Week 6
The nurse is caring for a client with chronic hypertension who struggles with medication compliance due to financial issues. When reviewing recent lab work results, which reflects the client's blood pressure issues? Select all that apply. blood urea nitrogen (BUN) complete blood count creatinine cardiac enzymes alanine aminotransferase (ALT) calcium
Correct response: blood urea nitrogen (BUN) creatinine calcium Explanation: Financial issues can lead to a client inability to afford medication and, thus, chronic issues with hypertension. Blood urea nitrogen (BUN) and creatinine levels reveal kidney function and, if abnormal, are reflective of chronic hypertension. Calcium levels fluctuate as calcium leaves the bone. Calcification of major blood vessels in the body can occur. Hypertension is not reflective in the complete blood count levels. Cardiac enzymes may indicate a myocardial infarction. Alanine aminotransferase (ALT) is a liver enzyme reflective of liver function.
The nurse working on the cardiac floor identifies which of the following to be the initial treatment of choice for small pericardial effusions and mild cardiac tamponade? NSAIDS Pericardiocentesis Corticosteroids Colchicine
Pericardiocentesis Explanation: Pericardiocentesis or removal of fluid from the pericardial sac is the initial treatment of choice. NSAIDS, colchicine, and corticosteroids may be used to minimize fluid accumulation.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition? A pulsating mass in the abdomen Syncope The pulse is unobtainable in one or both arms Hemiplegia
A pulsating mass in the abdomen Explanation: Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.
The nursing instructor is talking about myocardial infarctions (MI) to her junior nursing class. What would the instructor tell the students is the most common cause of an MI? Coronary thrombosis Venous stasis Arteriosclerosis Stroke
Coronary thrombosis Explanation: The most common cause of MI is coronary thrombosis, the consequence of a blood clot located within a coronary artery. Therefore, options B, C ,and D are incorrect.
A mediastinal shift occurs in which type of chest disorder? Tension pneumothorax Traumatic pneumothorax Simple pneumothorax Cardiac tamponade
Correct response: Tension pneumothorax Explanation: A tension pneumothorax causes the lung to collapse and the heart, the great vessels, and the trachea to shift toward the unaffected side of the chest (mediastinal shift). A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. A simple pneumothorax most commonly occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac.
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? Alkaline phosphatase Creatine kinase MB Myoglobin Troponin
Creatine kinase MB Explanation: There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.
A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? Decrease in central venous pressure (CVP) Increase in CVP Decrease in blood pressure Absence of cough
Decrease in central venous pressure (CVP) Explanation: A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.
Which type of aortic aneurysm is the most common? Abdominal aortic Thoracic Ascending aorta Aortic arch
Explanation: Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta, or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis.
A client who recently had a myocardial infarction develops pericarditis and complains of chest pain rated 6 (on a scale of 0-10) with deep breathing. Which ordered pro re nata medications is mostappropriate for the nurse to administer? Acetaminophen 650 mg PO every 4 hours Fentanyl 2 mg intravenous pyelogram (IVP) every 2-4 hours Ibuprofen 800 mg PO every 8 hours Morphine sulfate 6 mg IVP every 2-4 hours
Ibuprofen 800 mg PO every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation; thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? Initiate transcutaneous pacing Prepare for defibrillation Administer 1 mg of IV atropine Obtain a 12-lead ECG
Initiate transcutaneous pacing Explanation: The client is experiencing a third-degree heart block. Transcutaneous pacing should be implemented first. A permanent pacemaker may be indicated if the block continues. Defibrillation is not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not completed first.
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? Troponin I Myoglobin WBC (white blood cell) count C-reactive protein
Myoglobin Explanation: Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels does not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.
The nurse is caring for a client with ECG changes consistent with a myocardial infarction. Which of the following diagnostic test does the nurse anticipate to confirm heart damage? Fluoroscopy Nuclear cardiology Serum blood work Chest radiography
Nuclear cardiology Explanation: Nuclear cardiology uses a radionuclide to detect areas of myocardial damage. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. Serum blood work notes elevations in enzymes suggesting muscle damage.
The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? All options must be used. 1Position electrodes on the chest. 2Take vital signs. 3Administer the prescribed dose of morphine. 4Obtain a history of which drugs the client has used recently
Position electrodes on the chest. Take vital signs. Administer the prescribed dose of morphine. Obtain a history of which drugs the client has used recently. Explanation: The nurse should first connect the client to the monitor by attaching the electrodes. Electrocardiography can be used to identify myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement, electrolyte imbalances, and the effects of drugs on the client's heart. The nurse next obtains vital signs to establish a baseline. Next, the nurse should administer the morphine; morphine is the drug of choice in relieving myocardial infarction (MI) pain; it may cause a transient decrease in blood pressure. When the client is stable, the nurse can obtain a history of the client's drug use.
A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.7 kPa); HCO3-, 24 mEq/L (24 mmol/l). The nurse determines that which of the following is a possible cause for these findings? Chronic obstructive pulmonary disease (COPD). Diabetic ketoacidosis with Kussmaul's respirations. Myocardial infarction. Pulmonary embolus.
Pulmonary embolus. Explanation: A PaCO2 of 28 mm Hg (3.7 kPa) and PaO2 of 50 mm Hg (6.7 kPa) are both abnormal; the PaO2 of 50 mm Hg (6.7 kPa) signifies acute respiratory failure. In evaluating possible causes for this disorder, the nurse should consider conditions that lead to hypoxia and hyperventilation, such as pulmonary embolus. COPD is typically associated with respiratory acidosis and elevated PaCO2. The client with diabetic ketoacidosis most often has metabolic acidosis. A myocardial infarction does not often cause an acid-base imbalance because the primary problem is cardiac in origin.
A nurse is assessing a client who reports an acute visual disturbance that he describes as a "curtain" pulled over his visual field with occasional flashes of light. The nurse should notify the provider that this client might have which of the following disorders? Cataracts Angle-closure glaucoma Retinal detachment Macular degeneration
Retinal detachment
Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm termed abdominal aortic aneurysms? Select all that apply. Berry aneurysms Dissecting aneurysms Saccular aneurysms Fusiform aneurysms Bifurcating aneurysms
Saccular aneurysms Fusiform aneurysms Explanation: Abdominal aortic aneurysms can involve any part of the vessel circumference (saccular) or extend to involve the entire circumference (fusiform). Berry aneurysms typically occur in the circle of Willis. Dissecting aneurysms are false aneurysms and typically occur in the thoracic aorta. Aneurysms can occur at the bifurcation of a blood vessel but are not termed bifurcating aneurysms.
The nurse is assessing a client who has had a myocardial infarction. The nurse reviews the client's ECG strip (view the figure) and notices a premature ventricular contraction (PVC). Identify the PVC on this cardiac rhythm strip. Click to select the correct part of the image.
The client is having one PVC on this ECG strip.
A male client had a myocardial infarction. He was told that his infarction size was decreased as a result of collateral circulation. This means the client likely had: atherosclerosis, which caused resultant narrowing of the coronary artery. an acute occlusion, which caused resultant dilation of the artery and increased circulation. atherosclerosis, which caused resultant dilation of the artery and increased circulation. hypokalemia, which caused resultant dilation of the artery and increased circulation.
atherosclerosis, which caused resultant dilation of the artery and increased circulation. Explanation: Arteries may not supply sufficient blood to the heart if a major artery is suddenly occluded, but they may dilate to considerable size when disease (usually coronary atherosclerosis) develops slowly. The resultant collateral circulation may provide sufficient blood supply for myocardial function, at least during rest.
An angiogram reveals 80% to 90% occlusions in several coronary arteries but the client's troponin I level is normal. The client asks the nurse, "How it was possible to have such blockage yet have no symptoms?" How should the nurse respond? a. To compensate for long-standing narrowing of the vessels, new arteries formed to increase blood supply. b. Some people have no symptoms despite lack of blood supply. This is called "silent myocardial ischemia." c. The release of nitrous oxide from the narrowed vessels causes dilation and allows for adequate blood supply. d. Symptoms will not occur until at least one vessel is 100% occluded. This results in a myocardial infarction.
b. To compensate for long-standing narrowing of the vessels, new arteries formed to increase blood supply.
The nurse is preparing to present an educational session on pediatric cardiopulmonary arrests. The nurse will include which statement in the teaching? "Most pediatric arrests stem from airway and breathing issues." "Obtaining an automated external defibrillator (AED) is vital to survival." "Activate the emergency response system first in an unwitnessed event." "Start cardiopulmonary resuscitation (CPR) in an infant if the heart rate is below 75 beats per minute."
Correct response: "Most pediatric arrests stem from airway and breathing issues." Explanation: Most pediatric arrests are related primarily to airway and breathing, and usually only secondarily to the heart issues. This information guides the nurse to always assess the airway first in case of an emergency involving cardiopulmonary arrest. While obtaining an AED is important, pediatric arrests are more often respiratory related instead of cardiac. In an unwitnessed event, CPR should be started first. The emergency response system is first activated when the event is witnessed. CPR should be started when an infant's heart rate is less than 60 beats per minute.
A 46-year-old man has been diagnosed with pericarditis and has begun treatment. When assessing this patient, the nurse should prioritize assessments relevant to what complications of pericarditis? Select all that apply. Cardiac tamponade Pericardial effusion ST elevation myocardial infarction (STEMI) Cardiac arrest Transient ischemic attacks (TIAs)
Correct response: Cardiac tamponade Pericardial effusion Explanation: Nurses caring for patients with pericarditis must be aware of the potential of serious complications. The two major complications of pericarditis are pericardial effusion, the accumulation of fluid in the pericardial sac, and cardiac tamponade, compression of the heart from excessive fluid build-up. MI, cardiac arrest, and TIAs are not frequent complications of pericarditis.
Administration of a cardiotonic drug is contraindicated in which conditions? (Select all that apply.) Digitalis toxicity Hypertension Cardiac tamponade Hypotension Ventricular tachycardia
Correct response: Digitalis toxicity Cardiac tamponade Ventricular tachycardia Explanation: The cardiotonics are contraindicated in the presence of digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardimyopathy, or AV block.
A nurse is assessing a patient who has had valvular heart disease for more than 15 years. Which signs and symptoms should the nurse expect? (Choose all that apply.) Paroxysmal nocturnal dyspnea Orthopnea Cough Pericardial friction rub Pulsus paradoxus
Correct response: Paroxysmal nocturnal dyspnea Orthopnea Cough Explanation: Paroxymal nocturnal dyspnea, orthopnea, and coughing occur in long-term valvular disease. Pericardial friction rub is a sound auscultated in clients with pericarditis, not valvular disease. Pulsus paradoxus is a marked decrease in amplitude during inspiration, a sign of cardiac tamponade.
When the electrocardiogram (ECG) of a client in the emergency department indicates an ST-elevation myocardial infarction (STEMI) in progress, the physician orders a beta-adrenergic blocker. Which factors in the client's history will cause the nurse to withhold medication pending discussion with the physician? Select all that apply. Myocardial infarction caused by cocaine use Third-degree heart block Hypertension Shock Cerebrovascular accident
Myocardial infarction caused by cocaine use Third-degree heart block Shock Explanation: Beta-adrenergic blockers (beta-blockers) are beneficial during acute coronary syndrome because they enhance myocardial perfusion by lengthening diastole. They also reduce sympathetic response, thus decreasing myocardial oxygen demand and systolic blood pressure. However, if a STEMI was caused by cocaine use, beta blockers can intensify the coronary spasm. Additional reasons to avoid beta blockers include left ventricular failure, hypotension, shock, second- or third-degree heart block, and symptomatic bradycardia.
A nurse working in the OB clinic is talking to a client who asks the nurse why her primary care provider has not prescribed estrogen replacement therapy (ERT) to treat her pelvic organ prolapse (POP). The nurse informs the client that ERT is not for everyone and should not be given to clients who are at risk for developing which conditions? Select all that apply. endometrial cancer myocardial infarction (MI) stroke breast cancer deep vein thrombosis (DVT) pulmonary emboli (PE)
endometrial cancer myocardial infarction (MI) stroke breast cancer deep vein thrombosis (DVT) pulmonary emboli (PE) Explanation: Before hormone therapy is considered, a thorough medical history must be taken to assess the risk for complications such as MI, endometrial cancer, stroke, breast cancer, PE, and DVT.
A client presenting with which clinical situation is a candidate for enoxaparin therapy? A post-surgical hip replacement History of atrial fibrillation A post-surgical gastric resection History of unstable angina Post non-Q-wave myocardial infarction
orrect response: A post-surgical hip replacement A post-surgical gastric resection History of unstable angina Post non-Q-wave myocardial infarction Explanation: Enoxaparin is prescribed for the prevention of deep vein thrombosis (DVT) that may lead to pulmonary embolism (PE) after hip replacement or abdominal surgery; prevention of ischemic complications of unstable angina or non-Q-wave MI; prevention of DVT in patients with severely restricted mobility due illness. Enoxaparin is not prescribed for the management of atrial fibrillation.