Targeted Medical Surgical Cardiovascular Online Practice

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure?

"I can't get rid of these hiccups." Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation. Note: Dizziness is not a complication of the insertion procedure and is expected initially as the client adjust to pacemaker. Pain, stinging of insertion but manifestations of infection Headache is not a complication but part of another disease process.

A nurse is caring for a client who has a history of angina and is schedules for exercise electrocardiagraphy at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling?

"I smoked a cigarette this morning to calm my nerves about having this procedure." Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test. Note; It is not necessary for the client to be NPO prior to this procedure. The provider might withhold cardiovascular medications prior to this procedure to effectively monitor cardiovascular response to stress Episodes of chest pain are not a contraindication to the test.

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?

"I took my warfarin last night according to my usually schedule." Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding. Provider might: - have the client discontinue over the counter medications, such as aspirin, prior to surgery to reduce the risk of bleeding - provider might instruct the client to administer medications to treat high blood pressure to reduce the risk of hypertension - the provider might instruct client who takes insulin to take a reduced dose in the morning of surgery to regulate blood glucose.

A nurse is providing teaching for a client who is 2 days post-op following a heart transplant. Which of the following statements should the nurse include in the teaching?

"you may no longer be able to feel chest pain." Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart. Note; The client activity tolerance should gradually improve as the exalting process progresses. The client will need to permanently maintain a diet that is restricted in sodium and fat. The client will remain on immunosuppressants for the remainder of their life to help prevent rejection of the heart.

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

(D) 2nd ICS to the R of the atrium *apex left ventricular area Inspection of this location allows the nurse to assess for pulsations of the apex area of the heart, which is considered the apical pulse or point of maximal impulse. The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease?

A client who has Diabetes mellitus Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease./ Note: Hypothyroidism is not a risk factor for developing peripheral arterial disease. 25% is within the recommended range for daily intake of fat and diet does not place the client at risk for development of peripheral arterial disease. 2 12 oz bottles of beer a day is on side red moderate alcohol intake and doe not place the client at risk for development of peripheral arterial disease.

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of the medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following?

A persistent cough A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication. Note: Tendinitis is an adverse effect of Fluoroquinolones antibiotics. Frequent urination is an expected outcome of this medication. Constipation is an adverse effect of ACE inhibitors. However the client does not need to discontinue use or repot this to the provider.

A nurse is assessing a client who has pulmonary edema related to hear failure. Which of the following findings indicates effective treatment of the client's condition?

Absence of adventitious breath sounds Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving. Note: A moist productive cough usually accompanies pulmonary edema. However the presence of a nonproductive cough does not indicate that the problem is resolving. The respiratory rate usually decreases while at rest. It is not an indicator of effective treatment. SA O2 86% room air The value is below reference range the expected it is not an indicator of effective treatment.

A nurse in the emergency department is caring for a client who had an anterior MI. The client's history reveals she is 1 week post-op open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated?

Assisting with thrombolytic therapy The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy Note: Using a bedside commode is less stressful than using a bedpan, and most clients are allowed to use a commode following a MI. The nurse should administer supplemental oxygen to the client to increase myocardial tissue perfusion The nurse should administer IV morphine to the client to relieve pain and reduce myocardial oxygen demand.

A nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. Which of the following client findings should the nurse report to the provider?

Blood pressure 160/80 mm Hg The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites. Note: Mediastinal drainage of up to 150 mL/hr is expected during this time. A body temperature of 37.1 C within expected reference range and is desired following a CABG. A potassium level of 4.0mEq/L is the expected level during the postoperative period following a CABG.

A nurse is reviewing the laboratory results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which laboratory values?

Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL The expected reference range of cholesterol is less than 200 mg/dL, HDL above 45 mg/dL for men and above 55 mg/dL for women, and LDL less than 130 mg/dL.

A nurse is assessing a client in the emergency room who has a bradydysrhythmia. Which of the following findings should the nurse expect?

Confusion Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status Note: The nurse should expect to hear a friction rub during cardiac auscultation for a client who has pericarditis. The nurse should monitor a client who has bradydysrhtymia for hypotension And diaphoresis

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should recognize that an increase in which of the following is diagnostic of a myocardial infarction (MI)?

Creatine kinase- MB Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury. Note: Myoglobin is elevated following an MI, with skeletal muscle injury. However, it is not specific to the cardiac muscle. C-reactive protein increase soon after the beginning of the inflammatory process, such as rheumatoid arthritis, is not specific to cardiac muscle. Homocysteine is always present in the blood, an increased level might indicate a risk factor for the development of cardiovascular disease.

A nurse is caring for a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect?

Dyspnea on exertion The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output. Note: Tracheal deviation is expected in tension pneumothroax Pericardial rub is expected in pericarditis. Weight gain is expected for manifestation of dilated cardiomyopathy. Weight gain is due to ventricular compromise and fluid retention.

A nurse is caring for a client who presents to the ER with a BP of 254/138 mmhg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first?

Elevate the head of the client's bed. The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation. Note: The nurse should initiate seizure precaution because the the client is at risk. The nurse should tell the client to report vision changes because the client is at risk of blurred vision. The nurse should initiate an IV to provide access for medication administration to reduce the clients blood pressure. However, this is not the first action the nurse should take.

A nurse is caring for a client who has a history of DVT and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy?

INR 2.0 The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

A nurse is admitting a client who has a leg ulcer and a history of DM. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer?

Inquire about the presence or absence of claudication Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not. note: Family history is important, but it does not help to differentiate between arterial and venous ulcers. Both arterial and venous ulcers cause varying degrees of pain and discomfort and have the potential to become infected.

A nurse is caring for a client who is being treated for HF and has prescriptions for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication?

Lightheadedness Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness. Note: Furosemide is used to mange shortness of breath secondary to heart failure, shortness of breath is not an adverse effect of this medication. A dry cough is an adverse effect of ACE inhibitors. A metallic taste is not an adverse effect of furosemide

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Identify the area of the strip the nurse should examine to observe for atrial depolarization

P wave which is A. the nurse should examine the P wave of the rhythm strip to evaluate for atrial depolarization Note: B was the qrs complex of the rhythm strip and used to evaluate for ventricular depolarization T wave of rhythm strip to evaluate for ventricular repolarizaiotn.

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching?

Place the patch on an area of skin away from skin folds and joints. The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly. Note: The nurse should instruct the client to rotate the patch site to help prevent skin irritation The nurse should instruct the client to have a patch free interval of 10 to 12 hours each day to prevent tolerance to the medication. The nurse should emphasize that nitroglycerin patches offer ongoing prevention of angina attacks. The nurse should instruct eh client that the patches do not treat angina attacks because they do not take effect immediately.

A nurse is preparing a client for coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure?

Previous allergic reaction to shellfish The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure. Note: A urine output of 200mL in 4 hours is within the expected reference range. The procedure involves access through large arteries or veins to the heart and is not affected by peripheral arterial disease A hemoglobin level of 14.4g/dL is within the expected reference range.

A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first?

Review serum electrolyte values Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia. Note: The nurse should obtain the client's current weight to determine fluid loss from diuretic therapy. The nurse should determine the time of the last digoxin dose in order to evaluate when the next dose is due. The nurse should check the clients urine output to determine fluid loss from diuretic therapy. However the nurse should take another action first

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately?

Slurred speech The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately. Note: An irregular pulse is expected finding for a client who has atrial fibrillation and indicates the client is at risk for inadequate cardiac output. But not priority. Dependent edema is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate circulation, not priority Fatigue is expected for a client who has heart failure and indicates the client is at risk for inadequate cardiac output. Not priority.

A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider?

Urine output of 20 ml/hr Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture. Note: Seroanguineous drainage 1 hr postoperative is expected and is not a manifestation of shock. Seroanguineous drainage should decrease over the first few days and discontinue after day 5. Coughing is painful after an aortic aneurysm, this is not a manifestation of shock. The temp is within reference range.

A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a HR of 200-210 bpm and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions?

Vagal stimulation The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole. Note: The nurse housed in Itami ate chest compressions for pulse less ventricular tachycardia until the defibrillator is available. Suprventricular tachycardia does not require chest compression. The nurse should identify that atropine is used to treat bradydysrhytmia. Supra-ventricular tachycardia does not require atropine. The nurse should identify the cardio version, rather than defibrillation is used to treat supraventricuarl tachycardia. Defibrillation is used to treat ventricular fibrillation or pulseless ventricle tachycardia.

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find?

Weak peripheral pulses Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure. Note: Increased abdominal girth is a finding related to systemic congestion resulting from right-sided heart failure Jugular venous neck distention is finding a related to systemic congestion resulting from right sided heart failure Dependent edema is a finding related to systemic congestion resulting rom right sided heart failure.

A nurse is providing discharge teaching for a client who has HF. The nurse should instruct the client to report which of the following findings immediately to the provider?

Weight gain of 0.9 kg (2 lb) in 24 hr When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately. Note: Increase of 10 mm Hg in systolic blood pressure is a non urgent finding. Although the client should report the increase in blood pressure, not priority. Dyspnea with exertion is nonugent, it is expected for heart failure. Should report. Not priority. Dizziness when rising quickly is a nonurgent finding that is expected for a client who is taking medication to treat heart faultier, should report, not priority.

A nurse is planning a presentation about hypertension for a community women's group. Which of the following lifestyle modifications should the nurse include?

limited alcohol intake, regular exercise, tobacco cessation Note: Clients who have hypertension should: - limit alcohol intake -develop a regular exercise program to help reduce Bp -should avoid tobacco use because it exacerbates it Clients should have low magnesium and potassium intake but this is not considered a lifestyle choice.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds?

stop the heparin infusion The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury. Note: APtt of 96 seconds indicates excessive blood levels of heparin therefore the nurse should take corrective action by discontinue the heparin infusion. The nurse should monitor PT for a client who is taking an oral anticoagulant. However, it is not necessary to request a PT before taking any corrective action.

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication?

valvular disease Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium. Note: Ventricular depolarization occurs during a normal cardiac cycle and is not a potential complication of endocarditis. Gillian barre syndrome is associated with certain bacterial and viral infections but is not a potential complication for endocarditis. Myelodysplatic syndrome is a disorder of the bone marrow and is not a potential complication of endocarditis.