NRS 204 Cardiovascular Exam
A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurses responsibility in the care of the patients pacemaker? A) Monitoring for pacemaker malfunction or battery failure B) Determining when it is appropriate to remove the pacemaker C) Making necessary changes to the pacemaker settings D) Selecting alternatives to future pacemaker use
A) Monitoring for pacemaker malfunction or battery failure
The nurse is monitoring a hospitalized client who is being treated for a diagnosis of heart failure. The client is on a cardiac monitor and oxygen at 2 L/min nasal cannula. The client calls the nurse and reports severe dyspnea. On assessment the nurse notes that the clients heart rate is 128 bpm. The client is anxious and restless, is sweating profusely and the clients skin is cool and clammy. Wheezing and crackles are heard on auscultation of the lungs, and the client is expectorating blood-tinged frothy sputum. Pulse ox is 89%. What actions does the nurse take?
-Places client high fowlers -Stays with client and asks another nurse to contact HCP -Ensures oxygen and increases flow rate -Prepares to administer a diuretic and morphine sulfate -Inserts foley cath as prescribed -Prepares for intubation and ventilator support if required
A nurse is caring for clients in the telemetry unit and notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. The nurse analyzes these findings and determines that the client is experiencing...
-Ventricular fibrillation -Initiate rapid response -CPR/defibrillation
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. Which factor is highest priority with regard to this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output with cerebral and myocardial ischemia.
1. It can develop into ventricular fibrillation at any time.
The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding? 1.Hypotension 2.Flat neck veins 3.Complaints of nausea 4.Complaints of headache
1.Hypotension
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which findings would the nurse anticipate when auscultating the client's breath sounds? 1. Stridor 2. Crackles 3. Scattered rhonchi 4. Diminished breath sounds
2. Crackles
The triage nurse in the ED assesses a 66-year-old male patient who presents to the ED with complaints of midsternal chest pain that has lasted for the last 5 hours. If the patients symptoms are due to an MI, what will have happened to the myocardium? A) It may have developed an increased area of infarction during the time without treatment. B) It will probably not have more damage than if he came in immediately. C) It may be responsive to restoration of the area of dead cells with proper treatment. D) It has been irreparably damaged, so immediate treatment is no longer necessary
A) It may have developed an increased area of infarction during the time without treatment.
The nurse is caring for a patient who has had a biventricular pacemaker implanted. When planning the patients care, the nurse should recognize what goal of this intervention? A) Resynchronization B) Defibrillation C) Angioplasty D) Ablation
A) Resynchronization
The nurse is caring for a patient who is scheduled for cardiac surgery. What should the nurse include in preoperative care? A) With the patient, clarify the surgical procedure that will be performed. B) Withhold the patients scheduled medications for at least 12 hours preoperatively. C) Inform the patient that health teaching will begin as soon as possible after surgery. D) Avoid discussing the patients fears as not to exacerbate them
A) With the patient, clarify the surgical procedure that will be performed.
A patient with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the patient? A) Hyperlipidemia B) Bleeding at insertion site C) Left ventricular hypertrophy D) Congestive heart failure
B) Bleeding at insertion site
When planning the care of a patient with an implanted pacemaker, what assessment should the nurse prioritize? A) Core body temperature B) Heart rate and rhythm C) Blood pressure D)Oxygen saturation level
B) Heart rate and rhythm
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructors best response? A) Cardioversion is done on a beating heart; defibrillation is not. B) The difference is the timing of the delivery of the electric current. C) Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not. D) Cardioversion is always attempted before defibrillation because it has fewer risk
B) The difference is the timing of the delivery of the electric current.
A patient with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the patient about what potential adverse effects? A) Nervousness or paresthesia B) Throbbing headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia
B) Throbbing headache or dizziness
The nurse is caring for a patient who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output? A) Increased blood pressure B) Bounding peripheral pulses C) Changes in level of consciousness D) Skin flushing
C) Changes in level of consciousness
A patient is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the patients care? A) Ablate the area causing the dysrhythmia. B) Freeze hypersensitive cells. C) Diagnose the dysrhythmia. D) Determine the nursing plan of care
C) Diagnose the dysrhythmia.
A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication the client complains of dizziness. Which intervention would the nurse implement first? A. Obtain a 12-lead electrocardiogram B. Check the clients fingerstick blood glucose level C. Auscultate the clients apical pulse and blood pressure D. Measure the QRS interval duration on the rhythm strip
C. Auscultate the clients apical pulse and blood pressure
A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause? A) Decreased cardiac output B) Decreased cardiac contractility C) Infarction of the myocardium D) Coronary arteriosclerosis
D) Coronary arteriosclerosis
The health care provider recommends a carotid endarterectomy for a patient with carotid atherosclerosis and a history of transient ischemic attacks (TIAs). The patient asks the nurse to describe the procedure. Which response by the nurse is appropriate? a. The carotid endarterectomy involves surgical removal of plaque from an artery in the neck. b. The diseased portion of the artery in the brain is removed and replaced with a synthetic graft. c. A wire is threaded through an artery in the leg to the clots in the carotid artery and the clots are removed. d. A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque.
a. The carotid endarterectomy involves surgical removal of plaque from an artery in the neck.
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 bpm. The nurse determines that the client is experiencing: a. Premature ventricular contractions b. Ventricular tachycardia c. Ventricular fibrillation d. Sinus tachycardia
b. Ventricular tachycardia
A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that.. a. it will be important not to move at all during the procedure. b. monitored anesthesia care will be provided during the procedure. c. a flushed feeling may be noticed when the contrast dye is injected. d. arterial pressure monitoring will be required for 24 hours after the test.
c. a flushed feeling may be noticed when the contrast dye is injected.
The nurse would report which assessment finding to the primary health care provider before initiating thrombolytic therapy in a client with pulmonary embolism? A. Adventitious breath sounds B. Temperature of 99.4 orally C. Blood pressure of 198/110 D. Respiratory rate of 28 breaths per min
C. Blood pressure of 198/110
A nurse at a providers office is reviewing the laboratory results for a group of clients. The nurse should identify that which of the following results indicates the client is at risk for heart disease? Select all that apply A. Cholesterol (total) 245 mg/dL B. HDL 90 mg/dL C. LDL 140 mg/dL D. Triglycerides 125 mg/dL E. Troponin I 0.02 ng/mL
A. Cholesterol (total) 245 mg/dL C. LDL 140 mg/dL
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? A. Cracked lips B. Normal appearance C. Conjunctival hyperemia D. Desquamation of the skin
C. Conjunctival hyperemia
A 10 year old child with hemophilia A has slipped on the ice and bumped the knee. The nurse would prepare to administer which prescription? A. Injection of factor X B. Intravenous infusion of iron C. Intravenous infusion of factor VIII D. Intramuscular injection of iron using the Z-track method
C. Intravenous infusion of factor VIII
The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. The nurse determines that the procedure was effective when noting which of the following? A. Rising blood pressure B. Clearly audible heart sounds C. Client expressions of relief D. Rising central venous pressure
D. Rising central venous pressure
A 28-year-old tennis player presents to the emergency department with the following rhythm. She complains of headache, sore throat, and elevated temperature for 3 days. The nurse anticipates which of the following actions based on her cardiac rhythm? A. Prepare for transcutaneous pacing B. Administer oxygen C. Continue to monitor D. Notify the provider
C. Continue to monitor
A client has developed atrial fibrillation and has a ventricular rate of 150 beats per minute. The nurse should assess the client for which of the following? A. Flat neck veins B. Nausea and vomiting C. Hypotension and dizziness D. Hypertension and headache
C. Hypotension and dizziness
A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? Select all that apply A. Cool and clammy foot with capillary refill of 5 seconds B. Observed pacing spike followed by a QRS complex C. Persistent hiccups D. Heart rate 84/min E. Blood pressure 104/62 mm Hg
A. Cool and clammy foot with capillary refill of 5 seconds C. Persistent hiccups
The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the developmentof atherosclerosis? A) Immunosuppression B) Inflammation C) Infection D) Hemostasis
B) Inflammation
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patients heart? A) P wave B) T wave C) U wave D) QRS complex
B) T wave
The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the primary health care provider and prepares to implement which priority interventions? Select all that apply A. Administering oxygen B. Inserting a Foley catheter C. Administering furosemide D. Administering morphine sulfate intravenously E. Transporting the client to the coronary care unit F. Placing the client in a low fowlers side-lying position
A. Administering oxygen B. Inserting a Foley catheter C. Administering furosemide D. Administering morphine sulfate intravenously
A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5 mg at 1600 daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results? 1. Collaborate with the primary health care provider (PHCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed. 3. Collaborate with the PHCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the PHCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.
2. Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed.
The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1.Flat neck veins 2.A pulse rate of 60 beats/min 3.Muffled or distant heart sounds 4.Wheezing on auscultation of the lungs
3.Muffled or distant heart sounds
A client's cardiac rhythm suddenly changes on the monitor. There are no P waves, instead, there are fibrillatory waves before each QRS complex. How would the nurse interpret the rhythm? A. Atrial fibrillation B. Sinus tachycardia C. Ventricular fibrillation D. Ventricular tachycardia
A. Atrial fibrillation
A nurse is completing discharge teaching with a client following placement of an ICD. Which of the following information should the nurse include? Select all that apply A. Avoid large magnetic fields B. Caution family members that they can receive harmful unexpected shocks from the ICD C. Take body temperature at the same time each day D. Wear tight clothing to hold the device in place E. Perform arm stretching exercises to strengthen muscles surrounding the ICD
A. Avoid large magnetic fields C. Take body temperature at the same time each day
The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what? A) Arterial vasoconstriction B) Venous vasoconstriction C) Arterial vasodilation D) Venous vasodilation
A) Arterial vasoconstriction
The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response? A) Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are. B) Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts. C) Cardiac catheterization is usually done to evaluate cardiovascular response to stress. D) Cardiac catheterization is most commonly done to evaluate cardiac electrical activity
A) Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are.
A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention? A) Defibrillation B) ECG monitoring C) Implantation of a cardioverter defibrillator D) Angioplasty
A) Defibrillation
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do? A) Maintain firm contact between paddles and patient skin. B) Apply a layer of water as a conducting agent. C) Call all clear once before discharging the defibrillator. D) Ensure the defibrillator is in the sync mode
A) Maintain firm contact between paddles and patient skin.
The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? (select all that apply.) A) Need for careful monitoring for cardiac symptoms B) Need for carefully regulated exercise C) Need for dietary modifications D) Need for early resumption of prediagnosis activity E) Need for increased fluid intake
A) Need for careful monitoring for cardiac symptoms B) Need for carefully regulated exercise C) Need for dietary modifications
A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply. A) Pneumothorax B) Infection C) Atelectasis D) Bronchospasm E) Air embolism
A) Pneumothorax B) Infection E) Air embolism
The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located? A) SA node B) AV node C) Bundle of His D) Purkinje cells
A) SA node
A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what? A) Systole B) Diastole C) Repolarization D) Ejection fraction
A) Systole
A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure? A) The test is noninvasive, and nothing will be inserted into the patients body. B) The patients pain will be managed aggressively during the procedure. C) The test will provide a detailed profile of the hearts electrical activity. D) The patient will remain on bed rest for 1 to 2 hours after the test
A) The test is noninvasive, and nothing will be inserted into the patients body.
A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A. "I will notify the airport screeners about my pacemaker." B. "I will expect to have occasional hiccups." C. "I will have to disconnect my garage door opener." D. "I will take my pulse every 2-3 days."
A. "I will notify the airport screeners about my pacemaker."
A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review? A. "This means the pacemaker fires in an asynchronous pattern." B. "This means the pacemaker fires only when the heart rate is below a certain rate." C. "The pacemaker can automatically adjust to a clients increased activity level." D. "The pacemaker activity is triggered by heart muscle activity."
A. "This means the pacemaker fires in an asynchronous pattern."
A nurse on a cardiac unit caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? Select all that apply A. A client who has metabolic alkalosis B. A client who has a blood potassium level of 4.3 mEq/L C. A client who has an SaO2 of 96% D. A client who has COPD E. A client who underwent stent placement in a coronary artery
A. A client who has metabolic alkalosis D. A client who has COPD E. A client who underwent stent placement in a coronary artery
The parent of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the parent tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, would plan to avoid which during the physical assessment? A. Palpating the abdomen for a mass B. Assessing the urine for the presence of hematuria C. Monitoring the temperature for the presence of fever D. Monitoring the blood pressure for the presence of hypertension
A. Palpating the abdomen for a mass
The nurse is reviewing a pediatricians prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vasocclusive crisis. Which prescriptions documented in the child's record would the nurse question? Select all that apply A. Restrict fluid intake B. Position for comfort C. Avoid strain on painful joints D. Apply nasal oxygen at 2 L/minute E. Provide high calorie, high protein diet F. Give meperidine 25mg intravenously every 4 hrs for pain
A. Restrict fluid intake F. Give meperidine 25mg intravenously every 4 hrs for pain
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats per minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds and the PP and RR intervals are regular. How would the nurse interpret this rhythm? A. Sinus tachycardia B. Sinus bradycardia C. Sinus dysrhythmia D. Normal sinus rhythm
A. Sinus tachycardia
A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions would the nurse take? Select all that apply A. Stop the infusion B. Raise the head of the bed C. Administer protamine sulfate D. Administer diphenhydramine E. Call for the rapid response team
A. Stop the infusion D. Administer diphenhydramine E. Call for the rapid response team
The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply A. Sulfa allergy B. Osteoporosis C. Hypokalemia D. Hypouricemia E. Hyperglycemia F. Hypercalcemia
A. Sulfa allergy C. Hypokalemia E. Hyperglycemia F. Hypercalcemia
The client has developed atrial fibrillation with a ventricular rate of 150 beats per minute. Which associated findings would the nurse anticipate in the assessment? Select all that apply A. Syncope B. Dizziness C. Palpitations D. Hypertension E. Flat neck veins
A. Syncope B. Dizziness C. Palpitations
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hrs ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How would the nurse interpret the client's neurovascular status? A. The neurovascular status is expected because of increased blood flow through the leg. B. The neurovascular status is moderately impaired and the surgeon needs to be called. C. The neurovascular status is slightly deteriorating and needs to be monitored another hour D. The neurovascular status shows adequate arterial flow but venous complications are arising
A. The neurovascular status is expected because of increased blood flow through the leg.
The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse would use which most appropriate method to assess the urine output? A. Weighing the diapers B. Inserting a urinary catheter C. Comparing intake with output D. Measuring the amount of water added to formula
A. Weighing the diapers
The nurse is caring for a client who had cardiac surgery 24 hrs ago. The client has had a urine output averaging 20 mL/hr for 2 hrs. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the BUN level is 45 mg/dL and creatinine 2.2 mg/dL. How does the nurse interpret these findings?
Acute kidney injury and notifies the surgeon
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient? A) Implanted pacemaker B) Trancutaneous pacemaker C) ICD D)Asynchronous defibrillator
B) Trancutaneous pacemaker
The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement by the client reflects the need for further teaching? A. "I will avoid alcohol consumption." B. "I will take coated aspirin for my headaches." C. "I will take my pills every day at the same time." D. "I have already called my family to pick up my MedicAlert bracelet."
B. "I will take coated aspirin for my headaches."
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instructions? A. "A balance of rest and activity is important." B. "We can apply lotion or powder to the incision if it is itchy." C. "Activities in which our child could fall need to be avoided for 2-4 weeks." D. "Large crowds of people need to be avoided for at least 2 weeks after surgery."
B. "We can apply lotion or powder to the incision if it is itchy."
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter defibrillator. Which assessment is the nursing priority? A. Anxiety level of the client and family B. Activation status and settings of the device C. Presence of a Medic Alert card for the client to carry D. Knowledge of restrictions on postdischarge physical activity
B. Activation status and settings of the device
A nurse is caring for a client who is 4 hr postoperative following coronary artery bypass grafting (CABG) surgery. The client is able to inspire 200 mL with the incentive spirometer, then declines to try to cough because of the fatigue and pain. Which of the following actions should the nurse take? A. Allow the client to rest, and return in 1 hr. B. Administer IV bolus analgesic and return in 15 min. C. Document the 200 mL as an appropriate inspired volume. D. Tell the client coughing after incentive spirometry is required.
B. Administer IV bolus analgesic and return in 15 min.
The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? A. Blood pressure B. Airway patency C. Oxygen flow rate D. Level of consciousness
B. Airway patency
A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? Select all that apply A. Trace of bloody drainage on dressing B. Capillary refill of affected limb of 6 seconds C. Mottled appearance of the limb D. Throbbing pain of the affected limb that is decreased following IV bolus analgesic E. Pulse of 2+ in the affected limb
B. Capillary refill of affected limb of 6 seconds C. Mottled appearance of the limb
A client is wearing a continuous cardiac monitor which begins to sound it alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? A. Call a code B. Check the client's status C. Call the primary health care provider D. Document the lack of complexes
B. Check the client's status
The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A) A change in position from standing to sitting B) A heart rate of 54 bpm C) A pulse oximetry reading of 94% D)An increase in preload related to ambulation
B) A heart rate of 54 bpm
A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? A) Chest pain B) Bleeding at the implantation site C) Malignant hyperthermia D) Bradycardia
B) Bleeding at the implantation site
A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what? A) Decrease SA node conduction B) Control ventricular heart rate C) Improve oxygenation D) Maintain anticoagulation
B) Control ventricular heart rate
A patient has been scheduled for cardiovascular computed tomography (CT) with contrast. To prepare the patient for this test, what action should the nurse perform? A) Keep the patient NPO for at least 6 hours prior to the test. B) Establish peripheral IV access. C) Limit the patients activity for 2 hours before the test. D) Teach the patient to perform incentive spirometry
B) Establish peripheral IV access.
The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply. A) Loop connectivity B) Excitability C) Automaticity D) Conductivity E) Independence
B) Excitability C) Automaticity D) Conductivity
The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? A. Report of infrequent insomnia B. Development of inspiratory wheezes C. A baseline blood pressure of 150/80 followed by a blood pressure of 138/72 after two doses of the medication D. A baseline resting heart rate of 88 bpm followed by a resting heart rate of 72 bpm after two doses of medication.
B. Development of inspiratory wheezes
The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply A. Tremors B. Diarrhea C. Irritability D. Blurred vision E. Nausea and vomiting
B. Diarrhea D. Blurred vision E. Nausea and vomiting
A client with a history of type 2 diabetes is admitted to the hospital with chest pain and scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? A. Glipizide B. Metformin C. Repaglinide D. Regular Insulin
B. Metformin
A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. Which of the following prescriptions might be appropriate for this client? A. Defibrillation B. Pacemaker insertion C. Synchronized cardioversion D. Administration of IV lidocaine
B. Pacemaker insertion
Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription the nurse ensures that which medication is available on the nursing unit? A. Vit K B. Protamine sulfate C. Potassium chloride D. Aminocaproic acid
B. Protamine sulfate
The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the medication has achieved the expected effect? A. Cough becomes productive of frothy pink sputum B. Urine output increases from 10 mL/hr to greater than 50 mL hourly C. The serum potassium level changes from 3.8 to 3.1 mEq/L D. B-type natriuretic peptide (BNP) factor increases from 200 to 262 ng/mL
B. Urine output increases from 10 mL/hr to greater than 50 mL hourly
A client with myocardial infarction is developing cardiogenic shock. Which potential condition would the nurse anticipate and monitor the client for to detect cardiogenic shock? A. Pulsus paradoxus B. Ventricular dysrhythmias C. Rising diastolic bp D. Falling central venous pressure
B. Ventricular dysrhythmias
A client is having frequent premature ventricular contractions. The nurse would place priority on assessment of which information? A. Causative factors, such as caffeine B. Sensation of fluttering or palpitations C. Blood pressure and oxygen saturation D. Precipitating factors, such as infection
C. Blood pressure and oxygen saturation
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient? A) Start lifting the arm above the shoulder right away to prevent chest wall adhesion. B) Avoid cooking with a microwave oven. C) Avoid exposure to high-voltage electrical generators. D) Avoid walking through store and library antitheft device
C) Avoid exposure to high-voltage electrical generators.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? A) PP interval and RR interval are irregular. B) PP interval is equal to RR interval. C) Fewer QRS complexes than P waves D) PR interval is constant
C) Fewer QRS complexes than P waves
A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform? A) Instruct the patient to drink 1 liter of water before the test. B) Administer IV benzodiazepines and opioids. C) Inform the patient that she will remain on bed rest following the procedure. D) Inform the patient that an access line will be initiated in her femoral artery
C) Inform the patient that she will remain on bed rest following the procedure.
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient? A) Maintain a resting heart rate below 70 bpm. B) Maintain adequate control of chest pain. C) Maintain adequate cardiac output. D) Maintain normal cardiac structure
C) Maintain adequate cardiac output.
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? A) P wave B) T wave C) QRS complex D) U wave
C) QRS complex
The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding? A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B) Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C) This is an accurate indicator of myocardial injury. D) This result indicates muscle injury, but does not specify the source
C) This is an accurate indicator of myocardial injury.
The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurses assessment? A) Assessing the patients activity level B) Facilitating transthoracic echocardiography C) Vigilant monitoring of the patients ECG D)Close monitoring of the patients peripheral perfusion
C) Vigilant monitoring of the patients ECG
A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. Which result would indicate to the nurse that the client is receiving a therapeutic dose? A. Prothrombin time of 12.5 seconds B. Activated partial thromboplastin time of 28 seconds C. Activated partial thromboplastin time of 60 seconds D. Activated partial thromboplastin time longer than 120 seconds
C. Activated partial thromboplastin time of 60 seconds
The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hypersensitivity C. Activity intolerance D. Gastrointestinal disturbances
C. Activity intolerance
The nurse is reviewing an electrocardiogram rhythm strip. The p waves and QRS complexes are regular. The PR interval is 0.16 seconds and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats per minute. Which action would the nurse take? A. Check vital signs B. Check laboratory test results C. Monitor for any rhythm change D. Notify the primary care provider
C. Monitor for any rhythm change
A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? A. Monitor for kidney failure B. Monitor psychological status C. Monitor for signs of bleeding D. Have heparin sodium available
C. Monitor for signs of bleeding
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse would assess the infant for which early signs of HF? A. Pallor B. Cough C. Tachycardia D. Slow and shallow breathing
C. Tachycardia
A newly licensed nurse is observing a cardioversion procedure and hears the team leader call out "stand clear". This statement indicates which of the following events is occurring? A. The cardioverter is being charged to the appropriate setting B. The team should initiate CPR due to pulseless electrical activity C. Team members cannot be in contact with equipment connected to this client D. A time out is being called to verify correct protocols
C. Team members cannot be in contact with equipment connected to this client
The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurses most appropriate response? A) Administer sublingual nitroglycerin to allow the patient to finish the test. B) Initiate cardiopulmonary resuscitation. C) Administer analgesia and slow the test. D) Stop the test and monitor the patient close
D) Stop the test and monitor the patient close
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement? A) Clean the skin with providone-iodine solution. B) Ensure that the area for electrode placement is dry. C) Apply tincture of benzoin to the electrode sites and wait for it to become tacky. D) Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth
D) Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth
The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence? A) SA node to bundle of His to AV node to Purkinje fibers B) SA node to AV node to Purkinje fibers to bundle of His C) SA node to bundle of His to Purkinje fibers to AV node D) SA node to AV node to bundle of His to Purkinje fibers
D) SA node to AV node to bundle of His to Purkinje fibers
A group of nurses are participating in orientation to a telemetry unit. What should the staff educator tell this class about ST segments? A) They are the part of an ECG that reflects systole. B) They are the part of an ECG used to calculate ventricular rate and rhythm. C) They are the part of an ECG that reflects the time from ventricular depolarization through repolarization. D) They are the part of an ECG that represents early ventricular repolarization
D) They are the part of an ECG that represents early ventricular repolarization
The nurse is caring for a patient on telemetry. The patients ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show? A) Sinus bradycardia B) Myocardial infarction C) Lupus-like syndrome D)Wolf-Parkinson-White (WPW) syndrome
D)Wolf-Parkinson-White (WPW) syndrome
A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assessment, the nurse would ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. "Has the child complained of back pain?" B. "Has the child complained of headache?" C. "Has the child had any nausea or vomiting?" D. "Did the child have a sore throat or fever within the last 2 months?"
D. "Did the child have a sore throat or fever within the last 2 months?"
The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching? A. "Constipation and bloating might be a problem." B. "I'll continue to watch my diet and reduce my fats." C. "Walking a mile each day will help the whole process." D. "I'll continue my nicotinic acid from the health food store."
D. "I'll continue my nicotinic acid from the health food store."
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? A. "I will not mix the medication with food." B. "If more than one dose is missed I will call the pediatrician." C. "I will take my child's pulse before administering the medication." D. "If my child vomits after medication administration I will repeat the dose."
D. "If my child vomits after medication administration I will repeat the dose."
A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? A. "I need to notify my cardiologist if my feet and legs start to swell." B. "I am supposed to report to my cardiologist if my pulse rate decreases below 60." C. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." D. "My spouse told me that since I have this problem, we are going to stop walking in the mall every morning."
D. "My spouse told me that since I have this problem, we are going to stop walking in the mall every morning."
A nurse is teaching a client who is scheduled for coronary angiography. Which of the following statements should the nurse include? A. "You should have nothing to eat or drink for 4 hrs prior to the procedure." B. "You will be given general anesthesia during the procedure." C. "You should not have this procedure done if you are allergic to eggs." D. "You will need to keep your affected leg straight following the procedure."
D. "You will need to keep your affected leg straight following the procedure."
A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L and reports anorexia. The cardiologist prescribes a serum digoxin level to be done. Which level would the nurse recognize as being outside of the therapeutic range? A. 0.5 ng/mL B. 0.8 ng/mL C. 0.9 ng/mL D. 2.2 ng/mL
D. 2.2 ng/mL Digoxin range 0.5-2.0 ng/mL
A client in ventricular fibrillation is about to be defibrillated. Which energy level in joules would the nurse set on the monophasic defibrillator machine for the first delivery? A. 50 J B. 120 J C. 200 J D. 360 J
D. 360 J
A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's heart rate is 34/min and blood pressure is 83/48 mm Hg. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A. Transport the client to the cardiovascular laboratory B. Prepare the client for insertion of a permanent pacemaker C. Obtain a signed informed consent form for a pacemaker D. Apply transcutaneous pacemaker pads
D. Apply transcutaneous pacemaker pads
The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous IV infusion at a rate of 150 ml/hr, unchanged for the last 10 hrs. The client's urine output for the last 3 hours has been 90, 50, and 28 ml. The client's blood urea nitrogen level is 35 mg/dl, and the serum creatinine level is 1.8 mg/dl measured this morning. Which nursing action is the priority? A. Check the serum albumin level B. Check the urine specific gravity C. Continue to monitor urine output D. Call the provider
D. Call the provider
The nurse is assisting to defibrillate a client in ventricular fibrillation. Which intervention is a priority after placing the pads on the client's chest and before discharging the device? A. Ensure that the client has been intubated B. Set the defibrillation to "synchronize" mode C. Administer an amiodarone bolus D. Confirm the cardiac rhythm
D. Confirm the cardiac rhythm
The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? A. Stress B. Trauma C. Infection D. Fluid overload
D. Fluid overload
The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? A. Platelet count B. Hematocrit level C. Hemoglobin level D. Partial thromboplastin time
D. Partial thromboplastin time
A client in sinus bradycardia with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention would the nurse anticipate will be prescribed? A. Administer digoxin B. Defibrillate the client C. Continue to monitor the client D. Prepare for transcutaneous pacing
D. Prepare for transcutaneous pacing
Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium 9.8 mg/dL, serum magnesium 1.0 mEq/L, serum potassium 4.1 mEq/L, serum creatinine 0.9 mg/dL. Which result would alert the nurse that the client is at risk for digoxin toxicity? A. Serum calcium level B. Serum potassium level C. Serum creatinine level D. Serum magnesium level
D. Serum magnesium level
A pediatrician has prescribed oxygen as needed for an infant with heart failure. Which situation would likely increase the oxygen demand requiring the nurse to administer oxygen to the infant? A. During sleep B. When changing the infant's diaper C. When a parent is holding the infant D. When drawing blood for electrolyte level testing
D. When drawing blood for electrolyte level testing
