Cardio - NCLEX Saunders (Lab and Diagnostic Tests)

A client is at risk for developing disseminated intravascular coagulopathy (DIC). The nurse should become concerned with which fibrinogen level? A. 90 mg/dL B. 190 mg/dL C. 290 mg/dL D. 390 mg/dL

A. 90 mg/dL The normal fibrinogen level is 180 to 340 mg/dL for men and 190 to 420 mg/dL for women. A critical value is less than 100 mg/dL. With DIC, the fibrinogen level drops because fibrinogen is used up in the clotting process. For these reasons, the nurse should become most concerned with the level of 90 mg/dL.

A client is scheduled for a dipyridamole thallium scan. The nurse should check to make sure that the client has not consumed which substance before the procedure? A. Caffeine B. Fatty meal C. Excess sugar D. Milk products

A. Caffeine This test is an alternative to the exercise stress test. Dipyridamole (Persantine) dilates the coronary arteries as exercise would. Before the procedure, any form of caffeine should be withheld, as well as aminophylline or theophylline forms of medication. Aminophylline is the antagonist to dipyridamole.

The client's B-type natriuretic peptide (BNP) level is 691 pg/mL. Which intervention should the nurse institute when providing care for the client? A. Take daily weights and monitor trends. B. Encourage fluids to improve hydration. C. Elevate the legs above the level of the heart. D. Position supine with the head of the bed at 30 degrees.

A. Take daily weights and monitor trends. BNP levels greater than 500 pg/mL indicate that heart failure is probable. Nursing measures are geared toward decreasing intravascular volume, decreasing preload, and decreasing afterload. Option 2 increases intravascular volume, and options 3 and 4 increase preload.

A postcardiac surgery client with a blood urea nitrogen (BUN) level of 45 mg/dL and a serum creatinine level of 2.2 mg/dL has a total 2-hour urine output of 25 mL. The nurse understands that the client is at risk for which? A. Hypovolemia B. Acute kidney injury C. Glomerulonephritis D. Urinary tract infection

B. Acute kidney injury The client who undergoes cardiac surgery is at risk for acute kidney injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Kidney injury is signaled by a decreased urine output and increased BUN and creatinine levels. The client may need medications to increase renal perfusion and could need peritoneal dialysis or hemodialysis.

A client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned, knowing that this level could lead to which complication? A. Stroke B. Cardiac arrest C. High blood pressure D. Urinary stone formation

B. Cardiac arrest The normal calcium level is 8.6 to 10 mg/dL. A low calcium level could lead to severe ventricular dysrhythmias and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization, and move back during repolarization. Depolarization is responsible for cardiac contraction. Options 1, 3, and 4 are not associated with a low calcium level.

The nurse is monitoring a client following cardioversion. Which observations should be of highest priority to the nurse? A. Blood pressure B. Status of airway C. Oxygen flow rate D. Level of consciousness

B. Status of airway Nursing responsibilities after cardioversion include maintenance of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. Airway is the priority.

While the nurse is involved in preparing a client for a cardiac catheterization, the client says, "I don't want to talk with you. You're only the nurse. I want my doctor." Which response by the nurse should be therapeutic? A. "Your doctor expects me to prepare you for this procedure." B. "That's fine, if that's what you want. I'll call your health care provider." C. "So you're saying that you want to talk to your health care provider?" D. "I'm concerned with the way you've dismissed me. I know what I am doing."

C. "So you're saying that you want to talk to your health care provider?" In option 3, the nurse uses the therapeutic communication technique of reflection to redirect the client's feelings back for validation. Option 1 is nontherapeutic and addresses the legal issue of performing a procedure when in fact the client is refusing. Although option 2 may seem appropriate, it does not reflect the client's feelings and doesn't provide an opportunity for the client to express feelings. Option 4 is clearly nontherapeutic because it focuses on the nurse's feelings rather than the client's feelings.

A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. The nurse should do which first? A. Call a code blue. B. Call the health care provider. C. Check the client status and lead placement. D. Press the recorder button on the ECG console.

C. Check the client status and lead placement. Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Checking of the client and equipment is the first action by the nurse.

The nurse has reinforced instructions to the family of an older client who seems anxious about being discharged after cardiac surgery. The nurse understands further teaching is needed if a family member makes which statement? A. "Recuperation after cardiac surgery is generally slower for older people." B. "It's important to get out of bed every day, even if tired or weak at first." C. "Fatigue, discomfort, and lack of appetite occur more commonly with older people and may last for 2 to 5 weeks." D. "A daily half-mile-long brisk walk generally helps people bounce back more quickly and provides more of a sense of control."

D. "A daily half-mile-long brisk walk generally helps people bounce back more quickly and provides more of a sense of control." Clients generally increase activity by beginning a simple walking program, starting with distances of 400 feet twice daily and gradually increasing the distance until able to walk 1¼ mile (usually at the end of the second week). Exercise has physiological and psychological benefits. The statements made in options 1, 2, and 3 are correct.

The nurse monitors the laboratory data on a client at risk for coronary artery disease. A fasting blood glucose reading of 200 mg/dL is recorded on the chart. The nurse analyzes this result as indicative of which finding? A. Decreased, indicating a decreased risk of coronary artery disease B. Elevated, but would not present a risk for coronary artery disease C. Elevated, signaling the presence of diabetes mellitus, a risk factor of coronary artery disease D. Normal, indicating adequate blood glucose control with no risk for coronary artery disease

C. Elevated, signaling the presence of diabetes mellitus, a risk factor of coronary artery disease A fasting blood glucose of 200 mg/dL signals the presence of diabetes mellitus. Diabetes mellitus predisposes a client to coronary artery disease. Options 1, 2, and 4 are inaccurate interpretations.

The clinic nurse is obtaining cardiovascular data on a client. The nurse prepares to check the client's apical pulse and places the stethoscope in which position? A. Midsternum equal with the nipple line B. At the midaxillary line on the left side of the chest C. At the midline of the chest just below the xiphoid process D. At the midclavicular line at the fifth left intercostal space

D. At the midclavicular line at the fifth left intercostal space The heart is located in the mediastinum. Its apex or distal end points to the left and lies at the level of the fifth intercostal space. A stethoscope should be placed in this area to pick up heart sounds most clearly. The other options are incorrect because they do not represent the anatomical positioning of the heart's apex.

The nurse carries out a standard prescription for a stat electrocardiogram (ECG) on a client who has an episode of chest pain. The nurse should take which action next? A. Do a repeat 12-lead ECG. B. Wait to see whether the pain resolves. C. Report the episode of chest pain to the health care provider. D. Give sublingual nitroglycerin (Nitrostat) per the health care provider's prescriptions.

D. Give sublingual nitroglycerin (Nitrostat) per the health care provider's prescriptions. After completing the stat ECG, the nurse should administer a nitroglycerin tablet to dilate the coronary arteries and relieve ischemic pain. The nurse should not wait to see whether pain resolves on its own but should determine whether the pain is relieved with nitroglycerin. The nurse should do a repeat ECG if it is prescribed. The nurse should report the episode of pain to the health care provider but should administer the nitroglycerin before doing so.

A client has received instructions about an upcoming cardiac catheterization. The nurse determines that the client has the best understanding of the procedure if the client knows to report which symptoms? A. Chest pain B. Urge to cough C. Warm, flushed feeling D. Pressure at the insertion site

A. Chest pain The client is taught before cardiac catheterization to immediately report chest pain or any unusual sensations. The client is taught that a warm, flushed feeling may accompany dye injection, occasional palpitations may occur, and the urge to cough may occur as the catheter tip touches the cardiac muscle. The client may be asked to cough or breathe deeply from time to time during the procedure. Because a local anesthetic is used, the client should feel pressure, but not pain, at the insertion site.

A licensed practical nurse (LPN) is assisting in the care of a client who is having central venous pressure (CVP) measurements taken by the registered nurse (RN). The LPN should assist the RN by placing the bed in which position for the reading? A. Flat B. Semi-Fowler's C. Trendelenburg's D. Reverse Trendelenburg's

A. Flat To obtain a CVP measurement, the head of the bed should be flat in order for the readings to be accurate. The use of the other positions listed would result in false low or false high readings.

The nurse is told during shift report that a client is having occasional ventricular dysrhythmias. The nurse reviews the client's laboratory results, recalling that which electrolyte imbalance could be responsible for this development? A. Hypokalemia B. Hypernatremia C. Hypochloremia D. Hypercalcemia

A. Hypokalemia The nurse assesses the client's serum laboratory results for hypokalemia. The client may experience ventricular dysrhythmias in the presence of hypokalemia because this electrolyte imbalance increases the electrical instability of the heart. The electrolyte imbalances mentioned in the other options do not have this effect.

The nurse is assigned to assist with caring for a client after cardiac catheterization. The nurse should plan to maintain bed rest for this client in which position? A. High-Fowler's position B. Lateral (side-lying) position C. Head elevation of 45 degrees D. Head elevation of no more than 30 degrees

D. Head elevation of no more than 30 degrees After cardiac catheterization, the extremity into which the catheter was inserted is kept straight for the prescribed time period. The client may turn from side to side. The client is placed in the supine position and the head of the bed is not elevated to more than 30 degrees to keep the affected leg straight at the groin and prevent arterial occlusion. Bathroom privileges are not allowed during the immediate postcatheterization period. For the high-Fowler's position, the head of the bed is elevated 90 degrees.

The nurse is assisting in developing a plan of care for a client who will be returning to the nursing unit following a cardiac catheterization via the femoral approach. Which nursing intervention should be included in the postprocedure plan of care? A. Place the client's bed in the Fowler's position. B. Encourage the client to increase fluid intake. C. Instruct the client to perform range-of-motion exercises of the extremities. D. Hold regularly scheduled medications for 24 hours following the procedure.

B. Encourage the client to increase fluid intake. Immediately following a cardiac catheterization using the femoral approach, the client should not flex or hyperextend the affected leg. Placing the client in the Fowler's position increases the risk of hemorrhage. Fluids are encouraged to assist in removing the contrast medium from the body. Asking the client to move the toes is done to assess motion, which could be impaired if a hematoma or thrombus were developing. Flexion or hyperextension and range-of-motion exercises of the extremity are contraindicated. The regularly scheduled medications are needed to treat acute and chronic conditions.

The nurse is assisting a client who will wear a Holter monitor for continuous cardiac monitoring over the next 24 hours. The nurse takes which action to assist the client? A. Shaves the front of the client's chest B. Gives the client a device holder to wear around the waist C. Teaches the client to rest as much as possible during the next 24 hours D. Tells the client to cover the monitor in plastic wrap before taking a bath

B. Gives the client a device holder to wear around the waist The nurse applies electrocardiographic (ECG) monitoring leads to the chest in the usual fashion and gives the client a sling or holder to carry the transistor-sized monitor, which is worn around the chest or waist. The nurse would remind the client to maintain a normal schedule and to keep a diary of all activity and symptoms. The client should avoid activities that could interfere with the ECG recorder, such as using heavy machinery, electric shavers, hair dryers, or bathing or showering. Therefore, options 1, 3, and 4 are incorrect.

The nurse finds a client tensing while lying in bed staring at the cardiac monitor. Which is the nurse's best response when the client states, "There sure are a lot of wires around there. I sure hope we don't get hit by lightning!"? A. "Would you like a mild sedative to help you relax?" B. "Oh, don't worry, the weather is supposed to be sunny and clear today." C. "Yes, this equipment is a little scary. Can we talk about how the cardiac monitor works?" D. "I can appreciate your concerns. Your family can stay with you tonight if you want them to."

C. "Yes, this equipment is a little scary. Can we talk about how the cardiac monitor works?" The nurse should initially respond to validate the client's concern and then should determine the client's knowledge level of the cardiac monitor. This gives the nurse an opportunity to do client education if necessary. Bringing in the family, friends, or chaplain as an alternate resource may provide the client with additional psychological support. Pharmacological interventions should be considered only if necessary. Minimizing the client's concern is a communication block.

A client has just returned from the cardiac catheterization laboratory. The left femoral vessel was used as the access site. After returning the client to bed and conducting an initial assessment, the nurse assisting in caring for the client expects the health care provider to write a prescription for the client to remain on bed rest. In which position should the bed be positioned? A. In the high-Fowler's position B. With the head of bed elevated at least 60 degrees C. With the head of bed elevated no more than 30 degrees D. With the foot of bed elevated as much as tolerated by the client

C. With the head of bed elevated no more than 30 degrees Following cardiac catheterization, the extremity in which the catheter was inserted is kept straight for 4 to 6 hours. If the femoral artery was used, strict bed rest is enforced for 6 to 12 hours or per agency procedure. The client may turn from side to side. The affected leg is kept straight and the head is elevated no more than 30 degrees until hemostasis is adequately achieved.

A client has just returned from the cardiac catheterization laboratory. The left femoral vessel was used as the access site. After returning the client to bed, the nurse places a sign above the bed stating that the client should remain on bed rest and in which position? A. In semi-Fowler's position B. With the head of the bed elevated 45 degrees C. With the head of the bed elevated no more than 15 degrees D. With the foot of the bed elevated as much as tolerated by the client

C. With the head of the bed elevated no more than 15 degrees Following cardiac catheterization, the extremity used for catheter insertion is kept straight for 4 to 6 hours. If the femoral artery was used, strict bed rest is necessary for 4 to 6 hours. The client may turn from side to side. The head of the bed is not elevated more than 30 degrees to prevent kinking of the blood vessel at the groin and possible arterial occlusion.

A client diagnosed with angina pectoris returns to the nursing unit after experiencing an angioplasty. The nurse reinforces instructions to the client regarding the procedure and home care measures. Which statement by the client indicates an understanding of the instructions? A. "I am considering cutting my workload." B. "I need to cut down on cigarette smoking." C. "I am so relieved that my heart is repaired." D. "I need to adhere to my dietary restrictions."

D. "I need to adhere to my dietary restrictions." Following the angioplasty, the client needs to be instructed about specific dietary restrictions that must be followed. Following the recommended dietary and lifestyle changes helps prevent further atherosclerosis. Abrupt closure of the artery can occur if the recommended dietary and lifestyle changes are not followed. Cigarette smoking needs to be stopped. An angioplasty does not repair the heart.

A client is scheduled for a cardiac catheterization using a radiopaque dye. The nurse checks which most critical item before the procedure? A. Intake and output B. Height and weight C. Peripheral pulse rates D. Prior reaction to contrast media

D. Prior reaction to contrast media This procedure requires a signed informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure. Although intake and output, height and weight, and presence of peripheral pulses may be components of data collection, they are not the most critical items.