CHA 1 Exam 3

What is normal creatinine?

0.5-1.2

What meds would be appropriate for a patient in V-Tach who has a pulse & is upright and responsive?

Amiodarone and BB

What should you teach your patient who is having a stress test?

Don't take your BP meds in the morning

What type of symptoms would a patient with Class I HF experience?

No impact on physical activity

What S/S would indicate worsening L-sided HF?

S3 heart sound is present

What does an NSTEMI look like on an ECG?

ST depression or T wave inversion

What does a STEMI look like on an ECG?

ST elevation

Why does a Cyanotic heart defect cause clubbing?

Shunting is from R to L (it misses the lungs)

In fetal circulation there are two BLUE ____ and one RED ____?

Umbilical arteries and umbilical vein

What S/S may a patient with mitral valve stenosis experience?

Wet lung sounds (blood can back up and since the lungs come before the mitral valve, it backs up in to the lungs)

What is normal EGFR?

60 ml/min

What is a normal BP for a neonate?

60-100/30-60

What is a normal HR for a neonate?

120-160

What is a normal RR for a neonate?

30-60

A nurse assesses a patient who is recovering from a heart transplant. Which assessment findings would alert the nurse to the possibility of heart transplant rejection? Select all that apply. A. Shortness of breath B. Abdominal bloating C. New-onset bradycardia D. Increased ejection fraction E. Hypertension

A, B, C

A nursing student planning to teach patients about risk factors for coronary artery disease (CAD) would include which topics? Select All That Apply A. Advanced Age B. Diabetics C. Ethnic Background D. Medication Use E. Smoking

A, B, C, E

A nursing student studying acute coronary syndromes learn that the pain of a myocardial infarction (MI) differs from stable angina in what ways? Select all that apply. A. Accompanied by shortness of breath B. Feelings of fear or anxiety C. Lasts less than 15 minutes D. No relief from taking nitroglycerin E. Pain occurs without known cause

A, B, D, E

A nurse is assessing a patient with left-sided heart failure. For which clinical manifestation would the nurse assess? Select all that apply. A. Pulmonary crackles B. Confusion, restlessness C. Pulmonary hypertension D. Dependent edema E. Cough that worsens at night

A, B, E

A nurse teaches a patient with a new permanent pacemaker. Which instructions would the nurse include in this patient's teaching? Select all that apply. A. "Until your incision is healed, do not submerge your pacemaker. Only take showers." B. "Report any pulse rates lower than your pacemaker settings." C. "If you feel weak, apply pressure over your pacemaker." D. "Have your pacemaker turned off before having magnetic resonance imaging (MRI)." E. "Do not lift your left arm above the level of your shoulder for 8 weeks."

A, B, E

A nurse cares for a patient with right-sided heart failure. The patient asks, "Why do i need to weight myself every day." How would the nurse respond? A. "Weight is the best indication that you are gaining or losing fluids" B. "Daily weights will help us make sure that you're eating properly" C. "The hospital requires that all inpatients be weighed daily" D. "You need to lose weight to decrease the incidence of heart failure"

A. "Weight is the best indication that you are gaining or losing fluids"

After teaching a patient with congestive heart failure, the nurse assesses the patient's understanding. Which patient statements indicate a correct understanding of the teaching related to nutritional intake? Select All That Apply A. "I'll read the nutritional labels on food items for salt content" B. "I will drink at least 3L of water each day" C. "Using salt in moderation will reduce the workload of my heart" D. "I will eat oatmeal for breakfast instead of ham and eggs" E. "Substituting fresh vegetables for canned ones will lower my salt intake"

A, D, E

A nurse teaches a patient who experiences occasional premature ventricular contractions (PVC's) accompanied by palpitations that resolve spontaneously without treatment. Which statement would the nurse include in this patient's teaching? A. "Minimize or abstain from caffeine." B. "Lie on your side until the attack subsides" C. "Use your oxygen when you experience PVC's" D. "Take amiodarone (Cordarone) daily to prevent PVC's"

A. "Minimize or abstain from caffeine."

A nurse cares for a patient who is on a cardiac monitor. The monitor displayed the rhythm shown below. What action would the nurse take first? A. Assess airway, breathing, and circulation B. Administer an amiodarone bolus followed by a drip C. Cardiovert the patient with a defibrillator D. Begin cardiopulmonary resuscitation (CPR)

A. Assess airway, breathing, and circulation

While assessing a patient on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next? A. Assess for symptoms of left-sided heart failure B. Document this as a normal finding C. Call the healthcare provider immediately D. Transfer the patient to the intensive care unit

A. Assess for symptoms of left-sided heart failure

A patient had a myocardial infarction (MI). The nurse notes the patient's cardiac rhythm as shown below. What action by the nurse is most important? A. Assess the patient's blood pressure and level of consciousness B. Call the healthcare provider or the Rapid Response team C. Obtain an order for an emergency temporary pacemaker insertion D. Prepare to administer antidysrhythmic medication

A. Assess the patient's blood pressure and level of consciousness

A nurse admits a patient who is experiencing an exacerbation of heart failure. What action would the nurse take first? A. Assess the patient's respiratory status B. Draw blood to assess the patient's serum electrolytes C. Administer intravenous furosemide (Lasix) D. Ask the patient about current medications

A. Assess the patient's respiratory status

A patient with HF is placed on beta-blockers, what would we monitor that could indicate signs of complication?

Apical HR and worsening signs of HF

A patient has just finished a catheterization in the femoral artery and you see a pool of blood under them, what do you do first?

Assess the patient (NOT PRESSURE, you MUST assess first)

A patient is experiencing a "death rattle" what medication would be used?

Atropine drops or scopolamine (suctioning will not work)

A nursing student learns about modifiable risk factors for coronary artery disease. Which factors does this include? Select all that apply. A. Age B. Hypertension C. Obesity D. Smoking E. Stress

B, C, D, E

A patient is 1 day post op after a coronary artery bypass graft. What nonpharmacologic comfort measures does the nurse include when caring for this patient? Select all that apply. A. Administer pain medication before ambulating B. Assist the patient into a position of comfort in bed C. Encourage high-protein diet selections D. Provide complementary therapies such as music E. Remind the patient to splint the incision when coughing

B, D, E

A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? A. "Do you have trouble breathing or chest pain?" B. "Are you able to walk upstairs without fatigue?" C. "Do you awaken with breathlessness during the night? D. "Do you have new-onset heaviness in your legs?"

B. "Are you able to walk upstairs without fatigue?"

A nurse cares for a patient recovering from prosthetic valve replacement surgery. The patient asks, "Why will I need to take anticoagulants for the rest of my life?" What is the best response by the nurse? A. "The prosthetic valve places you at greater risk for a heart attack" B. "Blood clots form more easily in artificial replacement valves" C. "The vein taken from your leg reduces circulation in the leg" D. "The surgery left a lot of small clots in your heart and lungs"

B. "Blood clots form more easily in artificial replacement valves"

After teaching a patient who has an implantable cardio vertex-defibrillator (ICD), a nurse assesses the patient's understanding. Which statement by the patient indicates a correct understanding of the teaching? A. "I should wear a snug-fitting shirt over the ICD" B. "I will avoid sources of storing electromagnetic fields" C. "I should participate in a strenuous exercise program" D. "Now I can discontinue my antidysrhythmic medications"

B. "I will avoid sources of storing electromagnetic fields"

After teaching a patient who is being discharged home after mitral valve replacement surgery, the nurse assesses the patient's understanding. Which patient statement indicates a need for additional teaching? A. "I'll be able to carry heavy loads after 6 months of rest" B. "I will have my teeth cleaned by my dentist in 2 weeks" C. "I must avoid eating foods high in Vitamin K, like spinach" D. "I must use an electric razor instead of a straight razor to shave"

B. "I will have my teeth cleaned by my dentist in 2 weeks"

A nurse assesses a patient admitted to the cardiac unit. Which statement by the patient alerts the nurse to the possibility of right-sided heart failure? A. "I sleep with four pillows at night" B. "My shoes fit really tight lately" C. "I wake up coughing every night" D. "I have trouble catching my breath"

B. "My shoes fit really tight lately"

A patient is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the patient to the bathroom and notes the patient;s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best? A. Administer oxygen at 2 L/min B. Allow continued bathroom privileges C. Obtain a bedside commode D. Suggest the patient use a bedpan

B. Allow continued bathroom privileges

A patient has intra-arterial blood pressure monitoring after a myocardial infarction. The nurse notes that the patient's heart rate has increased from 88 to 110 beats/min, and the blood pressure dropped from 120/82 to 100/60 mm Hg. What action by the nurse is most appropriate? A. Allow the patient to rest quietly B. Assess the patient for bleeding C. Document the findings in the chart D. Medicate the patient for pain

B. Assess the patient for bleeding

A nurse assesses a patient who has mitral valve regurgitation. For which cardiac dysrhythmia would the nurse assess? A. Preventricular contractions B. Atrial Fibrillation C. Symptomatic bradycardia D. Sinus tachycardia

B. Atrial Fibrillation

A nurse assesses a patient with mitral valve stenosis. What clinical manifestations would alert the nurse to the possibility that the patient's stenosis has progressed? A. Oxygen saturation of 92% B. Dyspnea on exertion C. Muted systolic murmur D. Upper extremity weakness

B. Dyspnea on exertion

A nurse assesses a patient with pericarditis. Which assessment finding would the nurse expect to find? A. Heart rate that speeds up and slows down B. Friction rub at the left lower sternal border C. Presence of a regular gallop rhythm D. Coarse crackles in bilateral lung bases

B. Friction rub at the left lower sternal border

The nurse is caring for a patient on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below. After calling for assistance and a defibrillator, what action would the nurse take next? A. Perform a pericardial thump B. Initiate cardiopulmonary resuscitation (CPR) C. Start an 18-gauge intravenous line D. Ask the patient's family about code status

B. Initiate cardiopulmonary resuscitation (CPR)

After administering newly prescribed captopril (Capoten) to a patient with heart failure, the nurse implements interventions to decrease complications. Which priority interventions would the nurse implement for this patient? A. Provide food to decrease nausea and aid in absorption B. Instruct the patient to ask for assistance when rising from bed C. Collaborate with unlicensed assistive personnel to bathe the patient D. Monitor potassium levels and check for symptoms of hypokalemia

B. Instruct the patient to ask for assistance when rising from bed

The nurse is caring for a patient with a chest tube after a coronary artery bypass graft. The drainage slows significantly. What action by the nurse is most important? A. Increase the setting on the suction B. Notify the provider immediately C. Reposition the chest tube D. Take the tubing apart to assess for clots

B. Notify the provider immediately

A nurse is caring for 4 patients. Which patient would the nurse assess first? A. Patient with an acute myocardial infarction, pulse 102 beats/min B. Patient who is 1 hour post-angioplasty, and has tongue swelling and anxiety C. Patient who is post coronary artery bypass, with chest tube drainage at 100ml/hr D. Patient who is post coronary artery bypass with potassium 4.2 mEq/L

B. Patient who is 1 hour post-angioplasty, and has tongue swelling and anxiety

A nurse assist with the cardioversion of a patient experiencing acute atrial fibrillation. What action would the nurse take prior to the initiation of cardioversion? A. Administer intravenous adenosine B. Turn off oxygen therapy C. Ensure that a tongue blade is available D. Position the patient on the left side

B. Turn off the oxygen therapy

A nurse evaluates prescriptions for a patient with chronic atrial fibrillation. Which medication would the nurse expect to find on this patient's medication administration record to prevent a common complication of this condition? A. Sotalol (Betapace) B. Warfarin (Coumadin) C. Atropine (Sal-Tropine) D. Lidocaine (Xylocaine)

B. Warfarin (Coumadin)

What is the most important nursing action for a patient with new/suspected infective endocarditis?

Blood cultures STAT

The provider requests the nurse start an infusion of an inotropic agent on a patient. How does the nurse explain the action of this drug to the patient and spouse? A. "It constricts vessels, improving blood flow." B. "It dilates vessels, which lessens the work of the heart." C. "It increases the force of the heart's contractions." D. "It slows the heart rate down for better filling."

C. "It increases the force of the heart's contractions."

A patient presents to the emergency department with an acute myocardial infarction (MI) at 1500 (3pm). The facility has a 24-hour catheterization laboratory abilities. To improve patient outcomes, by what time would the patient have a percutaneous coronary intervention performed? A. 1530 (3:30pm) B. 1600 (4pm) C. 1630 (4:30pm) D. 1700 (5pm)

C. 1630 (4:30pm)

A telemetry nurse assesses a client who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment would the nurse complete first? A. Pulmonary auscultation B. Pulse strength and amplitude C. Level of consciousness D. Mobility and gait stability

C. Level of Conciousness

A patient had an acute myocardial infarction. What assessment finding indicates to the nurse that a significant complication has occurred? A. Blood pressure that is 20 mm Hg below baseline B. Oxygen saturation of 94% on room air C. Poor peripheral pulses and cool skin D. Urine output of 1.2 mL/kg/hr for 4 hours

C. Poor peripheral pulses and cool skin

A nurse cares for a patient with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions would the nurse implement to address this patient's concerns? A. Administer oxygen therapy at 2L nasal cannula B. Provide patient with a sleeping pill to stimulate rest C. Schedule periods of exercise and rest during the day D. Ask unlicensed assistive personnel to help bathe the patient

C. Schedule periods of exercise and rest during the day

What does elevated BNP with respiratory difficulties indicate?

CHF

If a patient's creatinine is off (>1.5) what procedure would you be unable to do?

Can't do coronary angiogram (kidneys can't excrete contrast dye)

A child is experiencing clubbed fingers, what heart problem could be causing this?

Cyanotic Defect (Tetralogy of Fallout)

What is the nurses first action for a patient in V-Fib that is pulseless and unresponsive?

D-Fibrillation

A nurse teaches a patient who has a history of heart failure. Which statement would the nurse include in this patient's discharge teaching? A. "Avoid drinking more than 3 quarts (3L) of liquids each day" B. "Eat six small meals daily instead of 3 larger meals" C. "When you feel short of breath, take an additional diuretic" D. "Weigh yourself daily while wearing the same amount of clothing"

D. "Weigh yourself daily while wearing the same amount of clothing"

A nurse assesses a patient after administering isosorbide mononitrate (Imdur). The patient's reports a headache. What action would the nurse take? A. Initiate oxygen therapy B. Hold the next dose of Imdur C. Instruct the patient to drink water D. Administer PRN acetaminophen

D. Administer PRN acetaminophen

A nurse prepares to defibrillate a patient who is in ventricular fibrillation. Which priority intervention would the nurse perform prior to defibrillating this patient? A. Make sure that the defibrillator is set to the synchronous mode B. Administer 1mg of intravenous epinephrine C. Test the equipment by delivering a smaller shock at 100 J D. Ensure that everyone is clear of contract with the patient and the bed

D. Ensure that everyone is clear of contract with the patient and the bed

A nurse is caring for a patient with acute pericarditis who reports sub sternal pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure would the nurse implement? A. Apply an ice pack to the patient's chest B. Provide a neck rub, especially on the left side C. Allow the patient to lie in bed with the lights down D. Sit the patient up with a pillow to lean forward on

D. Sit the patient up with a pillow to lean forward on

What med would NOT be appropriate for a patient in V-Tach who has a pulse?

Epinephrine (ONLY GIVE THIS IF THEY ARE PULSELESS)

What intervention can the RN perform to best help the patient with Pericarditis?

Give NSAIDS (extra pressure from the inflammation causes pain)

If a patient is experiencing SOB or chest discomfort with deep breathing, what should the nurse do?

If laying in bed, sit up the head of the bed. If the patient is standing, have them sit down

When should a patient take diuretics?

In the morning (it causes excessive urinating)

A patient with a history of HF has a newly placed PICC line. The patient is now feeling tired, has a fever, and a new murmur is heard. What might this indicate?

Infective endocarditis (caused by PICC line placement and bacteria traveling to the valves, stopping valves from closing properly)

Where would you Auscultate for the presence of pericarditis?

Left lower sternal border

What will you teach a patient with a new mechanical valve placed?

Life long warfarin therapy

What does OANM stand for and when is it used?

Oxygen, aspirin, nitro, morphine (MI Treatment)

A patient has just received their first dose of Captopril, what is an important consideration with this medication?

Patient needs to ring for help to get up, medication causes dizziness which is a safety concern

What statement made by a cardiac rehab patient after a CABG would indicate to the nurse that additional teaching is needed?

Patient states they will only come in to rehab when they are not feeling well

A patient with HF is experiencing SOB and pink tinged sputum, what would this be an indication of?

Pulmonary Congestion/Edema

What would indicate N-STEMI on an ecg or telemetry?

T-wave inversion is present indicating partial blockage

If a patient has a blockage, how long do we have to get them where they need to be?

TPA within 30min of arrival (if other 2 timelines aren't met)

Describe fetal blood flow

This will be a fill in the blank on the exam!!!!

A nurse is in charge of the coronary intensive care unit. Which client should the nurse see first? a. Client on a nitroglycerin infusion at 5 mcg/min, not titrated in the last 4 hours b. Client who is 1 day post coronary artery bypass graft, blood pressure 180/100 mm Hg c. Client who is 1 day post percutaneous coronary intervention, going home this morning d. Client who is 2 days post coronary artery bypass graft, became dizzy this a.m. while walking

b. Client who is 1 day post coronary artery bypass graft, blood pressure 180/100 mm Hg