cardiovascular

The nurse is reviewing the procedure for performance of an electrocardiogram (ECG). Which action by the nurse indicates understanding of the correct position for the V1lead when performing a 12-lead electrocardiogram?

"The lead should be placed on the fourth intercostal space right sternal border."

A client with rapid-rate atrial fibrillation asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective?

"The vagus nerve slows the heart rate." Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. Others include inducing the gag reflex and asking the client to strain or bear down.

The new registered nurse (RN) is reviewing cardiac rhythms with a mentor. Which statement by the new RN indicates that teaching about ventricular fibrillation has been effective?

"Ventricular fibrillation does not have P waves or QRS complexes."

Left sided heart failure

- signs of pulmonary congestion - dyspnea - tachypnea - crackles in the lungs - dry hacking cough - paroxysmal nocturnal dyspnea - increased BP( from fluid volume excess) or decreased BP (from pump failure)

cardiac tamponade sign & symptoms

- tachycardia -distant or muffled heart sounds -jugular vein distention - clear lung sounds - a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg)

The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription?

120 joules

Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg?

Assess peripheral pulses with an ultrasonic Doppler device. The priority is for the nurse to perform a comprehensive assessment of peripheral circulation. When pulses are difficult to palpate, the Doppler device is useful to determine the presence of blood flow to the area

A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused on reduction of which specific problem associated with this type of heart failure?

Bilateral lung crackles

The post-myocardial infarction client is scheduled for a technetium-99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure?

Signed informed consent

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions and short runs of ventricular tachycardia. The nurse plans to have which medication available for immediate use to treat the ventricular tachycardia?

Amiodarone Amiodarone is an antidysrhythmic that may be used to treat ventricular dysrhythmias

arterial ischemic leg ulcer

Foot care instructions for the client with peripheral arterial disease are the same as those for a client with diabetes mellitus. The client with arterial disease, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if venous stasis is also present

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment?

Hypotension and dizziness

The nurse employed in a cardiac unit determines that which client is the least likely to have an implanted cardioverter-defibrillator (ICD) inserted?

A client with an episode of cardiac arrest related to myocardial infarction This device is implanted in clients who are considered high risk, including those who have syncopal episodes related to ventricular tachycardia, those who are refractive to medication therapy, and those who have survived sudden cardiac death unrelated to myocardial infarction.

The nurse notes bilateral 2+ edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. Based on this observation, what should the nurse plan to do first?

Review intake and output records for the last 2 days.

A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept?

Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility.

An emergency room nurse is performing a cardiovascular assessment on a client. During auscultation of the heart sounds, the nurse hears these abnormal sounds.The nurse suspects that the client has which condition?

Ventricular hypertrophy

QRS complex

0.04 to 0.10

burn question A client sustains a burn injury to the entire right and left arms, the right leg, and the anterior thorax. According to the rule of nines, the nurse would assess that this injury constitutes which body percentage? Fill in the blank.

54

The nurse is assessing a client newly diagnosed with mild hypertension. Which assessment finding should the nurse expect?

Asymptomatic Hypertensive clients often have no symptoms until target organ involvement, which happens with very high blood pressure.

The nurse notes that a client's cardiac rhythm shows absent P waves, no PR interval, and an irregular rhythm. How should the nurse interpret this rhythm?

Atrial fibrillation

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action?

Check the client and the chest leads.

A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted?

Crackles in the bases As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of the episode.)

A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client?

Decreased heart rate and decreased blood pressure Hypothermia decreases the heart rate and the blood pressure because the metabolic needs of the body are reduced in this condition

The nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is unrelated to the aneurysm?

Hyperactive bowel sounds in the area

Hyperkalemia

Hyperkalemia can cause tall, peaked, or tented T waves on the ECG

The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease?

Palpating for diminished or absent peripheral pulses Raynaud's disease produces closure of the small arteries in the distal extremities in response to cold, vibration, or external stimuli. Palpation for diminished or absent peripheral pulses checks for interruption of circulation

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse anticipate in this client if PVCs are occurring?

Premature beats followed by a compensatory pause

The nurse is educating the client about variant angina. Which statement by the client indicates that the teaching has been effective?

Variant angina occurs at the same time each day."

The nurse is auscultating a 56-year-old adult client's apical heart rate before giving digoxin and notes that the heart rate is 48 beats/minute. Which action should the nurse take?

Withhold the digoxin, and assess for signs of decreased cardiac output and digoxin toxicity.

heart failure

is linked to the failure of the left ventricle

A client with no history of cardiovascular disease comes to the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which question should best help the nurse discriminate pain caused by a noncardiac problem?

"Does the pain get worse when you breathe in?"

The nurse determines that a client requires further teaching after permanent pacemaker insertion if which statement is made?

"My pulse rate should be less than what my pacemaker is set at." The client should call the health care provider (HCP) if the pulse rate is less than what the pacemaker is set at because this could be a sign of pacemaker or battery failure.

stage 1 ulcer

A stage 1 ulcer indicates a reddened area with an intact skin surface

A client with a history of hypertension has been prescribed triamterene. The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit?

Bananas Triamterene is a potassium-retaining diuretic, so the client should avoid foods high in potassium

The nurse is caring for a postoperative client who has lost a significant amount of blood because of complications during a surgical procedure. Which assessment finding would be indicative of further fluid volume deficit?

Pulse rate increases from 100 beats/min to 136 beats/min An increase in the pulse rate compensates for decreases in fluid volume

aortic valve

The aortic valve separates the aorta from the left ventricle

coronary artery disease dietary recommendation

The use of polyunsaturated oils is recommended to control hypercholesterolemia.

The nurse is listening to a lecture on Advanced Cardiac Life Support (ACLS). The instructor is discussing electrocardiographic (ECG) changes caused by myocardial ischemia. Which statement by the nurse indicates that teaching has been effective?

"ST segment elevation or depression can indicate ischemia." Tall, peaked T waves may indicate hyperkalemia. A prolonged PR interval indicates first-degree heart block. A widened QRS complex indicates delay in intraventricular conduction, such as a bundle branch block.

A client is at risk for vasovagal attacks that cause bradydysrhythmias. The nurse would tell the client to avoid which actions to prevent this occurrence? Select all that apply.

- Applying pressure on the eyes - Raising the arms above the head - Bearing down during a bowel movement - Simulating a gag reflex when brushing the teeth Vasovagal attacks or syncope occurs when the client faints because the body overreacts to certain triggers. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly.

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply.

- Be careful not to injure the legs or feet - Walk each day to increase circulation to the legs. - Cut down on the amount of fats consumed in the diet.

ear question A client with a history of ear problems is going on vacation by aircraft. The nurse advises the client to include which activities to prevent barotrauma during ascent and descent of the airplane? Select all that apply.

- Yawning - Swallowing - Chewing gum - Sucking on hard candy

A client's electrocardiogram shows that the ventricular rhythm is irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition?

Atrial fibrillation With atrial fibrillation, the ventricular rhythm is irregular and there are usually no discernible P waves.

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point?

Before each QRS complex If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted.

what to watch for when taking digoxin and furosemide (potassium wasting diuretic)

Diuretic therapy can cause hypokalemia. The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digoxin effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

Echocardiography

Echocardiography is a noninvasive, risk-free, pain-free test that involves no special preparation. It commonly is done at the bedside or on an outpatient basis. The client must lie quietly for 30 to 60 minutes while the procedure is being performed.

The nurse is caring for a client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. Which activity will assist with preventing dislodgement of the pacing catheter?

Limiting both movement and abduction of the right arm

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety?

Moving slowly from a sitting to a standing position Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls

Spironolactone is prescribed for a client with heart failure. In providing dietary instructions to the client, the nurse identifies the need to avoid foods that are high in which electrolyte?

Potassium Spironolactone is a potassium-retaining diuretic, and the client should avoid foods high in potassium

The nurse is preparing to ambulate a client on the third day after cardiac surgery. What should the nurse plan to do to enable the client to besttolerate the ambulation?

Premedicate the client with an analgesic. The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation

The nurse is evaluating a client's cardiac rhythm strip to determine if there is proper function of the VVI mode pacemaker. Which denotes proper functioning?

Spikes occur before QRS complexes when intrinsic ventricular beats do not occur.

A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure?

The client is wearing a nasal cannula delivering oxygen at 2 L/min. During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing

mitral valve

The mitral valve separates the left atrium from the left ventricle.

The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which problem? Refer to Figure.

The presence of hypokalemia This client is receiving furosemide, a diuretic that causes the excretion of potassium. The most likely cause of the PVCs in this client is hypokalemia.

The nurse monitors the client for which condition as a complication of polycythemia vera?

Thrombosis Polycythemia vera is a disorder of the bone marrow. It results in excessive production of white blood cells, red blood cells, and platelets. Clients with polycythemia vera are also more likely to form blood clots that can cause thrombi, strokes, myocardial infarctions, and abnormal bleeding

Long-term management of peripheral arterial disease

consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity are contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns

The home health nurse is visiting a client who has had a mechanical valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery?

"I need to throw away my straight razor and buy an electric razor." Mechanical valves require long-term anticoagulation to prevent clots from forming on the "foreign" object implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding, such as the use of straight razors.

The registered nurse (RN) is listening to a lecture on pulmonary edema. Which statement by the RN indicates that the teaching has been effective?

"The client will experience extreme anxiety." Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning, suffocation, or smothering. Therefore, the client will experience extreme anxiety.

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's (HCP's) prescriptions? Select all that apply.

- Elevation of the right leg - Administration of acetaminophen - Application of moist heat to the right leg - Monitoring for signs of pulmonary embolism

The nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply.

- Emotional stress - Atrial fibrillation - Nutritional anemia - Recent upper respiratory infection Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hypervolemia

The health care provider (HCP) prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply.

- Encourage coughing with deep breathing. - Encourage increased oral intake of water daily. - Place thigh-length elastic stockings on the client. *The nurse also would not include use of sequential compression boots for an existing thrombus. They are used only to prevent DVT, because they mimic skeletal muscle action and can disrupt an existing thrombus, leading to pulmonary embolism

right sided heart failure

-dependent edema (legs and sacrum) - jugular venous distention - abdominal distention - hepatomegaly - splenomegaly - anorexia and nausea - weight gain - nocturnal diuresis - steeling of the fingers and hands - - increased BP( from fluid volume excess) or decreased BP (from pump failure)

cholesterol info

-total cholesterol level <200 - LDL-C ( low-density lipoprotein cholesterol) <100 - HDL-C (high-density lipoprotein cholesterol) level >40

PR interval

0.12-0.20

burn question An adult client trapped in a burning house has suffered burns to the back of the head, the upper half of the posterior trunk, and the back of both arms. Using the rule of nines, what percentage does the nurse determine the extent of the burn injury to be? Fill in the blank.

22.5

venous stasis ulcer (vascular)

A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion.

Angioplasty

Angioplasty opens blocked arteries and restores normal blood flow to your heart muscle. It is not major surgery. It is done by threading a catheter (thin tube) through a small puncture in a leg or arm artery to the heart. The blocked artery is opened by inflating a tiny balloon in it. Then a stent (wire mesh tube) is inserted to keep the artery open.

Arterial ulcers

Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients

A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply.

Assess the client's pain level. Check the client's blood pressure. Administer a second nitroglycerin, 0.4 mg sublingually.

The nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications?

Bleeding and infection

The nurse is performing a cardiovascular assessment on a client. Which parameter would the nurse assess to gain the best information about the client's left-sided heart function?

Breath sounds Breath sounds are an accurate indicator of left-sided heart function.

The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do?

Lie down with the legs elevated and avoid sitting.

Vein ligation and stripping

Ligation means the surgical tying of veins through a small incision in the skin to prevent pooling of blood. Vein ligation and stripping is a minor surgery. It is used to remove a damaged vein and prevent complications of vein damage. If several valves in a vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is removed (stripped). can be performed to get rid of varicose veins

deep vein thrombosis (DVT) nursing interventions

Standard management for the client with DVT includes maintaining the activity level as prescribed by the health care provider; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Recent research is showing that ambulation, as previously thought, does not cause pulmonary embolism and does not cause the existing DVT to worsen. Therefore, the nurse should maintain the prescribed activity level, which could be bed rest or ambulation. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen.

A client's total cholesterol level is 344 mg/dL (8.6 mmol/L), low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL (4.25 mmol/L), and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL (1.2 mmol/L). Based on analysis of the data, how should the nurse direct client teaching?

The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught.

A new registered nurse (RN) is assisting the RN in admitting a client who has a diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs in the client with hypothermia. Which statement by the new RN indicates that the teaching has been effective?

The client will likely exhibit decreased heart rate and decreased blood pressure." The heart rate and blood pressure are decreased because the metabolic needs of the body are reduced with hypothermia

The nurse is developing a plan of care for a client recovering from pulmonary edema. The nurse establishes a goal to have the client participate in activities that reduce cardiac workload. The nurse should identify which client action as contributing to this goal?

Using a bedside commode Using a bedside commode decreases the work of getting to the bathroom or struggling to use the bedpan

cardiac catheterization

patient should report chest pain during or after cardiac catheterization immediately

cardiac tamponade

when extra fluid builds up in the space around the heart. This fluid puts pressure on the heart and prevents it from pumping well. A fibrous sac called the pericardium surrounds the heart. This sac is made up of 2 thin layers. Normally, a small amount of fluid if found between the 2 layers. The fluid prevents friction between the layers when they move as the heart beats. In some cases, extra fluid can build up abnormally between these 2 layers. If too much fluid builds up, the extra fluid can make it hard for the heart to expand normally. Because of the extra pressure, less blood enters the heart from the body. This can reduce the amount of oxygen-rich blood going out to the body.