Cardiovascular

Digoxin toxicity

Asses vision changes

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an

Anticoagulant

A client with heart failure has not slept for the past 3 nights because of dyspnea. Arterial blood gas (ABG) analysis reveals pH, 7.32; PaO2, 79 mm Hg; PaCO2, 50 mm Hg; and HCO3-, 29 mEq/L. What is the priority nursing intervention for this client?

Apply oxygen via nasal cannula at rate of 2 L/min

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the last several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?

Blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL

The nurse is assessing a client with Buerger's disease. The nurse should determine if the client is experiencing:

Inflammation and fibrosis of arteries, veins, and nerves.

The nurse is administering an IV potassium chloride supplement to a client who has heart failure. When developing a plan of care for this client, the nurse should consider that:

the administration of the IV potassium chloride should not exceed 10 mEq/h or a concentration of 40 mEq/L.

A client requested a do-not-resuscitate (DNR) order upon admission to the hospital. He now tells the nurse that he wants the medical team to do everything possible to help him get better and is concerned about the DNR order. Which response by the nurse is best?

"It isn't a problem to rescind your DNR order; I'll let your physician know your wishes right away."

A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride, an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within:

1-2 minutes after bolus administration

A nurse on the telemetry unit is faced with various monitor rhythms. Which rhythm takes priority?

A client's cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation.

The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first?

Assess respiratory status

Which condition most commonly results in coronary artery disease (CAD)?

Atherosclerosis

A client is taking spironolactone. Which change in the diet should the nurse teach the client to make when taking this drug?

Avoid eating foods high in potassium

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?

Be sure to take safety precautions because nitroglycerin may cause dizzy spells.

A client comes to the emergency department reporting of severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which of the following should the nurse do first when the client is admitted to the coronary care unit?

Begin telemetry monitoring

A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?

Blood pressure 88/46

The nurse is assessing a client with irreversible shock. The nurse should document which finding?

Circulatory collapse

During a home visit, the nurse assesses a client who is taking hydrochlorothiazide and lisinopril for the treatment of hypertension. Which finding would indicate the nurse should inform the health care provider of a possible need to change medication therapy?

Client has a persistent cough.

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

Contact the physician and report the findings.

A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of:

Digoxin toxicity

The nurse monitors the serum electrolyte levels of a client who is taking digoxin. Which electrolyte imbalance is a common cause of digoxin toxicity?

Hypokalemia

The nurse is reviewing the electrocardiogram of a client who has elevated ST segments visible in leads II, III, and aVf. Which is the nurse's best action?

Notify healthcare provider

A nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should:

Press the right upper abdomen

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs?

Prothrombin Time (PT)

While the nurse is assisting a client to ambulate as part of a cardiac rehabilitation program, the client has midsternal burning. The nurse should:

Stop and assess client further

A nurse just received a shift report for a group of clients on the telemetry unit. Which client should the nurse assess first

The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block

A client is given amiodarone in the emergency department for a dysrhythmia. Which finding indicates the drug is having the desired effect?

The number of premature ventricular contractions is decreasing.

The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client:

This drug will dilate your arteries and decrease your blood pressure.

The nurse is assessing a client with an atrial septal defect (ASD). Which requires immediate nursing intervention?

Uneven smile and facial droop

The client with peripheral vascular disease has been prescribed diltiazem. The nurse should determine the effectiveness of this medication by assessing the client for

Vasodilation

A client with Raynaud's phenomenon is considering having a sympathectomy. This nurse should tell the client that the surgery is performed:

When all treatment alternatives have failed.

A client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed?

Withhold the medication and notify the physician immediately.

An older client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider (HCP) has written a prescription to:

Withhold the medication prior to catheterization

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

Within 6 hours

During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when palpation of the radial pulse reveals:

irregular rhythm with beat more than 100 per minute

A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the nurse best explains the procedure to the client?

"PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter."

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of:

Acute pulmonary edema

A client has sudden, severe pain in the back and chest, accompanied by shortness of breath. The client describes the pain as a "tearing" sensation. The health care provider (HCP) suspects the client is experiencing a dissecting aortic aneurysm. The emergency supply cart is brought into the room because one complication of a dissecting aneurysm is:

Cardiac tamponade.

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The nurse suspects that these assessment findings are most probably due to the client experiencing a specific type of MI known as:

Anterior

An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment?

Explain that the ringing may be related to the aspirin use.

A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 124/80 mm Hg to 88/62 mm Hg. What should the nurse assess first?

Pedal pulses

A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?

Pericardial friction rub

A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?

Potassium level of 3.1

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:

Myocardial necrosis.

The nurse is caring for a client post myocardial infarction (MI). Orders include strict bed rest and a clear, liquid diet. What is the nurse's best response to the client when inquiring about the purpose of the new diet?

To reduce the metabolic workload of digestion