HC 3 Unit 2, Chapter 30

Which American Heart Association guidelines would the nurse teach a client to fight obesity and improve cardiovascular health? Select all that apply. A. Don't consume more calories than you can use in a day. B. Consume foods that contain vitamins, minerals, and fiber. C. Choose foods that are healthy and low in calories. D. Avoid gas-producing vegetables such as cabbage or broccoli. E. Eat vegetables, fruit and whole-grain foods. F. For calcium, choose whole milk dairy products.

A, B, C, E:

Which instructions would the nurse give the LVN/LPN monitoring a client after cardiac catheterization by radial artery approach? Select all that apply. A. Monitor the client's vital signs every 15 minutes for 1 hour. B. Assess the insertion site for bloody drainage or hematoma. C. Keep the client in bed for at least 6 hours. D. Assess peripheral pulses and skin temperature and color with every vital sign check. E. Monitor intake and output. F. Provide oral fluids for adequate contrast excretion.

A, B, D, E, F: All options except C are correct for safe recovery of the client after a cardiac catheterization. Keeping the client in bed for more than 2 hours is not necessary when the radial approach is used for the test.

Which assessment data would the nurse expect for a client diagnosed with angina? Select all that apply. A. Pain relieved at rest B. Sudden onset of pain C. Intermittent pain relieved by sitting upright D. Substernal pain that may spread across chest, back, and arms E. Sharp, stabbing pain that is moderate to severe F. Pain that usually lasts less than 15 minutes

A, B, D, F: angina pain is usually sidden in onset, in response to exertion, emotion, or extremes in temperature. It is usually located on the left side of chest without radiation but can be substernal and may spread across the chest and the back and/or down the arms. It usually lasts less than 15 minutes and is relieved with rest, nitrate administration, or oxygen therapy.

Which cardiovascular assessment changes would the nurse expect in an older client? Select all that apply. A. Presence of murmurs B. Atrial dysrhythmias C. Fewer premature ventricular contractions D. Very short QT interval on ECG E. Increased dizziness F. Positive orthostatic blood pressure

A, B, E, F: Calcification of heart valves can cause murmurs. Pacemaker cells decrease in number which can lead to atrial dysrhythmias and increased (not fewer) pvcs. The size of the left ventricle increases which can lead to widened QRS complexes and longer (not shorter) QT intervals. Baroreceptors become less sensitive which can lead to positive orthostatic BP and dizziness as well as fainting.

The nurse is teaching a class regarding reduction of risk factors for cardiovascular disease. Which teaching statement is appropriate? Select all that apply. A. "If you tend to get angry easily, then your risk for heart disease is higher." B. "To reduce your overall risk, it is important to keep your BMI greater than 30." C. "Do not eat more calories on a daily basis that you are able to burn." D. "Decreasing the amount that you smoke will decrease your overall cardiovascular risk." E. "Secondhand smoke creates a significant risk to others for cardiovascular disease." F. "Exercise moderately at least 2 days per week for a total of 150 minutes."

A, C, E, F: When teaching a class regarding risk reduction for cardiovascular disease the nurse will include that certain personality types have higher risks, such as those that tend to anger easily or stay frustrated. The nurse will also teach the importance of maintaining a BMI under 30 (ideally under 25) while not consuming more calories than an individual can burn on a daily basis. Secondhand smoke also creates a risk for CVD. Exercise is important and current guidelines include moderate exercise at least twice a week totaling 150 minutes. Smoking cessation is a critical teaching component. However, the key is cessation. Just a reduction in smoking does not decrease the risk, however, cessation does.

Which assessment factors for a 62-year-old client would the nurse recognize as modifiable risk factors for heart disease? Select all that apply. A. History of smoking B. Age C. Obesity D. Ethnic background E. Sedentary lifestyle F. Gender

A, C, E: Modifiable risk factors are personal lifestyle habits, including cigarette smoking, physical inactivity, obesity, and psychological variables. Nonmodifiable risk factors inclued the clients age, gender, ethnic origin, and family hx of cvd.

Which mechanisms regulate and mediate blood pressure? Select all that apply. A. Kidneys B. Gastrointestinal system C. Autonomic nervous system D. Respiratory system E. Endocrine system F. Carbon dioxide elimination

A, C, E: The ANS excites or inhibits SNS activity in response to impulses from chemoreceptors and baroreceptors; the kidneys sense a change in blood flow and activate the RAAS mechanism; the endo system, which releases various hormones (catecholamine, kinins, serotonin, histamine) to stim the SNS.

Which statements about the structure of the heart are accurate? Select all that apply. A. The heart normally pumps about 5 L of blood per minute. B. A muscular wall called the septum separates only the ventricles of the heart. C. The pericardium is a covering that protects the heart. D. The left ventricle pumps deoxygenated blood to the lungs. E. The right ventricle pumps blood into the aorta and svstemic arterial system. F. Coronary artery blood flow occurs primarily during diastole.

A, C, F: The septum separates the atria and the ventricles. The right ventricle pumps deoxygenated blood to the pulmonary artery and lungs, while the left ventricle pumps blood to the aorta and the systemic arterial system.

The nurse is conducting an admission assessment on a male client. Which assessment data is a risk factor for cardiovascular disease? Select all that apply. A. BMI of 26 B. BP of 120/66 C. Triglycerides 140 mg/dL D. Moderate exercise for 20-30 minutes weekly E. Exposure to secondhand cigarette smoke F. History of repeated streptococcal tonsillitis G. Family history of cardiovascular disease

A, D, E, G: A BMI of 26 is considered overweight which is a risk for CVD. Exercise for 20-30 minutes does not adhere to the recommended guidelines to combat the known risk of a sedentary lifestyle. Exposure to second hand smoke is a risk factor, as well as a family history of cardiovascular disease. Recurrent streptococcal infections are associated with valvular disease and place the client at risk for CVD. A blood pressure of 120/66 is within normal limits. Triglycerides of 140 mg/dL for a male client is also considered within normal limits.

The client asks the nurse about modifiable risk factors for heart disease. What nursing response is appropriate? (Select all that apply.) A. Cigarette smoking is one of the most significant modifiable risk factors. B. Your personal health over the past 10 years a modifiable risk. C. Your overall body mass index is nonmodifiable. D. Increasing physical exercise is a method to modify your risk. E. Diabetes mellitus is a modifiable risk factor.

A, D: Modifiable risk factors are those risks that are controllable such as cigarette smoking, personal lifestyle, obesity, and psychological variables. Past history cannot be modified. Diabetes mellitus can be controlled but it a lifelong condition that is not considered modifiable. The body mass index (BMI) is an indicator of weight and can be modified.

The nurse is teaching a class on risk factors for cardiovascular disease. Which risk factors will the nurse include? (Select all that apply.) A. Smoking history B. Elevated high-density lipoprotein (HDL) level C. Decreased bone density D. Low blood pressure E. Family history of heart disease F. Fiber-rich diet G. Elevated C-reactive protein levels H. Diabetes Mellitus

A, E, G, H: Factors that contribute to the risk for cardiovascular disease include elevated C-reactive protein levels, smoking, diabetes mellitus, and family history of heart disease. Elevation in C-reactive protein, suggestive of inflammation, is a risk factor for atherosclerosis and cardiac disease. Smoking cessation must also be emphasized. Smoking is a major modifiable risk factor for cardiovascular disease. Cardiovascular disease does have a genetic component and a history of diabetes mellitus increases the risk for heart disease.A diet rich in fiber is not a risk factor for cardiovascular disease, but rather a desirable behavior. Hypertension, not low blood pressure, is a risk for cardiovascular disease. Elevated low-density lipoprotein cholesterol is a risk for atherosclerosis. Elevated HDL cholesterol is desirable and may be cardioprotective.

Which is the most common and normal re sponse by a client to a cardiovascular illness? A. Denial D. Fear C. Loss of control D. Depression

A. A common and normal response is denial, which is a defense mechanism that enables the client to cope with threatening circumstances. He or she may deny the current cv condition, may state that it was present but is now absent or may be excessively cheerful.

Which client has an abnormal heart sound? A. S3 in a 54-year-old B. S1 in a 45-year-old C. S2 in a 38-year-old D. S3 in a 25-year-old

A. An S3 gallop in clients older than 35 years is considered abnormal and represents a decrease in left ventricular compliance. It can be detected as an early sign of HF or as a ventricular septal defect. An S3 heart sound is most likely to be a normal finding in those younger than 35.

What would the nurse calculate the cardiac output to be when the client's heart rate is 68 beats/min and the stroke volume is 50 mL? A. 3400 L/min B. 4000 L/min C. 4400 L/min D. 4800 L/min

A. CO is the amount of blood pumped from the left ventricle each minute. CO depends ont he relationship between HR and SV.

The nurse is assessing the client's heart sounds. Which instruction will the nurse provide if there is difficulty hearing heart sounds? A. "Please roll onto your left side." B. "Lay all the way down on your back." C. "Please hold your breath while I use my stethoscope." D. "I will just take your pulse instead."

A. If the nurse is having difficulty hearing the heart sounds while auscultating, the nurse can ask the client to roll to the left side or lean forward. This positions the heart closer to the chest wall and can make the heart sounds more audible. Taking the pulse instead of auscultating is not an appropriate nursing action, nor is asking the client to hold their breath for an undetermined time period. Asking the client to lay on their back will make it more difficult to hear sounds versus easier.

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? A. Potassium 3.0 mEq/L (3.0 mmol/L) B. Magnesium 2.1 mEq/L (1 mmol/L) C. International normalized ratio (INR) of 1.0 D. Calcium 8.5 mEq/L (4.25 mmol/L)

A. The nurse needs to contact the primary health care provider when a potassium level of 3.0 mEq/L (3.0 mmol/L) is noticed on a client admitted with heart failure. Normal potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Hypokalemia may predispose to the client to dysrhythmia, especially if the client is taking medications that deplete potassium (such as furosemide).A normal calcium level is 8.5 to 10.5 mEq/L (4.25 to 5 mmol/L). A normal magnesium level is 1.7 to 2.4 mEq/L (0.85 to 1.2 mmol/L). INR of 1.0 reflects a normal value.

Which nursing statement reflects appropriate cardiac physical assessment technique? A. "I will auscultate the aortic valve in the second intercostal space at the right sternal border." B. "I will palpate the apical pulse over the third intercostal space in the midclavicular line." C. "I will assess for orthostatic hypotension by moving the client from a standing to a reclining position." D. "I will assess for carotid bruit by auscultating over the anterior neck."

A. The statement that shows correct cardiac physical assessment technique is toauscultate the aortic valve in the second intercostal space at the right sternal border.Orthostatic hypotension is measured when a person moves from a reclining to a standing position. The apical pulse is palpated over the fifth intercostal space in the midclavicular line. A bruit is assessed by auscultating the carotid artery in the neck.

Which laboratory value test elevation does the nurse consider most significant in the diagnosis of a client's myocardial infarction (MI)? A.Troponin T and I B. Myoglobin C. Highly sensitive C-reactive protein D. Creatinine kinase MB

A. Troponin is a myocardial muscle preotein released into the bloodstream with injury to myocardial muscle. Troponins T and I are not found in healthy clients, so any rise in value indicates cardiac necrosis or acute MI.

Before administering which class of drugs would the nurse always check the client's heart A. Beta blockers B. Diuretics C. Anticoagulants D. Nonsteroidal anti-inflammatories

A. an increase in circulating catecholamines (epi and norepi) usually causes an increase in HR and contractility. Many CV drugs, particularly beta blockers, block this sympathetic (fight or flight) pattern by decreasing the HR. The nurse would chek to be sure that the HR was not too slow before administering a beta blocker.

Which questions would the nurse ask a client when a client is admitted reporting chest pain? Select all that apply. A. "How do you feel about the chest pain?" B. "How long does the pain last and how often does it occur?" C. "Where does the pain occur and what does it feel like?" D. "Have you had other symptoms that occur with the chest pain and what are they?" E. "What activities were you doing when the pain occurred?" F. "Is this episode of chest pain different from other episodes you have had?"

B, C, D, E. F: If pain is present, ask whether it is different from any other episodes of pain. Ask the client to describe which activities he or she was doing when it first occurred, such as sleeping, arguing, or running (precipitating factors). If possible, the client should point to the location of pain and describe if and how the pain radiated. In addition, ask how the pain feels and whether it is sharp, dull, or crushing (quality). To understand the severity of the pain, ask the client to grade it from 0-10. Ask about associated symptoms such as dyspnea, diaphoresis, nausea, and vomiting. aggravating factors that makes chest pain worse or less intense (relieving factors). Asking about how the client feels bout the pain is part of the psychosocial assessment.

Which client serum lipid tests suggest an increased risk for cardiovascular disease (CVD)? Select all that apply. A. HDL 65 mg/dL B. LDL 170 mg/dL C. Triglycerides 185 mg/dL D. Total cholesterol 175 mg/dI E. VLDL 39 mg/dL F. Total cholesterol 250 mg/dL

B, C, E, F: The desired ranges for lipids are- total cholesterol: <200; triglyceride between 40 and 160 for men and between 35 and 135 for women; HDL >45 for men: more than 55 for women; LDL <130.

Which triad of symptoms would the nurse assess for in a woman at risk for cardiovascular disease? Select all that apply. A.Severe chest pain B. Feeling of abdominal fullness C. Chronic fatigue despite adequate rest D. Extremity pain E. Dyspnea or inability to catch her breath F. intermittent claudication

B, C, E: Some clients, esp. women, do not experience pain in the chest but, instead, feel discomfort or indigestion. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feelings of an "inability to catch my breath" (dyspnea) are also common in heart disease.

Which actions by an older adult are likely to cause the experience of syncope? Select all that apply. A. Walking briskly for 20 minutes B. Turning the head C. Laughing D. Performing a Valsalva maneuver E. Rapidly swallowing fluids F. Shrugging the shoulders

B, D, F: Syncope in an older adult may result from hypersensitivity of the carotid sinus bodies in the carotid arteries. Pressure applied to these arteries while turning the head, shrugging the shoulders, or performing a Valsalva maneuver may stimulate a vagal response.

Which statements about blood pressure are ac-curate? Select all that apply. A. The right ventricle of the heart generates the greatest amount of blood pressure. B. Diastolic blood pressure is primarily determined by the amount of peripheral vasoconstriction. C. Systolic blood pressure is the amount of pressure or force generated by the left ventricle to distribute blood into the aorta with each contraction of the heart. D. Diastolic pressure is the highest pressure generated during contraction of the ventricles. E. To maintain adequate blood flow through the coronary arteries, mean arterial pressure (MAP) must be at least 90 mm Hg. F. Paradoxical blood pressure is an exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle.

B,C,F: The left ventricle generates the greatest amount of blood pressure. To maintain adequate blood flow thru the coronary arteries, MAP must be at least 60. Systolic pressure is the highest pressure during contraction of the ventricles.

For which pathophysiological conditions can a normal healthy heart adapt to maintain perfusion to the body tissues? A.Menses and gastroesophageal reflux disease B. stress and infection C. Kidney stones and peripheral vascular disease D. Bleeding and shortness of breath

B.

Which action will the nurse delegate to experienced assistive personnel (AP) working in the cardiac catheterization laboratory? A. Educate the client about the need to remain on bedrest after the procedure. B. Obtain client vital signs and a resting electrocardiogram (ECG). C. Have the client sign the consent form before the procedure is performed. D. Assess preprocedure medications the client took that day.

B. Checking vital signs and performing a 12-lead ECG can be delegated to the UAP.The primary health care provider will explain the catheterization procedure and have the client sign the consent form. Assessments and client teaching must be done by the RN.

Which action does the nurse perform to prevent kidney toxicity when caring for a client after cardiac catheterization? A. Assess pedal pulses every 15 minutes. B. Provide intravenous and oral fluids for 12 to 24 hours. C. Check the catheterization site every hour for 8 hours. D. Keep the catheterized extremity straight for 6 hours.

B. Contrast induced renal dysfunction can result from vasoconstriction and the direct toxic effect of the contrast agent on the renal tubules. Hydration pre- and post study helps eliminate or minimize contrast-induced renal toxicity.

The nurse is caring for a client immediately following a cardiac catheterization. Which nursing assessment data requires immediate nursing intervention? A. Blood pressure 146/70 B. Hematoma developing at insertion site C. Client reports of headache pain D. Client reports of extreme thirst

B. Following cardiac catheterization the client is at risk for bleeding at the insertion site. Hematoma formation is an indication that the artery is bleeding internally, and the priority nursing action is to apply manual pressure to the insertion site immediately. While the client's blood pressure is slightly elevated the priority of care remains responding to the development of the hematoma at the insertion site. After the client is stable, the nurse can then address the client's headache and thirst.

What does the nurse suspect when assessing a client at risk for CVD who states, "my right foot turns very dark red when I sit too long and when I put my foot up, it turns pale?" A. Central cyanosis B. Arterial insufficiency C. Peripheral cyanosis D. Venous insufficiency

B. Rubor (dusky redness) that replaces pallor in a dependent foot suggest arterial insufficiency. Venous insufficiency is a result of prolonged venous hypertension that stretches and damages the valves which can lead to backup of blood, edema, and decreased tissue perfusion.

A client who is to undergo cardiac catheterization must be taught which essential information by the nurse? A. "Take your oral hypoglycemic with a sip of water on the morning of the procedure." B. "Keep your affected leg straight for 2 to 6 hours." C. "Do not take your blood pressure medications on the day of the procedure." D. "Monitor the pulses in your feet when you get home."

B. The client undergoing cardiac catheterization must be taught to keep the affected leg straight for 2 to 6 hours after the test. The client will remain in bed and the affected leg kept straight for 2 to 6 hours after the procedure, depending on the type of vascular closure device used, to allow the arterial puncture to heal well and prevent bleeding.The nurse monitors the pulses in the affected extremity until discharge, then teaches the client to contact the primary health care provider immediately if pallor, pain, paresthesia, or coolness of the extremity develops. The client may take regular medications except oral hypoglycemics. Blood pressure may be elevated due to anxiety before the procedure, so antihypertensive medications are taken. Oral hypoglycemics are taken with or before meals based on an anticipated rise in glucose after eating. They are not taken when the client is NPO for procedures or surgery.

Which client assessment data is most consistent with cardiac pain requiring the nurse to notify the primary health care provider? A. Reports of abdominal pain and belching B. Reports of pressure in the upper abdomen and sternum and diaphoresis C. Apparent dyspnea on exertion (DOE) and an inability to sleep flat D. Reports claudication with ambulation and fatigue

B. The client with pain most consistent with an MI is the client with pressure in the mid-abdomen and diaphoresis. Typical symptoms of MI include chest pain or pressure, ashen skin color, diaphoresis, and anxiety.Although atypical cardiac pain can be perceived in the abdomen, abdominal pain and belching are more typical of peptic ulcer. DOE and orthopnea are typical problems for clients with heart failure. Claudication (pain in the legs with exercise or at rest) is symptomatic of peripheral arterial occlusive disease.

The nurse is teaching a class on diagnostic cardiovascular testing. Which teaching will the nurse include? A. The left side of the heart is catheterized first and may be the only side examined. B. An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. C. Holter monitoring allows periodic recording of cardiac activity during an extended period of time. D. Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism.

B. The correct statement about diagnostic cardiovascular testing is that an alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. Intravascular ultrasonography (IVUS) is performed when a flexible catheter with a miniature transducer is inserted at the distal tip to view the coronary arteries. The transducer emits sound waves, which reflect off the plaque and the arterial wall to create an image of the blood vessel. It is another option besides using the medium injection method of diagnostic cardiovascular testing.Lethal, not nonlethal, dysrhythmias are a complication of diagnostic cardiovascular testing. Holter monitoring allows periodic recording of cardiac activity during short periods of time. Several parts of the heart are examined during diagnostic cardiovascular testing and not just the left side of the heart.

A client with heart failure reports a 7.6-lb (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? A. Sodium restriction B. Daily weight monitoring C. Restricted activity D. Dietary consult

B. The nurse expects that the primary health care provider will want the client's daily weights monitored. A sudden weight increase of 2.2 lb (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight. It is possible for weight gains of up to 10 to 15 lb (4.5 to 6.8 kg), or 4 to 7 L of fluid to occur before excess fluid accumulation (edema) is apparent.The weight change is most likely from excessive fluid, so a dietary consult, sodium restrictions, and restricted activity are not appropriate interventions.

Which statement best defines the cardiovascular concept of preload? A. Amount of resistance the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels B. Degree of myocardial fiber stretch at the end of diastole and just before the heart contracts C. The volume of blood ejected each minute by the heart D. Force of blood exerted against the vessel walls

B. The stretch imposed on the muscle fibers results from the volume contained within the ventricle at the end of diastole.

Which statement made by the client on the way to the catheterization laboratory requires an immediate action by the nurse? "My allergies are bothering me, so I took some Benadryl last night before bed." "I was nervous last night, but I still remembered to take my warfarin." "I sure am hungry. I haven't had anything to eat since I went to bed last night." "I don't know what I will do if they find a blockage in my heart."

B. Warfarin should be held prior to the procedure to reduce the risk of excessive bleeding. The nurse will need to call the provider immediately to determine if the cardiac catheterization will need to be rescheduled. Benadryl prior to the procedure is not contraindicated. This statement requires no action by the nurse. The statement in option C informs the nurse that the client has been NPO which is required prior to the heart catheterization. This statement in option D indicates mild anxiety associated with the medical procedure. Emotional support from the nurse is an appropriate response.

Which instruction would the nurse give a client who is to have an exercise electrocardiography test? A. "Someone must drive you home because of sedative effects of the medications." B."Wear comfortable loose-fitting clothes and supportive, rubber-soled shoes." C. "Avoid smoking or drinking alcohol for at least a week before the test. D. "Do not eat or drink anything after midnight."

B. clients are advised to wear comfortable, loose clothing and rubber-soled, supportive shoes. Instruct the client to get plenty of rest the night before the procedure. They may have a light meal 2 hours before the test but should avoid smoking or drinking alcohol or caffeine-containing beverages on the day of the test. Usually cv drugs are withheld on the day of the test.

When the nurse assesses a client in the clinic for a physical examination and finds decreased skin temperature, what does this most likely indicate? A. Renal failure B. Arterial insufficiency C. Anemia D. Central cyanosis

B. decreased blood flow results in decreased skin temp. It is lowered in several clinical conditions, including HF, peripheral vascular disease, and shock. It can be assessed for symmetry by touching different areas of the body with the dorsal surface of the hand or fingers.

Which exercise regimen would the nurse teach an older adult is best to meet guidelines for physical fitness to promote heart health? A. Golfing for 4 hours once a week B. Brisk walk for 20 to 30 minutes each day C. Bike ride for 6 hours every Saturday D. Running for 15 minutes twice a week

B. recommended exercise guidlines are 150 mins of mod exercise or 75 min of vigorous exercise per week plus completing muscle-strengthening exercises at least 2 days per week. Regular physical activity promotes CV fitness and produces beneficial changes in blood pressure and levels of blood lipids and clotting factors.

Which statement by a client to the nurse indicates an understanding of cigarette usage related to cardiovascular rIsKs A. "I don't smoke as much as I used to and I'm down to half a pack a day." B. "I need to be completely cigarette free for at least 3 years." C. "I started smoking a few years ago but I plan to quit in a year or two." D. "I smoke to relax like when I go out with friends or when I drink."

B. three to four years after a client has stopped smoking, his or her CVD risk appears to be similar to that of a person who has never smoked.

The nurse is assessing a client with heart failure. Which assessment data is the best indicator of fluid balance? A. Blood pressure 144/79 B. Urine output 200 mL in the last 4 hours C. Weight increase of 9 pounds in the past week D. Generalized edema in the lower extremities

C. A sudden weight increase of 2.2 lb (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight. A weight increase of 9 pounds in the past week is a significant indicator of fluid balance as weight often increases first, allowing for intervention before other symptoms such as edema develop.

What action does the nurse plan to take prior to a cardiac catheterization when a client states he or she has an allergy to seafood and iodine-containing dyes? A. Inform the cardiologist because the test must be delayed for a week. B. Prepare to administer anticoagulation therapy before the test. C. Administer an antihistamine and / or a steroid before the test. D. Instruct the client that the test will be conducted using noncontrast dye.

C. An antihistamine or steroid may be given to a client with a positive hx or to prevent a reaction. The test does not need to be delayed and contrast dye is necessary to see any coronary artery blockages. Anticoagulants would not be given because that would cause bleeding.

Which laboratory finding is consistent with acute coronary syndrome (ACS)? A. Triglycerides 400 mg/dL (4.52 mmol/L) B. C-reactive protein 13 mg/dL (130 mg/L) C. Troponin 3.2 ng/mL (3.2 mcg/L) D. Lipoprotein-a 18 mg/dL (0.64 mcmol/L)

C. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).Normal C-reactive protein would be less than 1 mg/dL (10 mg/L). This tests for risk for coronary artery disease (CAD), not ACS. Normal triglycerides would be 35 to 135 mg/dL (0.40 to 1.50 mmol/L) for females and 40 to 160 mg/dL (0.45 to 1.81 mmol/L) for males. This tests for risk for CAD, not ACS. Normal lipoprotein-a is less than 30 mg/dL (1.07 mcmol/L). This also tests for risk for CAD, not ACS.

What does the nurse suspect when a client states "I get short of breath whenever I lie down for several hours?" A. Dyspnea on exertion B. Orthopnea C. Paroxysmal nocturnal dyspnea D. Fatigue

C. PND develops after the client has been lying down for several hours. In this position, blood from the lower extremities is redistributed to the venous system which increases venous return to the heart. A diseased heart cannot compensate for the increased volume and is ineffective in pumping the additional fluid into circulatory system. Pulmonary congestion occurs, and the client awakens abruptly, often with a feeling of suffocation and panic. He or she sits upright and dangles the legs over the side of the bed to relieve the dyspnea.

The nurse is teaching a class about mechanical properties of the heart. What teaching will the nurse include? A. Body size does not affect overall cardiac output. B. Cardiac output is the amount of blood ejected by the ventricles during each contraction. C. Preload is the degree of stretch in the myocardial fibers D. Stroke volume is the amount of blood pumped out of the heart each minute.

C. Preload refers to the degree of myocardia fiber stretch at the end of diastole and just before contraction. Cardiac output is the amount of blood pumped from the left ventricle each minute (not with each contraction). Stroke volume is the amount of blood ejected by the left ventricle during each contraction (not each minute). Body size does affect the overall cardiac output. In adults, the cardiac output ranges from 3 to 6 L/min.

When a client is hypovolemic, which tissue reacts and sends fewer impulses to the CNS? A. baroreceptors B. Central chemoreceptors C. Stretch receptors D. Kidney receptors

C. Stretch receptors in the vena cava and the right atrium are sensitive to pressure or volume changes. When a client is hypovolemic, stretch receptors int he blood vessels sense a reduced volume or pressure and send fewer impulses to the CNS. This rxn stimulates the SNS.

A client who is suffering from dyspnea on exertion and heart failure (HF) will most likely report which symptom during the health history? A. Brown discoloration of lower extremities B. Swelling of one leg C. Fatigue D. Slow heart rate

C. The HF client with dyspnea on exertion will most likely report fatigue during the health history. Although fatigue in itself is not diagnostic of heart disease, many people with heart failure are limited by leg fatigue during exercise. Fatigue that occurs after mild activity and exertion usually indicates inadequate cardiac output (due to low stroke volume) and anaerobic metabolism in skeletal muscle.Unilateral swelling is more typical with a local finding such as deep vein thrombosis, not a systemic problem such as heart failure. Tachycardia, rather than bradycardia, develops with heart failure and decreased cardiac output. Brown discoloration of the lower extremities is indicative of long-standing venous stasis, such as occurs with varicose veins.

Which client has the highest risk for cardiovascular disease? A. Man who is sedentary and reports four episodes of strep throat. B. Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L). C. Man who smokes and whose father died at 49 of myocardial infarction (MI). D. Woman with abdominal obesity who exercises three times per week.

C. The client who has the highest risk for cardiovascular disease is the man who smokes and whose father died at 49 years of age of MI. Smoking is a major risk factor for MI, and family history is a stronger risk factor than hypertension, obesity, diabetes, or sudden cardiac death.Although abdominal obesity is a risk factor, exercising three times weekly is not. Diabetes is a major risk factor for MI, but an HDL cholesterol of 75 mg/dL (1.94 mmol/L) is in the optimal range of greater than 55 mg/dL (1.42 mmol/L). Sedentary lifestyle is a major risk factor; however, smoking and inherited risk combined make that a greater risk. Frequent strep infections may be associated with valvular disease rather than coronary artery disease.

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus women. Which teaching will the nurse include? A. Men more than women tend to deny the importance of symptoms. B. Men do not tend to report chest pain. C. Women may experience extreme fatigue and dizziness as sole symptoms. D. Men are more likely than women to die after MI.

C. The differences in symptoms of MI in men versus women are that women may experience extreme fatigue and dizziness as sole symptoms. Women may have atypical symptoms, including absence of chest pain. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feeling an inability to "catch the breath" (dyspnea) are also common in heart disease. The client may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or vise-like.Men do report chest pain. Women have higher mortality from MI than men. Because of differences in symptoms, denial may occur more often in women.

What common assessment finding would the nurse expect to find in an older adult with cardiovascular disease? A. Lower leg swelling B. Pericardial friction rub C. S4 heart sound D. Change in point of maximal impulse (PMI) location

C. This question asks for a finding related to aging. An atrial gallop (S4) may be heard in clients with HTN, anemia, ventricular hypertrophy, MI, aortic or pulmonic stenosis, and pulmonary emboli. It may also be heard with advancing age because of a stiffened ventricle. Edema, friction rubs, and PMI changes occur with CVD but are not just age related.

Which statement about the peripheral vascular system is accurate‹ A. The velocity of blood flow depends on the diameter of the blood vessel; lumen B. The parasympathetic nervous system has the largest effect on blood flow to organs. C. Veins have valves that direct blood flow to the heart and prevent backflow. D. Blood flow decreases and blood tends to clot as the viscosity decreases.

C. Veins in the superficial and deep venous systems (except the smallest and the largest veins) have valves that direct blood flow back to the heart and prevent backflow. Skeletal muscles in the extremities provide a force that helps push the venous blood forward. Veins have the ability to accommodate large shifts in volume with minimal changes in venous pressure.

What is the nurses first action when the health care provider prescribes orthostatic blood pressure checks for a client? A. Wait for 1 minute before auscultating blood pressure while the client is sitting. B. Instruct the client to sit on the side of the bed before checking blood pressure. C. Measure the blood pressure after the client has been supine for 3 minutes. D. Tell the client to change positions rapidly between blood pressure checks.

C. ortho hypotsn is defined as a decrease of more than 20 of the systolic pressure or more than 10 of the diastolic pressure and a 10%-20% increase in HR. First, measure the BP when the client is supine. After remainig supine for at least 3 minutes, the client changes position to sitting or standing. After the position change, wait at least 1 min before auscultating BP and counting the radial pulse. The cuff should remain in the proper position on the clients arm. Observe and record s/s of dizziness.

What is the lowest mean arterial pressure (MAP) necessary to perfuse the major organs of the body? A .90 to 100 mm Hg B. 80 to 90 mm Hg C. 70 to 80 mm Hg D. 60 to 70 mm Hg

D. A MAP between 60 and 70 is necessary to maintain perfusion of major body organs, such as the kidneys and brain.

What is the priority problem when a nurse assesses a client with CVD and notes skin that is pale, cool, and moist? A. Skin integrity B. Abnormal body temperature C. Peripheral neurovascular dysfunction D. Decreased perfusion

D. Decreased perfusion is manifested as cool, pale, and moist skin. If there is normal blood flow or adequate perfusion to a given area in light-colored skin, it appears pink, perhaps rosy, and is warm.

How many cigarette pack-years has this client smoked: Smoked half a pack a day for 6 years? A. ½ pack-year B. 1 pack-year C. 2 pack-years D. 3 pack-years

D. Pack years are the number of packs of cigarettes per day multiplied by the number of years the client has smoked.

The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which teaching will the nurse include? A. "This is a painless test that is done to assess the structure of your heart using sound waves." B. "You will receive an injection of dobutamine and will walk on a treadmill to reveal whether you have coronary artery disease." C. "This is a noninvasive test performed to assess your heart rhythm." D. "This test evaluates you for potentially fatal cardiac rhythms."

D. The correct teaching about the purpose of EPS is when the nurse says that the test evaluates the potential for fatal cardiac rhythms. EPS are invasive tests performed to determine whether the client has lethal dysrhythmias and conduction abnormalities.A noninvasive test to assess the heart rhythm best describes the electrocardiogram. Injection of dobutamine followed by walking on a treadmill best describes an exercise stress test. Using sound waves to assess the structure of the heart best describes echocardiography..

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? A. Reassure the client that they will not feel pain. B. Teach the client about the reason for the TEE. C. Auscultate the client's precordium for murmurs. D. Validate that the client has remained NPO.

D. The essential nursing action the nurse must take is to validate that the client scheduled for a TEE has remained NPO. Owing to the risk for aspiration, the client must be NPO before the procedure.It is anticipated that the client with mitral stenosis may have an audible murmur, so auscultation is not essential at this time. Although teaching is important, the client could undergo the procedure without understanding the reason for the test. The client will have sedation during the test as it is uncomfortable. However, with sedation, the goal is to maintain client comfort during the procedure.

A client recovering from cardiac angiography develops slurred speech. What will the nurse do first? A. Assess the site of the procedure for bleeding. B. Call in another nurse for a second opinion. C. Maintain NPO status until the slurred speech resolves. D. Perform a neurologic assessment and notify the primary care provider.

D. The first action the nurse must do when a client recovering from a cardiac angiography develops slurred speech is to perform a complete neurologic assessment and notify the primary health care provider. Based on the assessment finding, the client probably is suffering a neurologic event, possibly a stroke. Neurologic changes such as visual disturbances, slurred speech, swallowing difficulties, and extremity weakness must be reported immediately for prompt intervention.Keeping the client NPO and waiting for symptoms to resolve are not appropriate. While the nurse can call for help from another nurse, this assessment does not warrant a second opinion and action is required immediately. While it is appropriate to assess the site of the procedure for bleeding, the slurred speech is not from bleeding at the site, rather it is likely a neurologic event so the priority is neurologic assessment.

Which assessment data is most important for the nurse to report to the primary care provider prior to a coronary arteriogram? A. The client reports intermittent substernal chest pain for 6 months. B. The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate. C. The client reports that a previous arteriogram was negative for coronary artery disease. D. The client develops wheezes and dyspnea after eating crab or lobster.

D. The most important information the nurse needs to report to the primary health care provider before a coronary arteriogram is that the client develops wheezes and dyspnea after eating crab or lobster. The contrast agent injected into the coronary arteries during the arteriogram is iodine based. The client with a shellfish allergy is likely to have an allergic reaction to the contrast and must be medicated with an antihistamine or a steroid before the procedure.The reason the client is having the procedure is to determine whether atherosclerotic plaque obstructing the coronary arteries is the underlying cause of the chest pain. The intermittent substernal chest pain does not need to be reported to the provider. The provider does not need information about the previous arteriogram at this time. It is appropriate to know that, but does not change the current need for the procedure. The nurse will palpate the distal pulses after the procedure. The pulses can be assessed with a Doppler device and marked in ink. Therefore, this information is not needed before the procedure is performed.

What is the priority medical-surgical concept when the nurse is assessing a client with cardiovascular disease (CVD)? A. Acid-base balance B. Fluid and electrolyte balance C. Gas exchange D. Perfusion

D. The priority concept when assessing for CVD is perfusion. The interrelated concept for this chapter is fluid and electrolyte balance. Gas exchange and acid-base balance are more pertinent to respiratory and renal illnesses.

A client has been admitted to the hospital with chest pain radiating down the left arm. Which test result best confirms that the client sustained a myocardial infarction (MI)? A. C-reactive protein of 1 mg/dL (10 mg/L) B. Homocysteine level of 13 mcmol/L C. Creatine kinase (CK) of 125 units/L D. Troponin of 5.2 ng/mL (5.2 mcg/L)

D. The test results that best confirm that this client sustained a MI is a troponin of 5.2 ng/mL (5.2 mcg/L). The presence of elevated troponin indicates myocardial damage. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).A C-reactive protein level lower than 1 mg/dL (10 mg/L) is optimal for identifying inflammation and risk for heart disease. A homocysteine level lower than 12 mcmol/L is optimal, but elevation indicates risk, not myocardial damage. CK totals must be broken down into isoenzyme MB to evaluate for heart damage. Elevations in the CK total may be caused by stroke or skeletal muscle damage.

What does the nurse suspect when a client who had a bruit on assessment during the previous 2 days does not have a bruit on assessment to day? A. The prescribed antiplatelet therapy is working. B. The problem has resolved spontaneously C. The previous findings may have been an anomaly. D. The occlusion of the blood vessel is now 90%.

D. bruits occur from turbulent blood flow in narrowed or atherosclerotic arteries. Assess for the absence or presence of bruits by placing the bell of the stethoscope on the neck over the carotid artery while the client holds his or her breath.