Cardiovascular system

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the patients ankle-brachial index (ABI) as ____________________.

0.78 or 0.79

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing physician for which vs takes just before administration? a. Pulse 48 b. Respirations 24 c. Blood pressure 118/74 d. Oxygen saturation 93%

A. Pulse 48

When assessing a newly admitted patient, the nurse notes a thrill along the left sternal border. To obtain more information about the cause of the thrill, which action will the nurse take next? a. Auscultate for any cardiac murmurs. b. Find the point of maximal impulse. c. Compare the apical and radial pulse rates. d. Palpate the quality of the peripheral pulses.

a. Auscultate for any cardiac murmurs.

A few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patients oral temperature. c. Notify the patients health care provider. d. Give the ordered acetaminophen (Tylenol).

a. Auscultate the heart sounds.

A 46-year-old is diagnosed with thromboangiitis obliterans (Buergers disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? a. Cessation of smoking b. Control of serum lipid levels c. Maintenance of appropriate weight d. Demonstration of meticulous foot care

a. Cessation of smoking

A patients cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Defibrillate at 360 joules. b. Give O2 per bag-valve-mask. c. Give epinephrine (Adrenalin) IV. d. Prepare for endotracheal intubation.

a. Defibrillate at 360 joules

A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first? a. Electrocardiogram (ECG) b. Computed tomography (CT) scan c. Chest x-ray d. Troponin level

a. Electrocardiogram (ECG)

A patient who has recently started taking rosuvastatin (Crestor) and niacin (Nicobid) reports all the following symptoms to the nurse. Which is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Skin flushing after taking the medications c. Dizziness when changing positions quickly d. Nausea when taking the drugs before eating

a. Generalized muscle aches and pains

While obtaining an admission health history from a patient with possible rheumatic fever, which question will be most pertinent to ask? a. Have you had a recent sore throat? b. Are you using any illegal IV drugs? c. Do you have any family history of congenital heart disease? d. Can you recall having any chest injuries in the last few weeks?

a. Have you had a recent sore throat?

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, a. I should reduce the amount of green, leafy vegetables that I eat. b. I should wear a Medic Alert bracelet stating that I take Coumadin. c. I will need to have blood tests routinely to monitor the effects of the Coumadin. d. I will check with my health care provider before I begin or stop any medication.

a. I should reduce the amount of green, leafy vegetables that I eat.

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective? a. I will call for help when I need to get up to use the bathroom. b. I will be sure to take the medication after eating something. c. I will need to include more high-potassium foods in my diet. d. I will expect to feel more short of breath for the next few days.

a. I will call for help when I need to get up to use the bathroom.

When evaluating the outcomes of preoperative teaching with a patient scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says, a. I will have incisions in my leg where they will remove the vein. b. They will circulate my blood with a machine during the surgery. c. I will need to take an aspirin a day after the surgery to keep the graft open. d. They will use an artery near my heart to bypass the area that is obstructed.

a. I will have incisions in my leg where they will remove the vein.

Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily activities, saying, I am too nervous to take care of myself. Based on this information, which nursing diagnosis is appropriate? a. Ineffective coping related to anxiety b. Activity intolerance related to weakness c. Denial related to lack of acceptance of the MI d. Social isolation related to lack of support system

a. Ineffective coping related to anxiety

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? a. It can develop into ventricular fibrillation at any time b. It is almost impossible to convert to a normal rhythm c. It is uncomfortable for the client, giving a sense of impending doom. d. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia

a. It can develop into ventricular fibrillation at any time Rationale: Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Clients frequently experience a feeling of impending doom. Ventricular tachycardia is treated with antidysrhythmic medications, cardioversion (if the client is awake), or defibrillation (loss of consciousness). Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently b. Encourage patient to ambulate in room. c. Titrate nesiritide rate slowly before discontinuing. d. Teach patient about safe home use of the medication

a. Monitor blood pressure frequently.

Which information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patients chest pain b. A large bruise at the patients IV insertion site c. A decrease in ST segment elevation on the electrocardiogram (ECG) d. An increase in cardiac enzyme levels since admission

a. No change in the patients chest pain

A patient with a history of an abdominal aortic aneurysm is admitted to the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first? a. Obtain the blood pressure. b. Ask the patient about tobacco use. c. Draw blood for ordered laboratory testing. d. Assess for the presence of an abdominal bruit.

a. Obtain the blood pressure

Which of these prescriptions written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever should the nurse implement first? a. Order blood cultures drawn from two sites. b. Give acetaminophen (Tylenol) PRN for fever. c. Administer ceftriaxone (Rocephin) 1 g IV. d. Obtain a transesophageal echocardiogram.

a. Order blood cultures drawn from two sites.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Apical pulse rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

a. Oxygen saturation of 88%

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patients a. P wave. b. PR interval. c. QT interval. d. QRS complex.

a. P wave

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/min. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? a. Sinus tachycardia b. Sinus bradycardia c. Sinus dysrhythmia d. Normal sinus rhythm

a. Sinus tachycardia Rationale: Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal- width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.

A patient whose cardiac monitor shows sinus tachycardia, rate 102, is apneic and no pulses are palpable by the nurse. What is the first action that the nurse should take? a. Start CPR. b. Defibrillate. c. Administer atropine per hospital protocol. d. Give 100% oxygen per non-rebreather mask.

a. Start CPR

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which medication category will the nurse plan to include when providing patient teaching about PAD management? a. Statins b. Vitamins c. Thrombolytics d. Anticoagulants

a. Statins

When caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty, which action should the nurse take first? a. Take the blood pressure and pulse rate. b. Check for the presence of pedal pulses. c. Assess the appearance of any ischemic ulcers. d. Start discharge teaching about antiplatelet drugs.

a. Take the blood pressure and pulse rate.

When reviewing the 12-lead electrocardiograph (ECG) for a healthy 86-year-old patient who is having an annual physical examination, which of the following will be of most concern to the nurse? a. The heart rate (HR) is 43 beats/min b. The PR interval is 0.12 seconds c. There is a right bundle-branch block d. The QRS duration is 0.13 seconds

a. The heart rate (HR) is 43 beats/min

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? a. The neurovascular status is normal because of increased blood flow through the leg. b. The neurovascular status is moderately impaired, and the surgeon should be called. c. The neurovascular status is slightly deteriorating and should be monitored for another hour. d. The neurovascular status is adequate from an arterial approach, but venous complications are arising.

a. The neurovascular status is normal because of increased blood flow through the leg Rationale: An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. The remaining options are incorrect interpretations.

Which action by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? a. The nurse assists the patient to do active range of motion exercises for all extremities. b. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet. c. The nurse gives atenolol (Tenormin) to the patient without consulting first with the health care provider. d. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.

a. The nurse assists the patient to do active range of motion exercises for all extremities

Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider? a. The patient complains of chest pain associated with ambulation. b. A loud systolic murmur is audible along the right sternal border. c. A thrill is palpable at the 2nd intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

a. The patient complains of chest pain associated with ambulation.

The standard policy on the cardiac unit states, Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg. The nurse will need to call the health care provider about: a. The postoperative patient with a BP of 116/42. b. The newly admitted patient with a BP of 122/60. c. The patient with left ventricular failure who has a BP of 110/70. d. The patient with a myocardial infarction who has a BP of 114/50.

a. The postoperative patient with a BP of 116/42.

When a patient requires defibrillation, in which order will the nurse accomplish the following steps? Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________ a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the paddles on the patients chest. e. Check the location of other personnel and call out all clear

a. Turn the defibrillator on c. Select the appropriate energy level d. Place the paddles on the patients chest e. Check the location of otherr personnel and call out all clear b. Deliver the electrical charge

During the assessment of a patient with infective endocarditis (IE), the nurse would expect to find a. a new regurgitant murmur. b. a pruritic rash on the trunk. c. involuntary muscle movement. d. substernal chest pain and pressure.

a. a new regurgitant

A patient at the clinic says, I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though. The nurse should a. attempt to palpate the dorsalis pedis and posterior tibial pulses. b. check for the presence of tortuous veins bilaterally on the legs. c. ask about any skin color changes that occur in response to cold. d. assess for unilateral swelling, redness, and tenderness of either leg.

a. attempt to palpate the dorsalis pedis and posterior tibial pulses.

To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should a. auscultate with the stethoscope diaphragm at the lower left sternal border. b. listen for a rumbling, low-pitched, systolic sound over the left anterior chest. c. feel the precordial area with the palm of the hand to detect vibration with cardiac contraction. d. ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.

a. auscultate with the stethoscope diaphragm at the lower left sternal border

The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to a. avoid giving any IM medications to prevent localized bleeding. b. discontinue the infusion for PTT values greater than 50 seconds. c. monitor posterior tibial and dorsalis pedis pulses with the Doppler. d. have vitamin K available in case reversal of the argatroban is needed.

a. avoid giving any IM medications to prevent localized bleeding.

After the nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patients heart rate b. Decrease in premature contractions c. Increase in peripheral pulse volume d. Decrease in ventricular ectopic beats

a. increase in the patients heart rate

While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate intervention by the nurse is to a. promote rest to decrease myocardial oxygen demand. b. educate the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. elevate the head of the bed 60 degrees to decrease venous return.

a. promote rest to decrease myocardial oxygen demand.

A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patients care? a. sildenafil (Viagra) b. furosemide (Lasix) c. diazepam (Valium) d. captopril (Capoten)

a. sildenafil (Viagra)

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? a. Continue to monitor the rhythm and BP. b. Apply the transcutaneous pacemaker (TCP). c. Have the patient perform the Valsalva maneuver. d. Give the scheduled dose of diltiazem (Cardizem).

b. Apply the transcutaneous pacemaker (TCP)

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention will the nurse include? a. Monitor labs for streptococcal antibodies. b. Arrange for insertion of a long-term IV catheter. c. Encourage the patient to get regular aerobic exercise. d. Teach the importance of completing all oral antibiotics.

b. Arrange for insertion of a long-term IV catheter

When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

b. Attach the cardiac monitor

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

b. Blood potassium level of 3.0 mEq/L

When auscultating over the patients abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a a. Thrill b. Bruit c. Heave d. Murmur

b. Bruit

A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and diaphoresis. Which of these actions that are included in the hospital dysrhythmia protocol should the nurse take first? a. Obtain a 12-lead electrocardiogram (ECG). b. Give O2 at 3 to 4 L/min. c. Take the patients blood pressure and respiratory rate. d. Notify the health care provider of the change in rhythm.

b. Give O2 at 3 to 4 L/min

. In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, a. I will have to buy some loose clothing that does not bind across my legs or waist. b. I will use a heating pad on my feet at night to increase the circulation and warmth in my feet. c. I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily. d. I will change my position every hour and avoid long periods of sitting with my legs down.

b. I will use a heating pad on my feet at night to increase the circulation and warmth in my feet.

A patient has ST segment changes that indicate an acute inferior wall myocardial infarction. Which lead will be best for monitoring the patient? a. I b. II c. V6 d. MCL1

b. II

When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? a. Exercise only if you do not experience any pain. b. It is very important that you stop smoking cigarettes. c. Try to keep your legs elevated whenever you are sitting. d. Put on support hose early in the day before swelling occurs.

b. It is very important that you stop smoking cigarettes.

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? a. Absence of flatus b. Loose, bloody stools c. Hypotonic bowel sounds d. Abdominal pain with palpation

b. Loose, bloody stools

Which nursing action will be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? a. Record hourly chest tube drainage. b. Monitor fluid intake and urine output. c. Check the abdominal wound for redness or swelling. d. Teach the reason for a prolonged rehabilitation process.

b. Monitor fluid intake and urine output.

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN? a. Evaluate the IV insertion site for extravasation. b. Monitor the patients BP and heart rate every hour. c. Adjust the rate to keep the systolic BP >90 mm Hg. d. Teach the patient the reasons for remaining on bed rest.

b. Monitor the patients BP and heart rate every hour

Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? a. Complaint of left calf pain b. New onset shortness of breath c. Red skin color of left lower leg d. Temperature of 100.4 F (38 C)

b. New onset shortness of breath

Which assessment finding in a patient who is hospitalized with infective endocarditis (IE) is most important to communicate to the health care provider? a. Generalized muscle aching b. Sudden onset left flank pain c. Janeways lesions on the palms d. Temperature 100.5 F (38.1 C)

b. Sudden onset left flank pain

Which action will the community health nurse include when planning ways to decrease the incidence of rheumatic fever? a. Immunize susceptible groups in the community with streptococcal vaccine. b. Teach community members to seek treatment for streptococcal pharyngitis. c. Educate about the importance of monitoring temperature when infections occur. d. Provide prophylactic antibiotics to people with a family history of rheumatic fever.

b. Teach community members to seek treatment for streptococcal pharyngitis

Which action will the nurse implement for a patient who arrives for a calcium- scoring CT scan? a. Administer oral sedative medications b. Teach the patient about the procedure c. Ask whether the patient has eaten today d. Insert a large gauge intravenous catheter.

b. Teach the patient about the procedure

A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? a. The LPN/LVN places the patient in a Fowlers position for meals. b. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. c. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. d. The LPN/LVN administers the ordered aspirin 160 mg after breakfast.

b. The LPN/LVN has the patient sit in a bedside chair for 90 minutes.

A 55-year-old with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is appropriate? a. Since you are diabetic, you would not be a candidate for a heart transplant. b. The choice of a patient for a heart transplant depends on many different factors. c. Your heart failure has not reached the stage in which heart transplants are considered. d. people who have heart transplants are at risk for multiple complications after surgery.

b. The choice of a patient for a heart transplant depends on many different factors.

After teaching a patient with newly diagnosed Raynauds phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? a. The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). b. The patient exercises indoors during the winter months. c. The patient places the hands in hot water when they turn pale. d. The patient takes pseudoephedrine (Sudafed) for cold symptoms.

b. The patient exercises indoors during the winter months.

Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately? a. The patient has 4+ peripheral edema in both legs. b. The patient has crackles audible to the lung apices. c. The patient has a palpable thrill felt over the left anterior chest. d. The patient has a loud systolic murmur all across the precordium.

b. The patient has crackles audible to the lung apices.

The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be. a. LDL cholesterol b. Troponins T and I. c. C-reactive protein. d. Creatine kinase- MB (CK-MB).

b. Troponins T and I.

The nurse notes that a patients cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Ventricular multifocal contractions

b. Ventricular bigeminy

A few days after experiencing a myocardial infarction (MI), the patient states, I just had a little chest pain. As soon as I get out of here, Im going for my vacation as planned. Which response should the nurse make? a. Where are you planning to go for your vacation? b. What do you think caused your chest pain episode? c. Sometimes plans need to change after a heart attack. d. Recovery from a heart attack takes at least a few weeks.

b. What do you think caused your chest pain episode?

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient a. that sudden cardiac death events rarely reoccur. b. about the purpose of outpatient Holter monitoring. c. how to self-administer low-molecular-weight heparin. d. to limit activities after discharge to prevent future events.

b. about the purpose of outpatient Holter monitoring

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to a. give IV diazepam (Valium) 2.5 mg. b. administer IV morphine sulfate 2 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

b. administer IV morphine sulfate 2 mg

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that a. sitting at the work counter, rather than standing, is recommended. b. compression stockings should be applied before getting out of bed. c. exercises such as walking or jogging cause recurrence of varicosities. d. taking one aspirin daily will help prevent clotting around venous valves.

b. compression stockings should be applied before getting out of bed.

A patient is admitted to the hospital with possible acute pericarditis. The nurse will plan to teach the patient about the purpose of a. electrolyte levels. b. echocardiography. c. daily blood cultures. d. cardiac catheterization.

b. echocardiography

Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration. b. note when Korotkoff sounds are audible during both inspiration and expiration. c. auscultate for a pericardial friction rub that increases in volume during inspiration. d. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).

b. note when Korotkoff sounds are audible during both inspiration and expiration

While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the water pill with the heart pill. When planning for the patients discharge the nurse will facilitate a. transfer to a dementia care service. b. referral to a home health care agency. c. placement in a long-term care facility. d. arrangements for around-the-clock care.

b. referral to a home health care agency.

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on the assessment finding of a. fever, chills, and diaphoresis. b. urine output less than 30 mL/hr. c. petechiae of the buccal mucosa and conjunctiva. d. increase in pulse rate of 15 beats/minute with activity.

b. urine output less than 30 mL/hr.

For a patient who has been admitted the previous day to the coronary care unit with an acute myocardial infarction (AMI), the nurse will anticipate teaching about a. typical emotional responses to AMI. b. when patient cardiac rehabilitation will begin. c. discharge drugs such as aspirin and b-blockers. d. the pathophysiology of coronary artery disease.

b. when patient cardiac rehabilitation will begin.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

c. Ask the patient to request assistance when getting out of bed.

Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Palpate the radial pulses bilaterally. b. Assess the feet for peripheral edema. c. Auscultate for a pericardial friction rub. d. Check the cardiac monitor for dysrhythmias.

c. Auscultate for a pericardial friction rub

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide

An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). Which of these assessment findings is most important for the nurse to report to the health care provider? a. Pulse rate of 56 b. 2+ pedal edema c. BP of 88/42 mm Hg d. Complaints of fatigue

c. BP of 88/42 mm Hg

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 and heart rate is 110. Based on this information, which nursing diagnosis is a priority for the patient? a. Acute pain related to myocardial ischemia b. Anxiety related to perceived threat of death c. Decreased cardiac output related to cardiogenic shock d. Activity intolerance related to decreased cardiac output

c. Decreased cardiac output related to cardiogenic shock

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

c. Have the patient sit in a chair with the feet flat on the floor.

The client has developed atrial fibrillation, with a ventricular rate of 150 beats/min. The nurse should assess the client for which associated s/s? a. Flat neck veins b. Nausea and vomiting c. Hypotension and dizziness d. hypertension and headache

c. Hypotension and dizziness Rationale: The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client the palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. I can expect indigestion as a side effect of nitroglycerin. b. I can only take the nitroglycerin if I start to have chest pain. c. I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin. d. I will help slow down the progress of the plaque formation by taking nitroglycerin.

c. I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, a. It will be 6 weeks before I can take a bath or return to my usual activities. b. I will notify the airlines when I make a reservation that I have a pacemaker. c. I wont lift the arm on the pacemaker side up very high until I see the doctor. d. I must avoid cooking with a microwave oven or being near a microwave in use.

c. I won't lift the arm on the pacemaker side up very high until I see the doctor

Which of the following assessment data obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 166/96 c. Jugular vein distention (JVD) to the level of the jaw d. Level 6 (0 to 10 scale) chest pain with deep inspiration

c. Jugular vein distention (JVD) to the level of the jaw

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include? a. Biologic replacement valves require the use of immunosuppressive drugs. b. Mechanical mitral valves require replacement approximately every 5 years. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.

c. Lifelong anticoagulant therapy is needed after mechanical valve replacement

A patient who is complaining of a racing heart and nervousness comes to the emergency department. The nurse places the patient on a cardiac monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Get ready to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patients blood pressure and oxygen saturation. d. Prepare to give b-blocker medication to slow the heart rate.

c. Obtain the patients blood pressure and oxygen saturation.

A patient who has had recent cardiac surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer? a. Fentanyl 2 mg IV b. IV morphine sulfate 6 mg c. Oral ibuprofen (Motrin) 800 mg d. Oral acetaminophen (Tylenol) 650 mg

c. Oral ibuprofen (Motrin) 800 mg

Which assessment finding by the nurse who is caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the physician? a. Complaints of incisional chest pain b. Crackles audible at both lung bases c. Pallor and weakness of the right hand d. Redness on either side of the chest incision

c. Pallor and weakness of the right hand

A patient has recently started taking oral digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for control of heart failure. Which assessment finding by the home health nurse is most important to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Liver is palpable 2 cm below the ribs on the right side. c. Serum potassium level is 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level is 3.0 mEq/L after 1 week of therapy

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? a. Administration of two anticoagulants reduces the risk for recurrent venous thrombosis. b. Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from occurring. c. The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation. d. Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant.

c. The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation

The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most relevant? a. The patient reports using cocaine once at age 16. b. The patient has a history of a recent upper respiratory infection. c. The patients 29-year-old brother has had a sudden cardiac arrest. d. The patient has a family history of coronary artery disease (CAD).

c. The patients 29-year-old brother has had a sudden cardiac arrest.

The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. b. Count the number of large squares in the R-R interval and divide by 300. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.

c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm? a. Asystole b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

c. Ventricular fibrillation Rationale: Ventricular fibrillation is characterized by irregular chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

During the administration of the fibrinolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. surface bleeding from the IV site. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

c. a decrease in level of consciousness

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops a. a dry, hacking cough. b. any ventricular ectopy. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

c. a systolic BP <90 mm Hg

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about a. electrical cardioversion. b. IV adenosine (Adenocard). c. anticoagulant therapy with warfarin (Coumadin). d. insertion of an implantable cardioverter-defibrillator (ICD).

c. anticoagulant therapy with warfarin (Coumadin)

A patient with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurses first action will be to a. ask the patient to recall the dietary intake for the last 3 days. b. question the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of dietary sodium restrictions.

c. assess the patient for clinical manifestations of acute heart failure

A patient tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynauds phenomenon. The nurse will anticipate teaching the patient about tests for a. hypertension. b. hyperlipidemia. c. autoimmune disorders. d. coronary artery disease.

c. autoimmune disorders

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient a. uses an additional pillow to sleep when feeling short of breath at night. b. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. c. calls the clinic when the weight increases from 124 to 130 pounds in a week. d. says that the nitroglycerin patch will be used for any chest pain that develops.

c. calls the clinic when the weight increases from 124 to 130 pound in a week

During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. elevated right atrial pressure. d. incompetent jugular vein valves.

c. elevated right atrial prssure

The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for the patient who a. was admitted with a large acute myocardial infarction. b. is being discharged after an exacerbation of heart failure. c. has had a mitral valve replacement with a mechanical valve. d. has been treated for rheumatic fever after a streptococcal infection.

c. has had a mitral valve replacement with a mechanical valve.

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. milk, yogurt, and other milk products. d. eggs and other high-cholesterol foods.

c. milk, yogurt, and other milk products

During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding the a. use of daily aspirin for anticoagulation. b. correct method for taking the radial pulse. c. need for frequent laboratory blood testing. d. possibility of valve replacement in 7 to 10 years.

c. need for frequent laboratory blood testing.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. avoid dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider about any nausea. d. never take digoxin if the pulse is below 60 beats/minute.

c. notify the health care provider about any nausea

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find a. a positive Homans sign. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. a large amount of drainage from the ulcer.

c. prolonged capillary refill in all the toes.

The primary pacemaker of the heart is the: a. vagus nerve b. bundle of his c. sa node d. av node

c. sa node

A patient experiences dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this cardiac rhythm as a. sinus rhythm with premature ventricular contractions (PVCs). b. junctional escape rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).

c. third-degree atrioventricular (AV) block

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? a. Call a code b. Call the health care provider c. Check the client's status and lead placement. d. Press the recorder button on the electrocardiogram console.

c.Check the client's status and lead placement. Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the off position. b. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position. c. Set the defibrillator/cardioverter energy to 300 joules. d. Administer a sedative before cardioversion is implemented.

d. Administer a sedative before cardioversion is implemented

When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing action should the nurse delegate to an LPN/LVN? a. Perform the initial assessment of the catheter insertion site. b. Teach the patient about the usual postprocedure plan of care. c. Check the rate on the infusion pump used to administer heparin. d. Administer the scheduled aspirin and lipid-lowering medication.

d. Administer the scheduled aspirin and lipid-lowering medication.

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? a. Palpate the abdomen. b. Assess the orientation. c. Check the capillary refill. d. Auscultate the lung sounds.

d. Auscultate the lung sounds

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? a. Need to participate in an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Importance of making a yearly appointment with the primary care provider d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

d. Benefits and side effects of angiotensin- converting enzyme (ACE) inhibitors

A patients cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? a. Prepare for possible temporary pacemaker insertion. b. Administer atropine sulfate 1 mg IV per agency protocol. c. Document the patients rhythm and assess the patients response to the rhythm. d. Call the health care provider before giving the prescribed metoprolol (Lopressor).

d. Call the health care provider before giving the prescribed metoprolol (Lopressor)

. When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? a. Pedal pulses 1+ b. Heart rate 100 beats/min c. Blood pressure 104/56 mm Hg d. Chest pain level 8 on a 10-point scale

d. Chest pain level 8 on a 10-point scale

The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction (AMI) 2 days previously. Which information is most important to report to the health care provider? a. The patient denies ever having a heart attack. b. The cardiac-specific troponin level is elevated. c. The patient has occasional premature atrial contractions (PACs). d. Crackles are auscultated bilaterally in the mid-lower lobes.

d. Crackles are auscultated bilaterally in the mid-lower lobes.

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when giving the medication? a. Administer the medication at the patients bedtime. b. Have the patient take this medication with an aspirin. c. Encourage the patient to take the colesevelam with a sip of water. d. Give the patients other medications 2 hours after the colesevelam.

d. Give the patients other medications 2 hours after the colosevelam

Which nursing action in the care plan for a patient who had an open repair of an abdominal aortic aneurysm 3 days previously is appropriate for the nurse to delegate to experienced nursing assistive personnel (NAP)? a. Check the lower extremity strength and movement. b. Monitor the quality and presence of the pedal pulses. c. Teach the patient the signs of possible wound infection. d. Help the patient to use a pillow to splint while coughing.

d. Help the patient to use a pillow to splint while coughing.

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge concerning long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever says, a. I will need to have monthly antibiotic injections for 10 years or longer. b. I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain. c. I will call the doctor if I develop excessive fatigue or difficulty breathing. d. I will be immune to further episodes of rheumatic fever after this infection.

d. I will be immune to further episodes of rheumatic fever after this infection

After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates, which statement by the patient indicates that the teaching has been effective? a. I will put on the nitroglycerin patch as soon as I develop any chest pain. b. I will check the pulse rate in my wrist just before I take any nitroglycerin. c. I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin. d. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.

d. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue

A patient admitted with acute dyspnea is diagnosed with dilated cardiomyopathy. Which information will the nurse include when teaching the patient about management of this disorder? a. Elevating the legs above the heart will help relieve angina. b. No more than two alcoholic drinks daily are recommended. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

When analyzing the waveforms of a patients electrocardiogram (ECG), the nurse will need to investigate further upon finding a a. T wave of 0.16 second. b. P-R interval of 0.18 second. c. Q-T interval of 0.34 second. d. QRS interval of 0.14 second.

d. QRS interval of 0.14 second

A 21-year-old student arrives at the student health center at the end of the quarter complaining that, My heart is skipping beats. An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take first? a. Have the patient transported to the hospital emergency department (ED). b. Administer O2 at 2 to 3 L/min using nasal prongs. c. Ask the patient about any history of coronary artery disease. d. Question the patient about current stress level and coffee use.

d. Question the patient about current stress level and coffee use

Which of these nursing interventions included in the plan of care for a patient who had an acute myocardial infarction (AMI) 3 days ago is most appropriate for the RN to delegate to an experienced LPN/LVN? a. Evaluating the patients response to ambulation in the hallway b. Completing the documentation for a home health nurse referral c. Educating the patient about the pathophysiology of heart disease d. Reinforcing teaching about the purpose of prescribed medications

d. Reinforcing teaching about the purpose of prescribed medications.

Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? a. Wrap both the legs in warm blankets. b. Notify the surgeon and anesthesiologist. c. Document that the pulses are absent and recheck in 30 minutes. d. Review the preoperative assessment form for data about the pulses.

d. Review the preoperative assessment form for data about the pulses.

Which electrocardiographic (ECG) change is most important for the nurse to communicate to the health care provider when caring for a patient with chest pain? a. Frequent premature atrial contractions (PACs) b. Inverted P wave c. Sinus tachycardia d. ST segment elevation

d. ST segment elevation

Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose 228 mg/dL b. Serum chloride 90 mEq/L c. Serum sodium 133 mEq/L d. Serum potassium 2.8 mEq/L

d. Serum potassium 2.8 mEq/L

Which action by a nurse who is administering fondaparinux (Arixtra) to a patient with venous thromboembolism (VTE) indicates that more education about the medication is needed? a. The nurse avoids rubbing the injection site after giving the medication. b. The nurse injects the medication into the abdominal subcutaneous tissue. c. The nurse fails to assess the partial thromboplastin time (PTT) before administration of the medication. d. The nurse ejects the air bubble in the syringe before administering the Arixtra.

d. The nurse ejects the air bubble in the syringe before administering the Arixtra.

Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? a. The pacemaker prevents or minimizes ventricular irritability. b. The pacemaker paces the atria at rates up to 500 impulses/minute. c. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. d. The pacemaker stimulates a heart beat if the patients heart rate drops too low.

d. The pacemaker stimulates a heart beat if the patients heart rate drops too low

Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for a. an additional antibiotic. b. a white blood cell (WBC) count. c. a decrease in IV infusion rate. d. a blood urea nitrogen (BUN) level.

d. a blood urea nitrogen (BUN) level

While caring for a patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to a. plan to take antibiotics before any dental appointments. b. limit physical activity to avoid stressing the heart valves. c. take 1 aspirin a day to prevent embolization from the valve. d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

A patient who has just been admitted with pulmonary edema is scheduled to receive these medications. Which medication should the nurse question? a. furosemide (Lasix) 40 mg b. captopril (Capoten) 25 mg c. digoxin (Lanoxin) 0.125 mg d. carvedilol (Coreg) 3.125 mg

d. carvedilol (Coreg) 3.125 mg

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. right upper quadrant tenderness. d. complaints of shortness of breath.

d. complaints of shortness of breath

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is a. weight loss of 2 pounds overnight. b. hourly urine output greater than 60 mL. c. reduction in patient complaints of chest pain. d. decreased dyspnea with the head of bed at 30 degrees.

d. decreased dyspnea with the head of bed at 30 degrees

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the PR interval is 0.24 seconds. The appropriate intervention by the nurse is to a. notify the patients health care provider immediately. b. administer atropine per agency bradycardia protocol. c. prepare the patient for temporary pacemaker insertion. d. document the finding and continue to monitor the patient.

d. document the finding and continue to monitor the patient

A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and a. elevate the left leg on a pillow. b. apply an elastic wrap to the leg. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

d. keep the patient in bed in the supine position.

A patient who has chronic heart failure tells the nurse, I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating! The nurse will document this assessment information as a. pulsus alternans. b. two-pillow orthopnea. c. acute bilateral pleural effusion. d. paroxysmal nocturnal dyspnea.

d. paroxysmal nocturnal dyspnea

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this problem is to a. force fluids to 3000 mL/day to decrease fever and inflammation. b. teach the patient to take deep, slow respirations to control the pain. c. remind the patient to ask for the opioid pain medication every 4 hours. d. position the patient in Fowlers position, leaning forward on the overbed table.

d. position the patient in Fowlers position, leaning forward on the overbed table.

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with deep vein thrombosis. The best method for the nurse to use in elevating the patients feet is to a. place the patient in the Trendelenburg position. b. place two pillows under the calf of the affected leg. c. elevate the bed at the knee and put pillows under the feet. d. put one pillow under the thighs and two pillows under the lower legs.

d. put one pillow under the thighs and two pillows under the lower legs.

When discussing risk factor modification for a 60-year-old patient who has a 4-cm abdominal aortic aneurysm, the nurse will focus patient teaching on which of these patient risk factors? a. Male gender b. Marfan syndrome c. Abdominal trauma history d. Uncontrolled hypertension

d. uncontrolled hypertension

The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as a. atrial fibrillation. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

d. ventricular tachycardia

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular cardiac rhythm, the nurse finds there are 25 small blocks from one R wave to the next. The nurse calculates the patients heart rate as ____________________.

60 there are 1500 small blocks in a minute, and the nurse will divide 1500 by 25.

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. An appropriate nursing diagnosis based on these findings is a. activity intolerance related to arthralgia. b. risk for infection related to open skin lesions. c. chronic pain related to permanent joint fixation. d. risk for impaired skin integrity related to pruritus.

a. Activity intolerance related to arthralgia

A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate? a. Allow the student to participate on the swim team. b. Refer the student to a cardiologist for further assessment. c. Obtain more detailed information about the students health history. d. Tell the student to stop swimming immediately if any dyspnea occurs.

a. Allow the student to participate on the swim team

The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. Have you been to the dentist lately? b. Do you have a history of a heart attack? c. Is there a family history of endocarditis? d. Have you had any recent immunizations?

a. Have you been to the dentist lately?

A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis? a. I cant get my shoes on at the end of the day. b. I can never seem to get my feet warm enough. c. I wake up during the night because my legs hurt. d. I have burning leg pains after I walk three blocks.

a. I cant get my shoes on at the end of the day.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? a. When I stand too long, my feet start to swell up. b. Sometimes I get tired when I climb a lot of stairs. c. My fingers hurt when I go outside in cold weather. d. My legs cramp whenever I walk more than a block.

d. My legs cramp whenever I walk more than a block

During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of feeling too tired to do anything. Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to leg swelling. c. impaired skin integrity related to peripheral edema. d. impaired gas exchange related to chronic heart failure.

a. activity intolerance related to fatigue

When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Check blood pressure. b. Monitor apical pulse rate. c. Monitor for dysrhythmias. d. Ask about chest discomfort.

d. Ask about chest discomfort

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week.

b. No regular aerobic execise

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlution? a. Sinus Tachycardia b. Pathologic Q wave c. Fibrillatory P waves d. Prolonged PR interval

b. Pathologic Q wave

When teaching a patient about dietery management of stage 1 hypertension, which instruction is most appropriate? a. Restrict all caffeine b. Restrict sodium intake c. Increase protein intake d. Use calcium supplements

b. Restrict sodium intake

The nurse obtains a BP of 180/75 mm Hg for a patient. What is the patients mean arterial pressure (MAP)? ________________

110 MAP = (SBP + 2 DBP)/3

Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. angiotensin-converting enzyme (ACE) inhibitors. b. digitalis preparations. c. b-adrenergic agonists. d. calcium channel blockers.

a. angiotensin-converting enzyme (ACE)

When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for a. dyspnea. b. flank pain. c. hemiparesis. d. splenomegaly.

a. dyspnea

Which of these patients admitted to the emergency department should the nurse assess first? a. 62-year-old who has gangrenous ulcers on both feet b. 50-year-old who is complaining of tearing chest pain c. 45-year-old who is taking anticoagulants and has bloody stools d. 36-year-old who has right calf tenderness, redness, and swelling

b. 50-year-old who is complaining of tearing chest pain

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? a. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure (BP) of 100/56 b. A patient who is cool and clammy, with new-onset confusion and restlessness c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who has crackles in both posterior lung bases and is receiving oxygen

b. A patient who is cool and clammy, with new-onset confusion and restlessness

A patient who has had an acute myocardial infarction (AMI) asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best? a. Most patients are able to enjoy intercourse without any complications. b. Sexual activity uses about as much energy as climbing two flights of stairs. c. The doctor will discuss sexual intercourse when your heart is strong enough. d. Holding and cuddling are good ways to maintain intimacy after a heart attack.

b. Sexual activity uses about as much energy as climbing two flights of stairs.

A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about a. back or lumbar pain. b. difficulty swallowing. c. abdominal tenderness. d. changes in bowel habits.

b. difficulty swallowing

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100

c. 40 to 60

. The nurse has just received change-of-shift report about the following four patients. Which patient should the nurse assess first? a. 38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain b. 45-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI) d. 60-year-old with variant angina who is to receive a scheduled dose of nifedipine (Procardia)

c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

A patient who was admitted with a myocardial infarction experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which action should the nurse take next? a. Notify the health care provider. b. Perform synchronized cardioversion. c. Administer the PRN IV lidocaine (Xylocaine). d. Document the rhythm and monitor the patient.

c. Administer the PRN IV lidocaine (Xylocaine)

Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? a. Adequate carbohydrate intake b. Prophylactic antibiotic therapy c. Application of compression to the leg d. Methods of keeping the wound area dry

c. Application of compression to the leg

A client in ventricular fibrillation is about to be defibrillated. To convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? a. 50 J b. 120 J c. 200 J d. 360 J

d. 360 J Rationale: The energy level used for all defibrillation attempts with a monophasic defibrillator is 360 joules.

The nurse has received change-of-shift report about the following patients on the telemetry unit. Which patient should the nurse see first? a. A patient with atrial fibrillation, rate 88, who has a new order for warfarin (Coumadin) b. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due

d. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due

For which problem is percutaneous coronary intervention (PCI) most clearly indicated? A Chronic stable angina B Left-sided heart failure C Coronary artery disease D Acute myocardial infarction

d. Acute myocardial infarction

When admitting a patient for a coronary arteriogram and angiogram, which information about the patient is most important for the nurse to communicate to the health care provider? a. The patients pedal pulses are +1 b. The patient is allergic to shellfish c. The patient has not eaten anything today d. The patient had an arteriogram a year ago

b. The patient is allergic to shell fish

Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patients response, which of these assessment data would indicate that the exercise level should be decreased? a. BP changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 100% to 98%. c. Heart rate increases from 66 to 90 beats/minute. d. Respiratory rate goes from 14 to 22 breaths/minute.

c. Heart rate increases from 66 to 90 beats/minute

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

c. Hypertension is usually asymptomatic until significant organ damage occurs.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

b. The patient is unable to move the left arm and leg when asked to do so.

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? a. Clipizide b. Metformin c. Repaglinide d. Regular insulin

B. Metformin Rationale: This needs to be withheld 24 hrs before and for 48 hrs after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hrs before and 48 hrs after cardiac catherization.

The nurse should evaluate that defibrillation of a client was most successful if which observation was made? a. Arousable, sinus rhythm, BP 116/72 b. Nonarousable, sinus rhythm, BP 88/60 c. Arousable, marked bradycardia, BP 86/54 d. nonarousable, supraventricular tachycardia, BP 122/60

a. Arousable, sinus rhythm, BP 116/72 Rationale: After defibrillation, the client requires continuous monitoring of electrocardiographic rhythm, hemodynamic status, and neruological status. Respiratory and metabolic acidosis develop during ventricular fibrillation because of lack of respiration and cardiac output. These can cause cerebral and cardiopulmonary complications. Arousable status, adequate BP, and sinus rhythm indicate successful response to defibrillation.

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of: a. Asthma b. Peptic ulcer disease c. Alcohol dependency d. Myocardial infarction (MI)

a. Asthma

The nurse is watching the cardiac monitor, and a clients rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse correctly interpret the client's heart rhythm? a. Atrial fibrillation b. Sinus tachycardia c. Ventricular fibrillation d. Ventricular tachycardia

a. Atrial fibrillation Rationale: Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombus formation.

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. Bell of the stethoscope with the patient in the left lateral position. b. Bell of the stethoscope with the patient sitting and leaning forward. c. Diaphragm of the stethoscope with the patient in the reclining position. d. Diaphragm of the stethoscope with the patient lying flat on the left side.

a. Bell of the stethoscope with the patient in the left lateral position.

A client is admitted to the ED with chest pain that is consistent with MI based on elevated troponin levels. Heart sounds are normal and vital signs are noted on the clients chart. The nurse should alert the health care provider because these changes are most consistent with which complication? Refer to chart Clients chart Time: 11AM 11:15 AM 11:30 AM 11:45 AM Pulse: 92 96 104 118 Resp.: 24 26 28 32 B/P: 140/88 128/82 104/68 88/58 a. Cardiogenic shock b. Cardiac tamponade c. Pulmonary embolism d. Dissecting thoracic aortic aneurysm

a. Cardiogenic shock rationale: it occurs with severe damage (more than 40%) to the left ventricle. Classic signs include hypotentension; a rapid pulse that becomes weaker; decreased urine output; and cool, clammy skin. Respiratory rate increases as the body develops metabolic acidosis from shock. Cardiac tamponade is accompanied by distant, muffled heart sounds and prominent neck vessels. Pulmonary embolism presents suddenly with severe dyspnea accompanying the chest pain. Dissecting aortic aneurysms usually are accompanied by back pain.

When the nurse enters the room, the patient with known coronary artery disease is moaning and holding his chest. The priority intervention by the nurse at that time is to: a. Check the ABC's and apply oxygen b. Call the doctor c. Insert a second IV d. administer digoxin

a. Check the ABC's and apply oxygen Rationale: The priority response is to check airway, breathing and circulation and apply oxygen. If the patient is having a MI, oxygen is not getting to part of the heart.

Atrial fibrillation is a cause for concern because (select all that apply) a. Clots may form in the quivering atria and break off, causing a stroke b. It results in ventricular fibrillation c. Cardiac out put is decreased d. This rhythm can cause hypertension f. It can cause an MI

a. Clots may form in the quivering atria and break off, causing a stroke c. Cardiac output is decreased Rationale: Concerns about atrial fibrillation are that clots may form in the atria, break off and cause a stroke; cardiac output is decreased by 15-30 % and patients may feel fatigued, dizzy or short of breath.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low-sodium foods. c. Teach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian.

a. Have the patient record dietary intake for 3 days.

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. It is important not to suddenly stop taking the atenolol. b. Atenolol will increase the strength of my heart muscle. c. I can expect to feel short of breath when taking atenolol. d. Atenolol will improve the blood flow to my coronary arteries.

a. It is important not to suddenly stop taking the atenolol.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? a. Pulsus paradoxus b. Prolonged PR intervals c. widened pulse pressure d. Clubbing of fingers

a. Pulsus paradoxus

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

a. Serum creatinine of 2.6 mg/dL

What factors affect cardiac output (select all that apply)? a. Stroke volume b. Heart rate c. Preload d. Afterload e. Mean arterial pressure f. Myocardial contractility

a. Stroke volume b. Heart rate c. Preload d. Afterload f. Myocardial contractility Rationale: Preload, afterload, heart rate, and myocardial contractility are all mechanisms that control cardiac output. If even one of these parameters are out of line, cardiac output may be affected. In a worst case senario, it a patient who had an MI and is now in heart failure has increased preload, increased afterload. significant tachycardia and has decreased myocardial contractility, this patient is in trouble. A main goal or treatment would be to stabilize some or all of these mechanisms quickly.

The nurse hears a murmur between the S1 and S2 heart sounds at the patients left 5th intercostal space and midclavicular line. How will the nurse record this information? a. Systolic murmur heard at mitral area. b. Diastolic murmur heard at aortic area. c. Systolic murmur heard at Erbs point. d. Diastolic murmur heard at tricuspid area.

a. Systolic murmur heard at mitral area.

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse immediately asks another nurse to contact the health care provider and prepares to implement which priority interventions? Select all that apply. a. administer oxygen b. Inserting a foley catheter c. Administer furosemide d. Administer morphine sulfate IV e. Transporting the client to the coronary care unit f. Placing the client in a low Fowler's side-lying position

a. administer oxygen b. inserting a foley catheter c. administer furosemide d. administer morphine sulfate IV Rationale: Pulmonary edema is a life-threatening eventthat can result from severe heart failure. In pulmonary edema the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's postion to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. AFoley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the cliebt's response to treatment is successful.

Signs and symptoms of right sided heart failure may include (select all that apply): a. edema, especially of lower extremities b. crackles in the lungs c. jugular venous distention d. dyspnea e. pulsus alternans

a. edema, especially of lower extremities c. jugular venous distention Rationale: Symptoms seen in right heart failure are due to the backup of fluid in the venous system, resulting in edema, jugular venous distention and loss of appetite or nausea.

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

b. 128/76 mm Hg

The nurse in the emergency department received change-of-shift report on four patients with hypertension's. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication. b. 43-year-old with a BP of 190/102 who is complaining of chest pain. c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

b. 43-year-old with a BP of 190/102 who is complaining of chest pain.

The nurse is evaluating the condition of a client after pericariocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? a. Muffled heart sounds b. A rise in blood pressure c. Jugular venous distention d. Client expressions of dyspnea

b. A rise in blood pressure Rationale: Following pericardiocentesis, the client usually expresses immediate relief. Heart sounds are no longer muffled or distant and blood pressure increases. Distended neck veins are a sign of increased venous pressure, which occurs with cardiac tamponade

A client who had cardiac surgery 24hrs ago has had a urine output averaging 20 mL/hr for 2 hrs. The client received a single bolus of 500 mL of IV fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? a. Hypovolemia b. Acute kidney injury c. Glomerulonephritis d. Urinary tract infection

b. Acute kidney injury Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion., hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal reference levels are BUN 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine: male, 0.6 - 1.2 mg/dL (53 -106 mcmol/L) and female 0.5 - 1.1 mg/dL (44 - 97 mcmol/L). The client may need peritoneal dialysis or hemodialysis. No date in the question indicated the presence of hypovolemia, glomerulonephritis, or UTI

The nurse is evaluating a client's response to cardioversion. which assessment would be the priority? a. BP b. Status of airway c. Oxygen flow rate d. Level of consciousness

b. Status of airway Rationale: Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection.

Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has persisted longer than 30 minutes. c. The pain worsens when the patient raises the arms. d. The pain is relieved after the patient takes nitroglycerin.

b. The pain has persisted longer than 30 minutes

A client with MI is developing cardiogenic shock. Because of the risk of myocardial ischemia, what condition should the nurse carefully assess the client for? a. Bradycardia b. Ventricular dsyrhytmias c. Rising diastolic blood pressure d. Falling central venous pressure

b. Ventricular dysrhythmias Rationale: Classic signs of cardiogenic shock shock as they relate to myocardial ischemia include low blood pressure and tachycardia. The central venous pressure would rise as the backward effects of the severe left ventricular failure became apparent. Dysrhythmias commonly occur as a result of decreased oxygenation and severe damage to greater than 40% of the myocardium.

A patient with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic thereapy? a. Do you take aspirin on a daily basis? b. What time did your chest pain begin? c. Is there any family history of heart disease? d. Can you describe the quality of your chest pain?

b. What time did your chest pain begin?

A client with MI suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds? a. Stridor b. Crackles c. Scattered rhonchi d. Diminished breath sounds

b. crackles Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auiscultation of the lungs reveals crackles. Rhonchi and diminished breath sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with laryngospasm or edema of the upper airway.

Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetals (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will a. reduce the fight or flight response. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. help prevent clotting in the coronary arteries.

b. decrease spasm of the coronary arteries.

The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an IV infusion at a rate of 150 mL/hour, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L) and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is priority? a. check the urine specific gravity b. Call the health care provider c. Put the IV line on a pump so that the infusion rate is sure to stay stable d. Check to see if the client had a blood sample for a serum albumin level drawn..

b.Call the health care provider Rationale: Following abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery. Normal reference levels are BUN, 10 to 20 mg/dL (3.6 - 7.1 mmol/L, and creatinine; male, 1.6 - 1.2 mg/dL (53-106 mcmol/L) and female 0.5-1.1 mg/dL (44-97 mcmol/L). Options a and d are not associated with the data in the question. The IV should have already been on a pump. Urine output lower than 30 mL/hour is reported to the health care provider

A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that a. Electrocardiographic (ECG) monitoring will be required for 24 hours after the test. b. It will be important to lie completely still during the procedure c. A warm feeling may be noted when the contrast dye is injected. d. Monitored anesthesia care will be provided during the procedure

c. A warm feeling may be noted when the contrast dye is injected.

To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of these nursing interventions will be most effective? a. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary. b. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes. c. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. d. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.

c. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? a. Sensation of palpitations b. Causative factors, such as caffeine c. Blood pressure and oxygen saturation d. Precipitating factors, such as infection

c. Blood pressure and oxygen saturation Rationale: Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders; states of hypoxemia; any number of physiological stressors, such as infection, illness, surgery, or trauma; and intake of caffeine, nicotines, or alcohol.

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? a. Homocysteine b. C-reactive protein c. Cardiac-specific troponin I and troponin T d. High-density lipoprotein (HDL) cholesterol

c. Cardiac-specific troponin I and troponin T

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

c. Have you been consistently taking your medications?

Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. I will switch from whole milk to 1% or nonfat milk. b. I like fresh salmon and I will plan to eat it more often. c. I will miss being able to eat peanut butter sandwiches. d. I can have a cup of coffee with breakfast if I want one.

c. I will miss being able to eat peanut butter sandwiches.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high-potassium foods. d. make an appointment with the dietitian for teaching.

c. Increase the dietary intake of high-potassium foods.

The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. Exercise more than usual while the monitor is in place. b. Remove the electrodes when taking a shower or tub bath. c. Keep a diary of daily activities while the monitor is worn. d. Connect the recorder to a telephone transmitter once daily.

c. Keep a diary of daily activities while the monitor is worn.

While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next? a. Use a ruler to measure the level of the JVD b. Document this finding in the patients record. c. Observe for JVD with the head at 30 degrees d. Have the patient perform the Valsalva maneuver.

c. Observe for JVD with the head at 30 degrees

The RN is observing a student nurse who is doing a physical assessment on a patient. The RN will need to intervene immediately if the student nurse: a. Places the patient in the left lateral position to check for the point of maximal impulse (PMI). b. Presses on the skin over the tibia for 10 seconds to check for edema. c. Palpates both carotid arteries simultaneously to compare pulse quality. d. Documents a murmur heard along the left sternal border as an aortic murmur.

c. Palpates both carotid arteries simultaneously to compare pulse quality.

A transesphageal echocardiogram (TEE) is ordered for a patient with possible endocarditis. Which of these actions included in the standard TEE orders will the nurse need to accomplish first? a. Administer O2 per mask. b. Start a large-guage IV line. c. Place the patient on NPO status d. Give lorazepam (Ativan) 1 mg IV.

c. Place the patient on NPO status

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patients environment for adverse stimuli that might increase BP.

c. Set up the automatic blood pressure machine to take BP every 15 minutes.

What nursing action should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? A. Teach the patient how to manage his or her physical activity. B. Teach the patient about the need for ongoing anticoagulation. C. Teach the patient about the need for continuous antibiotic prophylaxis. D. Teach the patient about the need to maintain standard infection control procedures.

c. Teach the patient about the need for continuous antibiotic prophylaxis.

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for frequent BP checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Teach the patient about ambulatory blood pressure monitoring.

c. Tell the patient how to self-monitor and record BPs at home.

Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish and iodine. b. The Patient has a history of coronary artery disease. c. The patient has a permanent ventricular pacemaker in place. d. The patient took all the prescribed cardiac medications today.

c. The patient has a permanent ventricular pacemaker in place.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patients most recent BP reading is 156/94 mm Hg. b. The patients pulse has dropped from 64 to 58 beats/min c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

c. The patient has developed wheezes throughout the lung fields.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurement. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurement.

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There is no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats/min. The nurse determines that the client is experiencing which dysrhythmia? a. Sinus tachycardia b. Ventricular fibrillation c. Ventricular tachycardia d. Premature ventricular contractions

c. Ventricular tachycardia Rationale: Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes ( longer than 0.12 seconds), and typically a rate between 140 and 180 impulses/minute. The rhythm is regular.

Ventricular tachycardia is characterized by a. a heart rate less than 60 bpm b. conduction originates in the AV node c. a reduction in cardiac output due to rapid ventricular rate d. electrical chaos in the ventricles

c. a reduction in cardiac output due to ventricular rate Rationale: With ventricular tachycardia, the ventricles beat so rapidly that they are unable to adequately fill and cardiac output is reduced.

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should should assess which item based on priority? a. Anxiety level of the client and family b. Presence of a Medicalert card for the client to carry c. Knowledge of restrictions on postdischarge physical activity d. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver.

d. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver Rationale: Th nurse caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing intervetions but are not the priority.

During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to a. Document that the PMI in the normal anatomic location b. Ask the patient about risk factors for coronary artery disease c. Auscultate both the carotid arteries for the presence of a bruit d. Assess the patient for symptoms of left ventricular hypertorphy

d. Assess the patient for symptoms of left ventricular hypertrophy

To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Myoglobin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP)

d. B-type natriuretic peptide (BNP)

A patient was admitted to the ED 24 hrs earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate? a. Unstable angina b. Cardiac tamponade c. Sudden cardiac death d. Cardiac dysrhythmias

d. Cardia dysrhythmias

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily before taking the medicaiton. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

d. Change position slowly to help prevent dizziness and falls.

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pad on the client's chest and before discharge, which intervention is a priority? a. Ensure that the client has been intubated b. Set the defibrillator to the "synchronize" mode. c. Administer an amiodarone bolus IV d. Confirm that the rhythm is actually ventricular fibrillation.

d. Confirm that the rhythm is actually ventricular fibrillation. Rationale: Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch if present is removed. The client does not have to be intubated to be defibrillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchronize. Amiodarone may be given subsequently but is not required before defibrillation.

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats/min. Which action should the nurse take? a. check vital signs b. check lab test results c. notify the health care provider d. continue to monitor for any rhythm

d. Continue to monitor for any rhythm Rationale: Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring between 0.12 and 0.20 seconds and 0.04 and 0.10 seconds, respectively. There are no irregularities in this rhythm currently, so there is no immediate need to check vital signs or lab results, or to notify the health care provider. Therefore, the nurse would continue to monitor the client for any rhythm change.

While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? a. Teach the patient about aneurysms. b. Notify the hospital rapid response team. c. Instruct the patient to remain on bed rest. d. Document the finding in the patient chart.

d. Document the finding in the patient chart

When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse? a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg d. ECG changes indicating coronary ischemia

d. ECG changes indicating coronary ischemia

After noting a pulse deficit when assessing a patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require A) a. a 2-D echocardiogram. B) b. a cardiac catheterization. C) c. hourly blood pressure (BP) checks. D) d. electrocardiographic (ECG) monitoring.

d. Electrocardiographic (ECG) monitoring

A patient with a nonST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? a. Platelet aggregation is enhanced by IV heparin infusion. b. Heparin will dissolve the clot that is blocking blood flow to the heart. c. Coronary artery plaque size and adherence are decreased with heparin. d. Heparin will prevent the development of new clots in the coronary arteries.

d. Heparin will prevent the development of new clots in the coronary arteries.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. The medication may not work as well if I take any aspirin. b. The doctor may order a blood potassium level occasionally. c. I will call the doctor if I notice that I have a frequent cough. d. I won't worry if I have a little swelling around my lips and face.

d. I won't worry if I have a little swelling around my lips and face.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that: a. A BP recheck should be scheduled in a few weeks. b. The dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. More diagnostic testing may be needed to determine the cause of the hypertension.

d. More diagnostic testing may be needed to determine the cause of the hypertension.

A client in sinus bradycardia, with a heart rate of 45 beat/min., complains of dizziness and has a B/P of 82/60 mm Hg. Which prescription should the nurse anticipate will be prescribed? a. Administer digoxin b. Defibrillate the client c. Continue to monitor the client d. Prepare for transcutaneous pacing.

d. Prepare for transcutaneous pacing Rationale: Sinus bradycardia is noted with a heart rate less than 60 beats/min. This rhythm becomes a concern when the client becomes symptomatic. Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous pacing provides a temporary measure to increase the heart rate and thus perfusion in the symptomatic client. Defibrillation is used for treatment of pulselessness ventricular tachycardia and ventricular fibrillation. Digoxin will further decrease the client's heart rate. Continuing to monitor the client delays necessary intervention.

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

d. Question the patient about whether the medication is actually being taken.

Nadolol (Corgard) is prescribed for a patient with angina. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and apical pulse rate. b. fewer complaints of having cold hands and feet. c. improvement in the quality of the peripheral pulses. d. the ability to do daily activities without chest discomfort.

d. The ability to do daily activities without chest discomfort.

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if a. the patient is restless and agitated. b. the blood pressure is 190/110 mm Hg. c. the patient complains about feeling anxious. d. the cardiac monitor shows a heart rate of 45

d. The cardiac monitor shows a heart rate of 45

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of dietary protein. c. The patient has only one cup of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

d. The patient has a glass of low-fat milk with each meal.

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? a. The patient rates the pain at a level 3 to 5 (0 to 10 scale). b. The patient states that the pain wakes me up at night. c. The patient says that the frequency of the pain has increased over the last few weeks. d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

Charateristics of sinus bradycardia include: a. P wave precedes every QRS complex b. Every QRS complex is normal c. rate 40-60 d. all of the above

d. all of the above

Ventricular fibrillation is associated with an absence of : a. heartbeat b. palpable pulses c. respiration's d. all of the above

d. all of the above

When developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patients gender. c. high incidence of cardiovascular disease in older people. d. elevation of the patients serum low density lipoprotein (LDL) level.

d. elevation of the patients serum low density lipoprotein (LDL) level

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? a. "I should notify my doctor if my feet or legs start to swell" b. "My doctor told me to call his office if my pulse rate decreases below 60" c. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast" d. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning"

d."My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning" Rationale: Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. The pain is a result of coronary artery spasm. The treatment of choice is usually a calcium channel blocker, which relaxes and dilates the vascular smooth muscle, thus relieving the coronary artery spasm in variant angina. Adverse effects can include peripheral edema, hypotension, bradycardia, and heart failure. Grapefruit juice interacts with calcium channel blockers and should be avoided. If bradycardia occurs, the client should contact the healthcare provider. Clients should also be taught to change positions slowly to prevent orthostatic hypotension. Physical exertion does not cause this type of angina; therefore, the client should be able to continure morning walks with his/her spouse