Cardiac, F&E
The nurse obtains a blood pressure of 176/83 for a patient. What is the patients mean arterial pressure?
114 mm Hg.
What is the daily potassium requirement of humans for optimal cell functioning?
20 mEq
When analyzing an ECG rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patients heart rate as:
50 There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.
After receiving report, which patient admitted to the emergency department should the nurse assess first?
50 yo who is complaining of sudden sharp and worst ever upper back pain.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
59 yo with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI).
During the administration of the thrombolytic agent to a patient with an acute myocardial infarction, the nurse should stop the drug infusion if the patient experiences:
A decrease in level of consciousness.
During the assessment of a 25 yo patient with infective endocarditis, the nurse would expect to find:
A new regurgitant murmur.
The nurse has received change of shift report about the following patients on the progressive care unit. Which patient should the nurse see first?
A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone due.
A registered nurse is teaching a student how to analyze the electrocardiogram of a hypokalemic client. Which statements made by the student nurse indicate effective learning? SATA.
A prolonged PR interval will be observed. A flattened T wave will be observed. A prominent U wave will be observed.
A nurse is reviewing the results of a diagnostic test of a client who is being moved out of the intensive care unit. A cardiac troponin T level assay was performed while the client was in the intensive care unit, which indicated high levels of troponin. Which condition was the client diagnosed with?
Acute myocardial infarction.
When caring for a patient who is recovering from a sudden cardiac death event and has no evidence of an acute MI, the nurse will anticipate teaching the patient that:
Additional diagnostic testing will be required.
A nurse is caring for a client with infective endocarditis. Which is the appropriate nursing intervention for this client?
Administering ampicillin.
A client complains of chest pain. On examination, a scratchy sound is heart through the stethoscope. Which intervention should be provided to the client? SATA.
Administering aspirin. Administering ampicillin. Administering glucocorticoids.
A 65 yo female client presents with complaints of crushing pain on the left side of the chest. After examining the client, it is found that the client has unstable angina. Which intervention to reduce the pain is appropriate for the client?
Administering nitroglycerin.
A physician orders IV potassium infusion for a hypokalemic client. Which intervention should be avoided by the nurse while administering IV potassium?
Administration of hypertonic potassium chloride IV bolus.
A client's lab results show overproduction of aldosterone. What is the best nursing intervention to maintain serum electrolyte levels in the client?
Administration of spironolactone.
What is the best intervention to correct hypervolemic hyponatremia in a client diagnosed with a serum sodium level of 120 mEq/L?
Administration of tolvaptan.
A 20 yo old has a mandatory ECG before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure is 114/54, and the student denies any health problems. Which action by the nurse is most appropriate?
Allow the student to participate on the soccer team.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about:
Anticoagulant therapy.
Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?
Application of elastic compression stockings.
A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/42, and is complaining of feeling faint. Which actions should the nurse take next?
Apply the transcutaneous pacemaker pads.
When planning care for a patient hospitalized with a streptococcal infective endocarditis, which intervention is a priority for the nurse to include?
Arrange for placement of a long-term IV catheter.
When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction, which action will the nurse take to evaluate the effectiveness of the medication?
Ask about chest pain.
A patient who is taking a potassium wasting diuretic for treatment of hypertension complains of generalized weakness. It is most appropriate for the nurse to take which action?
Ask the healthcare provider to order a basic metabolic panel.
A 19 yo student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An ECG shows occasional PVCs. Which action should the nurse take next?
Ask the patient about current stress level and caffeine use.
Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are effective?
Assess for the presence of jugular venous distention.
A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking though." The nurse should:
Assess for the presence of the dorsalis pedis and posterior tibial pulses.
A newly admitted patient is admitted with hyponatremia. When making room assignments, the charge nurse should take which action?
Assign the patient to a room near the nurses station.
A nurse is reviewing a client's cardiac rhythm in an electrocardiogram and notes that the reading shows that the P wave and PR interval are absent. Which condition does the nurse interpret from this result?
Atrial fibrillation.
When admitting a patient with a NSTEMI to the intensive care unit, which action should the nurse perform first?
Attach the cardiac monitor.
To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should:
Auscultate by placing the diaphragm of the stethoscope on the lower left sternal border.
A patient is recovering from a myocardial infarction and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?
Auscultate for a pericardial friction rub.
Two days after an acute MI, a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first?
Auscultate the heart sounds.
Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter?
Auscultate the patients breath sounds.
A 23 yo patient tells the healthcare provider about experiencing cold, numb fingers when running during the winter and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for:
Autoimmune disorders.
While caring for a 23 yo patient with mitral valve prolapse without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to:
Avoid use of over-the-counter medications that contain stimulant drugs.
The nurse obtains the following data when assessing a patient who experienced a STEMI 2 days previously. Which information is most important to report to the healthcare provider?
BIL crackles are auscultated in the mid-lower lobes.
The nurse is caring for a patient with a descending aortic aneurysm. Which assessment finding is most important to report to the healthcare provider?
Blood pressure 137/88.
A client has frequent premature ventricular contractions. Which factor should be the priority assessment by the nurse?
Blood pressure and oxygen saturation.
The nurse is caring for a patient with a massive burn injury and possible hypovolemia. Which assessment data will be of most concern to the nurse?
Blood pressure is 90/40.
The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the:
Blood pressure is 90/54.
Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the last 2 hours has been 40 mL. The nurse notifies the healthcare provider and anticipates an order for a(n):
Blood urea nitrogen level.
Which substance can reduce the body's response to cardiac drugs?
Calcium.
A patients cardiac monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 am, 0.22 seconds at 2:30 pm, and 0.28 seconds at 4:00 pm. Which action should the nurse take next?
Call the healthcare provider before giving the next dose of metoprolol (Lopressor).
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction. Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?
Cardiac specific troponin.
A client presents with chest pain. The pain has not reduced, even after administering three nitroglycerine tablets within 10 minutes. Which diagnostic test should the primary healthcare provider recommend to confirm that the client has developed myocardial infarction?
Cardiac troponin test.
Which heart condition increases the demand for myocardial oxygen? SATA.
Changes in heart rate. Increased muscle mass. Increased systemic blood pressure.
Which action could the nurse delegate to UAP trained as ECG technicians working on the cardiac unit?
Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.
A patient comes to the clinic complaining of frequent watery stools for the last 2 days. Which action should the nurse take first?
Check the patients blood pressure.
When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?
Chest pain level 7 on a 0 to 10 point scale.
The nurse reviews the following admission orders for a patient newly diagnosed with PAD. Which admission order should the nurse question?
Combined clopidogrel and omeprazole therapy.
What nutritional advice should the nurse give to a hypokalemic client? SATA.
Consume more orange juice. Add dried fruits to your diet. Consume more bananas and meat.
A nurse in the outpatient clinic is caring for a patient who has a magnesium level of 1.3 mg/dL. Which assessment would be most important for the nurse to make?
Daily alcohol intake.
A patient is admitted for hypovolemia associated with multiple draining wounds. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?
Daily weight.
Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetals (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will:
Decrease spasm of the coronary arteries.
A patient admitted to the coronary care unit with a STEMI is restless and anxious. The blood pressure is 86/40 and heart rate is 123. Based on this information, which nursing diagnosis is a priority for the patient?
Decreased cardiac output related to cardiogenic shock.
The long term care nurse is evaluating the effectiveness of protein supplements for an older resident who has a low serum total protein level. Which assessment finding indicates that the patients condition has improved?
Decreased peripheral edema.
During evaluation of a client who has undergone a bariatric surgery, the nurse finds that the client has an abnormally rapid heartbeat and hypotension. Which condition has the client developed?
Dehydration.
To improve the physical activity level for a mildly obese 71 yo patient, which action should the nurse plan to take?
Determine what kind of physical activities the patient usually enjoys.
A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to:
Document the finding and continue to monitor the patient.
A client presents with chest pain. Complete blood reports show an elevated level of white blood cells. Which clinical manifestation confirms that the client has myocarditis? SATA.
Dyspnea. Tonsillitis. Arthralgia.
A patient who has chest pain is admitted to the ED and all of the following are ordered. Which one should the nurse arrange to be completed first?
ECG.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of:
Echocardiography.
An older adult patient who is malnourished presents to the ED with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation?
Edema.
A client reports myalgia and fever. On physical examination, an S3 gallop rhythm was heard through the stethoscope. Which finding confirms that the client has developed myocarditis? SATA.
Elevated number of white blood cells. Elevated cardiac troponin. Elevated erythrocyte sedimentation rate.
When developing a teaching plan for a 61 yo man with the following risk factors for coronary artery disease, the nurse should focus on the:
Elevation of the patients low-density lipoprotein level.
The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?
Encourage fluid intake up to 4000 mL every day.
A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the healthcare provider?
Generalized muscle aches and pains.
Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66?
Give a sedative before cardioversion is implemented.
A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?
Give supplemental O2 at 2-3 L/min via nasal cannula.
A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is most appropriate when giving the medication?
Give the patients other medications 2 hours after the colesevelam.
When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
Give the scheduled aspirin and lipid-lowering medication.
Which substance is transported to the cells by facilitated transport?
Glucose.
The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction, and is NPO. Which assessment finding would be a priority for the nurse to report to the healthcare provider?
Gradually decreasing level of consciousness.
The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate?
Have you had any dental work done recently?
Following an acute myocardial infarction, a patient ambulates in the hallway. When the nurse is evaluating the patients response to activity, which assessment data would indicate that the exercise level should be decreased?
Heart rate increases from 66 to 92 beats/minute.
Which nursing intervention will be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes?
Help the patient modify favorite high-fat recipes by using monosaturated oils when possible.
Which nursing intervention for a patient who had an open repair of an AAA 2 days previously is appropriate for the nurse to delegate to UAP?
Help the patient to use a pillow to splint while coughing.
Heparin is ordered for a patient with a NSTEMI. What is the purpose of the heparin?
Heparin prevents the development of new clots in the coronary arteries.
Which condition causes pseudohypocalcemia?
Hypoalbuminemia.
A client has increased serum phosphorus levels. Which condition related to hyperphospatemia would the nurse expect to find in the client?
Hypocalcemia.
A 55 yo hypervolemic client has headache, muscle cramp, vomiting, and looks confused. Which condition has the client developed?
Hyponatremia.
Which IV fluids should be avoided for a patient with cerebral edema?
Hypotonic solution.
A nurse is providing discharge instructions to a client who is being discharged after treatment for myocardial infarction. Which statement made by the client indicates effective learning?
I have planned periods of rest in the morning and evening.
After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective?
I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart.
Spironolactone, an aldosterone antagonist, is prescribed for a patient. Which statement by the patient indicates that the teaching about this medication has been effective?
I will drink apple juice instead of orange juice for breakfast.
When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following?
I will have small incisions in my leg where they will remove the vein.
Which statement made by a patient with coronary artery disease after the nurse has completed teaching about therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed?
I will miss being able to eat peanut butter sandwiches.
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?
I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.
After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states:
I won't lift the arm on the pacemaker side up very high until I see the doctor.
The home health nurse cares for an alert and oriented older adult patient with a history of dehydration. Which instructions should the nurse give to this patient related to fluid intake?
Increase fluids if your mouth feels dry.
After the nurse gives IV atropine to a patient with symptomatic type 1 second degree AV block, which finding indicates that the medication has been effective?
Increase in patients heart rate.
Three days after experiencing an MI, a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, "I am too nervous to take care of myself." Based on this information, which nursing diagnosis is appropriate?
Ineffective coping related to anxiety.
A client visits the hospital with chest pain, and the vital signs are 101.5 F body temperature and 125/85 mm Hg blood pressure. The echocardiogram of the client shows valve perforation, and a new regurgitant murmur is heard through the stethoscope on examination. Which condition has the client developed?
Infective endocarditis.
A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L. Which prescribed therapy should the nurse question?
Infuse 5% dextrose in water at 125 mL/hr.
IV potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take?
Infuse the KCl at a rate of 10 mEq/hour.
Which action by a new RN who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias?
Injects IV adenosine over 2 seconds to a patient with supraventricular tachycardia.
Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?
Instruct the patient to call for assistance before getting out of bed.
The nurse is assessing a patient with myocarditis before administering the scheduled dose of digoxin. Which finding is most important for the nurse to communicate to the healthcare provider?
Irregular pulse.
A client is on digitalis and the lab results show that the client is hypokalemic. What effect could hypokalemia have on the drug administered?
It can cause digitalis toxicity.
A registered nurse is teaching a student nurse about the effects of aldosterone. Which statements made by the student nurse are correct? SATA.
It increases blood volume. It increases blood pressure.
After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement made by the patient indicates that the teaching has been effective?
It is important not to suddenly stop taking the carvedilol.
When developing a teaching plan for a 76 yo patient newly diagnosed with peripheral artery disease, which instructions should the nurse include?
It is very important that you stop smoking cigarettes.
Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the healthcare provider?
Jugular venous distention to jaw level.
A 73 yo patient with chronic atrial fibrillation develops sudden, severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the healthcare provider and immediately:
Keep the patient in bed in the supine position.
A 21 yo woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?
Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the healthcare provider?
Loose, bloody stools.
A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?
Lung sounds.
A nurse is caring for a client who has undergone cardiac surgery. What is the best method to assess the client's fluid loss or gain?
Measuring body weight and vital signs every day.
A nurse is assessing a newly admitted patient with chronic heart failure who forgot to take prescribed medications and seems confused. The patient complains of just blowing up and has peripheral edema and shortness of breath. Which assessment should the nurse complete first?
Mental status.
When caring for a patient with renal failure on a low phosphate diet, the nurse will inform UAP to remove which food from the patients food tray?
Milk carton.
Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?
Monitor fluid intake and urine output.
The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse take next?
Monitor ionized calcium level.
Which action can the RN who is caring for a critically ill patient with multiple IV lines delegate to an experienced LPN/LVN?
Monitor the IV sites for redness, swelling, or tenderness.
A nurse is assessing a client with pericarditis. Which assessment findings indicate pericarditis? SATA.
Muffled or distant heart sounds. Pericardial friction rub. Dyspnea.
While working in the outpatient clinic, the nurse notes that the patient has a history of intermittent claudication. Which statement by the patient would support this information?
My legs cramp whenever I walk more than a block.
A client presents with chest pain that has not been relieved by nitroglycerin medication. A review of the client's medical record shows that the client has type 2 diabetes. The blood pressure of the client is 150/90 mm Hg. Which condition has the client developed?
Myocardial infarction.
An older patient receiving iso-osmolar continuous feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the healthcare provider?
Na 154 mEq/L.
A registered nurse is teaching a student nurse about the reason for the development of natriuresis. Which statement made by the student nurse indicates effective teaching?
Natriuresis develops as a result of the excretion of large amounts of sodium.
During discharge teaching with a 68 yo patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on the:
Need for frequent laboratory blood testing.
A client presents with complaints of difficulty breathing and looks pale. The client experiences excessive perspiration and his or her electrocardiogram shows an irregular rhythm. Which other finding will indicate that the client may have developed a myocardial infarction?
Nitroglycerin did not relieve the pain, even after taking three doses.
Which information about a patient who has been receiving thrombolytic therapy for an acute MI is most important for the nurse to communicate to the healthcare provider?
No change in the patients chest pain.
The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should:
Note when Korotkoff sounds are auscultated during both inspiration and expiration.
A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?
Notify the doctor about any symptoms of heart failure such as shortness of breath.
A patient with renal failure has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion. The patient arrives for outpatient hemodialysis and is unresponsive to questions and has decreased deep tendon reflexes. Which action should the dialysis nurse take first?
Notify the patients healthcare provider.
The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?
Notify the surgeon and anesthesiologist.
Which nursing action can the RN delegate to experienced UAP working as a telemetry technician on the cardiac care unit?
Observe cardiac rhythms for multiple patients who have telemetry monitoring.
An 80 yo patient with a history of an abdominal aortic aneurysm arrives at the emergency department with severe back pain and absent pedal pulses. Which actions should the nurse take first?
Obtain the blood pressure.
A patient who is complaining of a racing heart and feeling anxious comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following ECG tracing. Which action should the nurse take next?
Obtain the patients vital signs including oxygen saturation.
The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
Obtain vital signs.
The healthcare provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patients feet is best?
One pillow is placed under the thighs and two pillows are placed under the lower legs.
A patient who has been receiving diuretic therapy is admitted to the ED with a serum potassium level of 3.0 mEq/L. The nurse should alert the healthcare provider immediately that the patient is on which medication?
Oral digoxin (Lanoxin) 0.25 mg daily.
A patient recovering from heart surgery develops pericarditis and complains of level 6 chest pain with deep breathing. Which ordered PRN medication will be the most appropriate for the nurse to give?
Oral ibuprofen 600 mg.
Which admission order written by the healthcare provider for a patient admitted with infective endocarditis and a fever would be a priority for the nurse to implement?
Order blood cultures drawn from two sites.
A client is running a high temperature and is found to have fluid volume deficit. Which signs and symptoms are likely to appear in the client because of fluid volume deficit? SATA.
Orthostatic hypotension. Poor skin turgor. Dark urine with low specific gravity.
A client has hypertension and elevated serum calcium concentration. Which condition is likely to occur in the client?
Osteopenia.
To determine whether there is a change in impulse conduction through the atria, the nurse will measure the duration of the patients:
P wave.
Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the healthcare provider?
Pallor and weakness of the right hand.
The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient?
Patient who had a mitral valve replacement with a mechanical valve.
After receiving the following information about four patients during change of shift report, which patient should the nurse assess first?
Patient who has just returned to the unit after balloon valvuloplasty.
The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced LPN/LVN?
Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg.
After receiving report on the following patients, which patient should the nurse assess first?
Patient with acute aortic regurgitation whose blood pressure is 86/54.
The nurse is reviewing the laboratory results for newly admitted patients on the cardiovascular unit. Which patient laboratory result is most important to communicate as soon as possible to the healthcare provider?
Patient with increase in troponin T and I level.
After receiving change of shift report, which patient should the nurse assess first?
Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes.
Which patient at the cardiovascular clinic requires the most immediate action by the nurse?
Patient with stable angina whose chest pain has recently increased in frequency.
A patients cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first?
Perform immediate defibrillation.
A client whose neck vein has bulged presents with a sharp pain in the chest. The electrocardiogram shows an elevated ST segment, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which condition has the client developed?
Pericarditis.
Which is the outer layer of the heart?
Pericardium.
Which are the clinical manifestations in clients with infective endocarditis? SATA.
Petechiae. Janeway lesions.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The priority intervention by the nurse for this problem is to:
Place the patient in Fowler's position, leaning forward on the over-bed table.
The nurse and unlicensed assistive personnel (UAP) on the telemetry unit are caring for four patients. Which nursing action can be delegated to the UAP?
Placing electrodes in the correct position for a patient who is to receive ECG monitoring.
The standard policy on the cardiac unit states, "Notify the healthcare provider for mean arterial pressure less than 70 mm Hg." The nurse will need to call the healthcare provider about the:
Postoperative patient with a BP of 116/42.
A patient who was admitted with an MI experiences a 45 second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?
Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.
Following a thyroidectomy, a patient complains of a tingling feeling around my mouth. Which assessment should the nurse complete immediately?
Presence of the Chvostek's sign.
A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to:
Prevent changes in heart muscle.
The nurse performing an assessment with a patient who has chronic peripheral artery disease of the legs and an ulcer on the right second toe would expect to find:
Prolonged capillary refill in all the toes.
A client's serum magnesium level is 1 mg/dL. What are the possible causes for this finding? SATA.
Prolonged diarrhea. Laxative abuse. Liver failure.
While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to:
Promote rest to decrease myocardial oxygen demand.
Which is the last region in the conduction of the cardiac conduction sequence?
Purkinje fibers.
When analyzing the rhythm of a patients ECG, the nurse will need to investigate further upon finding a(n):
QRS interval of 0.14 second.
A patient had a NSTEMI 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the RN to delegate to an experienced LPN/LVN?
Reinforcement of teaching about the purpose of prescribed medications.
Which ECG change is most important for the nurse to report to the healthcare provider when caring for a patient with chest pain?
ST-segment elevation.
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the healthcare provider?
Serum K 2.9 mEq/L.
A client has 3+ pitting edema on the feet and also has ascites. What is the most important clinical feature to be monitored given this condition?
Serum albumin level.
A patient is admitted to the ED with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse?
Serum calcium is 18 mg/dL.
Which condition is called hypocalcemia?
Serum calcium less than 8.5 mg/dL.
A patient who has a small cell carcinoma of the lung develops SIADH. The nurse should notify the healthcare provider about which assessment finding?
Serum sodium level of 120 mg/dL.
A patient who is recovering from an acute MI asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best?
Sexual activity uses about as much energy as climbing two flights of stairs.
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for:
Shortness of breath on exertion.
When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of:
Shortness of breath.
A patient who is being admitted to the ED with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patients care?
Sildenafil (Viagra).
A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take?
Start cardiopulmonary resuscitation (CPR).
A patient in the outpatient clinic has a new diagnosis of peripheral artery disease. Which group of medications will the nurse include when providing teaching about PAD management?
Statins.
Which statements regarding angina are correct? SATA.
Stress is the cause of the chest pain. The chest pain is reduced on resting.
Which assessment finding in a patient who is admitted with infective endocarditis is most important to communicate to the healthcare provider?
Sudden onset right flank pain.
Which wave in the electrocardiogram represents ventricular repolarization?
T wave.
A client's serum phosphorus level is 5.5 mg/dL. Which clinical manifestations would the client exhibit?
Tetany and hypotension.
A patient has a parenteral nutrition infusion of 25% dextrose. A student nurse asks the nurse why a peripherally inserted central catheter was inserted. Which response by the nurse is most appropriate?
The 25% dextrose is hypertonic and will be more rapidly diluted when given through a central line.
A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocation nurse (LPN/LVN) caring for the patient requires the RN to intervene?
The LPN/LVN has the patient sit in a chair for 90 minutes.
Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for:
The ability to do daily activities without chest pain.
A registered nurse is teaching a student nurse about infective endocarditis. Which statements made by the student nurse about the complication of the condition indicates effective learning? SATA.
The client may develop regurgitant heart valve defects. The client may develop heart failure. The client may develop abscess of the heart.
A nurse is caring for four clients with chest pain. Which client should be treated for infective endocarditis? SATA.
The client with a dental implant. The client with a pacemaker.
What is oncotic pressure?
The force exerted by albumin in the bloodstream.
When reviewing the 12-lead ECG for a healthy 79 yo patient who is having an annual physical examination, what will be of most concern to the nurse?
The heart rate is 42 bpm.
Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?
The nurse assists the patient to do range of motion exercises for all extremities.
Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction?
The pain has lasted longer than 30 minutes.
When assessing a pregnant patient with eclampsia who is receiving IV magnesium sulfate, which finding should the nurse report to the healthcare provider immediately?
The patellar and triceps reflexes are absent.
The nurse is caring for a 78 yo patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the healthcare provider?
The patient complains of chest pressure when ambulating.
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective?
The patient exercises indoors during the winter months.
The nurse is caring for a 64 yo patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the healthcare provider immediately?
The patient has BIL crackles.
A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the healthcare provider?
The patient is experiencing laryngeal stridor.
Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?
The patient states that the pain goes away with one sublingual nitroglycerin tablet.
The nurse is obtaining a health history from a 24 yo patient with hypertrophic cardiomyopathy. Which information obtained by the nurse is important?
The patients brother died from a sudden cardiac arrest.
Which information will the nurse include when teaching a patient who is scheduled for a radio-frequency catheter ablation for treatment of atrial flutter?
The procedure will use electrical energy to destroy areas of the conduction system.
A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse?
There are crackles audible throughout both lung fields.
A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the ED, the nurse obtains the following ECG tracing. The nurse interprets this heart rhythm as:
Third degree AV block.
The nurse is caring for a client with angina pectoris. Which precautionary measures should the nurse advise the client to follow?
To consume a low-fat diet.
The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be:
Troponins T and I.
A patient has a 6 cm thoracic aortic aneurysm that was discovered during a routine chest xray. When obtaining an admission history from the patient, it will be most important for the nurse to ask about:
Trouble swallowing.
When preparing to defibrillate a patient, in which order will the nurse perform the following steps?
Turn the defibrillator on. Select the appropriate energy level. Place the paddles on the patients chest. Check the location of other staff and call out all clear. Deliver the electrical charge.
When discussing risk factor modification for a 63 yo woman who has a 5 cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?
Uncontrolled hypertension.
The nurse identifies the nursing diagnosis fo decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis based on which assessment finding(s)?
Urine output less than 30 mL/hr.
When evaluating the discharge teaching for a patient with chronic peripheral artery disease, the nurse determines a need for further instruction when the patient says, "I will:"
Use a heating pad on my feet at night to increase the circulation and warmth in my feet.
The nurse needs to quickly estimate the heart rate for a patient with regular heart rhythm. Which method will be best to use?
Use the 3 second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
The nurse is caring for a patient who has a central venous access device (CVAD). Which action by the nurse is appropriate?
Use the push-pause method to flush the CVAD after giving medications.
The nurse obtains a rhythm strip on a patient who has had an MI and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate 162, RR interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as:
Ventricular tachycardia.
A few days after experiencing an MI and successful percutaneous coronary intervention, the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?
What do you think caused your chest pain?
A patient with ST-segment elevation in three contiguous ECG leads is admitted to the ED and diagnosed as having a STEMI. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?
What time did your chest pain?
The nurse is caring for a patient who was admitted to the coronary care unit following an acute MI and percutaneous coronary intervention the previous day. Teaching for this patient would include:
When cardiac rehabilitation will begin.