Med-Surg Cardiovascular System

One small box on the ECG papers measures [____] seconds.

0.04

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 140/80 and an ankle pressure of 112/70. The nurse calculates the patient's ankle-brachial index (ABI) as ____________________.

0.8

Calculate MAP for a pt with BP of 140/83.

102

A 6-second rhythm strip has [____] big boxes.

30

You count 30 small boxes between 2 consecutive R waves, What is the HR?

50 SMALL BOX METHOD COUNT THE NUMBER OF SMALL BOXES BETWEEN TWO CONSECUTIVE WAVEFORMS (R-R INTERVAL OR P-P INTERVAL) AND DIVIDED INTO 1500.TIME CONSUMING, BUT ACCURATE

You count 6 big boxes between 2 consecutive R waves, what is the HR?

50 LARGE BOX METHODS -COUNT THE NUMBER OF LARGE BOXES BETWEEN TWO CONSECUTIVE WAVEFORMS (R-R INTERVAL OR P-P INTERVAL) AND DIVIDE INTO 300-BEST USED IF THE RHYTHM IS REGULAR

On an irregular 6-seconds rhythm you count 9 R waves, hence the HR is [____] bpm.

90

Tall, peaked T waves is most likely caused by: A) hyperkalemia B) hypokalemia C) hypercalcemia D) hypocalcemia

A) Hyperkalemia T wave of the ECG represents ventricular repolarization as the heart rests and prepares to contract again. hyperkalemia causes of decreasing resting membrane potential the increasing velocity of the third phase of action potential was due to the increased potassium permeability and therefore, the shortening of QT-interval and peaked T-waves

The natural pacemaker of the heart is: A) SA node B) AV node C) Bundle of His D) Purkinje fibers

A) SA node The impulse starts in a small bundle of specialized cells located in the right atrium, called the SA node.

The most sensitive test for myocardial infraction is: A) Troponin B) BNP C) Myoglobin D) CK-MB

A) Troponin A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood.

A pt 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 hx of: a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

A) asthma Nadolol belongs to the class of beta-blocker medications used to treat angina and hypertension. Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.

The P wave of the ECG represents A) Atrial depolarization B) Atrial repolarization C) Ventricular depolarization D) Ventricular repolarization

A) atrial depolarization Electrical activity (depolarization) of both atria - also represents the simultaneous contraction of the atria This simultaneous contraction of the atria forces blood to pass through the AV valves between the atria and the ventricles Electrical stimulation (cells interiors become positive) - causing mechanical contraction of ventricles - systole

A pt who is being admitted to the ED with severe chest pain giving the following with severe chest pain gives the following list of meds taken at home to the nurse. Which of the meds has the most immediate implications for the pt's care? A) sildenafil (Viagra) B) furosemide (Lasix) C) diazepam (Valium) D) captopril (Capoten)

A) sildenafil (Viagra) Sildenafil (Viagra) would be the med with the most critical implications. Sildenafil is a potent vasodilator, so adding more vasodilation may result in a hypotensive crisis. A The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications also should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment. Nitrites cause vasodilation, which lowers the heart's workload and increases blood flow to heart muscles. Frusemide (Lasix) is a diuretic that reduces the amount of excess fluid in the body by increasing the amount of urine being produced. If chest pain was experienced with this medication, it is not contraindicated with nitrites.

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. Through the breakdown of mucocutaneous barriers and induction of bacteremia, dental therapy and other invasive procedures have been linked to seeding of heart valves and the development of 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 withregard to foods that are high in vitamin K, such as green, leafyvegetables. The other patient statements are accurate.

How much time is represented by 1 small box on ECG paper? A. 0.04 seconds B. 1 second C. 6 seconds D. 0.4 seconds

A. 0.04 seconds

An Adult patient's blood pressure is 80/40 mm Hg, Pulse is 40 beats/min, and ventilation is 18 breaths/min. A bradycardia is present when the heart rate is less than ________________? A. 60 beats /min B. 70 beats /min C. 85 beats /min D. 99 beats /min

A. 60 beats /min

A normal range for a QRS complex is________________? A. < 0.12 seconds B. >0.12 seconds C. 0.16 seconds D. 0.12*0.20 seconds

A. < 0.12 seconds

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicated effective treatment of the client's condition? A. Absence of adventitious breath sounds B. Presence of nonproductive cough C. Decrease in respiratory rate at rest D. SaO2 86% on room air

A. Absence of adventitious breath sounds Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicated that the pulmonary edema is resolving.

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.

The nurse is caring for a patient who received a mechanical aortic valve replacement 2 years ago. Current lab values include an international normalized ratio (INR) of 1.5, platelet count of 150,000/µL, and hemoglobin of 8.6g/dL. Which nursing action is most appropriate? A. Contact the health care provider. B. Assess the vital signs. C. Start intravenous fluids. D. Monitor for signs of bleeding.

A. Contact the health care provider. Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of Coumadin (Warfarin) prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the healthcare provider for an order increase the medication dose. Vital signs would be unchanged related to the low INR. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding.

A 60-year old patient develops acute pericarditis after myocardial infarction. Which of the following findings indicate a possible new complication is developing? A. Decreased BP with Tachycardia B. Presence of a pericardial friction rub C. Distant and muffled apical heart sounds D. Increased chest pain with deep breathing

A. Decreased BP with Tachycardia Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.

A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? A. Dyspnea on exertion B. Tracheal deviation C. Pericardial rub D. Weight loss

A. Dyspnea on exertion The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? A. I can't get rid of my hiccups B. I feel dizzy when I stand C. My incision sit stings D. I have a headache

A. I can't get rid of these hiccups Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply.) A. Limited alcohol intake B. Regular exercise program C. Decreased magnesium intake D. Reduced potassium intake E. Tobacco cessation

A. Limited alcohol intake B. Regular exercise program E. Tobacco cessation

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.

The Normal sinus rhythm (NSR) criterion that sinus bradycardia does not meet is: A. Normal HR B. Normal regular rhythm C. Normal P:QRS ratio D. Normal T wave

A. Normal HR

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations? (Select all that apply) A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages D. Subcutaneous nodules E. Erythema marginatum

A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? A. Prompt recognition and treatment of streptococcal pharyngitis B. Avoidance of respiratory infections in children born with heart defects C. Completion of 4 to 6 weeks of antibiotic therapy for ineffective endocarditis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

A. Prompt recognition and treatment of streptococcal pharyngitis The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever. Rheumatic fever is disease that can result from inadequately treated strep throat or scarlet fever. Rheumatic fever causes inflammation, especially of the heart, blood vessels, and joints. Symptoms include fever and painful, tender joints. Treatment involves medication, sometimes for life.

The major characteristics of atrial flutter rhythm is: A. Regular, fast, saw-toothed B. Irregular, slow, saw-toothed C. Regular, fast, wide QRS D. Irregular, slow, inverted T wave

A. Regular, fast, saw-toothed

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? A. Regurgitant murmur at the mitral valve area B. Point of maximal impulse palpable in fourth intercostal space C. Heart rate of 94 beats/min and capillary refill time of 2 seconds D. Respiratory rate of 18 breaths/min and heart rate of 90 beats/min

A. Regurgitant murmur at the mitral valve area A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.

A nurse is caring or a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately? A. Slurred Speech B. Irregular pulse C. Dependent edema D. Persistent fatigue

A. Slurred speech The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

The QRS complex represents_______________________? A. Ventricular depolarization B. Atrial depolarization C. Ventricular repolarization D. Atrial repolarization

A. Ventricular depolarization

A nurse is providing discharge teaching to a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A. Weight gain of 0.9 kg (2lb) in 24 hr B. Increase of 10 mm HG in systolic blood pressure C. Dyspnea with exertion D. Dizziness when rising quickly

A. Weight gain of 0.9 kg (2lb) in 24 hr. When using the urgent vs. non urgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

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.

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 nurse is an emergency department is assessing a client who has bradydysrhythmia. Which of the following findings should the nurse monitor for? A. Confusion B. Fristion rib C. Hypertension D. Dry skin

A.Confusion Bradydysrhythmia can cause decrease systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

Which BP finding by the nurse indicates that no change in therapy are needed for a pt with stage 1 hypertension who has a hx of heart failure? A) 108/54 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 pti with stage 1 hypertension. The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg.

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 normal levels of potassium (K) is 3.5-5.0. Hypokalemia may cause changes in ECG rhythms. Creatine is an amino acid located mostly in your body's muscles as well as in the brain. Normal levels is 0.7 -1.2 mg/dL. Value is within normal limits (WNL) Calcium (Ca) normal levels is 8.5 to 10.2 mg/dL. Value is WNL Sodium (Na) normal levels is 135 to 145 milliequivalents per liter (mEq/L). Value is WNL

What represents the ventricular contraction in ECG is: A) P wave B) QRS complex C) ST segment D) T wave

B) QRS complex The QRS complex refers to the combination of the Q, R, and S waves, and indicates ventricular depolarization and contraction (ventricular systole).

A patient with ST segment elevation in several ECG leads is admitted to the ED and diagnosed as having an ST-segment-elevation myocardial infraction (STEMI). Which questions 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? C) Is there any family hx of heart disease? D) Can you describe the quality of your chest pain?

B) What time did you chest pain begin? A pt with a STEMI is eligible for thrombolytic therapy if they had chest pain for 12 hours or less. Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information will also be needed, but it will not be a factor in the decision about thrombolytic therapy.

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."

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.

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.

A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease. A. A client who has hypothyroidism B. A client who has diabetes mellitus C. A client whose daily caloric intake consists of 25% fat D. A client who consumes two 12-oz bottles of beer a day

B. A client who has diabetes mellitus. Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.

What should the nurse teach the patient who has had a valve replacement with a biologic valve? A. Long-term anticoagulation therapy B. Antibiotic prophylaxis for dental care C. Exercise plan to increase cardiac tolerance D. β-Adrenergic blockers to control palpitations

B. Antibiotic prophylaxis for dental care The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

The P wave represents ________________? A. Ventricular depolarization B. Atrial depolarization C. Ventricular repolarization D. Atrial repolarization

B. Atrial depolarization

A nurse is caring for a client who is 8 hr postoperative following a coronary arty bypass graft (CABG). Which of the following findings should the nurse report? A. Mediastinal drainage 100 mL/hr B. Blood pressure 160/80 mm Hg C. Temperature 37.1 C (98.8 F) D. Potassium 4.0 mEq/L

B. Blood pressure 160/80 mmHg The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.

Which of the following indicate hemodynamic stability? Select all that apply: A) stroke volume 50 mL per beat. B) Cardiac output is 5 L/min. C) Mean arterial pulse (MAP) is 55 mmHg D) Systolic BP (SBP) is 120 mmHg E) presence of JVD

B. Cardiac output is 5 L/min. (normal is 4-8L/min D. SBP is 120 mmHg Normal Stroke Volume = around 70mL Normal MAP = > 65 JVD is never normal

A sinus arrhythmia has A. HR < 60 bpm B. Irregular rhythm C. HR > 100 bpm D. PR > 0.22 seconds

B. Irregular rhythm

Which of the following can cause bradycardia? A. Hyperthermia B. Hypothermia C. Hyperthyroidism D. Active infection

B. Hypothermia

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 health care provider. The other findings are typical of VTE.

A nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify their provider if they experience which of the following adverse effects of this medication? A. Tendon pain B. Persistent cough C. Frequent urination D. Constipation

B. Persistent cough A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.

A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching? A. Apply the new patch to the same site as the previous patch B. Place the patch on an area of skin away from skin folds and joints. C. Keep the patch on 24 hr per day D. Replace the patch at the onset of angina.

B. Place the patch on an area of skin away from skin folds and joints The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? A. Prolonged PR interval B. Pulsus paradoxus C. Widened pulse pressure D. Clubbing of the fingers

B. Pulsus paradoxus Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease and increased intracranial pressure. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? A. Obtain the client's current weight. B. Review serum electrolyte values. C. Determine the time of the last digoxin dose. D. Check the client's urine output.

B. Review serum electrolyte values Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level. because the client is at risk for dysrhythmias from hypokalemia.

The electrical impulse in the heart normally starts where? A. Bundle of HIS B. SA Node C. AV Node D. Purkinje Fibers

B. SA Node (pacemaker of the heart)

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 venoaus thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

You interpret the patient's cardiac rhythm to be a sinus bradycardia. The patient reports that he is feeling weak and lightheaded. Which of the following statements is true regarding the patient situation? A. The patient is asymptomatic, no treatment is necessary B. The patient is showing signs of hemodynamic instability, an IV should be started and a 12-lead ECG be obtained C. No additional interventions are needed because the patient is not complaining of chest pain D. Check back in on the patient in an hour to recheck his vital signs

B. The patient is showing signs of hemodynamic instability, an IV should be started and a 12-lead ECG Hemodynamic instability occurs when there's abnormal or unstable blood pressure, which can cause inadequate blood flow to your child's organs. Hemodynamic instability symptoms may include. Abnormal heart rate (arrhythmias) Chest pain.

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? A. Increased abdominal girth B. Weak peripheral pulses C. Jugular venous neck distention D. Dependent edema

B. Weak peripheral pulses Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure.

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.

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following adverse effects of the medication? A. Shortness of breath B. Lightheadedness C. Dry cough D. Metallic taste

B.Lightheadedness Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A. Initiate chest compressions B. Vagal stimulation C. Administration of atropine IV D. Defibrillation

B.Vagal stimulation The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

When AV node becomes the pacemaker, it fires at a rate of: A) 80-100 B) 60-80 C) 40-60 D) 20-40

C) 40-60 At rest, the SA nodal myocytes depolarize at an intrinsic rate between 60 and 100 beats per minute, which is generally considered a normal heart rate. If the SA Node fails to fire, or fires at a much slower rate, the AV node may take over as pacemaker at a rate of 40 - 60 BPM.

Three days after a myocardial infraction (MI), the pt 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 pericardial friction rub. The pt S/S describes a possible progression of pericarditis. The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms.

Which of the following is correct about BNP? A) BNP is released when atria stretch B) BNP is released when ventricles relax C) BNP indicates the progression of heart failure D) A high level of BNP indicates myocardial infarction

C) BNP indicates the progression of heart failure BNP stands for brain or B-type natriuretic peptide. It's made inside the pumping chambers of your heart when pressure builds up from heart failure. BNP levels go up when the heart cannot pump the way it should. The higher the number, the more likely heart failure is present and the more severe it is.

A patient who has severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infraction (AMI). Which of these ordered lab tests should the nurse monitor to help determine whether the pt has had an AMI? A) homocysteine B) C-reactive protein C) Cardiac-specific troponin 1 and troponin T D) High-density lipoprotein (HDL) cholesterol

C) Cardiac-specific troponin 1 and troponin T Cardiac-specific troponin I and troponin T are highly-specific indicators of MI and have greater sensitivity and specificity than creatinine-kinase MB Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful in determining the patient's risk for developing coronary artery disease but are not helpful in determining whether an acute MI is in progress.

Which of the info should the nurse include when teaching a pt with newly diagnosed with hypertension? A) Dietary sodium restriction will control BP for most pt B) Most pt 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 tx effectiveness

C) Hypertension is usually asymptomatic until significant organ damage occurs Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage blood pressure, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the HCP frequently when starting treatment for hypertension and then every 3 months once stable.

During the administration of the fibrinolytic agent to a pt with an acute myocardial infraction (AMI), the nurse should stop the drug infusion if the pt experiences: A) bleeding from the gums. B) Surface bleeding from the IV site C) a decrease in LOC D) a nonsustained episode of ventricular tachycardia (V tach)

C) a decrease in LOC The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding/ major bleed, a possible complication of thrombolytic therapy. Some bleeding of the gums is an expected side effect of the therapy but not an indication to stop infusion of the thrombolytic medication Surface bleeding from an IV site can happen, and IV site would need to be assessed, an IV may be paused to do so, and then continued once IV is changed or dressing is changed (if there is no issue) A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.

The nurse teaches the pt 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 activity while the monitor is worn. D) Connect the recorder to a telephone transmitter once daily

C) keep a diary of daily activity while the monitor is worn. The Holter monitor is a type of portable electrocardiogram (ECG). It records the electrical activity of the heart continuously over 24 hours or longer while you are away from the doctor's office. The pt is instructed to keep a diary describing daily activities while Holter monitor is being accomplished to help correct any rhythm disturbances with pt activities. The pt are taught that they should not take a shower or bath during Holter monitoring and that they should continue with their usual daily activities. The recorder store the info about the pt's rhythm until the end of the testing, when it is removed and data is analyzed.

A 25-yr-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. How should the nurse respond? A. "You will not feel well if you do not take the medicine and get over this infection." B. "Once you have been treated for a group A streptococcal infection, you will not get it again." C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." D. "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults.

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 any more 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.

Which topic will the nurse include in the 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.

nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider. A. Serosanguineous drainage on dressing B. Sever pain with coughing C. Urine output of 20 ml/hr D. Increase in temperature from 36.8 C (98.2 F) to 37.5 C (99.5 F)

C. Urine output of 20 mL/hr Urine less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys. hypovolemia, or graft thrombosis or rupture.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)? A. Myoglobin B. C-reactive protein C. Creatine kinase-MB D. Homocysteine

C. Creatine kinase-MB Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicated myocardial muscle injury.

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? A. Initiate seizure precautions B. Tell the client to report vision changes C. Elevate the head of the client's bed D. Start a peripheral IV

C. Elevate the head of the client's bed. The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? A. "My arthritis is really bothering me because I haven't taken my aspirin in a week." B. My blood pressure shouldn't be high because I took my blood pressure medication this morning." C. "I took my warfarin last night according to my usual schedule." D. I will check my blood sugar because I took a reduced dose of insulin this morning."

C. I took my warfarin last night according to my usual schedule. Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer? A. Explore the client's family history of peripheral vascular disease. B. Note the presence or absence of pain at the ulcer site. C. Inquire about the presence or absence of claudication. D. Ask if the client has had a recent infection.

C. Inquire about the presence or absence of claudication. Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Client's who have arterial ulcers experience claudication, but those who have venous ulcers do not.

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

Which patients are most at risk for developing endocarditis? (Select all that apply) A. Older woman with histoplasmosis B. Man with reports of chest pain and dyspnea C. Man who is homeless with history of IV drug use D.Patient with end-stage renal disease on peritoneal dialysis E. Adolescent with exertional palpitations and clubbing of fingers F. Female with peripheral intravenous site for medication administration

C. Man who is homeless with history of IV drug use D.Patient with end-stage renal disease on peritoneal dialysis Intravenous drug use, especially if reusing or sharing needles are at risk of developing sepsis. In addition, risk for infection is increased in the elderly, homeless, and those with chronic illness. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Chest pain, shortness of breath, and palpitations may be signs of endocarditis. Clubbing of the fingers indicates long-term hypoxia. Central venous catheters, not peripheral, increase risk to for infective endocarditis. Patients with fungal infections, such as histoplasmosis and candida, are at risk for pericarditis.

A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? A. Aspirin B. Oxygen C. Nitroglycerin D. Morphine sulfate

C. Nitroglycerin Aspirin, oxygen, nitroglycerin, and morphine sulfate are all used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a decrease in blood pressure.

Which of the following describes an atrial fibrillation rhythm? A. P present and upward, regular, HR 66, QRS 0.12 B. No P wave, regular HR 111, QRS 0.12 C. No P wave, irregular, HR 111, QRS 0.12 D. P wave inverted, HR 45, PR 0.16, QRS 0.10

C. No P wave, irregular, HR 111, QRS 0.12

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.

In patients with hyperkalemia, expected ECG changes could present as___________________? A. ST elevation B. Short T-wave C. Tall, peaked T-wave D. Inverted P-wave

C. Tall, peaked T-wave

True or false? The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increased blood flow.

True

True or false? The most serious dysrhythmias of all are the ventricular ones.

True

True or false? Vagal stimulation can lead to bradycardia.

True

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.

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 notes jugular venous distention (JVD) with the head of the patient's bed elevated 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 the right atrium, so JVD with the patient sitting at a 45-degree angle reflects elevated right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume 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 pt receives 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. An ECG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart. Chest pain is not the only sign have having irregular impulses of the heart.

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 right second 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.

How do you calculate the heart rate on an ECG strip?

Count the # of R waves in a 6 second rhythm strip, then multiply by 10.

PR interval becomes abnormal when it's longer than: A) 0.12 seconds B) 0.16 seconds C) 0.18 seconds D) 0.20 seconds

D) 0.20 seconds The normal PR interval is between 0.12 and 0.20 second; a PR interval greater than 0.20 second indicates abnormally slowed impulse conduction. all other times are within normal PR interval

When administering IV nitroglycerin (Tridil) to a pt 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 for chest discomfort

D) Ask for chest discomfort IV nitroglycerin is given to promote coronary artery vasodilation and would be evaluated by assessing the pt level of chest pain The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse also will monitor heart rate and blood pressure (BP) and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.

True or false? Valsalva maneuvers can help reduce HR in tachycardia.

True

When caring for a pt with acute coronary syndrome who has returned to the coronary care unit after having a balloon angioplasty, the nurse obtains the following assessment data. Which data indicates 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 The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse.

When monitoring a pt who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action? A) Pt complaints of feeling tired B) Pulse change from 80 to 96 bpm C) BP increases from 134/68 to 150/80 mmHG D) ECG changes indicating coronary ischemia

D) ECG changes indicating coronary ischemia ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately

A pt with a non-ST-segment-elevation myocardial infraction (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. Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It DOES NOT change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.

Which of the following pts has 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

D) Mr. D: BNP 2000 pg/mL Higher BNP levels are associated with progressively worse prognosis. BNP < 100 = HF is highly improbableBNP 100-500 = HF is probableBNP > 500 = HF is highly probable Risk of death was highest in those with BNP >2000 pg/mL in short- and long-term follow-up

Which of the following does NOT have a significant contribution to the action potential of the heart? A) Na B) K C) Ca D) P

D) P a phenomenon of excitable cells, such as nerve and muscle, and consists of a rapid depolarization (upstroke) followed by repolarization of the membrane potential. Action potentials are the basic mechanism for transmission of information in the nervous system and in all types of muscle. The principal ions involved in an action potential are sodium (Na) and potassium (K) cations Calcium (Ca) appears to regulate the function of nearly every channel involved in excitation.

when developing a health teaching plan for a 60 year old man with the following risk factors for CAD, the nurse should focus on the A) family hx of CAD B) increased risk associated with the pt's male sex C) high incidence of cardiovascular disease in older people D) elevation of the pt's serum LDL level.

D) elevation of the pt's serum LDL level. Family hx, gender, and age are nonmodifiable risk factors, the nurse should focus on LDL decreased LDL will help reduce pt's risk of developing CAD LDL is bad cholesterol HDL is "good" cholesterol

True or false? Large heart (cardiomegaly) may be seen in pt with heart failure and cardiomyopathy

True An enlarged heart (cardiomegaly) can be caused by damage to the heart muscle or any condition that makes the heart pump harder than usual

True or false? Low preload is seen in dehydration while high preload is seen in over hydration.

True. Preload is the initial stretching of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular filling.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has a medical history of PAD and 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 - a classic sign of PAD. 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.

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated? A. Administering IV morphine sulfate B. Administering oxygen at 2 L/min via nasal cannula C. Helping the client to the bedside commode D. Assisting with thrombolytic therapy

D. Assisting with thrombolytic therapy The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

Which of the following is not true about ventricular fibrillation? A. It is always irregular. B. It is always pulseless. C. It is a lethal dysrhythmia. D. Atropine is the drug of choice of ventricular fibrillation.

D. Atropine is the drug of choice of ventricular fibrillation. atropine can treat heart rhythm problems. Examples of pulseless ECG rhythms include sinus rhythm, atrial fibrillation A ventricular dysrhythmia is an irregular heartbeat caused by the ventricles of the heart, and some of these ventricular dysrhythmias can be considered lethal.

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. Which of the following findings should indicate to the nurse that the medication is effective? A. Hemoglobin 14 g/dl B. Minimal bruising of extremities C. Decreased blood pressure D. INR 2.0

D. INR 2.0 The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0-3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of a new clot formation and a stroke.

Which of the following is correct about ventricular tachycardia? A. It always comes with no pulse. B. It is a regular rhythm. C. It has narrow QRS. D. It is clinically significant.

D. It is clinically significant.

An 80-yr-old patient with uncontrolled type 1 diabetes is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? A. Aortic valve replacement B. Have a pacemaker inserted C. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Open commissurotomy procedure is used for mitral stenosis. The patient is not a candidate for a pacemaker.

A nurse is preparing a client for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure? A. Hemoglobin 14.4 g/dl B. History of peripheral arterial disease C. Urine output 200 mL/4hr D. Previous allergic reaction to shellfish

D. Previous allergic reaction to shellfish A contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure.

Which of the following is NOT a characteristic of normal sinus rhythm? A. HR 60-100 B. Regular rhythm C. P: QRS = 1:1 D. QRS > 0.12

D. QRS > 0.12

The nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? A. Increase the heparin infusion flow rate by 2 mL/hr B. Continue to monitor the heparin infusion as prescribed. C. Request a prothrombin time (PT). D. Stop the heparin infusion

D. Stop the heparin infusion The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A. Ventricular depolarization B. Guillan-Barre syndrome C. Myelodysplastic syndrome D. Valvular disease

D. Valvular disease Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.

A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? A. "You might no longer be able to feel chest pain." B. "Your level of activity intolerance will not change." C. "After 6 months, you will no longer need to restrict your sodium intake." D. "You will be able to stop taking immunosuppressants after 12 months."

D. You might no longer be able to feel chest pain. Heart transplant clients usually are no longer able to feel chest pain due to denervation of the heart.

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 Acute decompensated heart failure (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, because this suggests that the medications are helping to remove fluid from the lungs. 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).

A nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? A. "I'm still hungry after the bowl of cereal I ate at 7 a.m." B. "I didn't take my heart pills this morning because the doctor told me not to." C. "I have had chest pain a couple of times since I saw my doctor in the office last week." D. "I smoked a cigarette this morning to calm my nerves about having this procedure."

D.I smoked a cigarette this morning to calm my nerves about having this procedure. Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.

True of False? An ECG records the mechanical activity of the heart

False.

True of False? An ECG records the mechanical activity of the heart

False. An ECG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart. Changes in an ECG can be a sign of many heart-related conditions.

True or False? Afterload increases in case of vasodilation and decreases in case of vasoconstriction

False. The afterload is the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction. Afterload goes down when aortic pressure and systemic vascular resistance decreases through vasodilation. Afterload goes up when aortic pressure and systemic vascular resistance increases through vasoconstriction.

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

Inspection of the apex area of the heart allows for the nurse to assess for pulsations. The apical pulse or point of maximal impulse. The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.

True or False? AV node function is to delay the action potentials and allow ventricles to rest.

True

True or False? 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 L ventricle and therefore decreases cardiac output.

True

True or False? One of the major factors that affect the myocardial blood flow is changes in oxygen demands.

True

True or False? SA node is considered the natural pacemaker of the conduction system of the heart.

True

True or False? The apical pulse is located in the 5th intracostal space (ICS) and midclavicular line (MCL)

True

True or false? AV node slows fast arterial contraction to protect the ventricles

True

True or false? Q wave deeper than one big box is a serious finding

True

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

a. 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.

Which info about a pt who has been receiving fibrinolytic therapy for an acute myocardial infraction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patient's chest pain b. An increase in troponin levels from baseline c. A large bruise at the patient's IV insertion site d. A decrease in ST-segment elevation on the electrocardiogram

a. No change in the patient's chest pain No change in the patient's chest pain is the most important to report because the pt may be in need of another intervention to relieve the MI Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac markers into the circulation as the blocked vessel is opened.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart 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 nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.

The nurse is reviewing the lab tests for a pt who has recently been diagnosed with hypertension. Which result is most important to communicate to 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 HTN. Normal serum creatinine is 0.7 to 1.3 mg/dL Normal potassium is 3.5 to 5.2 mEq/L Normal serum hgb is 13.2 to 16.6 g/dL for men and 11.6 to 15 g/dL for women Normal blood glucose is 70-100 mg/dL

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurse's priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

a. give IV morphine sulfate 4 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 will also 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.

19. An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg). After 2 weeks, the patient returns to the clinic. The assessment finding that will be of most concern to the nurse is that the patient a. has BP of 88/42. b. has an apical pulse rate of 56. c. complains of feeling tired. d. has 2+ pedal edema.

a. has BP of 88/42. The patient's BP indicates that the dose of carvedilol may need to be decreased because the mean arterial pressure is only 57. Bradycardia is a frequent adverse effect of -Adrenergic blockade, but the rate of 56 is not as great a concern as the hypotension. -adrenergic blockade will initially 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.

Where do you see saw-toothed waves? A. Atrial flutter B. Atrial fibrillation

atrial flutter

22. A patient who is receiving dobutamine (Dobutrex) for the treatment of ADHF has all of 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. Teach the patient the reasons for remaining on bed rest. b. Monitor the patient's BP every hour. c. Adjust the drip rate to keep the systolic BP >90 mm Hg. d. Call the health care provider about a decrease in urine output.

b. Monitor the patient's BP every hour. An experienced LPN/LVN would be able to monitor BP and would know to report significant changes to the RN. Teaching patients and making adjustments to the drip rate for vasoactive medications are RN-level skills. Because the health care provider may order changes in therapy based on the decrease in urine output, the RN should call the health care provider about the decreased urine output.

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

b. The pain has lasted 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. Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain that occur with raising the arms or with deep breathing are more typical of musculoskeletal pain or pericarditis. Stable angina is usually relieved when the patient takes nitroglycerin.

When admitting a pt for a coronary arteriogram and angiogram, which info about the pt 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 pt had an arteriogram a year ago

b. The patient is allergic to shellfish. The contrast dye used for the procedure is iodine based, so patients who have shellfish allergies will require treatment with medications such as corticosteroids and antihistamines before the angiogram

Amlodipine (Norvasc) is ordered for a pt with newly diagnosed Prinzmetal's (variant) angia. When teaching the pt, the nurse will include the info that amlodipine will: a. reduce the fight or flight response. b. decrease spasm of the coronary arteries. c. increasing the force of myocardial contraction d. helps prevent clotting in the coronary arteries

b. decrease spasm of the coronary arteries. Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and β-adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations). Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

When admitting a patient with a myocardial infraction (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. an MI is caused by a lack of blood flow that causes the tissue in the heart muscle to die. the earlier the monitor is attached, the faster the info concerning cardiac status can be interpreted.

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 some nausea as a side effect of nitroglycerin." b. "I should 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. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart." Chest pain that continues after use of NTG may indicate a change to acute coronary syndrome (ACS) The emergency medical services (EMS) system should be activated when chest pain or other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken 5 mins apart

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 the drug, which statement by the patient indicates that teaching has been effective? a. "I will be sure to take the medication with food." b. "I will need to eat more potassium-rich foods in my diet." c. "I will call for help when I need to get up to use the bathroom." d. "I will expect to feel more short of breath for the next few days."

c. "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 angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of -adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating.

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. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

c. Auscultate the breath 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 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 troponin b. arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide b-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as the do with heart failure. 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 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 begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

c. 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 progression of heart failure. Digoxin therapy for heart failure is no longer considered the first-line measure, digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and b-adrenergic blockers is insufficient. Ca channel blockers are not generally used to the treatment of heart failure. The b-adergenic agonist such as dobutamine are administered through the IV route and are not used as initial therapy for heart failure.

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

c. Electrocardiogram (ECG) An ECG will provide the most info in the least amount of time concerning the pt's cardiac status. The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that reperfusion therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion, and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction (MI).

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

c. Lifelong anticoagulant therapy will be 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 biologic valves. 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 has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider. a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 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 3.0 mEq/L after 1 week of therapy Hypokalemia can predispose the patient to life-threatening dysrhythmias and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life threatening dysrhythmias.

The nurse plans to discharge teaching for a pt with chronic heart failure who has prescriptions of digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include. a. Limit dietary sources of potassium b. take the hydrochlorothiazide before bedtime c. notify the HCP if nausea develops d. skip the digoxin if the pulse is below 60 beats/min

c. notify the HCP if nausea develops Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the dose, if necessary The pt needs potassium- containing foods in diet to avoid hypokalemia pt should be taught to check their pulse daily before taking digoxin and if pulse is <60, call HCP before taking digoxin Diuretics should be taken early in the day to avoid sleep disruption

While admitting an 80 yo with heart failure to the hospital, the nurse learns that the pt lives alone and sometimes confuses "water pill" with the "heart pill". When planning for the pt's discharge the nurse will facilitate a. consult with a psychologist b. transfer to a long term care facility c. referral to a home health care agency d. arrangements for around the clock care

c. 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 pt's home situation and help the pt develop a method for taking the two medications as directed. There is no evidence that the pt requires services such as dementia care, long-term care, or around-the-clock home care

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. shortness of breath on exertion. d. right upper quadrant tenderness.

c. shortness of breath on exertion 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.

Which of these statements made by a pt 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% milk." b. "I like salmon and I will plan to eat it more often." c. "I can have a glass of wine with dinner if I want one." d. "I will miss being able to eat peanut butter sandwiches."

d. "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 pt with CAD. Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monounsaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The other patient comments indicate a good understanding of the TLC diet.

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? a. "The pain wakes me up at night." b. "The pain is level 3 to 5 (0 to 10 scale)." c. "The pain has gotten worse over the last week." d. "The pain goes away after a nitroglycerin tablet."

d. "The pain goes away after a 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 sx. The pain of chronic stable angina usually lasts only for a few minutes before subsiding with rest, calming down, or use of sublingual nitroglycerin. Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina.

True or false? Atrial fibrillation rhythms are always irregular.

true

How do you determine regularity on and ECG strip?

•Look at the R-R distances (using a caliper or marking by a pen on the paper) Regularity is when the R waves are equidistant

Steps to ECG Rhythm Analysis

•Step 1: Calculate Heart Rate •Step 2: Determine Regularity •Step 3: Analyze P waves •Step 4: Determine PR interval •Step 5: Determine QRS duration •Step 6: Interpret rhythm