Semester 3 Unit 4
When using a 5-electrode lead ECG monitoring system, the nurse recognizes which lead is most optimal for detecting dysrhythmias? A.III B.V1 C.V5 aVR
•Answer: B Rationale: Five-electrode ECG monitoring systems use four electrode leads to provide six limb lead tracings (leads I, II, III,aVR,aVL, oraVF) and the fifth electrode lead is a chest electrode that can be placed in any of the standard V1to V6locations. But in general, V1is selected because of its value in detecting dysrhythmias (e.g., arrhythmia monitoring).
(med surg) Patients with a heart transplantation are at risk for which complications in the first year after transplantation (select all that apply)? a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death
b. Infection c. Rejection e. Sudden cardiac death
(med surg) You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (select all that apply) a. increases SVR. b. produces diuresis. c. improves contractility. d. dilates renal blood vessels. e. works on the β1-receptors in the heart.
c. improves contractility. e. works on the β1-receptors in the heart.
(med surg) A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is a. ventricular dilation. b. ventricular hypertrophy. c. neurohormonal response. d. sympathetic nervous system activation.
c. neurohormonal response
Which of the drug therapy would NOT be included typically in the treatment of a pt with ACS/MI A. Calcium chanel blockers B. Morphine C. Stool softeners D. Lipid-lowering drugs
A. Calcium chanel blockers
True or False: Bachmann's bundle is located in the left artrium.
true
True or False: Depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests.
true
What area of the heart forms the QRS part on an EKG? A. SA node B. Purkinje fibers C. Left and right bundles D. AV node
B. Purkinje fibers
You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?* A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."
.The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.
The client with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which of the following questions should the nurse ask before initiating therapy with sildenafil? 1) Are you currently taking medication for angina? 2) Do you have a history of diabetes? 3) Have you ever had an allergic reaction to dairy products? 4) Have you ever been treated for migraine headaches?
1) Are you currently taking medication for angina? 1 (life threatening hypotension is an adverse effect in clients taking sildenafil and organic nitrates
(powerpoints) What is the treatment of choice for atrial flutter A. Antidysrhythmia drugs B. Radiofrequency catheter ablation is the treatment of choice for atrial flutter C. Calcium channel blockers D. β-blocker
B. Radiofrequency catheter ablation is the treatment of choice for atrial flutter
Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:* A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza. The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)
A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? A. Allows excess tissue fluid to be excreted B. Helps to control the volume of food intake and thus weight C. Aids the weakened heart muscle to contract and improves cardiac output D. Assists in reducing potassium accumulation that occurs when sodium intake is high
A. Allows excess tissue fluid to be excreted A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine. Sodium restriction does not control the volume of food intake; weight is controlled by a low-calorie diet and exercise (if permitted). The resulting elimination of excess fluid reduces the workload of the heart but does not improve contractility. Potassium is retained inefficiently by the body; an adequate intake of potassium is needed.
Which nursing interventions may promote safe drug administration in a child diagnosed with heart failure who is receiving digoxin? Select all that apply. A. Checking for compliance with the client's drug regimen B. Monitoring the client's serum potassium and magnesium levels regularly C. Administering digoxin only through the intramuscular route D. Calculating the correct dosage form, prescribed amounts, and the prescriber's order E. Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly
A. Checking for compliance with the client's drug regimen B. Monitoring the client's serum potassium and magnesium levels regularly D. Calculating the correct dosage form, prescribed amounts, and the prescriber's order E. Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly Digoxin may alter the serum potassium and serum magnesium levels, which affects heart function. Calculating the correct dose according to the healthcare provider's orders helps to prevent drug toxicity. Checking for compliance with the client's drug regimen is important so that the child does not have drug to drug interactions. Monitoring and recording drug intake and output, heart rate, blood pressure, daily weight, and respiration rate is a part of general nursing care. Administering digoxin through the intramuscular route is not advised because this method is very painful.
A patient is dx with left side systolic heart failure. What is the expected findings ? A. EF 38% B. EF 65 % C. EF 20% D. jugular vein distension
A. EF 38%
A client with a history of heart failure and atrial fibrillation reports a nine-pound (four kilogram) weight gain in the last two weeks. Which factor does the nurse consider as the most likely cause of this sudden weight gain? A. Fluid retention B. Urinary retention C. Renal insufficiency D. Abdominal distention
A. Fluid retention With the client's history and the large weight gain, fluid retention is the most likely cause of the increase in weight. Urinary retention occurs in the bladder, not the tissues, and does not account for the large weight gain. Renal insufficiency can occur with heart failure, but it is not the primary etiological factor of the sudden weight gain. Abdominal distention usually is caused by gas in the intestine and should not contribute to this large a weight gain. If the abdomen is enlarged, assessment by ballottement should be done to determine whether enlargement is caused by fluid in the peritoneal cavity (ascites).
(powerpoint) Most common reason for hospital admission in adults over 65 A. HF B. MI C. Dysrhythmias D. Depression
A. HF
(powerpoints) First drug choice to convert PSVT to normal sinus rhyme A. IV adenosine B. IV β-blockers C. Amiodarone D. Calcium channel blockers
A. IV adenosine
The school nurse is assessing a 10-year-old boy with hemophilia who has fallen while playing in the schoolyard. At which site does the nurse expect to find internal bleeding? A. Joints B. Abdomen C. Cerebrum D. Epiphyses
A. Joints Activity can result in bleeding in children with hemophilia; therefore weight-bearing joints, especially the knees, are the most common site of bleeding. The abdomen is usually protected from the trauma of direct force. The cerebrum is protected by the skull and is not likely to be injured. Bleeding from bones themselves is not common without other associated trauma.
A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply . A. Nausea B. Yellow vision C. Irregular pulse D. Increased urine output E. Heart rate of 64 beats per minute
A. Nausea B. Yellow vision C. Irregular pulse Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of the diuretic furosemide; a pulse rate of 64 beats per minute is an acceptable rate when a client is receiving digoxin.
The nurse is providing postprocedure care to a client who had a cardiac catheterization. The client begins to manifest signs and symptoms associated with embolization. Which action should the nurse take? A. Notify the primary healthcare provider immediately B. Apply a warm, moist compress to the incision site C. Increase the intravenous fluid rate by 20 mL/hr D. Monitor vital signs more frequently
A. Notify the primary healthcare provider immediately The primary healthcare provider must be notified immediately so that anticoagulation therapy can be instituted. Applying a warm, moist compress to the incision site is inappropriate because it may promote bleeding; if phlebitis occurs, then warm, moist compresses may be applied. Increasing the intravenous fluid rate by 20 mL hourly will not resolve an embolus. Although monitoring vital signs is appropriate, it is an insufficient intervention; the healthcare provider must be notified so that anticoagulants can be prescribed.
After surgery, a client reports sudden severe chest pain and begins coughing. The nurse suspects the client has a thromboembolism. What characteristic of the sputum supports the nurse's suspicion that the client has a pulmonary embolus? A. Pink B. Clear C. Green D. Yellow
A. Pink With a pulmonary embolus, there is partial or complete occlusion of pulmonary blood flow; when infarcted areas or areas of atelectasis produce alveolar damage, red blood cells move into the alveoli, resulting in hemoptysis. Clear sputum is associated with a viral infection. Green and yellow sputum are associated with a bacterial infection.
How do ACE-inhibitors, such as enalapril work to reduce HF? A. Prevent the conversion of angiotensin I to II B. Cause systemic vasodilation C. Promote the excretion of sodium and water D. Block the sympathetic nervous system stimulation of the heart E. Increase cardiac contractility F. Reduce preload and afterload
A. Prevent the conversion of angiotensin I to II B. Cause systemic vasodilation D. Block the sympathetic nervous system stimulation of the heart F. Reduce preload and afterload
A client with a history of heart failure is experiencing dyspnea with a respiratory rate of 32. Crackles are noted bilaterally. The client is in Sims position, receiving oxygen at 2 L/min via nasal cannula. Which action should the nurse take first? A. Raise the client to high-Fowler position B. Obtain the apical pulse and blood pressure C. Call the primary healthcare provider immediately D. Monitor the pulse oximeter to ascertain the oxygen level
A. Raise the client to high-Fowler position Raising the client to high-Fowler position will decrease orthopnea by using gravity to keep fluid in lower extremities, putting less stress on the heart. Obtaining a full set of vital signs would be the next priority after changing the client position. Calling the primary healthcare provider immediately would not be useful without having a full set of vital signs. The vital signs should include the oxygen saturation, which the healthcare provider would expect the nurse to provide.
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation
A. Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.
What is the correct sequence of electrical conduction of the heart? A. SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers B. None of the options are correct C. SA node, internodal pathways, AV node, Purkinje Fibers, Right and Left Bundle Branch, Bundle of His D. AV node, internodal pathways, SA node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers
A. SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers
The nurse is providing teaching to a client with atrial flutter who has received a prescription for an oral anticoagulant. The client asks the nurse to provide a list of foods that are high in phytonadione and that should be avoided. What should the nurse include on the list? Select all that apply. A. Spinach B. Oranges C. Broccoli D. Chicken breast E. Sweet potatoes
A. Spinach C. Broccoli
The primary healthcare provider has prescribed a stat chest x-ray exam and electrocardiogram for a client with a history of heart failure. The pulse oximeter has changed from 90% to 86% oxygen saturation. Which immediate actions will the nurse take? Select all that apply. A. Tell a staff member to get the electrocardiogram machine. B. Notify the x-ray department that a chest x-ray exam must be done stat. C. Have a staff member notify the nursing supervisor of the change in client status. D. Notify the healthcare provider of the change in the oxygen saturation to ask what to do. E. Tell the certified nursing assistant to get a prescription from the healthcare provider to increase the oxygen. F. Increase the supplemental oxygen without a prescription from 2 L nasal cannula to 4 L nasal cannula and notify the healthcare provider.
A. Tell a staff member to get the electrocardiogram machine. B. Notify the x-ray department that a chest x-ray exam must be done stat. C. Have a staff member notify the nursing supervisor of the change in client status F. Increase the supplemental oxygen without a prescription from 2 L nasal cannula to 4 L nasal cannula and notify the healthcare provider. A staff member can get the electrocardiogram machine and start the procedure. Ancillary personnel are trained to do electrocardiograms even if they are not able to interpret the results. Anyone can notify the x-ray department that the chest x-ray exam must be done. It is important to delegate the tasks to a specific person. Increasing the oxygen without a prescription is appropriate in the short term, but the nurse must obtain a prescription when notifying the healthcare provider. Notifying the healthcare provider of the change in oxygen saturation is appropriate, but it would be expected that nursing judgment had taken place and the oxygen already was increased from 2 L/min. Telling the certified nursing assistant (CNA) to get a prescription is an inappropriate action as a CNA is not allowed to take medical prescriptions. Taking a medical prescription is a nursing role.
Which are vasodilators ? (select all that apply) A. nitroglycerin B. Sodium nitroprusside(Nipride) C. Nesiritide (Natrecor) D. Milirinone
A. nitroglycerin B. Sodium nitroprusside(Nipride) C. Nesiritide (Natrecor)
Ventricular remodeling is changes in (select all that apply) A. size of the ventricle B. only the right ventricle C. shape of the ventricle D. mechanical performance of the ventricle
A. size C. shape D. mechanical performance of the ventricle
The nurse understands that patients with which dysrhythmia constitute the largest group of those hospitalized with dysrhythmias? A.Atrial fibrillation B.Sinus tachycardia C.Sinus bradycardia Ventricular fibrillation
A.Atrial fibrillation Rationale: Atrial fibrillation (AF) is the most common dysrhythmia seen in clinical practice. It is responsible for a third of hospitalizations for cardiac rhythm disturbances. Patients can live with this dysrhythmia, but most are treated with anticoagulation therapy to avoid possible blood clots.
(powerpoints) What is an early symptom of ADHF? What is an early symptom of chronic HF?
ADHF--> increased RR Chronic--> fatigue
select all statements that at true about IV nitroglycerine A. Vasodilator that reduces blood volume B. Improves coronary artery circulation C. Reduces preload D. Slightly reduces after-load E. Increases myocardial oxygen supply)
ALL are correct statements
A patient is taking digoxin, apical pulse 61, digoxin is 5. Which is correct a. hold dose now and administer the dose in the evening B. administer the dose as ordered C. hold the dose and notify the Dr. of the digoxin level D. Administer the dose and repeat a digoxin level in 6 hours
C. hold the dose and notify the Dr. of the digoxin level
A pt dx with ACS is on Nitro drip. Which nursing action could the RN delegate to the LPN A. teach the pt about nitro B. change the peripheral IV site C. monitor the patient BP every hour D. titrate the drip as ordered
C. monitor the patient BP every hour
A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? A. "My ankles are swollen." B. "I am tired at the end of the day." C. "When I eat a large meal, I feel bloated." D. "I have trouble breathing when I walk rapidly." Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "I am tired at the end of the day" is not specific to left ventricular heart failure. The statement "When I eat a large meal, I feel bloated" is not specific to left ventricular heart failure.
B. "I am tired at the end of the day."
A normal PR interval how many seconds and how many boxes A. less than 12 seconds (2 boxes) B. 0.12-0.2 seconds (3-5 boxes) C. Greater than 20 seconds 6-8 boxes
B. 0.12-0.2 seconds (3-5 boxes)
The pt was dx with MI yesterday. Which of the data would be most important to report A. Hyperglycemia B. bilateral crackles C. Q waves on EKG D. elevated troponin
B. bilateral crackles
What area of the heart is responsible for the delay of conduction between the artrium and ventricles? A. Bachmann's Bundle B. AV node C. Right bundle branch D. Bundle of His
B. AV node
A patient with heart failure has +1 ankle edema and feeling too tires to go to the BR. Which nursing dx is correct A. Fluid volume excess r/t edema B. Activity intolerance r/t altered preload C. Alterations in gas exchange r/t imbalance between oxygen D. Knowledge deficit r/t subjective data
B. Activity intolerance r/t altered preload
When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? A. Interview the client for a health history. B. Assess the client's heart and lung sounds. C. Monitor the client's pulse and temperature. D.Obtain the client's blood specimen for electrolytes.
B. Assess the client's heart and lung sounds. With heart failure, the left ventricle is not functioning effectively, which is evidenced by an increased heart rate and crackles associated with pulmonary edema. The health history interview is done after vital signs and breath sounds are obtained and the client is stabilized. Although an infection would complicate heart failure, there are no signs that indicate this client has an infection. Obtaining the client's blood specimen for electrolytes is inappropriate for immediate monitoring; it should be done after vital signs and clinical assessments have been completed.
You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?* A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.
B. Assist the patient up slowing and gradually.
A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? A. Perform daily weights B. Auscultate breath sounds C. Monitor intake and output D. Assess for dependent edema
B. Auscultate breath sounds Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important.
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A. High-potassium foods B. Drugs to treat erectile dysfunction C. Nonsteroidal antiinflammatory drugs D. Over-the-counter H2-receptor blockers
B. Drugs to treat erectile dysfunction
What is the hallmark for left sided HF with systolic dysfunction A. Pitting edema B. EF less than 45% C. Distended neck veins D. EF greater than 50%
B. EF less than 45%
Priority labs/diagnostics suspect for acute MI A. CBC B. EKG C. troponin, CK, CKMB D. Coronary angiography E. BMP
B. EKG C. troponin, CK, CKMB D. Coronary angiography
Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply:* A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea
B. Persistent cough D. Crackles F. Orthopnea The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.
Which of the following is a common side effect of Spironolactone?* A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough
B. Hyperkalemia
A nurse teaches the parents of an infant with a cardiac defect how to detect impending heart failure. What should the parents be taught to identify as an early sign? A. Slowed respiration B. Increased heart rate C. Distended neck veins D. Increased urine output
B. Increased heart rate Tachycardia results from sympathetic stimulation in the setting of heart failure; it is the body's attempt to increase cardiac output and increase oxygen supply to the body's cells. The respirations will increase, not decrease, when heart failure occurs. Distended neck veins occur only in adults when heart failure has progressed to systemic congestion. Urinary output is decreased as a result of sodium and water retention.
(Kahoot) You initially suspect he has an ACS, which symptom is not a typical manifestation ? A. Pressure-like chest pain B. Palpitations C. Dyspnea D. Nausea
B. Palpitations
A client with a history of a pulmonary embolus is to receive 3 mg of warfarin daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary? A. Poached eggs B. Spinach salad C. Sweet potatoes D. Cheese sandwich
B. Spinach salad Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet.
Knee-length elastic support stockings are prescribed for a client with varicose veins. What should the nurse teach the client about the elastic stockings? A. The stockings should reach the middle of the knee. B. The stockings should be applied before getting out of bed. C. The stockings should be applied at the first sign of discomfort. D. The stockings may be substituted with loose elastic bandages
B. The stockings should be applied before getting out of bed. To prevent distention of the veins, the stockings should be applied before the legs are placed in a dependent position. Knee-high stockings should end 2 inches (5 cm) below the knee to avoid popliteal pressure, which limits venous return. The stockings should be used preventatively before the discomfort associated with venous pressure and edema occurs. The stockings apply uniform pressure; loose elastic bandages may slip, creating uneven, ineffective pressure. Edema also may result.
(Kahoot) Which assessment data suggest that his chest pain is caused by an acute MI? A. pain increases with deep breathing B. pain last lasted longer than 30 minutes C. pain is relieved after the patient take Nitro D. pain resolved when patient raises his arm
B. pain last lasted longer than 30 minutes
The nurse knows that cardiac specific troponin will increase ____ hours after onset of MI A. Immediately B. 2-3 C. 4-6 D. 10-12
C. 4-6
What part of the heart's electrical system is known as the "gatekeeper"? A. SA node B. Tetany C. AV node D. Gap Junction
C. AV node
Which drug is used to prevent development of HR in its who had a MI and also used as 1st line tx in HR A. beta adrenergic blockers B. Beta adrenergic agonist C. Ace- inhibitors D. Calcium channel blockers
C. Ace- inhibitors
You dx STEMI with W.R the closest hospital with cardiac cath lab is 4 hours away. you... A. Transfer the patient to the cath lab 4 hours away B. Forego re-perfusion tx as chest pain began 6 hours ago C. Begin administering a fibrotic agent D. Start heparin drop
C. Begin administering a fibrotic agent
(Kahoot) W.R is recovering from an uncomplicated MI. Which rehabilitation guideline should be included A. Refrain from sexual activity for a minimum of 3 weeks B. Plan a diet that aims for 1-2 lb weight loss/week C. Begin an exercise program aiming at least 5-30 minutes session D. Consider using erectile agents and prophylactic NTG before sex
C. Begin an exercise program aiming at least 5-30 minutes session
A nurse discovers lower extremity pitting edema in a client with right ventricular heart failure. Which information should the nurse consider when planning care? A. Client has decreased plasma colloid osmotic pressure. B. Client has increased tissue colloid osmotic pressure. C. Client has increased plasma hydrostatic pressure. D. Client has decreased tissue hydrostatic pressure.
C. Client has increased plasma hydrostatic pressure. In right ventricular heart failure, blood backs up in the systemic capillary beds; the increase in plasma hydrostatic pressure shifts fluid from the intravascular compartment to the interstitial spaces, causing edema. Increase in tissue (interstitial) colloid osmotic pressure occurs with crushing injuries or if proteins pathologically shift from the intravascular compartment to the interstitial spaces, pulling fluid and causing edema. In right ventricular heart failure, increased fluid pressure in the intravascular compartment causes fluid to shift to the tissues; the tissue hydrostatic pressure does not decrease. Although a decrease in colloid osmotic (oncotic) pressure can cause edema, it results from lack of protein intake, not increased hydrostatic pressure associated with right ventricular heart failure.
A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action?* A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.
C. Hold the dose and notify the physician of the digoxin level.
The family of a client with right ventricular heart failure expresses concern about the client's increasing abdominal girth. What physiologic change should the nurse consider when explaining the client's condition? A. Loss of cellular constituents in blood B. Rapid osmosis from tissue spaces to cells C. Increased pressure within the circulatory system D. Rapid diffusion of solutes and solvents into plasma
C. Increased pressure within the circulatory system Failure of the right ventricle causes an increase in pressure in the systemic circulation. To equalize this pressure, fluid moves into the tissues, causing edema, and into the abdominal cavity, causing ascites; ascites leads to an increased abdominal girth. There is no loss of the cellular constituents in blood with right ventricular heart failure. Ascites is the accumulation of fluid in an extracellular space, not intracellular. The opposite of rapid diffusion of solutes and solvents into plasma results when there is a pressure increase in the systemic circulation.
Which information for a patient taking prednisone 40 mg daily x3 weeks is most important to report A. BP 130/90 B. +1 bilateral ankle edema C. Pt stopped the medication 2 days ago D. Pt has not been taking prescribed vitamin D
C. Pt stopped the medication 2 days ago
On an EKG the P-wave represents what area of the heart? A. Left bundle branch B. AV node C. SA node D. Bachmann's Bundle
C. SA node
What area of the heart's electrical conduction is known as the "pacemaker" of the heart? A. Bundle of His B. AV node C. SA node D. Purknije Fibers
C. SA node
A client develops a deep vein thrombosis after surgery. Which alteration in the client's condition may indicate that the client is experiencing a pulmonary embolus? A. Bradycardia B. Flushed face C. Unilateral chest pain D. Decreased blood pressure
C. Unilateral chest pain Pleuritic chest pain is caused by an inflammatory reaction of lung parenchyma or by pulmonary infarction or ischemia induced by obstruction of small pulmonary arteries. Pain is sudden in onset and is exacerbated by breathing. Tachycardia, not bradycardia, occurs in an attempt to meet oxygen demands of the body and respond to increased vascular resistance in the lung. The face will be pale, not flushed, because of reduced oxygenation and possible shock. The blood pressure is not an indicator of a pulmonary embolus. However, eventual hemodynamic instability will influence blood pressure.
During the administration of the thrombolytic, the nurse should stop the transfusion if that pt has A. Bleeding gums B. increased BP C. a decrease in LOC D. a non-sustained arrhythmia
C. a decrease in LOC
A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?* A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."
D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema." Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.
The SA node fires at a rate of? A. 80-90 bpm B. 60-80 bpm C. 40-60 bpm D. 60-100 bpm
D. 60-100 bpm
What area of the heart forms the PR segment on the EKG? A. Apex of heart B. Purkinje fibers C. Bundle of His D. AV node and Right and Left Bundles
D. AV node and Right and Left Bundles
Which psychosocial nursing diagnosis is most relevant for a patient experiencing an acute MI A. Decreased cardiac output B. Hopelessness C. Activity intolerance D. Anxiety
D. Anxiety
A pt with heart failure after a week of tx with metoprolol. What is most important to report A. Mild bilateral pedal edema B. HR 56 bpm C. complaints of increased fatigue D. BP of 84/42
D. BP of 84/42
(Kahoot) which are W.R's modifiable risk factors for MI A. Age B. HTN C. Smoking D. Both B and C
D. Both B and C
During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?* A. Lisinopril B. Losartan C. Lasix D. Digoxin
D. Digoxin The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.
What should the nurse do to prevent thrombus formation after most surgeries? A. Keep the client's bed gatched to elevate the knees. B. Have the client dangle the legs off the side of the bed. C. Have the client use an incentive spirometer every hour. D. Encourage the client to ambulate with assistance every few hours
D. Encourage the client to ambulate with assistance every few hours Ambulation is essential to promote venous return and prevent thrombus formation. Keeping the client's bed gatched to elevate the knees or having the client dangle the legs off the side of the bed cause increased popliteal pressure and impair venous return. Having the client use an incentive spirometer every hour helps prevent atelectasis, not thrombi.
The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?* A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level
D. Hold the dose and notify the physician about the potassium level
Which of the following tests/procedures are NOT used to diagnose heart failure?* A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring
D. Holter monitoring Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.
A client receiving warfarin (Coumadin) therapy reports use of the herb feverfew. The nurse observes the client for evidence of: A. Liver toxicity. B. Increased coagulation. C. Renal dysfunction. D. Increased bleeding potential.
D. Increased bleeding potential. Caution patient about certain herbs/dietary supplements bc they may increase the risk of bleeding such as bilberry, black cohosh, chamomile, chondroitin sulfate, DHEA, feverfew, garlic, ginger, ginkgo biloba, ginseng, goldenseal, grapeseed extract, green tea, horse chestnut seed extract, melatonin, niacin, omega-3 fatty acids, psyllium, red yeast rice extract, saw palmetto, soy, turmeric.
To determine whether there is a delay in condition through the ventricles, the nurse would measure A. P wave B. PR interval C. Q wave D. QRS complex
D. QRS complex
The day after surgery a client is encouraged to ambulate. The client angrily asks the nurse, "Why am I being made to walk so soon after surgery?" How should the nurse explain the primary purpose of early ambulation? A. To promote healing of the incision B. To decrease the incidence of urinary tract infections C. To use energy to help the client sleep better at night D. To keep blood from pooling in the legs to prevent clots
D. To keep blood from pooling in the legs to prevent clots The muscular action during ambulation facilitates the return of venous blood to the heart; this reduces venous stasis and minimizes the risk of postoperative thrombophlebitis. Protein and vitamin C promote wound healing. Walking is not related to the prevention of urinary tract infections. Although activity during the day may promote sleeping at night, it is not the reason for ambulating after surgery.
On a telemetry monitor, the nurse observes that a patient's heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain, but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse's first action? A.Synchronized cardioversion B.CPR and immediate defibrillation C.Administration of IV amiodarone (Cordarone) and dextrose D.Administration of oxygen and observation of the heart rhythm
D.Administration of oxygen and observation of the heart rhythm Rationale: Current advanced cardiac life support (ACLS) guidelines recommend administration of oxygen and observation of heart rhythm first, followed by administration of an IV antidysrhythmic agent such as amiodarone mixed with dextrose 5%. Synchronized cardioversion would be the next step. CPR and immediate defibrillation would be used only to treat unstable VT.
True or False: The SA node is located in the Left atrium
False
Treatment of choice for Dressler syndrome?
High-dose aspirin is the treatment of choice. Nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids are avoided in the first 4 weeks following MI because they can interfere with myocardial scar formation.
What are Amiodarone and ibutilide
Most common antidysrhythmic drugs used for conversion to and maintenance of sinus rhythm
Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.
Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.
A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply. A. Collapsed neck veins B. Distended abdomen C. Dependent edema D. Urinating at night E. Cool extremities
Right-sided heart failure is associated with increased systemic venous pressures and congestion, as manifested by a distended abdomen, dependent edema, and urinating at night. Distended, not collapsed, neck veins occur in right-sided heart failure. Cool extremities are key features of left-sided heart failure.
A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?* A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.
The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier
A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?* A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5
The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).
A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?* A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.
The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.
A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?* A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.
The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.
Which of the following is a late sign of heart failure?* A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum
The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.
These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?* A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors
The answer is D. This is a description of ACE inhibitors (option D).
A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?* A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.
The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.
A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?* A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02
The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe
Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure:* A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.
The answers are B and D.
Select all the correct statements about educating the patient with heart failure:* A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.
The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.
A nurse begins to develop a plan of care with a client who has left ventricular heart failure that resulted from a myocardial infarction (MI). Which goal is priority during the acute phase of recovery? A. Promote pain relief B. Increase activity tolerance C.Prevent cardiac dysrhythmias D. Maintain potassium and sodium intake
The major goal is to manage pain. Pain relief helps increase the oxygen supply and decrease myocardial oxygen demand, decreasing the workload of the heart. Increasing activity tolerance is the primary focus during the rehabilitative phase after an MI, not during the acute phase. While preventing dysrhythmia is important, it is not the priority. Although maintaining potassium intake is important, sodium should be limited to minimize fluid retention, which increases the workload on the heart
True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.*
True
(med surg) A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do (select all that apply)? a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate. c. Keep an accurate measure of intake and output. d. Teach the patient about dietary restriction of potassium. e. Withhold digitalis and notify health care provider if pulse is irregular.
a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate.
(med surg) The nurse recognizes that primary manifestations of systolic failure include a. ↓ EF and ↑ PAWP. b. ↓ PAWP and ↑ EF. c. ↓ pulmonary hypertension associated with normal EF. d. ↓ afterload and ↓ left ventricular end-diastolic pressure.
a. ↓ EF and ↑ PAWP (pressure within the pulmonary arterial system)
(med surg) In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) a. diffuse involvement of plaque formation in coronary veins. b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle. e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle.
A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia a. will always progress to myocardial infarction. b. will be relieved by rest, nitroglycerin, or both. c. indicates that irreversible myocardial damage is occurring. d. is frequently associated with vomiting and extreme fatigue.
b. will be relieved by rest, nitroglycerin, or both.
The primary health care provider orders the nurse to administer potassium chloride to a patient with 10 episodes of vomiting in two days. Which complication does the nurse anticipate from the potassium chloride? a. Cancer b. Seizures c. Respiratory acidosis d. Cardiac dysrhythmia
d. Cardiac dysrhythmia Rationale: Potassium chloride is an intravenous solution that should be carefully administered to a patient with severe emesis because hyperkalemia may cause fatal cardiac dysrhythmias. Patients with cancer often develop hypocalcemia. Hyponatremia or hypernatremia may cause confusion and seizures. An increased partial pressure of carbon dioxide leads to respiratory acidosis.
Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a.Prothrombin time b.Erythrocyte count c.Fibrinogen degradation products d.Activated partial thromboplastin time
d.Activated partial thromboplastin time Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.
