Cardiovascular Review CoursePoint - NCIV Exam 3
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A. Carvedilol B. Digoxin C. Furosemide D. Nitroprusside
A A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
The nurse is providing care for a client with pulmonary edema. Which assessment method should the nurse prioritize to monitor the respiratory status of this individual? A. Arterial blood gas (ABG) analysis B. Pulse oximetry C. Skin color assessment D. Lung sounds
A ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although a nurse can use any of the options to detect pulmonary changes, assessment of skin color and assessment of lung fields commonly are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? A. Application of a vascular closure device such as Angio-Seal or VasoSeal B. Direct manual pressure C. Application of a pneumatic compression device (e.g., FemoStop) D. Application of a sandbag to the area
A Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site and application of a pneumatic compression device after PTCA have been demonstrated to be effective; the former was the first method used to induce hemostasis after PTCA. Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.
Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? A. Application of a sandbag to the area B. Application of a vascular closure device C. Direct manual pressure D. Application of a mechanical compression device
A Applying a sandbag to the sheath insertion site is ineffective in reducing the incidence of bleeding and is not an acceptable standard of care. Application of a vascular closure device (Angio-Seal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (a C-shaped clamp) are all appropriate methods used to induce hemostasis after removal of a peripheral sheath.
The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? A. Urine output of 40 mL B. Potassium level of 4.0 mEq/L C. Heart rate of 100 bpm D. Dried blood at the puncture site
A Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The client is expected to have a minimum urine output of 30 mL/h. Dried blood at the insertion site is a finding that warrants no acute intervention. A serum potassium level of 4.0 mEq/L is within the normal range. The heart rate of 100 bpm is within the normal range and indicates no acute distress.
The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? A. Creatinine kinase-myoglobin (CK-MB) level B. Troponin C level C. Myoglobin level D. CK-MM
A Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (as a result of thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. Three isomers of troponin exist: C, I, and T. Troponins I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? A. IV morphine B. IV nitroglycerin C. Atenolol D. Amlodipine
A IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a long-term goal of rehabilitation for the client with an MI? A. Improvement in quality of life B. Limitation of the effects and progression of atherosclerosis C. Ability to return to work and a pre-illness functional capacity D. Prevention of another cardiac event
A Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of a client with an MI patient are to limit the effects and progression of atherosclerosis, to return the client to work and a pre-illness lifestyle, and to prevent another cardiac event.
A client diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI? A. Improved quality of life B. Limit to the effects and progression of atherosclerosis C. Return to work and the lifestyle experienced before the illness D. Prevention of another cardiac event
A Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of the client with an MI is to limit the effects and progression of atherosclerosis, to return the client to work and their pre-illness lifestyle, and to prevent another cardiac event.
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? A. Cardiac tamponade B. Elevated central venous pressure C. Hypertension D. Hypothermia
A Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.
The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? A. "What time did your chest pain start today?" B. "Do your parents have heart disease?" C. "How many sublingual nitroglycerin tablets did you take?" D. "What is your pain level on a scale of 1 to 10?"
A The client may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the client's chest pain lasts longer than 20 minutes and is unrelieved by nitroglycerin, if ST-segment elevation is found in at least two leads that face the same area of the heart, and if it has been less than 6 hours since the onset of pain. The most appropriate question for the nurse to ask is in relations to when the chest pain began. The other questions would not aid in determining whether the client is a candidate for thrombolytic therapy
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. B. Instruct the client to renew the nitroglycerin supply every 3 months. C. Instruct the client not to crush the tablet. D. Instruct the client to place nitroglycerin tablets in a plastic pill box.
A The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A. ST elevation B. Isolated premature ventricular contractions (PVCs) C. Sinus tachycardia D. Frequent premature atrial contractions (PACs)
A The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? A. Decreases resting heart rate B. Decreases cholesterol level C. Increases cardiac output D. Decreases platelet aggregation
A The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation
Which test used to diagnose heart disease is least invasive? A. Transthoracic echocardiography B. Magnetic resonance imaging C. Cardiac catheterization D. Coronary arteriography
A Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. Coronary arteriography requires the instillation of a contrast medium into each coronary artery.
A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to the client? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use. C. Cover the patch in plastic wrap after applying. D. Seek emergency treatment if flushing or nausea occurs.
A, B Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea.
The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A. Echocardiogram B. Cardiac catheterization C. Magnetic resonance imaging D. Positron emission tomography scan E. Troponin levels
A, B, C Echocardiogram, cardiac catheterization, and magnetic resonance imaging can provide ejection fraction estimates. The positron emission tomography scan reveals areas of decreased blood flow in the heart. Troponin levels are cardiac markers and do not measure ejection fractions.
A nurse is assessing a patient who has had valvular heart disease for more than 15 years. Which signs and symptoms should the nurse expect? (Choose all that apply.) A. Paroxysmal nocturnal dyspnea B. Orthopnea C. Cough D. Pericardial friction rub E. Pulsus paradoxus
A, B, C Paroxysmal nocturnal dyspnea, orthopnea, and coughing occur in long-term valvular disease. Pericardial friction rub is a sound auscultated in clients with pericarditis, not valvular disease. Pulsus paradoxus is a marked decrease in amplitude during inspiration, a sign of cardiac tamponade
The client has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should assess for indications of what potential complications? Select all that apply. A. Emboli B. Mitral valve damage C. Ventricular dysrhythmia D. Atrial-septal defect E. Plaque formation
A, B, C Possible complications include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, and bleeding from the catheter insertion sites. Atrial-septal defect and plaque formation are not complications of a balloon valvuloplasty.
A client with infective endocarditis is admitted to the hospital. While obtaining a history, what should the nurse ask the client about? Select all that apply. A. Renal dialysis B. Intravenous (IV) drug use C. Nasal piercing D. Prosthetic cardiac valves E. Recent urinary tract infection
A, B, C, D, E Endocarditis infections are common among IV injection drug users; clients with debilitating disease or indwelling catheters; clients receiving hemodialysis or prolonged IV fluid or antibiotic therapy; clients with oral, nasal, or nipple body piercings; and, clients with prosthetic cardiac valves.
The nurse is assessing a client with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? Select all that apply. A. Dyspnea B. Unusual fatigue C. Hypotension D. Syncope E. Peripheral cyanosis
A, B, D Systematic assessment includes a careful history, particularly as it relates to symptoms: chest pain or discomfort, difficulty breathing (dyspnea), palpitations, unusual fatigue, faintness (syncope), or sweating (diaphoresis). Each symptom must be evaluated with regard to time, duration, and the factors that precipitate the symptom and relieve it, and in comparison with previous symptoms. Hypotension and peripheral cyanosis are not typically associated with ACS
The nurse is caring for a client diagnosed with bacterial myocarditis. The client's heart rate is 120-130 beats per minute and blood pressure 158/89 mm Hg. What medications will the nurse administer to treat the client with myocarditis? Select all that apply. A. Carvedilol B. Amiodarone C. Nitroglycerin D. Penicillin E. Ibuprofen
A, B, D The nurse will administer a beta blocker, carvedilol, to lower heart rate and blood pressure; and amiodarone, an antidysrhythmic, to lower heart rate. Penicillin is used to treat bacterial myocarditis. Nitroglycerin would be given to decrease preload, but this is not a treatment for myocarditis. Ibuprofen may cause more inflammation with myocarditis.
Which assessments should a nurse perform when caring for a client following a cardiac catheterization? Select all that apply. A. Monitor BP and pulse frequently. B. Inspect pressure dressing for signs of bleeding. C. Inspect the color in every extremity. D. Palpate the insertion site for tenderness. E. Palpate the pulse in different locations.
A, B, E After a cardiac catheterization, the nurse monitors BP and pulse frequently to detect complications, checks the dressing over the insertion site frequently for signs of bleeding, palpates the pulse in various locations, and checks the color and temperature in the affected extremity to confirm that blood is circulating well.
The nurse is caring for a client newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the client to address modifiable risk factors for CAD, the nurse will include which factor(s)? Select all that apply. A. Elevated blood pressure B. Decreased LDL level C. Obesity D. Alcohol use E. Drug use
A, C Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factors for CAD. Alcohol and drug use are not included in the list of modifiable risk factors for CAD.
The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply. A. Colchicine B. Indomethacin C. Ibuprofen D. Prednisone
A, C, D Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be prescribed for pain relief during the acute phase. Indomethacin is contraindicated because it may decrease coronary blood flow. Corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or the patient does not respond to NSAIDs. Colchicine may also be used as alternative therapy.
The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply. A. Abrupt closure of the coronary artery B. Venous insufficiency C. Bleeding at the insertion site D. Retroperitoneal bleeding E. Arterial occlusion
A, C, D, E Complications after the procedure may include abrupt closure of the coronary artery and vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion, as well as acute kidney injury. Venous insufficiency is not a postprocedure complication of a PTCA.
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. A. Reduces myocardial oxygen consumption B. Decreases the urge to use tobacco C. Dilates blood vessels D. Decreases ischemia E. Relieves pain
A, C, D, E Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco.
The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. A. Adequate cough and gag reflexes B. Inability to speak C. Acceptable arterial blood gas values D. Labile vital signs E. Breathing without assistance of the ventilator
A, C, E Before being extubated, the client should have cough and gag reflexes and stable vital signs; be able to lift the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable arterial blood gas levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) A. Abrupt closure of the artery B. Aortic dissection C. Arterial dissection D. Nerve root pressure E. Coronary artery vasospasm
A, C, E Complications that can occur during a PTCA procedure include coronary artery dissection, perforation, abrupt closure, or vasospasm. Additional complications include acute myocardial infarction, serious dysrhythmias (e.g., ventricular tachycardia), and cardiac arrest. Some of these complications may require emergency surgical treatment. Complications after the procedure may include abrupt closure of the coronary artery and a variety of vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion
The nurse is providing discharge teaching to a client with recurrent endocarditis. What are prevention strategies will be included with the teaching? Select all that apply. A. Use a nail clipper for fingernail care B. Body piercing can be done in a clean area C. Report recurrent fever lasting longer than 7 days to the health care provider D. Use a toothpick to keep food from accumulating in the mouth E. Notify dentist of the history of endocarditis with any planned dental procedures
A, C, E The client at high risk for endocarditis should report recurrent fever lasting longer than 7 days to the health care provider, avoid nail biting, and notify the dentist of the history of endocarditis before any planned dental procedures. Body piercing and using toothpicks can provide an entry for infection for high-risk clients
A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client? A. Balloon angioplasty B. Balloon valvuloplasty C. Cardiac catheterization D. Cardiac graft procedure
B Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for symptomatic aortic stenosis.
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates A. An evolving MI B. An old MI. C. Variant angina. D. A cardiac dysrhythmia.
B An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? A. Posterior B. Anterior. C. Lateral. D. Inferior.
B An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.
A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug? A. Ibuprofen B. Clopidogrel C. Dipyridamole D. Acetaminophen
B Because of the risk of thrombus formation within the stent, the client receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement
A client has a blockage in the proximal portion of a coronary artery and decides to undergo percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse expect to administer during the procedure? A. Ceftriaxone B. Ticagrelor C. Hydrochlorothiazide D. Metoprolol
B During PTCA, the client receives heparin, an anticoagulant (ticagrelor), as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses do not routinely give antibiotics such as ceftriaxone during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive like metoprolol and a diuretic like hydrochlorothiazide may cause hypotension, which should be avoided during the procedure.
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. Decrease anxiety B. Enhance myocardial oxygenation C. Administer sublingual nitroglycerin D. Educate the client about his symptoms
B Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care, neither is a priority when a client is compromised.
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? A. "I should avoid taking a tub bath until my catheter site heals." B. "I should expect a low-grade fever and swelling at the site for the next week." C. "I should avoid prolonged sitting." D. "I should expect bruising at the catheter site for up to 3 weeks."
B Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? A. Recent consumption of a meal B. Prior intracranial hemorrhage C. Shellfish allergy D. Use of heparin
B History of a prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy. An allergy to iodine, shellfish, radiographic dye, and latex are of primary concern before a cardiac catheterization but not a known contraindication for thrombolytic therapy. Administration of a thrombolytic agent with heparin increases risk of bleeding; the primary healthcare provider usually discontinues the heparin until thrombolytic treatment is completed.
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? A. Troponin I B. Myoglobin C. WBC (white blood cell) count D. C-reactive protein
B Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.
A client in the ICU has a central venous pressure (CVP) line placed. The CVP reading is 10 mm Hg. To what condition does the nurse correlate the CVP reading? A. Hypovolemia B. Right-sided heart failure C. Left-sided heart failure D. Reduction in preload
B Normal CVP is 2 to 8 mm Hg. A CVP greater that 8 mm Hg indicates hypervolemia or right-sided heart failure. A CVP less than 2 mm Hg indicates a reduction in preload or hypovolemia.
The critical care nurse is caring for a client who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the client's left ventricular function? A. Central venous pressure (CVP) monitoring B. Pulmonary artery pressure monitoring (PAPM) C. Systemic arterial pressure monitoring (SAPM) D. Arterial blood gases (ABGs)
B Pulmonary artery pressure monitoring is used to assess left ventricular function. CVP is used to assess right ventricular function; systemic arterial pressure monitoring is used for continual assessment of BP. ABGs are used to assess for acidic and alkalotic levels in the blood.
Which changes occur to the heart as a result of heart transplant? A. Heart beats slower than the natural heart B. Heart beats faster than the natural heart C. No significant changes are noted in the heart D. The heart takes less time to increase the heart rate in response to exercise
B The transplanted heart beats faster than the client's natural heart, averaging 90 to 110 beats/minute, because sympathetic and vagus nerves that affect heart rate have been severed. The new heart also takes longer to increase the heart rate in response to exercise. Coronary artery disease is a common problem among heart transplant recipients
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? A. Alkaline phosphatase B. Creatine kinase MB C. Myoglobin D. Troponin
B There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.
The nurse is caring for a client with aortic regurgitation. What medication will the nurse administer to reduce afterload? A. Diltiazem B. Nitroprusside C. Metoprolol D. Isosorbide
B Vasodilators such as nitroprusside are used for afterload reduction to lower the volume and pressure overload of the left ventricle. Calcium channel blockers such as diltiazem are contraindicated due to their negative inotropic effects (decreases the strength of the contraction) and their potential to cause bradycardia. Beta blockers like metoprolol should be avoided to allow for compensatory tachycardia. Nitrates and isosorbide are used to treat angina.
A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. A. Absent P-waves B. Abnormal Q-waves C. T-wave hyperactivity and inversions D. ST-segment elevations E. U-wave elevations
B, C, D These three signs are classic ECG changes suggestive of a myocardial infarction. Changes can be diagnostic to the area of cellular damage. P wave and U wave changes are not characteristic of an MI.
The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. A. Morphine B. Atorvastatin C. Enalapril D. Aspirin E. Sildenafil
B, C, D Upon client discharge, there needs to be documentation that the client was discharged on a statin (atorvastatin), an ACE or angiotensin receptor blocking agent (enalapril), and aspirin. Morphine is used to reduce the client's pain and anxiety. Sildenafil is a medication used for pulmonary hypertension
The nurse working in the medical intensive care unit is caring for a client admitted with mitral stenosis. What will the nurse assess is related to the pathophysiology of mitral stenosis? Select all that apply. A. High-pitched murmur B. Fatigue C. Low-pitched murmur D. Shortness of breath with activity E. History of endocarditis
B, C, D, E Clients with mitral stenosis can have fatigue, a low-pitched murmur due to turbulent blood flow, shortness of breath from poor cardiac blood flow, and decreased cardiac output. A history of endocarditis can cause valve damage from vegetation break off. The high-pitched murmur is seen with mitral valve regurgitation.
A client who had coronary artery bypass surgery is exhibiting signs of heart failure. What medications will the nurse anticipate administering for this client? Select all that apply. A. Amlodipine B. Diuretics C. Nitroprusside D. Inotropic agents E. Digoxin
B, D, E Medical management of cardiac failure includes digoxin, diuretics, and IV inotropic agents. Amlodipine and calcium channel blockers are not used due to systolic dysfunction. Nitroprusside is a vasodilator that is not used for heart failure.
The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. A. Place pillows in the popliteal space. B. Apply antiembolism stockings. C. Encourage the client to cross their legs. D. Avoid elevating the knees on the bed. E. Initiate passive exercises.
B, D, E Preventive measures used to prevent venous stasis include application of sequential pneumatic compression devices; discouraging crossing of legs; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; and beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. A. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. B. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. C. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. D. Renew the supply every 6 months. E. Take the tablet in anticipation of any activity that can produce pain. F. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
B, D, E, F Nitroglycerine is very unstable and should be carried securely in its original container (capped, dark, glass bottle). The tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerine is also volatile and is inactivated by heat, moisture, air, light, and time. Therefore, storage and replacement is recommended every 6 months
A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? A. Predictable and consistent pain that occurs on exertion and is relieved by rest B. Pain that may occur at rest, but the threshold for pain is lower than expected C. Severe, incapacitating chest pain D. Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina
C
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A. Minimal oozing of blood from the IV site B. Presence of reperfusion dysrhythmias C. Altered level of consciousness D. Chest pain 2 of 10 (on a 1-to-10 pain scale)
C A client receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding, and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low and indicates the client's chest pain is subsiding, an expected outcome of this therapy.
A nurse is working with a client who has been scheduled for a percutaneous coronary intervention (PCI) later in the week. What anticipatory guidance should the nurse provide to the client? A. The client will remain on bed rest for 48 to 72 hours after the procedure. B. The client will be given vitamin K infusions to prevent bleeding following PCI. C. A sheath will be placed over the insertion site after the procedure is finished. D. The procedure will likely be repeated in 6 to 8 weeks to ensure success.
C A sheath is placed over the PCI access site and kept in place until adequate coagulation is achieved. Clients resume activity a few hours after PCI and repeated treatments may or may not be necessary. Anticoagulants, not vitamin K, are given during PCI.
The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? A. Maximizing cardiac output while minimizing heart rate B. Decreasing energy expenditure of the myocardium C. Balancing myocardial oxygen supply with demand D. Increasing the size of the myocardial muscle
C Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the client with ACS. Treatment is not aimed directly at minimizing heart rate because some clients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardium's energy expenditure is often beneficial, but this must be balanced with productivity.
A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? A. Administration of bronchodilators by nebulizer B. Administration of inhaled corticosteroids by metered dose inhaler (MDI) C. Client's consistent performance of deep-breathing and coughing exercises C. Client's active participation in the cardiac rehabilitation program
C Clearance of pulmonary secretions is accomplished by frequent repositioning of the client, suctioning, and chest physical therapy, as well as educating and encouraging the client to breathe deeply and cough. Medications are not normally used to achieve this goal. Rehabilitation is important, but will not necessarily aid the mobilization of respiratory secretions.
The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? A. "I eat six small meals a day when I am hungry." B. "My food tastes bland without salt." C. "I cut back on going up the steps during the day." D. "My best time of the day is the morning."
C Cutting back on activity like climbing stairs is an indication of a lessened ability to exercise. Eating small meals and not using salt are usually indicated for clients with heart failure. The client's assertion about morning being the best time of day is a vague statement.
A client is recovering from coronary artery bypass graft (CABG) surgery. During discharge preparation, the nurse should advise the client and family members to expect which common symptom that typically resolves spontaneously? A. Ankle edema B. Memory lapses C. Depression D. Dizziness
C For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate notification to a health care provider.
The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy? A. A history of alcoholism B. A history of amyloidosis C. A parent has the same disorder D. A long-standing history of hypertension
C Hypertrophic cardiomyopathy (HCM) is a rare autosomal dominant condition, occurring in men, women, and children (often detected after puberty) with an estimated prevalence rate of 0.05% to 0.2% of the population in the United States. Echocardiograms may be performed every year from 12 to 18 years of age and then every 5 years from 18 to 70 years of age in susceptible individuals (i.e., those with a family history of HCM). Alcoholism does not cause hypertrophic cardiomyopathy. Amyloidosis is a build up of an abnormal protein and can cause the heart to stiffen and not pump effectively. Hypertension cardiomyopathy is different from hypertrophic cardiomyopathy
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A. Isosorbide mononitrate (Isordil) B. Meperidine hydrochloride (Demerol) C. Morphine sulfate (Morphine) D. Nitroglycerin transdermal patch
C Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.
The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? A. Creatinine kinase-myocardial band (CK-MB) B. Total creatinine kinase (CK) C. Myoglobin D. Troponin I and T
C Myoglobin is a heme protein that transports oxygen. Its levels can increase as early as 1 hour after an MI. Negative results are an excellent parameter for ruling out an acute MI. The other biomarker choices start to increase in 2 to 4 hours.
A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? A. Activities that increase myocardial oxygen demand. B. An unpredictable amount of activity. C. Coronary artery spasm. D. The same type of activity that caused previous angina episodes.
C Prinzmetal angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.
The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? A. 30 minutes to 1 hour after pain B. 2 to 3 hours after admission C. 4 to 6 hours after pain D. 12 to 18 hours after admission
C Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days
An obese client describes symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm the suspected diagnosis. What diagnostic procedure would the nurse expect to be prescribed? A. Chest radiograph B. Radionuclide angiography C. Transesophageal echocardiography D. Electrocardiography
C TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.
A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? A. 5 minutes B. 15 minutes C. 10 minutes D. 20 minutes
C The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a client reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored
The ED nurse is caring for a client with a suspected MI. What drug should the nurse anticipate administering to this client? A. Oxycodone B. Warfarin C. Morphine D. Acetaminophen
C The client with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta- blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.
The nurse is assessing a client with left-sided heart failure. What assessment finding is expected? A. Ascites B. Jugular vein distention C. Air hunger D. Pitting edema of the legs
C With left-sided heart failure, the client typically has air hunger and other signs of pulmonary congestion. Ascites, jugular vein distention, and pitting edema of the legs are signs of right-sided heart failure.
A nurse working in the medical intensive care unit has a client admitted with mitral stenosis. The nurse is precepting a graduate nurse and explains the pathophysiology of the condition. What statement made by the graduate nurse will reflect an appropriate understanding of the disease process? Select all that apply. A. "It is caused by a tear that leads to the lungs becoming congested." B. "Mitral stenosis is caused by an obstruction between the right atrium and ventricle." C. "There is a narrowing between the left atrium and left ventricle." D. "Increased blood flow in the left atrium causes left atrial hypertrophy." E. "Mitral stenosis affects the coronary blood flow and can lead to angina."
C, D Poor left ventricular filling can cause decreased cardiac output. The increased blood volume in the left atrium causes it to dilate and hypertrophy. The left atrium and ventricle are affected with mitral stenosis. Mitral regurgitation causes the lungs to become congested. Mitral stenosis does not interfere with coronary blood flow.
A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication should the nurse monitor for? Select all that apply. A. Nausea and vomiting B. Pulmonary embolism C. Cardiac dysrhythmias D. Respiratory arrest E. Cardiac arrest
C, D, E Pulmonary edema is fluid accumulation in the lungs, which interferes with gas exchange in the alveoli. It represents an acute emergency and is a frequent complication of left-sided heart failure. Cardiac dysrhythmias and cardiac or respiratory arrest are associated complications. Nausea and vomiting are not complications but are symptoms of many disorders. The client is not at increased risk for the development of pulmonary embolism with pulmonary edema.
The OR nurse is explaining to a client that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe? A. Coronary artery bypass graft (CABG) B. Percutaneous transluminal coronary angioplasty (PTCA) C. Atherectomy D. Cardiopulmonary bypass
D Cardiopulmonary bypass is often used to circulate and oxygenate blood mechanically while bypassing the heart and lungs. PTCA, atherectomy, and CABG are all surgical procedures, none of which achieves the two goals listed.
What normal change due to aging does the nurse expect in the heart of an older client? A. Decreased left ventricular ejection time B. Decreased connective tissue in the SA and AV nodes and bundle branches C. Thinning and flaccidity of the cardiac values D. Widening of the aorta
D Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).
The nurse is caring for a client who will have coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse should address which subject? A. Symptoms of hypovolemia B. Symptoms of low blood pressure C. Complications requiring graft removal D. Intubation and mechanical ventilation
D Most clients remain intubated and on mechanical ventilation for several hours after surgery. It is important that clients realize that this will prevent them from talking, and the nurse should reassure them that the staff will be able to assist them with other means of communication. Teaching would generally not include symptoms of low blood pressure or hypovolemia, as these are not applicable to most clients. Teaching would also generally not include rare complications that would require graft removal.
The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? A. "After taking two tablets with no relief, I should call EMS." B. "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". C. "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension". D. "I can take nitroglycerin before sex so I won't develop chest pain".
D Nitroglycerin can be taken in anticipation of any activity that may produce pain. Because nitroglycerin increases tolerance for exercise and stress when taken prophylactically (i.e., before an angina-producing activity such as exercise, stair-climbing, or sexual intercourse), it is best taken before pain develops. The client is instructed to take three tablets 5 minutes apart; if the chest pain is not relieved, emergency medical services should be contacted. Nitroglycerin is very unstable; it should be carried securely in its original container (e.g., a capped dark glass bottle), and tablets should never be removed and stored in metal or plastic pillboxes. Side effects of nitroglycerin include flushing, throbbing headache, hypotension, and tachycardia.
A client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6 °F (37.6 °C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. What assessment is the nurse's highest priority? A. Body temperature B. Cardiac output C. Anxiety D. Acute pain
D The assessment of pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. The client's blood pressure and heart rate do not suggest a decreased cardiac output. Anxiety may be an important assessment, but addressing acute pain (the priority concern) may alleviate the client's anxiety
The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure? A. Avoid subcutaneous injections B. Use an electric toothbrush C. Avoid the use of nail clippers D. Avoid continuous BP monitoring
D The client receiving heparin receives bleeding precautions, which can include applying pressure to the site of any needle punctures for a longer time than usual, avoiding intramuscular injections, and avoiding tissue injury and bruising from trauma or constrictive devices (e.g., continuous use of an automatic BP cuff). Subcutaneous injections are permitted; a soft toothbrush should be used, and the client may use nail clippers, but with caution.
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A. Inform client of diagnostic tests. B. Remove hair from skin insertion sites. C. Assess distal pulses. D. Withhold anticoagulant therapy.
D The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.
A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? A. Streptokinase, aspirin, and B. Morphine administration morphine administration, stress testing, and admission to the cardiac care unit C. Serial liver enzyme testing, telemetry, and a lidocaine infusion D. Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
D The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.
An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply. A. Shortness of breath B. Chest pain C. Anxiety D. Indigestion E. Nausea
D, E Many women experiencing coronary events including--unstable angina, MIs, or sudden cardiac death events--are asymptomatic or present with atypical symptoms including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among clients of all ages and genders.
