Chapter 13 Sherpath cardiovascular alterations

Which information does the nurse include when instructing a patient about to undergo cardiac resynchronization therapy (CRT) for ventricular dysrhythmia? A. "This is a permanent pacemaker with an extra lead in the left ventricle." B. "The battery for the pacemaker will need to be replaced every 5 years." C. "It is a temporary pacemaker used until a permanent one can be inserted." D. "You will have a pulse generator implanted on the right side of your chest."

A. "This is a permanent pacemaker with an extra lead in the left ventricle." Rationale: CRT is permanent pacing with an additional lead in the left ventricle. This therapy is used for patients with heart failure and provides biventricular pacing to synchronize contractions of both ventricles. Pacemakers are powered by lithium batteries that last approximately 7 to 10 years. CRT is permanent pacing and not a temporary pacemaker that is inserted through the skin or a vein. For a pacemaker, a pulse generator is attached to the leads and implanted under the skin, usually on the left side of the chest.

Which issue would the nurse suspect is occurring when intermittent bubbling occurs in the water-seal chamber of a patient's pleural chest tube that was inserted after coronary artery bypass grafting (CABG)? A. An air leak is present. B. The suction needs to be increased. C. Subcutaneous emphysema is developing. D. The collection cannister needs to be changed.

A. An air leak is present. RationaleIntermittent bubbling in the water-seal chamber of a pleural chest tube indicates an air leak from the pleural space. Bubbling does not indicate that the suction needs to be increased but rather that there is a leak somewhere in the system. Subcutaneous emphysema would be palpated around the insertion site of the chest tube. Bubbling does not indicate that the collection cannister needs to be changed. The collection canister would be changed when there is no longer room for fluid to drain in the collection chamber.

Which problem would the nurse add to the plan of care for a patient who states, "I think I'm dying when the chest pain occurs?" A. Anxiety B. Lung congestion C. Excess fluid volume D. Deconditioning

A. Anxiety Rationale: The problem of anxiety would address the patient's fear of dying when the chest pain occurs. The problems of lung congestion and excess fluid volume would be more appropriate if the patient were experiencing heart failure. Deconditioning would be applicable for the patient recovering from a myocardial infarction.

Which action would the nurse take when caring for a patient recovering from a transesophageal echocardiography (TEE)? A. Assess for return of the gag reflex. B. Monitor the access site for bleeding. C.Analyze left ventricular ejection fraction (LVEF) percentage. D. Prepare for discharge after the heart rate returns to baseline.

A. Assess for return of the gag reflex. Rationale: Because an ultrasound probe is inserted into the esophagus during a TEE, the patient is unable to eat until the gag reflex returns. There is no specific access site for a TEE. The test is used to visualize heart valves, valvular function, endocarditis, heart defects, masses, tumors, and emboli; it does not determine the LVEF. The heart rate is not increased during a TEE.

Which outcome of left-sided heart failure (HF) would the nurse explain to a patient? A. Decreased perfusion B. Reduced respiratory rate C. Decreased peripheral vascular tone D. Reduced amount of blood in the left ventricle

A. Decreased perfusion Rationale: In left-sided HF, the left ventricle cannot pump efficiently. The ineffective pumping action causes a decrease in cardiac output, leading to poor perfusion. When gas exchange is impaired and carbon dioxide levels increase, the respiratory rate increases to help eliminate the excess carbon dioxide. When compensatory mechanisms are activated, blood is redistributed to critical organs by increasing peripheral vascular tone. The volume of blood remaining in the left ventricle increases after each beat.

Which patient action indicates to the nurse that teaching about angina was effective? A. Enrolls in a smoking cessation program B. Walks around the room when chest pain occurs C. Stands in place after taking a nitroglycerin tablet D. Orders a steak and creamed spinach on the dinner menu

A. Enrolls in a smoking cessation program RationaleEnrolling in a smoking cessation program indicates the patient is taking an action to reduce the risk factors for angina. Walking around the room during chest pain indicates that the patient does not understand the need to rest when chest pain occurs. Standing in place indicates that the patient does not understand the need to sit or recline after taking a nitroglycerin tablet because of the risk for orthostatic hypotension. Ordering a high-fat meal indicates that the patient does not understand the need to reduce fat intake to limit the development of coronary artery disease, which contributes to anginal pain.

Under which circumstance would the nurse expect a patient with angina to experience pain related to an increased oxygen demand? Select all that apply. One, some, or all responses may be correct. A. Fever B. Anemia C. Exercise D. Eating a large meal E. Lower extremity edema

A. Fever C. Exercise D. Eating a large meal E. Lower extremity edema Rationale: Angina occurs when oxygen demand is higher than the supply. Factors that increase oxygen demand by increasing the heart rate include fever, exercise, and eating a large meal. Factors that increase oxygen demand because of increased preload include volume overload, which would be evident by the lower extremity edema. Anemia is a factor that reduces oxygen supply.

Which potential complication would the nurse teach to a patient who had an acute myocardial infarction (AMI)? A. Heart failure B. Aortic dissection C. Valve dysfunction D. Pulmonary hypertension

A. Heart failure Rationale: Complications of AMI include heart failure. Aortic dissection is associated with hypertension. Valve function is not associated with AMI. Pulmonary hypertension is not a complication of an AMI.

Which assessment would the nurse complete in a patient demonstrating signs of a sympathetic nervous system effect on the cardiovascular system? Select all that apply. One, some, or all responses may be correct. A. Heart rate B. Capillary refill C. Blood pressure D. Cardiac rhythm E. Current serum potassium level

A. Heart rate C. Blood pressure Rationale: Beta-adrenergic effects on the cardiovascular system include accelerated atrioventricular conduction time, which would increase the heart rate. A beta- adrenergic effect would also increase the blood pressure. Beta-adrenergic effects on the cardiovascular system would not affect capillary refill time, the rhythm of the heart, or the serum potassium level.

Which symptom indicates to the nurse that a female patient may be experiencing cardiac ischemia? Select all that apply. One, some, or all responses may be correct. A. Nausea B. Vomiting C. Palpitations D. Substernal chest pain E. Intermittent pain in the arms

A. Nausea B. Vomiting C. Palpitations Rationale: Females tend to have less severe symptoms of cardiac ischemia, including nausea, vomiting, and palpitations. Substernal chest pain is a classic sign of cardiac ischemia that is more likely to occur in males. Intermittent pain in the arms could indicate cardiac ischemia or another noncardiac related disease process.

Which type of angina would the nurse identify in a patient who describes chest pain that occurs with exercise and is relieved with rest? A. Stable B. Variant C. Unstable D. Prinzmetal

A. Stable Rationale: Stable angina occurs with exertion and is relieved by rest. Variant angina is caused by coronary artery spasms and often occurs at rest without other precipitating factors. Unstable angina pain is often more severe, may occur at rest, and requires more frequent nitrate therapy. It is sometimes described as crescendo (increasing) in nature. Prinzmetal's angina is another term for variant angina.

The nurse visits the home of a patient recovering from the implantation of a cardioverter-defibrillator (ICD). Which observation indicates that the patient requires additional teaching about the device? A. Uses a razor blade to shave B. Wears a medical alert bracelet C. Writes down when the device fires D. Keeps a smartphone in right pants pocket

A. Uses a razor blade to shave Rationale: For everyday activities, an electric razor is safer to use because the patient could accidentally injure the face and bleed when shaving with a razor blade. A medical alert bracelet should be worn as a form of identification about the device. The times when the device fires should be documented by the patient. Because cellular phones should be kept at least 6 inches away from the device, placing the smartphone in the right pants pocket is appropriate.

Which action would the nurse take when a patient with heart failure (HF) develops a productive cough? Select all that apply. One, some, or all responses may be correct. A. Provide mouth care. B. Auscultate lung sounds. C. Assess for peripheral edema. D. Remove salt from the meal tray. E. Restrict oral fluids as prescribed.

ABCDE Rationale: A productive cough in the patient with HF could indicate the development of pulmonary edema. Despite the excess fluid, the patient would experience dry mucous membranes, which would be soothed with frequent mouth care. Lung sounds should be assessed for accumulation of excess fluid. The extremities, abdomen, and sacrum should be assessed for the accumulation of fluid in the periphery. The use of salt increases fluid retention and removing it from the meal tray would help prevent further accumulation of fluid. A fluid restriction would be prescribed to further reduce the accumulation of fluid.

Which statement indicates to the nurse that a patient is experiencing side effects from the ezetimibe being given to reduce cholesterol level? A. "I believe this medicine is giving me heartburn." B. "I sneeze constantly since taking this medication." C. "I bled for nearly an hour the last time I accidentally cut myself." D. "I have a strange metallic taste in my mouth that won't go away."

B. "I sneeze constantly since taking this medication." Rationale: Side effects of ezetimibe include sneezing. Bile acid sequestrants can cause heartburn. Bleeding is a side effect of medications used to prevent platelet adhesion and aggregation, such as aspirin and clopidogrel. A metallic taste in the mouth is a common side effect of nicotinic acid.

Which patient statement indicates to the nurse that teaching to reduce cardiac workload and oxygen consumption related to heart failure was effective? A. "I will stay on bedrest at home." B. "I will rest between activities at home." C. "I will plan to take a nap every afternoon." D. "I will resume my usual activities at home."

B. "I will rest between activities at home." Rationale: Nursing measures that reduce cardiac workload and oxygen consumption include the scheduling of rest periods and the modification of activities of daily living. The patient does not need to stay on bedrest but rather should advance activity as tolerated. A nap every afternoon is not necessary. Usual activities of daily living should be completed as tolerated.

Which statement indicates to the nurse that teaching provided to a patient prescribed sublingual nitroglycerin for angina was effective? A. "I will chew a tablet if chest pain occurs." B. "I will stop taking my medication for erectile dysfunction." C. "I will take up to five tablets before contacting emergency services." D. "I will swallow another tablet if chest pain does not subside in 15 minutes."

B. "I will stop taking my medication for erectile dysfunction." Rationale: Nitroglycerin is a nitrate, which should not be taken with medications used to treat erectile dysfunction. The route for the medication is sublingual, which means it should be placed under the tongue and not chewed. The patient would be instructed to take up to three doses of the medication and to notify emergency services if the pain does not subside after the third dose. The medication is not swallowed, and emergency services should be contacted if the pain does not subside after the third dose.

Which response would the nurse make when a patient with coronary artery disease (CAD) asks how fatty streaks developed in the blood vessels? A. "Your body makes too many foam cells, which caused the arteries to change shape." B. "It started with an injury to the inner lining of the arteries by smoking or hypertension." C. "A layer of cholesterol in the arteries caused platelets to accumulate and adhere to the area." D. "High-density lipoprotein, a type of cholesterol, is elevated and coated the inner arterial lining."

B. "It started with an injury to the inner lining of the arteries by smoking or hypertension." Rationale: Atherosclerosis is an inflammatory disease that progresses from endothelial injury to fatty streak, plaque, and complex lesion. The process begins with injury to the endothelium caused by cardiac risk factors, such as smoking and hypertension. Cytokines and low-density lipoproteins stimulate vascular smooth cell proliferation, which leads to vascular remodeling. Rupture of a fibrotic plaque causes platelets to aggregate to the injured arterial wall area. The oxidation of low-density lipoproteins leads them to penetrate the arterial wall and create foam cells, which then leads to vascular remodeling and eventual fatty streak formation.

Which information would the nurse include when teaching a patient with heart failure (HF) about an angiotensin-converting enzyme (ACE) inhibitor? A. "It will regulate your heart beat." B. "It will slow the progression of the disease." C. "It will reduce the cough you are experiencing." D. "It will remove the excess fluid from your body."

B. "It will slow the progression of the disease." Rationale: An ACE inhibitor is used in the treatment of HF to slow the progression of the disease. Digoxin is used to regulate the heart rate. An angiotensin II receptor antagonist can be used for patient who experience a cough from an ACE inhibitor. Diuretics are used to remove excess fluid from the body.

Which information would the nurse include when teaching a patient with coronary artery disease (CAD) about nicotinic acid? Select all that apply. One, some, or all responses may be correct. A. "The drug is to be taken before breakfast." B. "The prescribed dose is to be taken at night with food." C. "The medication is to be taken on an empty stomach." D. "Take this medication separately from other medications you take." E. "Take one 325 mg nonenteric coated aspirin tablet 30 minutes before a dose."

B. "The prescribed dose is to be taken at night with food." D. "Take this medication separately from other medications you take." E. "Take one 325 mg nonenteric coated aspirin tablet 30 minutes before a dose." Rationale: Nicotinic acid reduces total cholesterol, low-density lipoprotein, and triglyceride levels and increases high-density lipoprotein levels. It should be taken at night with food to reduce side effects. Because nicotinic acid affects the absorption of other medications, it is to be taken separately from other medications. Taking a 325 mg nonenteric coated aspirin tablet 30 minutes before nicotinic acid helps reduce the side effects.

Which symptom indicates to the nurse that a patient recovering from surgery to repair an abdominal aortic aneurysm requires intervention to prevent ischemic colitis? A. Bloody emesis B. Abdominal pain C. Increased flatus D. Clay-colored stools

B. Abdominal pain Rationale: Nursing care after surgery to repair an abdominal aortic aneurysm includes assessing for ischemic colitis. A symptom of this condition is abdominal pain. Bloody emesis is a symptom of an upper gastrointestinal bleed. Flatus is not an indication of ischemic colitis; it is a sign of returning bowel motility. Clay-colored stools indicate an absence of bile, which would not occur in ischemic colitis.

For which reason would the nurse question the use of fibrinolytic therapy as treatment for a patient with acute coronary syndrome (ACS)? A. History of stable angina B. Absent ST-segment elevation C. Symptoms present for an hour D. Previous deep vein thrombosis

B. Absent ST-segment elevation Rationale: Fibrinolysis is not effective in the treatment of an acute myocardial infarction (AMI) without ST-segment elevation (NSTEMI). Stable angina is not a contraindication for fibrinolytic therapy. The best outcomes occur in patients who are treated within 1 to 2 hours of the onset of symptoms. A previous deep vein thrombosis is not a contraindication for fibrinolytic therapy.

Which action would the nurse take for a patient who develops a third heart sound? A. Encourage ambulation twice a day. B. Assess breath sounds every 4 hours. C. Encourage oral fluid intake to 3 L/day. D. Monitor cardiac monitor for ventricular dysrhythmia.

B. Assess breath sounds every 4 hours. Rationale: A third heart sound or ventricular gallop is often heard in patients with heart failure or fluid overload. The nurse should assess breath sounds every 4 hours to monitor for the development of pulmonary edema. Ambulation would not be encouraged in the patient with heart failure or fluid overload. Oral fluids would not be encouraged because this would increase the risk for worsening fluid overload. A third heart sound is not associated with a ventricular dysrhythmia.

Which assessment would the nurse include when performing a focused examination of a patient with coronary artery disease (CAD)? Select all that apply. One, some, or all responses may be correct. A. Orientation B. Heart rhythm C. Blood pressure D. Apical heart rate E. Degree of mottling

B. Heart rhythm C. Blood pressure D. Apical heart rate Rationale: When performing a focused examination that involves the cardiovascular system, the nurse's focus would be on heart rhythm, blood pressure, and apical heart rate. Orientation is associated with the neurological assessment. Degree of mottling is associated with the skin assessment.

Which medication would the nurse question giving to a patient with a ventricular dysrhythmia? Select all that apply. One, some, or all responses may be correct. A. Sotalol B. Ibutilide C. Diltiazem D. Flecainide E. Propafenone

B. Ibutilide C. Diltiazem Rationale: Ibutilide prolongs the duration of action potential and the refractory period in the treatment of atrial fibrillation or atrial flutter. Diltiazem inhibits calcium ion influx into the myocardium in the treatment of atrial fibrillation or atrial flutter. Sotalol is a nonselective beta-blocker used in the treatment of ventricular dysrhythmias. Flecainide decreases conduction in all parts of the heart and is used to treat ventricular dysrhythmias. Propafenone stabilizes the cardiac member to slow the conduction velocity in the treatment of ventricular dysrhythmias.

Which action would the nurse take when a patient with an aortic aneurysm reports sudden severe anterior chest pain? A. Auscultate heart sounds. B. Measure blood pressure. C. Elevate the head of the bed. D. Obtain a prescription for oxygen.

B. Measure blood pressure Rationale: Severe anterior chest pain in a patient with an aortic aneurysm is a symptom of an ascending aorta dissection. Because the immediate goal is to control blood pressure, a baseline measurement would be measured at the onset of the pain. A murmur is not always a symptom of a dissecting aortic aneurysm. Elevating the head of the bed has minimal therapeutic value to the patient with a dissecting aortic aneurysm. Time should not be taken away from the patient's bedside to obtain a prescription for oxygen.

Which action would the nurse take when a patient with an aortic aneurysm reports sudden severe anterior chest pain? A. Auscultate heart sounds. B. Measure blood pressure. C. Elevate the head of the bed. D. Obtain a prescription for oxygen.

B. Measure blood pressure. Rationale: Severe anterior chest pain in a patient with an aortic aneurysm is a symptom of an ascending aorta dissection. Because the immediate goal is to control blood pressure, a baseline measurement would be measured at the onset of the pain. A murmur is not always a symptom of a dissecting aortic aneurysm. Elevating the head of the bed has minimal therapeutic value to the patient with a dissecting aortic aneurysm. Time should not be taken away from the patient's bedside to obtain a prescription for oxygen.

Which action would the nurse take for a patient recovering from placement of a stent during percutaneous transluminal coronary angioplasty (PTCA)? A. Increase IV fluids as prescribed. B. Monitor pulses on the affected extremity. C. Provide a dose of aspirin 325 mg by mouth. D. Keep the head of bed elevated 45 degrees.

B. Monitor pulses on the affected extremity. Rationale: After stent placement through a PTCA, the peripheral pulses of the affected extremity would be monitored because the femoral artery may have been occluded or injured during the procedure. IV fluids would not need to be increased. The patient would be prescribed aspirin 81 mg by mouth (not 325 mg) for an indefinite period of time. The head of the bed should be flat until bleeding from the insertion site has stopped.

Which disease process would the nurse suspect in a patient who develops pleuritic pain after an acute myocardial infarction (AMI)? A. Angina B. Pericarditis C. Endocarditis D. Heart failure

B. Pericarditis Rationale: Pericarditis is an acute or chronic inflammation of the pericardium. It may occur as a consequence of an AMI and is characterized by pleuritic pain that is worse with inspiration and cough. Angina does not cause pleuritic pain. Endocarditis does not occur after an AMI and is not characterized by pleuritic pain. Heart failure does not cause pleuritic pain.

Which assessment would the nurse prioritize when a patient with pulmonary edema caused by heart failure (HF) receives IV diuretics? A. Heart rate B. Urinary output C. Pulse oximetry D. Cardiac rhythm

B. Urinary output Rationale: Diuretic therapy is used to treatment pulmonary edema. Urinary output would be monitored hourly as the priority to assess the effectiveness of this therapy. The nurse would continue to assess heart rate, pulse oximetry, and cardiac rhythm; however, these assessments are not the priority when determining the efficacy of the diuretic.

Which statement indicates to the nurse that teaching provided to a patient with a 1-cm abdominal aortic aneurysm was effective? A. "I am at high risk for the aneurysm to rupture." B."I will need to have the size of the aneurysm checked periodically." C. "I should expect to experience abdominal pain because of the aneurysm." D. "I must plan to have surgery to repair the aneurysm as soon as possible."

B."I will need to have the size of the aneurysm checked periodically." Rationale: An aneurysm of 1 cm is considered small. Because of this, patients with smaller aneurysms are followed up diagnostically for any change in size. Aneurysms larger than 6 cm are the highest risk for a rupture. Abdominal pain in a patient with abdominal aortic aneurysm would indicate a rupture. Abdominal aortic aneurysms 5 cm or larger are usually surgically repaired.

Which statement indicates to the nurse that teaching provided to a patient about radiofrequency catheter ablation to treat atrial fibrillation was effective? A."There will be wires inserted into both ventricles of my heart." B. "It is essential for me to avoid magnetic fields after having this procedure." C. "After every energy transmission, I will be retested to make sure all areas are destroyed." D. "I will have a defibrillator implanted that will discharge when my heart rhythm becomes erratic."

C. "After every energy transmission, I will be retested to make sure all areas are destroyed." Rationale: During radiofrequency catheter ablation, a catheter with an electrode is positioned at the abnormal pathway and mild, painless radiofrequency energy is transmitted to cause coagulation and necrosis of the tissue causing the dysrhythmia. After each ablation attempt, the patient is retested until there is no recurrence of the dysrhythmia. Wires are inserted into both ventricles with a biventricular pacemaker. The patient would need to avoid magnetic fields if a cardioverter-defibrillator were implanted. A defibrillator is not implanted during a radiofrequency catheter ablation.

Which teaching would the nurse provide to a patient who is prescribed a beta-adrenergic blocking agent as treatment for angina? A. "Expect to experience shortness of breath." B. "Stop taking the medication if fatigue occurs." C. "Check the pulse on your wrist before each dose." D. "Swelling of the feet and ankles is an expected effect."

C. "Check the pulse on your wrist before each dose." Rationale: The nurse would instruct the patient to check their pulse on a regular basis. Shortness of breath is not an expected side effect of this medication and should be reported to the healthcare provider. Fatigue is an expected side effect; however, the medication should not be stopped abruptly. Edema of the feet and ankles is not an expected effect of a beta-blocker and should be reported to the healthcare provider.

Which statement by the patient indicates to the nurse that teaching provided about a Holter monitor was effective? A. "I will get an injection before the function of the left side of my heart is studied." B."I will have an ultrasound to look at the motion and function of my heart valves and chambers." C. "I will perform my usual daily activities and write down any symptoms in a journal if they occur." D. "I will have an electrocardiogram to record any changes that occur while riding a stationary bicycle."

C. "I will perform my usual daily activities and write down any symptoms in a journal if they occur." Rationale: For a Holter monitor, the patient would be instructed to engage in normal daily activities and keep a log of all activities and symptoms during the monitoring period. For a multigated blood acquisition (MUGA) study—not a Holter monitor— an isotope is injected to assess the left ventricular ejection fraction. In echocardiography, an ultrasound is used to visualize the motion and function of cardiac valves and chambers. During an exercise tolerance test (ETT), an electrocardiogram records cardiac functioning while the patient engages in exercise, such as riding a stationary bicycle.

Which statement would the nurse make when explaining the function of the left atrium to a patient? A. "It pumps oxygenated blood to the body." B."It pumps deoxygenated blood to the lungs." C. "It receives oxygenated blood from the lungs." D. "It receives deoxygenated blood from the body."

C. "It receives oxygenated blood from the lungs." Rationale: The left atrium receives oxygenated blood from the lungs via the pulmonary veins. The left ventricle pumps oxygenated blood to the body through the systemic circulation. The right ventricle pumps deoxygenated blood to the lungs through the pulmonary artery. The right atrium receives deoxygenated blood from the body through the superior and inferior vena cava.

For which reason would the nurse notify the healthcare provider when a patient develops a new onset of anginal pain? A. Cardiac cells are dying. B. Fluid overload is developing. C. A myocardial infarction could occur. D. The level of circulating oxygen has increased.

C. A myocardial infarction could occur. Rationale: Angina is the chest pain associated with myocardial ischemia. It is transient and does not cause cell death. Nevertheless, angina may be a precursor to cell death from a myocardial infarction, which is why the healthcare provider must be notified. Volume overload is one reason for an increase in oxygen demand; however, this does not indicate the development of angina. With anginal pain comes a decreased level of circulating oxygen.

Which action would the nurse question before completing an autotransfusion of drainage collected from the mediastinal tube of a patient recovering from coronary artery bypass grafting (CABG)? A. Complete the autotransfusion in 4 hours. B. Use a pressure bag to infuse the drainage. C. Add heparin 1000 units to the drainage before infusing. D. Attach a microaggregate filter to the autotransfusion tubing.

C. Add heparin 1000 units to the drainage before infusing. Rationale: Anticoagulants such as heparin may be added to the autotransfusion system; however, this is not necessary when autotransfusing mediastinal drainage. The autotransfusion should be completed within a 4-hour period. A pressure bag may be used for the autotransfusion. A microaggregate filter should be applied to the autotransfusion tubing.

Which condition would the nurse identify as the underlying cause in the development of coronary artery disease (CAD)? A. Diabetes B. Hypertension C. Atherosclerosis D. Hypercholesterolemia

C. Atherosclerosis Rationale: CAD is the result of progressive narrowing of one or more coronary arteries by atherosclerosis. Diabetes is a risk factor (not the underlying cause) for the development of CAD because of increased levels of low-density lipoproteins (LDL) and triglycerides. Hypertension is also a risk factor for the development of CAD because it causes direct injury to the vasculature. Hypercholesterolemia, or specifically high levels of LDL, is a risk factor for the development of CAD because of the depositing of cholesterol in the arterial vessels.

About which medication would the nurse instruct a patient with Marfan syndrome who is diagnosed with an aortic aneurysm? A. Nitrate B. Diuretic C. Beta-blocker D. Angiotensin-converting enzyme (ACE) inhibitor

C. Beta-blocker Rationale: For the patient with Marfan syndrome diagnosed with an aortic aneurysm, treatment is directed at controlling systolic blood pressure and decreasing the force of contraction of the heart. Because of this, beta-blockers are the initial pharmacological treatment of choice. Nitrates are not used in the treatment of an aortic aneurysm. Diuretics would be ineffective in the treatment of an aortic aneurysm. An ACE inhibitor is not indicated in the treatment of an aortic aneurysm.

Which treatment would the nurse anticipate for a patient with a right ventricular inferior wall infarction? A. Angioplasty B. Nitroglycerin C. IV fluids D. Thrombolytic therapy

C. IV fluids Rationale: The treatment for a right ventricular infarct is usually fluid therapy. Angioplasty, nitroglycerin, and thrombolytic therapy are used to treat an acute myocardial infarction that affects another heart structure.

Which technique would the nurse use to assess a patient with angina? A. Palpation B. Percussion C. Observation D. Laboratory values

C. Observation Rationale: Assessment of the patient with actual or suspected angina involves continual observation of the patient and monitoring of signs, symptoms, and diagnostic findings. The techniques of palpation and percussion are not used to assess a patient with angina. There are no specific laboratory values used to assess a patient with angina.

Which symptom would the nurse identify as a result of the renin- angiotensin-aldosterone system in a patient with heart failure (HF)? A. Tachypnea B. Tachycardia C. Peripheral edema D. Pulmonary edema

C. Peripheral edema Rationale: Angiotensin II is a potent vasoconstrictor that promotes salt and water retention by stimulation of aldosterone release. Sodium reabsorption increases, and this, in turn, increases blood volume. In patients with impaired function, the heart is unable to handle the extra volume effectively, resulting in peripheral edema. In HF, when gas exchange is impaired and carbon dioxide levels increase, the respiratory rate increases (tachypnea) to help eliminate the excess carbon dioxide. Activation of the adrenergic nervous system produces tachycardia in efforts to decrease preload and decrease stroke index. In left-sided HF, the volume of blood remaining in the left ventricle increases after each beat. As this volume increases, it backs up into the left atrium, pulmonary veins, and the lungs, causing pulmonary congestion and edema.

Which statement indicates to the nurse that a patient is attempting to address a modifiable risk factor for the development of coronary artery disease (CAD)? A. "I will change from smoking cigarettes to pipe-smoking." B. "I will find out at which age my mother had a heart attack." C."I will increase my physical activity after talking with my healthcare provider." D. "I will follow a low-calorie low-carbohydrate diet so I don't gain any more weight."

C."I will increase my physical activity after talking with my healthcare provider." Rationale: Modifiable risk factors for the development of CAD include smoking, physical activity, and obesity. Regular aerobic exercise reduces the risk for CAD; however, it should be discussed with the healthcare provider before beginning. Changing from one method of smoking tobacco to another method does not decrease the risk for CAD. A family history of CAD is a nonmodifiable risk factor. The patient should follow a low-fat low-cholesterol diet to reduce weight and not just prevent additional weight gain.

Which nursing statement explains the reason for a patient recovering from an acute myocardial infarction (AMI) to be prescribed an angiotensin-converting enzyme (ACE) inhibitor? A. "It will make your arteries wider and reduce pain." B. "It dissolves the clot that is blocking the artery in your heart." C."It stops the structure of the heart tissue from changing shape." D. "It reduces the amount of oxygen used by your heart to function."

C."It stops the structure of the heart tissue from changing shape." Rationale: ACE inhibitors are used to stop the ventricular remodeling that can occur after an AMI. Nitrates are vasodilators that reduce pain. Fibrinolytic therapy dissolves the clot that is occluding the coronary artery. Beta-blockers are used to reduce myocardial oxygen consumption.

Which electrocardiogram (ECG) finding would the nurse anticipate in a patient with a serum potassium level of 5.9 mEq/L? Select all that apply. One, some, or all responses may be correct. A. Prolonged PR interval B. Prolonged QT interval C.Widened QRS complex D. AV conduction changes E. Narrow elevated T waves

C.Widened QRS complex D. AV conduction changes E. Narrow elevated T waves Rationale: A widened QRS complex, AV conduction changes, and narrow elevated T waves on ECG are associated with an increased potassium level. A prolonged PR interval on ECG is associated with an increased calcium level. A prolonged QT interval on ECG is associated with a decreased potassium level.

Which information would the nurse include when teaching a patient with diabetes about a beta-blocker prescribed to treat angina? A. "Reduce your intake of carbohydrates while taking this medication." B."Take the beta-blocker 1 to 2 hours after taking medication to treat your diabetes." C."Sweating when taking this medication indicates that your blood glucose level is elevated." D. "Monitor your blood glucose level closely because signs of a low level can be masked by the medication."

D. "Monitor your blood glucose level closely because signs of a low level can be masked by the medication." Rationale: A side effect of beta-blockers is masking of hypoglycemic episodes. Because of this, patients with diabetes would be instructed to monitor blood glucose levels frequently. Reducing the intake of carbohydrates in a patient with diabetes taking a beta-blocker could exacerbate hypoglycemic episodes. There is no reason for the beta-blocker to be taken 1 to 2 hours after taking diabetes medication. Sweating is the only symptom that would indicate hypoglycemia in the patient with diabetes taking a beta-blocker.

Which statement would the nurse include in a teaching tool about the anatomy of the heart? A. "The right side of the heart is a high-pressure system." B."The atrioventricular valves are the pulmonic and aortic valves." C. "The heart lies behind the upper half of the sternum within the thoracic cavity." D."The endocardium covers the heart valves and the muscles that open the valves."

D. "The endocardium covers the heart valves and the muscles that open the valves." Rationale: The endocardium covers the heart valves and the small muscles that open the valves. The left side of the heart is a high-pressure system. The atrioventricular valves are the tricuspid and mitral valves. The heart lies within the mediastinal space of the thoracic cavity, directly under the lower half of the sternum and above the diaphragm.

Which statement made by the nurse to a patient explains why an aneurysm of the aorta would affect blood flow to the myocardium? A. "The aortic arch vessels supply blood to the atria." B. "The aortic root supports the leaflets of the mitral valve." C. "The descending aorta supplies blood to the posterior ventricles." D. "The right and left coronary arteries branch from the ascending aorta."

D. "The right and left coronary arteries branch from the ascending aorta." Rationale: Branches of the ascending aorta include the right and left coronary arteries, which feed the myocardium. The aortic arch vessels supply blood to the head and upper extremities. The aortic root supports the bases of the three aortic valve leaflets. Branches of the descending aorta supply blood to the distal spinal cord.

For which health problem would the nurse assess a patient who developed an aortic aneurysm? A. Pericarditis B. Endocarditis C. Heart failure D. Atherosclerosis

D. Atherosclerosis Rationale: Atherosclerosis is an underlying cause for the development of an aortic aneurysm in most cases. The development of an aortic aneurysm is not associated with pericarditis. An aortic aneurysm would not develop because of endocarditis. Heart failure is not a precipitating factor for the development of an aortic aneurysm.

Which laboratory value would the nurse monitor to determine the effectiveness of care provided to a patient with heart failure (HF)? A. Serum sodium B. Liver function studies C. Complete blood count D. B-type brain natriuretic peptide

D. B-type brain natriuretic peptide Rationale: B-type (brain) natriuretic peptide is a cardiac hormone that reflects the severity of HF. As the HF is treated, this test is used to assess the response to therapies. Serum sodium level would be used to determine the severity of HF. Liver function studies are used to determine the degree of hepatic congestion. A complete blood count is used to assess for anemia.

Which data would the nurse use to determine if a patient recovering from coronary artery bypass grafting (CABG) is developing postoperative hypovolemia? A. Breath sounds B. Blood pressure C. Cardiac rhythm D. Chest tube drainage

D. Chest tube drainage Rationale: Drainage from the mediastinal tube is one criterion used to determine if a patient is developing hypovolemia after CABG. Breath sounds are not used to determine the development of hypovolemia but may be used to assess for hypovolemia or excessive fluid volume. Blood pressure is used to determine if hypotension is developing. Cardiac rhythm is used to determine if a complication is developing.

Which action would the nurse take after a patient recovering from coronary artery bypass grafting (CABG) is extubated? A. Provide ice chips. B. Strip the mediastinal chest tube. C. Provide warm fluids to reduce vocal hoarseness. D. Coach the patient to deep breathe and cough every hour while awake.

D. Coach the patient to deep breathe and cough every hour while awake. RationaleOnce the patient is extubated after a CABG, pulmonary hygiene would be promoted every 1 to 2 hours while the patient is awake. Ice chips are not necessary after extubation. Chest tubes are not stripped because this causes an increase in high negative pressure in the system. The gag reflex should be assessed before providing the patient with food or fluids. Warm fluids are not required to reduce voice hoarseness after extubation.

Which assessment finding indicates to the nurse that a patient with arm paresthesia may have an aortic aneurysm? A. Red-purple lesions on the fingers B. Splinter hemorrhages on the fingernails C. Hemorrhagic lesions on the palms of the hands D. Different blood pressure measurements in the arms

D. Different blood pressure measurements in the arms

Which action would the nurse take when a patient recovering from surgery to repair an aortic aneurysm has a blood pressure of 88/50 mm Hg? A. Monitor cardiac rhythm. B.Assess peripheral pulses. C.Provide a vasodilator as prescribed. D. Increase IV fluids as prescribed.

D. Increase IV fluids as prescribed. Rationale: Nursing care of the patient recovering from surgery to repair an aortic aneurysm includes maintaining the blood pressure within normal limits. A drop in blood pressure or hypotension causes organ ischemia. Because of this, IV fluids should be provided as prescribed. Monitoring the cardiac rhythm would be done to determine if the patient is experiencing a complication. Assessing peripheral pulses would be done to determine if the patient has adequate blood flow to peripheral tissues. A vasodilator would be indicated if the patient were hypertensive.

Which symptom would the nurse identify as being associated with right-sided heart failure (HF)? Select all that apply. One, some, or all responses may be correct. A. Cough B. Fatigue C. Orthopnea D. Jugular vein distention E. Increased abdominal girth

D. Jugular vein distention E. Increased abdominal girth Rationale: Signs and symptoms of right-sided HF are caused by excess volume and include jugular vein distention and increased abdominal girth. Signs and symptoms of left- sided HF are caused by poor pumping action and include a cough, fatigue, and orthopnea.

Which action would the nurse take when hearing a new heart murmur in a patient recovering from an acute myocardial infarction (AMI)? A. Check capillary refill. B. Palpate peripheral pulses. C.Auscultate carotid arteries. D. Notify the healthcare provider.

D. Notify the healthcare provider. Rationale: The presence of a new murmur requires special attention, particularly in a patient with AMI. A papillary muscle may have ruptured, causing the mitral valve to not close correctly, which can be indicative of severe damage and impending complications, such as heart failure and pulmonary edema. Because of this risk, the healthcare provider would be notified. It is not essential for the nurse to assess capillary refill, peripheral pulses, or the carotid arteries.

Which action would the nurse take to enhance the breathing of a patient with heart failure (HF)? A. Elevate the foot of the bed. B. Perform chest physiotherapy. C. Suction the airway as needed. D. Place in semi-Fowler's position.

D. Place in semi-Fowler's position. Rationale: A patient with HF experiencing respiratory distress is more comfortable in a semi- Fowler's position. Elevating the foot of the bed would increase pressure on the diaphragm and adversely effect breathing. Chest physiotherapy is not indicated in the care of a patient with HF. Suctioning is not indicated in the care of a patient with HF.

Alteration in blood flow through which vascular structure contributes to the development of a ventricular dysrhythmia in a patient? Select all that apply. One, some, or all responses may be correct. A. Aorta B. Pulmonary vein C. Inferior vena cava D. Right coronary artery E. Left anterior descending artery

D. Right coronary artery E. Left anterior descending artery Rationale: The right coronary artery provides blood flow to the posterior portion of the left ventricle. The left anterior descending artery provides blood flow to the anterior left ventricle. The aorta, pulmonary vein, and inferior vena cava are not identified as supporting the left ventricle.

Which symptom would the nurse correlate to a dissection of the descending thoracic aorta? A. Chest pain B. Paresthesia of an arm C. Transient ischemic attack D. Transient paralysis of a lower extremity

D. Transient paralysis of a lower extremity Rationale: Branches of the descending thoracic aorta are the intercostal arteries that provide the major blood supply to the distal spinal cord. Dissection of this part of the aorta would cause transient paralysis of a lower extremity. Chest pain is associated with dissection of the aortic arch. Paresthesia of an arm and a transient ischemic attack are associated with dissection of the arch vessels.

Because of which cause would the nurse suspect that an older patient with a history of rheumatic heart disease developed a heart murmur? A. Pericarditis B. Endocarditis C. Aortic aneurysm D. Valvular heart disease

D. Valvular heart disease Rationale: Causes of valvular heart disease include rheumatic heart disease. The disorder can be initially identified by the presence of a murmur on auscultation. Pericarditis causes a friction rub. Endocarditis does not cause a heart murmur. Most aortic aneurysms are asymptomatic; however, back or abdominal pain would occur if the artery ruptures.

Which statement would the nurse make to a patient with acute coronary syndrome about the effects of ischemia on the heart muscle? A. "Limiting blood flow to the heart improves contractility of the ventricles." B. "The heart muscle reacts by limiting cell death to the outer layers of the heart." C. "With ischemia, excess oxygen floods the area and causes the heart to beat erratically." D."Reduced blood flow to the heart muscle limits oxygen to the area and causes cells to die."

D."Reduced blood flow to the heart muscle limits oxygen to the area and causes cells to die." Rationale: Reduced blood flow to an area of the myocardium causes significant and sustained oxygen deprivation to myocardial cells. Normal functioning is disrupted as ischemia and injury lead to eventual cellular death. Limiting blood flow to the heart causes impaired contractility. Cardiac cell death extends from the endocardium to the epicardium as the duration of the occlusion increases. Ischemia is caused by reduced blood flow, which limits oxygenation of the tissues. Excess oxygen would not flood the ischemic area. Ischemia causes the heart to beat erratically.

Which response would the nurse make when a patient with coronary artery disease (CAD) reports feeling fatigued and unable to complete routine household activities? A."This means that you need to get more exercise." B."We must speak with your healthcare provider about the possible need for emergent surgery." C."Your body is getting used to changes and fatigue will continue until all changes are made." D."There is an imbalance between oxygen supply and demand that occurs with tissue ischemia."

D."There is an imbalance between oxygen supply and demand that occurs with tissue ischemia." Rationale: A patient with CAD can have other problems, such as fatigue and decreased exercise tolerance. These problems are caused by an imbalance between oxygen supply and demand that occurs with tissue ischemia. Fatigue and exercise intolerance do not indicate that the patient needs to get more exercise. There is no indication that emergent surgery is needed. The statement made about oxygen supply and demand is vague and does not explain any specific problem associated with CAD.