Cardiac test 4

The client is experiencing sinus bradycardia with hypotension and dizziness. Which will the nurse administer? a. Atropine (Atropine) b. Digoxin (Lanoxin) c. Lidocaine (Xylocaine) d. Metoprolol (Lopressor)

A. Atropine is a cholinergic antagonist that inhibits parasympathetic-induced hyperpolarization of the sinoatrial node. This inhibition results in an increased heart rate.

The client with tachycardia is experiencing clinical manifestations. Which one alerts the nurse to the need for immediate intervention? a. Chest pain b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave

A. Chest pain, possibly angina, indicates that the tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain.

The client has a consistent and regular heart rate of 128 beats/min. Which physiologic alterations would be consistent with this finding? a. A decrease in cardiac output and blood pressure b. An increase in cardiac output and blood pressure c. An increase in blood pressure and decrease in cardiac output d. A decrease in blood pressure and increase in cardiac output

A. Consistently elevated heart rates initially cause blood pressure and cardiac output to increase. However, ventricular filling time, cardiac output, and blood pressure eventually decrease.

A client's cardiac status is being observed by telemetry monitoring. A nurse observes a P wave that changes shape in lead II. What conclusion will the nurse make from this? a. The P wave is originating from an ectopic focus. b. The P wave is firing twice from the sinoatrial (SA) node. c. There is no real P wave. d. The P wave is normal.

A. If the P wave is firing consistently from the SA node, the P wave will have a consistent shape in a given lead. If the impulse is from an ectopic focus, then the P wave will vary in shape in that lead.

The client is experiencing occasional premature atrial contractions (PACs) accompanied by palpitations. These episodes resolve spontaneously without treatment. What instructions will be included in a teaching plan for this client? a. Limit or abstain from caffeine. b. Lie on your left side until the attack subsides. c. Use your oxygen whenever you experience PACs. d. Take your quinidine twice daily on the days that you experience palpitations.

A. PACs usually have no hemodynamic consequences. For a client experiencing infrequent bouts of PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress.

The client's ECG reveals tachycardia with a heart rate of 170 beats/min that was initiated after a premature atrial contraction. This rhythm resolved spontaneously without treatment. What is the nurse's interpretation of this finding? a. Paroxysmal supraventricular tachycardia (PSVT) b. Ventricular tachycardia c. Ventricular fibrillation d. Rapid atrial flutter

A. PSVT is the term applied when the tachycardia is intermittent, initiated suddenly by a premature complex, such as a PAC. This dysrhythmia resolves without intervention.

A patient with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rhythm. When obtaining the patient's history, the nurse should question the patient regarding the incidence of A. stress. B. asthma. C. diabetes. D. weight gain.

A. Stress

A physical assessment finding that the nurse would expect to be present in the patient with acute left-sided heart failure is A. bubbling crackles and tachycardia. B. hepatosplenomegaly and tachypnea. C. peripheral edema and cool, diaphoretic skin. D. frothy blood-tinged sputum and distended jugular veins.

A. bubbling crackles and tachycardia.

Four hours after the onset of pain from an MI, a nurse should expect an increase in the A. creatine kinase-MB (CK-MB). B. leukocyte count. C. alkaline phosphatase (ALP). D. lactate dehydrogenase (LHD).

A. creatine kinase-MB (CK-MB).

After receiving change-of-shift report in the coronary care unit, which client should you assess first? a. The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea b. The client with percutaneous coronary angioplasty who has a dose of heparin scheduled c. The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 d. A client who has first-degree heart block, rate 68, after having an inferior myocardial infarction

A: Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; the client needs prompt intervention.

The nurse evaluates diagnostic results for a client who has chest pain. Which laboratory test is most specific for acute coronary syndromes? a. Troponin markers b. Serum lactate dehydrogenase (LDH) c. Serum myoglobin d. Creatine kinase (CK)-MB isoenzyme

ANS: A Although all these laboratory tests are appropriate to confirm or rule out a myocardial infarction, the one most specific for acute coronary syndromes is troponin T. When elevated, it serves to identify the development of unstable angina, subendocardial MI, or MI.

While evaluating a client's electrocardiogram (ECG) before surgery, the preoperative nurse identifies large, wide Q waves. What is the nurse's best interpretation of this finding? a. An acute myocardial infarction is occurring. b. The client had a myocardial infarction in the past. c. The ventricles are enlarged and failing. d. The ECG is a common variation of normal sinus rhythm.

ANS: B A wide and large Q wave develops as a result of myocardial infarction and necrotic ventricular cells that do not conduct electrical impulses. This change is usually permanent. When it appears alone, it indicates a past MI. The other interpretations are not correct.

The nurse administers intravenous dobutamine (Dobutrex) to a client who has heart failure. Which clinical manifestations indicate that the client's status is improving? (Select all that apply.) a. Decreased heart rate b. Increased heart rate c. Increased contractility d. Decreased contractility e. Increased respiratory rate

ANS: B, C Dobutamine is a positive inotropic agent that works by stimulating beta-adrenergic receptor sites. The result of this stimulation is an increase in the rate and force of the myocardial contraction. Dobutamine has no effect on respiratory rate.

The nurse is monitoring the electrocardiogram (ECG) of a client who has a myocardial infarction. Which changes does the nurse expect to see in the ECG tracing? (Select all that apply.) a. ST-segment depression b. T-wave inversion c. Normal Q waves d. ST-segment elevation e. T-wave elevation f. Abnormal Q wave

ANS: B, D, F When myocardial infarction occurs, the changes usually seen on an ECG tracing are ST-segment elevation, T-wave inversion, and an abnormal Q wave.

The nurse notes absent P waves and a heart rate of 200 beats/min on the client's telemetry. How does the nurse interpret these findings? a. Ventricular tachycardia b. Second-degree heart block c. Supraventricular tachycardia d. Premature ventricular contraction

C. Supraventricular tachycardia involves the rapid stimulation of atrial tissue. Thus, depolarization is stimulated above the ventricular conduction system and is using normal conduction pathways. P waves are obscured by the preceding T waves.

The emergency department nurse is assessing an 82-year-old client for a potential myocardial infarction. Which clinical manifestation does the nurse monitor for? a. Pain on inspiration b. Posterior wall chest pain c. Disorientation or confusion d. Numbness and tingling of the arm

ANS: C In older adults, disorientation or confusion may be the major manifestation of myocardial infarction caused by poor cardiac output. Pain manifestations could also be related to the myocardial infarction. However, the nurse is more concerned about the new onset of disorientation or confusion caused by decreased perfusion.

The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease? a. "Would you please state your full name and birth date?" b. "Have you ever had an exercise tolerance stress test?" c. "In what activities do you participate on a daily basis?" d. "Does anyone in your family have a history of heart disease?"

ANS: C Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). A stress test would not provide any information about risk factors.

The nurse teaches a client who is newly diagnosed with coronary artery disease. Which instruction does the nurse include to minimize complications of this disease? a. "Rest is the best medicine at this time. Do not start an exercise program." b. "You are a man; therefore there is nothing you can do to minimize your risks." c. "You should talk to your provider about medications to help you quit smoking." d. "Decreasing the carbohydrates in your diet will help you lose weight."

ANS: C Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). The nurse needs to encourage the client to stop smoking because this is a proven risk factor for coronary artery disease development. The nurse should also encourage weight loss and moderate exercise.

The nurse is assessing a client who has left ventricular failure secondary to a myocardial infarction. Which clinical manifestation of poor organ perfusion does the nurse monitor for in this client? a. Headache b. Hypertension c. Urine output of less than 30 mL/hr d. Heart rate of 55 to 60 beats/min

ANS: C The nurse should remain alert for signs of poor organ perfusion that are the result of decreased cardiac output. When the kidneys are not well perfused, urine output drops to less than 30 mL/hr. Other signs include changes in mental status; cool, clammy extremities with decreased or absent pulses; fatigue; and recurrent chest pain. The other manifestations do not indicate poor organ perfusion.

What does the P wave on an ECG tracing represent? a. Contraction of the atria b. Contraction of the ventricles c. Depolarization of the atria d. Depolarization of the ventricles

C. The ECG tracing of a P wave represents electrical changes caused by atrial depolarization.

The nurse is providing a cardiac class for a women's group. The nurse emphasizes that which characteristics place women at high risk for myocardial infarction (MI)? Select all that apply. a. Premenopausal b. Increasing age c. Family history d. Abdominal obesity e. Breast cancer

B, C, D Increasing age is a risk factor, especially after 70 years. Family history is a significant risk factor in both men and women. A large waist size/abdominal obesity is a risk factor for both metabolic syndrome and MI. Postmenopausal women are at higher risk for MI. Breast cancer is not a risk factor for myocardial infarction.

Which is a priority intervention for the client experiencing atrial fibrillation? a. Measuring urinary output b. Assessing for shortness of breath c. Assessing pulse oximetry every hour d. Measuring blood pressure in the lying and sitting positions

B. A serious and frequent complication of atrial fibrillation is systemic emboli, particularly pulmonary emboli. The nurse should assess for shortness of breath, chest pain, and hemoptysis because they are symptoms of pulmonary emboli.

Which client is most at risk for atrial fibrillation? a. A middle-aged client who takes an aspirin daily b. A client 3 days postcoronary artery bypass surgery c. An older adult client post-carotid endarterectomy d. An older adult with diabetes mellitus and hypertension

B. Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after CABG (coronary artery bypass graft) surgery.

The client has a heart rate averaging 56 beats/min. The client has no adverse symptoms associated with this bradycardia and is not being treated for it. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate? a. "Make certain that your bath water is warm (100° F)." b. "Avoid bearing down or straining while having a bowel movement." c. "Avoid strenuous exercise, such as running, during the late afternoon." d. "Limit your intake of caffeinated drinks to no more than two cups per day."

B. Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in a slowing of the heart rate. Such a response is not desirable in a person who has bradycardia.

A nurse is caring for a client with chronic atrial fibrillation who is at risk for systemic emboli. Which drug should the nurse expect to administer to prevent this complication? a. Sotalol (Betapace) b. Heparin (Heparin) c. Atropine (Atropine) d. Lidocaine (Xylocaine)

B. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin.

Which action will the nurse take to improve the quality of the electrocardiographic rhythm transmission to the monitoring system? a. Apply lotion to the client's chest before attaching the chest leads. b. Remove the hair from the chest area before attaching the chest leads. c. Instruct the client not to wear any clothing made from synthetic fabrics during the test. d. Apply skin protectant to area prior to placing electrode.

B. Electrocardiographic transmission quality is directly related to the degree of skin contact with the leads. Impedance is decreased by shaving contact areas, cleansing them with soap and water, and drying them thoroughly before attaching the leads.

Which alteration, when manifested in a client with atrial fibrillation, should alert the nurse to the possibility of an embolic stroke? a. A pulse deficit b. Speech alterations c. Distended neck veins d. Hyperresponsive deep tendon reflexes

B. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function.

The client has exactly 8.0 R-R intervals in 150 small blocks on the ECG paper. Based on this information, the nurse calculates the client's ventricular heart rate to be which of the following? a. 40 beats/min b. 80 beats/min c. 160 beats/min d. Cannot be calculated from the information provided

B. Precisely 6 seconds is represented by 150 small blocks on ECG paper. The number of R-R intervals, representing ventricular depolarization episodes present in 6 seconds, can be multiplied by 10 to calculate the ventricular heart rate.

The nurse observes a prominent U wave on the client's ECG tracing. What is the nurse's interpretation of this finding? a. This is a normal finding. b. The client may have a potassium imbalance. c. The client is at risk for R-on-T phenomenon. d. The client has an evolving myocardial infarction.

B. Prominent U waves may be the result of hypokalemia.

The client comes to the emergency department with chest discomfort. Which action does the nurse perform first? a. Administers oxygen therapy b. Obtains the client's description of the chest discomfort c. Provides pain relief medication d. Remains calm and stays with the client

B: A description of the chest discomfort must be obtained before further action can be taken.

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? a. 1 inch backup of blood in the IV tubing b. Facial drooping c. Partial thromboplastin time (PTT) 68 seconds d. Report of chest pressure during dye injection

B: During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding.

What physical assessment findings are expected in a client with atrial flutter and a rapid ventricular response? a. The presence of a split S1 and wheezing b. Anorexia and gastric distress c. Shortness of breath and anxiety d. Hypertension and mental status changes

C. Rapid atrial flutter may be manifested as palpitations, shortness of breath, and anxiety. Syncope, angina, and evidence of heart failure also may be present.

The client's heart rate increases slightly during inspiration and decreases slightly during expiration. What action will the nurse take? a. Notify the physician. b. Assess the client for chest pain. c. Document the finding as the only action. d. Prepare to administer antidysrhythmic drugs.

C. Sinus dysrhythmia is noted when the heart rate increases slightly during inspiration and decreases slightly during expiration. Sinus dysrhythmia is a variant of normal sinus rhythm that is frequently observed in healthy children and adults.

If a patient with heart failure is being treated with digoxin and has developed hypokalemia, the nurse should A. administer digoxin twice daily. B. reduce the digoxin dose to every other day. C. administer an IV bolus of potassium. D. monitor the patient for toxic effects that can occur at normal doses.

D. monitor the patient for toxic effects that can occur at normal doses.

Which of the following statements would indicate that a patient taking antihypertensive drugs understands the management of hypertension? A. "I need to have my blood pressure checked monthly." B. "I can still smoke while taking these drugs, as long as I cut down." C. "These pills will help control, but not cure, my high blood pressure." D. "When my blood pressure is back to normal, I can stop taking these pills."

C. "These pills will help control, but not cure, my high blood pressure.

What is the amount of blood pumped with each heartbeat? A. Systole B. Diastole C. Stroke volume D. Cardiac output

C. Stroke Volume

A nurse should be alarmed by which of the following changes in a 72-year-old patient's ECG? A. First-degree block B. Bundle branch block C. Ventricular fibrillation D. Left ventricular hypertrophy

C. Ventricular fibrillation

The primary mechanism of action of medications that relieve the pain of stable angina is by A. decreasing heart rate. B. increasing blood pressure. C. decreasing cardiac oxygen demand. D. increasing sympathetic stimulation to the heart.

C. decreasing cardiac oxygen demand.

The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? a. Reduce abdominal fat. b. Avoid stress. c. Do not smoke or chew tobacco. d. Avoid alcoholic beverages.

C: Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causes vasoconstriction and endothelial dysfunction and thickening of the vessel wall, increases carbon monoxide, and decreases oxygen. Because this is highly addicting, beginning smoking in the teen years may lead to decades of exposure.

The primary function of automaticity in heart muscle is to A. initiate an impulse in response to a stimulus. B. transmit electrical impulses that are received. C. respond to a stimulus only after repolarization. D. spontaneously and repetitively initiate an impulse.

D. spontaneously and repetitively initiate an impulse.

Information related to the patient's health and medication history that the nurse identifies as significant during assessment of the cardiovascular system is a history of A. metastatic cancer. B. calcium supplementation. C. frequent viral pharyngitis. D. use of recreational/abused drugs.

D. use of recreational/abused drugs.

What will the nurse administer to a client with sustained supraventricular tachycardia? a. Atropine (Atropine) b. Epinephrine (Adrenalin) c. Lidocaine (Xylocaine) d. Diltiazem (Cardizem)

D. Diltiazem, a calcium channel blocker, slows depolarization through the conduction system and is commonly used as an agent to terminate a sustained episode of supraventricular tachycardia.

In analyzing a client's ECG tracing, the nurse observes that not all QRS complexes are preceded by a P wave. What is the nurse's interpretation of this observation? a. The client has hyperkalemia. b. The client is in ventricular tachycardia. c. One of the chest leads is not making sufficient contact with the skin. d. Ventricular depolarization is being initiated at a site different from atrial depolarization.

D. Normal rhythm shows one P wave preceding each QRS, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization.

What will the nurse do to ensure the validity of comparison of electrocardiograms (ECGs) taken at different times? a. Remove electrodes after each ECG is completed. b. Place new ECG chest leads on the client before each ECG is completed. c. Position the client supine prior to each ECG. d. Ensure that electrode placement is identical for each ECG.

D. Positioning electrodes is crucial in obtaining an accurate ECG. To ensure validity of comparison of ECGs taken at different times, electrode placement must be accurate and identical at each test.

A nurse notes that the PR interval on a client's ECG tracing is 0.14 second. What action will the nurse take? a. Call the health care provider. b. Administer epinephrine. c. Administer oxygen via nasal cannula. d. Document the finding as the only action.

D. The PR interval normally ranges from 0.12 to 0.20 second. This is a normal finding, so the nurse simply documents this. No further action is required.

If a patient is being given a drug that blocks the action of the sympathetic division of the autonomic nervous system, the patient should be monitored for which of the following cardiovascular clinical manifestations? A. Increased heart rate and increased blood pressure B. Increased heart rate and decreased blood pressure C. Decreased heart rate and increased blood pressure D. Decreased heart rate and decreased blood pressure

D. Decreased heart rate and decreased blood pressure

Which of the following clinical manifestations indicates activity intolerance in a patient with heart failure who is undergoing a progressive increase in activity? A. Oxygen saturation of 95% B. Respiratory rate of 26 breaths/min C. Heart rate increase from 86 to 110 beats/min D. Systolic blood pressure change from 136 to 96 mm Hg

D. Systolic blood pressure change from 136 to 96 mm Hg