NUR 430: Exam 1

Normal PR Interval

0.12-0.20 seconds

Which of the following are possible complications following a Percutaneous Transluminal Coronary Angioplasty (PTCA)? Select all that apply: a. Hematoma formation b. Acute Renal Failure c. Hypothermia d. Cardiac Tamponade e. Bradycardia

A, B, D Hematoma formation at the site of sheath insertion is a common complication following a PCTA and should be monitored for postoperatively. Acute renal failure may also occur d/t the use of dye during the procedure. Cardiac Tamponade may occur if a coronary vessel ruptures following the procedure.

A client is scheduled for a Percutaneous Transluminal Coronary Angioplasty (PTCA). The nurse knows that a PTCA is the? a. Surgical repair of a diseased coronary artery b. Placement of an automatic internal cardiac defibrillator c. Non-invasive radiographic examination of the heart d. Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow

D PTCA is performed to improve coronary artery blood flow in a diseased artery. It is performed during a cardiac catheterization. Aorta Coronary Bypass Graft is the surgical procedure to repair a diseased coronary artery.

Normal QRS Duration

0.06 to 0.10 seconds

Sinus bradycardia originates in what part of the electrical conduction system? a. AV node b. SA node c. Bundle Branches d. Bundle of His

b. SA node

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. Lidocaine (Xylocaine)

b. Warfarin (Coumadin) Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

A patient with symptomatic sinus bradycardia at a rate of 40 beats/min typically experiences: a. high blood pressure b. hypotension & dyspnea c. facial flushing & ataxia d. calf pain & dry cough

b. hypotension & dyspnea A patient with symptomatic bradycardia suffers from low cardiac output, which may produce hypotension and dyspnea. The patient may also have chest pain, crackles, an S3 heart sound, and a sudden onset of confusion.

To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse: a. In all extremities b. At the insertion site c. Distal to the catheter insertion d. Above the catheter insertion

c. Distal to the catheter insertion Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

On an EKG, the lateral view of the heart is represented with leads?* a. V1, V2, V3 b. II, II, AVF c. I, AVL, V5, V6 d. V1, V2, V6

c. I, AVL, V5, V6

The client is exhibiting sinus bradycardia, is complaining of syncope and weakness, and has a BP of 98/60. Which collaborative treatment should the nurse anticipate being implemented? a. Administer a thrombolytic medication. b. Assess the client's cardiovascular status. c. Prepare for insertion of a pacemaker. d. Obtain a permit for synchronized cardioversion.

c. Prepare for insertion of a pacemaker. Patient is symptomatic, prepare for pacemaker

The client has just returned from a cardiac catherization. Which assessment data would warrant immediate intervention from the nurse? a. The client's BP is 110/70 and pulse is 90 b. The client's groin dressing is dry and intact c. The client refuses to keep the leg straight d. The client denies any numbness and tingling

c. The client refuses to keep the leg straight The client bends the legs, it could cause insertion site bleeding. This is arterial blood and the client could bleed to death very quickly, so this requires immediate intervention.

Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? a. Left atrium b. Right atrium c. Left ventricle d. Right ventricle

c. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases & fluid accumulates in the interstitial & alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium & right ventricle were damaged, right-sided heart failure would result.

Which of the following classes of meds maximizes cardiac performance in pts with heart failure by increasing ventricular contractibility? a. Beta-adrenergic blockers b. Calcium channel blockers c. Diuretics d. Inotropic agents

d. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility & ultimately increasing cardiac output.

A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further diagnostic testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the students family health history.

a. Allow the student to participate on the soccer team. In an aerobically trained individual, sinus bradycardia is normal. The students normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal.

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

a. Atropine and epinephrine

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).

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

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

c. Anticoagulation

You obtain an ECG on a patient and the rhythm is sinus bradycardia with a rate of 52 bpm. Your NEXT nursing action is to? a. Prepare to administer Atropine IV push b. Set-up for transcutaneous pacing c. Assess the patient d. Call a rapid response

c. Assess the patient Assess the patient. When discovering sinus bradycardia, the nurse should determine if the patient is having symptoms. Not all cases of this rhythm require medical treatment.

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. The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? 1. Sinus dysrhythmia 2. Sinus tachycardia 3. Sinus bradycardia 4. Normal sinus rhythm

2. Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.

The client is one day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first? 1. Medicate the client with intravenous morphine 2. Assess the client's chest dressing and vital signs 3. Encourage the client to turn from side to side 4. Check the client's telemetry monitor

2. The nurse must always assess the client to determine if the chest pain that is occurring is expected post-operatively or if it is a complication of surgery.

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. Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention with clear lung sounds, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg). Bradycardia is not a sign of cardiac tamponade.

Which of the following blood tests is most indicative of cardiac damage? a. Lactate dehydrogenase b. Complete blood count (CBC) c. Troponin I d. Creatine kinase (CK)

3. Troponin I levels rise rapidly & are detectable w/in 1 hour of myocardial injury. Troponin I levels aren't detectable in people w/out cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues & not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, & a complete chemistry is obtained to review electrolytes. Because CK levels may rise w/ skeletal muscle injury, CK isoenzymes are required to detect cardiac injury

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1. Sensation of palpitations 2. Causative factors, such as caffeine 3. Precipitating factors, such as infection 4. Blood pressure and oxygen saturation

4. Blood pressure and oxygen saturation Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours? 1. Creatine kinase (CK or CPK) 2. Lactic dehydrogenase (LDH) 3. LDH-1 4. LDH-2

A

A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time

A, D, E, G, H

A nurse cares for a client who is recovering from a right-sided heart catheterization. For which complications of this procedure should the nurse assess? (Select all that apply.) a. Thrombophlebitis b. Stroke c. Pulmonary embolism d. Myocardial infarction e. Cardiac tamponade

ACE Complications from a right-sided heart catheterization include thrombophlebitis, pulmonary embolism, and vagal response. Cardiac tamponade is a risk of both right- and left-sided heart catheterizations. Stroke and myocardial infarction are complications of left-sided heart catheterizations.

Which of the following should the nurse include in the plan of care for a client following a coronary angiogram? a. Immediate cardiac stress test b. Encourage fluids c. Activity restriction for 4 to 6 weeks d. Vigorous leg exercises

B The client's leg on the side where the cardiologist entered the femoral artery needs to remain still for a period of time after the procedure (usually 2 to 4 hours) in order to allow the arterial site to seal. A cardiac stress test would not be indicated because the angiogram provides a more definitive diagnostic work-up. A 4- to 6-week activity restriction may be indicated after a large myocardial infarction, but not for a simple coronary angiogram, after which the client can begin walking hours later. The client should be encouraged to drink fluids to protect the kidneys from the contrast dye.

The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by: A) Increasing preload. B) Decreasing afterload. C) Positive chronotropic effect. D) Positive inotropic effect.

B) Decreasing afterload. Rationale: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand, and reduces frequency of anginal pain.

Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY: A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression

B, C, D, F

A nurse assesses a client who is recovering after a coronary catheterization. Which assessment findings in the first few hours after the procedure require immediate action by the nurse? (Select all that apply.) a. Blood pressure of 140/88 mm Hg b. Serum potassium of 2.9 mEq/L c. Warmth and redness at the site d. Expanding groin hematoma e. Rhythm changes on the cardiac monitor

BDE In the first few hours postprocedure, the nurse monitors for complications such as bleeding from the insertion site, hypotension, acute closure of the vessel, dye reaction, hypokalemia, and dysrhythmias. The client's blood pressure is slightly elevated but does not need immediate action. Warmth and redness at the site would indicate an infection, but this would not be present in the first few hours.

A client presenting to the ER with chest pain and dizziness was found to be having a MI and subsequently suffered cardiac arrest. The ER health care team was able to successfully resuscitate the client. Lab work shows that the client is now acidotic. The nurse understands that the acidic serum pH most likely is caused from: A. fat forming ketoacids that are broken down. B. The client receiving too much sodium bicarbonate during resuscitation efforts. C. The decreased tissue perfusion that subsequently caused lactic acid production. D. An irregular heartbeat the client experienced during cardiac arrest.

C

A nurse assesses a client who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention? a. Urinary output less than intake b. Bruising at the insertion site c. Slurred speech and confusion d. Discomfort in the left leg

C A left-sided cardiac catheterization specifically increases the risk for a cerebral vascular accident. A change in neurologic status needs to be acted on immediately. Discomfort and bruising are expected at the site. If intake decreases, a client can become dehydrated because of dye excretion. The second intervention would be to increase the client's fluid status. Neurologic changes would take priority

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

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

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

C Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.

The client is admitted to the intensive care area following a coronary artery bypass graft. The nurse caring for the client manages the fluid volume status by checking the central venous pressure and finds a reading of 4 mm Hg. Which action should the nurse take at this time? a. Increase the rate of IV fluid using the protocol provided b. Continue her care with no further action c. Decrease the IV fluid using the protocol provided d. Administer furosemide (Lasix) as ordered

Correct: A The normal CVP reading is 8-12 mm Hg. A reading of 4 indicates possible bleeding and fluid loss. The nurse should administer IV fluid as ordered. Answers B, C and D are incorrect actions at this time.

A client is admitted to the ER with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? A. Gabapentin B. Midazolam C. Alprazolam D. Aspirin

D Early administration of aspirin in the setting of acute MI has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, can be lifesaving.

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A) Dilating just the coronary arteries B) Decreasing the blood pressure C) Increasing contractility of the heart D) Dilating arteries and veins

D) Dilating arteries and veins

Which of the following symptoms is most commonly associated with left-sided heart failure? a. Crackles b. Arrhythmias c. Hepatic engorgement d. Hypotension

a. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated w/ both right- & left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? a. Left-sided heart failure b. Pulmonic valve malfunction c. Right-sided heart failure d. Tricupsid valve malfunction

a. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure.

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

a. Bearing down for a bowel movement b. Possible inferior wall myocardial infarction (MI) e. Diltiazem (Cardizem) administered an hour ago 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.

Which of the following classes of meds protects the ischemic myocardium by blocking catecholamines & sympathetic nerve stimulation? a. Beta-adrenergic blockers b. Calcium channel blockers c. Narcotics d. Nitrates

a. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines & sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand promote vasodilation, & decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) & systemic vascular resistance (afterload).

The client returns to the intensive care unit following a coronary artery bypass graft. The nurse notes that the client is suddenly experiencing shortness of breath with muffled heart sounds. The blood pressure is 90/40, and the pulse rate is 110 beats per minute. Which action is most appropriate initially? a. Check the mediastinal tube for drainage b. Recheck the vital signs c. Administer pain medication d. Decrease the intravenous flow rate

a. Check the mediastinal tube for drainage Muffled heart sounds and a lack of drainage from the mediastinal tube indicate cardiac tamponade or fluid around the heart. This must be reported immediately to the physician. Answer B is incorrect because rechecking the vital signs wastes valuable time. Answer C is incorrect because there is no data to support the need for pain medication and it might lower the blood pressure. Answer D is incorrect because decreasing the intravenous flow rate can further shock.

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

a. Defibrillation 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 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

a. Heparin 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).

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patient's heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions

a. Increase in the patient's heart rate Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions.

A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus tachycardia d. Sinus dysrhythmia

a. Normal sinus rhythm

You're analyzing a patient's ECG reading. What should be found in the rhythm for it to be considered Sinus Bradycardia (select all that apply): a. One p wave present in front of every QRS complex b. Atrial rate 60 and ventricular rate of 60 c. Regular atrial and ventricular rate d. Atrial rate 40 and ventricular rate of 40 e. Regular atrial rate and irregular ventricular rate f. PR interval 0.14 seconds g. PR interval 0.36 seconds h. QRS interval 0.08 seconds i. QRS interval 0.16 seconds

a. One p wave present in front of every QRS complex c. Regular atrial and ventricular rate d. Atrial rate 40 and ventricular rate of 40 f. PR interval 0.14 seconds h. QRS interval 0.08 seconds

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patient's a. P wave. b. Q wave. c. P-R interval. d. QRS complex.

a. P wave. The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is the first negative deflection following the P wave and should be narrow and short.

Referring back to the previous question (6), Atropine was ineffective for treating the bradycardia. The patient is still symptomatic with a rate 35 bpm. What other options could be considered for the patient? Select all that apply: a. Transcutaneous pacing b. Amiodarone Infusion c. Dopamine Infusion d. Epinephrine Infusion

a. Transcutaneous pacing c. Dopamine Infusion d. Epinephrine Infusion

A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? a. Troponin result and when the next troponin level is due to be collected b. Diet status c. Last consumption of caffeine d. CK result and when the next CK level is due to be collected

a. Troponin result and when the next troponin level is due to be collected

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

a. Ventricular fibrillation

For a patient with symptomatic sinus bradycardia, appropriate nursing interventions include establishing IV access to administer: a. atropine b. anticoagulants c. calcium channel blocker d. beta-adrenergic blocker

a. atropine Atropine or epinephrine are standard treatments for sinus bradycardia

The patient with a pacemaker shows pacemaker spikes that are not followed by a QRS. The nurse interprets this as: a. failure to capture b. failure to pace. c. failure to sense. d. demand mode.

a. failure to capture

What is the first intervention for a pt experiencing MI? a. Administer morphine b. Administer oxygen c. Administer sublingual nitroglycerin d. Obtain an ECG

b. Administering supplemental oxygen to the pt is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation & prevent further damage. Morphine & nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

The patient has a temporary transvenous, demand-type ventricular pacemaker. The rate on the pacemaker is set at 60 beats/min. Which of the following situations would be of concern? a. A paced rhythm of 60 beats/min is seen on the monitor; no other waveforms are seen. b. A pacemaker spike is seen on the T wave of the preceding beat. c. The patient's inherent (own) rate falls to 58 and the pacemaker fires. d. The patient's inherent rate is 70 beats/min; no pacemaker spikes are seen.

b. A pacemaker spike is seen on the T wave of the preceding beat. Failure to sense manifests as pacer spikes that fall earlier than the programmed rate. This can cause an artificial R-on-T phenomenon similar to when a PVC occurs during the T wave, and ventricular tachycardia may occur.

The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to: a. Open and dilate the blocked coronary arteries b. Assess the extent of arterial blockage c. Bypass obstructed vessels d. Assess the functional adequacy of the valves and heart muscle.

b. Assess the extent of arterial blockage Cardiac catherization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catherization results.

A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action should the nurse take next? a. Administer intravenous diltiazem (Cardizem). b. Assess vital signs and level of consciousness. c. Administer sublingual nitroglycerin. d. Assess capillary refill and temperature.

b. Assess vital signs and level of consciousness. In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. The other interventions would not determine if the client is tolerating the loss of capture.

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

b. Atrial fibrillation

Which medication below should not be used for the treatment of sinus bradycardia in a patient with a transplanted heart? a. Isoproterenol b. Atropine c. Epinephrine d. Glucagon

b. Atropine

A nursing student is aware that which of the following is the treatment for unstable atrial flutter? a. Adenosine (Adenocard) 6 mg rapid IVP. b. Cardioversion with adjacent Heparin therapy c. Defibrillation STAT followed by CPR. d. Altemose 3 mg IVP over 1-2 seconds.

b. Cardioversion with adjacent Heparin therapy

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).

b. Check the client for a pulse.

A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patient's vital signs including oxygen saturation.

c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with oxygen administration. The other actions also are important and should be implemented rapidly.

The client is exhibiting sinus bradycardia, is complaining of syncope and weakness,and has a BP of 98/60. Which collaborative treatment should the nurse anticipatebeing implemented? a. Administer a thrombolytic medication. b. Assess the client's cardiovascular status. c. Prepare for insertion of a pacemaker. d. Obtain a permit for synchronized cardioversion.

c. Prepare for insertion of a pacemaker. Patient is symptomatic, prepare for pacemaker

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

c. Rate 200 beats/min; P wave not visible 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.

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

c. Sinus rhythm with first-degree atrioventricular (AV) block

Which of the following is NOT a treatment for symptomatic sinus bradycardia? a. Dopamine b. Atropine c. Synchronized cardioversion d. Transcutaneous pacing

c. Synchronized cardioversion

The client diagnosed with a myocardial infarction is six hours post-right femoral percutanous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse? a. The client is keeping the affected extremity straight b. The pressure dressing to the right femoral area is intact c. The client is complaining of numbness in the right foot d. The client's right pedal pulse is +3 and bounding

c. The client is complaining of numbness in the right foot Any neurovascular assessment data that is abnormal requires intervention by the nurse; numbness may indicate decreased blood flow to the right foot

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent ventricular pacemaker. d. The patient took all the prescribed cardiac medications today.

c. The patient has a permanent ventricular pacemaker. MRI is contraindicated for patients with implanted metallic devices such as pacemakers. The other information also will be reported to the health care provider but does not impact on whether or not the patient can have an MRI.

What is the primary reason for administering morphine to a pt with an MI? a. To sedate the pt b. To decrease the pt's pain c. To decrease the pt's anxiety d. To decrease oxygen demand on the pt's heart

d. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain & anxiety while causing sedation, but it isn't primarily given for those reasons.

In which of the following disorders would the nurse expect to assess sacral edema in a bedridden pt? a. Diabetes b. Pulmonary emboli c. Renal failure d. Right-sided heart failure

d. The most accurate area on the body to assess dependent edema in a bed-ridden pt is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.

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."

d. "Use a stool softener." 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.

A patient is experiencing sinus bradycardia with a rate of 34 bpm and blood pressure of 78/42. The patient reports symptoms of chest pain, has cool and clammy skin, dyspnea, and feels like they may faint. The nurse prepares to administer Atropine per a standing physician's order for the patient's symptomatic bradycardia. How will the nurse administer this medication? a. 3 mg IV push every 3-5 minutes, max dose of 5 mg b. 2 mg IV push every 1-2 minutes, max dose of 3 mg c. 3-5 mg IV push every 1 minute, max dose 10 mg d. 1 mg IV push every 3-5 minutes, max dose of 3 mg

d. 1 mg IV push every 3-5 minutes, max dose of 3 mg Atropine for symptomatic bradycardia should be given as 0.5-1 mg IV push every 3-5 minutes, max dose of 3 mg.

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mmHg, and is complaining of feeling faint. Which actions should the nurse take next ? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pad.

d. Apply the transcutaneous pacemaker (TCP) pad. The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.

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. Administer atropine 0.5 mg b. Administer epinephrine c. Defibrillate with 360 joules d. Begin cardiopulmonary resuscitation (CPR)

d. Begin cardiopulmonary resuscitation (CPR) We cannot defibrillate asystole

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.

d. Continue to monitor. 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.

Your patient is experiencing extreme fatigue, hypotension, palpations, and shortness of breath. You obtain an ECG and discover a rhythm of sinus bradycardia with a rate of 40 bpm. What finding below could be causing this condition? a. Potassium level of 3.9 meq/L b. Lisinopril 10 mg BID PO c. Blood glucose 84 d. Digoxin 0.125 mg PO daily

d. Digoxin 0.125 mg PO daily Digoxin slows down the heart rate and can lead to bradycardia.

Which of the following conditions is the predominant cause of angina? a. Increased preload b. Decreased afterload c. Coronary artery spasm d. Inadequate oxygen supply to the myocardium

d. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

What is the initial intervention in a patient with sinus tachycardia with the following vital signs: heart rate, 136 beats/min; blood pressure, 102/60 mm Hg; respiratory rate, 24 breaths/min; temperature, 99.2° F; SpO2, 94% on oxygen 2 L/min by nasal cannula? a. Administer adenosine IV push. b. Identify the cause. c. Administer nitroglycerine 0.4 mg sublingual. d. Administer lidocaine 75 mg IV push.

b. Identify the cause. Sinus tachycardia can be caused by a wide variety of factors, such as exercise, emotion, pain, fever, hemorrhage, shock, heart failure, and thyrotoxicosis. Many medications used in critical care can also cause sinus tachycardia; common culprits are aminophylline, dopamine, hydralazine, atropine, and catecholamines such as epinephrine. This patient has a stable heart rate and SpO2; therefore, there is time to identify the cause of the sinus tachycardia. Lidocaine is indicated for ventricular dysrhythmias. Nitroglycerine is not indicated because the patient is not having chest pain at this time. Adenosine is usually not indicated unless the heart rate is greater than 150 beats/min.

A 55-year-old pt is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this pt? a. Anxiety b. Ineffective tissue perfusion; cardiopulmonary c. Acute pain d. Ineffective therapeutic regimen management

b. MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this pt is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, & ineffective therapeutic regimen management are appropriate but don't take priority.

The nurse receives in report that the client with a pacemaker has experienced failure to 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.

b. Pacemaker spikes are noted, but no P wave or QRS complex follows.

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

b. Pallor and weakness of the right hand

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Administer atropine per agency dysrhythmia protocol. d. Provide supplemental oxygen via non-rebreather mask.

b. Start cardiopulmonary resuscitation (CPR). The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.

Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? a. Anxiety b. Stable angina c. Unstable angina d. Variant angina

b. The pain of stable angina is predictable in nature, builds gradually, & quickly reaches maximum intensity.

Beta-adrenergic blockers, such as metoprolol or atenolol, and calcium channel blockers, such as diltiazem, may be used to treat which sinus arrhythmia: a. sinus bradycardia b. sinus tachycardia c. sinus arrest d. sinus arrhythmia

b. sinus tachycardia Beta-adrenergic blockers and calcium channel blockers may be used to treat sinus tachycardia.

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.

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

Which of the following does the nursing student realize is the treatment for a stable patient presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm? a. Atropine b. Defibrillation c. Amiodarone d. Adenosine

c. Amiodarone This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and defibrillate.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: a. It is uncomfortable for the client, giving a sense of impending doom. b. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. c. It is almost impossible to convert to a normal sinus rhythm. d. It can develop into ventricular fibrillation at any time.

d. It can develop into ventricular fibrillation at any time. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? a. Cardiac dissection b. Ventricular septum rupture c. Mitral valve prolapse d. Pericarditis

d. Pericarditis

When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. P-R interval of 0.18 second. c. Q-T interval of 0.38 second. d. QRS interval of 0.14 second.

d. QRS interval of 0.14 second. Because the normal QRS interval is 0.06 to 0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval and Q-T interval are within normal range, and ST segment should be isoelectric (flat).

Which of the following is a compensatory response to decreased cardiac output? a. Decreased BP b. Alteration in LOC c. Decreased BP & diuresis d. Increased BP & fluid retention

d. The body compensates for a decrease in cardiac output w/ a rise in BP, due to the stimulation of the sympathetic NS & an increase in blood volume as the kidneys retain sodium & water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

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.

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

A pt who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The pt received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL & the serum creatinine is 2.2 mg/dL. A nurse interprets the pt is at risk for: a. Hypovolemia b. UTI c. Glomerulonephritis d. Acute renal failure

d. The pt who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor med therapy. Renal insult is signaled by decreased urine output, & increased BUN & creatinine levels. The pt may need meds such as dopamine (Intropin) to increase renal perfusion & possibly could need peritoneal dialysis or hemodialysis.

Which of the following types of angina is most closely related with an impending MI? a. Angina decubitus b. Chronic stable angina c. Noctural angina d. Unstable angina

d. Unstable angina progressively increases in frequency, intensity, & duration & is related to an increased risk of MI w/in 3 to 18 months.

Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output? a. Angina pectoris b. Cardiomyopathy c. Left-sided heart failure d. Right-sided heart failure

d. Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure.

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. give atropine per agency dysrhythmia protocol. c. prepare the patient for temporary pacemaker insertion. d. document the finding and continue to monitor the patient.

d. document the finding and continue to monitor the patient First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.

Persistent tachycardia in a patient who has had an MI may signal: a. chronic sick sinus syndrome b. pulmonary embolism or stroke c. the healing process d. impending heart failure or cardiogenic shock

d. impending heart failure or cardiogenic shock Sinus tachycardia occurs in about 30% of patients after acute MI and is considered a poor prognostic sign because it may be associated with massive heart danage.

A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent? a. Lateral b. Septal c. Anterior d. Inferior

d. inferior

A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers. a. Myoglobin b. CK-MB c. CK d. Troponin

d. troponin

he nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

d. ventricular tachycardia. The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.