Medsurg chpt 25

The nurse admits a 52-year-old woman with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. Which of the following responses by the nurse would be most appropriate?

"A woman's heart is smaller and has smaller arteries that become occluded more easily."

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse?

"Current evidence indicates that estrogen is ineffective as a cardioprotectant; estrogen is actually potentially harmful and is no longer a recommended therapy."

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include?

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

"Have you had any episodes of dizziness or fainting?"

The nurse is conducting patient teaching about cholesterol levels in the body. When discussing the patient's elevated low-density lipoprotein (LDL) and lowered high-density lipoprotein (HDL) levels, the patient shows an understanding of the significance of these levels by stating what?

"Increased LDL and decreased HDL increase my risk of coronary artery disease."

A 71-year-old woman has complained of chest pain that appears when she is doing housework or climbing stairs. The woman claims that the pain dissipates when she stops exerting herself and rests for a few minutes. The woman's history, combined with these complaints, prompted her primary care provider to order cardiac catheterization. What instructions should the nurse provide this patient in anticipation of her procedure?

"Make sure that you don't eat or drink before the procedure."

A nurse is preparing a client for a scheduled Adenocard (adenosine) stress test. Which of the following statements by the client indicates a need for further teaching?

"My wife is bringing me a cup of coffee to drink before the test."

A 76-year-old resident of an assisted living facility who has a history of heart failure has presented to her primary care provider for a scheduled appointment. Which of the woman's statements suggests that her heart failure is worsening?

"The last few weeks I've found that I'm more comfortable sleeping in a chair than in my bed."

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following?

"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

The nurse is assessing an African American client for signs of cyanosis. Which assessment finding is documented as cyanosis?

A grayish cast to the skin

The nurse assesses the patient and records the data collected. What would lead the nurse to anticipate that the patient will experience a decrease in cardiac output?

A heart rate of 54 beats per minute

The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding?

A heart rate of more than 20 bpm above the resting rate

The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" The nurse's appropriate response is which of the following?

Apricots, dried peas and beans, dates

A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching?

Avoid heavy lifting for the next 24 hours.

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal?

B-type natriuretic peptide (BNP)

The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure?

Baroreceptors

The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?

Clip the client's chest hair prior to applying the electrodes.

The nurse is assessing a client who has dyspnea and considering the process of gas exchange. Which structural characteristic of capillaries best enables gas exchange at the cellular level?

Capillaries are one cell-layer thick.

The nurse is taking a health history from a client admitted with the medical diagnosis of cardiovascular disease (CVD). Identify which of the following symptoms indicate CVD.

Chest pain, weight gain, fatigue

The nurse is caring for a client with a damaged tricuspid valve. The nurse knows that the tricuspid valve is held in place by which of the following?

Chordae tendineae

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. She detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?

Contact the physician and report her findings.

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition?

Heart Failure

The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition?

Heart failure

Which of the follow arteries carries deoxygenated blood?

Pulmonary artery

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit?

Count the heart rate at the apex.

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?

Crackles

A patient has been diagnosed with congestive heart failure (CHF). The physician has ordered a medication to enhance contractility. The nurse would expect which medication to be ordered for the patient?

Digoxin (Lanoxin)

The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmias. Which of the following assessment considerations is essential when caring for this age-group?

Digoxin level

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries?

Dobutamine

The nurse is caring for a post-cardiac catheterization client in the recovery room. Which of the following is a priority nursing consideration?

Dressing assessment

A patient's gradual decline in activity tolerance and increased shortness of breath have prompted her health care provider to assess the structure and size of her heart. Which of the following diagnostic tests is most likely to yield these assessment data?

Echocardiography

The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers which explanation?

Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?

Enzymes

Which area of the heart is located at the third intercostal (IC) space to the left of the sternum?

Erb point

Following the morning assessment of an older adult patient, the nurse has documented, "Edema 3+ present to ankles and feet; dorsalis pedis and posterior tibial pulses palpable bilaterally." The nurse should recognize that this patient may be exhibiting symptoms of:

Heart Failure

Which of the following suggestions can the nurse provide to a client to reduce sarcopenia?

Increased exercise

The nurse notes that the client has had a change in mental status. Why would it be important for the nurse to report extremes in the thought process of a client with cardiovascular disorder to the physician?

It may indicate a problem with oxygenation.

The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which of the following would the nurse regard as a priority to report to the physician?

K+ 3.1 mEq/L

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body?

Left Ventricle

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs?

Left atrium

A nurse working in a cardiac step-down unit understands that the following drugs can affect the contractility of the heart. The nurse recognizes that contractility is depressed by which of the following drugs?

Lopressor

The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer?

Lopressor

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is:

Loud and may be associated with a thrill sound similar to (a purring cat).

When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure?

Methylprednisolone (Solu-Medrol)

The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings?

Obtain an oxygen saturation level.

The nurse is explaining the three layers of tissue which make up the heart wall. As the nurse draws the layers in different colors to highlight the layers, which color would the nurse use for the heart valves?

Orange, the same color as the endocardium

During the assessment of a newly admitted female patient, the nurse has assessed the amplitude of the woman's temporal, dorsalis pedis, and posterior tibial pulses. The amplitude of these peripheral pulses contributes to the nurse's determination of this patient's:

Peripheral arterial circulation

The healthcare team is caring for a client with early atherosclerotic changes within the blood vessels. The physician orders diagnostic testing, and the nurse provides cardiovascular teaching. Which primary goal is the healthcare team working toward?

Preserving the natural heart by avoiding further heart disease

A student nurse is caring for a client with suspected cardiovascular disease. The nursing instructor asks the student what side effects a client may experience when undergoing a magnetic resonance imaging (MRI) test. What should the student respond?

Rapid heart rate

Which of the following nursing interventions is most appropriate when caring for a client with a nursing diagnosis of risk for injury related to side effects of medication (enoxaparin [Lovenox])?

Report any incident of bloody urine, stools, or both.

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to the lungs to be oxygenated?

Right ventricle

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur:

Right ventricular pressure must be higher than pulmonary arterial pressure.

One of your students asks what the consequences of uncorrected, left-sided heart failure would be. What would be your best response?

Right-sided heart failure

The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing?

ST-segment changes on the ECG

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by:

Stimulation of the vagus nerve.

Your client is going to have a stress test. What radionuclide would most likely be used to diagnose ischemic heart disease during this test?

Thallium-201

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons?

The client is at risk for renal failure due to the contrast agent that will be given during the procedure

The nurse is caring for a client with right-sided heart failure. When assessing the respiratory rate of this client, what is an indication that the client is having difficulty breathing?

Using accessory muscles during respiration

The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from?

The sinoatrial node

A patient recently diagnosed with pericarditis asks his nurse to explain what area of his heart is involved. The nurse tells the patient that the pericardium, which is inflamed, is the:

Thin fibrous sac that encases the heart.

The nurse is caring for a patient admitted with unstable angina. The laboratory results reveal that the initial troponin I level is elevated in this patient. What conclusion should the nurse draw from this fact?

This is an accurate indicator of myocardial injury.

The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function (cardiac output). What else are pulmonary artery pressure monitoring systems used for?

To assess the patient's response to interventions such as fluid administration and drug administration

The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred?

Troponin T and I

The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition?

catheter-related bloodstream infections

What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse?

contractility

The nurse is performing a focused assessment of a patient who has a complex cardiac history. The vital signs that the nurse obtains are as follows: Temperature 99.0°F (37.2°C); pulse 94 bpm; blood pressure 142/116 mm Hg; respiration 22 breaths per minute; SaO2 90% on room air. These findings should prompt the nurse to consider the possibility that this patient has:

decreased cardiac output

During an initial assessment, the nurse measures the client's apical pulse and compares it to the peripheral pulse. The difference between the two is known as pulse:

deficit

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain?

description of the pain

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

endocardium

The nurse auscultates the apex beat at which anatomical location?

fifth intercostal space, midclavicular line

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?

international normalized ratio (INR)

The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure?

pulse pressure

What does decreased pulse pressure reflect?

reduced stroke volume