Heart FA Davis practice Q's

The nurse is teaching a patient about the interventions to prevent the development of deep-vein thrombosis (DVT). Which statement made by the patient indicates the need for further teaching?

"I should limit my physical activity and spend more time sitting."

The nurse provides discharge teaching to a client who has received prescriptions for digoxin, furosemide, and a 2 gram sodium diet. Which statement indicated further teaching

'I can use little table salt on my food as long as I do not use it when cooking food'

Sublingual nitroglycerin is prescribed for a client with a hx of MI and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective.

'I should take one tablet before attempting activity that has caused angina'

Which statements about the heart are correct? Select all that apply. -The capillary bed consists of the delivery of waste and the removal of nutrients to the heart. -The atrioventricular valves are between the lungs and the heart. -Atrial contraction takes place immediately after depolarization. -Cardiac output consists of heart rate, preload, afterload, and contractility. -Atrial kick occurs in 30% of the population.

-Atrial contraction takes place immediately after depolarization. -Cardiac output consists of heart rate, preload, afterload, and contractility.

Laboratory markers predictive of heart disease

-C-reactive protein -HDL -LDL -Triglyceride -Total cholesterol -Homocysteine

The nurse assesses a client with long-term perfusion problems. The nurse suspects what underlying factor? Select all that apply. Lung cancer Aneurysm Chronic pulmonary disease Congenital heart defect Asthma

-Chronic pulmonary disease -Congenital heart defect -Lung cancer

Which symptom indicates poor perfusion? Select all that apply. Cool skin temperature Cyanosis Blood pressure of 120/80 mm Hg Nonpalpable pulses Muscular build

-Cool skin temperature -Cyanosis

Which symptoms should the nurse anticipate when providing care to a client who is diagnosed with left-sided heart failure? Select all that apply. Cyanosis Peripheral edema S3 and S4 heart sounds Jugular vein distention Weak peripheral pulses

-Cyanosis -S3 and S4 heart sounds -Weak peripheral pulses

Which clinical manifestations should the nurse anticipate when providing care to a client who is diagnosed with right-sided heart failure? Select all that apply. Weak pulses Dependent edema Delayed capillary refill Jugular vein distention Wheezes noted on lung auscultation

-Dependent edema -JVD (Also Hepatomegaly and Ascites)

Which factor is a modifiable risk factor for heart disease?

-Diet

Which medications should the nurse anticipate for a client diagnosed with heart failure who requires positive inotropic therapy? Select all that apply. Digoxin Enalapril Furosemide Metoprolol Dopamine

-Digoxin -Dopamine

Which clinical manifestations should the nurse anticipate when providing care to a client who is diagnosed with left-sided heart failure? Select all that apply. Dyspnea Hepatomegaly Fatigue Ascites Crackles noted on lung auscultation

-Dyspnea -Fatigue -Crackles (Also, delayed CRT, weak pulses, cool temp in extremities, pale color, SOB, orthopnea

Common cardiac diagnostic tests

-Echocardiogram -EKG -Chest x-ray -Coronary angiography -Stress test Rationale: Coronary angiography injects dye to better visualize the body's vascular system. An ECG assesses the heart's electrical conduction. A CXR shows the cardiac silhouette for enlargement. A stress test monitors the electrical conduction when the heart is stressed with activity. An echocardiogram is an ultrasound that shows valve and heart wall function. MRI, EGD, and PET scans are not commonly used.

In teaching a patient with heart disease about a coronary angiogram, which statements are correct? Select all that apply.

-It can detect the degree of occlusion. -It can determine whether the area can be treated with percutaneous transluminal coronary angioplasty (PTCA). -It is performed to determine the location of plaque within the coronary circulation.

The nurse is providing a community event about heart disease. Which statements are true regarding stable angina? Select all that apply.

-It is associated with symptoms that are often alleviated with rest and/or medication. -It is chest pain or discomfort that is associated with physical activity. -It is typically linked to fixed plaque formations.

Assessment signs of cardiac concerns

-JVD -Tachycardia -Hypotension -Bradycardia -Chest pain -Dizziness

What factor increases blood volume when the blood pressure is low?

-Kidneys release renin

Which factors most influence blood pressure? Select all that apply. Cardiac output Preload Peripheral vascular resistance Afterload Contractility

-Peripheral vascular resistance -Cardiac output

Which assessment finding demonstrates adequate perfusion? Pink skin and nailbeds Blood pressure 85/53 Pulse oximetry of 89% Cool extremities

-Pink skin and nailbeds

The nurse is auscultating the heart tones of a client. What sounds are considered normal? Select all that apply.

-S1 -S2

Assessment of heart sounds

-S1 -S2 -S4 -Clicks -Rubs

Visual assessment

-SOB -Restlessness -Color -Edema -Appearance -Diaphoresis

Assessment of cardiovascular risk factors

-Smoking Hx -Family hx of disease -Dietary intake -Ethnic background -Economic status -Occupation Rationale: When obtaining a risk assessment, the nurse needs to consider many factors including family history or CVD, diabetes, renal disease, hypertension, dyslipidemia, and current health status. Demographic data that can have an influence includes age, sex, and ethnic background. Modifiable risk factors include weight, dietary habits, alcohol consumption, and smoking history. Occupation and economic status can influence dietary habits and activity level and should be assessed by the nurse. Religious beliefs and country of birth do not have an increase risk.i

Laboratory markers of acute myocardial damage or injury

-Troponin -Myoglobin -CK-MB -BNP Rationale: When there is injury or damage to the cardiac muscle, enzymes are released, including creatinine kinase, troponin, myoglobin, and creatine kinase myocardial bands (an isoenzyme of creatine kinase). Brain natriuretic peptide is released from overstretched ventricles. Creatinine is a measurement of kidney function, and calcium and potassium are electrolytes.

Assessment locations of pulses Dorsalis pedis Radial Carotid Brachial Popliteal Temporal Femoral Posterior tibial

-radial -dorsalis pedis -femoral -popliteal -posterior tibial pulses. The brachial, carotid and temporal pulses are not commonly assessed routinely.

Which client should be classified, according to the American Heart Association and American College of Cardiology, as stage C?

A client with current symptoms of heart failure

Ischemic heart disease causes ____

A portion of the heart does not receive enough O2 and heart cells begin to die S-T depression

Which drug classification should the nurse anticipate for a client diagnosed with heart failure to reduce fluid volume and afterload?

Ace inhibitor

Which nursing intervention performed by the nurse when caring for a patient with coronary artery disease helps in dilating the coronary arteries?

Administering nitroglycerin as ordered

When an older client with HF is transferred from the ER to the medical service, which would the nurse on the unit do first

Asses the clients heart and lung sounds

A client is admitted to the hospital with a long hx of uncontrolled HTN. Which lab result will be most important for the nurse to review?

BUN

The greater the blood volume the greater the ____

Blood pressure

Contractility relies on the amount of ____ in the blood

Calcium

When a client has venous insufficiency, which finding by the nurse will be of most concern

Calf pain when the feet are dorsiflexed

The nurse is conducting a health class for adolescent. Which modifiable risk factor is most closely associated with the development of CHD in both men and women

Cigarette smoking

When caring for a client with HF, which type of lung sounds would the nurse expect to hear

Crackles

Which explanation would the nurse include when teaching a client with HF about the reason for a low-sodium diet

Decreased fluid retention

Systolic dysfunction

Difficulty with contraction and ejection of blood

Which drug classification should the nurse anticipate for a client diagnosed with heart failure to increase urine output?

Diuretic

Pulmonary Edema Diuretic Beta blocker

Diuretic Rationale: Pulmonary edema is often a medical emergency requiring the administration of a prescribed intravenous diuretic, such as furosemide, and the initiation of supplementary oxygen. Some clients may even require intubation and mechanical ventilation.

When teaching a group of female clients about clinical manifestations of coronary artery disease that are more common in women, which symptoms would the nurse include?

Dyspnea Indigestion Unusual fatigue

Which of the following diagnostic procedures is able to visualize internal cardiac structures?

Echocardiogram

Which diagnostic tests should the nurse anticipate will be ordered for the client with a cardiac condition? Select all that apply.

Electrocardiography Stress test Echocardiogram

Which is a cause for high-output failure for a patient diagnosed with heart failure?

Elevated demands on the heart

Fatigue Antidepressant Alternate rest and activity

Fatigue is a common clinical manifestation associated with heart failure. The nurse should alternate rest and activity periods for this patient. An antidepressant may be prescribed for the depression that often accompanies a diagnosis of heart failure.

Which medication should the nurse anticipate for a client diagnosed with heart failure with pulmonary edema? Digoxin Enalapril Furosemide Metoprolol

Furosemide

Acute Exacerbation of Heart Failure Hypertension Hypotension

Hypotension Rationale: In severe HF exacerbations, the client has decreased cardiac output and often presents with hypotension, cool extremities, decreased or no urine output, and poor or decreasing mentation. Often, he or she will have both an S3 and S4 heart sound.

Inotropic agents

Increase the force of contractions

Baroreceptor respond to low BP by ___

Increasing HR

When caring for a client who has HF with BP 102/72, pulse 106 BPM and bilateral lung crackles which prescribed action would the nurse question

Infuse normal saline at 100mL/hr

Which of the following statements is true regarding the pulmonary circulation?

It carries oxygenated blood away from the lungs.

Cool Extremities Right sided HF Left sided HF

Left A patient diagnosed with left-sided heart failure experiences weakened cardiac contractions. This results in a backflow of blood that negatively impacts peripheral circulation. Poor peripheral circulation manifests with cool skin and often poor skin color.

Which is a cause for diastolic dysfunction for a patient diagnosed with heart failure?

Left ventricle hypertrophy

Which surgical procedure is used to treat varicose veins?

Ligation and stripping

When reviewing lab results for a client with HF who has been receiving furosemide daily, the nurse notes a BUN of 42 and creat of 1.1 which action by the nurse is priority?

Notifying the health care provider about the results

Which info obtained by the nurse about a client would represent risk factors for the clients admission diagnosis of hypertension?

Occasional cocaine use African American

Which information about a client who has HF would the nurse communicate to the health care provider before administration of the prescribed digoxin

Potassium level of 2.3

The nurse provides immediate postoperative care to a client. The client reports a sudden onset of SOB and chest pain. Which action would the nurse take?

Provide supplemental O2

Which information will the nurse include when teaching a client with venous insufficiency about prevention of venous thrombosis

Put on compression stocking before arising

Which of the following conditions is periodic ischemic attacks affecting the extremities of the body?

Raynaud's phenomenon

Beta blockers

Reduce HR and afterload

Ace inhibitors

Reduce fluid volume and afterload

The nurse is teaching about a heart healthy diet to a community group with newly diagnosed hypertension. What should the nurse include in the teaching?

Reduction of salt is important to controlling the fluid in your body.

After obtaining client blood pressures of 172/104 mm Hg and 164/98 mm Hf during a blood pressure screening, which action would the nurse take next?

Refer the client to primary health care provider

When the kidneys do not get enough blood flow ___ is released

Renin

The nurse is performing a visual assessment on a client that is having chest pain. Which findings are most concerning? Select all that apply.

Restlessness Diaphoresis Shortness of breath Edema

Aldosterone causes ____

Sodium and water retention, increasing blood volume and pressure

When a client with angina is scheduled to have cardiac cath, which explanation would the nurse give about the purpose?

To visualize the disease process in the coronary arteries

Diastolic dysfunction

Unable to relax and fill appropriately *reduced filling ex: left ventricle hypertrophies in response to HTN and reduces filling space

When taking the health hx for a client admitted with HF, which assessment finding will the nurse expect the client to report

Using several pillows at night

Angiotensin II causes ___

Vasoconstriction thus causing increased BP

A patient has been started on anticoagulation therapy for prevention of developing another deep vein thrombosis. Which medication requires instructions on decreasing ingestion of vitamin K?

Warfarin

Left sided

Weakened left ventricle is unable to pump blood adequately. Left ventricle systolic dysfunction causes blood to back up in pulmonary system leading to pulmonary edema and crackles. Symptoms: -cyanosis -weak peripheral pulses -cardiomegaly -S3 and S4 heart sounds Results in: low BP and poor oxygenation

Right sides heart failure

When the right ventricle fails, it is unable to pump the blood received from the body Pooling of this blood can cause... -Hepatosplenomegaly -JVD -Peripheral edema Right ventricle may fail due to pulmonary disorders causing reduced oxygenation Cor pulmonale: (low O2 in the lungs causes vasoconstriction thus increasing afterload)

Which term means hardened artery?

arteriosclerosis

Which therapeutic device is used to treat ventricular fibrillation?

implantable cardioverter

Antidiuretic hormone (ADH) is release to ____

increase blood volume and increase BP

High output failure

results from elevated demands on the heart

Low output failure

results occurs with impaired venous return (maybe seen with hemorrhage)