Med Surg Cardiac Exam

The major pathology in atrial fibrillation (a. fib) is that the AV node fires at a very fast pace. True False

False

When assessing a patient with possible peripheral artery disease (PAD),the nurse obtains a brachial BP of 140/80 and an ankle pressure of112/70. The nurse calculates the patient's ankle-brachial index (ABI) as ____________________.

0.8

You connect Mr. Cameron to ECG and observe the following rhythm: Inverted T wave This finding on the ECG suggests: A. Myocardial ischemia B. Myocardial injury C. Myocardial infarction D. Myocardial necrosis

A. Myocardial ischemia T wave inversion -> NSTEMI

Calculation MAP for a patent with BP of 140/83. _____

102 [140+(2x83)]/3 = 102

The chest pain in Mr. Cameron's case is caused by A. O2 demand > O2 supply B. O2 supply > O2 demand C. coronary spasm D. high serum CO2 level

A. O2 demand > O2 supply pain is heart "screaming" for oxygen

You know that treatment for infective endocarditis involves which of the following? Select ALL that apply. A. Accurate identification of infecting organism B. Long-term antibiotic treatment C. Short-term antibiotic treatment D. Corticosteroids

A. Accurate identification of infecting organism B. Long-term antibiotic treatment

Since the patient is allergic to penicillin, she should not receive: A. Amoxil (Amoxicillin) B. Vancomycin C. Cefepime (Maxipime) D. Levofloxacin (Levaquin)

A. Amoxil (Amoxicillin)

Patient #2: J. G. is a 50-year-old African American man who comes monthly to the community health screening for blood pressure checkups. He says he had some headaches lately and a little dizziness. Initial Objective Data Alert and oriented and cooperative 5 feet 10 inches, 240 pounds Blood pressure 172/94, pulse 90, respirations 24, temperature 97.0° Subjective Data Is a truck driver and eats a lot of fast foods "It is hard to eat healthy on the road" Smokes one-half pack of cigarettes per day for 30 years Drinks at least a 6-pack of beer a day when he is not working States that he feels fine and is not a "hyper" person Has heard that BP drugs "make you impotent" Blood pressure is regulated by which body systems? (select all that apply) A. Autonomic nervous system B. Heart C. Lungs D. Kidneys E. Hormones

A. Autonomic nervous system B. Heart D. Kidneys E. Hormones

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. C. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

Patient #5: Mr. Kobe Bryant is a 35 y/o African-American male who was admitted with fever and hypotension. A CBC was drawn and showed WBC = 13,000/mm3. His Echo showed "aortic valve vegetation" and "low ejection fraction". The admitting physician updates the admitting diagnosis as "Infective Endocarditis". Once you know Mr. Bryant's diagnosis, you look to see if the Emergency Department RN did which of the following? A. Blood cultures B. Sputum cultures C. Urinalysis D. Occult Blood test

A. Blood cultures

Goal for blood pressure reduction in hypertensive crisis is A. Decrease MAP by no more than 25% within minutes to 1 hour. B. 120/80 C. 90/60 D. Decrease MAP of BP by 75% within minutes to 1 hour.

A. Decrease MAP by no more than 25% within minutes to 1 hour. If done too quickly, can cause rebound problems such as hypotensive crisis

Mr. Bryant is concerned about his diagnosis. He tells you, "I have no medical background - I play basketball. The doctor didn't explain this to me - Can you please tell me what is going on in my body?" Based on your understanding of the pathophysiology of infective endocarditis (IE), the following is an appropriate nursing diagnosis? A. Decreased Cardiac output related to valvular dysfunction manifested by low EF B. Endocarditis related to pharyngitis manifested by hypotension and fever. C. Risk for infection related to group A beta-hemolytic streptococci infection D. Fluid volume excess related to decrease contractility manifested by hypotension

A. Decreased Cardiac output related to valvular dysfunction manifested by low EF

Based on Mr. Cameron's presentation, what diagnostic test should you do first? A. ECG B. Serum troponin C. Chest x-ray D. Echocardiogram

A. ECG This will tell you right away if you're having heart damage.

Which tests are useful in the diagnosis of pericarditis? A. ECG B. Echocardiogram C. CBC D. ESR E. CRP F. Urinalysis

A. ECG B. Echocardiogram C. CBC D. ESR E. CRP

The presence of JVD indicates A. High venous pressure B. Low venous pressure C. High systemic resistance D. Low systemic resistance

A. High venous pressure

Which of the following nursing diagnoses are applicable to M.H.'s condition? Select all that apply. A. Impaired gas exchange r/t increased preload and alveolar-capillary membrane changes B. Excess fluid volume r/t increased venous pressure and decreased renal perfusion secondary to HF C. Activity intolerance r/t imbalance between O2 supply and demand secondary to pulmonary congestion D. Hypertension r/t history of chronic heart failure

A. Impaired gas exchange r/t increased preload and alveolar-capillary membrane changes B. Excess fluid volume r/t increased venous pressure and decreased renal perfusion secondary to HF C. Activity intolerance r/t imbalance between O2 supply and demand secondary to pulmonary congestion

Mr. Bryant has greatly improved and is ready to be discharged. The rounding physician puts discharge orders in for you. Which of the following must be included in the teaching plan of the patient? Select ALL that apply. A. Prophylactic antibiotic is required before any dental procedures. B. Endocardiocentesis may be needed if the medical treatment fails. C. Brush thoroughly 2-3 times a day and floss daily. D. Prescribed antibiotics must be completed at home via IV route. E. Prophylactic Coumadin (Warfarin) will be needed for the rest of his life.

A. Prophylactic antibiotic is required before any dental procedures. C. Brush thoroughly 2-3 times a day and floss daily. D. Prescribed antibiotics must be completed at home via IV route.

Which information should the nurse include in discharge education for this patient? (select all that apply) A. Salt restriction B. Weight reduction C. Smoking Cessation D. Avoid truck driving

A. Salt restriction B. Weight reduction C. Smoking Cessation

You realize that anxiety and acute pain are two major nursing diagnoses relevant for your patient. What intervention would aid your patient with anxiety? Select ALL that apply. A. Simple, complete explanations of all procedures B. Simple, complete explanations of possible causes of pain C. Alleviate pain with antiinflammatory medications as prescribed D. Position patient at 30 degrees E. Position patient at 45 degrees F. Provide an overbed table for support G. Leave the patient alone as often as possible

A. Simple, complete explanations of all procedures B. Simple, complete explanations of possible causes of pain C. Alleviate pain with antiinflammatory medications as prescribed E. Position patient at 45 degrees F. Provide an overbed table for support

Which mechanism for blood pressure regulation has the fastest action? A. Sympathetic stimulation B. Aldosterone C. Epinephrine D. Antidiuretic Hormone

A. Sympathetic stimulation

Which of the following is the strongest contraindication to the use of beta blockers? A. Symptomatic bradycardia B. Peripheral arterial disease C. Asthma D. Emphysema E. Diabetes

A. Symptomatic bradycardia

M. H is experiencing: A. Systolic HF B. Diastolic HF

A. Systolic HF

The ED physician orders the following tests: CBC, BMP, 12-lead ECG, cardiac enzymes, coagulation panel, and CXR. Which cardiac enzyme is the most sensitive and specific for myocardial damage? A. Troponin B. CRP C. CK-MB D. Myoglobin

A. Troponin sensitive and specific for damage to heart. if its elevated, we have it, and if its low, we don't have it

What is the main effect of norepinephrine (NE) on A1 and B1 receptors? A. Vasoconstriction and increased heart rate B. Vasoconstriction and decreased heart rate C. Vasodilatation and decreased heart rate D. vasodilatation and increased heart rate

A. Vasoconstriction and increased heart rate

Which of the following are classical symptoms of pericarditis? Select ALL that apply. A. auscultation of friction rub that correlates with patient's pulse. B. auscultation of friction rub that correlates with patient's breathing. C. Prominent heart sounds. D. ST elevation in most leads in ECG. E. Pleuritic pain that gets worse with inspiration. F. Pain that worsens in supine position

A. auscultation of friction rub that correlates with patient's pulse. D. ST elevation in most leads in ECG. E. Pleuritic pain that gets worse with inspiration. F. Pain that worsens in supine position

When developing a health teaching plan for Mr. Cameron, you should focus on his: A. high serum LDL B. age C. gender D. family history of CAD

A. high serum LDL because it is the only modifiable risk factor

Clinical manifestations of IE could include which of the following? Select ALL that apply. A. splinter hemorrhages B. Osler's nodes C. Janeway's Lesions D. Hemorrhagic retinal lesions E. Onset of new aortic or mitral murmur F. Low-grade fever

A. splinter hemorrhages B. Osler's nodes C. Janeway's Lesions D. Hemorrhagic retinal lesions E. Onset of new aortic or mitral murmur F. Low-grade fever

To hear the mitral murmur, you should place the bell of the stethoscope is placed over A. the apex of the heart B. the base of the heart C. 2nd right ISC D. 2nd left ISC

A. the apex of the heart

After you finished teaching Mr. Cameron about sublingual nitroglycerin (Nitrostat), which statement indicates that the teaching has been effective? A. "I will help slow down the progress of the plaque formation by taking nitroglycerin." B. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin. I can repeat every 5 minutes for a maximum of 3 doses before calling EMS" C. "I can only take the nitroglycerin if I start to have chest pain." D. "I can expect indigestion as a side effect of nitroglycerin."

B. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin. I can repeat every 5 minutes for a maximum of 3 doses before calling EMS"

It's been 30 minutes and the chest pain hasn't been relieved completely even with Nitroglycerin IV drip. Troponin is elevating. Therefore, acute MI is the diagnosis now. Cardiac cells can withstand ischemic conditions for ____ minutes before irreversible cell death begins. A. 10 B. 20 C. 30 D. 40

B. 20 minutes

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? A. Continue to monitor the rhythm and BP. B. Apply the transcutaneous pacemaker (TCP). C. Have the patient perform the Valsalva maneuver. D. Give the scheduled dose of diltiazem (Cardizem).

B. Apply the transcutaneous pacemaker (TCP). The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.

Which diagnostic finding indicates that LV remodeling has occurred? A. Low ejection fraction B. Enlargement of the heart C. High BNP level D. Mitral regurgitation murmur

B. Enlargement of the heart

M.H. begins to have increasing tachypnea and bilateral crackles. In semi-Fowler's position, she develops dyspnea. Your immediate first action should be which of the following? A. Apply nasal cannula at 6L/min B. Place her in High Fowler's position C. Administer prescribed Lasix D. Obtain CXR

B. Place her in High Fowler's position

What classification of hypertension does J. G. have? A. Stage 1 hypertension B. Stage 2 hypertension C. Anginal hypertension D. Hypertensive Crisis

B. Stage 2 hypertension

You have a patient diagnosed with IE. Which of the following is a risk factor for this condition? A. The patient had diarrhea about a month ago B. The patient had strep throat about 4 months ago C. The patient was born with 2 birth marks on his back D. Both of the patient's grandfathers have hypertension

B. The patient had strep throat about 4 months ago

Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess presence of pulsus paradoxus, you should: A. subtract the diastolic BP from the systolic BP. B. note when Korotkoff sounds are audible during both inspiration and expiration. C. auscultate for a pericardial friction rub that increases in volume during inspiration D. check the electrocardiogram (ECG) for variations in rate

B. note when Korotkoff sounds are audible during both inspiration and expiration.

After securing the airway, priority nursing management for a patient with hypertensive crisis is to: A. maintain bed rest B. place an IV C. monitor for signs of hypotension D. give IV antihypertensive medication

B. place an IV Then D, then C.

BNP is a major marker of congestive HF and it is released in response to: A. decreased renal perfusion B. ventricular stretch C. development of pulmonary edema D. low preload

B. ventricular stretch

Which of these statements made by Mr. Cameron about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? A. "I will switch from whole milk to 1% or nonfat milk." B. "I like fresh salmon and I will plan to eat it more often." C. "I will miss being able to eat peanut butter sandwiches." D. "I can have a cup of coffee with breakfast if I want one."

C. "I will miss being able to eat peanut butter sandwiches." He can still have peanut butter, good source of protein and fat.

Mr. Cameron indicated that his pain is in the middle of his chest and radiates to his left arm. It is about 6/10. He added that this was not the first time he had this pain. He said that the pain usually starts a few minutes after gardening or climbing stairs and is relieved by rest. Angina is suspected. Based on the pathophysiology of Mr. Cameron's condition, his coronary artery is blocked by A. 30% B. 50% C. 70% D. 90%

C. 70% With chronic stable angina, patients can have up to a 70% blockage

Longstanding hypertension can reset which receptor A. Chemoreceptors B. Osmoreceptors C. Baroreceptors D. Hemoreceptors

C. Baroreceptors

The physician decides to admit Mr. Cameron for observation. A Stress Test is scheduled for Mr. Cameron.To prepare Mr. Cameron for the stress test, you should: A. Have him NPO after midnight B. Allow him to have a light breakfast with a cup of coffee C. Hold his cardizem 24 hours before the test. D. shave Mr. Cameron's groin area.

C. Hold his cardizem 24 hours before the test. it is a calcium channel blocker and we want to know what his heart is actually doing

Patient #3: Patient M.B. has been diagnosed with left, systolic HF. An echocardiogram is done. Which of the following findings would you expect for M.B.? A. Ejection fraction of 65% B. Increased cardiac output C. Increased left ventricle size with thinner, dilated ventricular walls D. Increased right ventricle size and thicker ventricular walls

C. Increased left ventricle size with thinner, dilated ventricular walls

Based on the clinical presentation, M. H. is having A. Right-sided HF B. Left-sided HF C. Left and Right HF D. Compensated HF

C. Left and Right HF

The most important long-term goal for a client with hypertension would be to: A. Learn how to avoid stress B. Explore a job change or early retirement C. Make a commitment to long-term therapy D. Lose weight

C. Make a commitment to long-term therapy

JG is here for a follow-up visit and a more detailed physical exam regarding his diagnosis of hypertension. During this time he has been taking hydrochlorothiazide 12.5 mg/day and is following a low-sodium diet. J.G's blood pressure has been elevated on two occasions 1 month apart, he is about 25 lb overweight and continues his smoking and drinking habits. Physical Examination • Retinopathy • Blood pressure: 166/108 mm Hg • Sustained apical impulse palpable in the fifth intercostal space just lateral to the midclavicular line. Diagnostic Studies • ECG: left ventricular hypertrophy • Urinalysis: protein 30 mg/dL (0.3 g/L) • Serum creatinine level: 1.6 mg/dL (141 mmol/L) Diagnosis of hypertension is obtained by A. One high blood pressure reading at any clinic visit B. Average of one blood pressure on any clinic visit. C. The average of two or more blood pressure readings at two or more office visits D. Two high blood pressure readings taken less than one minute apart on the same visit

C. The average of two or more blood pressure readings at two or more office visits

You should terminate the stress test if Mr. Cameron develops A. HR of 120 B. sweating C. chest pain D. RR of 25

C. chest pain

The occlusion/obstruction of coronary arteries are determined using: A. echocardiogram B. ECG C. coronary angiogram D. chest x-ray

C. coronary angiogram

Mr. Cameron has a history of atrial fibrillation and has been taking Coumadin (Warfarin) and therefore he is not a candidate for fibrinolytic therapy. Instead, urgent cardiac catheterization is scheduled. [Evidence suggests that this should not completely contraindicate fibrinolytic therapy] You are preparing to care for Mr. Cameron following the cardiac catheterization performed through the femoral artery. You should place Mr. Cameron on: A. Bedrest in high Fowler's position B. Bedrest with bathroom privileges only C. Bedrest with head elevation at 60 degrees D. Bedrest with head elevation no greater than 30 degrees

D. Bedrest with head elevation no greater than 30 degrees Don't want him bent because he can open the wound on femoral artery

Treatment for hypertensive crisis initially involves? A. Fluid resuscitation B. IV antibiotics C. Oral hypertensives D. IV anti-hypertensives

D. IV anti-hypertensives

Which of M. H.'s symptoms is NOT related to left-sided HF A. Dyspnea B. Tachypnea C. Crackles D. JVD

D. JVD

Since she is allergic to Lisinopril, an alternative could be: A. Atenolol (Tenormin) B. Simvastatin (Zocor) C. Amlodipine (Norvasc) D. Losartan (Cozaar)

D. Losartan (Cozaar)

Which one of the following reveals a risk factor / etiology for Mr. Bryant's condition? A. 2 congenital birth marks on backside B. A single episode of diarrhea about one month ago C. Family history of maternal and fraternal grandfathers with HTN D. Medical history of strep throat about 4 months ago

D. Medical history of strep throat about 4 months ago

Which of the following is not a classification of hypertension? A. Primary Hypertension B. Pseudohypertension C. Isolated systolic hypertension D. Stage 3 hypertension

D. Stage 3 hypertension

On Day 2, you return for your second 12-hour shift. Which of the following findings indicates that the patient's endocarditis has worsened? Why? A. Ejection fraction measures 65% B. Serum potassium 4.8mEq/L C. Absent of murmur D. WBC increases to 18,000/mm3

D. WBC increases to 18,000/mm3 65% is normal EF K is normal level There should be a murmur if its getting worse

Which of the following is the most effective life style modification that affects the BP? A. Exercise B. Stop smoking C. Sodium restriction D. Weight loss

D. Weight loss

Hypertensive Crisis is an acute life threatening diagnosis in which the patient usually has: A. diastolic Blood pressure greater than 120 B. high risk for target organ damage including the brain, kidneys and eyes. C. signs and symptoms of headache, drowsiness, confusion, dyspnea and tachycardia D. all of the above

D. all of the above

Your patient has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe. You would expect to find which of the following? A. Positive Homan's sign B. swollen dry scaly ankles C. a large amount of drainage from the ulcer D. prolonged capillary refill in all the toes E. shiny taut appearance on skin of lower legs, ankles, and feet

D. prolonged capillary refill in all the toes E. shiny taut appearance on skin of lower legs, ankles, and feet

What assessment finding is indicative of target organ damage? A. ECG changes. B. Visual problems. C. Kidney dysfunction. D. Palpable apical pulse 5th ICS lateral to the MCL E. All of the above

E. All of the above

The nurse knows that which possible side effects or adverse reactions are important to consider when initiating treatment of hypertension using ACE-inhibitors or ARB's? A. ACE-inhibitors and ARB's can cause angioedema. B. Chronic cough may be related to hypertensive management with ACE-inhibitors. C. ACE is less effective in African Americans D. ACE and ARB can potentiate hyperkalemia especially in patients with renal impairment E. All of the above.

E. All of the above. •Angioedema (localized swelling) is a common adverse effect of ACE inhibitors and ARB •ACE inhibitors work in lungs causing chronic cough •For African americans, will likely go to ARBs first •Hyperkalemia is high potassium in the blood

¨The ED physician examines Mr. Cameron and based on the ECG findings the diagnosis is angina. The physician prescribes "MONA". What does MONA stand for?

Morphine Oxygen Nitroglycerine Aspirin

Atrial fibrillation is a dysrhythmia with irregular rate and irregular rhythm. True False

True

It is possible for someone with IE to come back with negative blood cultures. True False

True

Patient #1: Mr. Cameron is a 66-year old Caucasian gentleman who has a history of CAD. This morning while he was gardening, he felt "some chest pain." He drove himself to the ED. When a patient presents with chest pain, you should assume it is of a cardiac origin until that can be ruled out. True False

True

Patient #4: Mrs. M. H. developed 5/10 substernal chest pain (on a 0-10 pain scale) and shortness of breath. Substernal pain is highly associated with CV events. True False

True

Patient #6: Mr. Daniel Craig is a 28 y/o Caucasian male who has been admitted with "Acute Pericarditis". He tells you he has "severe, sharp chest pain. It hurts so much that I can't take a deep breath or lie down". Medical Hx: HTN x 2 years, HLD x 2 years Surgical Hx: Tonsillectomy Family Hx: Father died at 47 from MI, Mother alive with HTN, CAD, HLD, Uncle died at 52 from MI Medications: None on record. Most cases of acute pericarditis are idiopathic. True False

True Idiopathic: we don't really know how he got it

A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? a. Cessation of smoking b. Control of serum lipid levels c. Maintenance of appropriate weight d. Demonstration of meticulous foot care

a. Cessation of smoking Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.

AV node function is to delay the action potentials and allow ventricles to rest. a. true b. false

a. true

Large heart (cardiomegaly) may be seen in patient with heart failure and cardiomyopathy. a. true b. false

a. true

Which of these patients admitted to the emergency department should the nurse assess first? a. 62-year-old who has gangrenous ulcers on both feet b. 50-year-old who is complaining of "tearing" chest pain c. 45-year-old who is taking anticoagulants and has bloody stools d. 36-year-old who has right calf tenderness, redness, and swelling

b. 50-year-old who is complaining of "tearing" chest pain The patient's presentation is consistent with dissecting thoracic aneurysm, which will require rapid intervention. The other patients do not need urgent interventions.

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? a. Absence of flatus b. Loose, bloody stools c. Hypotonic bowel sounds d. Abdominal pain with palpation

b. Loose, bloody stools Loose, bloody stools at this time may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery.

Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? a. Complaint of left calf pain b. New onset shortness of breath c. Red skin color of left lower leg d. Temperature of 100.4° F (38° C)

b. New onset shortness of breath New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the healthcare provider. The other findings are typical of VTE.

A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? a. The LPN/LVN places the patient in a Fowler's position for meals. b. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. c. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. d. The LPN/LVN administers the ordered aspirin 160 mg after breakfast.

b. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. avoid dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider about any nausea. d. never take digoxin if the pulse is below 60 beats/minute.

c. notify the health care provider about any nausea. Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.

Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? a. Wrap both the legs in warm blankets. b. Notify the surgeon and anesthesiologist. c. Document that the pulses are absent and recheck in 30 minutes. d. Review the preoperative assessment form for data about the pulses.

d. Review the preoperative assessment form for data about the pulses. Many patients with aortic aneurysms also have peripheral arterial disease, so the nurse should check the preoperative assessment to determine whether pulses were present before surgery before notifying the health care providers about the absent pulses. Because the patient's symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 30 minutes before taking action. Warm blankets will not improve the circulation to the patient's legs.

When developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patient's male sex. c. high incidence of cardiovascular disease in older people. d. elevation of the patient's serum low density lipoprotein (LDL) level.

D. elevation of the patient's serum low density lipoprotein (LDL) level. Serum LDL is the only modifiable risk factor.

The most sensitive test for myocardial infarction is a. Troponin b. BNP c. Myoglobin d. CK-MB

a. Troponin

The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Have you been to the dentist lately?" b. "Do you have a history of a heart attack?" c. "Is there a family history of endocarditis?" d. "Have you had any recent immunizations?"

a. "Have you been to the dentist lately?" Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE.

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, a. "I should increase the amount of green, leafy vegetables that I eat." b. "I should wear a Medic Alert bracelet stating that I take Coumadin." c. "I will need to have blood tests routinely to monitor the effects of the Coumadin." d. "I will check with my health care provider before I begin or stop any medication."

a. "I should increase the amount of green, leafy vegetables that I eat." Patients taking Coumadin are taught to follow a consistent diet with regard to foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective? a. "I will call for help when I need to get up to use the bathroom." b. "I will be sure to take the medication after eating something." c. "I will need to include more high-potassium foods in my diet." d. "I will expect to feel more short of breath for the next few days."

a. "I will call for help when I need to get up to use the bathroom." Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The ACE inhibitors are potassium sparing, and the nurse should not teach the patient to increase sources of dietary potassium. Increased shortness of breath is expected with initiation of b-blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating.

A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate? a. Allow the student to participate on the swim team. b. Refer the student to a cardiologist for further assessment. c. Obtain more detailed information about the student's health history. d. Tell the student to stop swimming immediately if any dyspnea occurs.

a. Allow the student to participate on the swim team. In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.

A few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patient's oral temperature. c. Notify the patient's health care provider. d. Give the ordered acetaminophen (Tylenol).

a. Auscultate the heart sounds. The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature, giving acetaminophen (Tylenol), and notifying the health care provider also are appropriate actions but would not be done before listening for a rub.

A patient's cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Defibrillate at 200 joules. b. Give O2 per bag-valve-mask. c. Give epinephrine (Adrenalin) IV. d. Prepare for endotracheal intubation.

a. Defibrillate at 200 joules. The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, the other actions may be appropriate.

A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first? a. Electrocardiogram (ECG). b. Computed tomography (CT) scan c. Chest x-ray d. Troponin level

a. Electrocardiogram (ECG) An ECG will provide the most information in the least amount of time concerning the patient's cardiac status.

Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide rate slowly before discontinuing. d. Teach patient about safe home use of the medication.

a. Monitor blood pressure frequently. Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Since the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration and is used for ADHF but not in a home setting.

Which information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patient's chest pain b. A large bruise at the patient's IV insertion site c. A decrease in ST segment elevation on the electrocardiogram (ECG) d. An increase in cardiac enzyme levels since admission

a. No change in the patient's chest pain

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Apical pulse rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

a. Oxygen saturation of 88% A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require rapid nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patient's a. P wave. b. PR interval. c. QT interval. d. QRS complex.

a. P wave. The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q-T interval represents depolarization and repolarization of the entire conduction system.

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

a. Serum creatinine of 2.6 mg/dL This lab value may indicate that the kidneys have been damaged, possibly as a result of the hypertension.

A patient whose cardiac monitor shows sinus tachycardia, rate 102, is apneic and no pulses are palpable by the nurse. What is the first action that the nurse should take? a. Start CPR. b. Defibrillate. c. Administer atropine per hospital protocol. d. Give 100% oxygen per non-rebreather mask.

a. Start CPR. The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.

During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to leg swelling. c. impaired skin integrity related to peripheral edema. d. impaired gas exchange related to chronic heart failure.

a. activity intolerance related to fatigue. The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems.

Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. angiotensin-converting enzyme (ACE) inhibitors. b. digitalis preparations. c. b-adrenergic agonists. d. calcium channel blockers.

a. angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and b-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The b-adrenergic agonists such as dobutamine are administered through the IV route and are not used as initial therapy for heart failure.

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

a. asthma. Nadolol is a beta-blocker and can cause bronchospasm, especially in patients with a history of asthma (Lewis et al., 2017).

To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should: a. auscultate with the stethoscope diaphragm at the lower left sternal border. b. listen for a rumbling, low-pitched, systolic sound over the left anterior chest. c. feel the precordial area with the palm of the hand to detect vibration with cardiac contraction. d. ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.

a. auscultate with the stethoscope diaphragm at the lower left sternal border. Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. Because dyspnea is one clinical manifestation of pericarditis, the nurse should time the friction rub with the pulse rather than ask the patient to stop breathing during auscultation. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.

The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to: a. avoid giving any IM medications to prevent localized bleeding. b. discontinue the infusion for PTT values greater than 50 seconds. c. monitor posterior tibial and dorsalis pedis pulses with the Doppler. d. have vitamin K available in case reversal of the argatroban is needed.

a. avoid giving any IM medications to prevent localized bleeding. IM injections are avoided in patients receiving anticoagulation. A PTT of 50 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.

A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care? a. sildenafil (Viagra) b. furosemide (Lasix) c. diazepam (Valium) d. captopril (Capoten)

a. sildenafil (Viagra) Sildenafil (Viagra) would be the medication with the most critical implications. Sildenafil is a potent vasodilator, so adding more vasodilation may result in a hypotensive crisis (Lewis et al., 2017).

During inspiration, the chest wall expands and causes the intrathoracic pressure to become more negative like a vacuum, which induces a reduction in blood volume returning from the lungs into the left ventricle and therefore decrease cardiac output. a. true b. false

a. true

Low preload is seen in dehydration while high preload is seen in over hydration. a. true b. false

a. true

One of the major factors that affects the myocardial blood flow is changes in oxygen demands. a. true b. false

a. true

SA node is consider the natural pacemaker of the conduction system of the heart. a. true b. false

a. true

The apical pulse is located in the 5th ICS and MCL. a. true b. false

a. true

The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow. a. true b. false

a. true

In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, a. "I will have to buy some loose clothing that does not bind across my legs or waist." b. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." c. "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily." d. "I will change my position every hour and avoid long periods of sitting with my legs down."

b. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.

When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? a. "Exercise only if you do not experience any pain." b. "It is very important that you stop smoking cigarettes. c. "Try to keep your legs elevated whenever you are sitting." d. "Put on support hose early in the day before swelling occurs."

b. "It is very important that you stop smoking cigarettes. Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

A patient with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy? a. "Do you take aspirin on a daily basis?" b. "What time did your chest pain begin?" Correct - c. "Is there any family history of heart disease?" d. "Can you describe the quality of your chest pain?"

b. "What time did your chest pain begin?" A patient with a STEMI is eligible for thrombolytic therapy if he or she has had chest pain for 12 hours or less (Lewis et al., 2017).

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

b. 128/76 mm Hg This BP reading would indicate appropriate treatment for a patient with stage 1 hypertension.

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? a. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure (BP) of 100/56 b. A patient who is cool and clammy, with new-onset confusion and restlessness c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who has crackles in both posterior lung bases and is receiving oxygen

b. A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible, but do not have indications of severe decreases in tissue perfusion.

When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

b. Attach the cardiac monitor. The earlier the monitor is attached, the faster the information concerning cardiac status can be interpreted.

Which of the following indicate hemodynamic stability? Select all that apply. a. Stroke volume is 50 mL per beat. b. Cardiac output is 5 L/min. c. Mean arterial pressure (MAP) is 55 mmHg. d. SBP is 120 mmHg e. presence of JVD.

b. Cardiac output is 5 L/min. d. SBP is 120 mmHg This answer indicates hemodynamic stability.

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN? a. Evaluate the IV insertion site for extravasation. b. Document the patient's BP and heart rate every hour. c. Adjust the rate to keep the systolic BP >90 mm Hg. d. Teach the patient the reasons for remaining on bed rest.

b. Document the patient's BP and heart rate every hour. An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive medications, and monitoring for serious complications such as extravasation require RN level education and scope of practice.

A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and diaphoresis. Which of these actions that are included in the hospital dysrhythmia protocol should the nurse take first? a. Obtain a 12-lead electrocardiogram (ECG). b. Give O2 at 3 to 4 L/min. c. Take the patient's blood pressure and respiratory rate. d. Notify the health care provider of the change in rhythm.

b. Give O2 at 3 to 4 L/min. Since this patient has dyspnea in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by oxygen

Which of the following may cause changes in ECG rhythms? a. Na is 136 mEq/L b. K is 2.8 mEq/L c. Ca is 8.5 mg/dL d. Creatine 1.0 mg/dL

b. K is 2.8 mEq/L Hypokalemia may cause changes in ECG rhythms (Lewis et al., 2017).

Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has persisted longer than 30 minutes. c. The pain worsens when the patient raises the arms. d. The pain is relieved after the patient takes nitroglycerin.

b. The pain has persisted longer than 30 minutes. Cardiac chest pain lasting longer than 30 minutes and not relieved by rest or use of nitroglycerin could be indicative of AMI.

When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a a. T wave of 0.16 second. b. P-R interval of 0.18 second. c. Q-T interval of 0.34 second. d. QRS interval of 0.14 second.

d. QRS interval of 0.14 second. Because the normal QRS interval is 0.04 to 0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T wave interval are within the normal range.

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? a. The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). b. The patient exercises indoors during the winter months. c. The patient places the hands in hot water when they turn pale. d. The patient takes pseudoephedrine (Sudafed) for cold symptoms.

b. The patient exercises indoors during the winter months. Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking aspirin andNSAIDs with Raynaud's phenomenon.

When admitting a patient for a coronary arteriogram and angiogram, which information about the patient is most important to communicate to the health care provider? a. The patient's pedal pulses are +1. b. The patient is allergic to shellfish. c. The patient has not eaten anything today. d. The patient had an arteriogram a year ago.

b. The patient is allergic to shellfish. These procedures require the use of contrast medium, which may be contraindicated in patients with shellfish allergy.

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to a. give IV diazepam (Valium) 2.5 mg. b. administer IV morphine sulfate 2 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

b. administer IV morphine sulfate 2 mg. Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it also will increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that: a. sitting at the work counter, rather than standing, is recommended. b. compression stockings should be applied before getting out of bed. c. exercises such as walking or jogging cause recurrence of varicosities. d. taking one aspirin daily will help prevent clotting around venous valves.

b. compression stockings should be applied before getting out of bed. Compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended to the patient who had just had sclerotherapy.

Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will a. reduce the "fight or flight" response. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. help prevent clotting in the coronary arteries.

b. decrease spasm of the coronary arteries. This statement refers to the action of a calcium channel blocker (CCB) (Lewis et al., 2017).

A patient is admitted to the hospital with possible acute pericarditis. The nurse will plan to teach the patient about the purpose of a. electrolyte levels. b. echocardiography. c. daily blood cultures. d. cardiac catheterization.

b. echocardiography. Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization is not a diagnostic procedure for pericarditis. Electrolyte levels are not helpful in making a diagnosis of pericarditis.

Afterload increases in case of vasodilation and decreases in case of vasoconstriction. a. true b. false

b. false

Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should: a. check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration. b. note when Korotkoff sounds are audible during both inspiration and expiration. c. auscultate for a pericardial friction rub that increases in volume during inspiration. d. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).

b. note when Korotkoff sounds are audible during both inspiration and expiration. Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus.

While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate a. transfer to a dementia care service. b. referral to a home health care agency. c. placement in a long-term care facility. d. arrangements for around-the-clock care.

b. referral to a home health care agency. The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as dementia care, long-term care, or around-the-clock home care.

After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been EFFECTIVE? a. "I can expect indigestion as a side effect of nitroglycerin." b. "I can only take the nitroglycerin if I start to have chest pain." c. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." d. "I will help slow down the progress of the plaque formation by taking nitroglycerin."

c. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." Chest pain that continues after use of NTG may indicate a change to acute coronary syndrome (ACS). (Lewis et al., 2017)

Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. "I will switch from whole milk to 1% or nonfat milk." b. "I like fresh salmon and I will plan to eat it more often." c. "I will miss being able to eat peanut butter sandwiches." d. "I can have a cup of coffee with breakfast if I want one."

c. "I will miss being able to eat peanut butter sandwiches." This answer demonstrates that teaching has been INEFFECTIVE. Peanut butter is an appropriate source of fat in the diet of a patient with CAD. (Lewis et al., 2017)

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, a. "It will be 6 weeks before I can take a bath or return to my usual activities." b. Incorrect "I will notify the airlines when I make a reservation that I have a pacemaker." c. "I won't lift the arm on the pacemaker side up very high until I see the doctor." d. "I must avoid cooking with a microwave oven or being near a microwave in use."

c. "I won't lift the arm on the pacemaker side up very high until I see the doctor." The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? a. "Administration of two anticoagulants reduces the risk for recurrent venous thrombosis." b. "Lovenox will start to dissolve the clot, and Coumadin will prevent anymore clots from occurring." c. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." d. "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."

c. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." Low molecular weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE.

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100

c. 40 to 60 If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60. The slower rates are typical of the bundle of His and the Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/minute.

Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? a. Adequate carbohydrate intake b. Prophylactic antibiotic therapy c. Application of compression to the leg d. Methods of keeping the wound area dry

c. Application of compression to the leg Compression of the leg is essential to healing of venous stasis ulcers.High dietary intake of protein, rather than carbohydrates, is needed.Prophylactic antibiotics are not routinely used for venous ulcers. Moist environment dressings are used to hasten wound healing.

Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Palpate the radial pulses bilaterally. b. Assess the feet for peripheral edema. c. Auscultate for a pericardial friction rub. d. Check the cardiac monitor for dysrhythmias.

c. Auscultate for a pericardial friction rub. The patient's signs/symptoms describe a possible progression to pericarditis (Lewis et al., 2017).

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum creatine kinase (CK) b. Arterial blood gases (ABGs) c. B-type natriuretic peptide (BNP) d. 12-lead electrocardiogram (ECG)

c. B-type natriuretic peptide (BNP) BNP is secreted when ventricular pressures increase, as with heart failure, and elevated BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs, and CK also may be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.

Which of the following is correct about BNP? a. BNP is released when atria stretch b. BNP is releases when ventricles relax. c. BNP indicates the progression of heart failure d. High level of BNP indicates myocardial infarction.

c. BNP indicates the progression of heart failure. The release of BNP indicates the progression of heart failure. It is released in response to ventricular stretch (Lewis et al., 2017).

An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). Which of these assessment findings is most important for the nurse to report to the health care provider? a. Pulse rate of 56 b. 2+ pedal edema c. BP of 88/42 mm Hg d. Complaints of fatigue

c. BP of 88/42 mm Hg The patient's BP indicates that the dose of carvedilol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of b-adrenergic blockade, but the rate of 56 is not unusual with b-blocker therapy. b-adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs.

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? a. Homocysteine b. C-reactive protein c. Cardiac-specific troponin I and troponin T d. High-density lipoprotein (HDL) cholesterol

c. Cardiac-specific troponin I and troponin T Cardiac-specific troponin I and T are highly-specific indicators of MI and have greater sensitivity and specificity than creatinine-kinase MB (Lewis et al., 2017).

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

c. Hypertension is usually asymptomatic until significant organ damage occurs. This information would be most important for a nurse to communicate when caring for a patient with newly-diagnosed hypertension.

Which of the following assessment data obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 166/96 c. Jugular vein distention (JVD) to the level of the jaw d. Level 6 (0 to 10 scale) chest pain with deep inspiration

c. Jugular vein distention (JVD) to the level of the jaw The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include? a. Biologic replacement valves require the use of immunosuppressive drugs. b. Mechanical mitral valves require replacement approximately every 5 years. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.

c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than 5 years. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.

A patient who has had recent cardiac surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer? a. Fentanyl 2 mg IV b. IV morphine sulfate 6 mg c. Oral ibuprofen (Motrin) 800 mg d. Oral acetaminophen (Tylenol) 650 mg

c. Oral ibuprofen (Motrin) 800 mg The pain associated with pericarditis is caused by inflammation, so nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

A patient has recently started taking oral digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for control of heart failure. Which assessment finding by the home health nurse is most important to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Liver is palpable 2 cm below the ribs on the right side. c. Serum potassium level is 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level is 3.0 mEq/L after 1 week of therapy Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which also can cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level.

The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Print a 1-minute electrocardiogram (ECG) strip and count the number ofQRS complexes. b. Count the number of large squares in the R-R interval and divide by 300. c. Use the 3-second markers to count the number of QRS complexes in 6seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.

c. Use the 3-second markers to count the number of QRS complexes in 6seconds and multiply by 10. This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.

During the administration of the fibrinolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. surface bleeding from the IV site. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

c. a decrease in level of consciousness. A decrease in level of consciousness may indicate that the patient is experiencing a major bleed associated with the use of thrombolytics (Lewis et al., 2017).

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops a. a dry, hacking cough. b. any ventricular ectopy. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

c. a systolic BP <90 mm Hg. Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about a. electrical cardioversion. b. IV adenosine (Adenocard). c. anticoagulant therapy with warfarin (Coumadin). d. Incorrect insertion of an implantable cardioverter-defibrillator (ICD).

c. anticoagulant therapy with warfarin (Coumadin). Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation. Cardioversion may be done after several weeks of Coumadin therapy. ICDs are used for patients with recurrent ventricular fibrillation.

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient a. uses an additional pillow to sleep when feeling short of breath at night. b. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. c. calls the clinic when the weight increases from 124 to 130 pounds in a week. d. says that the nitroglycerin patch will be used for any chest pain that develops.

c. calls the clinic when the weight increases from 124 to 130 pounds in a week. Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an "as necessary" basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by elevating the head of the bed further.

During assessment of a 72-year-old with ankle swelling, the nurse notesjugular venous distention (JVD) with the head of the patient's bedelevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. elevated right atrial pressure. d. incompetent jugular vein valves.

c. elevated right atrial pressure. The jugular veins empty into the superior vena cava and then into theright atrium, so JVD with the patient sitting at a 45-degree anglereflects elevated right atrial pressure. JVD is an indicator ofexcessive fluid volume (increased preload), not decreased fluid volume.JVD is not caused by incompetent jugular vein valves or atherosclerosis.

Which of the following is correct about ECG? a. It is an invasive procedure in which the patient receive electrical signals. b. ECG is used to evaluate the structure and function of valves. c. it is a non-invasive test done at the bedside used to rule out MI. d. ECG is only indicated for patients with chest pain.

c. it is a non-invasive test done at the bedside used to rule out MI.

The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. exercise more than usual while the monitor is in place. b. remove the electrodes when taking a shower or tub bath. c. keep a diary of daily activities while the monitor is worn. d. connect the recorder to a telephone transmitter once daily.

c. keep a diary of daily activities while the monitor is worn. The patient should be educated to keep a diary of daily activities while the monitor is worn.

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. milk, yogurt, and other milk products. d. eggs and other high-cholesterol foods.

c. milk, yogurt, and other milk products. Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000 mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction.

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find: a. a positive Homans' sign. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. a large amount of drainage from the ulcer.

c. prolonged capillary refill in all the toes. Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? a. "When I stand too long, my feet start to swell up." b. "Sometimes I get tired when I climb a lot of stairs." c. "My fingers hurt when I go outside in cold weather." d. "My legs cramp whenever I walk more than a block."

d. "My legs cramp whenever I walk more than a block." Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Fatigue that occurs sometimes with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

The nurse has received change-of-shift report about the following patients on the telemetry unit. Which patient should the nurse see first? a. A patient with atrial fibrillation, rate 88, who has a new order for warfarin (Coumadin) b. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due

d. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.

Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the "off" position. b. Perform cardiopulmonary resuscitation (CPR) until the paddles are incorrect position. c. Set the defibrillator/cardioverter energy to 300 joules. d. Administer a sedative before cardioversion is implemented.

d. Administer a sedative before cardioversion is implemented. When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this patient.

When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Check blood pressure. b. Monitor apical pulse rate. c. Monitor for dysrhythmias. d. Ask about chest discomfort.

d. Ask about chest discomfort. IV nitroglycerin is given to promote coronary artery vasodilation and would be evaluated by assessing the patient's level of chest pain (Lewis et al., 2017).

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? a. Palpate the abdomen. b. Assess the orientation. c. Check the capillary refill. d. Auscultate the lung sounds.

d. Auscultate the lung sounds. This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? a. Need to participate in an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Importance of making a yearly appointment with the primary care provider d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) < 40% receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.

A patient's cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? a. Prepare for possible temporary pacemaker insertion. b. Administer atropine sulfate 1 mg IV per agency protocol. c. Document the patient's rhythm and assess the patient's response to the rhythm. d. Call the health care provider before giving the prescribed metoprolol (Lopressor).

d. Call the health care provider before giving the prescribed metoprolol (Lopressor). The patient has progressive first-degree atrioventricular (AV) block, and the beta-blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? a. Pedal pulses 1+ b. Heart rate 100 beats/min c. Blood pressure 104/56 mm Hg d. Chest pain level 10 on a 10-point scale

d. Chest pain level 10 on a 10-point scale A complaint of 10/10 chest pain may indicate a coronary artery dissection or rupture (Lewis et al., 2017).

When monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action? a. Patient complaint of feeling tired. b. Pulse change from 80 to 96 beats/minute. c. BP increase from 134/68 to 150/80 mm Hg. d. Electrocardiographic (ECG) changes indicating coronary ischemia.

d. Electrocardiographic (ECG) changes indicating coronary ischemia. This assessment finding requires the most rapid action.

A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? a. Platelet aggregation is enhanced by IV heparin infusion. b. Heparin will dissolve the clot that is blocking blood flow to the heart. c. Coronary artery plaque size and adherence are decreased with heparin. d. Heparin will prevent the development of new clots in the coronary arteries.

d. Heparin will prevent the development of new clots in the coronary arteries. This answer describes the use of heparin in patients with an NSTEMI.

Which of the following patients is having the poorest prognosis? a. Mr. A: BNP 100 pg/mL b. Mr. B: BNP 500 pg/mL c. Mr. C: BNP 1000 pg/mL d. Mr. D: BNP 2000 pg/mL Correct -

d. Mr. D: BNP 2000 pg/mL This patient has the highest BNP, which could indicate long-term damage (Lewis et al., 2017).

A 21-year-old student arrives at the student health center at the end of the quarter complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take first? a. Have the patient transported to the hospital emergency department (ED). b. Administer O2 at 2 to 3 L/min using nasal prongs. c. Ask the patient about any history of coronary artery disease. d. Question the patient about current stress level and coffee use.

d. Question the patient about current stress level and coffee use. In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.

Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose 228 mg/dL b. Serum chloride 90 mEq/L c. Serum sodium 133 mEq/L d. Serum potassium 2.8 mEq/L

d. Serum potassium 2.8 mEq/L Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.

Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? a. The pacemaker prevents or minimizes ventricular irritability. b. The pacemaker paces the atria at rates up to 500 impulses/minute. c. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. d. The pacemaker stimulates a heart beat if the patient's heart rate dropstoo low.

d. The pacemaker stimulates a heart beat if the patient's heart rate drops too low. The permanent pacemaker will discharge when the ventricular rate drops below the set rate. The pacemaker will not decrease ventricular irritability or discharge if the patient develops ventricular fibrillation. Since the patient has a slow ventricular rate, overdrive pacing will not be used.

Which information given by a patient admitted with stable angina will help the nurse confirm this diagnosis? a. The patient rates the pain at a level 3 to 5 (0 to 10 scale). b. The patient states that the pain "wakes me up at night." c. The patient says that the frequency of the pain has increased over the last few weeks. d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet. Chronic stable angina refers to chest pain that occurs intermittently over long period of time with similar pattern of onset, duration, and intensity of symptoms. The pain of chronic stable angina usually lasts only for a few minutes before subsiding with rest, calming down, or use of sublingual nitroglycerin (NTG)

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for: a. diastolic murmur. b. peripheral edema. c. right upper quadrant tenderness. d. complaints of shortness of breath.

d. complaints of shortness of breath. The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease, but are not indicators of possible hypoxemia.

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is a. weight loss of 2 pounds overnight. b. hourly urine output greater than 60 mL. c. reduction in patient complaints of chest pain. d. decreased dyspnea with the head of bed at 30 degrees.

d. decreased dyspnea with the head of bed at 30 degrees. Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patient's response.

A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and: a. elevate the left leg on a pillow. b. apply an elastic wrap to the leg. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

d. keep the patient in bed in the supine position. The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.

A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as a. pulsus alternans. b. two-pillow orthopnea. c. acute bilateral pleural effusion. d. paroxysmal nocturnal dyspnea.

d. paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this problem is to: a. force fluids to 3000 mL/day to decrease fever and inflammation. b. teach the patient to take deep, slow respirations to control the pain. c. remind the patient to ask for the opioid pain medication every 4 hours. d. position the patient in Fowler's position, leaning forward on the overbed table.

d. position the patient in Fowler's position, leaning forward on the overbed table. Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends to increase pericardial pain. Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN. The patient would receive scheduled doses of a nonsteroidal anti-inflammatory drug (NSAID).

The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial fibrillation. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

d. ventricular tachycardia. The absence of P waves, wide QRS, rate &gt;150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.The absence of P waves, wide QRS, rate &gt;150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.