Quiz #4 Cardiovascular

Orthostatic hypotension

decrease of at least 20 mmHg systolic or 10 mmHg diastolic within 3min of moving from lying/sitting to standing -dizzy, lightheaded, syncope can occur -increases risk with age and risk for falls

EJ <40% indicates:

decreased left ventricular function -usually requires HF treatment

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise:

decreases venous congestion.

The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?

defibrillation

preload

degree of stretch of the cardiac muscle fibers at the end of diastole

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour?

25%

Amylase normal range

25-125 units

Potassium normal range

3.5-5.0

Albumin normal range

3.5-5.5g

ventricular pacemaker rate

30-40

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?

Monitor the site for bleeding or hematoma.

Diltiazem (Cardizem)

calcium-channel blocker -treats Coronary Arterial Disease (CAD)

A stroke can occur if plaque build up occurs in:

carotid artery

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?

"The small box will transmit the heart rhythm to the central monitor all the time."

3 complications of hemodynamic monitoring

-pneumothorax -infection -air embolism The longer these are left in, the greater the risk for infection

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse?

"Current evidence indicates that estrogen replacement is not effective at preventing cardiovascular disease and carries some risks."

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include?

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours." The nurse should instruct the client to follow these guidelines: For the next 24 hours, do not bend at the waist, strain, or lift heavy objects if the artery of the groin was used; contact the primary provider if swelling, new bruising or pain from the procedure puncture site, or a temperature of 101°F or more occur. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The client should not drive to the hospital.

A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?

"Flex your calf muscles, avoid alcohol, and change positions slowly."

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

"Have you had any episodes of dizziness or fainting?

A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching?

"I will drink coffee with only two of my meals." Explanation: Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate. The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate.

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client?

"Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium, so the client should be encouraged to eat fruits and vegetables that are high in potassium.

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following?

"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." -The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization.

The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?

"The F waves are flutter waves representing atrial activity."

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply?

"The only difference is the heart rate." Explanation: All characteristics of sinus bradycardia are the same as those of normal sinus rhythm except for the rate, which will be below 60 in sinus bradycardia

The nurse is assessing vital signs on a client who is 3 months status post myocardial infarction (MI). While the healthcare provider is examining the client, the client's spouse approaches the nurse and states "We are too afraid he will have another heart attack, so we just don't have sex anymore." What is the nurse's best response?

"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse?

"The rhythm has a normal beat, then a premature beat pattern." Explanation: Bigeminy is a rhythm in which every other complex is a premature ventricular contraction (PVC). In trigeminy, every third complex is a PVC.

What determines the heart's weight/size?

-age -gender -body weight -extent of physical exercise and conditioning -heart disease

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation?

"Walk to the point of pain, rest until the pain subsides, then resume ambulation." Explanation: The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops.

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?

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

Pulmonary Artery Pressure monitoring

-assesses left vent function -diagnoses etiology of shock -balloon tipped, flow-directed catheters (1.5 mL of air) in the right atrium -inserted in subclavian vein (fem vein avoided)

The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse?

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

Coronary atherosclerosis is the ________ leading cause of cardiac death and can cause _______, _________, and sudden _________ death.

#1 MI HF Cardiac

electrophysiology study (EPS)

- invasive test to evaluate source of rhythm disorder - catheter used to induce dysrhythmia - can be used for ablation - prep and aftercare similar to a cardiac catheterization

Why should a pt w/a mechanical valve replacement take antibiotics before getting teeth cleaned?

-"you are at risk for developing an infection in your heart" endocarditis

The nurse is educating a client with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.)

-Avoid constricting garments. -Elevate the legs above the heart frequently throughout the day. -Sleep with the foot of the bed elevated.

Angina Nursing Diagnoses

-Decreased Activity tolerance r/t acute pain, dysrhythmias -Anxiety r/t situational crisis -Decreased Cardiac output r/t myocardial ischemia, medication effect, dysrhythmia -Ineffective Coping r/t personal vulnerability to situational crisis of new diagnosis, deteriorating health -Ineffective Denial r/t deficient knowledge of need to seek help with symptoms -Acute Pain r/t myocardial ischemia -Ineffective Sexuality pattern r/t disease process, meds, loss of libido -Readiness for enhanced Knowledge: expresses an interest in learning

Acute Coronary Syndrome Nursing Diagnoses

-Decreased cardiac output r/t cardiac disorder -Risk for decreased Cardiac tissue perfusion

Risk factors for heart attack/Coronary heart disease

-Fam Hx -HTN -obesity -high cholesterol -diabetes -kidney diseases -smoking -sedentary lifestyle -alcohol/drug abuse

Angioplasty Nursing Diagnoses

-Fear r/t possible outcome of interventional procedure -Ineffective peripheral Tissue Perfusion r/t vasospasm, hematoma formation -Risk for bleeding -Risk for decreased Cardiac tissue perfusion: ventricular ischemia, dysrhythmias -Readiness for enhanced Knowledge

Right side HF symptoms

-JVD -edema -ascites

Endocarditis S/S

-Petechia on trunk, conjunctiva, mucous membranes -hemorrhagic streaks under nails

Anticoagulation Therapy Nursing Diagnoses

-Risk for bleeding: altered clotting function from anticoagulants -Risk for deficient Fluid volume: hemorrhage: altered clotting mechanism -Readiness for enhanced Knowledge

ventricular asystole characteristics

-absent QRS complexes -referred to as flatline.

post TEE care

-bedrest with HOB 45degrees 2-6hr -nurse monitor VS (same times as pulse check), LOC, return of gag and cough reflex (withhold food/drink until return) -pt may have sore throat, SOB, diff swallowing -monitor site for bleeding/hematoma -assess peripheral pulses in affected extremity Q15m for 1hr, Q30m for 1 hr, and hourly Q4h -check temp/color/cap refill of extremity same time intervals (pain, tingling, numbness=arterial insufficiency)q

Labs for check

-cardiac biomarkers -blood chemistry, hematology, coagulation -lipid profile -BNP -C-reactive protein -homocysteine

Creatine Kinase(CK)/Creatine phosphokinase(CPK) Lab

-cardiac enzymes test for disease/injury involving heart muscle, skeletal muscle, or brain -normal: 30-135(male)/50-170(female) -elevates within 6hr of injury -return to normal in 2-3days

Common symptoms of cardiovascular problems

-chest pain/discomfort (angina, arrhythmias, valvular heart disease, Acute Coronary Syndrome) -SOB or dyspnea (cardiogenic shock -pain/discomfort in upper body(one or both arms, back, neck, jaw, or stomach) -peripheral edema, wt gain, abdominal distention (enlarged spleen and liver or ascites) HF -palpitations (tachy: from caffeine, stimulants, ACS, lytes imbalances, stress, valvular heart disease, ventricular aneurysms) -Unusual fatigue, dizziness, syncope, LOC changes -diaphoresis

Causes of hypovolemia

-dehydration -excessive blood loss -vomit/diarrhea -overdiuresis

Intra-arterial BP monitoring

-direct continuous BP measurements -cath inserted into radial (commonly) artery -can draw blood and ABG from it -used for critically ill patients w/severe hypotension and HTN -circulation assessed via doppler or allen's test prior to insertion

Halter monitor

-done at home in controlled environment -pt keeps diary of any symptoms

CK-MB lab

-drawn 3x -elevates in 3-6hr; peak in 12-24hr; normal in 12-48hr -done for cardiac ischemia/infarction -usually doesnt rise with angina

transesophageal echocardiography (TEE)

-enters through mouth --> esophagus -gives clearer images than echo -pt given topical anesthetic and sedation -need patient consent -NPO 8-12hrs

genetic blood disorders that can impair cardiovascular function

-factor V leiden -hemochromatosis -sickle cell disease

Risk factors for CAD: nonmodifiable

-family hx (first deg relatives) -age (45+ in men/55+ in women) -gender (men develop earlier than women) -race (higher in african americans) -Hx of premature menopause (before 40) -Hx of preeclampsia -Primary hypercholesterolemia (genetic elevated LDL)

prep for stress test

-fast for several hrs (at least 3) -avoid stimulants (tobacco/caffeine) -can take meds with sip of water but withhold cardiac meds (beta blockers, calcium channel blockers, digoxin) up to 48hrs prior

Nursing Interventions to prevent intravascular catheter bloodstream infections

-hand hygiene -dressing checks/changes (wear sterile gloves and change Q2-7days) -Assess site regularly -daily CHG baths -edu pt to report any discomfort at site

Gerontologic considerations of the heart

-heart walls thicken (hypertrophy) -slower HR -size of heart increases from thickening -reduced strength of contraction -valves stiffen and stop closing properly (backflow of blood=murmurs)

diet, exercise, wt loss are important strategies for mgmt of 3 major cardiovascular risk factors called:

-hyperlipidemia -htn -diabetes

Risk factors for CAD: modifiable

-hyperlipidemia -tobacco -HTN -Diabetes -Metabolic syndrome -obesity -physical inactivity -chronic inflammatory conditions (rheumatoid arthritis, lupus, HIV/AIDS) -chronic kidney disease

Dobutamine

-increases HR, myocardial contraction, and BP -used in stress tests for those w/bronchospasm or pulmonary disease

What labs are drawn prior to a cardiac catheterization?

-lytes (metabolic) -glucose (metabolic) -BUN (renal) -creatine (renal) -coags (aPTT/INR/PT) -CBC (hct, hbg, platelets) these labs are redrawn post cath to compare for blood loss

CVP (central venous pressure)

-measures pressure in vena cava or right atrium (equal to diastole) -normal CVP 2-6 mmHg ->6mmHg = elevated right vent preload

Echocardiogram

-noninvasive ultrasound -measures EJ (55%-65% normal) and presence of leaky valves -examines size, shape, and motion of heart -test is 30-45min

Homocysteine

-normal: 4-17 -elevation indicated atherosclerosis

Myoglobin lab (protein)

-normal: 5-70 -elevates in 3hr; normal in 24hr -drawn for MI, skeletal muscle inflammation, ischemia or trauma -more sensitive than CK, but not specific

Trops I and T lab

-normal: <0.35(I)/<0.2(T) -elevates in 3hr; remains elevated for 10-14days -indicates myocardial injury/infarction -cardiac specific

C-reactive protein (CRP) lab

-normal: <0.8 -elevates w/inflammatory response -predictor of CVD

BNP lab

-normal: <100 -elevates with HF and returns to normal after treatment -indicates: HF, MI, PE, cor pulmonale, heart transplant rejection

infective endocarditis s/s

-osler's nodes (red, painful lesions on finger/toe pads) -janeway lesions (painless on palms/soles) -splinter hemorrhages (tiny blood spots under nails)

Left sided HF s/s

-pulmonary congestion/crackles -S3 or "ventricular gallop" -dyspnea on exertion (DOE) -low o2 sat -dry, nonproductive cough (initially) -oliguria (decreased urine output) -PND (paroxysmal nocturnal dyspnea): SOB and wakes person up 1-2hr after sleeping -altered digestion

Therapeutic effect of beta-adrenergic blocking agent

-reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. -reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. -This helps to control chest pain and delays the onset of ischemia during work or exercise. -This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality.

NSR (Normal Sinus Rhythm) characteristics

-regular with a ventricular and atrial rate of 60 to 100 bpm. -P-wave has a consistent shape and is always in front of the QRS. -PR interval is a consistent interval between 0.12 and 0.20 seconds -P:QRS ratio is 1:1. (one p-wave before every QRS)

Nursing assessment of cardiovascular system is dependent upon:

-s/sx -risk factors -practice setting -purpose of assessment

Pericarditis relief

-sitting upright -analgesics -anti inflammatory

digoxin

-slows HR -increases cardiac contractility -drug of choice for A-Fib

Left side HF symptoms

-tachycardia (best to assess apically) -SOB -crackles -fatigue -S3 heart sounds -AMS -orthopnea -labored breathing

Atypical atherosclerosis s/s in women

-vague indigestion -heart palpitations -numbness -asymptomatic

What is the action of nitroglycerin?

-vasodilator (at low doses has a preference for venous dilation). -This results in decreased preload. **At higher doses nitroglycerin also decreases afterload by vasodilating arteries.**

Right sided HF s/s

-visceral/peripheral congestion -JVD -dependent edema -hepatomegaly (enlarged liver) -ascites -wt gain

Bilirubin normal range

0.1-1.0 mg

After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?

0.12 and 0.2 seconds.

Creatinine normal range

0.4-1.0 mg

The physician prescribed a Tegapore dressing to treat a venous ulcer. What should the nurse expect that the ankle-brachial index (ABI) will be if the circulatory status is adequate?

0.50

specific gravity normal range

1.010 - 1.025

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of:

1.5 to 2.5 times the baseline control.

AST/ALT normal range

10-40 units

Sodium normal range

135-145

Hgb normal range

14-17.4

Platelet normal range

140,000-400,000

Ammonia normal range

15-45 mcg/dL

Troponin remains elevated for as long as ___________ and it therefore can be used to detect recent myocardial damage.

2 weeks

Phosphorus normal range

2.7-4.5 mg

RBC normal range

4.5-5.5 million

EF (ejection fraction) _____% or less indicates ______ _______.

40 systolic dysfunction

AV node rate

40-60 bpm

WBC normal range

4000-11000

Hct normal range

42-52%

Triglycerides normal range

44-180 (males) 10-190 (females) overall: <200

Total protein normal range

6.0-8.0 g/dL

SA node rate

60-100 bpm

HF is the most common hospital admit reason for people ____ years and older.

65

The nurse assesses a client with increasing shortness of breath and peripheral edema. The healthcare provider inserts a triple lumen catheter and orders a transduced central venous pressure (CVP). What CVP reading does the nurse suspect will correlate with the client's symptoms?

8 mm Hg -The normal CVP reading is 2-6 mmHg. A reading of 0 mmHg indicates hypovolemia. A reading of 8 mmHg, which is high, correlates with hypervolemia and the client's symptoms of fluid overload with increasing shortness of breath and edema.

BUN normal range

8-20

Calcium normal range

8.8-10.2 mg

Chloride normal range

97-107 mEq/L

C-reactive protein normal range

<0.8 mg

Lipase normal range

<10-140 unit

what is a normal LDL level?

<100 mg/dL (fasting)

LDL normal value

<100 mg/dL if CAD present

BNP normal range

<100 pg

Total cholesterol normal value

<200 mg/dL

HDL normal value

>40 mg/dL (male) >50 mg/dL (female)

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?

A client with atrial arrhythmias

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

A defibrillator Explanation: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death.

The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about?

Beta blocker

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

Administer an IV bolus of atropine. Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first.

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?

All options are correct There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise.

Bioprosthesis valve

Animal Lasts 7-15yr

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?

Anticoagulant Explanation: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation.

An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take?

Assess for factors that may be causing the client's delirium

A nurse is preparing a client for cardiac catheterization. The nurse knows that which nursing intervention must be provided when the client returns to the room after the procedure?

Assess the puncture site frequently for hematoma formation or bleeding.

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle

Atrial depolarization

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?

Atrial depolarization

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor.

The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack?

Avoid situations that contribute to ischemic episodes.

A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which post-implantation instructions must be provided to the client with a permanent pacemaker?

Avoid sources of electrical interference. The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc.

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

Avoid undergoing magnetic resonance imaging (MRI).

Which of the following assessment results is considered a major risk factor for PAD?

BP of 160/110 mm Hg

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?

Begin CPR

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?

Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute

Which of the following is a characteristic of an arterial ulcer?

Border regular and well demarcated

ejection fraction

measurement of the volume percentage of left ventricular contents ejected with each contraction -normal: 55%-65%

Homografts valves

Cadavers Expensive Lasts 10-15yrs

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce?

Changing positions slowly related to possible hypotension

A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?

Chest discomfort not relieved by rest or nitroglycerin

Most common symptom of pericarditis

Chest pain -abrupt onset -aggravated by respiratory mvmt (DB&Cough), changes in position, swallowing

Pentoxifylline (Trental) is a medication used for which of the following conditions?

Claudication

The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?

Clip the client's chest hair prior to applying the electrodes.

A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.)

Computed tomography Transesophageal echocardiography X-ray

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?

Constant, intense back pain and falling blood pressure

Assess the puncture site frequently for hematoma formation or bleeding.

Continue to monitor the client as ordered.

Carvedilol

Decrease cardiac force Increased SOB

After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension?

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

Statins

Decreases MI risk -assess unexplained muscle pain/cramp/tenderness

A nurse is caring for a client who experienced an MI. The client is ordered to receive metoprolol. The nurse understands that this medication has which therapeutic effect?

Decreases resting heart rate

The nurse recognizes which as being true of cardioversion?

Defibrillator should be set to deliver a shock during the QRS complex. Explanation: Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?

Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?

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

A client is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the client's care?

Diagnose the dysrhythmia. -A client may undergo an EP study in which electrodes are placed inside the heart to obtain an intracardiac ECG. This is used not only to diagnose the dysrhythmia but also to determine the most effective treatment plan. However, because an EP study is invasive, it is performed in the hospital and may require that the client be admitted.

Which is a characteristic of arterial insufficiency?

Diminished or absent pulses

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

Regurgitation

Does not close properly Blood backflows Occur from degeneration (rheum fever, endocarditis, cardiomyopathy)

Mechanical valves

Dont require anticoags

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?

Dorsiflex the foot while the leg is elevated to check for calf pain.

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?

Double-check the monitoring equipment One of the reasons for lack of pacemaker spikes is faulty monitoring equipment

Stress test

ECG taken under controlled exercise stress conditions (exercise or chemically induced with dobutamine) -terminated when pt has achieved target HR(pass) or changes in symptoms(fail) -if fail, next step is cardiac catheterization

The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider?

Evaluating laboratory values

Varicose veins are more common in:

Females Hispanic Elderly Obesity Occupations w/prolonged standing

Which class of medication lyses and dissolves thrombi?

Fibrinolytic Explanation: Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of clients.

A nurse is caring for a client who has premature ventricular contractions. What sign would the nurse assess in this client?

Fluttering/heart skipping Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering" or "skipping a beat." Associated signs and symptoms include pallor, nervousness, sweating, and faintness.

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

Hypokalemia PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (e.g., exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.

What is a side effect of nitroglycerin?

Hypotension

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin?

In 3 to 5 days

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. Explanation: A heart rate slower than 60 beats per minute is pathologic in clients with heart disorders, increased intracranial pressure, hypothyroidism, or digitalis toxicity. The danger in sinus bradycardia is that the slow rate may be insufficient to maintain cardiac output.

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery?

Inadequate tissue perfusion Explanation: The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?

Increased abdominal and back pain Explanation: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time?

Ineffective peripheral tissue perfusion related to venous congestion

ischemia cardiomyopathy

Lack of blood supply r/t weakened heart muscles from heart attack of coronary heart disease -fatigue/SOB/chest pain/swelling Bilateral LEs/weight gain -life threatening if untreated

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

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

S3 sounds indicate

Left ventricle failure

The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?

Loss of arterial elasticity

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When auscultating a murmur, what does the nurse expect to hear?

Loud and may be associated with a thrill sound similar to (a purring cat).

MONA stands for

Morphine Oxygen Nitroglycerin Aspirin

Aortic dissection may be mistaken for which of the following disease processes?

Myocardial infarction (MI)

BP stages

Normal: <120/<80 Stage 1 htn: 130-139/80-89 Stage 2 htn: >140/>90

Autograft valves

Not as durable Need replacing more frequently Anticoags 3mos

The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings?

Obtain an oxygen saturation level.

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.

6Ps for neurovascular assessment (chronic venous insufficiency)

Pallor Parathesia (numbness/tingling) Pain Pulses Polar(temp) Paralysis

DVT and varicose veins can be a causes of:

Peripheral venous disease (PVD)

The nurse is educating a patient at risk for atherosclerosis. What nonmodifiable risk factor does the nurse identify for the patient?

Positive family history -Risk factors are classified by the extent to which they can be modified by changing one's lifestyle or modifying personal behaviors. Stress, obesity, and hyperlipidemia are all risk factors that can be modified by personal behaviors. Family history is a nonmodifiable risk factor, because it cannot be changed.

A patient complains of a "stabbing pain and a burning sensation" in his left foot. The nurse notices that the foot is a lighter color than the rest of the skin. The artery that the nurse suspects is occluded would be the:

Posterior tibial.

A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition?

Premature atrial contraction Explanation: A premature atrial contraction (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?

Prepare to administer protamine sulfate.

Lisinopril

Prevent HF -assess for swelling of tongue and throat

Clopidogrel (plavix)

Prevent platelet aggregation -assess black tarry stools/bleeding gums

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?

QRS complex

The nurse analyzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?

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

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?

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

A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is?

Relieved by rest and nitroglycerin

Which finding indicates that hypertension is progressing to target organ damage?

Retinal blood vessel damage An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity.

Which of the following is the most effective intervention for preventing progression of vascular disease?

Risk factor modification

What is an early manifestation of mitral valve stenosis (right side hf)?

SOB on exertion

Which dysrhythmia is common in older clients?

Sinus bradycardia

A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

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

What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.

Smoking Diabetes mellitus Physical inactivity

A client with hypertension has a blood pressure of 132/88 mm Hg. For which type of hypertension will the nurse prepare teaching for this client?

Stage 1 hypertension

Clinical manifestations of atherosclerosis

Symptoms are caused by myocardial ischemia -chest pain/angina (most common) -epigastric distress -pain radiating to jaw or left arm -SOB

A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?

The medication increases the force of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient?

The patient had a vagal response.

The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?

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

The client has just been diagnosed with a arrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?

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

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD?

To decrease workload of the heart Explanation: Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial oxygen by reducing heart rate and workload of the heart.

Heart valves and locations

Tricuspid valve- between the right atrium and right ventricle Mitral valve- between left atrium and left ventricle Aortic valve-between left ventricle and aorta Pulmonary valve- between right ventricle and pulmonary artery

CVP > 6mmHg indicates?

hypervolemia or right side HF

Most serious complication of peripheral venous disease (PVD)

Venous ulcerations

If the SA node malfunctions, the AV node takes over as the pacemaker resulting in:

a lower HR

Atherosclerosis

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and the lumen -blockages/narrowing of coronary vessels reduce blood flow to myocardium which causes ischemia

Non-modifiable risk factors

age gender heredity race

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?

alerting the healthcare provider of the third-degree heart block The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not a priority. The identification of a code status during a heart block is not appropriate. IV fluids are not helpful if the heart is not perfusing.

A patient is admitted to a special critical care unit for the treatment of an arterial thrombus. The nurse is aware that the preferred drug of choice for clot removal, unless contraindicated, would be:

alteplase

Atrial Fibrillation (A-Fib)

an irregular and often very fast heart rate originating from abnormal conduction in the atria -atrial rate: 300-600 bpm -ventricular rate: 120-200 bpm (if untreated) -Both the ventricular and atrial rhythm are highly irregular. -P-waves will not be discernible(visible) -fibrillatory or f waves: irregular undulating waves that vary in amplitude and shape -PR interval cannot be measured -P:QRS ratio = Many:1.

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. Explanation: After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy

right side of the heart is made up of the right _______ and ________.

atrium ventricle -distributes venous blood (deoxygenated) to lungs thru pulm artery for oxygenation

The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia?

atropine The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia?

Which is not a likely origination point for cardiac arrhythmias?

bundle of His

Which is a diagnostic marker for inflammation of vascular endothelium?

c-reactive protein

Clubbing of fingers indicates:

chronic hypoxemia r/t congenital heart disease or. suggestive pulmonary disease

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is:

cigarette smoking

Nocturia in HF

common to wake 2-3x to pee bc the fluid accumulated in extremities during day is redistributed into circulatory system when recumbent at night

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following?

computed tomography angiography (CTA)

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?

continuous IV infusion Explanation: The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent.

adenosine

drug of choice for SVT

ST segment represents:

early ventricular repolarization -lasts from the end of the QRS complex to the beginning of the T wave

A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?

electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals:

elevational pallor

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

endocardium

three layers of the heart

endocardium, myocardium, epicardium

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?

enzymes

Which area of the heart that is located at the third intercostal space to the left of the sternum?

erb point

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:

forcing blood into the deep venous system.

A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation?

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

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should:

keep the affected leg level or slightly dependent. -maintain bed rest

Cool/cold skin and diaphoresis indicates:

low cardiac output -cardiogenic shock -acute MI

pericardium

membranous sac enclosing the heart -visceral pericardium adheres to epicardium -parietal pericardium is the outermost layer that attaches to the great vessels, diaphragm, sternum, and vertebral column

The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme?

myocardial necrosis Explanation: An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.

A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate:

no immediate treatment. Explanation: This client's ECG suggests sinus dysrhythmia. Sinus dysrhythmia does not cause any significant hemodynamic effect and therefore is not typically treated.

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as

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

Atherosclerosis risk factors

obesity sedentary lifestyle smoking/2nd hand smoke HTN Diabetes

Allen's test

occlude both ulnar and radial artery until hand blanches then release ulnar. If the hand pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned. ABGS must be put on ice and whisked to the lab.

left side of the heart is the left atrium and ventricle and it distributes ________ blood to body via aorta.

oxygenated

ABGs ranges

pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-26 PaO2 >80 mmHg SaO2 >94%

The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect?

pacemaker site infection Explanation: Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage.

A client who is diagnosed with Raynaud syndrome reports cold and numbness in the fingers. Which finding should the nurse identify as an early sign of vasoconstriction?

pallor

the apical impulse is also called:

point of maximal impulse -located at left 5th intercostal

The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse?

potassium level of 6 mEq/L Explanation: Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L.

Diastolic dysfunction may cause

pulmonary or systemic congestion -"stiff" ventricles

Cold, pain, pallor of fingers/toes indicates:

raynauds -skin changes: white, blue, red -color changes accompanied with numbness, tingling, burning pain

CVP <2mmHg indicates

reduced right vent preload -hypovolemia

Afterload

resistance to left ventricular ejection

Pericarditis S/S

sharp, severe substernal or epigastric pain -can radiate to neck, arms, and back -associated S/S: fever, malaise, dyspnea, cough, nausea, dizziness, and palpitations -S/S can be intermittent w/sudden onset -pain increases with inspiration, swallowing, coughing, and rotation of trunk

The electrical conduction system of the heart has several components, all of which are instrumental in maintaining polarization, depolarization, and repolarization of cardiac tissue. Which of the conductive structures is known as the pacemaker of the heart?

sinoatrial node

A client is diagnosed with an arrhythmia at a rate slower than 60 beats/minute with a regular interval between 0.12 and 0.20 seconds. What type of arrhythmia does the client have?

sinus bradycardia Sinus bradycardia is an arrhythmia that proceeds normally through the conduction pathway but at a slower than usual (less than 60 beats/minute) rate.

Modifiable risk factors

smoking htn high cholesterol diabetes obesity physical inactivity modifiable by medications or lifestyle changes

pericardial space/cavity

space between the parietal and visceral pericardium -filled with approx 20mL of fluid that lubricates surface of the heart and reduces friction during systole

A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose?

supraventricular tachycardia -Supraventricular tachycardia (SVT) is an arrythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill.

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities?

ulcers

Amiodarone drug

used for ventricular dysrhythmias -PVCs

radionuclide imaging

used to detect myocardial perfusion still going to injured tissue from MI using radioisotope injection

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gaiter area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect?

venous insufficiency

diastole is when the _______ fill with blood during relaxing phase

ventricles

QRS complex represents:

ventricular depolarization

T wave represents:

ventricular repolarization

The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?

ventricular tachycardia

GFR normal range

~125 ml