Exam 3 PrepU Questions (Chapters 25-31)
What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse? (Chapter 25, Page 672)
Contractility
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? (Chapter 25, Page 678)
"Current evidence indicates that estrogen is ineffective as a cardioprotectant; estrogen is actually potentially harmful and is no longer a recommended therapy."
The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include? (Chapter 25, Page 705)
"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."
The client is being prepared for echocardiography when he asks the nurse why he needs to have this test. What would be the nurse's best response? (Chapter 25, Page 702)
"Echocardiography is a way of determining the functioning of the left ventricle of your heart."
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? (Chapter 26, Page 741)
"Spike" on the rhythm strip
The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? (Chapter 26, Page 718)
"The only difference is the heart rate."
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? (Chapter 25, Page 684)
"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? (Chapter 26, Page 713)
"The small box will transmit the heart rhythm to the central monitor all the time."
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? (Chapter 26, Page 719)
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."
The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? (Chapter 26, Page 744)
"We will be getting rid of our microwave oven so it will not affect my pacemaker."
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? (Chapter 26, Page 724)
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as: (Chapter 26, Page 717)
90 bpm
The nurse admits an adult female client with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. What response by the nurse will be most appropriate? (Chapter 25, Page 678)
A woman's heart is smaller and has smaller arteries that become occluded more easily."
Which assessments should a nurse perform when caring for a client following a cardiac catheterization? Select all that apply. (Chapter 25, Page 703)
A) Monitor BP and pulse frequently B) Inspect pressure dressing for signs of bleeding C) Palpate the pulse in different locations
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? (Chapter 26, Page 737)
A client with atrial dysrhythmias
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? (Chapter 25, Page 687)
A heart rate of more than 20 bpm above the resting rate
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? (Chapter 26, Page 719)
AAll options are correct
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? (Chapter 26, Page 718)
Administer an IV bolus of atropine
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? (Chapter 26, Page 724)
Anticoagulant
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?" What is the appropriate response by the nurse? (Chapter 25, Page 694)
Apricots, dried peas and beans, dates
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? (Chapter 25, Page 696)
Assess the client
Which term describes the ability of the heart to initiate an electrical impulse? (Chapter 25, Page 675)
Automaticity
A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? (Chapter 25, Page 695)
B-type natriuretic peptide (BNP)
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? (Chapter 25, Page 677)
Baroreceptors
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). The client's blood pressure is 104/68 mm Hg. The client's pulse rate is 76 beats/minute. The nurse detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take? (Chapter 25, Page 686)
Contact the health care provider and report the findings
The nurse accompanies a client to an exercise stress test. The client can achieve the target heart rate, but the electrocardiogram indicates ST-segment elevation. Which procedure will the nurse prepare the client for next? (Chapter 25, Page 699)
Cardiac catheterization
The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition? (Chapter 25)
Catheter-related bloodstream infections
Which area of the heart is located at the third intercostal (IC) space to the left of the sternum? (Chapter 25, Page 689)
Erb point
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? (Chapter 26, Page 721)
Decreased cardiac output and decreased systolic and diastolic blood pressure
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? (Chapter 26, Page 743)
Double-check the monitoring equipment
Which symptom is an early warning sign of acute coronary syndrome (ACS) and heart failure (HF)? (Chapter 25, Page 680)
Fatigue
What is a harsh grating sound caused by abrasion of the pericardial surfaces during the cardiac cycle? (Chapter 25, Page 691)
Friction rub
The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for? (Chapter 26, Page 729)
Heart block
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? (Chapter 25, Page 695)
Heart failure
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? (Chapter 25, Page 678)
Heart failure
A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following a therapeutic regimen? (Chapter 25, Page 682)
High density lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? (Chapter 26, Page 719)
Hypovolemia
The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition? (Chapter 25, Page 694)
Impaired myocardial contractility
The critical care nurse is caring for clients in an emergency department. When caring for a variety of clients, when is the presence of a third heart sound normal? (Chapter 25, Page 691)
In pediatric clients
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? (Chapter 26, Page 737)
It is used to eliminate ventricular dysrhythmias
The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which finding is a priority to report to the healthcare provider? (Chapter 25, Page 694)
K+ 3.1 mEq/L
A nurse is preparing a client for a scheduled adenosine stress test. Which statement made by the client indicates a need for further education? (Chapter 25, Page 700)
My family is bringing me a cup of coffee to drink before the test."
The client's heart rate is observed to be 140 bpm on the monitor. The nurse knows to monitor the client for what condition? (Chapter 25)
Myocardial ischemia
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as: (Chapter 26, Page 718)
Normal sinus rhythm
The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings? (Chapter 25, Page 687)
Obtain an oxygen saturation level
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? (Chapter 26, Page 715)
P wave
The nurse is assessing a patient's electrocardiogram (ECG). What phase does the nurse determine is the resting phase before the next depolarization? (Chapter 25, Page 676)
Phase 4
The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia? (Chapter 26, Page 729)
Premature ventricular contraction
The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? (Chapter 25, Page 687)
Pulse pressure
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? (Chapter 26, Page 716)
QRS complex
The clinic nurse is assessing a client's pulse before outpatient diagnostic testing. What should the nurse document when assessing the client's pulse? (Chapter 25, Page 688)
Rate, quality, and rhythm
The physician orders medication to treat a client's cardiac ischemia. What is causing the client's condition? (Chapter 25, Page 675)
Reduced blood supply to the heart
What does decreased pulse pressure reflect? (Chapter 25, Page 687)
Reduced stroke volume
A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client report increases the likelihood of a cardiovascular disorder? (Chapter 25, Page 678)
Shortness of breath
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? (Chapter 26, Page 719)
Sinus tachycardia
The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from? (Chapter 25, Page 675)
The sinoatrial node
A patient recently diagnosed with pericarditis asks the nurse to explain what area of the heart is involved. How does the nurse best describe the pericardium to the client? (Chapter 25, Page 673)
Thin fibrous sac that encases the heart
During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? (Chapter 25, Page 692)
Wheezes with wet lung sounds
The cardiologist has scheduled a client for drug-induced stress testing. What instructions should the nurse provide to prepare the client for this test? (Chapter 25, Page 700)
You will receive medication via IV administration
The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing? (Chapter 25, Page 699)
ST-segment changes on the ECG
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? (Chapter 26, Page 715)
Atrial depolarization
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? (Chapter 26, Page 726)
Atrial flutter
A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? (Chapter 26, Page 731)
Begin cardiopulmonary resuscitation
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? (Chapter 26, Page 731)
Begin cardiopulmonary resuscitation (CPR)
The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current? (Chapter 25, Page 696)
Clip the client's chest hair prior to applying the electrodes
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? (Chapter 25, Page 706)
Continue to monitor the client as ordered
What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse? (Chapter 25, Page 672
Contractility
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? (Chapter 25, Page 688)
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? (Chapter 25, Page 822)
Crackles
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? (Chapter 26, Page 747)
I'll keep a log of each time my ICD discharges."
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? (Chapter 26, Page 732)
Delayed conduction, producing a prolonged PR interval
A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client? (Chapter 26, Page 737)
Immediate CPR
What is the treatment of choice for ventricular fibrillation? (Chapter 26, Page 731)
Immediate bystander CPR
Central venous pressure is measured in which heart chamber? (Chapter 25, Page 688)
Right atrium
A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by: (Chapter 25, Page 677)
Stimulation of the vagus nerve
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? (Chapter 25, Page 705)
The client and family understands the discharge instructions
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? (Chapter 25, Page 703)
The client is at risk for renal failure due to the contrast agent that will be given during the procedure
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? (Chapter 26, Page 744
"I should ask for a handheld device search when I go through airport security."
A client has undergone cardiac catheterization and will be discharged today. What information should the nurse emphasize during discharge teaching? (Chapter 25, Page 705)
Avoid heavy lifting for the next 24 hours
The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. What explanation will the nurse offer to explain the urination? (Chapter 25, Page 683)
Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain? (Chapter 25, Page 679)
Description of the pain
The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmia. Which of the following assessment considerations is essential when caring for this client? (Chapter 25, Page 678)
Digoxin level
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? (Chapter 25, Page 699)
Dobutamine
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? (Chapter 26, Page 741)
Document the findings and continue to monitor the client
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? (Chapter 26, Page 713)
Electrocardiogram
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? (Chapter 25, Page 673)
Endocardium
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? (Chapter 25, Page 693)
Enzymes
The nurse prepares to auscultate heart sounds. What nursing intervention will be most effective to assist with this procedure? (Chapter 25, Page 690)
Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard
The nurse is caring for a client who is scheduled for a transesophageal echocardiogram. What nursing intervention is a priority after the procedure? (Chapter 25, Page 703)
Keep the head of the bed elevated 45 degrees and keep NPO until return of the gag reflex
The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position? (Chapter 25, Page 689)
Left 5th intercostal space at the midclavicular line
The nurse auscultates the PMI (point of maximal impulse) at which anatomic location? (Chapter 25, Page 675)
Left midclavicular line, fifth intercostal space
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? (Chapter 25, Page 673)
Left ventricle
After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When auscultating a murmur, what does the nurse expect to hear? (Chapter 25, Page 692)
Loud and may be associated with a thrill sound similar to (a purring cat)
While the nurse is preparing a client for a cardiac catheterization, the client states that they have allergies to seafood. Which of the following medications may the nurse give prior to the procedure? (Chapter 25, Page 701)
Methylprednisolone
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? (Chapter 25, Page 683)
Report any incident of bloody urine, stools, or both
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to the lungs to be oxygenated? (Chapter 25, Page 673)
Right ventricle
It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: (Chapter 25, Page 677)
Right ventricular pressure must be higher than pulmonary arterial pressure
The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this? (Chapter 25, Page 691)
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