Cardiology Practice Questions

A nurse is providing postprocedure care to a client who had a cardiac catheterization via a brachial artery. For the first hour after the procedure, what is the priority nursing intervention? A. Monitor the vital signs every 15 minutes B. Maintain the client in the supine position C. Keep the client's lower extremities in extension D. Administer the prescribed oxygen at 4 L/min via nasal cannula

A Rationale A cardiac catheterization may cause cardiac irritability; therefore the client's vital signs should be monitored every 15 minutes for 1 hour and then every 30 minutes for the next 2 hours until stable. The vital signs may then be monitored every 4 hours. When a brachial artery is used for catheter insertion, a low-Fowler, not supine, position usually is recommended because it promotes respirations. Keeping the client's lower extremities in extension is not necessary. A brachial, not femoral, artery was used for the catheter insertion. Although administering the prescribed oxygen at 4 L/min via nasal cannula may be done, it is not the priority. The client's response to the procedure is the priority.

The healthcare provider prescribes permanent pacemaker implantation for a client with a heart block. Which explanation about the procedure should the nurse reinforce with this client? A. It stimulates a normal heart rate. B. It shocks the atrioventricular node. C. It slows the heart to a normal rate. D. It synchronizes heart valve action.

A Rationale An implanted permanent pacemaker stimulates a normal heart rate by synchronizing impulses to the atria and ventricles at a prescribed rate. The pacemaker can be set at a fixed-rate or demand-mode, and it can be configured to stimulate atrial, ventricular, or atrial-ventricular pacing. The pacemaker stimulates contractions; however, an automatic defibrillator is a different device that shocks detected abnormal rhythms at the atria and/or ventricles. The pacemaker increases the heartbeat to a normal rate, not decreases it. The implantable pacemaker affects the electrical conduction system of the heart and not the anatomic structures, such as the heart valves.

Which catecholamine receptor is responsible for increased heart rate? A. Beta 1 receptor B. Beta 2 receptor C. Alpha 1 receptor D. Alpha 2 receptor

A Rationale Beta 1 receptors are responsible for increased heart rate. Beta 2 receptors, alpha 1 receptors, and alpha 2 receptors are not present in the heart; therefore, they are not responsible for increasing the heart rate. Beta 2 receptors are present in such organs as blood vessels, kidneys, bronchioles, and bladder. Alpha receptors are present in such organs as eyes, skin, and liver.

A client is in the intensive care unit. The nurse observing the telemetry monitor identifies flattening T waves and peaked P waves. What problem should the nurse consider based on these ECG changes? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypomagnesemia

A Rationale Flattened or inverted T waves, peaked P waves, depressed ST segments, and elevated U waves are associated with hypokalemia. Prolongation of the QT interval may indicate hypocalcemia. Hyponatremia is not reflected in the heart's electrical conduction. Although flattening of T waves may occur with hypomagnesemia, the ST segment may be shortened, and the PR and QRS intervals may be prolonged.

A client who just returned from surgery reports shortness of breath and chest pain. Which should the nurse initially administer? A. Supplemental oxygen B. Intravenous morphine C. Endotracheal intubation D. Sublingual nitroglycerin

A Rationale Oxygen supports vital centers of the body while the cause of the problem is investigated. Although an intravenous morphine may be done eventually if the client is experiencing a myocardial infarction, it is not the initial action and requires a prescription. Endotracheal intubation is not implemented by a nurse. Later, endotracheal intubation may be necessary if the client experiences respiratory failure or obstruction. Although a sublingual nitroglycerin may be done eventually if the client is experiencing angina, it is not an initial action and requires a prescription.

A client is brought to the emergency department with chest pain. The client asks why an electrocardiogram (ECG) has been prescribed. What does the nurse explain that the ECG will do? A. Indicates acutely impaired blood flow to the heart muscle B. Detect altered heart sounds C. Determine the flow of blood to the heart muscle D. Evaluate the spatial relationship of structures within the heart

A Rationale The ECG waveform can indicate myocardial ischemia or injury as evidenced by ST waveform depression or elevation, respectively. Ischemia or injury is caused by an acute lack of blood flow through the coronary arteries that supply oxygenated blood to the heart muscle. Auscultation can detect various heart sounds. Blood flow to the heart muscle is assessed during a cardiac catheterization. Spatial relationships of structures within the heart are assessed via an echocardiogram.

A woman comes to the emergency department reporting signs and symptoms that are determined by the primary healthcare provider to be caused by a myocardial infarction. The nurse obtains a health history. Which reported symptoms does the nurse determine are specifically related to a myocardial infarction in women? Select all that apply. A. Severe fatigue B. Sense of unease C. Choking sensation D. Chest pain relieved by rest E. Pain radiating down the left arm

A, B Rationale A myocardial infarction in women may be asymptomatic, atypical, or mild. Unique symptoms include overwhelming fatigue, a sense of uneasiness, indigestion, and shoulder tenderness. A sense of unease is a unique characteristic of a myocardial infarction in women. The client knows something is not right but cannot identify what it is. This uneasiness often is disregarded by the client. A choking sensation occurs in both men and women with a myocardial infarction. Chest pain relieved by rest occurs in both men and women with angina; it is caused by coronary artery spasms leading to myocardial ischemia. Angina frequently is a precursor to a myocardial infarction. Pain radiating down the left arm occurs in both men and women. It can radiate also to the neck, lower jaw, left arm, left shoulder, and, less frequently, the right arm and back.

The client is admitted with paroxysmal supraventricular tachycardia at a rate of 140 beats per minute. The client's blood pressure is 110/55 mm Hg, and the client is asymptomatic except for a "fluttering feeling" in the chest. Which treatments should the nurse be prepared to administer? Select all that apply. A. Intravenous adenosine B. Intravenous beta blockers C. Intravenous amiodarone D. Synchronized cardioversion E. Intravenous calcium channel blockers

A, B, C, E Rationale Medications that may be used for paroxysmal supraventricular tachycardia include adenosine, beta blockers, amiodarone, and calcium channel blockers. If the client is symptomatic or hemodynamically unstable, synchronized cardioversion is considered

A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure? Select all that apply. A. Dependent edema B. Swollen hands and fingers C. Collapsed neck veins D. Right upper quadrant discomfort E. Oliguria

A, B, D Rationale With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. Jugular venous collapse and oliguria are key features of left-sided heart failure. Left-sided heart failure is associated with decreased cardiac output.

A client who recently had a myocardial infarction is admitted to the cardiac care unit. How can the nurse best determine the effectiveness of the client's ventricular contractions? A. Observing anxiety levels B. Monitoring urinary output hourly C. Evaluating cardiac enzyme results D. Assessing breath sounds frequently

B Rationale A decreased urinary output reflects a decreased cardiac output; immediate action is indicated if urinary output decreases. Although anxiety may occur, the priority is to monitor urinary output, which reflects cardiac effectiveness. Cardiac enzyme results do not reflect effectiveness of cardiac contractions; they reflect tissue damage. Although the presence of crackles (rales) will indicate pulmonary edema, it will not determine the effectiveness of ventricular contractions.

The nurse notices that the client's cardiac rhythm has become irregular; QRS complexes are missing after some of the P waves. The nurse also notes that the PR intervals become progressively longer until a P wave stands without a QRS; then the PR interval is normal with the next beat and starts the cycle again with each successive PR interval getting longer until there is a missing QRS. The nurse notifies the primary healthcare provider. Which rhythm does the nurse share with the provider? A. First degree atrioventricular (AV) block B. Second degree AV block Mobitz I (Wenckebach) C. Second degree AV block Mobitz II D. Third degree AV block (complete heart block)

B Rationale Also called Mobitz I or Wenckebach heart block, second degree AV block type I is represented on the ECG as a progressive lengthening of the PR interval until there is a P wave without a QRS complex. In first degree AV block, a P wave precedes every QRS complex, and every P wave is followed by a QRS. Second degree AV block type II (Mobitz II) is a more critical type of heart block that requires early recognition and intervention. There is no progressive lengthening of the PR interval, which remains the same throughout with the exception of the dropped beat(s). Third degree block often is called complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In complete heart block, the atria and ventricles beat independently of each other because the AV node is completely blocked to the sinus impulse and is not conducted to the ventricles. One hallmark of third degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform.

A nurse identifies premature ventricular complexes (PVCs) on a client's cardiac monitor. What does the nurse conclude that these complexes are a sign of? A. Atrial fibrillation B. Cardiac irritability C. Impending heart block D. Ventricular tachycardia

B Rationale Cardiac irritability is the cardinal reason for PVCs. Atrial fibrillation is a type of dysrhythmia, not the cause of PVCs; the source of atrial fibrillation is the atrium, not the ventricles. Impending heart block type of dysrhythmia is associated with interference with the conduction system. Ventricular tachycardia is a type of dysrhythmia, not the cause of PVCs.

A client who is suspected of having had a silent myocardial infarction has an electrocardiogram (ECG) prescribed by the primary healthcare provider. While the nurse prepares the client for this procedure, the client asks, "Why was this test prescribed?" Which is the best reply by the nurse? A. "This test will detect your heart sounds." B. "This test will reflect any heart damage." C. "This procedure helps us change your heart's rhythm." D. "The ECG will tell us how much stress your heart can tolerate."

B Rationale Changes in an ECG will reflect the area of the heart that is damaged because of hypoxia. A stethoscope is used to detect heart sounds. Medical interventions, such as cardioversion or cardiac medications, not an ECG, can alter heart rhythm. An ECG will reflect heart rhythm, not change it. Identifying how much stress a heart can tolerate is accomplished through a stress test; this uses an ECG in conjunction with physical exercise.

A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The primary healthcare provider prescribes an electrocardiogram (ECG) and lab tests. A change in which component of the ECG tracing should the nurse recognize as the client actively A. QRS complex B. S-T segment C. P wave D. R wave

B Rationale In ECG tracing, the displacement of the S-T segment is caused by an active ischemic injury in the myocardium. The QRS complex, the P wave, and the R wave are not associated with an MI.

A client is experiencing a myocardial infarction. What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? A. Arterial spasm B. Heart muscle ischemia C. Blocking of the coronary veins D. Irritation of nerve endings in the cardiac plexus

B Rationale Ischemia causes tissue injury and the release of chemicals, such as bradykinin, that stimulate sensory nerves and produce pain. Arterial spasm, resulting in tissue hypoxia and pain, is associated with angina pectoris. Arteries, not veins, are involved in the pathology of a myocardial infarction. Tissue injury and pain occur in the myocardium.

The nurse is caring for a client who is admitted with the diagnosis of mild heart failure. Which type of lung sounds should the nurse expect to hear? A. Stridor B. Crackles C. Wheezes D. Friction rubs

B Rationale Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration. Stridor is not heard in heart failure, but with tracheal constriction or obstruction. Wheezes are not heard with heart failure, but with asthma. Friction rubs are not heard with heart failure, but with pleurisy.

A thallium scan is prescribed for a client with a history of chest pain. Which information should the nurse include when explaining the purpose of the test to the client? A. It monitors action of the heart valves. B. It assesses myocardial ischemia and perfusion. C. It visualizes ventricular systole and diastole. D. It identifies the adequacy of electrical conductivity.

B Rationale Thallium imaging is used to assess myocardial ischemia or necrotic muscle tissue related to angina or myocardial infarction. Necrotic or scar tissue does not extract the thallium isotope, leading to cold spots. Action of the heart valves is available from an echocardiogram or, if indicated, from a cardiac catheterization with an angiography. Visualization of the ventricular systole and diastole is determined by cardiac angiography. Identifying the adequacy of electrical conductivity is determined by an electrocardiogram (ECG).

During auscultation of the heart, where does the nurse expect the first heart sound (S 1) to be the loudest? A. Base of the heart B. Apex of the heart C. Left lateral border D. Right lateral border

B Rationale The first heart sound is produced by closure of the mitral and tricuspid valves; it is heard best at the apex of the heart. The base of the heart is where the second heart sound (S 2) is best heard; S 2 is produced by closure of the aortic and pulmonic valves. The left lateral border covers a large area; the auscultatory areas that lie near it are the pulmonic and mitral areas. The right lateral border covers a large area; the only auscultatory area near it is the aortic area.

When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? A. Interview the client for a health history. B. Assess the client's heart and lung sounds. C. Monitor the client's pulse and temperature. D. Obtain the client's blood specimen for electrolytes.

B Rationale With heart failure, the left ventricle is not functioning effectively, which is evidenced by an increased heart rate and crackles associated with pulmonary edema. The health history interview is done after vital signs and breath sounds are obtained and the client is stabilized. Although an infection would complicate heart failure, there are no signs that indicate this client has an infection. Obtaining the client's blood specimen for electrolytes is inappropriate for immediate monitoring; it should be done after vital signs and clinical assessments have been completed.

The client is experiencing fatigue, difficulty breathing, and dizziness. Which dysrhythmia does the nurse interpret from the cardiac monitor? A. Atrial flutter B. Sinus tachycardia C. Sinus bradycardia D. Atrial fibrillation

B Sinus tachycardia is regular rhythm but at a rate higher than 100 beats per min. The client may experience shortness of breath, palpitation, fatigue, and dizziness. Atrial flutter (saw-tooth waves) arises from a conduction defect in the atrium resulting in a rapid atrial rate, usually between 200 to 350 times/minute. The atrial rate is faster than the atrioventricular (AV) node can conduct so that not all atrial impulses are conducted through to the ventricle. Sinus bradycardia is a regular rhythm but at a rate lower than 60 beats per minute. Atrial fibrillation is an irregular rhythm that is a result of multiple irritable foci firing in the atria and bombarding the AV node with irregular conduction of impulses through the node.

What are the clinical manifestations of myocardial infarction in women? Select all that apply. A. Anoxia B. Indigestion C. Unusual fatigue D. Sleep disturbances E. Tightness of the chest

B, C, D Rationale Indigestion, unusual fatigue, and sleep disturbances are clinical manifestations of myocardial infarction in women. Anoxia and tightness of the chest are clinical manifestations of angina pectoris, not myocardial infarction.

A nurse is caring for a client after cardiac surgery. Which signs will cause the nurse to suspect cardiac tamponade? Select all that apply. A. Hypertension B. Pulsus paradoxus C. Muffled heart sounds D. Jugular vein distention E. Increased urine output

B, C, D Rationale Pulsus paradoxus is present in cardiac tamponade. Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid, thready pulse and muffled heart sounds. The increased venous pressure associated with cardiac tamponade causes jugular vein distention. Tamponade causes hypotension, not hypertension, and a narrowed pulse pressure. As the heart becomes more inefficient, there is a decrease in kidney perfusion and therefore a decrease in urine output.

A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply. A. Collapsed neck veins B. Distended abdomen C. Dependent edema D. Urinating at night E. Cool extremities

B, C, D Rationale Right-sided heart failure is associated with increased systemic venous pressures and congestion, as manifested by a distended abdomen, dependent edema, and urinating at night. Distended, not collapsed, neck veins occur in right-sided heart failure. Cool extremities are key features of left-sided heart failure.

A client is admitted to the hospital with the diagnosis of myocardial infarction. The nurse should monitor this client for which signs and symptoms associated with heart failure? Select all that apply. A. Weight loss B. Unusual fatigue C. Dependent edema D. Nocturnal dyspnea E. Increased urinary outpu

B, C, D Rationale Unusual fatigue is attributed to inadequate perfusion of body tissues because of decreased cardiac output in response to cardiac ischemia; women more commonly report unusual fatigue than men. Dependent edema occurs with right ventricular failure because of hypervolemia. Dyspnea at night, which usually requires the assumption of the orthopneic position, is a sign of left ventricular failure. Orthopnea, a compensatory mechanism, limits venous return, which decreases pulmonary congestion and promotes ventilation, easing the dyspnea. Weight gain, not loss, occurs because of fluid retention. Urinary output decreases, not increases, with heart failure because the sympathetic nervous system and the renin-angiotensin-aldosterone system stimulate the retention of sodium and water in the kidneys.

The nurse is planning to teach a client with heart failure about the signs and symptoms of cardiac decompensation. What clinical manifestations should the nurse include? Select all that apply. A. Weight loss B. Extreme fatigue C. Coughing at night D. Excessive urination E. Difficulty breathing

B, C, E Rationale Fatigue is caused by a lack of adequate oxygenation of body cells caused by a decreased cardiac output. As the cardiac output decreases, pulmonary congestion increases, resulting in pulmonary edema; coughing, especially when lying down, and blood-tinged sputum occur. Auscultation reveals crackles and rhonchi. Dyspnea is associated with pulmonary edema that occurs as cardiac output decreases and pulmonary congestion increases. Weight gain, not loss, occurs as fluid is retained by the kidneys. Fluid retention, not diuresis, occurs because of decreased circulation to the kidneys, resulting from decreased cardiac output.

A client with a long history of cardiovascular problems, including angina and hypertension, is scheduled to have a cardiac catheterization. During preprocedure teaching, what does the nurse explains to the client is the major purpose for catheterization? A. To obtain the pressures in the heart chambers B. To determine the existence of congenital heart disease C. To visualize the disease process in the coronary arteries D. To measure the oxygen content of various heart chambers

C Rationale Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization. Although pressures can be obtained, they are not the priority for this client; this assessment is appropriate for those with valvular disease. Determining the existence of congenital heart disease is appropriate for infants and young adults with cardiac birth defects. Measuring the oxygen content of various heart chambers is appropriate for infants and young children with suspected septal defects.

The nurse in the intensive care unit is monitoring a client who had an aortic valve replacement. What can a slowing pulse rate during the early postoperative period after open heart surgery indicate? A. Shock B. Hypoxia C. Heart block D. Cardiac failure

C Rationale During open heart surgery, the conductive system of the heart can be damaged because of trauma. Shock results in a weak, rapid pulse. Hypoxia causes tachycardia. Heart failure causes a rapid pulse rate.

An electrocardiogram is prescribed for a client complaining of chest pain. The nurse recognizes which as an early finding of an infarcted area of the heart? A. Flattened T waves B. Absence of P waves C. Elevated ST segments D. Disappearance of Q waves

C Rationale Elevated ST segments are an early typical finding after a myocardial infarct because of the altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation. Q waves may become distorted with conduction or rhythm problems, but they do not disappear unless there is cardiac standstill.

An electrocardiogram (ECG) is prescribed for a client who reports chest pain. Which early finding does the nurse expect on the lead over the infarcted area? A. Flattened T waves B. Absence of P waves C. Elevated ST segments D. Disappearance of Q waves

C Rationale Elevated ST segments are an early, typical finding after a myocardial infarct because of altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation. Q waves may become distorted with conduction or rhythm problems, but they do not disappear unless cardiac standstill occurs.

A client with a history of heart failure and hypertension is admitted with reports of syncope. Which prescribed medication should the nurse prepare to administer based on the electrocardiogram (ECG) rhythm strip image? A. Digoxin B. Enalapril C. Atropine D. Metoprolol

C Rationale This rhythm strip reflects sinus bradycardia. Sinus bradycardia has PQRST complexes within acceptable limits, but the rate is less than 60 beats per minute. In this strip the PR interval is 0.16, the rhythm is regular, and the rate is 40 beats per minute. Atropine, an anticholinergic that increases the heart rate, is administered when the heart rate is so slow that it causes symptoms. Digoxin is a cardiac glycoside that slows the heart rate. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that slows the heart rate. Metoprolol is a beta blocker that slows the heart rate.

A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. A. Age B. Height C. Weight D. Smoking E. Family history

C, D Rationale Obesity is a modifiable risk factor that is associated with coronary artery disease (CAD); an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is a modifiable risk factor for CAD. The incidence of CAD does increase with age. However, age is not a modifiable risk factor. Height is unrelated to the incidence of CAD. Family history is not a modifiable risk factor for CAD because one cannot control heredity.

A client has second degree atrioventricular (AV) block. Which information will the nurse consider when planning care? Select all that apply. A. A temporary pacemaker is the only viable treatment. B. None of the P waves are conducted to the ventricles. C. Some P waves are conducted to the ventricles. D. Treatment consists of atropine or a pacemaker. E. Treatment consists of a permanent pacemaker.

C, D Rationale Second degree heart block refers to AV conduction that is intermittently blocked. Therefore, some P waves are conducted, and some are not. The client may require administration of atropine as well as transcutaneous or transvenous pacing for emergent treatment. Third degree block often is called complete heart block because no atrial impulses are conducted through the AV node to the ventricles. Treatments include transcutaneous or transvenous pacing and implanting a permanent pacemaker

The nurse is evaluating the client's cardiac rhythm and measures a PR interval of 0.08 seconds (two small boxes). How should the nurse interpret this finding? A. Normal conduction in the atrioventricular (AV) node B. End of the P wave to the next deflection C. Delayed conduction in the AV node D. Abnormally fast conduction

D Rationale When the PR interval is shorter than normal, the speed of conduction is abnormally fast. The PR interval measures the time it takes for the impulse to depolarize the atria, travel to the AV node, and dwell there briefly before entering the bundle of His. The normal PR interval is 0.12 to 0.20 seconds, three to five small boxes wide. When the PR interval is longer than normal, the speed of conduction is delayed in the AV node. The interval from the beginning of the P wave to the next deflection from the baseline is called the PR interval.

A client presents to the emergency department with weakness, dizziness, and difficulty breathing. The nurse performs an electrocardiogram (ECG) and notices this arrhythmia. Which arrhythmia is the client exhibiting? A. Atrial fibrillation (AF) B. Ventricular tachycardia (VT) C. Junctional tachycardia D. Supraventricular tachycardia (SVT)

A AF can be chronic or intermittent. Note the wavy baseline with uncoordinated atrial electrical activity and irregular ventricular rhythm. AF clients who have valvular disease are particularly at risk for venous thromboembolism (VTE). Symptoms depend upon the ventricular rate and, if rapid, the client can experience fatigue, weakness, shortness of breath, dizziness, anxiety, syncope, palpitations, chest discomfort, and hypotension. Clients should be monitored carefully for these complications. Some clients can be asymptomatic. VT is a rapid ventricular rate typically between 140 and 250 beats per min and characterized by wide bizarre QRS complexes. Clients exhibiting junctional tachycardia may have no P waves or inverted P waves and a rate greater than 100. SVT involves the rapid stimulation of atrial tissue at a rate of over 150 beats per min in adults. During SVT, P waves may not be visible, especially if there is a 1:1 conduction with rapid rates because the P waves are embedded in the preceding T wave. SVT may occur in healthy young people, especially women.

An older adult client is diagnosed with left-sided congestive heart failure. Which assessments should the nurse expect to find? Select all that apply. A. Dyspnea B. Crackles C. Hacking cough D. Peripheral edema E. Jugular distention

A, B, C Rationale The left ventricle pumps oxygen-rich blood to the rest of the body. Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents the body from getting enough oxygen-rich blood. The blood backs up into the lungs instead, which causes a buildup of fluid. Common symptoms may include: dyspnea, shallow respirations, crackles, dry, hacking cough, and frothy, pink-tinged sputum. Right-sided heart failure occurs when the right side of the heart can't perform its job effectively. Common symptoms of right-sided heart failure include peripheral edema, weight gain, and jugular distention.

A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? A. Allows excess tissue fluid to be excreted B. Helps to control the volume of food intake and thus weight C. Aids the weakened heart muscle to contract and improves cardiac output D. Assists in reducing potassium accumulation that occurs when sodium intake is high

A Rationale A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine. Sodium restriction does not control the volume of food intake; weight is controlled by a low-calorie diet and exercise (if permitted). The resulting elimination of excess fluid reduces the workload of the heart but does not improve contractility. Potassium is retained inefficiently by the body; an adequate intake of potassium is needed.

A client admitted to the hospital for chest pain is diagnosed with stable angina. Which information should the nurse include in the teaching session? A. It is relieved by rest. B. It is precipitated by light activity. C. It is described as sharp or knifelike. D. It is unaffected by the administration of vasodilators.

A Rationale Anginal pain commonly is relieved by immediate rest because rest decreases the cardiac workload and oxygen need. Angina usually is precipitated by exertion, emotion, or a heavy meal. Anginal pain usually is described as tightness, indigestion, or heaviness. Nitroglycerin, a vasodilator and a standard treatment for angina, dilates coronary arteries, which increases oxygen to the myocardium, decreasing pain.

The client is in atrial fibrillation. Which information should the nurse consider about atrial fibrillation when planning care for this client? A. A loss of atrial kick B. No physiologic changes C. Increased cardiac output D. Decreased risk of pulmonary embolism

A Rationale Atrial fibrillation arises from multiple ectopic foci in the atria, causing chaotic quivering of the atria and ineffectual atrial contraction. The atrioventricular (AV) node is bombarded with hundreds of atrial impulses and conducts these impulses in an unpredictable manner to the ventricles. This irregularity is called "irregularly irregular." The ineffectual contraction of the atria results in loss of "atrial kick." If too many impulses conduct to the ventricles, atrial fibrillation with rapid ventricular response may result and compromise cardiac output. One complication of atrial fibrillation is thromboembolism. The blood that collects in the atria is agitated by fibrillation, and normal clotting is accelerated. Small thrombi, called mural thrombi, begin to form along the walls of the atria. These clots may dislodge, resulting in pulmonary embolism or stroke. The client may or may not be aware of the atrial fibrillation. If the ventricular response is rapid, the client may show signs of decreased cardiac output or worsening of heart failure symptoms.

The nurse is assessing a client with the diagnosis of chronic heart failure. Which clinical finding should the nurse expect the client to experience? A. Dependent edema in the evening B. Chest pain that decreases with rest C. Palpitations in the chest when resting D. Frequent coughing with yellow sputum

A Rationale Decreased cardiac output causes fluid retention, which results in dependent edema; this is often noticed in the evening after the client has been standing or sitting for prolonged periods. Chest pain is indicative of cardiac ischemia. Palpitations are indicative of cardiac dysrhythmias. Coughing with yellow sputum is indicative of an infectious process in the respiratory tract; pink, frothy sputum is associated with pulmonary edema that can result from heart failure.

For which client should the nurse conclude that a prescription for digoxin is appropriate? A. Client A B. Client B C. Client C D. Client D

A Rationale Digoxin is used to treat atrial fibrillation, which is depicted in the strip. Client B is a normal sinus rhythm; digoxin is not indicated. Client C is ventricular tachycardia; digoxin is not indicated. Client D is sinus bradycardia; digoxin is contraindicated.

A primary healthcare provider prescribes a heart-healthy diet for a client with angina. The client's spouse says to the nurse, "I guess I'm going to have to cook two meals, one for my spouse and one for myself." Which is the most appropriate response by the nurse? A. "The diet prescribed for your spouse is a healthy diet. It contains guidelines that many of us should follow." B. "I wouldn't bother. For this diet all that you need to do is to reduce the amount of salt you use and fry foods in peanut oil." C. "You're right. Be careful to cook a small portion for each of you to eat to not waste food." D. "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen."

A Rationale Heart-healthy diets are low in cholesterol, sodium, and fat, particularly saturated fats, and high in vegetables and fruits; this type of diet is advocated for all individuals. Fried foods are not advocated on a heart-healthy diet; peanut oil is a monounsaturated fatty acid, and these acids should not exceed 15% of the calories of the diet. The responses "You're right. Be careful to cook a small portion for each of you to eat to not waste food" and "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen" can be discouraging and encourage noncompliance.

A nurse is caring for a client with first degree atrioventricular (AV) block. Which information will the nurse consider when planning care? A. Every P wave is conducted to the ventricles. B. Some P waves are conducted to the ventricles. C. There are no P waves visible on the rhythm strip. D. None of the P waves are conducted to the ventricles.

A Rationale In first degree AV block, a P wave precedes every QRS complex, which is followed by a T wave indicating complete conduction. P waves are visible, but the PR interval is prolonged. Second degree heart block refers to AV conduction that is intermittently blocked. Therefore, some P waves are conducted and some are not. Third degree block is often called complete heart block because no atrial impulses are conducted through the AV node to the ventricles.

A client is experiencing tachycardia. Which adverse hemodynamic effects will the nurse consider when planning care for this client? Select all that apply. A. Decreased ventricular filling time B. Increased coronary artery filling C. Decreased cardiac output D. Increased atrial kick E. Increased cardiac output

A, C Rationale Tachycardia is a fast heart rate; the fast heart rhythm may cause a decrease in cardiac output because of the decreased filling time for the ventricles. There is also a decreased, not increased, time for coronary artery filling during diastole. During atrial systole, a bolus of atrial blood is ejected into the ventricles; this step is called the atrial kick, and it contributes more blood to the cardiac output of the ventricles. With fast heart rates, there is less time for the atria to fill, and therefore less blood (atrial kick) to pump.

A nurse is assessing a client's ECG reading. The client's atrial and ventricular heart rates are equal at 88 beats per min. The PR interval is 0.14 seconds, and the QRS width is 0.10 seconds. Rhythm is regular with normal P waves and QRS complexes. How will the nurse interpret this rhythm? A. Normal sinus rhythm B. Sinus tachycardia C. Sinus bradycardia D. Sinus arrhythmia

A Rationale Normal sinus rhythm reflects normal conduction of the sinus impulse through the atria and ventricles. Atrial and ventricular rates are the same and range from 60 to 100 beats per minute. Rhythm is regular or essentially regular. PR interval is 0.12 to 0.20 seconds. QRS interval is 0.04 to 0.10 seconds. P and QRS waves are consistent in shape. Sinus tachycardia results when the sinoatrial (SA) node fires faster than 100 beats per minute. Bradycardia is defined as a heart rate less than 60 beats per minute. Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration. The heart rate slightly increases during inspiration and slightly slows during exhalation because of changes in vagal tone.

The nurse notes that the client's ECG rhythm strips show more P waves than QRS complexes. When there are PR intervals, they are all consistent. How should the nurse interpret this strip? A. Second degree AV block Mobitz II B. First degree atrioventricular (AV) block C. Third degree AV block (complete heart block) D. Second degree AV block Mobitz I (Wenckebach)

A Rationale Second degree AV block type II (Mobitz II) is a more critical type of heart block that requires early recognition and intervention. There is no progressive lengthening of the PR interval, which remains the same throughout, with the exception of the dropped beat(s). In first degree AV block, a P wave precedes every QRS complex, and the PR interval is prolonged. Third degree block often is called complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In complete heart block, the atria and ventricles beat independently of each other because the AV node is completely blocked to the sinus impulse, and it is not conducted to the ventricles. One hallmark of third degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. Also called Mobitz I or Wenckebach phenomenon, second degree AV block type I is represented on the ECG as a progressive lengthening of the PR interval until there is a P wave without a QRS complex.

A client is scheduled to have a coronary artery bypass graft (CABG). The client's spouse asks what the benefit of the surgery is. How should the nurse respond? A. "This surgery significantly decreases symptoms in most clients." B. "This procedure will enable your spouse to return to work after healing occurs." C. "Studies have consistently shown that this surgery increases an individual's life span." D. "Evidence substantiates that surgery can prevent progression of coronary artery disease."

A Rationale The majority of those who have this surgery have marked relief from their symptoms because the flow of blood to myocardial cells is increased. Whether the procedure will enable the client to return to work depends on the client's presurgical condition and occupation, not the surgery itself. So far, studies have failed to show that coronary artery bypass surgery affects life span. The surgery itself does not affect the disease process; clients must reduce risk factors (obesity, smoking, and high-fat/high-cholesterol diet) as well.

For which expected response should the nurse monitor a client after a cardiac catheterization? A. Marked increase in the volume of urine output B. Decrease in blood pressure of 25% from the precatheterization blood pressure C. Complaints of heart pounding with mild chest discomfort D. Respiratory distress with an increase in respiratory rate of more than 24 respirations per minute

A Rationale There is increased urinary output as a result of the diuretic effect of the contrast medium. A decrease of 10% to 20% is expected because of the diuretic effect of the contrast medium; a decrease greater than 20% may be pathologic. Although heart pounding with mild chest discomfort may occur during the procedure because of trauma to the conduction system, it usually does not continue after the procedure. Respiratory distress may be an indication of a pulmonary embolus from a venous clot and should be reported immediately.

Serum cardiac marker studies are prescribed for a client after a myocardial infarction. Which laboratory test is most important for the nurse to monitor? A. Troponin B. Myoglobin C. Homocysteine D. Creatine kinase (CK)

A Rationale Troponin is the biomarker of choice for a myocardial infarction. Troponin, specifically subtypes cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI), reflects myocardial muscle protein released into circulation soon after injury. Troponin increases as quickly as CK and remains increased for 2 weeks. Although myoglobin is one of the first cardiac markers to increase after a myocardial infarction (MI), it lacks cardiac specificity. Homocysteine is produced when proteins break down, but it is more indicative of cardiovascular disease than a myocardial infarction. CK isoenzyme levels, especially the creatine phosphokinase (MB) subunit, begin to increase in 3 to 6 hours, peak in 12 to 24 hours, and are increased for 48 hours after the occurrence of the infarct. Although reliable in assisting with an early diagnosis of MI, it is not as sensitive or specific as the troponin test.

A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)? Select all that apply. A. Obesity B. Hypertension C. Diabetes insipidus D. Asian-American ancestry E. Increased high-density lipoprotein (HDL)

A, B Rationale Obesity increases cardiac workload associated with vascular changes that lead to ischemia, which causes an MI. Hypertension damages blood vessels and increases peripheral resistance and cardiac workload, which may lead to an MI. Diabetes mellitus, not insipidus, is a risk factor for an MI. The risk is higher for African-Americans, not Asian-Americans. Increased levels of low-density lipoprotein (LDL), not HDL, increase the risk for heart disease.

Which clinical indicators is the nurse most likely to identify when taking the admission history of a client with right ventricular failure? Select all that apply. A. Edema B. Vertigo C. Polyuria D. Ascites E. Palpitations

A, D Rationale Heart failure is the failure of the heart to pump adequately to meet the needs of the body, resulting in a backward buildup of pressure in the venous system. Clinical manifestations include edema, ascites, hepatomegaly, tachycardia, and fatigue. Dyspnea occurs in left-sided heart failure because of pulmonary congestion and inadequate delivery of oxygen to all body cells. Vertigo generally is not related to right ventricular failure. Because a diminished cardiac output decreases blood flow to the kidneys, there will be a decreased, not increased, urine output (polyuria). Palpitations may indicate dysrhythmias or anxiety.

A client with angina pectoris is scheduled for a stress echocardiogram. What should the nurse tell the client that an echocardiogram is? A. A tool used solely to determine the cause of chest pain B. A noninvasive approach to assess cardiovascular status C. A modality of minimal value in planning treatment for angina D. An invasive test that measures the body's reaction to progressive increases in exertion

B Rationale A stress echocardiogram is noninvasive and uses echoes from pulsed high-frequency sound waves to locate and study the movements and dimensions of cardiac structures; it assesses myocardial disease, valve function, congenital heart defects, blood flow abnormalities, and systemic and pulmonic hypertension. A stress echocardiogram assesses structural defects as well as blood flow abnormalities. A stress echocardiogram is valuable in diagnosing and indicating treatment for a variety of conditions involving the heart's structure and function. A stress echocardiogram is not an invasive examination.

What must the nurse do to determine a client's pulse pressure? A. Multiply the heart rate by the stroke volume. B. Subtract the diastolic from the systolic reading. C. Determine the mean blood pressure by averaging the two. D. Calculate the difference between the apical and radial rate.

B Rationale Pulse pressure is obtained by subtracting the diastolic from the systolic reading after the blood pressure has been recorded. Multiplying the heart rate by the stroke volume is the definition of cardiac output; it is not the pulse pressure. Determining the mean blood pressure by averaging the two is not pulse pressure. Calculating the difference between the apical and radial rate is the pulse deficit.

An 80-year-old client with a history of coronary artery disease is admitted to the hospital for observation after a fall. During the night the client has an episode of paroxysmal nocturnal dyspnea. In what position should the nurse place the client to best decrease preload? A. Contour B. Orthopneic C. Recumbent D. Trendelenburg

B Rationale The client's paroxysmal dyspnea was probably caused by sleeping in bed with the legs at the level of the heart; the orthopneic position increases venous return from dependent body areas, increasing the intravascular volume. Sitting up and leaning forward while keeping the legs dependent slows venous return and increases thoracic capacity. Although the contour position elevates the client's head, it does not place the legs in a dependent enough position to substantially decrease venous return. The recumbent position is contraindicated. Venous return increases when the lower extremities are at the level of the heart. Also, the pressure of the abdominal organs against the diaphragm decreases thoracic capacity. The Trendelenburg position is contraindicated. Venous return increases when the lower extremities are higher than the level of the heart. Also, the pressure of the abdominal organs against the diaphragm decreases thoracic capacity.

A client has serially decreasing blood pressures after surgery. Which mechanisms involved in the regulation of blood pressure should the nurse consider? Select all that apply. A. Dilation of arterioles to increase peripheral resistance B. Activation of regulators that control renal angiotensin II C. Release of vasodilators, for example antidiuretic hormone D. Increase of left ventricular stroke volume to maintain blood volume E. Enervation of the sympathetic nervous system to constrict arterioles

B, D, E Rationale When the kidney senses a decreased circulating blood volume angiotensin I is released, which produces angiotensin II, a powerful vasoconstrictor; also, it stimulates the adrenal cortex to release aldosterone, which causes active reabsorption of sodium and water. Baroreceptors in the aortic arch and carotid sinus respond to altered arterial pressure, initiating events that ultimately stimulate peripheral vasoconstriction, thus increasing cardiac output. Alpha 1-adrenergic receptors are located in vascular smooth muscles and, when stimulated, cause vasoconstriction of the blood vessels. Arterioles will constrict, not dilate, to increase peripheral resistance. Antidiuretic hormone (vasopressin) will cause vessels to constrict, not dilate.

The client's underlying heart rhythm is sinus rhythm, but the rhythm is irregular because of occasional early beats. The configuration of the P waves is normal, except the P wave of the early beat does not look the same as the others. The morphology of the QRS complex is the same for all beats. The heart rate is 66 beats per min, and the blood pressure is normal. How should the nurse interpret this finding? A. Sinus tachycardia B. Normal sinus rhythm C. Sinus rhythm with premature atrial contractions (PACs) D. Sinus bradycardia with premature ventricular contractions (PVCs)

C A PAC is a single ectopic beat arising from atrial tissue, not the sinus node. The PAC occurs earlier than the next normal beat and interrupts the regularity of the underlying rhythm. The P wave of the PAC has a different shape than the sinus P wave because it arises from a different area in the atria; it may follow or be in the T wave of the preceding normal beat. If the early P wave is in the T wave, this T wave will look different from the T wave of a normal beat. Sinus tachycardia results when the sinoatrial (SA) node fires faster than 100 beats per minute. Normal sinus rhythm (NSR) reflects normal conduction of the sinus impulse through the atria and ventricles. Atrial and ventricular rates are the same and range from 60 to 100 beats per minute. Rhythm is regular or essentially regular. PR interval is 0.12 to 0.20 seconds. QRS interval is 0.06 to 0.12 seconds. P and QRS waves are consistent in shape. Bradycardia is defined as a heart rate less than 60 beats per minute.

A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client? A. Prevent dyspnea B. Prevent cyanosis C. Increase oxygen concentration to heart cells D. Increase oxygen tension in the circulating blood

C Rationale Administration of oxygen increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, usually is associated with myocardial infarction. Although administering oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a myocardial infarction from a coronary occlusion.

How can the nurse best describe heart failure to a client? A. A cardiac condition caused by inadequate circulating blood volume B. An acute state in which the pulmonary circulation pressure decreases C. An inability of the heart to pump blood in proportion to metabolic needs D. A chronic state in which the systolic blood pressure drops below 90 mm Hg

C Rationale As the heart fails, cardiac output decreases; eventually the decrease will reach a level that prevents tissues from receiving adequate oxygen and nutrients. Heart failure is related to an increased, not decreased, circulating blood volume. The condition may be acute or chronic; the pulmonary pressure increases and capillary fluid is forced into the alveoli. The blood pressure usually does not drop.

A client who has been experiencing chest pain and vomiting for several hours is admitted to the hospital with a diagnosis of myocardial infarction. The client is transferred immediately to the cardiac intensive care unit. The client's potassium level is below the expected range. Considering this laboratory result, what should the nurse monitor the client's electrocardiogram (ECG) for? A. Tall, peaked P waves B. Increased P-R intervals C. Elevated U and flattened T waves D. Multiple trigeminy and bigeminy runs

C Rationale Elevated U and flattened T waves reflect low serum potassium levels. U waves are not expected; they signify repolarization of the terminal Purkinje fibers and are seen with hypokalemia. T waves represent ventricular repolarization; T waves flatten with hypokalemia and peak with hyperkalemia. Changes in P waves reflect atrial depolarization and contraction activity; P waves flatten with hyperkalemia, not hypokalemia. Increased P-R intervals are related to a delay in conduction from the sinoatrial (SA) node to the ventricles and are not altered with hypokalemia. Trigeminy and bigeminy reflect ventricular irritability, not the serum potassium level.

A client is admitted to the hospital with multiple signs and symptoms associated with a cardiac problem. What clinical finding alerts the nurse that the primary healthcare provider probably will insert a pacemaker? A. Angina B. Chest pain C. Heart block D. Tachycardia

C Rationale Heart block is the primary indication for a pacemaker because there is an interference with the electrical conduction of impulses from the atria to the ventricles of the heart. The primary treatment for angina is medication; angina is not an indication for a pacemaker. The primary treatment for chest pain is medication; chest pain is not an indication for a pacemaker. The primary treatment for tachycardia is medication; tachycardia is not an indication for a pacemaker.

The nurse is interpreting the client's rhythm strip and finds that the P and QRS waves are consistent, with a P wave preceding every QRS complex. The PR interval is 0.26 seconds long. The rate is 64 beats per minute. How should the nurse interpret this rhythm? A. Complete heart block B. Normal sinus rhythm (NSR) C. Sinus rhythm with first degree AV block D. Sinus rhythm with second degree atrioventricular (AV) block

C Rationale In first degree block, P and QRS waves are consistent in shape. A P wave precedes every QRS complex, which is followed by a T wave. PR interval is prolonged and is greater than 0.20 seconds. NSR reflects normal conduction of the sinus impulse through the atria and ventricles; PR interval is 0.12 to 0.20 seconds. In second degree AV block, QRS may be normal or widened and have at least one or more nonconducted QRS complexes. In third degree AV block, QRS has no relationship with P waves.

A nurse discovers lower extremity pitting edema in a client with right ventricular heart failure. Which information should the nurse consider when planning care? A. Client has decreased plasma colloid osmotic pressure. B. Client has increased tissue colloid osmotic pressure. C. Client has increased plasma hydrostatic pressure. D. Client has decreased tissue hydrostatic pressure.

C Rationale In right ventricular heart failure, blood backs up in the systemic capillary beds; the increase in plasma hydrostatic pressure shifts fluid from the intravascular compartment to the interstitial spaces, causing edema. Increase in tissue (interstitial) colloid osmotic pressure occurs with crushing injuries or if proteins pathologically shift from the intravascular compartment to the interstitial spaces, pulling fluid and causing edema. In right ventricular heart failure, increased fluid pressure in the intravascular compartment causes fluid to shift to the tissues; the tissue hydrostatic pressure does not decrease. Although a decrease in colloid osmotic (oncotic) pressure can cause edema, it results from lack of protein intake, not increased hydrostatic pressure associated with right ventricular heart failure.

Metoprolol is prescribed for a client. Which condition in the client's electronic medical record will cause the nurse to question the prescription? A. Hypertension B. Angina pectoris C. Sinus bradycardia D. Myocardial infarction

C Rationale Metoprolol is a beta blocker; it decreases the heart rate and thus is contraindicated with bradycardia. Metoprolol is an antihypertensive agent and is given for hypertension. By reducing cardiac output, metoprolol reduces myocardial oxygen consumption, which helps prevent ischemia from anginal pain and myocardial infarction.

A client with a coronary occlusion is experiencing chest pain and distress. Why does the nurse administer oxygen? A. To prevent dyspnea B. To prevent cyanosis C. To increase oxygen concentration to heart cells D. To increase oxygen tension in the circulating blood

C Rationale Oxygen increases the transalveolar oxygen gradient, which improves the efficiency of the cardiopulmonary system. This enhances the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, usually is associated with myocardial infarction. Although increasing oxygen tension in the circulating blood may be true, it is not specific to heart cells.

A client is admitted to the hospital for an emergency cardiac catheterization. What adaptation is the client most likely to complain of after this procedure? A. Fear of dying B. Skipped heartbeats C. Pain at the insertion site D. Anxiety in response to intensive monitoring

C Rationale Pain at the arterial puncture site is attributable to entry and cannulation of the artery and is a common complaint after a cardiac catheterization. Fear of dying might occur during the precatheterization period. Although skipped heartbeats may occur during the procedure because of trauma to the conduction system, usually it does not continue after the procedure. Although some clients may be anxious, many feel safe when receiving ongoing monitoring.

A client is admitted to the hospital with atrial fibrillation. A diagnosis of mitral valve stenosis is suspected. The nurse concludes that it is most significant if the client presents with what history? A. Cystitis as an adult B. Pleurisy as an adult C. Childhood strep throat D. Childhood German measles

C Rationale Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve. Group A streptococcal antigens bind to receptors on heart cells, where an autoimmune response is triggered damaging the heart. Cystitis usually is caused by Escherichia coli, which does not affect heart valves. Pleurisy usually follows pulmonary problems unrelated to streptococcal infection; it does not result in damage to heart valves. The rubella virus does affect the valves of the heart.

The spouse of a client who had emergency coronary artery bypass surgery asks why there is a dressing on the client's left leg. How should the nurse explain the dressing? "This is the access site for the heart-lung machine." "A filter is inserted in the leg to prevent embolization." "A vein in the leg was used to bypass the coronary artery." "The arteries in the extremities are examined during surgery."

C Rationale The response that a vein in the leg was used to bypass the coronary artery provides information and reduces anxiety. The nurse understands that the greater saphenous vein of the leg is used to bypass the diseased coronary artery, and one surgical team obtains the vein while another team performs the chest surgery; this shortens the surgical time and decreases the risks of surgery. The internal mammary arteries are the grafts of choice, but the surgery is usually longer because of the necessity of dissecting the arteries from the chest wall. In addition, the internal mammary arteries may have been used in a previous bypass surgery. Cardiopulmonary bypass (extracorporeal circulation) is accomplished by placement of a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body; blood is returned to the body via a cannula in the aorta or the femoral artery. Off-pump surgery is used for minimally invasive surgical techniques. A filter is not inserted in the leg to prevent embolization during a coronary artery bypass graft (CABG). The arteries in the extremities are not examined during a CABG.

The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client's pain exhibits which characteristic? A. Causes mild perspiration B. Occurs after moderate exercise C. Continues after rest and nitroglycerin D. Precipitates discomfort in the arms and jaw

C Rationale When neither rest nor nitroglycerin relieves the pain, the client may be experiencing an acute myocardial infarction. Angina may cause mild diaphoresis; acute myocardial infarction causes profuse diaphoresis, which should be reported. Chest pain after exercise is expected; activity increases cardiac output, which can cause angina. Anginal pain can, and often does, radiate.

A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority? A. Increase left ventricular filling and improve cardiac output B. Decrease oxygen needs of the vital organs and prevent cardiac dysrhythmias C. Decrease the workload on the heart and promote maximum coronary artery filling D. Increase venous return to the right atrium and increase pulmonary arterial blood flow

C Rationale With a myocardial infarction, circulation of blood to cardiac muscle is reduced, depriving it of oxygen; therefore the oxygen demands of the body need to be decreased to reduce stress on the heart and reduce cardiac output. Increased coronary artery filling allows more blood and therefore oxygen to reach cardiac muscle; this increases myocardial efficiency. Increasing left ventricular filling increases the workload of the heart. Oxygenation of vital organs must be maintained. Decreasing oxygen to vital organs of the body may interfere with their ability to function. Increasing venous return to the right atrium increases the workload of the heart.

A client with heart disease has been reading on the Internet about the anatomy and physiology of the heart and tells the nurse, "I'm so confused." The nurse reinforces the pattern of circulation in the body. Which client statement indicates a correct understanding? A. "Blood enters the heart through the ductus arteriosus, flows into the left side of the heart, and exits via the aorta into the systemic circulation." B. "Blood enters the heart from the inferior vena cava; it then flows through the left atrium into the left ventricle, then into the lungs, and back into the aorta." C. "Blood enters the heart from the aorta, flows into the right atrium and right ventricle, through the lungs, then into the left atrium and left ventricle, and finally exits through the superior vena cava." D. "Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta."

D Rationale "Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta" correctly describes the flow of blood through the heart after birth. The ductus arteriosis is a fetal structure that is not present in the adult heart. Blood enters the right side of the heart via the inferior and superior vena cava; blood flows from the right atrium, to the right ventricle, to the lungs, and then to the left atrium. Blood exits, not enters, the heart from the aorta.

A nurse is caring for a client with a myocardial infarction. What is most important for the nurse to assess that has a direct relationship to the action potential of the heart? A. Heart rate B. Refractory period C. Pulmonary pressure D. Strength of contractions

D Rationale A direct relationship exists between the strength of cardiac contractions and electrical conductions through the myocardium. The heart rate is related to such factors as sinoatrial (SA) node function, partial pressures of oxygen and carbon dioxide, and emotions. Refractory period is the period when the heart is at rest, not when it is contracting. Pulmonary pressure does not influence action potential; it becomes increased in the presence of left ventricular failure.

When a client has a myocardial infarction, one of the major manifestations is a decrease in the conductive energy provided to the heart. When assessing this client, the nurse is aware that the existing action potential is in direct relationship to what? A. Heart rate B. Refractory period C. Pulmonary pressure D. Strength of contraction

D Rationale A direct relationship exists between the strength of cardiac contractions and the electrical conductions through the myocardium. The heart rate is related to factors such as sinoatrial (SA) node function, partial pressures of oxygen and carbon dioxide, and emotions. The refractory period is when the heart is at rest, not when it is contracting. Pulmonary pressure does not influence action potential; it becomes elevated in the presence of left ventricular failure.

The nurse observes the following pattern on a client's electrocardiogram (ECG) strip. What dysrhythmia does the nurse identify? A. Asystole B. Atrial flutter C. Ventricular fibrillation D. Premature ventricular complex

D Rationale Beats 2 and 4 are premature ventricular complexes or beats. The impulse originates in the ventricles, and it occurs before the next expected ventricular beat. Asystole is characterized by an absence of electrical and mechanical cardiac activity, with no countable heartbeat. Atrial flutter is characterized by an atrial rate of 250 to 350 regular beats per minute, more than 100 irregular ventricular beats per minute, a sawtooth P wave, variable PR intervals, and normal QRS complexes. Ventricular fibrillation is characterized by lack of organization in electrical impulses, conduction of impulses, and ventricular contractions.

A nurse is caring for a client with the diagnosis of right ventricular failure. Which condition unrelated to cardiac disease is the major cause of right ventricular failure? A. Renal disease B. Hypovolemic shock C. Severe systemic infection D. Chronic obstructive pulmonary disease (COPD)

D Rationale COPD causes destruction of capillary beds around the alveoli, interfering with blood flow to the lungs from the right side of the heart. As the heart continues to strain against this resistance, heart failure eventually results. Renal disease causes stress on the left side of the heart. Hypovolemic shock will not cause stress on the right side of the heart. Severe systemic infection probably will produce greater stress on the left side of the heart.

A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? A. "My ankles are swollen." B. "I am tired at the end of the day." C. "When I eat a large meal, I feel bloated." D. "I have trouble breathing when I walk rapidly."

D Rationale Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "I am tired at the end of the day" is not specific to left ventricular heart failure. The statement "When I eat a large meal, I feel bloated" is not specific to left ventricular heart failure.

A client is admitted for a coronary artery bypass graft. The client states that the preoperative teaching materials contain information about pacemaker wires being inserted during surgery as a precautionary measure. The client asks, "What is the purpose of the pacemaker?" What is the best response by the nurse? A. "These pacing wires can be attached to a temporary pacemaker to shock the heart if it starts beating too fast." B. "This type of pacemaker will automatically defibrillate the heart if the heart forgets to beat." C. "The pacemaker will maintain a constant cardiac rhythm." D. "In case of too slow of a heart rate, the epicardial leads are attached to a pacemaker to maintain a normal rate."

D Rationale Epicardial pacing involves attaching an atrial and ventricular pacing lead to the epicardium during heart surgery. The leads are passed through the chest wall and attached to the external power source. Epicardial pacing leads are placed prophylactically in case any bradydysrhythmias or tachydysrhythmias occur in the early postoperative period. Vagal stimulation during surgery may cause a severe bradycardia; in anticipation, pacemaker wires are inserted into the right atrium to be used to initiate impulses if the natural rate decreases below the preset rate of the pacemaker. This will ensure that the heart beats at the rate set for the pacemaker. This pacemaker initiates an impulse if the heart rate drops below a certain rate; the concept underlying this pacemaker is to speed up the heart, not to slow it down. There are no data to support the fact that this is a defibrillator pacemaker. The pacemaker wires are not used for defibrillation; defibrillator paddles are placed so that electricity affects the entire heart muscle. The rhythm can be irregular; however, if the pause between two beats is too long, the pacemaker will initiate an impulse.

A nurse witnesses a person fall. The person becomes unresponsive and pulseless. The nurse plans to use an automated external defibrillator (AED) that is available on site. What should the nurse do first? A. Remove all jewelry. B. Wash the chest area. C. Use a grounded electrical source. D. Remove medication patches on the chest.

D Rationale Medication patches that interfere with electrode placement must be removed before application of electrodes because of possible burn caused by electrical conduction in the area of the patch. Jewelry usually is not a problem with the function of an automated external defibrillator. Skin preparation is unnecessary. The AED is battery-operated and does not need a grounded electrical source.

The nurse is conducting a nutrition class for a group of clients with heart failure (HF). Which information is most important for the nurse to share with the class? A. Restricting fluid intake B. Eating a low caloric diet to reduce weight C. Recognizing which products are high in cholesterol D. Choosing fresh or frozen vegetables instead of canned ones

D Rationale The key principle to teach HF clients is the importance of decreasing sodium in their diet and which foods contain sodium. If sodium is decreased, water retention will decrease also. Fresh or frozen vegetables have less sodium than canned ones. If the client is on a low-sodium diet and receiving diuretics but continues to be fluid overloaded, then fluid restriction may be instituted. A low caloric diet is not indicated for all HF clients. Some are very thin because of various factors, including the work of breathing and rapid heart rate. A low cholesterol diet is important for clients with coronary artery disease and for the American population in general but is not specifically related to HF.

The nurse provides discharge teaching to a client who has received prescriptions for digoxin, furosemide, and a 2-gram sodium diet. Which statement from the client indicates that further teaching is needed? A. "I must check my pulse every day." B. "I can gradually increase my exercise as long as I take rest periods." C. "I should call my healthcare provider if I have difficulty breathing when I am lying flat." D. "I can use a little table salt on my food as long as I do not use it when cooking food."

D Rationale The response "I can use a little table salt on my food as long as I do not use it when cooking" demonstrates that the client did not understand the discharge teaching. Table salt and foods high in sodium should be avoided. Sodium intake causes fluid retention, which can precipitate a fluid volume excess, which contributes to heart failure. Digoxin should be withheld if the client's pulse is less than a preset rate (i.e., 60 beats per minute) because this is a sign of digoxin toxicity; the risk of digoxin toxicity is increased if the client develops hypokalemia as a result of receiving furosemide. Slowly increasing activities while ensuring rest periods limits the stress on the heart and is desirable. Orthopnea is a sign of pulmonary edema related to heart failure, and the healthcare provider should be notified.