Prep U - Cardiovascular
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order?
Heparin (if dysrhythmia persists longer than 48 hours)
The nurse understands that asystole can be caused by several conditions. Select all that apply.
Hypoxia Hypovolemia Hypothermia Acidosis
A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?
Immediate CPR
What is the treatment of choice for ventricular fibrillation?
Immediate bystander CPR
The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation?
In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output.
The nurse is caring for a client who will have coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse should address which subject?
Intubation and mechanical ventilation
The nurse is discharging a client after a cardiac catheterization. What would the nurse include in the discharge teaching?
Keep extremity straight for couple of hours. Report any numbness, tingling, or sharp pain in the extremity. Drink large amount of fluid to rid body of contrast dye.
The nurse is caring for a client who is scheduled to undergo mechanical valve replacement. Client education would include coverage of which intervention?
Long-term anticoagulant therapy
A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching?
"I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD."
The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching?
"I will report if I feel lightheaded and dizzy at my next doctor's appointment." (report immediately)
A client scheduled for a catheter ablation procedure confides to the nurse that he is worried about having some of his heart cells destroyed. The best response by the nurse is which of the following?
"Only the specific cells causing your dysrhythmia are destroyed; your heart will function better without these cells." (Ablation therapy destroys specific cells that are the cause of a tachydysrhythmia.)
The nursing student learning on a cardiac unit asks the instructor why loss of the "atrial kick" causes a decrease in cardiac output, because the ventricles are still contracting. What is the nursing instructor's best response?
"The atrial contraction fills the ventricles and accounts for nearly one-third of the volume ejected during ventricular contraction."
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response?
"The difference is the timing of the delivery of the electric current."
A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following?
"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."
The nurse is caring for a client scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response?
"This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion."
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?
"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response?
"You are at risk of developing an infection in your heart."
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond?
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first?
12-lead ECG
The nurse is teaching a client scheduled for an autograft aortic valve replacement. What statements are true about autograft replacement process? Select all that apply.
The grafts are obtained by excising the client's own pulmonic valves and a portion of the pulmonary artery. The autograft is an alternative for children and women of child-bearing age. Aortic valve autografts have remained viable for more than 20 years.
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?
Magnesium and potassium
The nurse is caring for an adult client who has gone into ventricular fibrillation. When assisting with defibrillating the client, what must the nurse do?
Maintain firm contact between paddles and the client's skin.
Which nursing intervention would reduce cardiac workload in a client with myocarditis?
Maintain the client on bed rest.
The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias?
Monitor cardiac rhythm continuously.
A client with type 2 diabetes and persistent atrial fibrillation is prescribed atenolol. Which actions will the nurse take when providing the medication to the client? Select all that apply.
Monitor heart rate. Assess blood pressure. Monitor blood glucose level.
The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.)
Abrupt closure of the artery Arterial dissection Coronary artery vasospasm
A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure?
Administer moderate sedation IV and analgesic medication as prescribed.
A client recovering from percutaneous transluminal coronary angioplasty (PTCA) develops chest pain and an arrhythmia on the electrocardiogram (ECG). Which action(s) will the nurse take to help this client? Select all that apply.
Administer oxygen Obtain a 12-lead ECG Provide nitroglycerine Notify the primary healthcare provider
What is the drug of choice for a stable client with ventricular tachycardia?
Amiodarone
The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment?
An automatic external defibrillator
A client is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in the care of the client's pacemaker?
Monitoring for pacemaker malfunction or battery failure
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?
Ask the patient to lean forward and listen again.
The nurse is caring for a client newly diagnosed with myocarditis. Which diagnostic test would the nurse find most helpful in confirming the diagnosis?
Myocardial biopsy
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication?
Atelectasis
The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia?
Atenolol (Beta-blockers lower HR)
A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?
Atropine
Which medication is the drug of choice for sinus bradycardia?
Atropine
A client is being discharged after having a cardiac catheterization through the femoral artery. Which teaching will the nurse provide for the client to perform self-care at home? Select all that apply.
Avoid bending at the waist for at least the first 24 hours. Notify the health care provider if new bruising occurs at the site. Call 911 if there is a large amount of bleeding from the access site. Apply pressure to the site for 10 minutes if it begins to bleed.
A nurse is caring for a client who has had an automatic cardiac defibrillator implanted. What instructions should the nurse provide to the client?
Avoid devices with a magnetic field.
The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply.
Avoid handheld screening devices in airports Check pulse daily, reporting sudden slowing or increase Wear a medical alert, noting the presence of a pacemaker (walk through antitheft devices quickly)
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?
Begin cardiopulmonary resuscitation (CPR)
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?
Bigeminy
The nurse is assessing an older adult's cardiovascular system. Which assessment finding indicates to the nurse that the client is experiencing age-related changes to the conduction system? Select all that apply.
Bradycardia Exercise intolerance
Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles?
Cardiac tamponade
The OR nurse is explaining to a client that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe?
Cardiopulmonary bypass (used to circulate and oxygenate blood mechanically while bypassing the heart and lungs)
A client with a history of atrial fibrillation has experienced a TIA. What does the nurse expect will be the priority preventative medical treatment(s) to reduce the risk of a cerebrovascular accident (CVA)? Select all that apply.
Cholesterol-lowering drugs Anticoagulant therapy
The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point?
The treatments include medications, medical devices, surgery, or transplantation.
The nurse is teaching a client diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without resorting to taking medications. What should the nurse teach the client?
To rest and relax before taking nitroglycerin
The nurse caring for a client whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this client?
Transcutaneous pacemaker
A client with end stage heart disease has a ventricular assist device (VAD) implanted. Which assessment finding(s) indicates to the nurse that the client is experiencing a complication from this device? Select all that apply.
Peripheral edema Elevated body temperature Reduced urine output
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?
Ventricular fibrillation
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?
Premature ventricular contraction (PVC)
What is the drug of choice for a stable client with ventricular tachycardia?
Procainamide
Which medication is an antidote to heparin?
Protamine sulfate
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?
RR interval
During a client's care conference, the team is discussing whether the client is a candidate for surgery maze procedure. What would be the most important criterion for a client to have this surgery?
Refractory atrial fibrillation
Which terms describes the backward flow of blood through a heart valve?
Regurgitation
A client with infective endocarditis is admitted to the hospital. While obtaining a history, what should the nurse ask the client about? Select all that apply.
Renal dialysis Intravenous (IV) drug use Nasal piercing Prosthetic cardiac valves Recent urinary tract infection
The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter?
Sawtooth
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse's pressing the discharge button?
Shouting "Clear!"
The nurse is instructing a new graduate nurse. Together, they are caring for a client with infective endocarditis. What is a sign of infective endocarditis?
Splinter hemorrhage
The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason?
The defibrillator won't deliver a shock if the synchronizer switch is turned on.
During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?
Decreased cardiac output
A client who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?
Dental procedures
A nurse is caring for a client who was admitted yesterday with myocarditis. The client takes insulin, digoxin, and metformin at home and continues these medications during hospitalization. During the morning assessment, the client reports anorexia, nausea, vomiting, headache, and disturbed color vision. An ECG strip shows a prolonged PR interval. What should the nurse suspect?
Digoxin toxicity
The nurse and student nurse are observing a cardioversion procedure. The nurse is correct to tell the student that electrical current will be initiated at which time?
During ventricular depolarization (QRS complex)
The nurse is assessing a client with mitral regurgitation. The nurse expects to note what finding in this client?
Dyspnea, fatigue, and weakness (for acute regurgitation; chronic is asymptomatic)
A client is experiencing symptoms of infective endocarditis. Which tests will the nurse expect to be prescribed for this client? Select all that apply.
Echocardiogram Two blood cultures White blood cell count Erythrocyte sedimentation rate
The client has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse would assess for indications of which potential complications? Select all that apply.
Emboli Mitral valve damage Ventricular dysrhythmia
The ED nurse is caring for a client who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
Ensure no one is touching the client at the time shock is delivered.
A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?
Exertional dyspnea, orthopnea, pulmonary edema
The nurse is caring for a client scheduled for a cardiac stress test at 1100. When the nurse enters the client's room at 0800, the client requests toast or at least some coffee. What is the best response by the nurse?
Explain that no food or drink is allowed for 4 hours before the stress test. (Especially caffeine)
A nurse is caring for a client who has premature ventricular contractions. What sign would the nurse assess in this client?
Fluttering/heart skipping (other s/s include pallor, nervousness, sweating, and faintness)
The nurse is auscultating the breath sounds of a client with pericarditis. Which finding is most consistent with this diagnosis?
Friction rub
When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize?
Heart rate and rhythm
A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment?
acute pain (pain relief and absence of comps)
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug?
aspirin or clopidogrel. (prevent thromboembolism)
The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available?
atropine sulfate (removal may cause bradycardia)
A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client?
balloon valvuloplasty (procedure to enlarge a narrowed valve opening)
What are contributing causes to pericarditis? Select all that apply.
cardiac surgery tuberculosis myocarditis chest trauma
For a client who has undergone peripheral arteriography, how should the nurse assess the adequacy of peripheral circulation?
checking peripheral pulses
The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply.
colchicine ibuprofen prednisone
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease?
echocardiogram
A client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows:
elevated troponin levels.
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?
fever, shock, and strenuous exercise. (all options are correct)
What is a harsh grating sound caused by abrasion of the pericardial surfaces during the cardiac cycle?
friction rub (indicative of pericarditis)
The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for?
heart block (beta blockers interfere with conduction)
The health care provider prescribes esmolol for a client with supraventricular tachycardia. During esmolol therapy, what should the nurse monitor?
heart rate and blood pressure. (may cause hypotension and bradycardia)
A group of nurses is participating in orientation to a telemetry unit. The nurse who is providing the education should tell the class that ST segments:
represent early ventricular repolarization.
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of arrhythmia would the cardiologist likely diagnose?
sinus tachycardia
The nurse is providing discharge teaching to a client with recurrent endocarditis. What are prevention strategies will be included with the teaching? Select all that apply.
use a nail clipper for fingernail care report recurrent fever lasting longer than 7 days to the health care provider notify dentist of the history of endocarditis with any planned dental procedures