CHA exam 2
A patient has an ejection fraction of less than 30%. The nurse prepares to provide patient education about which potential treatment? A. Automatic implantable cardioverter/defibrillator B. Heart transplant C. Mechanical implanted pump D. Ventricular reconstructive procedures
A
A patient has an implantable cardioverter defibrillator. In cardioversion shock, why is the defibrillator certain synchronize mode? A. Avoid discharging the shock during the T-wave B. Discharging the shock during the R wave C. Discharging the shock during the T-wave D. Avoid discharging the shock during the Q wave
A
A patient in the emergency department with chest pain has a Possible MI. Which laboratory test is done to determine this diagnosis? A. Troponin T and I B. Serum potassium C. Homocysteine D. Highly sensitive c-reactive proteins
A
A patient is diagnosed with mitral valve stenosis. Which finding warrants immediate notification of the healthcare provider because of the potential for decompensation? A. Irregular heart rhythm signifying Atrial fibrillation B. Slow, bounding peripheral pulses associated with bradycardia C. an increase and decrease in pulse rate that follows inspiration and expiration D. An increase in pulse rate and blood pressure after exertion
A
A patient is diagnosed with new onset infective endocarditis. Which recent procedure is the patient most likely to report? A. Teeth cleaning B. Urinary bladder catheterization C. Chest radiography D. ECG
A
A patient who reports having a sore throat two weeks ago now reports chest pain. On physical assessment, the nurse hears a new murmur, pericardial friction rub, and tachycardia. The electrocardiogram shows a prolonged PR intro. What condition does the nurse suspect in this patient? A. Rheumatic carditis B. Heart failure C. Cardiomyopathy D. Aortic stenosis
A
A patient with atrial fabulation is scheduled to have an elective cardioversion. The nurse ensures that the patient has a prescription for a 4 to 6 week supply of which type of medication? A. Anticoagulants B. Digitalis C. Diuretics D. Potassium supplements
A
A patient with atrial fabulation suddenly developed shortness of breath, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication? A. Pulmonary embolism B. Embolic stroke C. Absence of atrial kick D. Increased cardiac output
A
An older adult patient with heart failure is volume depleted and has a low sodium level. The healthcare provider has ordered valsartan, and angiotensin receptor blocker. After the initial dose for what complication does the nurse carefully monitor for in this patient? A. Hypotension B. Cough C. Fluid retention D. Chest pain
A
Based on the prevalence and risk factors for atrial fibrillation, which patient group is at highest risk for atrial fibrillation? A. Older adults B. Diabetics C. Substance abusers D. Pediatric cardiology patients
A
During assessment of a patient with heart failure, the nurse notes that the patient's pulse is alternate and strength. What does this assessment indicate to the nurse? A. Pulses paradoxes B. Orthostatic hypotension C. Hypotension D. Pulsus alternans
A
In a patient's record, the nurse notes frequent episodes of bradycardia and hypotension related to unintended vagal stimulation. Which instruction for the patient's care does the nurse relate to the UAP? A. Avoid raising the patient's arms above the head during hygiene B. Ambulate the patient slowly and stuff frequently for brief rest C. Generously lubricate rectal thermometer probes and insert very cautiously D. Monitor the heart rate and rhythm if the patient is vomiting
A
The healthcare provider recommends to a patient that diagnostic testing be performed to assess for valvular heart disease. The nurse teaches the patient about which test that is commonly use for this purpose? A. Echocardiography B. Electrocardiography C. Exercise testing D. Thallium scanning
A
The nurse is assessing the pulses of a patient with valvular disease and finds "bounding" arterial pulses. What is this finding most characteristic of? A. Aortic regurgitation B. Aortic stenosis C. Mitral valve prolapse D. Mitral insufficiency
A
The nurse is teaching a patient about treatment regimen for heart failure. Which statement by the patient indicates a need for further instruction? A. I must weigh myself once a month and watch for fluid retention B. If my heart feels like it's racing, I should call the doctor C. I'll need to consider my activities for the day and rest as needed D. I'll need periods of rest and activity, and they should avoid activity after meals
A
The nurse taking a medical history of a patient makes special special notation to follow up on valvular abnormalities of the heart. Which recurrent condition in the patient's history causes the nurse to make this notation? A. Streptococcal infections of the throat B. Staphylococcal infections of the skin C. Vaginal yeast infections D. Fungal infections of the feet or inner thighs
A
The patient is scheduled for an exercise stress test. Which medications does the nurse expect the cardiologist will want held before the procedure? A. Atenolol and cardizem B. Vitamins and potassium C. Colace and enteric-coated aspirin D. Acetaminophen and metered-dose bronchodilator
A
The patient with episodes of stable ventricular tachycardia is scheduled to have an elective cardioversion. Which patient information will the nurse report immediately to the healthcare provider? A. The patient is prescribed digoxin 0.125 mg daily B. The patient's urine output for the past 24 hours was 2100 mL C. The patient monitor shows runs of 12-20 PVCs D. The patient takes A multivitamin every day
A
What is the most common problem for the patient with valvular heart disease? A. Reduce cardiac output B. Difficulty coping C. Shortness of breath D. Altered body image
A
What is the most significant laboratory cardiac marker in a patient who has had a MI? A. Presence of troponin T and I B. Elevation of myoglobin levels C. Decreased creatinine Kinase levels D. Elevation of the white blood cell count
A
Which test is the best tool for diagnosing heart failure? A. Echocardiography B. Pulmonary artery catheter C. Radionuclide studies D. Multigated angiographic scan
A
Which category of cardiovascular drugs blocks sympathetic stimulation to the heart and decreases the HR? A. Beta Blockers B. Catecholamines C. Steroids D. Benzodiazepines
A * Beta blocker slow the heart rate and decrease the force of cardiac contraction. Should be given within the first one to two hours after an MI in patient when they are hemodynamically stable
Emergency personnel discovered a patient lying outside in the cool evening air for an unknown length of time. The patient is in a hypothermic state. What other assessment finding does the nurse expect to see? A. BP and HR lower than normal B. HR and RR higher than normal C. Normal VS as a result of compensatory mechanisms D. Gradually improved VS enteral nutrition
A * bradycardia and severe hypotension occur with severe hypothermia
When the nurse assesses a patient with cardiovascular disease, there is difficulty auscultation the first heart sound (S1). What is the nurses BEST action? A. Ask the patient to lean forward or roll to their left side B. Instruct the patient to take a deep breath and hold it. C. Auscultate with the bell instead of the diaphragm D. Ask the UAP to complete a 12-lead EKG immediately
A * having them lean forward or roll to the left brings the heart closer to the chest wall
The nurse is caring for a patient at risk for MI. For what primary reason does the nurse plan interventions to rent anxiety or overexertion? A. An increase in heart rate increases myocardial oxygen demand B. A release of epinephrine and norepinephrine causes an MI C. An increase in activity or emotion affects preload and after load D. Cardiac output is decreased by anxiety or physical stress
A * if HR becomes too fast, diastolic filling time is limited and CO may start to decrease; increased HR increases O2 demand by myocardium
The nurse is performing a cardiac assessment on an older adult. What is a common assessment finding for this patient? A. S4 heart sound B. Leg edema C. Pericardial friction rubs D. Change in point of maximum impulse (PMI) location
A * it can be heard with advancing age because of a stiffened ventricle
The nurse is providing health teaching for a patient at risk for heart disease. Which factor is the MOST modifiable, controllable risk factor? A. Obesity B. Diabetes Mellitus C. Ethnic background D. Family history of cardiovascular disease
A * modifiable (changeable) risk factors: cigarette use; physical inactivity; obesity; psychological variables
The nurse performing a physical assessment on a patient with a history of cardiovascular disease observes that the patient has ascites, jaundice, and anasarca. How does the nurse interpret these findings? A. Late signs of severe right-sided heart failure B. Early signs of mild right-sided heart failure C. Late signs of mild left-sided heart failure D. Early signs of left and right-sided heart failure
A * right-sided heart failure signs and symptoms: jugular (neck vein) distention; enlarged liver or spleen; anorexia and nausea; dependent edema (legs and sacrum); distended abdomen; swollen hands and fingers; polyuria at night; weight gain; increased BP (from excess volume) or decreased BP (from failure)
The nurse is caring for several patients who have a dysrhythmia. What does the nurse teach each of the patients to do? A. Stay at least 4 feet away from a microwave oven that is operating B. Avoid electronic-mail detectors, such as those at the airport C. Learn the procedure for assessing the pulse D. Purchase an automatic external defibrillator for home use
C
The nurse is caring for the patient with coronary artery disease. The patient reports palpitations and chest discomfort, and the nurse notes a Tachydysrhythmias on the electrocardiogram monitor. What does the nurse do next? A. Analyze the ECG strips B. Notify the healthcare provider C. Give supplemental oxygen D. Administer a narcotic analgesic
C
The patient has excess fluid in the pericardial cavity seen on echocardiogram. For which complication is the patient at increased risk? A. Pericardial friction rub B. Pulsus paradoxes C. Cardiac tamponade D. Systemic emboli
C
The patient is a 48-year-old female who came to the emergency department with symptoms of indigestion with abdominal fullness, chronic fatigue even with rest, and feeling of an "inability to catch my breath." What is the nurses best interpretation of these symptoms? A. The symptoms are not indicate of of the presence of heart disease B. The patient may need a work up for fibromyalgia C. Women with heart disease present was atypical symptoms D. This patient may be experiencing signs of painful gastric ulcers
C
Which definition best describes left-sided heart failure? A. Increase volume and pressure develop and result in peripheral edema B. It can occur when cardiac output remains normal or above normal C. There is decreased tissue perfusion from poor cardiac output in pulmonary congestion from increased pressure in the pulmonary vessels D. It is the percentage of blood ejected from the heart during systole
C
Which dysrhythmia results in asynchrony of atrial contraction and decreased cardiac output in? A. Sinus tachycardia B. Atrial flutter C. Atrial fibrillation D. First-degree atrioventricular block
C
Which is a characteristic of dilated cardiomyopathy? A. Results from replacement of myocardial tissue with fibrous tissue B. Causes Steph and chuckles that restrict feeling during diastole C. Causes symptoms of left ventricular failure D. Causes right ventricular failure early in the disease
C
Which priority medical surgical concept applies to a patient with heart failure? A. Gas exchange B. Infection C. Perfusion D. Comfort
C
Why does the nurse document the precise location of crackles auscultated in the lungs of a patient with heart failure? A. Crackles will eventually change to wheezes as the pulmonary edema worsens B. The level of fluid spreads laterally as the pulmonary edema worsens C. The level of fluid ascends as the pulmonary edema worsens D. Crackles will eventually diminish as the pulmonary edema worsens
C
A young patient reports having frequent episodes of palpitations but denies having chest pain. Which follow-up question does the nurse asked to assess the patient's symptoms of palpitations? A. Have you noticed a worsening of shortness of breath when you are lying flat? B. Do your shoes feel unusually tight, or are your rings tighter than usual? C. Do you feel dizzy or have you lost consciousness with the palpitations? D. Does anyone in your family have a history of palpitations?
C * dizziness and palpitations are associated with decreased cardiac output
A nurse is monitoring the patient's blood pressure and electro cardiogram during a stress test. Which parameter indicates the patient should stop exercising? A. Increase in heart rate B. Increase in blood pressure C. ECG showing the P-wave and QRS complex D. ECG showing ST-segment depression
D
A patient comes to the emergency department extremely anxious, tachycardic, struggling for air, and with a moist cough productive of frothy, blood-tinged sputum. What is the priority nursing intervention? A. Apply a pulse oximeter and cardiac monitor B. Administer high-flow oxygen therapy via face mask C. Prepare for continuous positive airway pressure ventilation D. Prepare for intubation and mechanical ventilation
B
A patient has received heart transplant for dilated cardiomyopathy. Because the patient has a high risk for cardiac tamponade, for which signs/symptoms does the nurse immediately notify the health care provider? A. Crackles and wheezes of the lungs B. Pulsus paradoxus and muffled hurt sounds C. Hepatomegaly and ascites D. Dependent edema and fluid retention
B
A patient is prescribed diuretics for treatment of heart failure. Because of this therapy, the nurse pays particular attention to which lab test value? A. Peak in trough levels of the drugs B. Serum potassium C. Serum sodium D. Prothrombin time
B
A patient scheduled to have elective cardioversion for atrial fibrillation will receive drug therapy for about six weeks before the procedure. What information about the drug therapy does the nurse teach the patient? A. Manage orthostatic hypotension B. Watch for bleeding signs C. Eat potassium-rich food sources D. Report muscle weakness or tremors
B
In what way does arterial embolization to the brain manifest itself in a patient with in effective endocarditis? A. Dysarthria B. Dysphagia C. Atelectasis D. Electrolyte imbalances
B
Long term anticoagulant therapy for a patient with valvular heart disease and chronic atrial fibrillation includes which drug? A. Heparin sodium B. Warfarin sodium C. Diltiazem D. Enoxaparin
B
Patient patient reports chest pain and dizziness after exertion, and the family reports a concurrent new onset of mild confusion in the patient, as well as difficulty concentrating. What is the priority problem for this patient? A. Activity intolerance B. Decreased cardiac output C. Acute confusion D. Inadequate oxygenation
B
The nurse identifies a priority problem of fatigue and weakness for the patient with heart failure. After the patient ambulate's 200 feet down the hall, the patient's blood pressure change is decreased by more than 20 mm HG. How does the nurse interpret this data? A. The patient is building endurance B. The activity is too stressful C. The patient could walk further D. The activity is appropriate
B
The nurse is assessing a patient with pericarditis. In order to hear a pericardial friction rub, with which stethoscope technique does the nurse use? A. Place the diaphragm at the Apex of the heart B. Place the diaphragm at the left lower sternal border C. Place the bell just below the left clavicle D. Placed the bell at several points while the patient holds his or her breath
B
The nurse is interviewing a patient with a history of high blood pressure and heart problems. Which statement by the patient causes the nurse to suspect the patient may have heart failure? A. I noticed a very fine red rash on my chest B. I had to takeoff my wedding ring last week C. I have had Fever quite frequently D. I have pain in my shoulder when I cough
B
The nurse is monitoring a patient who is sleeping. The monitor shows that the patient's heart rate increases slightly during inspiration and decreases slightly during exhalation. Which cardiac rhythm does the nurse document? A. Normal sinus rhythm B. Sinus arrhythmia C. Sinus bradycardia D. Sinus tachycardia
B
The nurse is reviewing the lab results for a patient who was admitted with dyspnea. Which diagnostic test best differentiate between heart failure and lung dysfunction? A. Arterial blood gas B. BNP C. Hemoglobin D. Serum electrolytes
B
The patient is admitted to the emergency department was sudden onset of chest pain that is intense, is sub sternal radiating to the left arm, and has lasted over an hour. What is the most likely cause of this chest pain? A. Angina B. Myocardial infarction C. Pericarditis D. Pleuropulmonary
B
The patient with a history of allergy to iodine-based contrast dye's is scheduled for a cardiac Catherine station. What action does the nurse expect with regard to the scheduled test? A. Delay the test for a week or more B. Administer an anti-histamine and/or steroid before the test C. The test will be performed without administration of contrast dye D. The patient will receive anticoagulation therapy before the test
B
The surgical noninvasive intervention of a balloon valvuloplasty is often used for which type of patient? A. Young adults with a genetic valve defect B. Older adults who are non-surgical candidates C. Adults who is open heart surgery field D. Older adults who need replacement valves
B
What is the expected outcome for a patient with the collaborative problem of preventing and managing pulmonary edema? A. No dysrhythmias B. Clear lung sounds C. Less fatigue D. No disorientation
B
What is the significance of a sodium level of 130 mEq/L For a patient with heart failure? A. Increased risk for ventricular dysrhythmias
B
The patient with atrial fabulation is not a candidate for which long-term anticoagulation therapy. Which procedure is contra indicated for this patient? A. Biventricular pacing B. Elective cardioversion C. Transthoracic pacing D. Radio frequency catheter ablation
D
What is an early sign of left ventricular failure that a patient is most likely to report? A. Nocturia B. Weight gain C. Swollen legs D. Nocturnal coughing
D
Which medications will the nurse hold until after a patient's cardiac catheterization? A. Daily vitamin and enteric-coated aspirin B. Atenolol and IV antibiotic C. Potassium and folic acid D. Warfarin and furosemide
D
Which patient has abnormal heart sounds? A. S1 in a 45yo patient B. S2 in a 30yo patient C. S3 in a 15yo patient D. S3 in a 54yo patient
D * an early diastolic filling sound indicating an increase in left ventricular pressure
Cardiac dysrhythmia result in complications for the client. Which of the following nursing diagnosis is a priority for a client with a cardiac dysrhythmia? A. Activity Intolerance B. Impaired gas exchange C. Decreased Tissue Perfusion D. Decreased Cardiac Output
D * decreased cardiac output occurs with tachycardia and bradycardia ** activity intolerance and decreased tissue perfusion can occur with cardiac dysrhythmias impaired gas exchange would mean that there is an issue between the lungs and blood vessels
While listening to a patient's heart sounds, the nurse detects a murmur. What does the nurse understand about the cause of murmurs? A. A murmur is caused by the closing of the aortic and pulmonic valves B. A murmur is caused when blood flows from the atrium to a noncompliance ventricle C. A murmur is caused by anemia, hypertension, or ventricular hypertrophy D. A murmur is caused when there is turbulent blood flow through normal or abnormal valves
D * murmurs reflect turbulent blood flow through normal or abnormal valves and are classified according to their timing in the cardiac cycle
Which exercise regimen for an older adult meets the recommended guidelines for physical fitness to promote heart health? A. 6-hour bike ride every Saturday B. Golfing for 4 hours 2x/week C. Running for 15 min 3x/week D. Brisk walk 30 min every day
D * regular physical activity promotes cardiovascular fitness and produces beneficial changes in blood pressure and levels of blood lipids and clotting factors. Recommendation is 150 min of moderate exercise or 75 min of vigorous exercise per week plus muscles-strengthening at least 2 days/week
The nurse is working in a women's health clinic is reviewing the risk factors for several patients for stroke and MI. Which patient has the HIGHEST risk for MI? A. 49yo on estrogen replacement therapy B. 55yo with unstable angina C. 23yo with diabetes that is currently not well controlled D. 60yo with well-controlled hypertension
B * patients with unstable angina may present with ST changes on a 12-lead ECG but do not have changes in troponin levels. Ischemia is present but is not severe enough to cause detectable myocardial damage or cell death
A patient is scheduled to have and exercise electrocardiography test. What instruction does the nurse provide to the patient before the procedure takes place? A. Have nothing to eat or drink after midnight B. Avoid smoking or drinking alcohol for at least two weeks before the test C. We are comfortable, loose clothing, and rubber- soled supportive shoes D. Someone must drive you home because of the possible sedative effects of the medications
C
A patient is undergoing diagnostic testing for reports of chest pain. Which test is done to determine the location and extent of coronary artery disease? A. Electrocardiogram (ECG) B. Echocardiogram C. Cardiac catheterization D. Chest x-ray
C
Which laboratory tests are used to predict a patient's risk for coronary artery disease? Select all that apply A. Cholesterol level B. Triglyceride level C. Prothrombin time D. Low density lipoprotein level E. Albumin level F. Protein level
A, B, D,
A patient to it was admitted for newly diagnosed heart failure is now being discharged. The nurse instruct the patient and family on how to manage heart failure at home. What major self-management categories should the nurse include? Select all that apply A. Medications B. Weight C. Heart transplants D. Activity E. Diet F. What to do when symptoms get worse
A, B, D, E, F
The nurse is taking the initial history and vital signs on a patient with fatigue. The nurse notes a regular apical pulse of 130 bpm. The nurse assesses the patient for what contributing factors? Select all that apply A. Anxiety or stress B. Fever C. Hypovolemia D. Anemia or hypoxemia E. Hypothyroidism F. Constipation
A, B, C, D
A patient had an emergency pericardiocentesis for cardiac temponade. Which nursing interventions are included in the post procedural care of this patient? Select all that apply A. Closely monitor for the recurrence of tamponade B. Be prepared to provide adequate fluid volumes to increase cardiac output C. Prepared the patient for emergency sternotomy if tamponade recurs D. Administer diuretics to decrease food volumes around the heart E. Send the pericardial effusion specimen to the lab for culture F. Keep the patient on bedrest and supine for at least 24 hours
A, B, C, E
A patient is diagnosed with moderate mitral valve stenosis. Which findings is the nurse most likely to encounter during the physical assessment of this patient? Select all that apply A. Dyspnea on exertion B. Orthopnea C. Palpitations D. Asymptomatic E. Neck vein distention F. Early wet productive cough
A, B, C, E
A patient is treated for acute pulmonary Adema. Which medications does the nurse prepare to administer to this patient? Select all that apply A. Nitroglycerin SL B. Furosemide IV C. Morphine sulfate IV D. Metaprolol IV E. Nitroglycerin IV F. Oxygen by nasal cannula at 1 L per minute
A, B, C, E
A patient with heart failure has in adequate tissue perfusion. Which nursing interventions are included in the plan of care for this patient? Select all that apply A. Monitor respiratory rate, rhythm, and quality every 1 to 4 hours B. Auscultate Bra Sounds every 4-8 hours C. Provide supplemental oxygen to maintain oxygen saturation at 90% or greater D. Placed a patient in a supine position with pillows under each leg E. Assist the patient in performing coughing and deep-breathing exercises every two hours F. Encourage the patient to perform all ADLs even when tired
A, B, C, E
A patient has an invasive temporary pacemaker. In what ways does the nurse ensure the patient safety related to electrical issues with the pacemaker? Select all that apply A. Ensure that external ends of the lead wires are insulated with rubber gloves B. Loop the wire ends in cover with non-conductive tape C. Ensure that no electrical equipment is used in the patient's room D. Report frayed wire to the biomedical engineering department E. Wash hands before touching any of the wires F. Notify the healthcare provider if the pacemaker fails to capture and pace the heart
A, B, D, F
I'm the nurse is providing discharge instructions for a patient who had a cardiac catheterization. Which instructions must the nurse include? Select all that apply A. Notify the healthcare provider for increased swelling, redness, warmth, or pain B. Leave the dressing in place for the first day C. Limit activity for at least 2 to 3 weeks D. Avoid lifting and exercise for a few days E. Report any bruise or hematoma to the healthcare provider F. Bruising or a small hematoma as expected
A, B, D, F
The nurse is giving a community presentation about heart disease in women. What information does the nurse include in the presentation? Select all that apply A. Dyspnea on exertion may be the first and only symptom of HF B. Symptoms are subtle or atypical C. Pain is often relieved by rest D. Having waist and abdominal obesity is a higher risk than having fat in the buttocks and thighs E. Pain always responds to nitroglycerin F. Common symptoms include back pain, nausea, indigestion, vomiting, and anorexia
A, B, D, F * assess women for nonspecific cardiovascular symptoms such as fatigue, malaise, anxiety, and shortness of breath
Which descriptions accurately characterize restrictive cardiomyopathy? Select all that apply A. Prognosis is poor B. Symptoms are similar to left or right-sided heart failure C. Some patience day without any symptoms D. It is most common type of cardiomyopathy E. It is the rarest of cardiomyopathies F. Filling is restricted during diastole
A, B, E, F
The cause of dilated cardiomyopathy may include which factors? Select all that apply A. Alcohol abuse B. Sedentary lifestyle C. Infection D. Chemotherapy E. Poor nutrition F. Cigarette smoking
A, C, D, E
Which patients are at greatest risk for developing ineffective endocarditis? Select all that apply A. IV drug user B. Patient with a myocardial infarction C. Patient with a prosthetic mitral valve D. Patient with my chores to gnosis who recently had an abscess tooth removed E. Older adult patient with urinary tract infection and valve damage F. Patient with cardiac dysrhythmias
A, C, D, E
Which non-specific signs and symptoms are frequently seen and women who present with coronary artery disease? Select all that apply A. Malaise B. Hypoventilation C. Shortness of breath D. Anxiety E. Fatigue F. Diaphoresis
A, C, D, E * signs and symptoms of CAD: chest pain; palpitations; dyspnea; fatigue; cough; hemoptysis (coughing blood); syncope
Which clinical manifestations are reflections of sustained tachydysrhythmias? Select all that apply A. Chest discomfort B. Moist cyanotic skin C. Palpitations D. Hypertension E. Syncope F. Restlessness
A, C, D, E, F
A patient comes to the ED reporting chest pain. In evaluating the patient's pain, which questions does the nurse ask the patient? Select all that apply A. How long does the pain last and how often does it occur? B. How do you feel about the pain? C. Is the pain different from any other episodes of pain you've had? D. What activities were you doing when the pain first occurred? E. Where is the chest pain? What does it feel like? F. Have you had other signs and symptoms that occur at the same time?
A, C, D, E, F * duration of pain, frequency of pain, type of pain, activity level or with rest, and other signs & symptoms can indicate it the patient is experiencing angina or experiencing a MI
The nurse is teaching a patient with a permanent pacemaker. What information about the pacemaker does the nurse tell the patient? Select all that apply A. Report any pulse rate lower than what it said on the pacemaker B. If the surgical incision is near the shoulder, avoid overextending the joint C. Keep handheld cellular phones at least 6 inches away from the generator D. Avoid sources of strong electromagnetic fields, such as magnets E. Avoid strenuous activities that may cause the device to discharge inappropriately F. Carry a pacemaker identification card and wear a medical alert bracelet
A, C, D, F
Traditionally, what medications will most likely be ordered for a patient with atrial fabulation? Select all that apply A. Diltiazem hydrochloride B. Furosemide C. Heparin D. Enoxaparin E. Sodium warfarin F. Metoprolol
A, C, D, F
Which are nursing responsibilities after a patient receives an elective cardioversion to establish a normal heart rhythm? Select all that apply A. Maintain an open airway B. Remove oxygen devices C. Assessed vital signs in level of consciousness D. Document results of the cardioversion E. Provide sips of water or ice chips F. Monitor for dysrhythmias
A, C, D, F
The nurse is instructing a patient with CHF on what signs to look for when experiencing an exacerbation of CHF. Which are appropriate teaching points for this patient? Select all that apply A.It is possible to gain 10 to 15 pounds before edema develops B. Notify the provider of a weight loss of 3 to 5 pounds within two weeks C. Notify the provider of a weight gain of 2 pounds within 1 to 2 days D. Notify the provider if you noticed that your shoes or rings feel tight E. Notify the provider if your skin becomes dry and scaly F. Sitting up or standing will relieve orthopnea
A, C, D, F * also known as left-sided heart failure Signs and symptoms: fatigue, weakness, oliguria, nocturia, angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities, pulmonary congestion- cough (especially at night), SOB/ dyspnea, crackles or wheezes in lungs, frothy/pink-tinged sputum, tachypnea, S3/S4 summation gallop
The patient has a diagnosis of angina. Which assessment data would the nurse expect to find? Select all that apply A. Sudden onset of pain B. Intermittent pain relieved with sitting upright C. Substernal pain that may spread across chest, back, and arms D. Pain usually lasts less than 15 min E. Sharp, stabbing pain that is moderate to severe F. Pain relieved with rest
A, C, D, F * signs and symptoms: Substernal chest discomfort radiating to the left arm; precipitated by exertion or stress or in variant angina; relieved by nitroglycerin at rest; lasting less than 15 minutes; few, if any, associated symptoms
The nurse assesses a pericardial friction rub and a cardiac patient. What is the nurses best interpretation of this finding? Select all that apply A. It occurs with movements of the heart during the cardiac cycle B. It originates in the septum between the ventricles C. It is a transient sign of inflammation D. It is often heard with cardiac valve insufficiency E. It can occur after myocardial infarction F. It is very loud and can be heard without a stethoscope
A, C, E
The nurse is assessing a patient with right sided heart failure. Which assessment findings does the nurse expect to see in this patient? Select all that apply A. Dependent edema B. Weight loss C. Jugular venous distention D. Hypotension E. Hepatomegaly F. Angina
A, C, E
Which statements about permanent pacemakers are accurate? Select all that apply A. Permanent pacemaker Street conduction disorders such as complete heart block B. Permanent pacemaker is our powered by lithium batteries that can last for 20 years or more C. Permanent pacemakers are available as pacemaker/defibrillator devices D. Biventricular permanent pacemakers allow synchronized depolarization of the ventricles E. The pulse generator of a permanent pacemaker is usually implanted in the subclavian area F. The patient with a permanent pacemaker should be taught to avoid lifting his or her arm over the head for at least six months
A, C, E
The nurse interprets a patient serum lipid test. Which results suggest an increased risk for cardiovascular disease? Select all that apply A. LDL 160 mg/dL B. HDL 60 mg/dL C. Total cholesterol 180 mg/dL D. Triglycerides 175 mg/dL E. Lp(a) 45 mg/dL F. Total cholesterol 250 mg/dL
A, D, E, F
Which interventions are effective for a patient with a potential for pulmonary Adema caused by heart failure? Select all that apply A. Sodium and fluid restriction B. Slow infusion of hypotonic saline C. Administration of potassium D. Administration of loop diuretics E. Position in semi-Fowler's to high Fowlers position F. Weekly weight monitoring
A, D, E, F
A client is experiencing tachycardia. Which of the following symptoms should the nurse expect the client to be experiencing? (Select All That Apply) A. Weakness B. Headache C. Hypertension D. Dizziness E. Hypotension
A. Weakness; D. Dizziness; and E. Hypotension *weakness, dizziness, and hypotension occur with tachycardia **headaches and hypertension occur with fluid overload
When is BNP produce and released for a patient with heart failure? A. When a patient has an in large liver B. When a patient has fluid overload C. When a patient ejection fraction is lower than normal D. When a patient has ventricular hypertrophy
B
Which assessment finding in a patient who has had a cardiac catheterization does the nurse report immediately to the healthcare provider? A. Pain at the catheter insertion site B. Catheterize extremity dusky with decreased peripheral pulses C. Small hematoma at the catheter insertion site D. Pulse pressure of 40 mmHg with a slow, bounding pulse
B
Which drug for symptomatic bradycardia does the nurse prepare to administer to a patient with Bradydysrhythmias? A. Epinephrine B. Atropine C. Calcium D. Lidocaine
B
Which dysrhythmia causes the ventricles to quiver, resulting in absence of cardiac output? A. Ventricular tachycardia B. Ventricular fibrillation C. Asystole D. Third-degree heart block
B
Which measure is most accurate when assessing a patient for fluid restriction? A. Documenting edema as mild, moderate, or severe B. Measuring and monitoring daily patient weight C. Assessing peripheral swelling as 1+ to 4+ D. Auscultating lungs for abnormal sounds such as crackles
B
Which treatment intervention applies to a patient with infective endocarditis? A. Administration of oral penicillin for six weeks or more B. Hospitalization for initial IV antibiotics; then home to continue IV therapy C. Complete bed rest for the duration of treatment D. Long-term anticoagulation therapy with heparin followed by oral warfarin
B
Which type of cardiomyopathy results from replacement of myocardial tissue with fibrous and fatty tissue? A. Hypertrophic cardiomyopathy B. Arrhythmogenic right ventricular cardiomyopathy C. Dilated cardiomyopathy D. Restrictive cardiomyopathy
B
A patient entering the cardiac rehabilitation unit seems optimistic and at times unexpectedly cheerful and upbeat. Which statement by the patient causes the nurse to suspect email adaptive use of denial and the patient? A. I am sick and tired of talking about these dietary restrictions. Can we talk about it tomorrow? B. Oh, I don't really need that medication information. I am sure that I'll soon be able to get by without it. C. This whole episode of heart problems has been an eye-opener for me, but I really can't wait to get out of here. D. That doctor is driving me crazy with all his instructions. Could you put all the information away in my suitcase?
B * people are often in denial with
The nurse is performing an assessment on a patient brought in by emergency personnel. The nurse immediately observed that the patient has spontaneous respirations in the skin is cool, pale, and moist. What is the PRIORITY patient problem? A. Abnormal normal body temperature B. Decreased Perfusion C. Altered skin integrity D. Potential for peripheral neurovascular dysfunction
B * these are signs of left-sided HF which can lead to decreased perfusion from lack of oxygen circulating in the body and build up of fluid in the lungs
Which description BEST designed the cardiovascular concept of afterload? A. Degree of myocardial fiber stretch at end of diastole and just before heart contracts B. Amount of resistance the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels C. Pressure that the ventricle must overcome to open the tricuspid valve D. Force of contraction independent of preload
B *afterload is the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into peripheral blood vessels
Syncope and the aging person can likely occur with which actions by the patient? Select all that apply A. Laughing B. Turning the head C. Performing a Valsalva maneuver D. Walking briskly for 20 to 30 minutes E. Shrugging their shoulders F. Swallowing fluids
B, C, E * syncope in the aging person may result from hypersensitivity of the carotid sinus bodies in the carotid arteries. Pressure applied to these arteries while turning the head, shrugging the shoulders, or performing a Valsalva maneuver (bearing down during defecation) may stimulate a vagal response. A decrease in BP and HR can result, which can produce syncope.
The patient has infective endocarditis. Which findings does the nurse expect when assessing this patient? Select all that apply A. Pericardial friction rub B. Osler's nodes C. Petechiae D. A new regurgitant murmur E. Grading pain that is aggravated by breathing F. Fever associated with chills and night sweats
B, C, D, F
A patient has had a permanent pacemaker surgically implanted. What are the nursing responsibilities for the care of this patient following surgical implantation? Select all that apply A. Administer short-acting sedatives B. Assess the implantation site for bleeding, swelling, redness, tenderness, or infection C. Teach about in monitor for the initial activity restrictions D. Observe for overstimulation of the chest wall, which could lead to pneumothorax E. Monitor the ECG rhythm to check that the pacemaker is working correctly F. Assessed 30 the implantation site dressing is clean and dry
B, C, E, F
The nurse is assessing a patient with left sided heart failure. Which assessment findings does the nurse expect to see in this patient? Select all that apply A. Ascites B. S3 heart sound C. Paroxysmal nocturnal dyspnea D. Jugular venous distention E. Oliguria during the day F. Wheezes or crackles
B, C, E, F
The nurse is explaining the purpose of angiography to a patient. Which material will the nurse explain to the patient? Select all that apply A. Determine an abnormal structure of the heart B. Identify an arterial obstruction C. Assess the cardiovascular response to increased workload D. Identify an arterial narrowing E. Identify an aneurysm F. Determine if cardiac enlargement is present
B, D, E
Which characteristics describe mitral valve stenosis? Select all that apply A. Classic signs of dyspnea, angina, and syncope B. Rumbling apical diastolic murmur C. S3 often present due to severe regurgitation D. Right-sided failure results in neck vein distention E. The patient may experience palpitations while laying on the left side F. Mild mitral stenosis is usually asymptomatic
B, D, F
The nurse is caring for a patient at risk for heart problems. What are normal findings for the cardiovascular assessment of this patient? Select all that apply A. Presence of a thrill B. Splitting of S2; decreases with expiration C. Jugular venous distinction to the level of the mandible D. Point of maximal impulse (PMI) in the 5th intercostal space at midclavicular line E. Paradoxical chest movement with inspiration and expiration F. Accentuated or intensifies S1 after exercise
B, D, F * splitting of S2 occurs because of longer systolic phase of the right ventricle and narrows during expectation; the PMI is also referred to as the apical pulse; a decrease in sound intensity of the S1 can indicate mitral regurgitation and HF
What measures are taken to prepare a patient for a pharmacologic stress echocardiogram? Select all that apply A. Patient can eat his/her diet as ordered B. IV access needs to be present C. Oxygen at 2 L per nasal cannula is placed on patient three hours prior to test D. An oral laxative is given the day before the test E. Patient is to be NPO for 3 to 6 hours before the test F. Teach the patient that blood pressure and heart rate will be continuously monitored
B, E, F
A client with atrial fibrillation will be having an elective cardioversion. Prior to the procedure, the nurse should evaluate which of the following? (Select all that apply) A. Sodium levels B. Potassium levels C. Magnesium levels D. Calcium levels E. Echocardiogram
B. Potassium levels and C. Magnesium levels *potassium and magnesium imbalances make the heart more prone to cardiac dysthymia, which can result in complications with a cardioversion
A client's EKG is showing a cardiac dysthymia. Which lab values would be important to assess as a potential cause for this? (Select all that apply) A. PT/PTT B. Sodium C. Potassium D. BUN/ creatinine E. Magnesium F. Hemoglobin
B. Sodium; C. Potassium; and E. Magnesium *potassium and magnesium can directly result in cardiac dysrhythmia. Sodium levels give an indication of dehydration or fluid overload (HF) which both can result in cardiac dysrhythmia. **PT/PTT, BUN, creatinine, and hemoglobin levels are not an influence on cardiac dysrhythmia
A patient is admitted for percarditis. In order to assist the patient to feel more comfortable, what does the nurse instructed patient to do? A. Sit in a semi-Fowler's position with pillows under the arms B. Lying on the side in a fetal position C. Sit up and lean forward D. Lie down and bend the legs at the knees
C
A patient is admitted for possible ineffective endocarditis. Which test does the nurse anticipate will be performed to confirm a positive diagnosis? A. CT scan B. MRI C. Blood cultures D. Echocardiogram
C
A patient with a history of valvular heart disease requires an invasive dental procedure. The nurse notified the healthcare provider to obtain a patient prescription for which type of medication? A. Anticoagulants B. Antihypertensives C. Antibiotics D. Antianginals
C
A patient with heart failure has excessive aldosterone secretion and is experiencing thirst and continuously asking for water. What instruction does the nurse give the UAP? A. Severely restrict fluid to 500 mL plus output from the previous 24 hours B. Give the patient as much water as desire to prevent dehydration C. Restrict fluid to 2 L daily, with accurate intake and output D. Frequently offer the patient ice chips and moistened toothettes
C
A patient's bilateral radial pulses are occasionally week and irregular. Which assessment technique does the nurse use first to investigate this finding? A. Check the color and the capillary refill in the upper extremities B. Check the peripheral pulses in the lower extremities C. Take the apical pulse for one minute, noting any irregularity in heart rhythm D. Check the cardiac monitor for irregularities in rhythm
C
The night shift nurse is listening to report and hears that a patient has paroxysmal nocturnal dyspnea. What does the nurse plan to do next? A. Instruct patient to sleep in his side lying position and then check on the patient every two hours to help with switching sides B. Make the patient comfortable in a bedside recliner with several pillows to keep the patient more upright throughout the night C. Check on the patient several hours after bedtime and assist the patient to sit upright and dangle the feet when dyspnea occurs D. Check the patient frequently because the patient has insomnia due to a fear of suffocation
C
The nurse here is in report that the patient has been diagnosed with mitral regurgitation (insufficiency). What early symptom is most likely to be first reported by the patient? A. Atypical chest pain B. Chronic weakness C. Anxiety D. Dyspnea
C
The nurse is interviewing a patient with spontaneous ventricular tachycardia who may be a possible candidate for an implantable cardioverter defibrillator. The nurse senses that the patient is anxious. What is the nurses most therapeutic response? A. Your feelings are natural; patient reports psychological distress related to ICD B. ICD is similar to defibrillation, which saved your life during the last episode C. You seem anxious. What are your concerns about having this treatment? D. Would you like to talk to the doctor about the details of the procedure?
C
The nurse is reviewing electrocardiogram results of a patient admitted for fluid and electrolyte imbalances. The T waves are tall and peaked. The nurse reports this finding to the healthcare provider and obtains in order for which serum level test? A. Sodium B. Glucose C. Potassium D. Phosphorus
C
The nurse is reviewing the monitored rhythms of several patients in the cardiac step down unit. The patient with which cardiac dysrhythmia has the greatest need of immediate attention? A. Chronic atrial fibrillation B. Paroxysmal supraventricular tachycardia that has suddenly terminated C. Sustained rapid ventricular response D. Sinus tachycardia with premature atrial complexes
C
The nurse is taking a history on a patient recently diagnosed with heart failure. The patient admits to "sometimes having trouble catching my breath"but is unable to provide more specific details. What question does the nurse asked together more data about the patient's symptoms? A. Do you have any medical problems, such as high blood pressure? B. What did your doctor tell you about your diagnosis? C. What was your most strenuous activity in the past week? D. How do you feel about being told that you have heart failure?
C
The nurse is teaching a patient with an implanted cardioverter defibrillator. What instruction does the nurse emphasize to the patient? A. Rest for several hours after an internal defibrillator shock before resuming activities B. Have family members step away during the internal defibrillator shock for safety C. Expect to cope with the discomfort in fear associated with having an ICD shock the heart D. Report any pulse rate higher than what is that on the pacemaker
C
A 65-year-old patient comes to the clinic reporting fatigue. The patient would like to start an exercise program but thinks "anemia might be causing the fatigue." What is the nurse's FIRST action? A. Advise the patient to start out slowly and gradually build strength and endurance B. Obtain an order for a complete blood count and nutritional profile C. Assess the onset, duration, and circumstances associated with the fatigue D. Perform a physical assessment to include testing of strength and tone
C * fatigue is associated with heart failure, CAD, MI
The nurse is taking report on a patient who will be transferred from the cardiac intensive care unit to the general med-surg unit. The reporting nurse states that the S4 is heard on auscultation of the heart. This is MOST closely associated with which situation? A. Heart murmur B. Pericardial friction rub C. Ventricular hypertrophy D. Normal Heart Sounds
C *signs and symptoms: dyspnea; angina; fatigue, syncope, palpitations; mild cardiomegaly; S4 gallop; ventricular dysrhythmia; sudden death common; HF
What is included in post procedural care of a patient after a cardiac catheterization? Select all that apply A. Patient remains on bed rest for 12 to 24 hours B. Patient is placed in a high Fowler's position C. Dressing is assessed for bloody drainage or hematoma D. Peripheral pulses in the affected extremity, as well as skin temperature and color, are monitored with every vital sign check E. Adequate oral and IV fluids are provided for hydration F. Vital signs are monitored every hour for 24 hours
C, D, E
The nurse is teaching a patient with heart failure about signs and symptoms of suggest a return or worsening of heart failure. What does the nurse include in the teaching? Select all that apply A. Rapid weight loss of 3 pounds in a week B. Increase in exercise tolerance lasting 2 to 3 days C. Cold symptoms (cough) lasting more than 3 to 5 days D. Excessive awakening at night to urinate E. Development of dyspnea or angina at rest or worsening angina F. Increased swelling in the feet, ankles, or hands
C, D, E, F
A patient has recently diagnosed with acute heart failure. Which medication order does the nurse question? A. Dobutamine, a beta-adrenergic agonist B. Milrinone, a phosphodiesterase inhibitor C. Levosomendan, a positive inotropic D. Carvedilol, a beta blocker
D
A patient is about to undergo elective cardioversion. The nurse sets the defibrillator for synchronized mode so that the electrical shock is not delivered on the T-wave. This is done to avoid which complication? A. Electrical burns to the skin B. Ventricular standstill C. Arcing from the electrodes D. Ventricular fibrillation
D
A patient is admitted for heart failure and has edema, neck vein distention, and ascites. What is the most reliable way to monitor fluid gain or loss in this patient? A. Check for pitting Adema in the dependent body parts B. Auscultate the lungs for crackles or wheezing C. Assess skin turgor in the condition of mucous membranes D. Where is the patient daily at the same time with the same scale
D
A patient is diagnosed with recurrent supraventricular tachycardia. What does the nurse do in order to accomplish their preferred treatment? A. Placed the patient on the cardiac monitor and perform carotid massage B. Give oxygen and establish IV access for antidysrhythmic drugs C. Assist the provider and attempting atrial overdrive pacing D. Provide information about radio frequency catheter ablation therapy
D
A patient may die without symptoms from which type of cardiomyopathy? A. Dilated cardiomyopathy B. Arrhythmogenic right ventricular cardiomyopathy C. Restrictive cardiomyopathy D. Hypertrophic cardiomyopathy
D
Based on the ideology and the main cause of heart failure, which patient has the greatest need for health promotion measures to prevent heart failure? A. Patient with Alzheimer's B. Patient with cystitis C. Patient with asthma D. Patient with hypertension
D
The nurse is reviewing diagnostic test results for a patient who is hypertensive. Which lab results is an early warning sign of decreased her compliance and prompt the nurse to immediately notify the healthcare provider? A. Normal BNP B. Decreased hemoglobin C. Elevated thyroxine (T4) D. Presence of microalbuminuria
D
The nurse is taking a history and vital signs on a patient who is come to the clinic for a routine check up. The patient has a pulse rate of 50 bpm but denies any distress. What does the nurse to next? A. Give supplemental oxygen B. Establish IV access C. Complete a health history D. Check the blood pressure
D
After report on the following patients, which of these four patients should the nurse assess FIRST? A. A client post cardiac catheterization is complaining of a headache rated 2/10 and requesting pain meds B. A client post coronary artery bypass graft is complaining of aching chest pain rated 3/10, BP 140/72, pulse 92, and RR 22 C. A client with end-stage HF, a DNR, BP 82/50, pulse 52, and SpO2 86% D. A client post angiography with stent placement has new onset atrial fibrillation with rapid ventricular response and a rate of 140 bom
D. A client post angiography with stent placement has new onset atrial fibrillation with rapid ventricular response and a rate of 140 bpm *this client is at greater risk of immediate life-threatening condition
coronary artery disease (CAD) symptoms
•chest pain •palpitations •dyspnea •fatigue •cough •hemoptysis (coughing up blood) • syncope *remember LIPIDS: low energy, irritating cough/hemoptysis, palpitations, intense chest pain, dyspnea, syncope!
myocardial infarction (MI) symptoms
Pain or discomfort in: •substernal chest pain/pressure radiating to the left arm •jaw, back, shoulder, or abdomen •typically the morning without cause •lasting 30 min or longer -often relieved with opioids Frequent associated symptoms: •nausea/vomiting •diaphoresis •dyspnea •feelings of fear and anxiety •dysrhythmias •fatigue •palpitations •epigastric distress •dizziness •disorientation/acute confusion •feeling short of breath
