Unit 6 cardiac

A patient has a history of angina pectoris. To decrease the pain from angina pectoris, what should the patient do? A. take a cardiac glycoside at the first system of cardiac pain B. Avoid taking more than three or four nitroglycerin tablets a day C. Take nitroglycerin three times daily D. Take nitroglycerin sublingually prophylactically before strenuous exercise.

A. take a cardiac glycoside at the first system of cardiac pain

Cardiac output affected by:

Activity level Metabolic rate Age Body size Physiologic, psychological stress response Interaction of heart rate, contractility, preload, afterload

SA node (sinoatrial node)

Acts as pacemaker Creates impulse 60-100 times per minute

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tackycardia , and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse and expects which interventions to be prescribed? Select all that apply. A. Administering oxygen B. Inserting a Foley catheter C. Administering furosemide D. Administering morphine sulfate intravenously E. Transporting the client to the coronary care unit F.placing the client in a low-Fowler's side lying position

A. Administering oxygen B.inserting a Foley catheter C. Administering furosemide D. Administering morphine sulfate intravenously

The nurse is providing patient teaching for a patient with Raynaud's disease. Which information should be included? ( select all that apply) A. Avoid cold. B. Warm hands and feet with heating pad C. Practice stress reduction techniques D. Comply with smoking cessation E.. Limit caffeine intake.

A. Avoid cold. C. Practice stress reduction techniques D. Comply with smoking cessation E.. Limit caffeine intake.

A patient is admitted to the medical floor with a diagnosis of HF. Which assessment findings are consistent with the medical diagnosis? ( Select all that apply) A. Increase in abdominal girth B. Weight loss of 6 pounds in the past 2 weeks C. Pitting edema D. Nervous tremors E. Night sweats

A. Increase in abdominal girth C. Pitting edema

A patient experienced intense chest pain, anxiety, and nausea. The admitting diagnosis is suspected myocardial infarction. When providing care for the patient in the emergency department, the nurse must understand what about a myocardial infarction? A. It involves a critical reduction in blood supply to the myocardium B. There is a marked increased in cardiac output C. A sudden irregularity of cardiac contraction occurs D. There is a marked decrease in cardiac output

A. It involves a critical reduction in blood supply to the myocardium

A 75-year-old patient is diagnosed with heart failure. The nursing diagnosis of activity intolerance, related to dyspnea and fatigue, would be appropriate. What nursing intervention would be most appropriate for this diagnosis? A. Plan frequent rest periods B. Allow the patient to shower C. Encourage the patient to perform all ADLs D. Encourage fluid intake of 3000 mL/day

A. Plan frequent rest periods

A patient is admitted to the hospital with a diagnosis of heart failure. Recently the patient's symptoms have been getting worse as a result of arteriosclerosis. In establishing a patient care plan, what is the primary goal of treatment? A. Reduce the workload of the heart B. Promote rest for the heart C. Reduce fluid retention D. Reduce circulating blood volume

A. Reduce the workload of the heart

A patient presents with dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distension and abdominal distention. What does the nurse suspect the patient is experiencing? A. Right-sided heart failure B. Left-sided heart failure C. Cardiac dysrhythmias D. Valvular heart disease

A. Right-sided heart failure

A 24-year-old man seeks medical attention for complaints of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. Next, the nurse should check the client'a medical history for which item? A. Smoking history B.recent exposure to allergens C.history of recent insect bites D. Familial tendency toward peripheral vascular disease

A. Smoking history

The primary Heath care provider is going to perform carotid massage on a client with rapid rate atrial fibrillation. Which interventions should the nurse anticipate ? Select all that apply. A. The client should be placed on a cardiac monitor B. The PHCP massages the carotid artery for a full minute C. The head should be turned toward the side to be massaged. D. Rhythm strips should be obtained before, during, and after the procedure. E. Monitor the vital signs, cardiac rhythm, and level of consciousness after the procedure.

A. The client should be placed on a cardiac monitor D. Rhythm strips should be obtained before, during, and after the procedure. E. Monitor the vital signs, cardiac rhythm, and level of consciousness after the procedure

A patient receives a diagnosis of angina pectoris, with no subsequent cardiac involvement. The health care provider prescribes nitroglycerin. What explanation would the nurse give to this patient about why this medication is given sublingually? A. superficial blood vessels promote rapid absorption of the medication B. Stomach acids destroy the medication. C. Saliva helps break down the medication for absorption D. The medication is too rapidly absorbed in the stomach

A. superficial blood vessels promote rapid absorption of the medication

Factors affecting blood pressure

Age Exercise Stress Race Sex Medications Obesity Diurnal Variations Medical Conditions Disease process

Nonmodifiable risk factors for heart disease

Age Gender Race Personal health history Family history

Factors affecting pulse

Age, gender, exercise, fever, medications, hypovolemia, stress, position changes, pathology

Cardiac Output (CO)

Amount of blood pumped by the ventricles into pulmonary, systemic circulations

The nurse has reinforced instructions to the client with Raynaud's disease about self-management of the disease process. The nurse determines that the client needs further teaching if the client makes which statement? A. "Smoking cessation is very important " B." Moving to a warmer climate should help." C." Sources of caffeine should be eliminated from the diet." D." Taking nifedipine as prescribed will decrease vessel spasm "

B. " moving to a warmer climate should help"

A postcadiac surgery client with blood urea nitrogen (BUN) level of 45 mg/dL and a serum creatinine level of 2.2 mg/dL has a total 2-hour urine output of 25 ml. The nurse understands that the client is at risk for which condition? A. Hypovolemia B. Acute kidney injury C. Glomerulonephritis D. Urinary tract infection

B. Acute kidney injury

What is the primary goal of patient teaching after a myocardial infarction? A. Explaining the disease process B. Assisting the patient in developing a healthy lifestyle C. Describing the precipitating causes and onset of pain D. Educating the patient on causative factors that initiate cardiac vasoconstriction

B. Assisting the patient in developing a healthy lifestyle

A client is wearing a continuous cardiac monitor which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. The nurse should do which action first? A. Call a code blue B. Check the client status and lead placement C.call the primary health care provider D. Press the recorder button on the ECG console

B. Check the client status and lead placement

A client with myocardial infarction suddenly becomes tachycardia, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds expecting to hear which breath sounds bilaterally? A.rhonchi B. Crackles C. Wheezes D. Diminished breath sounds

B. Crackles

What actions would the nurse expect to be used to treat heart failure? (select all that apply) A. Cardiotonic drugs B. Diuretic agents C. Generous fluid intake D. Ace inhibitors, beta-adrenergic blockers, nitrates E. oxygen therapy

B. Diuretic agents D. Ace inhibitors, beta-adrenergic blockers, nitrates E. oxygen therapy

What is the most useful noninvasive diagnostic tool for evaluating the patient with heart failure? A. Coronary angiography B. Echocardiogram C. Electrocardiogram D. Thallium scanning

B. Echocardiogram

The nurse is aware that the patient will benefit from the administration of streptokinase and tissue plasminogen activators when administered how long after admission for acute MI signs and symptoms? A. In the first 24 hours B. In the first 30 minutes to 1 hour C. In the first 72 hours D. In the second 6 hours after an MI

B. In the first 30 minutes to 1 hour

A patient has a diagnosis of hypertension. When providing discharge teaching what should the nurse include? ( select all that apply) A. Instruction in consuming a bland diet B. Instruction to limit sodium intake to 2 G/day c. Encouragement to begin a vigorous exercise program D. monitoring and keeping a record of blood pressure measurements at home E. Education on continuing to take antihypertensive medications as prescribed

B. Instruction to limit sodium intake to 2 G/day E. Education on continuing to take antihypertensive medications as prescribed

The nurse is assisting with caring for the client Immediately after insertion of a permanent demand pacemaker via the right subclavian vein. The nurse prevents dislodgement of the pacing catheter by implementing which intervention? A. Limiting movement and abduction of the left arm B. Limiting movement and abduction of the right arm C. Assisting the client to get out of bed and ambulated with a walker D. Having the physical therapist do active range of motion to the right arm

B. Limiting movement and abduction of the right arm

The nurse is checking the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago, after undergoing an aortoiliac bypass graft. The affected leg is warm , and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. Based on this data, the nurse should make which determination about the client's neurovascular status? A. Moderately impaired, and the surgeon should be called B. Normal, caused by increased blood flow through the leg C. Slightly deteriorating, and should be monitored for another hour D. Adequate from an arterial approach, but venous complications are arising

B. Normal, caused by increased blood flow through the leg

A patient with a history of IV drug use is diagnosed with acute infective endocarditis. Which nursing intervention for this patient is most appropriate? A. Early ambulation B. Restricted activity for several weeks C. Low-calorie diet D. Dilution of blood by increased fluid intake

B. Restricted activity for several weeks

When providing patient teaching regarding coronary artery disease, the nurse can include which of the following when advising the patient about modifiable risk factors? (select all that apply) A. Family history B. Smoking C. Cholesterol level D. Obesity E. Ethnicity

B. Smoking C. Cholesterol level D. Obesity

The nurse is monitoring a client following cardio version. Which observation should be of highest priority to the nurse ? A. Blood pressure B. Status of airway C. Oxygen flow rate D. Level of consciousness

B. Status of airway

An 86-year-old patient is receiving an intravenous infusion at 83 mL/ hour via an electronic infusion pump. Why is it so vital that the IV lines of older adult patients be monitored carefully? A. These patients do not become dehydrated very easily. B. These patients are at an increased risk for developing fluid overload of the circulatory system C. These patients are at an increased risk for developing a venous infection D. Aging patients present an increased risk for developing thrombophlebitis in the peripheral system.

B. These patients are at an increased risk for developing fluid overload of the circulatory system

To use an external cardiac defibrillator on a client which action should be performed to check the cardiac rhythm? A. Holding the defibrillator paddles firmly against the chest B. Applying the adhesive patch electrodes to the skin and moving away from the client C. Applying standard electrocardiographic monitoring leads to the client and observing the rhythm D. Connecting standard electrocardiographic electrodes to a transtelephonic monitoring device

B.applying the adhesive patch electrodes to the skin and moving away from the client

Before administering a dose of digoxin to an assigned patient, the nurse observes that the patient's pulse rate is 52. What is the most appropriate nurse action? A. Notify the charge nurse B. Recognize that these are signs of digoxin toxicity and withhold the dose. C. Administer the medication D. Hold the medication and notify the health care provider

C. Administer the medication

When a patient returns to the unit following cardiac catheterization, which nursing activity should follow immediately after taking of vital signs? A. placing the patient in a warm bed and encouraging sleep B. providing the patient with fluids C. Assessing the patient's peripheral pulses D. Reapplying the patient's dressing where the dye was injected

C. Assessing the patient's peripheral pulses

The nurse is caring for a client on the cardiac monitor who is alone in a room at the end of the hall. The client had a short burst of ventricular tachycardia, followed by ventricular fibrillation. The client suddenly loses consciousness. Which intervention should the nurse do first ? A. Go to the nurses station quickly and call a code B. Run to get a defibrillator from an adjacent nursing unit C. Call for help and initiate cardiopulmonary resuscitation D. Start oxygen by cannula at 10 L/ minute and lower head of the bed

C. Call for help and initiate cardiopulmonary resuscitation

A patient has Buerger's disease. What is the most important aspect of patient compliance to decrease signs and symptoms of Buerger's disease? A. Low-fat diet B. Weight loss C. Cessation of tobacco use D. Keeping extremities warm

C. Cessation of tobacco use

What is the best nursing action that will lessen the severity of a patient's orthostatic hypotension? A. Turn him from side to side every 2 hours B. Limit times he will have to get in and out of the bed C. Change his position routinely, especially from horizontal to vertical D. Encourage him to move very slowly

C. Change his position routinely, especially from horizontal to vertical

The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse should expect to note which specific characteristic of this condition? A.dyspnea B. Hacking cough C. Dependent edema D. Crackles on lung auscultation

C. Dependent edema

The nurse is assessing a patient and suspects the patient is experiencing thrombophlebitis in the lower leg. What symptoms would the nurse assess? ( select all that apply) A. Numbness along a vein B. Severe cramping C. Edema of the extremity D. Calf is warm to the touch E. Pain in the effected extremity

C. Edema of the extremity D. Calf is warm to the touch E. Pain in the effected extremity

A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath, and the client is visibly anxious. Which is a life-threatening complication that could be occurring ? A.pneumonia B.pulmonary edema C.pulmonary embolism D.myocardial infarction

C.pulmonary embolism

platelet plug formation

Closes hole in blood vessel,temporary

Secondary Risk Factors

Control high bp Decrease high blood cholesterol Decrease stress Abstain from or consume only small amounts of alcohol

A patient is admitted with a diagnosis of possible aortic abdominal aneurysm. What is the most important factor to monitor as a possible complication? A. Body temperature B. Skin turgor C. Respiratory rate D. Blood pressure

D. Blood pressure

A 10-year- old patient is diagnosed with rheumatic fever. Of all manifestations seen in rheumatic fever, which is most likely to lead to permanent complications? A. Sydenham's chorea B. Erythema marginatum C. Subcutaneous nodules D. Carditis

D. Carditis

When a patient is receiving heparin therapy, what would be the nurse's most appropriate action? A. Observe him for cyanosis B. Assess degree of edema in all extremities C. Give the injection intramuscularly D. Observe emesis, urine, and stools for blood

D. Observe emesis, urine, and stools for blood

When caring for a patient whose health care provider has ordered furosemide, what will the nurse recognize when the medication is having the desired effect? (select all that apply) A. The patient becomes very thirsty B. The patient's resting heart rate slows C. The patients blood pressure is reduced D. Production of urine is increased E. The patient's weight decreased

D. Production of urine is increased E. The patient's weight decreased

The nurse is preparing to ambulated a postoperative client after cardiac surgery. The nurse plans to do which to enable the client to best tolerate the ambulation? A. Provide client with walker B. Remove the telemetry equipment C. Encourage the client to cough and deep breathe D. Premedicate the client with an analgesic before ambulating

D.premedicate the client with an analgesic before ambulating

Stroke Volume (SV)

Difference between end-diastolic volume and end-systolic volume

cardiac reserve

Hearts ability to respond to strenuous activity by adjusting cardiac output

Afterload

How hard is it for ventricles to push the blood out ; vascular tone

Preload

How relaxed is the heart at the end of relaxation phase

coagulation cascade

Larger than platelet plug, intrinsic pathway

Diastolic BP

Pressure of ventricles at rest

systolic blood pressure

Pressure that results from contraction of ventricles

Hemostasis

Process by which body slows and stops flow of blood

determinants of blood pressure

Pumping action of the heart Peripheral vascular resistance-how the arteries and arterioles let blood flow through the heart Blood volume Blood viscosity

Modifiable risk factors

Quit smoking Eat healthy diet for normal BMI Start daily regiment of physical activity

poor contractility

Reduces flow of blood from heart Reduces cardiac output Increased ventricular pressures

Ejection Fraction (EF)

Stroke volume divided by end-diastolic volume

vasoconstriction

Triggered by substances released at injury site and by nerve impulses from pain receptors

Pulse

Wave of blood created by left ventricle contraction , reflex heartbeat

Pulse pressure

difference between systolic and diastolic pressure

Fibrinolysis

the breakdown of a clot by plasmin, which digests fibrin threads and inactivates certain clotting factors; breakdown of clot

Contractility

the capability or quality of shrinking or contracting, especially by muscle fibers