Cardio

At a staff meeting, a nurse-manager states that the unit performance improvement committee will perform a concurrent audit of the documentation of all coronary artery bypass clients' clinical pathways weekly for 4 weeks. A nurse asks why this is necessary. Which response is the best explanation of the audit's purpose?

"Audits are an evaluation tool used to improve compliance with hospital policy and standards." *Concurrent audit is an evaluation method used to review a client's medical record for compliance with predetermined criteria of nursing care.

A nurse is attempting to administer lisinopril to a client. The client refuses to take the pill, stating that in the past he developed a rash as an allergic reaction to the medication. Which of the following is the best response by the nurse?

"I will call the physician with this information." *the doctor will be able to change the med to something else*

A client who has just been diagnosed with myocardial infarction (MI) begins to cry and tells the nurse that his brother died of a heart attack last year. Which response by the nurse is most appropriate?

"you sound as if you think you are going to die " *

The nurse is assessing a client who is at risk for cardiac tamponade due to chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if his blood pressure is 108/82 mm Hg?

26 *Pulse pressure is the difference between systolic and diastolic pressures.

Which of the following signs and symptoms suggest that a client's abdominal aortic aneurysm is extending?

Increased abdominal and back pain *Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain

The nurse may expect to be instructed to obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?

Magnesium and potassium

A cognitively alert client is scheduled for a coronary artery bypass graft surgery in the morning. The nurse checks the chart for preoperative orders and finds that the surgical consent form hasn't been signed. Which of the following is the best action for the nurse to take?

NOTIFY surgeon *surgeon is responsible for having the client sign the consent form after explaining the procedure

The nurse reviews a client's medication history before administering a cholinergic blocking agent. Which of the following drugs may have delayed absorption because of the adverse effects of a cholinergic blocking agent?

Nitroglycerin (Nitrostat)

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 164/92 mm Hg and notes a 5-lb (2.3-kg) weight gain over the past 6 months. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?

Noncompliance (non adherence to therapeutic regimen) non compliance is the most serious problem when managing Hypertension patients. not eating right,not taking meds b/c symptoms aren't serious.

A nurse is caring for a client who has been administered digoxin (Lanoxin) 0.125 mg by mouth daily. The client develops sinus bradycardia with a heart rate of 50 beats/minute. His vital signs are stable. Which of the following actions should the nurse take first?

Notify the physician. *Because bradycardia is an adverse effect of digoxin, the nurse should notify the physician and follow his orders.

A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg by mouth three times daily with meals. The nurse should provide which instruction concerning long-term care?

Practice meticulous foot care." * Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential

A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?

Recommend he have his blood pressure rechecked within 2 months *Although hypertension is more prevalent in the black population, a blood pressure of 150/90 mm Hg isn't considered normal. He should have his blood pressure rechecked within 2 months. One year is too long to wait. He need not see his physician yet.

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate?

The severity of discomfort isn't related to the size of varicosities.

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician prescribes a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine if the client has other major risk factors for CAD, the nurse should assess for:

a history of diabetes mellitus.

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of:

acute pulmonary edma *Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema

A client develops atrial fibrillation after an acute myocardial infarction. The physician prescribes digoxin (Lanoxin), 0.125 mg I.M. daily. The nurse clarifies the order with the physician because I.M. administration of digoxin leads to

an increased serum creatine kinase (CK) level.

The nurse administers basic cardiac life support to a client in cardiac arrest after establishing unresponsiveness. Which action does the nurse perform during basic life support?

assessing the patency of airway

The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first:

establish unresponsiveness *The nurse should first establish unresponsiveness. The nurse should then call for help, assess the client for breathing while opening the airway, deliver two breaths, and check for a carotid pulse.

In caring for a client with vasovagal syncope, the nurse should know that the associated temporary loss of consciousness is most commonly related to:

bradyrhythmia.

A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and family to expect which common, spontaneously resolving symptom?

depression *For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia

Which measurement can best be used to monitor the respiratory status of a client with pulmonary edema?

Arterial blood gas (ABG) analysis *ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy.

A client with atrial fibrillation is diagnosed with an embolic stroke. Identify the heart chamber that is the most likely source of the fragmented clot responsible for the stroke.

Clients with atrial fibrillation are at increased risk for clot formation in the left ventricle of the heart due to stagnation of blood. If a piece of the clot breaks loose and travels to the brain, the client suffers an embolic stroke.

SELECT ALL THAT APPLY* The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)?

Serum troponin Serum myoglobin

The nurse is performing a cardiac assessment on a client with hypertension. Identify the area where the nurse should place the stethoscope to best auscultate the pulmonic valve.

Typically, the pulmonic valve is best heard at the second intercostal space, at the left sternal border.

The nurse is teaching a client about maintaining a healthy heart. The nurse should include which recommendation?

Use alcohol in moderation.

When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are found in the carotid sinus and aorta. Which other area should the nurse mention as a site of arterial baroreceptors?

left ventricular wall *Arterial baroreceptors are found in the left ventricular wall as well as the carotid sinus and aorta.

The nurse is assessing a client with heart failure. Which heart valve sound will the nurse hear best at the fifth left intercostal space at the midclavicular line?

mitral

An increase in the creatine kinase-MB isoenzyme (CK-MB) can be caused by:

myocardial necrosis

When a client is started on oral or I.V. diltiazem (Cardizem), the nurse should monitor for which adverse reaction?

heart failure

The physician prescribes digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digoxin toxicity?

hypokalemia

A hospitalized client experiences digoxin- (Lanoxin-) induced premature ventricular contractions (PVCs). Which type of effect do such contractions represent?

latrogenic

A client with a history of I.V. drug abuse is admitted to the medical-surgical unit for evaluation for ineffective endocarditis. Nursing assessment is most likely to reveal that this client has:

osler's nodes & splinter hemorrhaging

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis is appropriate?

risk for injury *b/c physical excertion may cause synacope or sudden death.

The nurse should advise the client with an axillofemoral bypass graft to avoid:

tight belts *Tight belts around the waist can occlude the axillofemoral bypass; the client should use suspenders instead

A 43-year-old man was transferring a load of firewood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which immediate order by the physician?

tissue plasminogen activator (tpa)

To avoid a falsely elevated serum digoxin level, the nurse should wait how long after administering oral digoxin (Lanoxin) to draw a blood sample?

At least 8 hours

SELECT ALL THAT APPLY The nurse is preparing a teaching plan for a client who recently underwent surgery for insertion of a permanent pacemaker. Which instructions should the nurse include in the teaching plan?

-CHEACH HEART RATE FOR 1 MIN DAILY -Report redness, swelling, or discharge at insertion site. -Avoid magnetic resonance imaging (MRI) diagnostic studies.

SELECT ALL THAT APPLY * A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure?

-orthopnea -cough -crackles

SELECT ALL THAT APPLY A client is receiving heparin I.V. for the treatment of thrombophlebitis. Which laboratory value should the nurse monitor throughout heparin therapy?

-partial thromboblastin time (PTT) -Platelet count

SELECT ALL THAT APPLY A client is prescribed furosemide (Lasix) to manage his heart failure. What laboratory values should be monitored while the client receives this medication?

-CBC -serum potassium

A 52-year-old client with a history of hypertension has just had a total hip replacement. The physician orders hydrochlorothiazide (Hydro-Chlor), 35 mg oral solution by mouth, once per day. The label on the solution reads hydrochlorothiazide 50 mg/5 ml. To administer the correct dose, how many milliliters should the nurse pour?

3.5 *The correct formula to calculate a drug dosage is: dose on hand/quantity on hand = dose desired/X. In this example, the equation is: 50 mg/5 ml = 35 mg/X; X = 3.5 ml.

A client is admitted to the coronary care unit with a suspected diagnosis of acute myocardial infarction. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain?

4-6 hours *Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.

A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?

Blood pressure *Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment.

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should be instructed to avoid which of the following?

Caffeine-containing products

A client is recovering from an acute myocardial infarction (MI). During the first week of recovery, the nurse should stay alert for which abnormal heart sound?

Pericardial friction rub * A pericardial friction rub, which sounds like squeaky leather, may occur during the first week after an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other.

The nurse is caring for a client with hemiparesis caused by a stroke. Which intervention takes highest priority?

Placing the client on the affected side

A client newly diagnosed with heart failure is placed on bed rest. What is the most appropriate rationale for this action?

to reduce hearts work load