Cardio PrepU 27, 28, 29, 30

Cardiogenic shock may cause cold

, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal.

IV morphine

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload?

Instruct the client on side effects of flushing, throbbing headache, and tachycardia.

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan?

Ventricular assist device (VAD)

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant?

Constant, intense back pain and falling blood pressure

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?

Valsartan

A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering?

chest pain that occurs at rest and usually in the middle of the night

A client who has been diagnosed with Prinzmetal's angina will present with which symptom?

"Client will verbalize the intention to stop smoking."

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include?

"I anticipated this complication and I will call the health care provider right now."

A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings?

Assess for elevated blood urea nitrogen levels.

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?

"It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet."

A client with peripheral arterial disease asks the nurse about using a heating pad to warm the feet. The nurse's best response is which of the following?

"I should expect a low-grade fever and swelling at the site for the next week."

A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?

Keeping the legs in a neutral or dependent position

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching?

Low serum potassium level

A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

Nitroglycerin (Nitrostat)

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication?

A pulsatile abdominal mass Low back pain Lower abdominal pain

A nurse suspects the presence of an abdominal aortic aneurysm. What assessment data would the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply.)

Cardiac tamponade

A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload?

right-sided heart failure.

Ascites, jugular vein distention, and pitting edema of the legs are signs of

The client is going into cardiogenic shock.

Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit?

shock.

Coronary artery stenosis is not related to .... Right arterial flutter is not indicative of ....

50 seconds or less.

Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath?

an angiotensin receptor blocker (ARB) or a combination of hydralazine and isosorbide dinitrate is prescribed

If the patient cannot continue taking an angiotensin-converting enzyme (ACE) inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia

Left ventricle to left atrium

Incomplete closure of the mitral valve results in backflow of blood from the:

pericardial effusion.

Increased right and left ventricular end-diastolic pressures, inability of the ventricles to fill adequately, and atrial compression are all effects of

atropine is usually given to treat this response.

Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV

AAA

Some patients complain that they can feel their heart beating in their abdomen when lying down, or they may say that they feel an abdominal mass or abdominal throbbing. The most important diagnostic indication of an abdominal aortic aneurysm is a pulsatile mass in the middle and upper abdomen. Signs of impending aneurysm rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves.

inadequate tissue perfusion

The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump?

atropine

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol?

There is excess fluid volume in the interstitial space in areas affected by gravity.

The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean?

Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client?

The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels.

The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication?

air hunger

The nurse is assessing a client with left-sided heart failure. What assessment finding is expected?

From a break in the skin

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?" The nurse is most safe to speculate which of the following?

"What time did your chest pain start today?"

The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client?

Class III (Moderate)

The nurse is caring for a client in the hospital with chronic heart failure who has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, the client becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)?

Elevated blood pressure Alcohol use Obesity Physical inactivity

The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply.

administration of a vasodilating drug (as ordered by a health care provider)

The nurse is discussing basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload?

Arterial blood gases

The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status?

Lie very still at intermittent times during the test.

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?

fatty deposits in the lumen of arteries

The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond?

Atrial fibrillation

The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?

Increased venous return.

The pathophysiology of pericardial effusion is associated with all of the following except: EXCEPT

Valsartan (Diovan).

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer?

Heart failure is this considered according to the New York Heart Association (NYHA)?

This client is comfortable at rest, but has "marked limitations" on physical activity. Merely walking down the hall causes fatigue and dyspnea. Therefore, this client is in Class III (moderate). With Class I (mild), ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea, and the client does not experience any limitation of activity. With Class II (mild), the client is comfortable at rest, but the ordinary physical activity of daily living results in fatigue, heart palpitations, or dyspnea; the client's activity is only slightly limited. With Class IV (severe), symptoms of cardiac insufficiency occur at rest, and discomfort increases if any physical activity is undertaken.

cardiogenic shock

This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs.

Venous return is decreased (not increased) with

Venous return is decreased (not increased) with

"See if rest relieves the chest pain before using the nitroglycerin."

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions?

a client with a chronic, nonhealing skin lesion

Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy?

Minimally invasive direct coronary bypass

Which technique is used to surgically revascularize the myocardium?

valve damage.

While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate:

Prepare to administer protamine sulfate.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?

Valsartan (Diovan)

angiotensin receptor blocker

The classic signs of cardiogenic shock

are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage.

Clients with unstable angina experience

chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

Clients with stable angina experience

chest pain that lasts 15 minutes or less and may radiate.

A client with Prinzmetal's angina will

complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time.

Indications of a rupturing abdominal aortic aneurysm include

constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Elevated blood urea nitrogen indicates

impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.

The microorganisms that cause infective endocarditis

include bacteria and fungi. Streptococci and staphylococci are the bacteria most frequently responsible for this disorder. Both bacteria are abundantly found on the skin. These organisms are not found in the other locations.

Carvedilol (Coreg)

is a beta-adrenergic blocking agent (beta-blocker).

Digitalis/digoxin (Lanoxin)

is a cardiac glycoside.

Metolazone (Zaroxolyn)

is a thiazide diuretic.

Clients with Cardiac Syndrome X experience

prolonged chest pain that accompanies exercise and is not always relieved by medication.

Reduced cardiac output and stroke volume

reduces arterial blood pressure and tissue perfusion.

A ruptured aneurysm causes

severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.

Preload is

the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload.

With left-sided heart failure,

the client typically has air hunger and other signs of pulmonary congestion.

With right-sided heart endocarditis

the nurse assesses for signs and symptoms of organ damage such as stroke, meningitis, heart failure, myocardial infarction, glomerulonephritis, and splenomegaly. This requires further assessment and collaborative interventions to prevent further deterioration. The other actions like deep breathing and changing positions with NPO status will not help the client.

to cardiogenic shock, but is not the premise for the intra-aortic balloon pump.

to cardiogenic shock, but is not the premise for the intra-aortic balloon pump. Coronary artery stenosis is not related to shock. Right arterial flutter is not indicative of shock.

Preload alterations occur when

too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.

Loop diuretics such as

urosemide blocks sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. Furosemide also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.

Left-sided and right-sided heart failure eventually cause

venous congestion with jugular vein distention and edema as the heart fails to pump blood forward.

Frank hematuria indicates excessive anticoagulation and bleeding

— and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.