Chapter 25: Assessment of Cardiovascular Function

What is the gold standard test for coronary artery disease?

Heart Catheterization (Cath Lab)

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition?

Heart failure

What does the distal port of PA catheter with balloon inflated measure? Where is this catheter placed?

Left Ventricular Preload - Located in Pulmonary Artery

Which type of echocardiogram produces a better quality image of the heart?

Trans-Esophageal Echocardiogram

T/F - We want a high level of HDL?

True!

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse?

"Current evidence indicates that estrogen is ineffective as a cardioprotectant; estrogen is actually potentially harmful and is no longer a recommended therapy."

What are some nursing diagnoses for heart catheterization?

1. Risk for bleeding/hemorrhage at puncture site 2. Risk for alteration in perfusion 3. Risk for cardiac dysrhythmias 4. Risk for decreased renal function

What is the normal flow rate of the NS infusion?

3-5 mL/min

What pressure is the NS infusion bag pressurized to?

300 mm Hg (Usually 500 cc NS infusion bag)

21. The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place? A) Apply antibiotic ointment to the insertion site twice daily. B) Change the site dressing whenever it becomes visibly soiled. C) Perform passive range-of-motion exercises to prevent venous stasis. D) Aspirate blood from the device once daily to test pH.

499 *: B Feedback: Gauze dressings should be changed every 2 days or transparent dressings at least every 7 days and whenever dressings become damp, loosened, or visibly soiled. Passive ROM exercise is not indicated and it is unnecessary and inappropriate to aspirate blood to test it for pH. Antibiotic ointments are contraindicated.

The nurse is assessing a patient who reports feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding?

A heart rate of more than 20 bpm above the resting rate

What overall factor can cause decrease in CVP?

Decrease in blood volume (hypovolemia, shock, dehydration, etc.)

What is the purpose of an electrophysiology study?

Determine source of arrhythmias

How is a chest x-ray used as a diagnostic tool?

Determines size, contour, and position of heart

Why is NS used instead of dextrose?

Dextrose can grow bacteria!

Which end of a pulmonary artery catheter is inserted into the pulmonary artery?

Distal End (Usually Yellow)

What is cardiomegaly?

Enlarged Heart

What is the purpose of cardiac stress testing?

Evaluate myocardial blood flow and perfusion

The transducers must be level to which anatomical location for precise measurement?

Phlebostatic Axis (4 ICS - Mid Axillary Line)

What does the Central Venous Pressure (CVP) measure? Where is the catheter placed?

Preload on right side of heart - Placed in right atrium

If a patent is scheduled for a cardiac stress test and complains of chest pain prior to the procedure, should the nurse allow the patient to continue the stress test or prevent the patient from performing the stress test?

Prevent the patient from performing the stress test

You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate?

The client and family understands the discharge instructions.

The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition?

heart failure

The balloon on the distal tip of a pulmonary artery catheter is inflated and the pressure is measured. What is the term for the measurement obtained?

pulmonary artery wedge pressure

During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure?

wheezes with wet lung sounds

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include?

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."

The nurse is assessing vital signs on a client who is 3 months status post myocardial infarction (MI). While the healthcare provider is examining the client, the client's spouse approaches the nurse and states "We are too afraid he will have another heart attack, so we just don't have sex anymore." What is the nurse's best response?

"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

Heath Catheterization Post-Procedure Care

1. Assess VS & O2 sat q15 minutes for 2-3 hours 2. Assess cardiac status / monitor pattern 3. Assess groin puncture site q15 minutes for 2-3 hours - Look for bleeding including behind site 4. Assess pedal pulses q15 minutes for 2-3 hours 5. Immobilize leg with puncture site = bed rest 6. Encourage fluids - flush dye out of body via kidneys - More fluids if renal insufficiency

Which blood chemistry values (minerals) are essential to monitor for hear function?

1. Calcium (8.6 to 10.2 mg/dL) 2. Magnesium (1.3 to 2.3 mEq/dL) ** 3. Potassium (3.5 to 5 mEq/L) **

What are the 2 major sources of cholesterol?

1. Dietary Intake 2. Synthesis in Liver

What are some cardiac test for determining cardiac rhythms?

1. EKG/ECG 2. Haltar Monitor - Wear for 24 hours 3. Event Cardiac Monitoring - Loop recorder placed invasively 4. Trans-Telephonic Monitoring - Place phone over receiver in chest

What are the 2 types of cardiac stress testing?

1. Exercise Stress Test 2. Pharmacologic Stress Test

Heath Catheterization Pre-Procedure Care

1. Informed Consent 2. NPO 8-12 hours before procedure 3. Allergies (Dyes & Medications) 4. Routine Meds 5. Baseline Assessment 6. Locate & mark peripheral pulses 7. Pre-procedure medicines

What are some factors that lower HDL?

1. Smoking 2. Obesity 3. Diabetes 4. Physical Inactivity

What is the normal CVP?

2-6 mm Hg

What is normal PA pressure?

25/10 mm Hg

28. When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood

502 vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply. A) A transducer B) A flush system C) A leveler D) A pressure bag E) An oscillator *: A, B, D Feedback: To perform hemodynamic monitoring, a CVP, pulmonary artery, or arterial catheter is introduced into the appropriate blood vessel or heart chamber. It is connected to a pressure monitoring system that has several components. Included among these are a transducer, a flush system, and a pressure bag. A pressure monitoring system does not have a leveler or an oscillator.

30. The nurse is doing discharge teaching with a patient who has coronary artery disease. The patient asks why he has to take an aspirin every day if he doesnt have any pain. What would be the nurses best response?

503 A) Taking an aspirin every day is an easy way to help restore the normal function of your heart. B) An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks. C) Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely. D) An aspirin a day eventually helps your blood carry more oxygen that it would otherwise. *: B Feedback: An aspirin a day is a common nonprescription medication that improves outcomes in patients with CAD due to its antiplatelet action. It does not affect oxygen carrying capacity or perfusion. Aspirin does not restore cardiac function.

32. The patient has a homocysteine level ordered. What aspects of this test should inform the nurses care? Select all that apply. A) A 12-hour fast is necessary before drawing the blood sample. B) Recent inactivity can depress homocysteine levels. C) Genetic factors can elevate homocysteine levels.

504 D) A diet low in folic acid elevates homocysteine levels. E) An ECG should be performed immediately before drawing a sample. *: A, C, D Feedback: Genetic factors and a diet low in folic acid, vitamin B6 , and vitamin B12 are associated with elevated homocysteine levels. A 12-hour fast is necessary before drawing a blood sample for an accurate serum measurement. An ECG is unnecessary and recent inactivity does not influence the results of the test.

39. The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? (Mark all that apply.) A) Need for careful monitoring for cardiac symptoms B) Need for carefully regulated exercise

507 C) Need for dietary modifications D) Need for early resumption of prediagnosis activity E) Need for increased fluid intake *: A, B, C Feedback: Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing three major cardiovascular risk factors: hyperlipidemia, hypertension, and diabetes. There is no need to increase fluid intake and activity should be slowly and deliberately increased.

What is the normal MAP?

70-90 mm Hg

What is the normal pulmonary artery wedge pressure?

8-12 mm Hg

33. A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure? A) The test is noninvasive, and nothing will be inserted into the patients body. B) The patients pain will be managed aggressively during the procedure. C) The test will provide a detailed profile of the hearts electrical activity. D) The patient will remain on bed rest for 1 to 2 hours after the test.

: A Feedback: Before transthoracic echocardiography, the nurse informs the patient about the test, explaining that it is painless. The test does not evaluate electrophysiology and bed rest is unnecessary after the procedure.

18. The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response? A) Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are. B) Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts. C) Cardiac catheterization is usually done to evaluate cardiovascular response to stress. D) Cardiac catheterization is most commonly done to evaluate cardiac electrical activity.

: A Feedback: Cardiac catheterization is usually used to assess coronary artery patency to determine if revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.

29. The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located? A) SA node B) AV node C) Bundle of His D) Purkinje cells

: A Feedback: The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).

37. A patients declining cardiac status has been attributed to decreased cardiac action potential. Interventions will be aimed at restoring what aspect of cardiac physiology? A) The cycle of depolarization and repolarization B) The time it takes from the firing of the SA node to the contraction of the ventricles C) The time between the contraction of the atria and the contraction of the ventricles D) The cycle of the firing of the AV node and the contraction of the myocardium

: A Feedback: This exchange of ions creates a positively charged intracellular space and a negatively charged extracellular space that characterizes the period known as depolarization. Once depolarization is complete, the exchange of ions reverts to its resting state; this period is known as repolarization. The repeated cycle of depolarization and repolarization is called the cardiac action potential.

34. A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply. A) Pneumothorax B) Infection C) Atelectasis D) Bronchospasm E) Air embolism

: A, B, E * 505 Feedback: Complications from use of hemodynamic monitoring systems are uncommon, but can include pneumothorax, infection, and air embolism. Complications of hemodynamic monitoring systems do not include atelectasis or bronchospasm.

25. The nurses assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the patients plan of care? A) Risk for ineffective breathing pattern related to hypotension B) Risk for falls related to orthostatic hypotension C) Risk for ineffective role performance related to hypotension D) Risk for imbalanced fluid balance related to hemodynamic variability

: B * 501 Feedback: Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompanies it. It does not normally affect breathing or fluid balance. The patients ability to perform normal roles may be affected, but the risk for falls is the most significant threat to safety.

38. A patient has been scheduled for cardiovascular computed tomography (CT) with contrast. To prepare the patient for this test, what action should the nurse perform? A) Keep the patient NPO for at least 6 hours prior to the test. B) Establish peripheral IV access. C) Limit the patients activity for 2 hours before the test. D) Teach the patient to perform incentive spirometry.

: B Feedback: An IV is necessary if contrast is to be used to enhance the images of the CT. The patient does not need to fast or limit his or her activity. Incentive spirometry is not relevant to this diagnostic test.

31. The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis? A) Immunosuppression B) Inflammation C) Infection D) Hemostasis

: B Feedback: High-sensitivity CRP is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis.

2. During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI? A) Left midclavicular line of the chest at the level of the nipple B) Left midclavicular line of the chest at the fifth intercostal space C) Midline between the xiphoid process and the left nipple D) Two to three centimeters to the left of the sternum

: B Feedback: The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.

26. A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis? A) Pleurisy B) Heart failure C) Valve dysfunction D) Cardiomyopathy

: B Feedback: The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.

8. The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what? A) Development of an atrial-septal defect B) Myocardial ischemia C) Formation of a pulmonary embolism D) Release of potassium ions from cardiac cells

: B Feedback: Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Patients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.

24. The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply. A) Loop connectivity B) Excitability C) Automaticity D) Conductivity E) Independence

: B, C, D Feedback: Three physiologic characteristics of two types of specialized electrical cells, the nodal cells and the Purkinje cells, provide this synchronization: automaticity, or the ability to initiate an electrical impulse; excitability, or the ability to respond to an electrical impulse; and conductivity, the ability to transmit an electrical impulse from one cell to another. Loop connectivity is a distracter for this question. Independence of the cells has nothing to do with the synchronization described in the scenario.

27. A lipid profile has been ordered for a patient who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results? A) As close to the end of the day as possible B) After a meal high in fat C) After a 12-hour fast D) Thirty minutes after a normal meal

: C Feedback: Although cholesterol levels remain relatively constant over 24 hours, the blood specimen for the lipid profile should be obtained after a 12-hour fast.

15. A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where? A) Endocardium B) Pericardium C) Myocardium D) Visceral pericardium

: C Feedback: The myocardium is the layer of the heart responsible for the pumping action.

35. The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurses most recent assessment reveals that CVP is 7 mm Hg. What is the nurses most appropriate action? A) Arrange for continuous cardiac monitoring and reposition the patient. B) Remove the CVP catheter and apply an occlusive dressing. C) Assess the patient for fluid overload and inform the physician. D) Raise the head of the patients bed and have the patient perform deep breathing exercise, if possible.

: C Feedback: The normal CVP is 2 to 6 mm Hg. Many problems can cause an elevated CVP, but the most common is due to hypervolemia. Assessing the patient and informing the physician are the most prudent actions. Repositioning the patient is ineffective and removing the device is inappropriate.

14. The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence? A) SA node to bundle of His to AV node to Purkinje fibers B) SA node to AV node to Purkinje fibers to bundle of His C) SA node to bundle of His to Purkinje fibers to AV node D) SA node to AV node to bundle of His to Purkinje fibers

: D * 496 Feedback: The normal electrophysiological conduction route is SA node to AV node to bundle of HIS to Purkinje fibers.

36. A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients? A) Pulmonary artery systolic pressure B) Right ventricular afterload C) Pulmonary artery pressure D) Left ventricular preload

: D Feedback: Monitoring of the pulmonary artery diastolic and pulmonary artery wedge pressures is particularly important in critically ill patients because it is used to evaluate left ventricular filling pressures (i.e., left ventricular preload). This device does not directly measure the other listed aspects of cardiac function. * 506

40. The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurses most appropriate response? A) Administer sublingual nitroglycerin to allow the patient to finish the test. B) Initiate cardiopulmonary resuscitation. C) Administer analgesia and slow the test. D) Stop the test and monitor the patient closely.

: D Feedback: Signs of myocardial ischemia would necessitate stopping the test. CPR would only be necessary if signs of cardiac or respiratory arrest were evident.

20. A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care? A) Fluctuations in core body temperature B) Signs and symptoms of esophageal varices C) Signs and symptoms of compartment syndrome D) Perfusion distal to the insertion site

: D Feedback: The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.

6. The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate? A) Possible hypovolemia B) Possible myocardial infarction (MI) C) Left-sided heart failure D) Aortic valve regurgitation

Ans: A Feedback: Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart failure are less likely causes of decreased CVP.

Which assessment test must a patient pass before inserting an arterial line? Why?

Allen Test (Ensure patency of both radial and ulnar artery)

5. The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what? A) Increased LDL and decreased HDL increase my risk of coronary artery disease. B) Increased LDL has the potential to decrease my risk of heart disease. C) The decreased HDL level will increase the amount of cholesterol moved away from the artery walls. D) The increased LDL will decrease the amount of cholesterol deposited on the artery walls.

Ans: A Feedback: Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

16. The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what? A) Arterial vasoconstriction B) Venous vasoconstriction C) Arterial vasodilation D) Venous vasodilation

Ans: A Feedback: Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.

13. The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems? A) To assess the patients response to fluid and drug administration B) To obtain specimens for arterial blood gas measurements C) To dislodge pulmonary emboli D) To diagnose the etiology of chronic obstructive pulmonary disease

Ans: A Feedback: Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.

3. The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure? A) 46 mmHg B) 99 mmHg C) 198 mmHg D) 76 mmHg

Ans: A Feedback: Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

1. A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what? A) Systole B) Diastole C) Repolarization D) Ejection fraction

Ans: A Feedback: Systole is the action of the chambers of the heart becoming smaller and ejecting blood. This action of the heart is not diastole (relaxations), ejection fraction (the amount of blood expelled), or repolarization (electrical charging).

12. The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patients CVP is increasing. Of what may this indicate? A) Psychosocial stress B) Hypervolemia C) Dislodgment of the catheter D) Hypomagnesemia

Ans: B Feedback: CVP is a useful hemodynamic parameter to observe when managing an unstable patients fluid volume status. An increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility. Stress, dislodgement of the catheter, and low magnesium levels would not typically result in increased CVP.

9. The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A) A change in position from standing to sitting B) A heart rate of 54 bpm C) A pulse oximetry reading of 94% D) An increase in preload related to ambulation

Ans: B Feedback: Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

11. A resident of a long-term care facility has complained to the nurse of chest pain. What aspect of the residents pain would be most suggestive of angina as the cause? A) The pain is worse when the resident inhales deeply. B) The pain occurs immediately following physical exertion. C) The pain is worse when the resident coughs. D) The pain is most severe when the resident moves his upper body.

Ans: B Feedback: Chest pain associated with angina is often precipitated by physical exertion. The other listed aspects of chest pain are more closely associated with noncardiac etiologies.

19. The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function? A) Central venous pressure (CVP) monitoring B) Pulmonary artery pressure monitoring (PAPM) C) Systemic arterial pressure monitoring (SAPM) D) Arterial blood gases (ABG)

Ans: B Feedback: PAPM is used to assess left ventricular function. CVP is used to assess right ventricular function; SAPM is used for continual assessment of BP. ABG are used to assess for acidic and alkalotic levels in the blood.

7. While auscultating a patients heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient? A) An older adult B) A 20-year-old patient C) A patient who has undergone valve replacement D) A patient who takes a beta-adrenergic blocker

Ans: B Feedback: S3 represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is called a physiologic S3 . It is an abnormal finding in a patient with an artificial valve, an older adult, or a patient who takes a beta blocker.

23. The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment? A) Whether the patient and involved family members understand the role of genetics in the etiology of the disease B) Whether the patient and involved family members understand dietary changes and the role of nutrition C) Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately D) Whether the patient and involved family members understand the importance of social support and community agencies

Ans: C Feedback: During the health history, the nurse needs to determine if the patient and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.

17. A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform? A) Instruct the patient to drink 1 liter of water before the test. B) Administer IV benzodiazepines and opioids. C) Inform the patient that she will remain on bed rest following the procedure. D) Inform the patient that an access line will be initiated in her femoral artery.

Ans: C Feedback: During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.

4. The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding? A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B) Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C) This is an accurate indicator of myocardial injury. D) This result indicates muscle injury, but does not specify the source.

Ans: C Feedback: Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.

10. The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult? A) Decreased left ventricular ejection time B) Decreased connective tissue in the SA and AV nodes and bundle branches C) Thinning and flaccidity of the cardiac values D) Widening of the aorta

Ans: D Feedback: Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).

22. A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate? A) Left-sided heart catheterization B) Cardiac telemetry C) Transesophageal echocardiography D) Hardwire continuous ECG monitoring

Ans: D Feedback: Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.

The nurse is caring for a client on a monitored telemetry unit. During morning assessment, the nurse notes abnormal ECG waves on the telemetry monitor. Which action would the nurse do first?

Assess the client.

Homocysteine levels have been linked to levels of?

Atherosclerosis from damage to endothelial lining of arteries

A client has undergone cardiac catheterization and will be discharged today. What information should the nurse emphasize during discharge teaching?

Avoid heavy lifting for the next 24 hours.

How is the pulmonary artery wedge pressure measured?

Balloon is inflated at distal end of pulmonary artery catheter

What is the normal CO and normal CI?

CO = 4-8 L/min CI = 2.8-4.2 L/min

What is the difference between Cardiac Output and Cardiac Index?

CO = HR x SV CI = CO / BSA (Body Surface Area)

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit?

Count the heart rate at the apex.

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?

Crackles

What are the cardiac biomarkers that are released when myocardial cells become necrotic from ischemia or injury/trauma?

Creatinine Kinase (CK), Creatinine Kinase Isoenzymes (CK-MB), Myoglobin, Tropinin T, Tropinin I

What is the difference between an echocardiogram and a trans-esophageal echocardiogram?

Echocardiogram - Non-invasive procedure where gel is placed on chest and a transducer is moved across gel on chest Trans-Esophageal Echocardiogram - Invasive procedure where scope is inserted into esophagus

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?

Enzymes

What is the purpose of a calcium coronary storage test?

Evaluates the buildup of calcium in plaque on the walls of the coronary arteries. Calcium is normally not found in walls of corner arteries and is an indicator of coronary artery disease!

The nurse is completing a cardiac assessment. Upon auscultation, the nurse hears a grating sound using the diaphragm of the stethoscope. How will the nurse best document this finding?

Friction rub

Which molecule transports cholesterol away from the tissues and cells of the arterial wall to the liver for excretion?

HDL

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

Have you had any episodes of dizziness or fainting?"

The nurse instructor is teaching a group of nursing students about adventitious heart sounds. The instructor explains that auscultation of the heart requires familiarization with normal and abnormal heart sounds. What would the instructor tell these students a ventricular gallop indicates in an adult?

Heart failure

Which diagnostic test is more specific for cardiac function? C-reactive Protein or High Sensitivity C-reactive Protein?

High Sensitivity C-Reactive Protein

What overall factor can cause increase in CVP?

Increase in blood volume (fluid overload, right side heat failure, vasoconstriction)

Why is aspirin and NSAIDS important when identifying routine meds prior to heart catheterization?

Increase risk of bleeding

Higher levels of C-reactive protein indicate?

Inflammation (Produced in liver in response to inflammation)

The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which finding is a priority to report to the health care provider?

K+ 3.1 mEq/L

The nurse is caring for a client who is scheduled for a transesophageal echocardiogram. What nursing intervention is a priority after the procedure?

Keep the head of the bed elevated 45 degrees and keep NPO until return of the gag reflex.

What cardiac function is mainly evaluated with echocardiogram?

Left Ventricular Function (Wall motion, ejection fraction)

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When ausculatating a murmur, what does the nurse expect to hear?

Loud and may be associated with a thrill sound similar to (a purring cat).

The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer?

Metoprolol

Should the balloon on the pulmonary artery catheter be left inflated?

NO!

What is Brain Natriuretic Peptide and why is it released?

Neurohormone released by ventricles in response to increase preload (stretch) with resulting elevated ventricular pressure

The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings?

Obtain an oxygen saturation level.

Why do we continuously flush the catheter with IV normal saline?

Prevent the tube from becoming clogged

Which end of a pulmonary artery catheter is placed in right atrium?

Proximal (Usually Blue)

The nurse is assessing a client taking an anticoagulant. What nursing intervention is most appropriate for a client at risk for injury related to side effects of medication enoxaparin?

Report any incident of bloody urine, stools, or both.

What does the distal port of PA catheter with balloon deflated measure? Where is the catheter placed?

Right Ventricular Afterload- Located in Pulmonary Artery

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. What priority reason will the nurse notify the healthcare provider?

The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

What part of the pulmonary artery catheter measures core body temperature?

Thermistor

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate?

Thready pulse

How does an echocardiogram work?

Uses sound waves to produce an image of the heart

Why is Viagra important when identifying routine meds prior to heart catheterization?

Vasodilator that doesn't allow body to respond to increase BP - Therefore, not good when given with other vasodilators (Ex. Nitroglycerin)

Describe the tubing of a hemodynamic monitoring catheter?

Very stiff

Your client is being prepared for echocardiography when he asks you why he needs to have this test. What would be your best response? a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." b) "This test can tell us a lot about your heart." c) "This test will find any congenital heart defects." d) "Echocardiography will tell your doctor if you have cancer of the heart."

a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." Echocardiography uses ultrasound waves to determine the functioning of the left ventricle and to detect cardiac tumors, congenital defects, and changes in the tissue layers of the heart. All answers are correct. Option C is the best answer because it addresses the client's question without making him anxious or minimizing the question.

Identify which of the following as an age-related change associated with conduction system of the heart? a) Heart block b) Murmur c) Thrills d) Tachycardia

a) Heart block Age-related changes to the conduction system may include bradycardia and heart block. Age-related changes to the heart valves include the presence of a murmur or thrill.

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following? a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." b) "The medications will prevent your husband from having an erection." c) "It is usually better to just give up sex after a heart attack." d) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it."

a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.

A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) Avoid heavy lifting for the next 24 hours. b) Take a tub bath, rather than a shower. c) Bend only at the waist. d) New bruising at the puncture site is normal.

a) Avoid heavy lifting for the next 24 hours. For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.

The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures? a) Cardiac catheterization b) Transesophageal echocardiogram c) Pharmacologic stress test d) Telemetry monitoring

a) Cardiac catheterization An elevated ST-segment means an evolving myocardial infarction. A cardiac catheterization would be the logical next step.

The nurse is assessing the client newly prescribed Lasix 20mg daily for 3+ pitting edema. To evaluate the effectiveness of diuretic therapy, which of the following would be documented? a) Edema b) Blood pressure c) Urine output d) Weight

a) Edema The best method to evaluate the effectiveness of diuretic therapy is to note a decrease in edema. Weight, blood pressure, and urine output all are affected by diuretic therapy, but the therapeutic goal is to decrease the edema.

The nurse is interviewing a client who is complaining of chest pain. Which of the following questions related to the client's history are most important to ask? Select all that apply. a) How would you describe your symptoms? b) Do you have any children? c) How did your mother die? d) Are you allergic to any medications or foods?

a) How would you describe your symptoms? c) How did your mother die? d) Are you allergic to any medications or foods? During initial assessment, the nurse should obtain important information about the client's history that focuses on a description of the symptoms before and during admission, family medical history, prescription and nonprescription drug use, and drug and food allergies.

The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following? a) Hypervolemia b) Excessive blood loss c) Overdiuresis d) Left-sided heart failure (HF)

a) Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.

Age-related changes associated with the cardiac system include which of the following? Select all that apply. a) Increased size of the left atrium b) Myocardial thinning c) Endocardial fibrosis d) Increase in the number of SA node cells

a) Increased size of the left atrium c) Endocardial fibrosis Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening.

The nurse is caring for a client on the cardiac unit. Which change of condition may indicate potential increasing of right-side heart failure? Select all that apply. a) Increased weakness on ambulation b) Jugular vein distention c) Edema changed from a 3+ to a 1+ d) One-pound weight loss e) Increased palpitations f) Increased dyspnea

a) Increased weakness on ambulation b) Jugular vein distention e) Increased palpitations f) Increased dyspnea A change in assessment finding may indicate an increase in heart failure. Right-sided heart failure symptoms include jugular vein distention, increased dyspnea, increased palpitations, and an increased weakness on ambulation. Edema is a common sign of right-sided heart failure, but changing from a 3+ to 1+ is improvement in condition. Weight loss is also improvement in condition.

A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a) Irregularly irregular heart rate b) Increased PR interval c) Fourth heart sound (S4) d) Orthostatic hypotension

a) Irregularly irregular heart rate An irregularly irregular heart rate indicates atrial fibrillation and should be investigated further. It's normal for an elderly client to have a prolonged systole, which causes an S4 heart sound. It's also normal for an elderly client to have slowed conduction, causing an increased PR interval. As a person ages, it's normal for baroreceptors in the body to decrease their response to changes in body position, which can cause orthostatic hypotension.

A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education? a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR b) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR) c) Obtaining the supine measurements prior to the sitting and standing measurements d) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling

a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.

The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart. Which of the following actions should the nurse complete prior to the patient undergoing the procedure? Select all that apply. a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. d) Sedate the patient prior to the procedure. e) Position the patient on his/her stomach for the procedure.

a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the patient may be offered a headset to listen to music.

The nurse is aware that age-related changes in the heart muscle put the elderly at risk for dyspnea, angina, and syncope. Which of the following is an age-related change in the cardiovascular system that affects the sympathetic nervous system? a) An increased contractility response to exercise b) A decreased response to beta-blockers c) Decreased time for the heart rate to return to baseline d) Tachycardia

b) A decreased response to beta-blockers The sympathetic nervous system exhibits structural and functional changes that are age-related. Heart rate will decrease, and it will take longer for the heart rate to return to baseline. Refer to Table 12-1 in the text.

Which of the following would be a factor that may decrease myocardial contractility? a) Administration of digoxin (Lanoxin) b) Acidosis c) Sympathetic activity d) Alkalosis

b) Acidosis Contractility is depressed by hypoxemia, acidosis, and certain medications, such as beta-adrenergic blocking medications. Contractility is enhanced by sympathetic neuronal activity, and certain medications, such as Lanoxin.

The nurse practitioner inspects the patient's skin during a physical examination. She is looking for any abnormalities, especially skin findings associated with cardiovascular disease. The nurse notes a bluish tinge in the buccal mucosa and the tongue. She knows this is probably due to: a) Intermittent arteriolar vasoconstriction. b) Congenital heart disease. c) Peripheral vasoconstriction. d) Blood leaking outside the blood vessels.

b) Congenital heart disease. Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and cardiogenic shock, this sign is indicative of congenital heart disease. Refer to Table 12-3 in the text.

A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a) Call the physician and obtain an order for a fluid bolus. b) Continue to monitor the client as ordered. c) Call the physician and obtain an order for a diuretic. d) Rezero the equipment and take another reading.

b) Continue to monitor the client as ordered. Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to rezero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.

A nurse is completing a head to toe assessment on a patient diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined? a) Legs, Toes b) Fingers, hands c) Under the sacrum d) Lips, earlobes

b) Fingers, hands When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.

Which of the following is a true statement regarding the role of baroreceptors? a) Increases in heart rate b) Initiates the parasympathetic response c) Initiates the sympathetic response d) Increases blood pressure

b) Initiates the parasympathetic response During elevations of blood pressure, the baroreceptors increase their rate of discharge. This initiates parasympathetic activity and inhibits sympathetic response, lowering the heart rate and blood pressure.

The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage? a) Rash b) Orthostatic hypotension c) Dry mouth d) Nausea

b) Orthostatic hypotension A common side effect of Nitrostat, especially at higher dosages, is orthostatic hypotension. The action of the medication is to dilate the blood vessels to improve circulation to the heart. The side effect of the medication is orthostatic hypotension. A rash, nausea, and dry mouth are not common side effects.

You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate? a) The client and family understands the need for medication. b) The client and family understands the discharge instructions. c) The client and family understands the need to restrict activity for 72 hours. d) The client and family understands the client's CV diagnosis.

b) The client and family understands the discharge instructions. The client is relaxed and feels secure. The test is performed uneventfully or the client is stabilized when complications are managed successfully. The client and family have an accurate understanding of the diagnostic testing process and discharge instructions. The scenario does not indicate that the client has a CV diagnosis, a need for medication, or a need to restrict their activity for 72 hours.

A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe? a) Radionuclide angiography b) Transesophageal echocardiography c) Electrocardiography d) Chest radiograph

b) Transesophageal echocardiography TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.

The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? a) Sympathetic nerve fibers b) Vagus nerve c) Baroreceptors d) Chemoreceptors

c) Baroreceptors Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.

A nurse working in a cardiac step-down unit understands that the following drugs can affect the contractility of the heart. The nurse recognizes that contractility is depressed by which of the following drugs? a) Lanoxin b) Dobutrex c) Lopressor d) Intropin

c) Lopressor Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility.

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is: a) Quiet but readily heard. b) Easily heard with no palpable thrill. c) Loud and may be associated with a thrill sound similar to (a purring cat). d) Very loud; can be heard with the stethoscope half-way off the chest.

c) Loud and may be associated with a thrill sound similar to (a purring cat). Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.

A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? a) A pulse deficit b) Weak pulse c) Thready pulse d) Bounding pulse

c) Thready pulse The nurse is most correct to anticipate a thready (barely palpable) pulse quality. A bounding pulse indicates a strong cardiac output. A weak pulse indicates a lower pulse quality. A pulse deficit occurs when the pulses between the apex of the heart differs from the radial pulse.

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred? a) CK-MB b) Brain natriuretic peptide (BNP) c) Troponin T and I d) Myoglobin

c) Troponin T and I After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.

The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" The nurse's appropriate response is which of the following? a) Bok choy, cooked leeks, alfalfa sprouts b) Cranberries, apples, popcorn c) Asparagus, blueberries, green beans d) Apricots, dried peas and beans, dates

d) Apricots, dried peas and beans, dates Apricots, dried peas and beans, dates, and kiwi contain high amounts of potassium. The other foods listed contain minimal amounts.

What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse?

contractility

The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "The first test I am getting is an echocardiography. I am glad that it is not painful." b) "I had an ECG already. It provided information on my heart rhythm. c) "I am able to have a nuclide study because I do not have any allergies." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."

d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker." A magnetic resonance imaging (MRI) test is prohibited on clients with various metal devices within their body. External metal objects must be removed. All other options are correct statements not needing clarification.

The health care provider documents that the patient's pulse quality is a +1 on a scale of 0 to 4. The nurse knows that this describes a pulse that is: a) Full, easy to palpate, and cannot be obliterated. b) Diminished, but cannot be obliterated. c) Strong and bounding and may be abnormal. d) Difficult to palpate and is obliterated with pressure.

d) Difficult to palpate and is obliterated with pressure. The quality of pulses is reported using descriptors and a scale of 0 to 4. The lower the number, the weaker the pulse and the easier it is to obliterate it. A +1 pulse is weak and thready and easily obliterated with pressure.

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a) Thallium b) Ativan c) Diazepam d) Dobutamine

d) Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.

Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)? a) Hypotension b) Change in level of consciousness c) Weight gain d) Fatigue

d) Fatigue Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.

A patient's heart rate is observed to be 140 bpm on the monitor. The nurse knows that the patient is at risk for what complication? a) A stroke b) Right-sided heart failure c) A pulmonary embolism d) Myocardial ischemia

d) Myocardial ischemia As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially patients with coronary artery disease.

Which of the following tests used to diagnose heart disease is least invasive? a) Cardiac catheterization b) Magnetic resonance imaging c) Coronary arteriography d) Transthoracic echocardiography

d) Transthoracic echocardiography Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. This procedure requires the instillation of a contrast medium into each coronary artery.

During an initial assessment, the nurse measures the client's apical pulse and compares it to the peripheral pulse. The difference between the two is known as pulse:

deficit

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

endocardium

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body?

left ventricle