Nurs 4 - Mod 11: Cardiac Dysfunction-including dysrhythmias (EAQ's)

While obtaining objective data during the assessment of the cardiovascular system of a patient, the nurse identifies that which findings will require further evaluation? Select all that apply. 1 A thready pulse is present. 2 Hands and feet are cold to touch. 3 Edema is absent in the extremities. 4 Veins in the neck are not distended. 5 Capillary refill takes longer than two seconds.

1 - A thready pulse is present. 2 - Hands and feet are cold to touch. 5 - Capillary refill takes longer than two seconds. Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. Capillary refill taking longer than two seconds indicates the possibility of reduced arterial capillary perfusion or anemia. Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern.

A patient on a cardiac unit is shivering. What does the nurse expect to see on the patient's ECG tracing? 1 Artifact 2 Asystole 3 Atrial flutter 4 Junctional dysrhythmia

1 - Artifact An artifact is a distortion of the baseline and waveforms seen on the electrocardiogram (ECG). If the patient is shivering or shows any muscle activity, accurate interpretation of the heart rhythm is difficult and artifacts can occur on the monitor. Asystole is the absence of all cardiac electrical activity. Atrial flutter occurs in chronic lung disease or hypertension. Junctional dysrhythmias are associated with an electrolyte imbalance or rheumatic heart disease.

The nurse determines that a patient is experiencing type II second-degree atrioventricular (AV) block based on what electrocardiogram (ECG) findings? Select all that apply. 1 Atrial rhythm is regular. 2 Ventricular rate is regular. 3 PR intervals are consistent. 4 QRS complex is less than 0.12 second. 5 There are more P waves than QRS complexes.

1 - Atrial rhythm is regular. 3 - PR intervals are consistent. 5 - There are more P waves than QRS complexes. Type II second-degree AV block (Mobitz II) is a more critical type of heart block that requires early recognition and intervention. There are more than one P wave for each QRS complex, usually in the ratio of 2:1, 3:1, or more. There is no progressive lengthening of the PR interval, which remains the same throughout with the exception of the dropped beat(s). Atrial rhythm is regular, while ventricular rhythm may be irregular. QRS complex is greater than 0.12 second because of the presence of bundle branch block.

A patient receives morphine sulfate to relieve chest pain. The nurse should monitor this patient for which complications associated with the medication? Select all that apply. 1 Bradypnea 2 Dysrhythmias 3 Bradycardia 4 Hypotension 5 Decreased ejection fraction

1 - Bradypnea 4 - Hypotension Morphine sulfate is prescribed to patients with chest pain. Morphine acts as a vasodilator; it decreases cardiac workload, contractility, and blood pressure. The nurse should monitor for signs of bradypnea and hypotension, to avoid myocardial ischemia and infarction. The nurse should monitor dysrhythmias and bradycardia in a patient receiving docusate. Morphine sulfate does not directly affect ejection fraction; indirectly, improved oxygenation will lead to more effective cardiac pumping.

During the 48 hours after a myocardial infarction (MI), a nurse should assign the highest priority to monitoring the patient for what complication? 1 Dysrhythmias 2 Anxiety and fear 3 Metabolic acidosis 4 Medication side effects

1 - Dysrhythmias The nurse must be most alert for dysrhythmias, which may signal another MI or impending complications. The nurse should also be alert for increased anxiety, which may cause pain and lead to a secondary infarction. Anxiety and fear are highly likely but secondary in importance to monitoring the patient for dysrhythmias. Metabolic acidosis and reactions to new medications are not likely but should still be included as part of overall assessment of the patient.

A patient's electrocardiogram (ECG) shows prolonged PR interval, normal P waves, and normal QRS complexes. The patient is asymptomatic and has a normal heart rate and a regular rhythm. The nurse interprets the finding as which type of atrioventricular (AV) block? 1 First-degree AV block 2 Third-degree AV block 3 Type I second-degree AV block 4 Type II second-degree AV block

1 - First-degree AV block First-degree AV block conducts every impulse to the ventricles with prolonged AV conduction time. In first-degree AV block, heart rate is normal and heart rhythm is regular. The ECG of a patient with first-degree AV block shows normal P wave, prolonged PR interval, and the normal shaped QRS complex. Third degree AV block is suspected if no impulses are conducted from atria to ventricles. Type I second-degree AV block is suspected if the rhythm on the ECG appears as grouped beats. Type II second-degree AV block is suspected if the ventricular rhythm is irregular.

The nurse assesses a patient with diabetes who reports shortness of breath, neck pain, and hypoglycemic symptoms. The patient's blood pressure is 130/86 mm Hg, heart rate is 102 beats/minute, respiratory rate is 24 breaths/minute, and the fingerstick blood glucose is 136 mg/dL. The nurse recognizes that the patient is experiencing what? 1 Myocardial infarction 2 Late-stage diabetic ketoacidosis 3 Early-onset diabetic ketoacidosis 4 Hyperosmolar hyperglycemic nonketotic syndrome

1 - Myocardial infarction Signs and symptoms of a myocardial infarction (MI) include shortness of breath, neck pain, and cool, clammy skin. Although cool, clammy skin may resemble a hypoglycemic reaction, when found along with shortness of breath and neck pain it is very specific for an MI. The patient is not experiencing a complication of diabetes (ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome). The blood glucose is close to normal, and further diagnostics would be required to determine a diabetic complication. Only cool, clammy skin is indicative of hypoglycemia.

A patient with a heart rate of 180 beats/minute has a regular heart rhythm, normal P waves, and normal PR intervals. The nurse expects to see what QRS complex shape on the patient's ECG tracing? 1 Normal 2 Not measurable 3 Wide and distorted 4 Abnormally shaped

1 - Normal A normal P wave and normal PR interval in electrocardiogram (ECG) and the heart rate of 180 beats/minute indicates sinus tachycardia. The patient with sinus tachycardia generally shows normal QRS complexes. The QRS complex will not be measurable in the patient with ventricular fibrillation. The QRS complex will be wide and distorted or abnormally shaped in the ECG of a patient who has ventricular tachycardia or premature ventricular contractions. The P wave in these patients will not usually be visible and the PR interval will not be measurable.

A patient with a history of unstable angina reports a sudden onset of retrosternal chest heaviness and tightness, fatigue, shortness of breath, and nausea. What actions should the nurse take? Select all that apply. 1 Obtain a 12-lead ECG. 2 Administer sublingual nitroglycerin. 3 Place the patient in a supine position. 4 Apply high-flow oxygen by face mask. 5 Auscultate for a pericardial friction rub.

1 - Obtain a 12-lead ECG. 2 - Administer sublingual nitroglycerin. Initial management of the patient with chest pain includes the following: Obtain a 12-lead ECG and start continuous ECG monitoring. Position the patient in an upright, not supine, position unless contraindicated, and initiate oxygen by nasal cannula (not high-flow by face mask) to keep oxygen saturation above 93%. Establish an intravenous (IV) route to provide an access for emergency drug therapy. Give sublingual nitroglycerin and aspirin (chewable). Morphine sulfate is given for pain unrelieved by nitroglycerin (NTG). Auscultating for a pericardial friction rub is not an appropriate action.

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? 1 Oxygen, nitroglycerin, aspirin, and morphine 2 Aspirin, nitroprusside, dopamine, and oxygen 3 Nitroglycerin, lorazepam, oxygen, and warfarin 4 Oxygen, furosemide, nitroglycerin, and meperidine

1 - Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. Furosemide, meperidine, nitroprusside, dopamine, lorazepam, and warfarin may be used later in the patient's treatment.

A patient is experiencing unifocal premature ventricular contractions (PVCs). The nurse expects to find what ECG characteristics? Select all that apply. 1 P wave that is not visible 2 PR interval that is not measurable 3 Wide and distorted QRS complex 4 Normal T wave 5 PVCs that have the same shape

1 - P wave that is not visible 2 - PR interval that is not measurable 3 - Wide and distorted QRS complex 5 - PVCs that have the same shape A premature ventricular contraction (PVC) is a contraction that results from an ectopic focus in the ventricles. In other words, the QRS complex occurs prematurely. The P wave is rarely visible and is usually hidden in the PVC. The PR interval is not measurable. The QRS complex is wide and distorted in shape compared with a QRS complex coming down a normal conduction pathway. PVCs that arise from the same foci appear the same in shape and are called unifocal PVCs. The T wave is generally normal.

A patient is experiencing third-degree AV block. The nurse expects to see what ECG findings that are characteristic of this rhythm? Select all that apply. 1 The PR interval is variable. 2 The P wave has a normal shape. 3 The atrial rate is more than 100 beats per minute. 4 The ventricular rate is irregular. 5 The atrial and ventricular rhythms are regular but unrelated.

1 - The PR interval is variable. 2 - The P wave has a normal shape. 5 - The atrial and ventricular rhythms are regular but unrelated. A third-degree AV block is often called a complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In such situations, the atria and ventricles beat independently because the AV node is completely blocked to the sinus impulse and; therefore, it is not conducted to the ventricles. One of the characteristics of a third-degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. The P wave has a normal shape. The atrial and ventricular rhythms are regular, but these are not related to each other. The atrial rate is usually a sinus rate of 60 to 100 beats per minute.

The nurse presents information about electrocardiogram (ECG) changes associated with myocardial infarction (MI) to a group of nursing students. What should the nurse include in the information? Select all that apply. 1 The ST segment will be elevated. 2 The T wave will be normal. 3 A pathologic Q wave that develops during MI is wide and deep. 4 The pathologic Q wave will eventually disappear from the ECG. 5 A physiologic Q wave is normally very short and narrow.

1 - The ST segment will be elevated. 3 - A pathologic Q wave that develops during MI is wide and deep. 5 - A physiologic Q wave is normally very short and narrow. The typical ECG changes associated with MI are pathologic Q wave, ST segment elevation, and T wave inversion. ST segment elevation is considered significant if it is 1 mm or more above the isoelectric line in at least two contiguous leads. A pathologic Q wave that develops during MI is wide (greater than 0.03 seconds in duration) and deep (greater than or equal to 25% of the height of the R wave). The pathologic Q wave may remain on the ECG indefinitely. A physiologic Q wave is the first negative deflection following the P wave. It is normally very short and narrow.

The nurse provides teaching about the conduction system of the heart to a group of nursing students. The nurse should include that the electrical impulses travel through the heart in what order? 1. Bundle of His 2. Sinoatrial node 3. Purkinje fibers 4. Internodal pathways 5. Atrioventricular node

1. - Sinoatrial node 2. - Internodal pathways 3. - Atrioventricular node 4. - Bundle of His 5. - Purkinje fibers The conduction system of the heart consists of specialized neuromuscular tissue. The electrical impulse of the heart begins at the sinoatrial node in the upper right atrium. This impulse travels through the intermodal fibers and spreads over the atrial musculature. This causes atrial contraction. The impulse then reaches the atrioventricular (AV) node. From the AV node the impulse moves down through the bundle of His and ends at the Purkinje fibers. Impulses from the Purkinje fibers cause ventricular contractions.

The nurse provides information about thrombolytic therapy to a group of student nurses. Which statement made by a student nurse indicates the need for further teaching? 1 "A symptom of major bleeding with thrombolytic therapy is an increase in heart rate." 2 "Significant facial trauma within the past 3 months is a relative contraindication." 3 "The goal is to give the thrombolytic within 30 minutes of the patient's arrival to the emergency department." 4 "The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG."

2 - "Significant facial trauma within the past 3 months is a relative contraindication." Significant closed-head or facial trauma within the past 3 months is an absolute contraindication due to increased risk of bleeding; the benefit does not outweigh the risk. Treatment of STEMI with thrombolytic therapy aims to limit the infarction size by dissolving the thrombus in the coronary artery and reperfusing the heart muscle. Signs and symptoms of bleeding during thrombolytic therapy include a drop in BP, increase in HR, sudden change in the patient's mental status, and blood in the urine or stool. The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG.

A patient experiences prolonged chest pain that is not immediately reversible. The patient's health care provider explains that the cause of the pain is that a once-stable atherosclerotic plaque has ruptured, causing platelet aggregation and thrombus formation. The nurse recognizes this meets the definition of what diagnosis? 1 Unstable angina 2 Acute coronary syndrome (ACS) 3 ST segment elevation myocardial infarction (STEMI) 4 Non-ST segment elevation myocardial infarction (NSTEMI)

2 - Acute coronary syndrome (ACS) When ischemia is prolonged and not immediately reversible, ACS develops. ACS is associated with deterioration of a once stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as STEMI.

A patient is scheduled for cardiac catheterization. What does the nurse provide to the patient as the primary rationale for the procedure? 1 Bypassing obstructed vessels 2 Assessing the presence of arterial blockages 3 Opening and dilating blocked coronary arteries 4 Assessing the need for antianginal medications

2 - Assessing the presence of arterial blockages Cardiac catheterization is performed to assess the extent and severity of coronary artery blockage. The results of a cardiac catheterization will facilitate decisions regarding the need for medical management, angioplasty, or coronary artery bypass surgery.

The nurse observing a telemetry monitor notes that a patient that was in sinus rhythm is now in a different rhythm. The electrocardiogram (ECG) now shows no P waves, fine and wavy lines between the QRS complexes, QRS complexes that measure 0.08 sec, and QRS complexes that occur irregularly with a rate of 120 beats/minute. The nurse correctly interprets this rhythm as what? 1 Sinus tachycardia 2 Atrial fibrillation 3 Ventricular fibrillation 4 Ventricular tachycardia

2 - Atrial fibrillation Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not contracting truly, just fibrillating. Sinus tachycardia is a sinus rate above 100 beats/minute with normal P waves. Ventricular fibrillation is seen on the ECG without a visible P wave, an unmeasurable heart rate, PR, or QRS, and the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature ventricular contractions (PVCs) that have distorted QRS complexes with regular or irregular rhythm; the P wave usually is buried in the QRS complex without a measureable PR interval.

A patient's permanent pacemaker is failing to capture. The nurse recalls that the definition of failure to capture is when the electrical charge to the myocardium is insufficient to produce what cardiac activity? 1 Spontaneous atrial activity 2 Atrial or ventricular contraction 3 Excitability during the cardiac cycle 4 Spontaneous ventricular activity

2 - Atrial or ventricular contraction Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. Failure to sense occurs when the pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires inappropriately. This can result in the pacemaker firing during the excitable period of the cardiac cycle, resulting in ventricular tachycardia.

Which symptoms should the nurse recognize as unstable angina in a perimenopausal client? 1 Dyspnea, hyperglycemia, and polyuria 2 Fatigue, indigestion, and shortness of breath 3 Peripheral edema with decreased urinary output 4 Altered mentation with difficulty breathing

2 - Fatigue, indigestion, and shortness of breath A perimenopausal client (female between 40 and 58 years old in menopause transition) with fatigue, indigestion, and dyspnea may be experiencing an unstable anginal (UA) attack. A client experiencing dyspnea, hyperglycemia, and polyuria may have diabetes. Peripheral edema with decreased urine output may indicate right heart failure due to a history of UA or coronary artery disease. Altered mentation (confusion) and difficulty breathing could be caused by many conditions, including heart failure exacerbation, sepsis, or UA in an older client.

The nurse assesses a patient who has been administered the tissue-type plasminogen activator alteplase for an acute myocardial infarction. Which assessment finding is the highest priority and should be reported to the primary health care provider immediately? 1 Anorexia 2 Hematuria 3 Oral temperature of 100.4° F (38° C) 4 Occasional premature ventricular contractions

2 - Hematuria Alteplase is a proteolytic enzyme that digests threads and other substances in the blood, including clotting factors, thereby causing hypercoagulability of the blood and possibly bleeding, which is evidenced by blood in the urine. Anorexia and increased temperature are not issues directly related to this drug. Alteplase may cause premature ventricular contractions, which should be monitored, but this is usually not a problem because the drug has a short half-life.

The patient is diagnosed with acute coronary syndrome (ACS). The nurse reviews the patient's electrocardiogram (ECG) and notes ST segment depression and T wave inversion. The ECG findings are indicative of what? 1 Myocardial injury 2 Myocardial ischemia 3 Myocardial infarction 4 The presence of a pacemaker

2 - Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from an inadequate supply of blood and oxygen to the heart. Myocardial injury is identified with ST-segment elevation. Myocardial infarction is identified with ST-segment elevation and a widened and deep Q wave. A pacemaker's presence is evident on the ECG by a spike leading to depolarization and contraction.

The nurse reviews a patient's electrocardiogram (ECG) and determines that the patient is experiencing type I second-degree atrioventricular (AV) block. The nurse made this interpretation based on what ECG characteristics? Select all that apply. 1 Every P wave is conducted to the ventricle. 2 Ventricular rate is slower. 3 Atrial rate is increased. 4 P wave is normal in shape. 5 PR intervals are consistent and greater than 0.20 second.

2 - Ventricular rate is slower. 4 - P wave is normal in shape. In type I second-degree AV block, AV conduction is intermittently blocked. Therefore, some P waves are conducted and some are not. Additionally, the ventricular rate may be slower. This is due to nonconducted or blocked QRS complexes and leads to bradycardia. The P wave has a normal shape. Atrial rate is normal. There is progressive lengthening of the PR intervals until another QRS complex is blocked.

For which problem is percutaneous coronary intervention (PCI) most clearly indicated? 1 Chronic stable angina 2 Left-sided heart failure 3 Acute myocardial infarction 4 Coronary artery disease (CAD)

3 - Acute myocardial infarction PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD normally are treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.

A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include when discussing physical activity? 1 "Start out with 30-minute sessions." 2 "Be sure to perform physical activity at least twice a week." 3 "Physical activity should be regular, rhythmic, and repetitive." 4 "Your heart rate during exercise should only go up to 30 beats over your resting heart rate."

3 - "Physical activity should be regular, rhythmic, and repetitive." Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes. Encourage the patient to perform physical activity on most days of the week. Activity intensity is determined by the patient's heart rate. If an exercise stress test has not been performed, the heart rate of the patient recovering from an MI should not exceed 20 beats/minute over the resting heart rate.

The nurse teaches a student nurse about diagnostic studies used for acute coronary syndrome. Which statement made by the student nurse indicates effective learning? 1 "A nitroprusside stress echocardiogram is used for patients with acute pericarditis." 2 "A pathogenic Q wave is always present in the electrocardiogram (ECG) of patients with unstable angina." 3 "Serum cardiac markers are proteins that are released from necrotic heart muscle." 4 "Coronary angiography is the only way to confirm the diagnosis of unstable angina."

3 - "Serum cardiac markers are proteins that are released from necrotic heart muscle." Serum cardiac markers such as myoglobin, creatine kinase, cardiac-specific troponin I (cTnI), and cardiac-specific troponin T (cTnT) are released in patients with myocardial infarction (MI) into the blood from necrotic heart muscle. These markers are important to diagnose MI. A patient with a pathologic Q wave and ST-elevated MI has prolonged coronary occlusion because the MI evolves with time. Pharmacologic stress echocardiogram testing with dobutamine, dipyridamole, or adenosine simulates the effects of exercise and is performed on patients who are unable to exercise or have abnormal, nondiagnostic baseline echocardiograms. A coronary angiography is used for patients with stable or high-risk unstable angina.

A patient phones a health care provider's office and states, "I am having severe chest tightness that won't go away even when I lie down." In addition to contacting emergency responders, what instruction should the nurse provide to the patient? 1 "Lie down with your feet elevated." 2 "Go to a neighbor's house to get assistance." 3 "Take chewable aspirin. The total dose should be 325 mg." 4 "Take your blood pressure. It will be useful information for your care."

3 - "Take chewable aspirin. The total dose should be 325 mg." The symptoms described by the patient may be due to acute coronary syndrome (ACS). Advise the patient to take chewable aspirin; the dose is 162 to 325 mg (typically 4 baby aspirin or 2 adult aspirin). The patient should not increase oxygen demand by walking to a neighbor's house or by taking the BP. The patient's BP may be elevated and lying with the feet elevated will most likely increase the BP.

A patient with chest pain experiences a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. The nurse expects that which intravenous medication will be prescribed? 1 Digoxin 2 Atropine 3 Adenosine 4 Vasopressin

3 - Adenosine Paroxysmal supraventricular tachycardia (PSVT) is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The symptoms associated with PSVT include hypotension, palpitations, dyspnea, and angina. In PSVT, the heart rate will be greater than 180 beats/minute and the electrocardiogram will often show a hidden P wave. Intravenous adenosine is the standard drug for paroxysmal supraventricular tachycardia. Digoxin, atropine, and vasopressin are not prescribed for paroxysmal supraventricular tachycardia. Digoxin is used in the treatment of atrial fibrillation. Atropine is used in the treatment of junctional escape rhythm. Vasopressin is used in the treatment of asystole.

A nurse examines a patient with cardiovascular problems and assesses for the presence of pitting edema. What is the best location to assess for edema? 1 Face 2 Wrist 3 Ankle 4 Chest

3 - Ankle Edema is a common and early symptom of cardiovascular conditions. The nurse should look for edema by depressing the skin over the tibia or medial malleolus for 5 seconds. This edema is commonly seen in dependent areas, such as on the feet and the ankle, due to gravity. Edema on the face, wrist, or chest may be due to other, noncardiac conditions.

The nurse reviews a patient's laboratory results and recognizes that which result is most indicative of myocardial infarction? 1 Increased myoglobin 2 Increased C-reactive protein 3 Increased creatine kinase-MB 4 Increased white blood cell count

3 - Increased creatine kinase-MB Biochemical markers, such as creatine kinase (CK) and troponin are released specifically by myocardial cells when injured and are detectable in the blood. The CK enzymes are fractionated into bands. The creatine kinase-MB (CK-MB) is specific to heart muscles and helps to quantify myocardial damage. Myoglobin, although one of the first markers to increase after a myocardial infarction (MI), does not have as high of a cardiac specificity as others. C-reactive protein is increased after an MI as a result of the inflammation caused by tissue damage; however, it is also not as highly specific to cardiac tissue. An increased white blood cell count may be present after an MI but is due to a generalized inflammatory response.

The nurse provides care for a patient with right-sided heart failure and expects what assessment findings? Select all that apply. 1 Splinter hemorrhages 2 Pericardial friction rub 3 Jugular vein distention 4 Tricuspid valve regurgitation 5 Pitting edema of the lower extremities

3 - Jugular vein distention 4 - Tricuspid valve regurgitation 5 - Pitting edema of the lower extremities Patients with right-sided heat failure may present with pitting edema of the lower extremities due to interruption of venous return to the heart. The tricuspid valve is located in the right side of the heart; its regurgitation results in the back-up of blood. Jugular vein distention is the result of blood back-up on the right side of the heart. Splinter hemorrhages are often caused by infective endocarditis. A pericardial friction rub is indicative of pericarditis.

The nurse recognizes that which medication(s) may relieve spasms associated with radial artery coronary artery bypass surgery? Select all that apply. 1 Captopril 2 Carvedilol 3 Nicardipine 4 Verapamil 5 Tenecteplase

3 - Nicardipine 4 - Verapamil The radial artery is a thick muscular artery that is prone to spasm. A patient with coronary revascularization of the radial artery is administered long-acting nitrates and calcium channel blockers treatment. Nicardipine and verapamil are calcium channel blockers that will help to control the spasms. Captopril, an ACE inhibitor, prevents ventricular remodeling and prevents the progression of heart failure in a patient with elevated ST-segment myocardial infarction. Carvidilol, a beta blocker, helps reduce workload on the heart. Tenecteplase stops the infarction in a patient with myocardial infarction (MI) by dissolving the thrombus and reperfusing the myocardium.

A patient with ventricular dysfunction receives a prescription for an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what indication of intolerance of this type of medication? 1 Constipation 2 Hyperactivity 3 Persistent cough 4 Decreased potassium levels

3 - Persistent cough A nonproductive and persistent cough may occur in 5 percent to 25 percent of individuals. It may take up to two weeks or longer for coughing to subside after the ACE inhibitor is discontinued. If one ACE inhibitor causes coughing, it is likely that the others will also. Other side effects of ACE inhibitors include drowsiness (versus hyperactivity), elevated (versus decreased) blood potassium levels, and diarrhea (versus constipation).

The nurse reviews a patient's electrocardiogram (ECG) tracing and notes a heart rate of 82 and an irregular rhythm. How should the nurse interpret the findings? 1 Sinus tachycardia 2 Junctional dysrhythmia 3 Premature atrial contractions 4 Paroxysmal supraventricular tachycardia

3 - Premature atrial contractions When premature atrial contractions are present, the result is an irregular rhythm. In sinus tachycardia, the patient's heart rate is 101 to 200 beats per minute, and the cardiac rhythm is regular. A heart rate of 40 to 180 beats per minute with regular cardiac rhythm is observed in patients with junctional dysrhythmias. A heart rate of 150 to 220 beats per minute with regular cardiac rhythm is observed in patients with paroxysmal supraventricular tachycardia.

The nurse suspects that a patient is experiencing myocardial infarction (MI). Which component of the patient's electrocardiogram (ECG) is most important for the nurse to analyze to make this determination? 1 P wave 2 PR interval 3 ST segment 4 Heart rate

3 - ST segment The typical ECG change seen during myocardial injury is ST segment elevation. The P wave represents time for the passage of the electrical impulse through the atrium; there are no specific changes that occur with MI. A prolonged PR interval is indicative of a heart block and is usually not associated with MI. A specific change is heart rate is not associated with MI.

The nurse provides education to a patient that receives a prescription for sublingual nitroglycerin for treatment of angina. Which statement made by the patient indicates the need for further teaching? 1 "I cannot take sildenafil and nitroglycerin at the same time." 2 "I can take a tablet 5 to 10 minutes before starting an activity that causes angina." 3 "After taking a tablet, I may experience a headache, dizziness, or flushing." 4 "After the bottle is open, the tablets lose potency and should be replaced every 12 months."

4 - "After the bottle is open, the tablets lose potency and should be replaced every 12 months." After the bottle is open, the tablets lose potency and should be replaced every 6 months. The patient can take the medication prophylactically before starting an activity that is known to cause angina. In these cases the patient can take a tablet or spray 5 to 10 minutes before beginning the activity. Headache, dizziness, or flushing may occur after taking the medication. Patients should be instructed not to combine nitroglycerin with drugs used for erectile dysfunction (e.g., sildenafil [Viagra]) as severe hypotension can occur.

The nurse recognizes that which type of medication may be prescribed for a patient with an ejection fraction of 25%? 1 Lipid lowering agent 2 Beta-adrenergic blocker 3 Calcium channel blocker 4 Angiotensin-converting enzyme (ACE) inhibitor

4 - Angiotensin-converting enzyme (ACE) inhibitor Patients with chronic stable angina who have an ejection fraction (EF) of 40% or less should take an ACE inhibitor indefinitely, unless contraindicated. These drugs result in vasodilation and reduced blood volume. They also prevent ventricular remodeling, and prevent the progression of heart failure in the patient. Lipid lowering agents reduce low density cholesterol and triglyceride levels in the blood. Beta-adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, blood pressure, and contractility. Calcium channel blockers are prescribed to decrease blood pressure in patients with beta blocker intolerance and Prinzmetal's angina.

The nurse expects to assess what heart rate in a patient with paroxysmal supraventricular tachycardia (PSVT)? 1 Slower than 60 beats/minute 2 Between 60 and 100 beats/minute 3 Between 100 and 150 beats/minute 4 Between 150 and 220 beats/minute

4 - Between 150 and 220 beats/minute Paroxysmal supraventricular tachycardia (PSVT) is characterized by a heart rate of 150 to 220 beats/minute. A heart rate of fewer than 60 beats/minute is considered bradycardia. A rate of 100 beats/minute is the upper limit for a normal heart rate, and a rate of 100 to 150 beats/minute is the range for a sinus tachycardia.

The nurse is caring for a patient 24 hours after the patient was diagnosed with ST segment elevation myocardial infarction (STEMI). The nurse should monitor the patient for what complication of myocardial infarction (MI)? 1 Unstable angina 2 Cardiac tamponade 3 Sudden cardiac death 4 Cardiac dysrhythmias

4 - Cardiac dysrhythmias The most common complication after MI is dysrhythmias, which are present in 80 percent of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.

The nurse notes artifact on a patient's telemetry monitor. Which factors contribute to artifact? 1 Disabled automaticity 2 Stimulation of the vagus nerve fibers 3 Electrodes placed in the incorrect lead 4 Excessive hair under the electrode pads

4 - Excessive hair under the electrode pads One reason that artifact is seen on the monitor is when leads and electrodes are not secure. Electrode pads may not be secure if there is excessive hair under the pads, the skin is oily, or if diaphoresis is present. Disabled automaticity would cause an atrial dysrhythmia. Electrodes placed in the incorrect place will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.

A patient experienced sudden cardiac death (SCD) while hospitalized and survived. The nurse expects that what preventive treatment will be prescribed? 1 External pacemaker 2 An electrophysiologic study (EPS) 3 Medications to prevent dysrhythmias 4 Implantable cardioverter-defibrillator (ICD)

4 - Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital, but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used, but are not best for prevention of SCD.

A patient survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? 1 Drug therapy with beta-blocker 2 Coronary artery bypass graft (CABG) 3 Percutaneous coronary intervention (PCI) 4 Implantable cardioverter-defibrillator (ICD)

4 - Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary.

A patient who has received a maximum dose of nitroglycerin continues to report chest pain. What is the next medication that the nurse should administer to the patient? 1 Esmolol 2 Docusate 3 Ticagrelor 4 Morphine sulfate

4 - Morphine sulfate Morphine sulfate is the drug of choice for a patient with unrelieved chest pain even after the administration of nitroglycerin. Esmolol is a beta blocker used to slow down the heart during minimally invasive direct coronary artery bypass (MIDCAB). Docusate is a stool softener that facilitates bowel movements. Ticagrelor is used in dual antiplatelet therapy on a patient with ongoing angina and negative cardiac markers.

Diagnostic tests confirm that a patient has experienced a ST-segment-elevation myocardial infarction (STEMI). The nurse should prepare the patient for what first line of treatment? 1 Antiplatelet and statins therapy 2 Dual antiplatelet therapy and heparin 3 Transmyocardial laser revascularization 4 Percutaneous coronary intervention (PCI)

4 - Percutaneous coronary intervention (PCI) Emergent PCI is the first line of treatment for patients with confirmed STEMI (i.e., ST-elevation on the ECG and/or positive cardiac biomarkers). The goal is to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory. Antiplatelet and statins therapy improves vein graft patency in a patient who has undergone CABG involving the saphenous vein. Dual antiplatelet therapy and heparin will help a patient with ongoing angina and negative cardiac markers. Transmyocardial laser revascularization is used for a patient with advanced coronary artery disease and persistent angina even after maximum medical therapy.

A patient's electrocardiogram (ECG) tracing shows wide and distorted QRS complexes. How should the nurse interpret the finding? 1 Sinus tachycardia 2 Ventricular fibrillation 3 Junctional dysrhythmias 4 Premature ventricular contractions

4 - Premature ventricular contractions Premature ventricular contractions are caused by premature impulses originating from the ventricles of the heart and not from the sinoatrial node. This causes the QRS complex to be wide and distorted. The QRS wave appears normal in patients with sinus tachycardia. The QRS wave is not measurable in the electrocardiogram of a patient with ventricular fibrillation. The QRS complex will be normal in the electrocardiogram of patient with junctional dysrhythmias.

The nurse observes a student nurse who is providing thrombolytic therapy to a patient three hours after the patient's report of chest pain. Which action performed by the student nurse indicates the need for the nurse to intervene? 1 Monitors the patient for blood in the urine 2 Assesses the patient regularly for neurologic status changes 3 Draws blood samples from the patient before initiation of the therapy 4 Reduces the dose of the thrombolytic agent during episodes of chest pain

4 - Reduces the dose of the thrombolytic agent during episodes of chest pain Thrombolytic therapy helps stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium. In order to be effective, the entire dose of a thrombolytic agent must be administered as soon as possible after the onset of symptoms. Unless contraindicated, the patient should be provided with heparin intravenously (IV) along with other thrombolytic therapy to dissolve the unstable thrombus and reduce spasms in the coronary artery. A major complication of the thrombolytic therapy is bleeding; therefore the nurse should monitor the urine and stool for bleeding. Monitoring for neurologic changes in the patient helps assess for cerebral bleeding. The nurse should draw the blood samples from the patient before initiation of the therapy to assess the baseline laboratory values.

Which electrocardiogram (ECG) characteristics in a patient with acute coronary syndrome suggests myocardial ischemia? 1 Normal T wave 2 Pathologic Q wave 3 ST segment elevation 4 ST segment depression

4 - ST segment depression Typical ECG changes that are seen in myocardial ischemia include ST segment depression and/or T wave inversion. The typical ECG change seen during an acute myocardial infarction is ST segment elevation. Depression of the ST segment and T wave inversion occurs in response to an inadequate supply of blood and oxygen, which causes an electrical disturbance in the myocardial cells. Pathologic Q waves may be seen in patients with a myocardial infarction. ST segment elevation may be seen in myocardial injury.

A patient with paroxysmal supraventricular tachycardia (PSVT) that is receiving intravenous adenosine becomes hemodynamically unstable. The nurse expects what to be included in the patient's immediate treatment plan? 1 β-adrenergic blocker 2 Calcium channel blocker 3 Catheter ablation therapy 4 Synchronized cardioversion

4 - Synchronized cardioversion Paroxysmal supraventricular tachycardia is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The standard drug of choice to treat paroxysmal supraventricular tachycardia is intravenous (IV) adenosine. Sometimes the drug therapy is ineffective and the patient becomes hemodynamically unstable. For patients who are unresponsive to treatment, synchronized cardioversion is used. Synchronized cardioversion is low energy shock, which uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. Drug therapy is not effective for such patients. β -adrenergic blockers and calcium channel blockers do not improve paroxysmal supraventricular tachycardia. Catheter ablation therapy is used in patients with Wolff-Parkinson-White syndrome who have recurring paroxysmal supraventricular tachycardia (PSVT).

The nurse reviews the electrocardiogram (ECG) tracing of a patient with an electrolyte imbalance and expects to find a disturbance in which waveform? 1 P wave 2 Q wave 3 S wave 4 T wave

4 - T wave The T wave represents ventricular repolarization in an electrocardiogram. Disturbances (e.g., tall, peaked, inverted) in T waves can occur due to electrolyte imbalances, ischemia, and infarction. Disturbances in the P wave can be due to alterations in atrial conduction. Disturbances in the Q wave can occur due to myocardial infraction. Disturbances in the S wave do not affect the normal functioning of heart.

A patient asks the nurse about resuming sexual activity after acute coronary syndrome (ACS). What should the nurse include in the patient's teaching plan? 1 Take a hot shower just before intercourse to provide relaxation. 2 Limit the time, including foreplay, to 30 minutes to prevent overexertion. 3 Wait an hour after ingesting a large meal before engaging in sexual activity. 4 Taking a prophylactic nitrate may decrease chest pain during sexual activity.

4 - Taking a prophylactic nitrate may decrease chest pain during sexual activity. Taking a prophylactic nitrate may decrease chest pain during sexual activity. Hot or cold showers should be avoided just before or after intercourse. Consumption of food and alcohol should be reduced before intercourse is anticipated (e.g., waiting 3-4 hours after ingesting a large meal before engaging in sexual activity). There is no established time limit. Foreplay is desirable because it allows a gradual increase in heart rate before orgasm.

The nurse recognizes that which cardiac dysrhythmia is life-threatening and necessitates immediate intervention? 1 Sinus tachycardia 2 Atrial fibrillation 3 Junctional tachycardia 4 Ventricular fibrillation

4 - Ventricular fibrillation Ventricular fibrillation is a life-threatening dysrhythmia that requires immediate intervention. During ventricular fibrillation, the ventricles are quivering and are no longer able to contract to produce effective cardiac output. Because there is no cardiac output, the body is left without oxygenation. Sinus tachycardia requires treatment to slow the rate to 60 to 100 beats/minute. Atrial fibrillation requires treatment to convert the rhythm back to a normal sinus rhythm with one atrial contraction for every ventricular contraction. Normal sinus rhythm, in which the rate is 60 to 100 beats/minute, requires no treatment.

1 - Contact the primary health care provider The ECG tracing is showing ST elevation indicative of myocardial infarction (MI). The primary health care provider should be notified immediately so appropriate interventions can be prescribed. Morphine sulfate is the drug of choice for a patient experiencing an acute MI. Whenever possible, the patient experiencing an MI should be placed in a position promoting respirations. The Trendelenburg position inhibits respirations. Digoxin toxicity is characterized by ST segment depression, not elevation.

A patient reports a new onset of jaw pain. The nurse obtains the following electrocardiogram (ECG) tracing. What action should the nurse take? 1 Contact the primary health care provider 2 Administer hydrocodone 3 Place the patient in a Trendelenburg position 4 Recognize the ECG changes as indicative of digitalis toxicity

1 - The cardioversion was successful. The patient has converted to a normal sinus rhythm (NSR). The cardioversion was successful. Accelerated junctional rhythm is characterized by an absent P wave and inverted P wave before or following the QRS complex. Hyperkalemia is characterized by a peaked T wave. The T wave in this tracing is norma

After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. How should the nurse interpret the findings? 1 The cardioversion was successful. 2 The cardioversion will need to be repeated. 3 The patient is in an accelerated junctional rhythm. 4 The ECG tracing indicates hyperkalemia.

2 Myocardial ischemia Typical ECG changes that are seen in myocardial ischemia include ST segment depression and/or T wave inversion. Medications, fluid overload, and dehydration do not often affect the ST segment position on the ECG tracing.

The nurse reviews the following electrocardiogram (ECG) tracing. The nurse recognizes that the abnormal ECG finding is usually caused by what? 1 Medications 2 Myocardial ischemia 3 Fluid overload 4 Dehydration