urinating." C.Patient states, "The lights look like they have halos around them." D. Blood glucose level of 190
Patient states, "The lights look like they have halos around them."
Which finding on an ECG indicates myocardial ischemia and injury?
ST ELEVATION
ECG changes
ST elevation (indicating injury), Q waves (indicating necrosis), and T-wave inversion (indicating ischemia and evolution of the infarction).
The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside . Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
Set up the automatic noninvasive BP machine to take readings every 15 minutes.
A client has been diagnosed as having Class 2 Heart Failure as defined by the New York Heart Association. Which of the following statements regarding activity should the nurse make to this client?
The discomfort you experience may occur with ordinary physical activity
Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be important to report to the health care provider before the MRI? A. The patient has an allergy to shellfish. B. The patient has a history of atherosclerosis. C. The patient has a permanent cardiac pacemaker. D. The patient took the prescribed heart medications today.
The patient has a permanent cardiac pacemaker.
The nurse working on a cardiac unit is preparing to administer medications to a patient admitted. Which medication should the nurse question before administering?
Vitamin K to a patient with a diagnosis of deep vein thrombosis and an INR of 2.8.
The nurse notes a small, circular, deep, painful ulcer on the tip of the patient's great toe. Further assessment reveals unilateral weak pedal pulse and the foot is cool to touch. The nurse suspects this may be
arterial ulcer
A patient is admitted to the emergency department after complaining of acute chest pain radiating down his left arm. Which laboratory studies are indicated?
creatinine kinase & troponin T and troponin I
The nurse is taking the history from a client with CHF caused by hypertension. What data from the history supports this medical diagnosis?
dyspnea after walking one block
A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings?
have you consistently taken your medications?
A 69- year-old man reports experiencing pain in the lower left leg and foot when walking. The nurse notes that the lower leg is slightly edematous and hairless. This pain is relieved with rest. What problem should the nurse suspect that this man is experiencing?
intermittent claudication
The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to
keep a diary of daily activities while the monitor is worn
The nurse is caring for a woman diagnosed with mitral regurgitation. Which problem suggests that her condition may be deteriorating?
left side heart failure
A 47-year old woman is admitted to the emergency department. It is suspected that she has a deep vein thrombosis. What assessment findings are consistent with this diagnosis?
leg swelling and pain
An adult male patient is admitted to emergency following a fall in which he sustained a large laceration to the occipital area of his head. He relates that prior to the fall, he had developed unrelieved chest pain that has been present for approximately 20 minutes in total and is still present. The doctor diagnoses the patient with an MI and deep laceration. To minimize cardiac damage, which of the following doctor's order is most appropriate for this patient:
morphine, bed rest, and oxygen administration
A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first?
take VS
A patient with angina is beginning nitroglycerin. Before administering the drug the nurse informs the patient that immediately after administration, the patient may experience what?
throbbing headache or dizziness
Amiodarone
treats ventricular arrhythmias Ex. burst of v tach, then regular HR
A patient who has had a myocardial infarction states that he is prone to constipation. The nurse advises this patient to establish a regular bowel regimen because straining to have a bowel movement may
trigger a vagal response
Diltiazem
used to treat atrial arrhythmia -SLOW HR
The nurse notes a large, superficial, ulcer on the lateral side of the patient's ankle. The patient states that his foot aches all the time. There is a moderate amount of exudate oozing from the ulcer. The nurse suspects this may be indicative of what problem?
venous ulcer
