Dysrhythmias, Misc nclex, Nursing : Stroke, Cardiac Dysrythmias, 5555555 --CLOSER

What should not be used with Intracerebral Strokes : (meds)

Coumadin, Anticoagulant.

Artherosclerosis is associated with :

Diabetes and Hypertension.

Expressive Aphasia:

Difficulty in speaking and writing. BROCAS AREA -MOTOR SPEECH

_______ may be a problem with a stroke:

Elimination

Sources for Embolism with Ischemic embolic Stroke:

Endocardium : MOST COMMON, Carotid artery, Prosthetic Heart Valves ,Irregular heart rhythms, MI.

What are the four signs someone has had a stroke :

FACE , ARMS , SPEECH AND TIME.

TIA IS NOT A STROKE BUT CAN BE:

INDICATOR OR WORSENING VASCULAR DIEASE.

· Nurse is providing discharge teaching to a client who has a new prescription for Verapamil for angina. Which of the following instructions should the nurse include?

Inc. your daily intake of dietary fiber

Plaque formation in the Veins leads to :

Narrowing of arteries.

What happens when blow flow is halted to the brain:

Neurological Metabolism is altered in = 30 seconds. Neurological Metabolism stops in 2 minutes. Cellular Death in 5 Minutes.

Left Brain Damage :

Paralyzed on Right side, Impaired speech and Language Impaired left/right discrimination Slow performance, Cautious Aware of deficits, Depression, Anxiety Impaired Comprehension to language and math.

Initial Interventions:

Patent Airway, Remove Dentures, Pulse Oximetry, May need Heart Monitoring, IV Access,BP Control.

A nurse palpates the pulse of a patient and documents the following: 6/6/12 pulse 85 and regular, 3+, and equal in radial, popliteal, and dorsalis pedis. What does the number 3+ represent? a) Pulse rhythm b) Pulse rate c) Pulse deficit d) Pulse quality (amplitude)

Pulse quality (amplitude) Correct Explanation: Pulse quality/amplitude describes the quality of the pulse in terms of its fullness, ranging from absent (0) to bounding (4+). Pulse rates are measured in beats per minute. Pulse rhythm is the pattern of the pulsations and the pauses between them. The pulse deficit is the difference between the apical and radial pulse rates.

Onset of the Embolic Stroke :

Rapid Onset, maybe headache. less likely to have a warning.

Hemorrhagic Stroke : Subarachnoid.

Results form bleeding into the cerebrospinal fluid - filled space between arachnoid and pia matter on the surface of the brain.

Hemorrhage Stroke :

Results from spontaneous bleeding in brain, subarachnoid, and ventricles.

Hemorrhagic Stroke :Intracerebral

Results when Blood vessel in the Brain Ruptures.

Embolic Ischemic Stroke :

Results when an Embolus lodge in and occludes a cerebral artery, resulting in Infarction and Edema.

Warning signs of a stroke :

Sudden Severe Headache, Unexplained Dizziness, Sudden Difficulty Speaking, Sudden Dimness of loss of vision, Sudden weakness or numbness.

· A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide?

Take medication with orange juice to enhance absorption

Patients should do what to the environment with their eyes :

Teach patients to scan the environment.

Elimination can be :

Temporary or Permanent

Conductivity

The ability of an object to transfer heat or electricity to another object.

TPA hits :

The clot.

Medical Interventions for Stroke Medications:

Thrombolytic Therapy : Clot Buster , drugs such as TPA.

Narrowing of Arteries causes :

Turbulent blood flow (can't get through) increased risk of clot formation.

Receptive Aphasia:

Wernicke;s Area: Difficulty in understanding written and spoken language. WERNICKES AREA.

hemorrhagic stroke-

a ruptured artery or aneurysm

transient sympt can indicate

a transient ischemic attack (TIA) which can be a warning of an impending stroke

a hemorrhagic stroke, if caught early enough

and evacuation of the clot can be done with cessation of the active bleed, the prognosis improves significantly

what can prevent the subsequent occurance of a stroke-

anti-thrombotic med and/or surgical removal of artherosclerotic plaques in the carotid

anti platelet ex:

aspirin

A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Apply supplemental oxygen. b) Avoid caffeinated beverages. c) Lie down and elevate the feet. d) Request sublingual nitroglycerin.

b) Avoid caffeinated beverages. Explanation: If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages. pg.700

sympt will vary based on the

brain that is deprived of oxygenated blood

You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Nausea b) Hypotension c) Fluttering d) Fever

c) Fluttering Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever. pg.702

Your client has just been diagnosed with a dysrhythmia. The client asks you to explain normal sinus rhythm. What would you explain are the characteristics of normal sinus rhythm? a) Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds. b) Heart rate between 60 and 150 beats per minute. c) The sinoatrial (SA) node initiates the impulse. d) The ventricles depolarize in 0.5 seconds or less.

c) The sinoatrial (SA) node initiates the impulse. Explanation: The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats per minute; the SA node initiates the impulse; the impulse travels to the AV node in 0.12 to 0.2 seconds; the ventricles depolarize in 0.12 seconds or less; and each impulse occurs regularly. pg.698

ischemic strokes-

caused by a thrombotic or embolic blockage of blood flow to the brain

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? a) "You'll need to take an extra dose of your antiarrhythmic before you shoot." b) "Being that close to a rifle might make your ICD fire." c) "Enjoy your time with your grandson." d) "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."

d) "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Explanation: The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of his antiarrhythmic. pg.724

Which PR interval presents a first-degree heart block? a) 0.14 seconds b) 0.18 seconds c) 0.16 seconds d) 0.24 seconds

d) 0.24 seconds Explanation: In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block. pg.711

what can be placed on affected hand if swelling is severe

glove -massage affected hand by stroking distal to proximal

anticoagulants use

is controversial and NOT recommended due to high risk of intracerebral bleeding

· A nurse is teaching a client who takes Warfarin daily. Which of the following statements by the client indicates a need for further teaching?

o I have started taking ginger root to treat my joint stiffness

· A nurse is teaching a client who has a new prescription for Colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include?

o Take medication 4hrs after other medications

hemiplegia-

paralysis

gabapentin can be given for

paresthetic pain in an affected extremity

antipileptic meds EX:

phenytoin (Dilantin); gabapentin (Neurontin)

Ischemic Stroke usually occurs in _____.

sleep.

hemiparesis

weakness

agraphia

writing difficulty

A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following? a) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" b) "Hypothyroidism" c) "Beta-adrenergic blocking agents" d) "Anything that stimulates the parasympathetic nervous system (negative chronotropy)"

"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Correct Explanation: Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following? a) "Hypertension is difficult to diagnose." b) "Hypertension often causes no pain." c) "Hypertension often causes no symptoms." d) "Hypertension often kills early in the disease process."

"Hypertension often causes no symptoms." Correct Explanation: Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.

The nurse is caring for a motor vehicle accident client who is unresponsive on arrival to the emergency department. The client has numerous fractures, internal abdominal injuries, and large lacerations on the head and torso. The family arrives and seeks update on the client's condition. A family member asks, "What causes the body to go into shock?"Given the client's condition, which statement is most correct? a) "The client is in shock because your loved one is not responding and brain dead." b) "The client is in shock because all peripheral blood vessels have massively dilated." c) "The client is in shock because the heart is unable to circulate the body fluids." d) "The client is in shock because the blood volume has decreased in the system."

"The client is in shock because the blood volume has decreased in the system." Correct Explanation: Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Hypovolemic shock, where the volume of extracellular fluid is significantly diminished due to the loss of or reduced blood or plasma, frequently occurs with accidents.

What do patients associate Subarachnoid strokes with :

"The worst Headache of my life "

if the pt has homonomous hemianopsia

(loss of visual field in both eyes) instruct the pt to use a scanning technique when eating or ambulating -turning head from the direction of the unaffected side to to affected side)

sympt with R hemisphere stroke-

-altered perception of deficits (overestimation of abilities) -one sided neglect syndrome -loss of depth perception -poor impulse control and judgement -LEFT hemiplegia (paralysis) or hemiparesis (weakness) -visual changes, such as hemianopsia

meds for stroke:

-anticoagulants (heparin sodium; enoxaparin (Lovenox); warfarin (Coumadin) -anti-platelets (aspirin) -thrombolytic meds (retaplase recombinant rtPA, Retavase) -antipileptic meds (phenytoin, Dilantin; gabapentin, Neurontin)

assist the pts communication skills if his speech is impaired-

-ask pt to follow simple commands -yes/no responses in relation to close ended questions -picture board

assist the pts with safe feeding-

-assess gag and swallowing reflex; speech therapy may request a study -if a swallowing deficit is identified, the clients liquids may need to be thickened to avoid aspiration -eat upright and swallow with head and neck flexed -place food in the back of the mouth on the unaffected side -have suction on stand-by -distraction free environment

nursing care for pts with stroke:

-assess swallowing and gag reflex -prevent complications of immobility: clients are ambulated as soon as possible -maintain skin integrity -ROM every 2 hr -elevate the affected extremities to promote venous return and reduce swelling -safe environment to reduce risk of falls -scanning technique -prevent DVT -assistance with ADL's -pt have decreased endurance and impaired balance due to paralysis on one side of the body -shoulder subluxation can occur if affected arm is not support -support pt during periods of emotional lability and depression

risk factors:

-cerebral aneurysm -arteriovenous malformation (AV) -diabetes mellitus -obesity -HTN -artherosclerosis -hyperlipidemia -hypercoagulability -A fib -use of oral contraceptives -smoking -cocaine use

sympt consistent with a L hemisphere stroke-

-expressive and receptive aphasia (inability to speak and understand) -agnosia (unable to recognize familiar objects) -alexia (reading difficulty -agraphia (writing difficulty) -right extremity hemiplegia (paralysis) or hemiparesis (weakness) -slow cautious behavior -depression, anger, and quick to become frustrated -visual changes such as hemianopsia (loss of visual field)

a nurse is planning care for a pt who has dysphagia and has a new dietary prescription. what should the nurse include in the plan of care?

-have suction equip available for use -use thickened liquids -place food on the pts unaffected side of her mouth -teach the pt to swallow with her neck flexed

a pt has a R hemispheric stroke. what are the expected findings?

-impulse control difficulty -left hemiplegia -loss of depth perception

antiplatelets use

-low dose aspirin is given within 24-48 hrs following a stroke to prevent further clot formation -other anti platelets such as plavix are NOT recommended

monitor-

-pts temp, BP -O2, greater than 92 -cardiac monitor for arrhythmias -cardiac assessment for murmurs or irregularity -LOC, increased ICP sign -electrocardiogram -HOB 30 degrees to reduce ICP and promote venous drainage -avoid extreme flexion of the head or neck, keep midline -seizure precautions

a pt has global aphasia (both receptive and expressive). what should the nurse include in the pts plan of care?

-speak at a slower rate -look directly at the pt -allow extra time for the pt to answer -DO NOT complete sentences -give instructions one step at a time

· A nurse is caring for a client who has HF and a prescription for Digoxin 125mcg PO daily. Available is Digoxin PO 0.25mg/tablet. How many tablets should the nurse administer per dose?

0.5 tablet

pt with a stroke monitor their VS every

1-2 hr

Symptoms with Ischemic Stroke increase in how many hours :

1st 72 HOURS.

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client is now receiving an I.V. infusion of heparin sodium at 1,200 units/hour. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive? mL/hour

24 Correct Explanation: First, calculate how many units are in each milliliter of the medication: 25,000 units/500 mL = 50 units/1 mL. Next, calculate how many milliliters the client receives per hour: 1,200 units/1 hour divided by 50 units/1 mL. So 1,200 units/1 hour X 1 mL/50 units = 24 mL/hour.

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The nurse is assessing a client who is at risk for cardiac tamponade from chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if his blood pressure is 108/82 mm Hg?

26 Correct Explanation: Pulse pressure is the difference between systolic and diastolic pressures. Normally, systolic pressure exceeds diastolic pressure by approximately 40 mm Hg. Narrowed pulse pressure, a difference of less than 30 mm Hg, is a sign of cardiac tamponade.

DO NOT POSITION ON PARALYZED SIDE FOR MORE THAN:

30 Minutes. if redness develops do not massage .

· A nurse is preparing to infuse a 250ml unit of packed RBC's over 2hrs. The drop factor of the manual IV tubing is 15gtts/ml. Drops per minute?

31gtts/min

Cerebrovascular Facts:

3rd Highest cause of death in the USA, #1 cause of permanent death.

The rapid response team has been called to manage an unwitnessed cardiac arrest in a client's hospital room. The estimated maximum time a person can be without cardiopulmonary function and still not experience permanent brain damage is: a) 12 to 15 minutes. b) 4 to 6 minutes. c) 8 to 10 minutes. d) 1 to 2 minutes.

4 to 6 minutes. Correct Explanation: After a person is without cardiopulmonary function for 4 to 6 minutes, permanent brain damage is almost certain. To prevent permanent brain damage, it is important to begin CPR promptly after a cardiopulmonary arrest.

· A nurse is preparing to administer Digoxin to a 6-month old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

90bpm

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a) A client with poor kidney perfusion b) A new myocardial infarction client c) A client with atrial dysrhythmias d) A client with third-degree heart block

A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. pg.716

Clinical Manifestations of a stroke :

AFFECT: Difficulty with emotions, depression , loss/ changes in body image, frustration, crying spells, exaggeration , inappropriate responses.

The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings? a) Capillary refill in the toes within 3 seconds b) Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet c) Redness, inflammation, and sharp pain with calf muscle contraction d) Edema and coolness in the ankles and feet

Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet Explanation: This choice is the most accurate description of an interference with arterial circulation. The dorsalis pedis is one of the most peripheral pulses, its absence along with coolness indicates compromised arterial flow. Impaired blood flow will also affect the nervous status in the foot, resulting in decreased sensation. Capillary refill in 2 seconds is normal; edema and coolness is more an indication of venous impairment; inflammation and calf pain likely indicate a thrombophlebitis.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to a) Administer the prescribed enoxaparin (Lovenox). b) Monitor partial thromboplastin (PTT) time. c) Encourage a diet high in vitamin K. d) Have the client limit physical activity.

Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? a) Altered patterns frequently produce neurological deficits. b) Altered patterns frequently turn into life-threatening arrhythmias. c) Altered patterns frequently affect the heart's ability to pump blood effectively. d) Altered patterns frequently cause a variety of home safety issues.

Altered patterns frequently affect the heart's ability to pump blood effectively. Explanation: The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.

The nurse is teaching the client with a new permanent pacemaker. Which statement by the client indicates the need for further discharge education? a. "I will be able to shower again soon." b. "I need to take my pulse every day." c. "I might trigger airport security metal detectors." d. "I no longer need my heart pills."'

Answer: "I no longer need my heart pills."' Rationale: All discharge medications are still needed after the pacemaker is implanted.

In teaching clients at risk for bradydysrhythmias, what information does the nurse include? a. "Avoid potassium-containing foods." b. "Stop smoking and avoid caffeine." c. "Take nitroglycerin for a slow heartbeat." d. "Use a stool softener."

Answer: "Use a stool softener." Rationale: Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this.

When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be which of the following? a. 60 Beats/min b. 75 Beats/min c. 100 Beats/min d. 150 Beats/min

Answer: 100 Beats/min Rationale: Since each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).

The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node? a. The QRS complex is present. b. The PR interval is 0.24 second. c. A P wave precedes every QRS complex. d. The ST segment is elevated.

Answer: A P wave precedes every QRS complex. Rationale: A P wave is generated by the SA node and represents atrial depolarization.

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan? a. Synchronized cardioversion b. Electrophysiology studies (EPS) c. Anticoagulation d. Radiofrequency ablation therapy

Answer: Anticoagulation Rationale: Because of the risk for thromboembolism, anticoagulation is necessary.

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which of the following nursing interventions is most appropriate at this time? a. Reinforcing the pressure dressing as needed b. Encouraging range-of-motion exercises of the involved arm c. Assessing the incision for any redness, swelling, or discharge d. Applying wet-to-dry dressings every 4 hours to the insertion site

Answer: Assessing the incision for any redness, swelling, or discharge Rationale: After pacemaker insertion, it is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement. The nonpressure dressing is kept dry until removed, usually 24 hours postoperative. It is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site.

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets that this rhythm is which of the following? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

Answer: Atrial fibrillation Rationale: Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating.

A patient in asystole is likely to receive which of the following drug treatments? a. Atropine and epinephrine b. Lidocaine and amiodarone c. Digoxin and procainamide d. β-Adrenergic blockers and dopamine

Answer: Atropine and epinephrine Rationale: Normally the patient in asystole cannot be successfully resuscitated. However, administration of atropine and epinephrine may prompt the return of depolarization and ventricular contraction.

Which teaching is essential for a client who has had a permanent pacemaker inserted? a. Avoid talking on a cell phone. b. Avoid contact sports and blows to the chest. c. Avoid sexual activity. d. Do not take tub baths.

Answer: Avoid contact sports and blows to the chest. Rationale: No pressure should be applied over the generator site.

The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate? Select all that apply a. Bearing down for a bowel movement b. Possible inferior wall myocardial infarction (MI) c. Client stating that he just had a cup of coffee d. Client becoming emotional when visitors arrived e. Diltiazem (Cardizem) administered an hour ago

Answer: Bearing down for a bowel movement; Possible inferior wall myocardial infarction (MI); Diltiazem (Cardizem) administered an hour ago Rationale: The Valsalva maneuver stimulates the vagus nerve, causing bradycardia. Inferior wall MI is a cause of bradycardia and heart blocks. Calcium channel blockers such as diltiazem may cause bradycardia.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate the client at 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Give the client IV lidocaine.

Answer: Check the client for a pulse. Rationale: The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate using 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Administer IV ibutilide (Corvert).

Answer: Check the client for a pulse. Rationale: The nurse needs to assess the pulse and client stability before proceeding with further interventions; pulseless ventricular tachycardia is treated with defibrillation.

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take? a. Administer atropine. b. Administer digoxin. c. Administer clonidine. d. Continue to monitor.

Answer: Continue to monitor. Rationale: The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment. Atropine is used in emergency treatment of symptomatic bradycardia. This client has normal vital signs. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Clonidine is used in the treatment of hypertension; a side effect is bradycardia.

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next? a. Defibrillate at 200 J. b. Establish IV access. c. Place an oral airway and ventilate. d. Start cardiopulmonary resuscitation (CPR).

Answer: Defibrillate at 200 J. Rationale: Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols.

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention? a. Defibrillation b. Cardiopulmonary resuscitation (CPR) c. Administration of atropine d. Administration of oxygen

Answer: Defibrillation Rationale: Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over: in asystole, there is no rhythm to interrupt; therefore this intervention is not used.

The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which? Select all that apply. a. Use of beta-adrenergic blockers b. Excessive alcohol use c. Advancing age d. High blood pressure e. Palpitations

Answer: Excessive alcohol use; Advancing age; High blood pressure Rationale: Excessive alcohol use may cause atrial fibrillation. Atrial fibrillation occurs more frequently in older people. Hypertension is a risk factor in the development of atrial fibrillation.

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? a. ST segment b. Heart rate c. Troponin d. Myoglobin

Answer: Heart rate Rationale: The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? a. Heparin b. Atropine c. Dobutamine d. Magnesium sulfate

Answer: Heparin Rationale: Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).

The nurse receives in report that the client with a pacemaker has experienced loss of capture. Which situation is consistent with this? a. The pacemaker spike falls on the T wave. b. Pacemaker spikes are noted, but no P wave or QRS complex follows. c. The heart rate is 42, and no pacemaker spikes are seen on the rhythm strip. d. The client demonstrates hiccups.

Answer: Pacemaker spikes are noted, but no P wave or QRS complex follows. Rationale: Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode.

The nurse is caring for a client with heart rate of 143. For which manifestations should the nurse observe? Select all that apply. a. Palpitations b. Increased energy c. Chest discomfort d. Flushing of the skin e. Hypotension

Answer: Palpitations; Chest discomfort; Hypotension Rationale: Tachycardia, heart rate greater than100 beats/min, produces palpitations, that is, the ability to feel the heart beating in the chest. Chest discomfort may occur because decreased time for diastole results in lower perfusion through the coronary arteries to the myocardium. Hypotension results from decreased time for ventricular filling, secondary to shortened diastole and therefore reduced cardiac output and blood pressure.

A patient has sought care following a syncopal episode of unknown etiology. Which of the following nursing actions should the nurse prioritize in the patient's subsequent diagnostic workup? a. Preparing to assist with a head-up tilt-test b. Assessing the patient's knowledge of pacemakers c. Preparing an intravenous dose of a b-adrenergic blocker d. Teaching the patient about the role of antiplatelet aggregators

Answer: Preparing to assist with a head-up tilt-test Rationale: A head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV b-blockers are not indicated and addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient education surrounding antiplatelet aggregators is not directly relevant to the patient's syncope.

The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. a. Respiratory rate b. QT interval c. Heart rate and rhythm d. Magnesium level e. Urine output

Answer: QT interval; Heart rate and rhythm; Magnesium level Rationale: Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore monitoring of heart rate and rhythm is needed.Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia. Although it is always important to monitor vital signs and urine output, these assessments are not specific to amiodarone.

Which of the following ECG characteristics is consistent with a diagnosis of ventricular tachycardia (VT)? a. Unmeasurable rate and rhythm b. Rate 150 beats/min; inverted P wave c. Rate 200 beats/min; P wave not visible d. Rate 125 beats/min; normal QRS complex

Answer: Rate 200 beats/min; P wave not visible Rationale: VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. P wave inversion and a normal QRS complex are not associated with VT. Rate and rhythm are not measurable in ventricular fibrillation.

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? a. It is important to consume a diet high in green leafy vegetables. b. You should take aspirin or ibuprofen for headache. c. Report nosebleeds to your provider immediately. d. Avoid caffeinated beverages.

Answer: Report nosebleeds to your provider immediately. Rationale: Warfarin causes decreased ability to clot; a nosebleed could be indicative of excessive dosing.

The nurse recognizes that which intervention provides safety during cardioversion? a. Using the defibrillator at 200 joules b. Obtaining informed consent c. Setting the defibrillator to the synchronized mode d. Removing oxygen

Answer: Setting the defibrillator to the synchronized mode Rationale: Setting the defibrillator to the synchronized mode ensures discharging the shock during the vulnerable period on the T wave, which may cause ventricular fibrillation.

The client's rhythm strip shows a heart rate of 76 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? a. Normal sinus rhythm b. Sinus bradycardia c. Sinus rhythm with first-degree atrioventricular (AV) block d. Sinus rhythm with premature ventricular contractions

Answer: Sinus rhythm with first-degree atrioventricular (AV) block Rationale: These are the characteristics of sinus rhythm with first-degree AV block.

You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

Answer: The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min Rationale: This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? a. The client is semirecumbent in bed. b. Chest leads are placed as for the previous ECG. c. The client is instructed to breathe deeply through the mouth. d. The client is instructed to lie still.

Answer: The client is instructed to breathe deeply through the mouth. Rationale: Normal breathing is required or artifact will be observed, perhaps leading to inaccurate interpretation of the ECG.

Which information would cause the nurse to withhold digoxin in the client with atrial fibrillation and heart failure? a. The client has sinus tachycardia with a rate of 102. b. The cardiac monitor shows atrial fibrillation with a heart rate of 98. c. The client has a creatinine level of 1.0 mg/dL. d. The digoxin level is 2.8 mg/dL.

Answer: The digoxin level is 2.8 mg/dL. Rationale: The therapeutic range for digoxin is 0.8 to 2.0 ng/mL; hold the medication because this client has digoxin toxicity.

Which of the following statements best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? a. The length of time it takes to depolarize the atrium b. The length of time it takes for the atria to depolarize and repolarize c. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers d. The length of time it takes for the electrical impulse to travel from the SA node to the AV node

Answer: The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers Rationale: The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. The P wave represents atrial contraction and the R wave is part of the QRS complex that represents ventricular contraction. Therefore when measuring the time from the beginning of the P wave to the beginning of the QRS (PR interval), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers.

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? a. Client states he is dizzy and weak. b. The nurse notes dyspnea. c. The client has a heart rate of 42. d. The monitor shows sinus rhythm.

Answer: The monitor shows sinus rhythm. Rationale: Sinus rhythm presents with heart rates from 60 to 100 beats/min; by definition, the bradydysrhythmia has resolved.

The nurse obtains a 6-second rhythm strip and charts the following analysis: atrial rate 70, regular; ventricular rate 40, regular; QRS 0.04 sec; no relationship between P waves and QRS complexes; atria and ventricles beating independently of each other. Which of the following would be a correct interpretation of this rhythm strip? a. Sinus dysrhythmias b. Third-degree heart block c. Wenckebach phenomenon d. Premature ventricular contractions

Answer: Third-degree heart block Rationale: Third-degree heart block represents a loss of communication between the atrium and ventricles. This is depicted on the rhythm strip as no relationship between the P waves, representing atrial contraction, and QRS complexes, representing ventricular contraction. The atrium are beating totally on their own at 70 beats/min, whereas the ventricles are pacing themselves at 40 beats/min.

For which of the following dysrhythmias is defibrillation primarily indicated? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse

Answer: Ventricular fibrillation Rationale: Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.

Medications you want for Stroke :

Anticoagulants, Platelet Aggregation Inhibitors.

They should be wearing a :

Antiembolic hose. TED hose

A 45-year-old client had a complete abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago. The client's abdominal dressing is dry and intact. The client is taking liquids and voiding a sufficient quantity of straw-colored urine. While sitting up in the chair, the client has severe pain and numbness in her left leg. The nurse should first: a) Assess color and temperature of the left leg. b) Encourage the client to change her position. c) Administer pain medication. d) Assess for edema in the left leg.

Assess color and temperature of the left leg. Explanation: The client is likely suffering from an embolus as a result of abdominal surgery. The nurse should inspect the left leg for color and temperature changes associated with tissue perfusion. Administering pain medication without gathering more information about the pain can mask important signs and symptoms. Although assessing for edema is important, it is not critical to this situation. Encouraging the client to change her position does not adequately address the need for gathering more data.

Homonymous Hemianopia:

Blindness occurs in the same half of the visual fields of both eyes.

Ischemia Stroke results from :

Blocked Blood vessel, May have partial or complete blockage,

Embolic stroke comes from :

Blood clot that was lose from somewhere else breaks loose and goes to the brain.

Brain has constant supply of :

Blood.

Anatomy of Cerebral Circulation: (3 Parts)

Carotid Arteries ( Anterior), Vertebral Arteries (Posterior), and Circle of Willis CONNECTS THE TWO.

What site of Atherosclerosis is more scary to be at :

Carotid Arteries or up by the brain.

Possible Surgical Interventions:

Carotid Endarectomy , Hematoma, Aneurysm Clipping, AVM Repair, Other.

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions would be appropriate for the nurse to give the client for promoting circulation to the extremities? a) Use a heating pad to promote warmth. b) Massage calf muscles if pain occurs. c) Participate in a regular walking program. d) Keep the extremities elevated slightly.

Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and resume activity when pain subsides. With arterial disease, extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. To avoid burns, heating pads should not be used by anyone with impaired circulation. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets? a) Valvuloplasty b) Annuloplasty c) Chordoplasty d) Commissurotomy

Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve's outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.

The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)? a) Reduction in forward flow b) Accumulation of blood in the lungs c) Reduction in cardiac output d) Congestion in the peripheral tissues

Congestion in the peripheral tissues Correct Explanation: Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues

What is the biggest problem with stroke with Elimination:

Constipation , decreased sensation , immobility, and weak muscles, dehydration.

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? a) Document the findings and recheck the client in 1 hour. b) Encourage the client to perform isometric leg exercise to improve circulation in his legs. c) Contact the physician and report the findings. d) Slow the I.V. fluid to prevent any more swelling at the puncture site.

Contact the physician and report the findings. Correct Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.

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? a) Slow the I.V. fluid to prevent any more swelling at the puncture site. b) Document the findings and recheck the client in 1 hour. c) Contact the physician and report the findings. d) Encourage the client to perform isometric leg exercise to improve circulation in his legs.

Contact the physician and report the findings. Correct Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.

The nurse is caring for a child with hemophilia who is actively bleeding from the leg. The nurse should apply: a) Ice bag with elevation of the leg twice a day. b) Direct pressure to the injured area continuously for 10 minutes. c) Direct pressure, checking every few minutes to see if the bleeding has stopped. d) Ice to the injured leg area several times a day.

Direct pressure to the injured area continuously for 10 minutes. Explanation: For the child with hemophilia who is actively bleeding, the nurse should apply direct pressure to the injured area for 10 minutes continuously along with elevating the leg. The continuous application of direct pressure aids in stopping the bleeding. Elevating the leg reduces blood flow to the area, thereby minimizing the extent of blood loss. Although ice will cause local vasoconstriction and slow the bleeding, applying continuous direct pressure is essential.

Dysarthia:

Disturbance of the muscular control of speech.

Non-Modifiable Risk factors :

Doubles after age 55. More common in males, but more women die from it . African Americans, Genetic Risk Factors.

YOU WANT TO WATCH FOR A :

GI BLEED.

You should screen for:

Glucose level and Coagulation Disorder , Recent history of GI Bleed, Stroke ,Head Trauma.

what increases risk for strokes?

HTN, smoking, diabetes mellitus -early tx of HTN, maintenance of blood glucose levels within range, and refraining from smoking will decrease this

Atherosclerosis:

Hardening and thickening of arteries. Major Cause of Stroke.

How to prevent Stroke :

Healthy Diet, Regular Exercise, No smoking, Limits on Alcohol

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color? a) Milia b) Nevi c) Xanthelasma d) Hemangioma

Hemangioma Correct Explanation: Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye that commonly appear as a result of the aging of the skin or a lipid disorder. Nevi are freckles.

Hemorrhage Intracerebral stroke can occur in people with both:

Hypertension and Atherosclerosis.

Modifiable factors for Stroke:

Hypertension, Heart Disease, Diabetes Mellitus, Smoking, Alcohol, obesity, Sleep Apnea, Poor Diet.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? a) Atelectasis b) Urinary retention c) Osteomyelitis d) Hypovolemic shock

Hypovolemic shock Correct Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

A 64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the physician in the emergency department. After completing ordered diagnostic tests, the physician indicates to the client what caused the symptoms that brought him to the hospital. What is the origin of the client's symptoms? a) Cardiac disease b) Impaired cerebral circulation c) Diabetes insipidus d) Hypertension

Impaired cerebral circulation Correct Explanation: TIAs result from impaired blood circulation in the brain, which can be caused by atherosclerosis and arteriosclerosis, cardiac disease, or diabetes. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by cardiac disease. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by diabetes. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by hypertension.

Apraxia:

Inability to carry out learned sequential movements or complex commands.

Agnosia:

Inability to recognize objects.

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Inadequate tissue perfusion b) Mental alertness c) Blood glucose level d) Activity intolerance

Inadequate tissue perfusion Correct Explanation: The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.

A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking? a) Intermittent claudication b) Thromboangiitis obliterans c) Orthopnea d) Dyspnea

Intermittent claudication Correct Explanation: Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger's disease.

Which kind of stroke causes the worst prognosis :

Intracerebral hemorrhagic Stroke , 50% die in the first 48 hours.

Two types of Hemorrhage Stroke :

Intracerebral, and Subarachnoid.

Stroke is caused by :

Ischemia to part of a brain. OR Hemorrhage in the part of the brain.

What's the second most common kind of stroke?

Ischemic Embolic Stroke.

You have to use Thrombolytic Therapy for :

Ischemic Stroke.

two types of strokes:

Ischemic and Hemorrhage.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Use of antiembolytic stockings b) Keeping the legs in a neutral or dependent position c) Elevation of the legs above the heart d) Application of ace wraps from the toe to below the knees

Keeping the legs in a neutral or dependent position Correct Explanation: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Urine output of 40 cc/mL over the last hour b) Nausea and severe headache c) Left arm numbness and weakness d) Chest pain score of 3/10 (on a scale of 1 to 10)

Left arm numbness and weakness Explanation: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions. A urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

Language skills are usually on what side of the brain:

Left.

Infarction:

Local area of obstruction of blood flow leading to Necrosis.

Left side of the Brain deals with:

Logic, Math, Language, Reading, Writing, Analysis.

What does a stroke result in :

Loss of function controlled by the part of brain affected. How much depends on severity.

Aphasia:

Loss of the power of expression.

With a TIA ; Amaurosis Fugax occurs :

Loss of vision, numbness or loss of sensation, inability to speak.

· A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify?

MRI of chest

diagnostic procedures:

MRI, CT or CAT scan MRA lumbar puncture glasgow coma scale

Diagnostic Studies of a Stroke:

MRI, CT, CEREBRAL ANGIOGRAM, TRANSCRANIAL DOPPLER, EKG,CHEST X RAY, ABGS.

GOALS OF RESPIRATORY CARE:

Maintain Airway , Suctioing :effects on Intracranial Pressure. Position : Side Lying. Assess Swallowing, Keep 02 sat 95%

A 12-year-old client fractured her right leg while skiing and is undergoing an open reduction of the femur fracture. She returns to the orthopedic unit where you practice nursing with a cast in place. What is the rationale for frequently assessing her pedal pulses? a) Ensuring there wasn't nerve damage during surgery b) Making sure surgery was successful c) Maintaining adequate circulation d) Typical postoperative nursing management

Maintaining adequate circulation Correct Explanation: Circulation, sensation, and mobility of exposed fingers or toes must be assessed every 1 to 2 hours to ensure neurovascular status is not compromised.

Elimation can be a problem :

May not be able to tell you, or decreased sensation for Elimination. cannot get undressed fast enough

· Nurse is measuring a client for knee-high anti-embolic stockings to help prevent venous stasis. Which of the following actions should the nurse take?

Measure from heel to popliteal space

Clinical Manifestations with Intellect :

Memory and Judgment are impaired, Difficulty learning concepts. (ABSTRACT THINKING)

Manifestations of a stroke with Motor Function:

Mobility, Respiratory , Swallowing and Speech, Gag Reflex, Self-care Abilities.

Which positioning strategy should be used for the patient diagnosed with hypovolemic shock? a) Prone b) Supine c) Modified Trendelenburg d) Semi-Fowler's

Modified Trendelenburg Correct Explanation: A modified Trendelenburg position is recommended in hypovolemic shock. Elevation of the legs promotes the return of venous blood.

antipileptic meds are

NOT commonly given following a stroke unless the pt develops seizures

Symptoms for a TIA:

Occur rapidly and last short time.

The Blood to the brain is made up of :

Oxygen and Glucose.

TIA FACTS:

PERIOD OF TIME that blood flow is not too the brain. NOT A STROKE ,BLOOD FLOW IS JUST HINDERED.

· A nurse is caring for a client who is prescribed Warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of Warfarin?

PT

Assessment of the pulse amplitude is accomplished by which of the following? a) Palpating the flow of blood through an artery b) Auscultating the flow of blood through an artery c) Palpating the area of the left ventricle d) Auscultating the area of the left ventricle

Palpating the flow of blood through an artery Correct Explanation: The pulse amplitude describes the quality of the pulse in terms of its fullness and reflects the strength of left ventricular contraction. It is assessed by the feel of the blood flowing through an artery.

Right Brain Damage :

Paralyzed on left side , Left-sided Neglect Spatial - Perceptual Deficits Tends to deny or minimize problems Short Attention span Impulsive.

Goals of Musculoskeletal:

Passive Rom, Maximize muscle Function, Prevent Deformity . USE TROCHANTER ROLL . EACH JOINT SHOULD BE POSITIONED HIGHER THAN WHATS NEXT TO IT.

The nurse is assisting the physician with placing a ventricular assist device (VAD). Which assessment finding would confirm the successful implementation? a) Temperature within normal limits b) Pedal pulse stronger c) Respiratory rate decreased d) Heart rate increased

Pedal pulse stronger Correct Explanation: The ventricular assist device (VAD) is a medical mechanical device used to improve cardiac output and redistribute blood. The best evidence to confirm successful implementation is by identifying a strong pedal pulse in a lower extremity. Respiratory rate decreases as a client rests. Heart rate decreases when the tissues obtain the needed oxygen. The temperature within normal limits does not confirm successful implementation

Right side of the Brain deals with :

Personality, Creativity, Intuition, Music , Art, Spatial Abilities.

To eat what position should they be in:

Place in High Fowlers position, Head flexed, Forward for feeding, and 30 min .after.

When the nurse observes that the patient's systolic blood pressure is less than 80 to 90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock? a) Compensatory b) Irreversible c) Refractory d) Progressive

Progressive Correct Explanation: In compensatory shock, the patient's blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150. In progressive shock, the patient's skin appears mottled and mentation demonstrates lethargy. In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.

A patient has been diagnosed with congestive heart failure. Which of the following is a cause of crackles heard in the bases of the lungs? a) Pulmonary congestion b) Mitral valve stenosis c) Heart palpitations d) Pulmonary hypertension

Pulmonary congestion Correct Explanation: Crackles heard in the bases of the lungs are a sign of pulmonary congestion. Heart palpitations are caused by tachydysrhythmias. Crackles heard in the bases of the lungs are not signs of pulmonary hypertension and mitral valve stenosis.

A nurse is assessing the pulse volume of a client with influenza. The nurse notes that the client has a thready pulse. Which of the following is a description of a thready pulse? a) Pulse is strong and remains despite moderate pressure. b) Pulse is strong, and light pressure causes it to disappear. c) Pulse is felt with difficulty and disappears with slight pressure. d) Pulse is felt easily, and moderate pressure causes it to disappear.

Pulse is felt with difficulty and disappears with slight pressure. Correct Explanation: Thready pulse is felt with difficulty or not easily felt, and slight pressure causes it to disappear. A weak pulse is stronger than a thready pulse, and light pressure causes it to disappear. A normal pulse is felt easily, and moderate pressure causes it to disappear. A bounding pulse is strong and does not disappear with moderate pressure.

Which of the following is the most common symptom of a polyp? a) Diarrhea b) Rectal bleeding c) Abdominal pain d) Anorexia

Rectal bleeding Correct Explanation: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.

You should not swallow until :

Reflex is evaluated

Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: a) Control chest pain. b) Reduce coronary artery vasospasm. c) Control the arrhythmias associated with MI. d) Revascularize the blocked coronary artery.

Revascularize the blocked coronary artery. Correct Explanation: The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and reestablish a blood supply to the area.

Spatial Perceptual Alterations affects mostly the :

Right side stroke.

Homonymous Hemianopsia lets you see the :

Right side.

Narrowing of Arteries can also cause :

Rupture of Clot , Blood Clot.

Factors affecting Blood Flow to the brain:

Systemic Blood Pressure, Cardiac Output, Blood Viscosity , Intracranial Pressure.

1/3 of all strokes are followed by :

TIA

An elderly male client has been taking doxazosin (Cardura) 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first: a) Take his blood pressure lying, standing, and sitting. b) Report the symptoms to the physician. c) Review his other medications. d) Test his urine for ketones.

Take his blood pressure lying, standing, and sitting. Explanation: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. Testing the urine for ketones would be appropriate if the client had diabetes mellitus. Because an adverse effect of doxazosin is orthostatic hypotension, the nurse should first take the client's blood pressure; later, she can review other mediations. The client's report of symptoms should be reported to the physician with the blood pressure readings.

A client arrives in the emergency department reporting intense pain in the abdomen and tells the nurse that it feels like a heartbeat in the abdomen. Which nursing assessment would indicate potential rupture of an aortic aneurysm? a) The blood pressure and pulse are within normal limits, but the client's skin color is pale and slightly diaphoretic. b) The client has been taking an antihypertensive for the past 3 years but forgot to take it today. c) The client reports feeling nauseated. d) The client reports increasing severe back pain.

The client reports increasing severe back pain. Correct Explanation: Increased severe back pain and increased irritation to nerves are indicative of a potential rupture of an aneurysm. The client would be hypertensive and present with tachycardia, so the other choices are not correct. Nausea, although possible, or a missed dose of medication, do not indicate potential rupture.

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? a) The development of right-sided heart failure b) The development of left-sided heart failure c) The development of corpulmonale d) The development of chronic obstructive pulmonary disease (COPD)

The development of left-sided heart failure Correct Explanation: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Corpulmonale is a condition in which the heart is affected secondarily by lung damage.

What might be wrong with someone's arms that just had a stroke ?

The may not be able to raise their arms and keep them there.

Why does a stroke affect the opposite side of the body:

The pathways cross at the medulla, so a stroke on one side of the brain affects motor function on the opposite side.

Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: a) Control chest pain. b) Revascularize the blocked coronary artery. c) Reduce coronary artery vasospasm. d) Control the arrhythmias associated with MI.

The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and reestablish a blood supply to the area.

ischemic Stroke is the result of :

Thrombosis of narrowing of the blood vessel.

What are the two types of Ischemic Strokes :

Thrombotic, and Embolic

Signs of a TIA:

Tinnitus, Vertigo, Darkened or blurred vision, diplopia, dysphagia.

Necrosis is :

Tissue Death.

TIA:

Transient Ischemic Attack.

· A nurse is caring for a client who is on Warfarin therapy for A Fib. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K

Symptoms of Subarachnoid Stroke:

Vomiting, stiff neck, seizures, loss of consciousness.

Clot buster Drugs should be given within :

Within 3 hours . of onset and symptoms.

notify the provider immediately if the pts BP exceeds

a systolic greater than 180 or diastolic greater than 110 -this can indicate an ischemic stroke

an embolic stroke may be reversed with-

a thrombolytic enzyme, such as recombinant tissue plasminogen activator (rtPA, Retavase) if given within 4.5 hrs of the initial sympt

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I can still drink coffee and tea." b) "I should increase my fluid intake." c) "I should eat foods rich in protein." d) "I'll enroll in an aerobic exercise program."

a) "I can still drink coffee and tea." Explanation: The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are. pg.699

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? a) "I should ask for a handheld device search when I go through airport security." b) "I should avoid contact sports." c) "I'll watch the incision for swelling or redness and will report if either occurs." d) "I should avoid large magnetic fields, such as an MRI machine or large motors."

a) "I should ask for a handheld device search when I go through airport security." Explanation: At security gates at airports, government buildings, or other secured areas, the client with a permanent pacemaker should show a pacemaker ID card and request a hand (not handheld device) search. The client should obtain and carry a physician's letter about this requirement. pg.720

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? a) "Spike" on the rhythm strip b) Quality of the pulse c) Scar on the chest d) Vibration under the skin

a) "Spike" on the rhythm strip Explanation: Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin. pg.718

A 26-year-old Air Force staff sergeant is returning for diagnostic follow-up to the cardiologist's office where you practice nursing. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? a) All options are correct b) Elevated temperature c) Shock d) Strenuous exercise

a) All options are correct Explanation: It occurs in clients with healthy hearts as a physiologic response to strenuous exercise, anxiety and fear, pain, fever, hyperthyroidism, hemorrhage, shock, or hypoxemia. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Fever is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Shock is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Strenuous exercise is one cause. pg.694

A patient's ECG tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as which of the following? a) Atrial flutter b) Atrial fibrillation c) Ventricular tachycardia d) Ventricular fibrillation

a) Atrial flutter Explanation: The nurse correctly identifies the ECG tracing as atrial flutter. Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. pg.703

Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker? a) Avoid sources of electrical interference b) Keep moving the arm on the side where the pacemaker is inserted c) Keep the arm on the side of the pacemaker higher than the head d) Delay for at least 3 weeks activities such as swimming and bowling

a) Avoid sources of electrical interference Explanation: The nurse must instruct the patient with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the patient to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow. pg.717

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following? a) Decreased cardiac output b) Ineffective health maintenance c) Ineffective breathing pattern d) Risk for vascular trauma

a) Decreased cardiac output Explanation: Based on assessment data for this client, the most logical nursing diagnosis will be decreased cardiac output. Third-degree AV block that is causing symptoms will be a slow rhythm that will produce a decreased cardiac output. pg.712

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a) Elective electrical cardioversion b) Elective electrical defibrillation c) Chemical cardioversion d) Mace procedure

a) Elective electrical cardioversion Explanation: Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure. pg.715

You enter your client's room and find him pulseless and unresponsive. What would be the treatment of choice for this client? a) Immediate defibrillation b) Electric cardioversion c) Chemical cardioversion d) IV lidocaine

a) Immediate defibrillation Explanation: Defibrillation is used during pulseless ventricular tachycardia, ventricular fibrillation, and asystole (cardiac arrest) when no identifiable R wave is present. pg.716

A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? a) Implantable cardioverter defibrillator b) Epinephrine c) Pacemaker d) Atropine

a) Implantable cardioverter defibrillator Explanation: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation and who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). pg.721

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation? a) In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. b) Sinus bradycardia means your heart is not beating fast enough to keep you alive. c) Sinus bradycardia is nothing to worry about. d) In many clients a heart rate slower than 70 beats per minute is considered to slow to maintain an adequate cardiac output.

a) In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. Explanation: A heart rate slower than 60 beats per minute is pathologic in clients with heart disorders, increased intracranial pressure, hypothyroidism, or digitalis toxicity. The danger in sinus bradycardia is that the slow rate may be insufficient to maintain cardiac output. Option B is incorrect as it is an incomplete answer to the client's question. Option C minimizes the client's concern so it is incorrect. Option D is incorrect as it gives the client incorrect information. pg.698

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a) Lead wire dislodgement b) Faulty generator c) Fracture of the lead wire d) Sensitivity is too low

a) Lead wire dislodgement Explanation: Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation. pg.720

Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia? a) Monitor vital signs and cardiac rhythm b) Keep the patient flat for one hour after administration c) Document heart rate before and after administration d) Administer every five minutes during cardiac resuscitation

a) Monitor vital signs and cardiac rhythm Explanation: The nurse should monitor the patient's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill patient. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a patient flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? a) PR interval b) T wave c) P wave d) QRS

a) PR interval Explanation: First-degree AV block occurs when atrial conduction is delayed through AV node resulting in a prolonged PR interval. The QRS complex, T wave, and P wave are not prolonged in first-degree AV block. pg.711

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? a) Peaked T waves b) Flattened P waves c) Prolonged QT interval d) Occasional U waves

a) Peaked T waves Explanation: The patient's serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a patient's serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a patient's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a patient's serum potassium level. pg.696

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a) Premature ventricular contraction (PVC) b) Ventricular fibrillation c) Ventricular bigeminy d) Ventricular tachycardia

a) Premature ventricular contraction (PVC) Explanation: A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles. pg.707

You are an operating room nurse caring for a client who is having a pacemaker implanted. The physician has requested a demand mode pacemaker for this client. What is this type of pacemaker? a) Self-activated b) A fixed-rate pacemaker c) A temporary pacemaker d) Asynchronous

a) Self-activated Explanation: Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. Temporary pacemakers are used until a permanent pacemaker can be implanted. pg.718

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? a) Shouts, "All clear" b) States, "Charging" c) Placing gel on the chest d) Checking the ECG rhythm

a) Shouts, "All clear" Explanation: Preceding pressing the discharge button, the nurse shouts "All clear" to ensure that no one is in contact with the client. The other options are correct but not the nursing action immediately preceding. pg.716

A patient comes to the emergency department with complaints of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a) Sinus tachycardia b) Ventricular tachycardia c) Normal sinus rhythm d) Sinus bradycardia

a) Sinus tachycardia Explanation: Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy). pg.699

Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes: a) Treating the underlying cause b) Immediate defibrillation c) Administration of amiodarone d) Electrical cardioversion

a) Treating the underlying cause Explanation: Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected. pg.699

The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order? a) Turn on the defibrillator and place it in "not sync" mode. b) Call "clear" three times ensuring patient and environmental safety. c) Deliver the prescribed electrical charge. d) Charge the defibrillator to the prescribed voltage. e) Apply the multifunction conductor pads to the patient's chest.

a) Turn on the defibrillator and place it in "not sync" mode. d) Charge the defibrillator to the prescribed voltage. e) Apply the multifunction conductor pads to the patient's chest. b) Call "clear" three times ensuring patient and environmental safety. c) Deliver the prescribed electrical charge. Explanation: This is the sequence of events the nurse should implement when delivering emergent defibrillation. If not followed correctly, the patient and health care team may be placed in danger. pg.716

The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include? a) Your family and friends may want to take a CPR class. b) Do not be concerned if you experience symptoms of lightheadedness and dizziness. c) If you miss a dose of your antiarrhythmia medication, double up on the next dose. d) It is not necessary to learn how to take your own pulse.

a) Your family and friends may want to take a CPR class. Explanation: Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provider. pg.714

A physician orders esmolol (Brevibloc) for a client with supraventricular tachycardia. During esmolol therapy, the nurse should monitor the client's: a) heart rate and blood pressure. b) ocular pressure. c) cerebral perfusion pressure. d) body temperature.

a) heart rate and blood pressure. Explanation: Because class II antiarrhythmics such as esmolol inhibit sinus node stimulation, they may produce bradycardia. Hypotension with peripheral vascular insufficiency also may occur, especially with esmolol. Class II antiarrhythmics don't alter body temperature, ocular pressure, or cerebral perfusion pressure. pg.701

EXCITABILITY

ability to respond to stimuli

embolic stroke-

an embolus traveling from another part of the body to a cerebral artery -blood to the brain distal to the occlusion is immediately shut off causing neuro deficits or a loss of consciousness

what can a high BP indicate-

an ischemic stroke

The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response? a) "A transvenous pacemaker is used in place of a transarterial pacemaker." b) "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." c) "A transvenous pacemaker is used for a ventricular tachyarrhythmia." d) "A transvenous pacemaker is a permanent pacemaker that is asynchronous."

b) "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." Explanation: A transvenous pacemaker is a temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those that occur during acute MIs or after coronary artery bypass graft surgery, or to override tachydysrhythmias. pg.717

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? a) 0.3 b) 0.2 c) 0.1 d) 0.4

b) 0.2 Explanation: Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second. pg.696

A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Prepare for endotracheal intubation. b) Begin cardiopulmonary resuscitation. c) Provide electrical cardioversion. d) Administer intravenous epinephrine.

b) Begin cardiopulmonary resuscitation. Explanation: In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the patient as soon as possible. If defibrillation is not readily available, CPR is begun until the patient can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a patient in ventricular fibrillation. pg.709

A 78-year-old client was just admitted to the cardiac step-down unit where you practice nursing. Upon stabilizing his condition, you begin a conversation about his symptoms and you answer his questions to the best of your ability. In your discussion of cardiac dysrhythmias, which of the following would you rule out as a likely origination point for cardiac dysrhythmias? a) Ventricles b) Bundle of His c) Atria d) Atrioventricular node

b) Bundle of His Explanation: Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His. Cardiac dysrhythmias do not originate in the Bundle of His. pg.693

Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which difference will the nurse confirm? a) Both procedures sedate the clients. b) Cardioversion uses less electrical energy. c) Both used to eliminate ventricular dysrhythmias. d) Machine determines when electrical energy is delivered.

b) Cardioversion uses less electrical energy. Explanation: Cardioversion uses less electrical energy (50 to 100 joules) than defibrillation (200 to 360 joules). All of the other statements are correct. pg.716

A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? a) Insertion of a permanent pacemaker b) Catheter ablation therapy c) Insertion of an ICD d) Maze procedure

b) Catheter ablation therapy Explanation: Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study. Usual indications for ablation are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects). pg.726

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent? a) Disrupting the heart during the critical period of atrial repolarization. b) Disrupting the heart during the critical period of ventricular repolarization. c) Disrupting the heart during the critical period of ventricular depolarization. d) Disrupting the heart during the critical period of atrial depolarization.

b) Disrupting the heart during the critical period of ventricular repolarization. Explanation: It is similar to defibrillation. One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave. By doing so, the machine prevents disrupting the heart during the critical period of ventricular repolarization. Therefore, options A, C, and D are incorrect. pg.716

The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action? a) Apply oxygen via nasal cannula and obtain a 12-lead ECG. b) Document the findings and continue to monitor the patient. c) Instruct the patient to bear down as if having a bowel movement. d) Notify the patient's primary care provider of the findings.

b) Document the findings and continue to monitor the patient. Explanation: The patient's ECG tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the patient. pg.711

Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do? a) Take Jack's blood pressure. b) Double-check the monitoring equipment. c) Nothing, there's no cause for alarm. d) Suggest the need for a new beta-blocker to the doctor.

b) Double-check the monitoring equipment. Explanation: One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. It's important to be careful. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Focus on the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Check the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. pg.721

You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a) Pacemaker implantation b) Elective cardioversion c) Mace procedure d) Defibrillation

b) Elective cardioversion Explanation: Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Mace procedure is only a distractor for this question. Pacemakers are implanted for bradycardia. pg.704

A 65-year-old client has come to the emergency department reporting light-headedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms? a) Electroencephalogram b) Electrocardiogram c) Electrocautery d) Echocardiogram

b) Electrocardiogram Explanation: An electrocardiogram is used to identify normal and abnormal cardiac rhythms. An electrocardiogram is the device used to identify normal and abnormal cardiac rhythms. pg.694

A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? a) Administration of epinephrine b) Insertion of a pacemaker c) Insertion of an implantable cardioverter defibrillator (ICD) d) Administration of atropine

b) Insertion of a pacemaker Explanation: Third-degree AV block, also known as a complete block, occurs when no atrial impulse is conducted through the AV node into the ventricles. A permanent pacemaker may be necessary if the block persists. pg.713

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a) It uses less electrical energy than cardioversion. b) It is used to eliminate ventricular dysrhythmias. c) The client is sedated before the procedure. d) It is a scheduled procedure 1 to 10 days in advance.

b) It is used to eliminate ventricular dysrhythmias. Explanation: The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion. pg.715

The nurse is analyzing a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as which of the following? a) Junctional tachycardia b) Normal sinus rhythm c) Sinus tachycardia d) First-degree atrioventricular (AV) block

b) Normal sinus rhythm Explanation: The ECG tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1. pg.698

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a) Date and time of insertion b) Pacer rate c) Location of the generator d) Model number

b) Pacer rate Explanation: After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG. pg.723

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following? a) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers c) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches d) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers

b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers Explanation: The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers. pg.693

A 26-year-old client is returning for diagnostic follow-up. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minutes. What type of dysrhythmia would you expect the cardiologist to diagnose? a) Supraventricular bradycardia b) Sinus tachycardia c) Supraventricular tachycardia d) Sinus bradycardia

b) Sinus tachycardia Explanation: Sinus tachycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100 to 150 beats/minute). Sinus tachycardia is the dysrhythmia with a faster than usual heart rate (100 to 150 beats/minute). pg.699

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a) Ventricular tachycardia b) Ventricular fibrillation c) Atrial fibrillation d) Third-degree heart block

b) Ventricular fibrillation Explanation: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. pg.709

Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: a) have the same shape b) occur at a rate of more than six per minute c) are paired with a normal beat d) occur during the QRS complex

b) occur at a rate of more than six per minute Explanation: When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy. pg.708

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? a) "I need to stay at least 10? away from the microwave." b) "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." c) "I'll keep a log of each time my ICD discharges." d) "I can't wait to get back to my football league."

c) "I'll keep a log of each time my ICD discharges." Explanation: The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD. pg.725

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following? a) "The QRS complex will be smaller in sinus bradycardia." b) "The P waves will be shaped differently." c) "The only difference is the rate, which will be below 60 bpm in sinus bradycardia." d) "The P-R interval will be prolonged in sinus bradycardia, and you will have to measure carefully to note the width."

c) "The only difference is the rate, which will be below 60 bpm in sinus bradycardia." Explanation: All characterestics of sinus bradycardia are the same as those of normal sinus rhythm, except for the rate, which will be below 60 in sinus bradycardia. pg.726

A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following? a) 70 bpm b) 100 bpm c) 90 bpm d) 80 bpm

c) 90 bpm Explanation: An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90. pg.697

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? a) Altered patterns frequently cause a variety of home safety issues. b) Altered patterns frequently turn into life-threatening arrhythmias. c) Altered patterns frequently affect the heart's ability to pump blood effectively. d) Altered patterns frequently produce neurological deficits.

c) Altered patterns frequently affect the heart's ability to pump blood effectively. Explanation: The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer. pg.693

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment? a) A cell phone to call 911 b) A stethoscope c) An automatic external defibrillator d) A blood pressure cuff

c) An automatic external defibrillator Explanation: Most malls in the United States now have automatic external defibrillators in common areas. These defibrillators can easily be applied and obtain electrical confirmation of no ventricular contraction or R wave. The machine allows an electrical stimulation when the discharge button is depressed. A blood pressure cuff and stethoscope will not provide the equipment needed to save the client's life. The 911 can be called by a bystander, but the priority is to obtain the life-saving equipment. If defibrillation is performed within the first 3 minutes of cardiac arrest, the potential for survival is 74%. pg.717

The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle? a) Ventricular repolarization b) Ventricular depolarization c) Atrial depolarization d) Early ventricular repolarization

c) Atrial depolarization Explanation: The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave. pg.696

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a) Asystole b) Ventricular fibrillation c) Atrial flutter d) Premature ventricular contraction

c) Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart. pg.702

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? a) P wave resent before each QRS b) Normal PR interval c) Atrial rate of 300 to 400 d) Regular rhythm

c) Atrial rate of 300 to 400 Explanation: ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves. pg.703

The nurse is caring for a patient following the insertion of a permanent pacemaker. Which of the following discharge instructions are appropriate for the nurse to review with the patient? Select all that apply. a) Wear a medical alert noting the presence of a pacemaker. b) Avoid the usage of microwave ovens and electronic tools. c) Avoid handheld screening devices in airports. d) Refrain from walking through antitheft devices. e) Check pulse daily, reporting sudden slowing or increase.

c) Avoid handheld screening devices in airports. e) Check pulse daily, reporting sudden slowing or increase. a) Wear a medical alert noting the presence of a pacemaker. Explanation: Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the patient should be instructed initially to restrict activity on the side of implantation. Patients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Patients should walk through antitheft devices quickly and avoid standing in or near these devices. Patients can safely use microwave ovens and electronic tools. pg.720

A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker? a) Keep moving the arm on the side where the pacemaker is inserted. b) Keep the arm on the side of the pacemaker higher than the head. c) Avoid sources of electrical interference. d) Delay for at least 3 weeks activities such as swimming and bowling.

c) Avoid sources of electrical interference. Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc. The main warning to a client with a pacemaker is to avoid sources of electrical interference. pg.720

The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Defibrillate with 360 joules (monophasic defibrillator) b) Administer atropine 0.5 mg c) Begin cardiopulmonary resuscitation (CPR) d) Administer epinephrine

c) Begin cardiopulmonary resuscitation (CPR) Explanation: Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors. pg.710

A client has had a pacemaker inserted and is ready for discharge. The nurse is providing education about pacemaker safety. Which of the following are items that the nurse will be sure to address? Choose all that apply. a) Avoid large magnetic fields. b) Sit at least 12 feet from television sets. c) Carry a card identifying yourself as a pacemaker recipient. d) Monitor your pulse once a month. e) Do not spend time near a microwave oven.

c) Carry a card identifying yourself as a pacemaker recipient. a) Avoid large magnetic fields. Explanation: Recent pacemaker technology allows clients to safely use most household electronic appliances and devices, including microwave ovens, electric tools, and televisions. The client with a pacemaker should monitor his or her pulse daily. He or she should always carry medical identification of pacemaker use. The client should avoid large magnetic fields (eg, large motors, magnetic resonance imaging, arc welding, electrical substations). pg.720

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? a) Decreased blood pressure with reflex tachycardia b) Decreased peripheral vascular resistance c) Decreased cardiac output and decreased systolic and diastolic blood pressure d) Increased cardiac output and increased systolic and diastolic blood pressure

c) Decreased cardiac output and decreased systolic and diastolic blood pressure Explanation: As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia. pg.701

The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? a) The procedure will occur in the operating room under general anesthesia. b) After the procedure, the arrhythmia will not recur. c) During the procedure, the arrhythmia will be reproduced under controlled conditions. d) The procedure takes less time than a cardiac catheterization.

c) During the procedure, the arrhythmia will be reproduced under controlled conditions. Explanation: During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia. pg.724

Which of the following is a potential cause of premature ventricular complexes (PVCs)? a) Bradycardia b) Alkalosis c) Hypokalemia d) Hypovolemia

c) Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia. pg.707

While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following? a) Hypothyroidism and athletic training b) Vagal stimulation and sleep c) Hypovolemia and fever d) Digoxin and vagal stimulation

c) Hypovolemia and fever Explanation: Causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, sleep, hypothyroidism, athletic training, and Digoxin all will cause a slow heart rate. pg.698

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? a) A maze procedure or IV bolus of furosemide b) Cardiac catheterization c) IV bolus of atropine or temporary pacing d) Cardioversion or IV bolus of dopamine

c) IV bolus of atropine or temporary pacing Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists. pg.713

Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion? a) Administer digitalis and diuretics 24 hours before cardioversion b) Facilitate CPR until the patient is prepared for cardioversion c) Instruct the patient to restrict food and oral intake d) Monitor blood pressure every 4 hours

c) Instruct the patient to restrict food and oral intake Explanation: The nurse should instruct the patient to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the patient is in cardiopulmonary arrest, the nurse should facilitate CPR until the patient is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a patient with cardiac dysrhythmia. pg.715

A 28-year-old female patient presents to the emergency department (ED) stating severe restlessness and anxiety. Upon assessment, the patient's heart rate is 118 bpm and regular, the patient's pupils are dilated, and the patient appears excitable. Which action should the nurse take next? a) Place the patient on supplemental oxygen. b) Prepare to administer a calcium channel blocker. c) Question the patient about alcohol and illicit drug use. d) Instruct the patient to hold her breath and bear down.

c) Question the patient about alcohol and illicit drug use. Explanation: The patient is experiencing sinus tachycardia. Since the patient's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the patient about alcohol and illicit drug use. This information will direct the patient's plan of care. Causes of tachycardia include medications that stimulate the sympathetic response, stimulants, and illicit drugs. The treatment goals for sinus tachycardia is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but determining the cause of the tachycardia is essential. pg.700

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) a) The patient will have to schedule monthly chest x-rays to make sure the device is patent. b) The patient may have a throbbing pain that is normal c) Record events that trigger a shock sensation. d) Call for emergency assistance if feeling dizzy. e) Avoid magnetic fields such as metal detection booths.

c) Record events that trigger a shock sensation. d) Call for emergency assistance if feeling dizzy. e) Avoid magnetic fields such as metal detection booths. Correct Explanation: The nurse should instruct the patient to avoid large magnetic fields such as those created by magnetic resonance imaging, large motors, arc welding, electrical substations, and so forth. Magnetic fields may deactivate the device, negating its effect on a dysrhythmia. The patient should call 911 for emergency assistance if a feeling of dizziness occurs. The patient should maintain a log that records discharges of an implantable cardioverter defibrillator (ICD). Record events that precipitate the sensation of shock. This provides important data for the physician to use in readjusting the medical regimen. Throbbing pain is not normal and should be reported immediately. An initial x-ray is indicated prior to discharge, but monthly x-rays are unnecessary. pg.725

A 66-year-old female client is having cardiac diagnostic tests to determine the cause of her symptoms. In her follow-up visit to the cardiologist, she is told that she has a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia did the tests reveal? a) Heart block b) Atrial bradycardia c) Sinus bradycardia d) None

c) Sinus bradycardia Explanation: Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (≤60 beats/minute) rate. Sinus bradycardia is a slower than usual (≤60 beats/minute) heart rate. pg.698

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute b) The registered nurse stating to administer Lanoxin (digoxin) c) The registered nurse administering atropine sulfate intravenously d) The registered nurse stating to administer all medications accept those which are cardiotonics

c) The registered nurse administering atropine sulfate intravenously Explanation: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed. pg.699

The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? a) Sustained asystole b) Supraventricular tachycardia c) Ventricular fibrillation d) Atrial fibrillation

c) Ventricular fibrillation Explanation: Ventricular fibrillation is called the rhythm of a dying heart. It is the rhythm that needs attention first because there is no cardiac output, and it is an indication for CPR and immediate defibrillation. Sustained asystole either is from death, or the client is off of the cardiac monitor. Supraventricular tachycardia and atrial fibrillation is monitored and reported to the physician but is not addressed first. pg.709

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? a) Adenosine (Adenocard) b) Atropine c) Warfarin (Coumadin) d) Amiodarone (Pacerone)

c) Warfarin (Coumadin) Explanation: Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone (Cordarone), flecainide (Tambocor), ibutilide (Corvert), propafenone (Rythmol), or sotalol (Betapace) prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation (Fuster, Rydén et al., 2011). pg.704

systemic or catheter-directed thrombolytic therapy restores

cerebral blood flow -must be admin within 6 hr of the onset of sympt -CANT be used for a hemorrhagic stroke

strokes are known as-

cerebrovascular accidents (CVA's) or brain attacks

Ischemic Stroke is the most :

common form of a stroke. Type most often signaled by a TIA.

prevention of DVT-

compression socks frequent position changes mobilization

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a) "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." b) "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." c) "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." d) "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."

d) "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. pg.696

The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following? a) "This is okay as long as you are not having any symptoms." b) "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase." c) "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." d) "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."

d) "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Explanation: A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate. This may indicate pacemaker malfunction. pg.720

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education. a) "I will call the doctor if my incision becomes swollen and red." b) "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." c) "I will avoid any large magnets that may affect my pacemaker." d) "We will be getting rid of our microwave oven so it will not affect my pacemaker."

d) "We will be getting rid of our microwave oven so it will not affect my pacemaker." Explanation: Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances. pg.717

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "You should avoid tennis; basketball or football would be a good substitute." b) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." c) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." d) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."

d) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." Explanation: It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey). pg.725

The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following? a) "There is a long list of clients in line to be cardioverted." b) "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." c) "The doctor wants to see if your heart will switch back to its normal rhythm by itself." d) "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."

d) "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Explanation: Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. pg.702

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? a) A suction machine b) Cardioversion equipment c) An ECG machine d) A defibrillator

d) A defibrillator Explanation: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed. pg.716

You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do? a) Call for the doctor and just wait. b) Administer additional lidocaine. c) Prepare for defibrillation. d) Adjust the IV infusion.

d) Adjust the IV infusion. Explanation: Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Do not do anything else. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Stay focused on the IV. Call for the physician and while waiting, adjust the IV infusion to the slowest possible rate until the physician can examine the patient. pg.701

In looking at the ECG of a new patient, 43-year-old Mrs. Smith, you see what appears to be a P wave slightly different than normal. You're considering the possibility of premature atrial contractions (PAC). Which of the following questions will you ask her when taking her history? a) Caffeine b) Nicotine c) Hyperthyroidism or other metabolic disorders d) All options are correct

d) All options are correct Explanation: There are a number of causes of premature atrial contractions (PAC), which it is why it's so important to know and review a patient's complete history when examining for dysrhythmias. There are a number of causes of premature atrial contractions (PAC). pg.700

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? a) Potassium supplement b) Diuretic c) Antihypertensive d) Anticoagulant

d) Anticoagulant Explanation: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations. pg.704

An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms? a) Bundle branch block b) Heart block c) Atrial flutter d) Atrial fibrillation

d) Atrial fibrillation Explanation: In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not atrial flutter. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not heart block. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not bundle branch block. pg.704

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a) Ventricular fibrillation b) Atrial fibrillation c) Ventricular tachycardia d) Atrial flutter

d) Atrial flutter Explanation: Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011). pg.702

Which medication is the drug of choice for sinus bradycardia? a) Pronestyl b) Cardizem c) Lidocaine d) Atropine

d) Atropine Explanation: Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias. pg.699

Treatment of symptomatic bradycardia includes which of the following? a) Cardioversion b) Adenocard c) Lidocaine d) Atropine

d) Atropine Explanation: Treatment of symptomatic bradycardia includes transcutaneous pacing and atropine. Lidocaine may be used in the treatment of ventricular fibrillation. Cardioversion and Adenocard may be used in patients diagnosed with atrial flutter. pg.699

The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms? a) Atrial flutter b) Tachycardia c) Atrial fibrillation d) Bradycardia

d) Bradycardia Explanation: If symptomatic, the treatment is the same as for bradycardia: the patient may be treated with pacing (temporary or permanent), IV atropine, or epinephrine. pg.706

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a) Clients with recurrent life-threatening bradycardias b) Clients with sinus tachycardia c) Clients with ventricular bradycardia d) Clients with recurrent life-threatening tachydysrhythmias

d) Clients with recurrent life-threatening tachydysrhythmias Explanation: The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect. pg.715

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a) Clients with recurrent life-threatening bradycardias b) Clients with sinus tachycardia c) Clients with ventricular bradycardia d) Clients with recurrent life-threatening tachydysrhythmias

d) Clients with recurrent life-threatening tachydysrhythmias Explanation: The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect. pg.715

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? a) Plavix b) Lovenox c) Aspirin d) Coumadin

d) Coumadin Explanation: Warfarin (Coumadin) is indicated if the patient with atrial fibrillation is at high risk for stroke. Aspirin, Lovenox, and Plavix are not indicated. If immediate anticoagulation is necessary, the patient may be placed on heparin until the warfarin level is therapeutic. pg.705

After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following? a) IV bolus of dobutamine b) Cardiac catheterization c) IV bolus of lidocaine d) Defibrillation

d) Defibrillation Explanation: Because there is no coordinated cardiac activity, cardiac arrest and death are imminent if the dysrhythmia is not corrected. Early defibrillation is critical to survival. pg.717

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? a) P waves hidden with the QRS complex b) An irregular rhythm c) A variable heart rate, usually fewer than 60 bpm d) Delayed conduction, producing a prolonged PR interval

d) Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds). pg.711

A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following? a) Reposition the extremity and turn the patient to left side. b) Obtain a 12-lead ECG and a portable chest x-ray. c) Check the security of all connections and increase the milliamperage. d) Document the findings and continue to monitor the patient.

d) Document the findings and continue to monitor the patient Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the patient. Repositioning the patient, placing the patient on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape. pg.718

The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do? a) Assist with a temporary pacemaker. b) Prepare the client for maze surgery. c) Send the client to the cardiac catheterization laboratory. d) Give an IV bolus of atropine.

d) Give an IV bolus of atropine. Explanation: Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. pg.699

A 63-year-old client is in the cardiac step-down unit where you practice nursing. In your discussions about his condition, the client is puzzled as to what causes the heart to be an effective pump. Which of the following statements would you include in your response? a) Sufficient blood pressure b) Inherent rhythmicity of all muscle tissue c) Inherent electrons in muscle tissue d) Inherent rhythmicity of cardiac muscle tissue

d) Inherent rhythmicity of cardiac muscle tissue Explanation: Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively. pg.693

What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? a) Palpate the client's pulse and observe the client's response. b) Provide supplemental oxygen. c) Monitor blood pressure continuously. d) Monitor cardiac rhythm continuously.

d) Monitor cardiac rhythm continuously. Explanation: The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias. pg.692

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply. a) T wave b) P-R interval c) QRT wave d) P wave e) S-Q segment

d) P wave b) P-R interval a) T wave Explanation: The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval. pg.696

Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following: a) Postoperative site hematoma b) Normal postoperative healing c) Internal bleeding at pacemaker site d) Pacemaker site infection

d) Pacemaker site infection Explanation: Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These include swelling, unusual tenderness, drainage, and increased warmth. pg.723

The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) QRS complex that is 0.10 seconds long b) ST segment that is isoelectric in appearance c) PR interval that is 0.18 seconds long d) QT interval that is 0. 46 seconds long

d) QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal. pg.696

John, an 82-year-old retired librarian is brought into the ED where you practice nursing. The client's heart rate is greater than 155 beats/minute. As you connect him to the ECG, you notice that his rhythm is regular, rate is 162 beats/minute, and diastole is shortened. He is intermittently alert and reports chest pain. P waves cannot be identified. What condition would you expect the physician to diagnose? a) Atrial flutter b) Sinus tachycardia c) Heart block d) Supraventricular tachycardia

d) Supraventricular tachycardia Explanation: Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (≥150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not sinus tachycardia. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not heart block. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not atrial flutter. pg. 707

When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating a) sinus bradycardia. b) normal sinus rhythm. c) sinus tachycardia. d) sinus dysrhythmia.

d) sinus dysrhythmia. Explanation: Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. pg.700

thrombotic stroke-

development of a blood clot on an artherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion

strokes involve a

disruption in the cerebral blood flow secondary to ischemia, hemorrhage, brain attack or embolism

sympt of a thrombotic stroke

evolve over a period of several hours to days

Give mouth care before and after :

feeding.

lumbar puncture is used to assess-

for the presence of blood in the cerebrospinal fluid; a + finding is consistent with a cerebral hemorrhage or ruptured aneurysm

what do you have to assess for before feeding!!

gag and swallowing reflexes

anticoagulant EX:

heparin sodium; enoxaparin (Lovenox); warfarin (Coumadin)

one sided neglect syndrome-

ignore left side of body, cannot see, feel or mover affected side, so pt unaware of its existence -can occur with L side but more common in R

a pt has L hemispheric stroke. what is an expected finding?

inability to recognize familiar objects

aphasia-

inability to speak or understand

ischemia-

inadequate blood supply to an organ

Spatial Perceptual Alterations are:

incorrect perception of self or illness, erroneous perception of self in space.

a fever can indicate-

increase in ICP

MRI, CT or CAT scan may be used to identify

ischemia, edema, and necrosis

thrombotic and embolic are together-

ischemic

the left cerebral hemisphere is responsible for:

language, math skills, and analytic thinking

hemianopsia-

loss of visual field in one or both eyes

what can decrease risk of stroke?

maintaining healthy weight and regular exercise

· A nurse is providing teaching to a client about smoking cessation. Which of the following client statements indicates a need for further education?

o "I will test my ability to quit smoking by going to the bar where I used to smoke."

· A client with a hx or MI is prescribed Aspirin 325mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?

o Antiplatelet aggregate

· A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instruction should the nurse include in the teaching?

o Apply patch in the morning

· A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? Select all that apply.

o Apply the patch to a hairless area and rotate sites o Apply a new patch each morning o Remove patch for 10-12hrs daily

· A nurse is caring for a client who just had a cardiac catheterization. Which of the following nursing interventions should the nurse include in the client's plan of care? Select all that apply.

o Check peripheral pulses in the affected extremity o Keep client's hip and leg extended o Have client remain in bed up to 6hrs post op

· A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?

o Check the PT's vital signs

· A nurse is caring for a client who had congestive heart failure and is taking Digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

o Check vital signs

· A nurse is teaching a client who is Post Op following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? Select all that apply.

o Count your pulse for 1 min. each morning o Don't wear tight clothing over insertion area

· A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

o Crushing the medication might cause you to have a stomachache or indigestion

· A nurse finds that a client didn't receive a scheduled dose of Lasix. Which of the following should the nurse include in the incident/variance report? Select all that apply

o Date of incident o Time client was to receive the medication o The client's vital signs

· A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload.

o Dyspnea o Jugular vein distention o Confusion

· Nurse is caring for a client who has thrombophlebitis and is receiving Heparin by continuous IV infusion. The client asks the nurse how long it will take for the Heparin to dissolve the clot. Which of the following responses should the nurse give?

o Heparin does not dissolve clots. It stops new clots from forming

· A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder?

o Hypercholesterolemia o Hypertension o Obesity o Smoking

· A nurse is reinforcing teaching with a client regarding reduction of risk factors for coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply.

o I must stop smoking o I need to monitor my weight o I am limiting my intake of fast foods

· A nurse is instruction a client who has a new diagnosis of Raynaud's disease about preventing the onset of manifestations. Which of the following client statements should indicate to the nurse the need for additional teaching?

o I will take my medications at the first sign of an attack

· A nurse is assessing a client who had fluid overload. Which of the following findings should the nurse expect? Select all that apply.

o Inc. HR o Inc. BP o Inc. RR

· A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching?

o Increasing my intake of foods containing trans fatty acids can lower my risk.

· A nurse is assisting with obtaining an ECG for a client who has A Fib. Which of the following actions should the nurse take? Select all that apply.

o Inspect electrode pads o Instruct the client not to talk during the test

· Nurse in an emergency dept is assessing a client who is having a suspected acute MI. Which of the following manifestations should the nurse expect to find for a client experiencing an acute MI?

o Nausea o Tachycardia o Diaphoresis

· Nurse is caring for a client who reports an area of redness, warmth, tenderness and pain in the right calf. The nurse anticipated which of the following orders when notifying the provider of this finding?

o Obtain a venous duplex ultrasound

· A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG trip should the nurse recognize as normal sinus rhythm?

o P wave falls before the QRS complex

· A nurse is caring for a male client who has peripheral vascular disease, takes dietary supplements and has a new prescription for Warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the Warfarin?

o Saw Palmetto o Glucosamine o Gingko Biloba

· A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?

o Take one tablet at the first indication of chest pain

· A nurse in an emergency department is caring for a client who reports substernal chest pain and dyspnea. The client is vomiting and diaphoretic. Which of the following lab tests are used to diagnose a MI? Select all that apply

o Troponin I o Troponin T o CPK o Myoglobin

· A nurse is planning to teach a client about a low potassium diet. Which of the following foods should the nurse instruct the client to avoid?

o Yogurt o Orange Juice

Avoid Fluid ____

overload.

nurse is caring for a pt who has L homonomous hemianopsia. what is the appropriate nursing interventions?

place the pts bedside table on the right side of the bed

the prognosis for a pt who has had a hemorrhagic stroke is

poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood

A client with gestational hypertension is likely to exhibit: a) proteinuria, headaches, and vaginal bleeding. b) headaches, double vision, and vaginal bleeding. c) proteinuria, headaches, and double vision. d) proteinuria, double vision, and uterine contractions.

proteinuria, headaches, and double vision. Correct Explanation: A client with gestational hypertension typically complains of headache, double vision, and sudden weight gain. Additional findings include proteinuria. Vaginal bleeding and uterine contractions aren't associated with gestational hypertension.

You should toilet the patient for up to :

q 2 H.

alexia-

reading difficulty

thombolytic meds EX:

reteplase combinant rtPA (Retavase)

Subarachnoid is caused by the :

rupture of an Aneurysm (Blister on a blood vessel)

if the pt has one sided neglect:

teach him to protect and care for the affected extremity to avoid injuring

MRA, magnetic resonance angiography, is used to identify-

the presence of a cerebral hemorrhage, abnormal vessel structures (AV malformation, aneurysm) , vessel ruptures, and regional perfusion of blood flow in the carotid arteries and brain

the glasgow coma scale score is used when

the pt has a decreased level of consciousness or orientation -the risk for increased ICP exists related to the swelling of the brain that can occur secondary to ischemic result

shoulder subluxation-

the weight of the arm is so much on affected side that is can cause a painful dislocation of the shoulder from its socket -supporting arm, can use a sling

agnosia-

unable to recognize usual objects

You should place the food on the :

unaffected side.

right cerebral hemisphere is responsible for

visual and spatial awareness and proprioception

some pts report transient sympt such as

visual disturbances, dizziness, slurred speech, and a weak extremity

3 causes of stroke:

1. hemorrhagic 2. thrombotic 3. embolic

A-Fib is responsible for :

20% of all strokes.

How much should you elevate the HOB :

30 degrees.

Hypertension management will decrease stroke by :

50%

Someone with Diabetes has how many times more likely to get a stroke.

5x

Automatacity

ABILITY TO DO THINGS WITH OUT NEEDING TO OCCUPY SPACE IN THE MIND, AN AUTOMATIC RESPONCE OR PATTERN

· Nurse is assessing an older client who is receiving Digoxin. The nurse should recognize that which of the following findings is a manifestation of Digoxin toxicity?

Anorexia

· Nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a HR?

Apex of heart

· A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which of the following actions should the nurse take?

Assess apical pulse for a full minute

Cerebral Vascular Disease is usually caused by :

Atherosclerosis.

What is a Major cause of a stroke :

Atherosclerosis.

An ultrasonic Doppler is used for a) Aiding palpation of diastolic blood pressure b) Auscultating a pulse that is difficult to palpate c) Aiding palpation of pulse and rhythm d) Auscultating diastolic blood pressure

Auscultating a pulse that is difficult to palpate Correct Explanation: A Doppler device can be used to detect a pulse that is not easily palpable.

· Nurse is teaching a client about following a low-cholesterol diet after coronary artery bypass grafting. Which of the following client food choices reflects the client's understanding of these dietary restrictions?

Beans

Embolic Ischemic Stroke is closely related into those with :

CARDIAC DISORDERS.