MS EXAM #1
Pulmonary artery
only artery in the body that contains deoxygenated blood
Pulmonary vein
only vein in the body that contains oxygenated blood
Ejection fraction
percent of end diastolic volume ejected with each heart beat (left ventricle)
Atrioventricular valves
tricuspid and mitral
What is it when a plaque ruptures but the artery is not completely occluded?
unstable angina
What is the difference between unstable angina and MI?
with MI, the plaque completely occludes
Left anterior descending artery (L coronary artery)
down the anterior wall of the heart
Depolarization
electrical activation of cell caused by influx of sodium into cell while potassium exits cell
Three layers
endocardium, myocardium, epicardium
Epicardium
exterior layer of the heart
A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is modifiable by the client?
Dyslipidemia
The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure?
Heart and blood vessels
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
Heart failure
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?
Homans'
Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity?
Intermittent claudication
The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? A. High-density lipoprotein (HDL), 80 mg/dL B. Cholesterol, 280 mg/dL C. A ratio of LDL to HDL, 4.5 to 1.0 D. Low density lipoprotein (LDL), 160 mg/dL
A. High-density lipoprotein (HDL), 80 mg/dL A fasting lipid profile should demonstrate the following values (Alberti et al., 2009): LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients); total cholesterol less than 200 mg/dL; HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females; and triglycerides less than 150 mg/dL.
The nurse is presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would the nurse name as the most common cause of peripheral arterial problems in the older adult? A. Coronary thrombosis B. Atherosclerosis C. Arteriosclerosis D. Raynaud's disease
B. Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.
Which is a modifiable risk factor for coronary artery disease (CAD)? A. Increasing age B. Diabetes mellitus C. Race D. Gender
B. Diabetes mellitus While diabetes mellitus cannot be cured, blood glucose and symptomatology can be managed through healthy living. Gender, race, and increasing age are nonmodifiable risk factors.
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
Ophthalmic examination
The client is asking the nurse about heart-healthy food choices for lunch. What are foods that are heart healthy? Select all that apply. A. baked chicken leg B. broiled trout c. white rice with butter D. soy yogurt E. blueberries
B. broiled trout D. soy yogurt E. blueberries Heart-healthy foods include soy products, fish high in omega-3s, and fruit. The chicken leg has more fat than a chicken breast. The white rice does not have enough fiber, so brown rice is a better option.
Which of the following assessment results is considered a major risk factor for PAD?
BP of 160/110 mm Hg
The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive?
Beta blocker
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?
Bibasilar crackles
*CO =
SV × HR
A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?
Secondary
Stroke volume
Amount of blood ejected from one of the ventricles per heartbeat.
Cardiac output
Amount of blood pumped by Beech ventricle in liters per minute.
A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level?
Severely reduced The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure.
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly.
Murmurs
Sounds created by abnormal, turbulent flow of blood in the heart.
Normal heart sounds
Sounds produced when the valves close; normal heart sounds are S1 (atrioventricular valves) and S2 (semi lunar valves).
Cardiac conduction system
Specialized heart cells strategically located throughout the heart that are responsible for methodically generating in coordinating the transmission of electrical impulses to the myocardial cells.
Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements.
Weight reduction
What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis?
Teach the patient how to apply an elastic sleeve
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following?
The adrenal gland
After load
The amount of resistance to ejection of blood from the ventricle.
A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause?
The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.
b (Persistent cough Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.)
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Increased appetite b) Persistent cough c) Weight loss d) Ability to sleep through the night
a (Persistent cough)
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Persistent cough b) Ability to sleep through the night c) Increased appetite d) Weight loss
Which of the following is the most common site for a dissecting aneurysm?
Thoracic area
Which of the following is the most common site for a dissecting aneurysm?
Thoracic area The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.
Exercise Stress Test
Treadmill / stationary bike used to increase heart rate
ECG-when will patients have pain?
When the T wave inverts
Pharmacologic Stress Test
Vasodilating meds used to reach target heart rate.
The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following?
Vasospasm
A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect?
Venous insufficiency
Types of angina
1) Stable - Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin 2) Unstable angina - Symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin 3) Intractable or refractory angina - Severe incapacitating chest pain 4) Variant Angina - aka Prinzmetal. Coronary spasm 5) Silent ischemia - Objective evidence via ECG changes but patient reports NO PAIN
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? A. Cool, clammy skin and a diaphoretic, pale appearance B. Intermittent nausea and emesis for 3 days C. Chest discomfort not relieved by rest or nitroglycerin D. Anxiousness, restlessness, and lightheadedness
C. Chest discomfort not relieved by rest or nitroglycerin Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with acute coronary syndrome or MI, may also occur with angina and, alone, are not indicative of an MI.
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A. Diltiazem B. Isosorbide mononitrate C. Clopidogrel D. Metoprolol
C. Clopidogrel Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.
The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following?
Checking the patient's heart rate
c (Potassium)
A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? a) White blood cell (WBC) count b) Calcium c) Potassium d) Platelet count
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures?
"I have my wife look at the soles of my feet each day."
A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements?
"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet."
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect?
"My chest pain is decreasing." Explanation: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure
A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention?
A 40-year-old African-American man
Contractility
ability of cardiac muscle to shorten in response to electrical impulse
Visceral pericardium
adhering to the epicardium
11. An antidote for propranolol hydrochloride (a beta-adrenergic blocker) that is used to treat bradycardia is: a. digoxin. b. atropine. c. protamine sulfate. d. sodium nitroprusside.
b. atropine.
1. The most common heart disease for adults in the United States is: a. angina pectoris. b. coronary artery disease. c. myocardial infarction. d. valvular heart disease.
b. coronary artery disease.
23. The nurse expects a postoperative PTCA patient to be discharged: a. the same day as surgery. b. within 24 hours of the procedure. c. 3 days later. d. after 1 week.
b. within 24 hours of the procedure.
What prevents thrombus formation?
blood thinners
13. In the United States, about 1 million people will have an acute myocardial infarction each year. Of these 1 million, what percentage will die? a. 10% to 15% b. 25% c. 30% to 40% d. 60%
b. 25%
3. The most frequently occurring sign of myocardial ischemia is: _____________________________________.
chest pain referred to as angina pectoris
Circumflex artery (L coronary artery)
circles around to the lateral left wall of the heart
After an MI, the patient starts walking again, how high do you want the heart rate to increase?
10-20
A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply.
- Coronary artery disease -Myocardial infarction -Stroke
b (Morphine sulfate)
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate? a) Dopamine (Intropin) b) Morphine sulfate c) Nitroglycerin d) Furosemide (Lasix)
Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?
A client diagnosed with kidney disease
Laboratory Tests
-Cardiac biomarkers -Lipid profile -Coagulation Studies -Brain (B-type) natriuretic peptide -C-reactive protein -Homocysteine
**Most Common Clinical Manifestations
-Chest pain -Dyspnea -Peripheral edema, weight gain -Fatigue -Dizziness, syncope, changes in level of consciousness
Inspection of Skin
-Color -Temperature -Texture
Health History
-Demographic information -Family/genetic history -Cultural/social factors -Risk factors --Modifiable --Nonmodifiable
Cardiac stress testing
-Exercise stress testing -Pharmacologic stress testing
Medications
-Name, dosage, frequency, and reason -taken independently as prescribed? -Vitamins, herbal , and OTC meds
Coagulation Studies
-PT -INR -aPTT
Which of the following are alterations noted in Virchow's triad? Select all that apply.
-Stasis of blood -Vessel wall injury -Altered coagulation
Elimination Patterns
-Straining -Nocturia -Gastrointestinal symptoms / Bleeding
A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching?
"Don't take aspirin while you're taking warfarin."
A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?
"Flex your calf muscles, avoid alcohol, and change positions slowly."
The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question, asked by the nurse, is most important?
"How do you prepare your food?"
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following?
"Hypertension often causes no symptoms."
Electrocardiography
-12-lead ECG -Continuous monitoring: hardwire, telemetry -Signal-averaged ECG -Continuous ambulatory monitoring - Holter -Wireless mobile monitoring
Brain (B-type) natriuretic peptide
-< 100 pg/mL
Homocysteine
-< 12 mcmol/L
C-reactive protein
-< 1mg/L
A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively?
A middle-aged African-American man
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? A. The patient has at least a 70% occlusion of a major coronary artery. B. The patient has an ejection fraction of 65%. C. The patient has had angina longer than 3 years. D. The patient has compromised left ventricular function.
A. The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
Which medication should a nurse have on hand when removing a sheath after cardiac catheterization?
Atropine Explanation: Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine on hand to increase the client's heart rate if this occurs. Heparin thins the blood; clients should stop taking it before the sheath removal. Protamine sulfate is an antidote to heparin, but the nurse shouldn't administer it during sheath removal. Adenosine treats tachyarrhythmias.
9. List three of five collaborative problems for a patient with angina: ____________________, _______________________, and __________________________.
Answer should include three of the following: acute coronary syndrome or myocardial infarction, dysrhythmias, cardiac arrest, heart failure, and cardiogenic shock.
You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult?
Atherosclerosis
Control of heart rate
Autonomic nervous system, baroreceptors
Which is a modifiable risk factor for coronary artery disease (CAD)? A. Family history B. Hyperlipidemia C. Male gender D. Increasing age
B. Hyperlipidemia Other modifiable risk factors for CAD include tobacco use, hypertension, diabetes, metabolic syndrome, obesity, and physical inactivity. Increasing age, male gender, and family history are nonmodifiable risk factors for CAD.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? A. lateral. B. inferior. C. anterior. D. posterior.
C. anterior. An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.
What is the most prevalent cardiovascular disease in adults?
CAD
What can elevate due to a bruise or headache?
CK-MB
A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea?
Call for a chest x-ray.
Myocardial ischemia
Condition in which heart muscle cells receive less oxygen than needed.
The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is which of the following?
Contrast phlebography
Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot?
Contrast phlebography
Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot?
Contrast phlebography When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.
The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? A. "Do your parents have heart disease?" B. "What is your pain level on a scale of 1 to 10?" C. "How many sublingual nitroglycerin tablets did you take?" D. "What time did your chest pain start today?"
D. "What time did your chest pain start today?" The client may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the client's chest pain lasts longer than 20 minutes and is unrelieved by nitroglycerin, if ST-segment elevation is found in at least two leads that face the same area of the heart, and if it has been less than 6 hours since the onset of pain. The most appropriate question for the nurse to ask is in relations to when the chest pain began. The other questions would not aid in determining whether the client is a candidate for thrombolytic therapy.
A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? A. Cholesterol plugs in the lumen of veins B. Blood clots in the arteries C. Emboli in the veins D. Fatty deposits in the lumen of arteries
D. Fatty deposits in the lumen of arteries Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, the other options are incorrect.
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A. Urine output B. Hourly IV infusion C. Vascular sites for bleeding D. Prothrombin time (PT) or international normalized ratio (INR)
D. Prothrombin time (PT) or international normalized ratio (INR) The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.
Which of the following body system responses correlates with systolic heart failure (HF)?
Decrease in renal perfusion A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure.
The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics?
Diminished or absent pulses
Which of the following is a cerebrovascular manifestation of heart failure?
Dizziness
A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency?
Elevate the legs periodically for at least 15 to 20 minutes.
Sexuality and Reproduction
Fears
Which of the following medication classifications lyses and dissolves thrombi
Fibrinolytic
The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following?
If a dosage of medication is missed, double up on the next one to catch up.
Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?
Increased abdominal and back pain
Apical impulse
Impulse normally palpated at the fifth intercostal space, left midclavicular line; caused by contraction of the left ventricle; also called the point of maximal impulse.
A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene?
Instruct the client to sit for several minutes before standing.
A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment?
Numbness, cool skin temperature, and pallor
Ejection fraction
Percentage of the in diastolic blood volume ejected from the ventricle with each heartbeat.
Diastole
Period of ventricular relaxation resulting in ventricular filling.
When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true?
Pressures should not differ more than 5 mm Hg between arms.
A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client?
Stop Smoking Nicotine from tobacco products causes vasospasm and can thereby dramatically reduce circulation to the extremities. When the client elevates the feet above the heart level, the heart must work against gravity to supply blood to the feet. Antiembolytic stocking are helpful for venous return to the heart, but constriction is not helpful for lack of arterial blood flow. Crossing the legs for more than a few minutes at a time compresses arteries and decreases blood supply to the legs and feet.
d (Congestion in the peripheral tissues)
The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)? a) Reduction in cardiac output b) Reduction in forward flow c) Accumulation of blood in the lungs d) Congestion in the peripheral tissues
Which of the following is a classic sign of cardiogenic shock?
Tissue hypoperfusion Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation). Low blood pressure is a classic sign of cardiogenic shock. Hypoactive bowel sounds are classic signs of cardiogenic shock. Decreased urinary output is a classic sign of cardiogenic shock.
Which of the following nursing interventions should a nurse perform when a patient with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta blockers?
Withhold the drug and inform the primary health care provider. Before administering beta blockers, the nurse should monitor the patient's apical pulse. If the heart rate is less than 60 bpm, the nurse should withhold the drug and inform the primary health care provider.
What is myoglobin?
a heme protein that helps transport oxygen
3. A healthy level of serum cholesterol would be a reading of: a. 160 to 190 mg/dL. b. 210 to 240 mg/dL. c. 250 to 275 mg/dL. d. 280 to 300 mg/dL.
a. 160 to 190 mg/dL.
22. A goal of dilation in PTCA is to increase blood flow through the artery's lumen and achieve a residual stenosis of less than: a. 20%. b. 35%. c. 60%. d. 80%.
a. 20%.
8. The nurse advises a patient that sublingual nitroglycerin should alleviate angina pain within: a. 3 to 4 minutes. b. 10 to 15 minutes. c. 30 minutes. d. 60 minutes
a. 3 to 4 minutes.
16. Which of the following statements about myocardial infarction pain is incorrect? a. It is relieved by rest and inactivity. b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms.
a. It is relieved by rest and inactivity.
A nurse is completing a head to toe assessment on a patient diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined? a) Legs, Toes b) Fingers, hands c) Under the sacrum d) Lips, earlobes
b) Fingers, hands When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.
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? a) Sympathetic nerve fibers b) Vagus nerve c) Baroreceptors d) Chemoreceptors
c) Baroreceptors Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate.
Which of the following tests used to diagnose heart disease is least invasive? a) Cardiac catheterization b) Magnetic resonance imaging c) Coronary arteriography d) Transthoracic echocardiography
d) Transthoracic echocardiography Transthoracic echocardiography uses high-frequency sound waves that pass through the chest wall (transthoracic) and are displayed on an oscilloscope. MRI uses magnetism to identify disorders that affect many different structures in the body without performing surgery. While an MRI does not expose clients to radiation, it does require intravenous infusion to instill medication and contrast medium. Cardiac catheterization requires the insertion of a long, flexible catheter from a peripheral blood vessel in the groin, arm, or neck into one of the great vessels and then into the heart. This procedure requires the instillation of a contrast medium into each coronary artery.
A blood pressure of 140/90 mm Hg is considered to be
hypertension.
Repolarization
return of cell to resting state caused by reentry of potassium into cell while sodium exits
AV node
secondary pacemaker
What should a patient do if they are having angina?
stop all activity and sit or rest in bed
A nurse is teaching nitroglycerin to a client with hospitalized client with coronary artery disease who is being discharged. The nurse tells the client that nitroglycerin has which of the following actions? Choose all that apply.
• Reduces myocardial oxygen consumption • Dilates blood vessels • Decreases ischemia • Relieves pain Explanation: Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco.
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is:
"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."
A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking blood pressure."
Echocardiogram
-Evaluate the size, shape, position, thickness and movement of the heart and great vessels -Measure the ejection fraction
Physical Examination
-General Appearance -Inspection of Skin -Inspection of Extremities -Blood Pressure -Arterial Pulses -Heart Sounds -lung assessment -Abdomen
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply.
-Smoking -Diabetes mellitus -Physical inactivity
areas to listen to on the heart
-aortic: right 2nd intercostal space -pulmonic: left 2nd intercostal space -mitral: left 5th intercostal, medial to midclavicular line
Preload
-degree of stretch of cardiac muscle fibers at end of diastole -vL of blood in ventricles at end of diastolic -Increased in hypervolemia, regurgitation of cardiac valves heart failure
You are assessing a client recently admitted to your unit for hypotension. While assessing this client, you find a pulsatile mass near the umbilicus. What would you suspect?
Aortic aneurysm
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status?
Arterial blood gases In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation.
Coronoary atherosclerosis
Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. In coronary atherosclerosis, blockages and narrowing of the coronary vessels reduce blood flow to the myocardium. Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups. CAD, coronary artery disease, is the most prevalent cardiovascular disease in adults. Think of CAD on a continuim Hypertension, diabetes, etc leads to CAD leads to angina leads to MI/death
When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor?
Atrioventricular block Explanation: The chief complications of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reported reactions include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A. calcium-channel blocker B. beta-blocker C. nitrate D. thrombolytic
A. calcium-channel blocker
The nurse is performing wound care for a patient with a necrotic sacral wound. The prescribed treatment is isotonic saline solution with fine mesh gauze and a dry dressing to cover. What type of debridement is the nurse performing?
Nonselective debridement Nonselective débridement can be accomplished by applying isotonic saline dressings of fine mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze. Pain management is usually necessary.
When will troponin, CK-MB, and myoglobin be tested?
in the beginning, then every 6 hrs
What happens to troponin during an MI?
increase is detected in a few hrs, may remain elevated up to 3 weeks
What does caffeine do to the heart?
increases demand and decreases output
Posterior descending artery (R coronary artery)
inferior wall of the heart; "widow maker"; if blocked off = BAD because of the amount of heart it covers
What two types of specialized electrical cells provide synchronization?
nodal cells and purkinje cells
According to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed
secondary.
SA node
sends out a lot of electricity (signals) power part
Pericardial space
space between the two pericardium layers; normally filled with about 20 mL of fluid (which lubricates the surface of the heart and reduces friction during systole)
What is the difference between stable and unstable angina?
stable is relieved with rest
Coronary arteries
supply arterial blood to the heart; originate from the aorta just above the aortic valve leaflets; perfused during diastole
Aortic valve
the valve between the left ventricle and the aorta
Pulmonic valve
the valve between the right ventricle and the pulmonary artery
Why is it better if the ischemia is farther out?
there will still be some healthy cells that can repolarize and depolarize
What are symptoms of CAD?
they are related to the location and degree of vessel obstruction
Why do diabetics have silent heart attacks?
they can't feel things normally
Pericardium
thin, fibrous sac that encases the heart; composed of two layers
A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:
visual disturbances.
What are atypical symptoms of MI?
weakness, dyspnea, and nausea
What are risk factors that should be decreased with angina?
weight loss, diet, smoking
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:
forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.
Cardiac conduction system
generates and transmits electrical impulses that stimulate contraction of the myocardium
What are concerns about lifestyle changes and reduction of risk factors in angina patients?
go low and slow, do not slam the patient with quitting smoking, drinking, drugs, etc all at once
Which is a potassium-sparing diuretic used in the treatment of heart failure?
Spironolactone (Aldactone)
Heart Sounds
-S1 ("lub") ---tricuspid and mitral valves close, beginning of systolic -S2 ("dub") ---aortic and pulmonic valves close, end of systolic/ beginning of diastolic
A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.)
- Computed tomography -Transesophageal echocardiography -X-ray
Abdomen
-Abdominal distension -Bladder distention -Hepatojugular reflux
Current Health
-Cardiac condition -Cause of illness -Consequences of illness -Influence on controlling illness
**Cardiovascular Disease: Common S&S
-Chest pain / discomfort -Shortness of breath / dyspnea -Peripheral edema, weight gain, abdominal distension -Palpitations -Vital fatigue -Dizziness, syncope, changes in level of consciousness
Past Health
-Concerns -Changes in health in past year? Past 5 years? -Risk factors -PCP or cardiologist -Routine check-ups
Assessment
-Physical examination -Palpation, percussion, auscultation -Medications -Nutrition -Elimination -Activity, exercise -Sleep, rest -Vital signs -Self-perception, self-concept -Roles, relationships -Sexuality, reproduction -Coping, stress tolerance -Prevention strategies -Family history
Echocardiography
-Transthoracic -Transesophageal
Magnetic Resonance Imaging (MRI)
-Uses a magnet and radio waves -Can be done with or without IV contrast medium -Produces cross-sectional images of pulmonary and cardiovascular structures Provides information about structural abnormalities
Positron Emission Tomography (PET) scan
-Uses radioactive material (intravenous fluid or inhaled gas) -Produces 3-D image -Provides information about myocardial perfusion
Two functions of the cardiovascular system
1) delivering oxygen and nutrients to all of the cells of the body 2) removing waste products for excretion
The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following?
4 or 5
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions?
Stabilizing heart rate and blood pressure and easing anxiety
A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? A. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. B. Atherosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. C. Arteriosclerosis is a formation of clots in the inner lining of the arteries. D. Atherosclerosis is a formation of clots in the inner lining of the arteries.
A. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. Arteriosclerosis refers to the loss of elasticity or hardening of the arteries, that accompanies the aging process. Therefore, options B, C, and D are incorrect.
A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? A. Assess chest pain and administer prescribed drugs and oxygen B. Assess the client's physical history C. Assess blood pressure and administer aspirin D. It is not important to assess the client or to notify the physician
A. Assess chest pain and administer prescribed drugs and oxygen The nurse assesses the client for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing blood pressure or the client's physical history does not clearly indicate that the client has CAD. The nurse does not administer aspirin without a prescription from the physician.
The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? A. Atropine B. Sodium nitroprusside C. Digoxin D. Protamine sulfate
A. Atropine Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV atropine is usually given to treat this response.
Which of the following is a manifestation of right-sided heart failure?
Systemic venous congestion
The nurse is seeing a client for the first time and has just checked the client's blood pressure. For what value would the nurse consider the client prehypertensive?
Systolic BP is between 120 and 130 mm Hg.
The nurse is working a cardiac care unit with a client on a diltizem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. A. decreasing R to R interval B. an absent P wave C. T-wave inversion D. slowing heart rate E. ST elevation
A. decreasing R to R interval D. slowing heart rate The ECG changes that occur with an MI are seen in the leads that view the involved surface of the heart. The expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave. The diltezam will slow the heart rate and decrease the R to R interval.
A client is recovering from coronary artery bypass graft (CABG) surgery. During discharge preparation, the nurse should advise the client and family members to expect which common symptom that typically resolves spontaneously? A. depression B. ankle edema C. memory lapses D. dizziness
A. depression For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate notification to a health care provider.
A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does nurse identify as a major indication of concern? A. hematocrit of 30% B. hemoglobin of 16 g/dL C. heart rate of 87 bpm D. blood pressure of 129/72 mm Hg
A. hematocrit of 30% Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lower hematocrit can imply internal bleeding. Blood pressure of 129/72 and heart rate of 87 bpm are normal. A hemoglobin count of 16 g/dL is also normal.
The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as A. high. B. low. C. critically high. D. within normal limits.
A. high. The normal LDL range is 100 to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk clients).
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
ACE inhibitor
S4
An abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hyper trophy of the ventricle.
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?
Assess for elevated blood urea nitrogen levels. Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.
To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? A. 30 minutes B. 60 minutes C. 9 days D. 6 to 12 months
B. 60 minutes The 60-minute interval is known as "door-to-balloon time" in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as "door-to-needle time" for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.
A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? A. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. B. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. C. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. D. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider.
B. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? A. Hyperkalemia B. Atelectasis C. Urinary tract infection (UTI) D. Elevated blood glucose level
B. Atelectasis Respiratory complications that may occur include atelectasis. An incentive spirometer and the use of deep breathing exercises are necessary to prevent atelectasis and pneumonia. Elevated blood sugar levels, hyperkalemia, UTI, and are complications that can occur but are unrelated to the respiratory system.
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? A. Alkaline phosphatase B. Creatine kinase MB C. Troponin D. Myoglobin
B. Creatine kinase MB There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? A. Atenolol B. IV morphine C. IV nitroglycerin D. Amlodipine
B. IV morphine IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings? A. HMG-CoA reductase inhibitor B. Nicotinic acid C. Fibric acid D. Bile acid sequestrant
B. Nicotinic acid The most appropriate class of medications based on the client's laboratory findings would be nicotinic acid. This class of medications is prescribed for clients with minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride levels are elevated.
A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? A. Amantadine B. Nitroglycerin C. Digoxin D. Diphenhydramine
B. Nitroglycerin A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin. Amantadine, digoxin, and diphenhydramine can interact with a cholinergic blocking agent but not through delayed absorption. Amantadine and diphenhydramine enhance the effects of anticholinergic agents.
The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. A. morphine B. aspirin C. enalapril D. atorvastatin E. sildenafil
B. aspirin C. enalapril D. atorvastatin Upon client discharge, there needs to be documentation that the client was discharged on a statin (atorvastatin), an ACE or angiotensin receptor blocking agent (enalapril), and aspirin. Morphine is used to reduce the client's pain and anxiety. Sildenafil is a medication used for pulmonary hypertension.
What is a modifiable risk factor for the development of atherosclerosis? A. gender B. consumption of a high-fat diet C. infection with chlamydia pneumonia D. family history
B. consumption of a high-fat diet There are many known risk factors for development of atherosclerosis. Factors that are modifiable, or that a client can change, include diet, activity level, and smoking cessation. Some that are nonmodifiable include gender, heredity, certain diseases, and history of infection with Chlamydia pneumoniae. These factors individually or collectively contribute to hyperlipidemia, which then triggers atherosclerotic changes.
A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? A. exercise avoidance B. smoking cessation C. a protein-rich diet D. antioxidant supplements
B. smoking cessation The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.
vL=
BP -Increasing vL equals increased BP
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?
Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute
Hypertension
Blood pressure that is persistently greater than 140/90 mm Hg.
Which of the following is a characteristic of an arterial ulcer?
Border regular and well demarcated
When starting a client on oral or I.V. diltiazem, for which potential complication should the nurse monitor? A. Hypertension B. Renal failure C. Atrioventricular block D. Flushing
C. Atrioventricular block The chief complications of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reported reactions include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication.
Semilunar valves
composed of three leaflets, which are shaped like half-moons; closed during diastole (relaxation) and open during systole (contraction)
A client kept his appointment to see a cardiologist for post-hospitalization follow up. The cardiologist examines him and inquires as to the medication's efficacy since his hospitalization. Effective medications are intended to produce arterial vasodilation. What type of medication, listed below, is not as an effective vasodilator as others?
Calcium-channel blockers Explanation: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents.
A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in education for this client?
Change positions (lying or sitting to standing) slowly.
A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have?
Class I (Mild) Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? A. Cleanse the site with disinfectants and dress the wound appropriately B. Normal activities of daily living can be resumed the first day after surgery C. Refrain from sexual activity for 1 month D. Monitor the site for bleeding or hematoma.
D. Monitor the site for bleeding or hematoma. The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or the development of a hard mass indicative of hematoma. A nurse does not advise the client to clean the site with disinfectants or refrain from sexual activity for 1 month.
Which s the analgesic of choice for acute myocardial infarction (MI)? A. Ibuprofen B. Meperidine C. Aspirin D. Morphine
D. Morphine The analgesic of choice for acute MI is morphine administered in IV boluses to reduce pain and anxiety. Aspirin is an antiplatelet medication. Meperidine and Ibuprofen are not the analgesics of choice.
A client who is resting quietly reports chest pain to the nurse. The cardiac monitor indicates the presence of reversible ST-segment elevation. What type of angina is the client experiencing? A. silent angina B. stable angina C. intractable angina D. variant angina
D. variant angina Variant or Prinzmetal's angina is distinguished by pain occurrence during rest. Stable angina occurs with activity. Silent angina occurs without symptoms, and intractable angina is evidenced by incapacitating pain.
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?
Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
Preload
Degree of stretch of the cardiac muscle fibers at the end of diastole.
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously?
Depression Explanation: For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate physician notification.
The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?
Echocardiogram
Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred?
Echocardiogram
The diagnosis of heart failure is usually confirmed by which of the following?
Echocardiogram Although the chest X-ray can indicate cardiomegaly and the ECG can indicate a left ventricular abnormality, it is the echocardiogram that is diagnostic. This test measures ejection fraction (EF) which, if greater than 40% and accompanied with signs and symptoms of heart failure, indicates diastolic dysfunction and impaired ventricular relaxation.
A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement?
Echocardiography
Which of the following diagnostic tests may reveal an enlarged left ventricle?
Echocardiography
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?
Electrolyte and water loss The nurse should closely monitor a patient being administered diuretics for electrolyte and water loss. Digitalis preparations (not diuretics) are potent and may cause various toxic effects. The nurse should monitor the patient for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. However, the effects do not include vasculitis, flexion contractures, or enlargement of joints
Which of the following is accurate regarding Raynaud's disease?
Episodes may be triggered by unusual sensitivity to cold.
An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include?
Nonpharmacological interventions
When teaching a patient about hypertension and lifestyle changes the nurse emphasizes that which of the following should be included in the diet?
Fresh fruits and vegetables
You are caring for a client with suspected right-sided heart failure. What would you know that clients with suspected right-sided heart failure may experience?
Gradual unexplained weight gain
Which of the following is true regarding the African American population and the development of hypertension?
Greater rate of stage 2 hypertension
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?
Homans' A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.
Myocardial ischemia
INADEQUATE OXYGEN SUPPLY; condition in which heart muscle cells receive less oxygen than needed; tachycardia (most at risk) and history of CAD; if heart rate increases --> diastolic time is shortened -->which may not allow adequate time for myocardial perfusion
A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan?
Instruct the patient on side effects of flushing, throbbing headache, and tachycardia. Explanation: The patient should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The patient should renew the nitroglycerin supply every 6 months. If the pain is severe, the patient can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.
A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking?
Intermittent claudication
Which of the following terms refers to a muscular, cramplike pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest?
Intermittent claudication
A client diagnosed with pulmonary edema has a PaCO2 of 72 mm Hg and an oxygen saturation of 84%. What method of oxygen delivery would best meet the needs of this client?
Intubation and mechanical ventilation The client?'s respiratory status is severely compromised and has developed signs of respiratory failure. When respiratory failure occurs, the client is intubated and oxygen is administered under continuous positive airway pressure or with mechanical ventilation with positive end-expiratory pressure. A face mask, cannula, or Venturi mask will not deliver the concentration or ventilatory support that an endotracheal tube with mechanical ventilation will provide.
The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?
Loss of arterial elasticity
If a patient comes in with chest pain that started 6 hrs ago, myoglobin and CK-MB are slightly elevated, troponin of 0.2 What is happening?
MI-troponin should be 0
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate?
Morphine sulfate Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing.
Which of the following medications is a human brain natriuretic peptide (BNP) preparation?
Natrecor Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing dieresis and vasodilation, reducing blood pressure, and improving cardiac output. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors.
Which of the following are risk factors for venous disorders of the lower extremities?
Obesity
Which of the following are risk factors related to venous stasis for DVT and pulmonary embolism?
Obesity
The nurse is caring for a client with long-standing hypertension. As a client advocate, which instruction is most helpful in preventing further complications?
Obtain a regular appointment with eye doctor.
Treatment of Acute MI
Obtain diagnostic tests including ECG within 10 minutes of admission to the ED Oxygen Aspirin, nitroglycerin, morphine, beta-blockers Angiotensin-converting enzyme inhibitor within 24 hours. Kidneys will excrete sodium and fluid (diuresis), decreasing the oxygen demand on the heart. Evaluate for percutaneous coronary intervention or thrombolytic therapy As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor Bed rest Give the oxygen because you want to load blood with as much supplemental oxygen as possible due to ischemia. Aspirin makes the blood slippery, a blood thinner. Any other areas with plaque, it could slip over it. Nitro = vasodilat Morphine = vasodilate and pain Betablocker = slows heart rate ACE inhibitor decreases the fluid No thrombolytic therapy if cath lab is available. Lots of contraindications for thrombolytic therapy because it eats ALL clots....at any time in your body there are thousands of microclots. This could cause super abnormal bleeding.
A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason?
Older adults have impaired cardiovascular reflexes.
d (55% Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.)
On his return to the cardiac step-down unit after his diagnostic procedure, a client awaits the report from his cardiologist. As the client's nurse, you review the process of measuring ejection fraction and explain to the client that it measures the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? a) 45% b) 50% c) 40% d) 55%
A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess?
Peripheral pulses every 15 minutes following surgery The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable.
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately?
Persistent cough Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.
The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following?
Pitting edema The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response.
A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned?
Postural hypotension and resulting injury
A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together?
Potassium level
Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation?
Prazosin hydrochloride (Minipress)
A systolic blood pressure of 135 mm Hg would be classified as which of the following?
Prehypertension
The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as which of the following?
Prehypertension
A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms?
Raynaud's disease Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.
Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy?
Rebound
A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern?
Rebound hypertension
Which of the following findings indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage
Four chambers
Right atrium and ventricle, left atrium and ventricle
Which of the following terms describes high blood pressure from an identified cause, such as renal disease?
Secondary hypertension
Atrioventricular node
Secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve.
Of the following diuretic medications, which conserves potassium?
Spironolactone (Aldactone)
The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium?
Spironolactone (Aldactone)
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions?
Stabilizing heart rate and blood pressure and easing anxiety For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.
A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details?
The client can walk about 50 feet before getting pain in the right lower leg.
d (Left ventricular function)
The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? a) Right ventricular function b) Right atrial function c) Left atrial function d) Left ventricular function
Hemodynamic monitoring
The use of pressure monitoring devices to directly measure cardiovascular function.
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks?
Troponin Explanation: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer?
Valsartan (Diovan) Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker).
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status?
Weighing the client daily at the same time each day Increased fluid volume leads to rapid weight gain — 2.2 lb (1 kg) for each liter of fluid retained. Weighing the client daily at the same time and in similar clothing provides more objective data than measuring fluid intake and output, which may be inaccurate because of omitted measurements such as insensible losses.
d (IV)
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? a) III b) II c) I d) IV
d (Dopamine (Intropin) Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.)
Which drug is most commonly used to treat cardiogenic shock? a) Metoprolol (Lopressor) b) Furosemide (Lasix) c) Enalapril (Vasotec) d) Dopamine (Intropin)
An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for:
a history of diabetes mellitus. Explanation: Diabetes mellitus, smoking, and hypertension are other major risk factors for CAD. Elevated HDL levels aren't a risk factor for CAD; in fact, increased HDL levels seem to protect against CAD. Ischemic heart disease is another term for CAD, not a risk factor. Alcoholism hasn't been identified as a major risk factor for CAD
Your client is being prepared for echocardiography when he asks you why he needs to have this test. What would be your best response? a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." b) "This test can tell us a lot about your heart." c) "This test will find any congenital heart defects." d) "Echocardiography will tell your doctor if you have cancer of the heart."
a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." Echocardiography uses ultrasound waves to determine the functioning of the left ventricle and to detect cardiac tumors, congenital defects, and changes in the tissue layers of the heart. All answers are correct. Option C is the best answer because it addresses the client's question without making him anxious or minimizing the question.
A patient has undergone a cardiac catheterization. He is to be discharged today. What information should the nurse emphasize during discharge teaching? a) Avoid heavy lifting for the next 24 hours. b) Take a tub bath, rather than a shower. c) Bend only at the waist. d) New bruising at the puncture site is normal.
a) Avoid heavy lifting for the next 24 hours. For the next 24 hours, the patient should not bend at the waist, strain, or life heavy objects. The patient should avoid tub baths, but shower as desired. The patient should call her the health care provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit or more.
The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures? a) Cardiac catheterization b) Transesophageal echocardiogram c) Pharmacologic stress test d) Telemetry monitoring
a) Cardiac catheterization An elevated ST-segment means an evolving myocardial infarction. A cardiac catheterization would be the logical next step.
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation? a) Irregularly irregular heart rate b) Increased PR interval c) Fourth heart sound (S4) d) Orthostatic hypotension
a) Irregularly irregular heart rate An irregularly irregular heart rate indicates atrial fibrillation and should be investigated further. It's normal for an elderly client to have a prolonged systole, which causes an S4 heart sound. It's also normal for an elderly client to have slowed conduction, causing an increased PR interval. As a person ages, it's normal for baroreceptors in the body to decrease their response to changes in body position, which can cause orthostatic hypotension.
A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education? a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR b) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR) c) Obtaining the supine measurements prior to the sitting and standing measurements d) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling
a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.
28. A complication after cardiac surgery that is associated with an alteration in preload is: a. cardiac tamponade. b. elevated central venous pressure. c. hypertension. d. hypothermia.
a. cardiac tamponade.
7. The pain of angina pectoris is produced primarily by: a. coronary vasoconstriction. b. movement of thromboemboli. c. myocardial ischemia. d. the presence of atheromas.
a. coronary vasoconstriction.
12. Calcium channel blockers act by: a. decreasing SA node automaticity. b. increasing AV node conduction. c. increasing the heart rate. d. creating a positive inotropic effect.
a. decreasing SA node automaticity
Conductivity
ability to transmit an electrical impulse from one cell to another
What are collaborative problems of angina pectoris?
acute pulmonary edema, heart failure, cardiogenic shock, dysrhythmias and cardiac arrest, MI
4. More than 50% of people with coronary artery disease have the risk factor of: _________________________.
age; more than 50% are older than 65 years of age
What treatments are used for MI?
aspirin, nitro, morphine, beta-blockers, angiotensin-converting enzyme inhibitor (within 24 hrs), if indicated-heparin, LMWH, clopidogrel or ticlopidine, glycoportein IIb/IIIa inhibitor, bed rest
2. The most common cause of cardiovascular disease is: __________________________________________.
atherosclerosis
Which of the following would be a factor that may decrease myocardial contractility? a) Administration of digoxin (Lanoxin) b) Acidosis c) Sympathetic activity d) Alkalosis
b) Acidosis Contractility is depressed by hypoxemia, acidosis, and certain medications, such as beta-adrenergic blocking medications. Contractility is enhanced by sympathetic neuronal activity, and certain medications, such as Lanoxin.
You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate? a) The client and family understands the need for medication. b) The client and family understands the discharge instructions. c) The client and family understands the need to restrict activity for 72 hours. d) The client and family understands the client's CV diagnosis.
b) The client and family understands the discharge instructions. The client is relaxed and feels secure. The test is performed uneventfully or the client is stabilized when complications are managed successfully. The client and family have an accurate understanding of the diagnostic testing process and discharge instructions. The scenario does not indicate that the client has a CV diagnosis, a need for medication, or a need to restrict their activity for 72 hours.
17. Myocardial cell damage can be reflected by high levels of cardiac enzymes. The cardiac-specific isoenzyme is: a. alkaline phosphatase. b. creatine kinase (CK-MB). c. myoglobin. d. troponin.
b. creatine kinase (CK-MB).
26. The most common nursing diagnosis for patients awaiting cardiac surgery is: a. activity intolerance. b. fear related to the surgical procedure. c. decreased cardiac output. d. anginal pain.
b. fear related to the surgical procedure.
15. The most common site of myocardial infarction is the: a. left atrium. b. left ventricle. c. right atrium. d. right ventricle.
b. left ventricle.
21. A candidate for percutaneous transluminal coronary angioplasty (PTCA) is a patient with coronary artery disease who: a. has compromised left ventricular function. b. has had angina longer than 3 years. c. has at least 70% occlusion of a major coronary artery. d. has questionable left ventricular function.
c. has at least 70% occlusion of a major coronary artery.
19. An intravenous analgesic frequently administered to relieve chest pain associated with myocardial infarction is: a. meperidine hydrochloride. b. hydromorphone hydrochloride. c. morphine sulfate. d. codeine sulfate.
c. morphine sulfate.
What are blockages and narrowing of the the coronary vessels that reduce blood flow to the myocardium?
coronary athersclerosis
What are examples of blood thinners?
coumadin, warfarin, heparin
25. A candidate for coronary artery bypass grafting (CABG) must meet which of the following criteria? a. A blockage that cannot be treated by PTCA b. Greater than 60% blockage in the left main coronary artery. c. Unstable angina. d. All of the above.
d. All of the above.
To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals:
dependent pallor. If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.
24. The nurse needs to be alert to assess for clinical symptoms of possible postoperative complications of PTCA, which include: a. abrupt closure of the artery. b. arterial dissection. c. coronary artery vasospasm. d. all of the above.
d. all of the above.
What is the goal for angina treatment?
decrease myocardial oxygen demand and increase oxygen supply, immediate and appropriate treatment and prevention of angina, reduction of anxiety, awareness of the disease process, adherence to the self care program, and absence of complications
The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise:
decreases venous congestion Regular walking is the best way to decrease venous congestion because using the leg muscles as a pump helps return blood to the heart. Regular exercise also aids in stress reduction and weight reduction and increases the formation of HDLs — which are all beneficial to a client with peripheral vascular disease. However, these changes don't have as significant an effect on the client's condition as decreasing venous congestion.
Parietal pericardium
enveloping the visceral pericardium; a touch fibrous tissue that attaches to the great vessels, diaphragm, sternum, and vertebral column and supports the heart in the mediastinum
12. List four of seven symptoms seen in postpericardiotomy syndrome. ______________________, ______________________, ______________________, and ______________________.
fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia.
5. List four of seven modifiable risk factors that are considered major causes of coronary artery disease: __________________, _______________________, ________________________, and ______________________________________.
hyperlipidemia, cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, and physical activity.
Papillary muscles
located on the sides of the ventricular walls; connected to the valve leaflets by the chordae tendineae (thin fibrous bands)
What two parts maintain valve closure?
papillary muscles and chordae tendineae
Systole
period of contraction; blood is pumped out of the heart by arteries
Diastole
period of relaxation; period of ventricular relaxation resulting in ventricular filling; blood is returned to the heart by veins
What regulates the myocardial contractile process?
troponin
Contractility
increased by catecholamines, Sympathetic Nervous System (SNS), some medications Decreased by hypoxemia (low O2 in blood), acidosis, some medications
What happens to myoglobin during an MI?
increases in 1-3 hrs, peaks within 12 hrs
What are symptoms (besides chest pain) of an MI?
jaw pain, left arm pain
A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements?
"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.
Transesophageal Echocardiography (TEE)
-An invasive procedure used when conventional echocardiography is not appropriate -Requires an informed consent -During procedure, monitor: LOC, BP, EKG, respirations, & O2 saturation
Health Promotion, Perception, and Management Questions
-Ask regarding health promotion, preventive practices --What type of health issues do you have? Are you able to identify any family history or behaviors that put you at risk of this health problem? --What are your risk factors for heart disease? What do you do to stay healthy? --How is your health? Have you noticed any changes? -Ask regarding health promotion, preventive practices --Do you have a cardiologist or primary health care provider? How often do you go for checkups? --Do you use tobacco or alcohol? --What medications do you take?
The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.)
-Avoid constricting garments. - Elevate the legs above the heart level for 30 minutes every 2 hours. -Sleep with the foot of the bed elevated about 6 inches.
Cardiac biomarkers
-CK, CK-MB -Myoglobin -Troponin T and I
Inspection of Extremities
-Capillary refill -Peripheral edema
Physical Examination
-Do the physical findings match the data obtained in health history? -What are the baseline findings? -Is the current treatment plan effective?
Nutrition
-Eating habits -Height / Weight / BMI / Waist Circumference -Cholesterol levels -Blood Glucose level -Blood Pressure
Patient Routines
-meds -nutrition -activity and exercise -elimination patterns -sleep habits
Afterload
-resistance to ejection of blood from ventricle, must over come this. -increased in hypertension and vasoconstriction -increase after load = increased cardiac workload
Angiography (angiogram)
-uses x-ray -Contrast medium injected into blood vessel -Allows visualization of heart, great vessels, & coronary arteries -Provides information about patterns of circulation, cardiac output, cardiac functions, and changes in vessel wall appearance
11. The vessel most commonly used for CABG is the: __________________________________.
. greater saphenous vein
7. Management of coronary heart disease requires a therapeutic range of cholesterol and lipoproteins. An acceptable blood level of total cholesterol is _______________ with an LDL/HDL ratio of _______________. The desired level of LDL should be ________________ mg/dL, and the HDL level should be greater than ________________ mg/dL. Triglycerides should be less than _______________mg/dL.
. less than 200 mg/dL; 3.5:1.0; less than 100 mg/dL; greater than 60 mg/dL; 150 mg/dL
A man has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER?
10 minutes Explanation: The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored.
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following?
130/80 or lower
Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period.
140, 90
The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be?
2.0-3.0
8. The American Heart Association recommends that an average American diet contain about ________________% fat.
25% to 35%
A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose?
4.8 mL
A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, "What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?"
50
On his return to the cardiac step-down unit after his diagnostic procedure, a client awaits the report from his cardiologist. As the client's nurse, you review the process of measuring ejection fraction and explain to the client that it measures the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects?
55%
c (BP and pulse measurements every 15 to 30 minutes Bedside ECG monitoring is standard, as are continuous pulse oximetry, automatic BP, and pulse measurements approximately every 15 to 30 minutes.)
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? a) Intubation of the airway b) Insertion of a central venous catheter c) BP and pulse measurements every 15 to 30 minutes d) Hourly administration of a fluid bolus
a, b, d (An echocardiogram is usually performed to confirm the diagnosis of HF, identify the underlying cause, and determine the EF, which helps identify the type and severity of HF. This information may also be obtained noninvasively by radionuclide ventriculography or invasively by ventriculography as part of a cardiac catheterization procedure. A chest x-ray and an electrocardiogram (ECG) are obtained to assist in the diagnosis. Pulmonary arteriography is the one diagnostic tool here that does not apply.)
A 78-year-old client has been diagnosed with right-sided heart failure from her symptomology. Her cardiologist will confirm his suspicions through diagnostics. Which of the following diagnostics are used to reveal right ventricular enlargement? Select all that apply. a) Chest radiograph b) Echocardiography c) Pulmonary arteriography d) Electrocardiogram
Percutaneous Transluminal Coronary Angioplasty
A balloon-tipped catheter is used to open blocked coronary vessels and resolve ischemia. Improves blood flow within a coronary artery by compressing and "cracking" the atheroma. Used in patients with angina and as an intervention for ACS (acute coronary syndrome)
b (administer oxygen, morphine, and a bronchodilator for client comfort. A living will is a statement of a client's wishes in the event that a life-threatening illness or injury occurs. The client's comfort should be paramount and the nurse should respect his wishes. Morphine, oxygen, and bronchodilators can relieve dyspnea and make the client more comfortable, which will enable him to breathe more easily. The nurse shouldn't arrange for intubation without the client's consent or ask his family for permission to initiate mechanical ventilation.)
A client with stage IV heart failure has a living will indicating that he doesn't want to be placed on a ventilator. A nurse is caring for this client when he begins experiencing severe dyspnea. The nurse should: a) ask the client's family to consent to ventilator placement. b) administer oxygen, morphine, and a bronchodilator for client comfort. c) administer oxygen and hope the client will change his mind. d) call for respiratory therapy to intubate the client.
A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize?
A cuff that is too small will give a false high blood pressure.
Hypotension
A decrease in blood pressure to less than 100/60 mm Hg that compromises systemic perfusion.
b (10 minutes The survival rate decreases for every minute that defibrillation is delayed. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. The other options are too long of a time frame.)
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? a) 15 minutes b) 10 minutes c) 20 minutes d) 25 minutes
d (The force of the contraction related to the status of the myocardium)
A nurse is administering lanoxin, which she knows increases contractility as well as cardiac output. Contractility refers to which of the following? a) Fluid overload and tissue perfusion status b) The amount of blood presented to the ventricles just before systole c) The amount of resistance to the ejection of blood from the ventricles d) The force of the contraction related to the status of the myocardium
c (Slightly reduced )
A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level? a) Normal b) High c) Slightly reduced d) Severely reduced
a (Excess pericardial fluid compresses the heart and prevents adequate diastolic filling)
A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when a) Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. b) Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction. c) The pericardial space is eliminated with scar tissue and thickened pericardium. d) The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction.
b (Potassium level of 2.8 mEq/L)
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? a) Magnesium level of 2.5 mg/dl b) Potassium level of 2.8 mEq/L c) Sodium level of 152 mEq/L d) Calcium level of 7.5 mg/dl
Postural (orthostatic) hypotension
A significant drop in blood pressure (20 mm Hg systolic or more) after an upright posture is assumed.
Stress Test
A study to measure cardiac function as a client's heart is stressed to reach a target heart rate (THR)
Angina Pectoris
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow. Physical exertion or emotional stress increases myocardial oxygen demand and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand. May be described as tightness, choking, or a heavy sensation. Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left). Anxiety frequently accompanies the pain. Other symptoms may occur: dyspnea/shortness of breath, dizziness, nausea, and vomiting. The pain of typical angina subsides with rest or NTG. Unstable angina is characterized by increased frequency and severity and is not relieved by rest and NTG. Requires medical intervention! Angina pain varies from mild to severe
Cardiac stress test
A test used to evaluate the functioning of the heart during a period of increased oxygen demand; test may be initiated by exercise or medications.
d (An LVAD only supports a failing left ventricle. A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.)
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? a) It never needs batteries. b) It's designed for extremely active patients. c) It's specifically designed for long-term use. d) An LVAD only supports a failing left ventricle.
d (An LVAD only supports a failing left ventricle.)
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? a) It's specifically designed for long-term use. b) It never needs batteries. c) It's designed for extremely active patients. d) An LVAD only supports a failing left ventricle.
Nursing Process: The Care of the Patient with ACS - Assessment
A vital component of nursing care! Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications. Monitor ECG. Examine IV sites frequently
The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? A. "I can take nitroglycerin before sex so I won't develop chest pain". B. "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". C. "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension". D. "After taking two tablets with no relief, I should call EMS."
A. "I can take nitroglycerin before sex so I won't develop chest pain".
Baroreceptor's
Nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure.
Sinoatrial (SA) node
Primary pacemaker of the heart, located in the right atrium.
A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. A. Dilates blood vessels B. Relieves pain C. Decreases ischemia D. Decreases the urge to use tobacco E. Reduces myocardial oxygen consumption
A. Dilates blood vessels B. Relieves pain C. Decreases ischemia E. Reduces myocardial oxygen consumption Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco.
When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? A. Inadequate fluid volume B. Anuria C. Normal glomerular filtration D. Overhydration
A. Inadequate fluid volume Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric client does not produce urine.
An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply. A. Indigestion B. Chest pain C. Nausea D. Shortness of breath E. Anxiety
A. Indigestion C. Nausea Many women experiencing coronary events including--unstable angina, MIs, or sudden cardiac death events--are asymptomatic or present with atypical symptoms including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among clients of all ages and genders.
The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? A. Myoglobin B. Total creatinine kinase (CK) C. Troponin I and T D. Creatinine kinase-myocardial band (CK-MB)
A. Myoglobin Myoglobin is a heme protein that transports oxygen. Its levels can increase as early as 1 hour after an MI. Negative results are an excellent parameter for ruling out an acute MI. The other biomarker choices start to increase in 2 to 4 hours.
The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? A. Preload is reduced. B. More blood returns to the heart. C. It increases myocardial oxygen consumption. D. It functions has a vasoconstrictor.
A. Preload is reduced. Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain.
A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. What is the best response by the nurse? A. The nurse will ask the dietitian to talk with the client about modifying the diet. B. Cholesterol is within the recommended guidelines and the client doesn't need to lower it. C. Client should begin a running program, working up to 2 miles per day. D. Client should take statin medication and not worry about cholesterol.
A. The nurse will ask the dietitian to talk with the client about modifying the diet. A dietitian can help the client decrease the fat in the diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl. LDL should be less than 79 mg/dl, and HDL should be greater than 40 mg/dl. Although this client should take statin medication, the client should still be concerned about cholesterol levels and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase activity level, but doesn't need to run 2 miles per day.
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? A. Troponin B. Total creatine kinase C. CK-MB D. Myoglobin
A. Troponin Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
Which term refers to preinfarction angina? A. Unstable angina B. Variant angina C. Refractory angina D. Silent angina
A. Unstable angina Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.
The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. A. adequate cough and gag reflexes B. breathing without assistance of the ventilator C. acceptable arterial blood gas values D. labile vital signs E. inability to speak
A. adequate cough and gag reflexes B. breathing without assistance of the ventilator C. acceptable arterial blood gas values Before being extubated, the client should have cough and gag reflexes and stable vital signs; be able to lift the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable arterial blood gas levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: A. an expected part of the aging process. B. high level of blood fat. C. a condition in which the lumen of arteries fill with scar tissue. D. a vascular occlusive disease.
A. an expected part of the aging process Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Arteriosclerosis does not involve scar tissue formation. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes.
A client who had coronary artery bypass surgery is exhibiting signs of heart failure. What medications will the nurse anticipate administering for this client? Select all that apply. A. digoxin B. nitroprusside C. amlodipine D. diuretics E. inotropic agents
A. digoxin D. diuretics E. inotropic agents Medical management of cardiac failure includes digoxin, diuretics, and IV inotropic agents. Amlodipine and calcium channel blockers are not used due to systolic dysfunction. Nitroprusside is a vasodilator that is not used for heart failure.
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. enhance myocardial oxygenation B. decrease anxiety C. educate the client about his symptoms D. administer sublingual nitroglycerin
A. enhance myocardial oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care, neither is a priority when a client is compromised.
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with A. percutaneous coronary intervention (PCI). B. IV nitroglycerin. C. IV heparin. D. thrombolytics.
A. percutaneous coronary intervention (PCI). The client with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.
A client was transferring a load of firewood in the morning and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? A. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry B. morphine administration, stress testing, and admission to the cardiac care unit C. serial liver enzyme testing, telemetry, and a lidocaine infusion D. streptokinase, aspirin, and morphine administration
A. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.
Contractility
Ability of the cardiac muscle to shorten in response to an electrical impulse.
Opening snaps
Abnormal diastolic sound generated during opening of a rigid atrioventricular valve leaflet.
Summation Gallup
Abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia.
Systolic click
Abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricle contraction.
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority?
Acute pain Explanation: The nursing diagnosis of Acute pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. This makes Risk for imbalanced body temperature an incorrect answer. The client's blood pressure and heart rate don't suggest a nursing diagnosis of Decreased cardiac output. Anxiety could be an appropriate nursing diagnosis, but addressing Acute pain (the priority concern) may alleviate the client's anxiety.
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD?
An LVAD only supports a failing left ventricle. A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.
Myocardial Infarction
An area of the myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus. In unstable angina, the plaque ruptures but the artery is not completely occluded. Unstable angina and acute myocardial infarction are considered the same process but at different point on the continuum. The term acute coronary syndrome includes unstable angina and myocardial infarction.
Cardiac catheterization
An invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries.
Which aneurysm occurs as a result of infection at arterial suture or graft sites?
Anastomotic An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma
S3
And abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure.
To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the:
Anterior surface of the foot near the ankle joint.
Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent?
Antiplatelets Explanation: Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as Plavix or aspirin. Nitrates, beta blockers, and calcium channel blockers would not be used for this purpose.
The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities?
Apply a heating pad to the patient's abdomen. Nursing interventions may involve applications of warmth to promote arterial flow and instructions to the patient to avoid exposure to cold temperatures, which causes vasoconstriction. Adequate clothing and warm temperatures protect the patient from chilling. If chilling occurs, a warm bath or drink is helpful. A hot water bottle or heating pad may be applied to the patient's abdomen, causing vasodilation throughout the lower extremities.
A patient arrives at the ED with an exacerbation of left-sided heart failure and complains of shortness of breath. Which of the following is the priority nursing intervention?
Assess oxygen saturation leve Assessment is priority to determine severity of the exacerbation. It is important to assess the oxygen saturation level of a heart failure patient, as below normal oxygen saturation level can be life-threatening. Treatment options vary according to the severity of the patient's condition and may include supplemental oxygen, oral and IV medications, major lifestyle changes, implantation of cardiac devices, and surgical approaches.
You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult?
Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. Therefore, options A, B, and D are incorrect.
Which of the following is a key diagnostic laboratory test for heart failure?
B-type natriuretic peptide
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? A. "Only take one nitroglycerin tablet for each episode of angina." B. "See if rest relieves the chest pain before using the nitroglycerin." C. "Place the nitroglycerin tablet between cheek and gum." D. "Call 911 if you develop a headache following nitroglycerin use."
B. "See if rest relieves the chest pain before using the nitroglycerin." Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? A. Troponin level B. 12-lead ECG C. 2 L oxygen via nasal cannula D. Aspirin 325 mg orally
B. 12-lead ECG The nurse should complete the 12-lead ECG first. The priority is to determine whether the client is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.
The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) A. Aortic dissection B. Abrupt closure of the artery C. Nerve root pressure D. Arterial dissection E. Coronary artery vasospasm
B. Abrupt closure of the artery D. Arterial dissection E. Coronary artery vasospasm Complications that can occur during a PTCA procedure include coronary artery dissection, perforation, abrupt closure, or vasospasm. Additional complications include acute myocardial infarction, serious dysrhythmias (e.g., ventricular tachycardia), and cardiac arrest. Some of these complications may require emergency surgical treatment. Complications after the procedure may include abrupt closure of the coronary artery and a variety of vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion (Bhatty, Cooke, Shettey, et al., 2011).
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? A. Assess the client's level of anxiety and provide emotional support. B. Assess the client's level of pain and administer prescribed analgesics. C. Ensure that the client's family is kept informed of the client's status. D.Prepare the client for pulmonary artery catheterization.
B. Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.
A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? A. Pain score 5/10 B. Central venous pressure reading of 1 C. Heart rate 66 bpm D. Blood pressure 110/68 mm Hg
B. Central venous pressure reading of 1 The central venous pressure (CVP) reading of 1 is low (2-6 mm Hg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.
The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) A. It subsides after taking nitroglycerin. B. It is viselike and radiates to the shoulders and arms. C. It is sudden in onset and prolonged in duration. D. It is substernal in location. E. It is relieved by rest and inactivity.
B. It is viselike and radiates to the shoulders and arms. C. It is sudden in onset and prolonged in duration. D. It is substernal in location. Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? A. Store the drug in a cool, well-lit place. B. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. C. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. D. Restrict alcohol intake to two drinks per day.
B. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates act primarily to relax coronary smooth muscle and produce vasodilation. They can cause hypotension, which makes the client dizzy and weak. The nurse should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates are taken at the first sign of chest pain and before activities that might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three doses. If the pain persists, the client should seek medical assistance immediately. Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. Alcohol is prohibited because nitrates may enhance the effects of the alcohol.
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? A. Troponin I B. Myoglobin C. WBC (white blood cell) count D. C-reactive protein
B. Myoglobin Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.
A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A. Magnesium B. Potassium C. Sodium D. Calcium
B. Potassium Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.
After undergoing cardiac surgery, a client discovers a painless lump and reports this to the nurse. What is the most important nursing intervention for this client? A. Inform the client that the lump will be removed by the surgeon. B. Reassure the client by informing him or her that the lump will disappear with time. C. Reassure the client by informing him or her that the lump will disappear after a course of drug therapy. D. Reassure the client and direct the client to the health care provider.
B. Reassure the client by informing him or her that the lump will disappear with time. The nurse will reassure the client by informing him or her that the lump will disappear with time and will not require surgery, drug therapy, or a visit to the health care provider.
A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. A. Absent P-waves B. ST-segment elevations C. U-wave elevations D. Abnormal Q-waves E. T-wave hyperactivity and inversions
B. ST-segment elevations D. Abnormal Q-waves E. T-wave hyperactivity and inversions These three signs are classic ECG changes suggestive of a myocardial infarction. Changes can be diagnostic to the area of cellular damage. P wave and U wave changes are not characteristic of an MI.
A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? A. Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina B. Severe, incapacitating chest pain C. Predictable and consistent pain that occurs on exertion and is relieved by rest D. Pain that may occur at rest, but the threshold for pain is lower than expected
B. Severe, incapacitating chest pain
A client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6 °F (37.6 °C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. What assessment is the nurse's highest priority? A. cardiac output B. acute pain C. anxiety D. body temperature
B. acute pain The assessment of pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. The client's blood pressure and heart rate do not suggest adecreased cardiac output. Anxiety may be an important assessment, but addressing acute pain (the priority concern) may alleviate the client's anxiety.
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?
Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.
A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A. "Nitroglycerine causes headaches, but removing the patch decreases the incidence." B. "You do not need the effects of nitroglycerine while you sleep." C. "Removing the patch at night prevents drug tolerance while keeping the benefits." D. "Contact dermatitis and skin irritations are common when the patch remains on all day."
C. "Removing the patch at night prevents drug tolerance while keeping the benefits." Tolerance to antiangina effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerin are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while the client rests, there is less demand on the heart but not the primary reason for removing the patch.
A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate? A. "Would you like something to calm your nerves?" B. "Don't cry; you have the best team of doctors." C. "Tell me what concerns you most." D. "Everything will be fine. Your family is here for you."
C. "Tell me what concerns you most." Allowing the client to share feelings tends to relieve or reduce emotional distress. Telling a client that everything is fine negates the feelings they are expressing. Telling a client not to cry can be viewed as insensitive to the feelings being expressed. Providing a prescribed sedative may be helpful but does not address the fears and concerns of the client.
A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? A. 5 minutes B. 20 minutes C. 10 minutes D. 15 minutes
C. 10 minutes The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a client reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored.
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? A. 100 seconds or less. B. 125 seconds or less. C. 50 seconds or less. D. 75 seconds or less.
C. 50 seconds or less. Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.
The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? A. Encourage use of a multivitamin B. Avoid use of caffeine C. Addressing obesity D. Drink at least 2 liters of water a day
C. Addressing obesity Published information by Balistreri et al. (2010) indicated a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests decreasing obesity and body fat stores may help to reduce the risk. Avoiding the use of caffeine, encouraging the use of a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to artherosclerosis.
The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? A. Report changes in the usual pattern of chest pain. B. Avoid fatty foods and exercise. C. Avoid situations that contribute to ischemic episodes. D. Take over-the-counter decongestants
C. Avoid situations that contribute to ischemic episodes. Teaching for clients with Raynaud's disease and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? A. Suction the airway. B. Prepare to administer intravenous fluids. C. Check blood pressure. D. Assess pupils for reactiveness.
C. Check blood pressure. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? A. Raynaud's disease B. Cardiogenic shock C. Coronary artery disease D. Venous occlusive disease
C. Coronary artery disease The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A clientt is given a prescription for metoprolol after being examined by the health care provider. What is the most important teaching for the nurse to give to the client? A. If dizziness occurs, adjust the medication. B. Take the medication at the same time each day. C. Don't suddenly stop taking the medication without calling your health care provider. D. Dress warmly. Blood circulation may be reduced in the extremities.
C. Don't suddenly stop taking the medication without calling your health care provider. All teaching points need to be covered, but the nurse needs to emphasize that metoprolol should not be suddenly stopped because some conditions can become worse.
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance? A. Hypokalemia B. Hyperkalemia C. Hypermagnesemia D. Hypomagnesemia
C. Hypermagnesemia Untreated hypomagnesemia may result in coma, apnea, and cardiac arrest. Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves). Signs of hyperkalemia include mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval). Signs and symptoms of hypomagnesemia include paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension.
The nurse notes that the post cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order? A. Decrease intravenous fluids B. Prepare the client for diaylsis C. Increase intravenous fluids D. Irrigate the urinary catheter
C. Increase intravenous fluids Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. The heallthcare provider may increase intravenous fluids. Irrigating the urinary catheter will be done if there is a suspected blockage. Dialysis is not indicated by urinary volumes.
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? A. Clopidogrel B. Aspirin C. Protamine sulfate D. Alteplase
C. Protamine sulfate Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin). Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.
Following cardiac surgery, the nurse assesses the client for any common complication of hypovolemia. What significant indication of a complication should the nurse monitor? A. Central venous pressure (CVP) reading of 8 mm Hg B. Heart rate of 60 bpm C. Pulmonary artery wedge pressure (PAWP) of 6 mm Hg D. Blood pressure reading of 130/95 mm Hg
C. Pulmonary artery wedge pressure (PAWP) of 6 mm Hg In the presence of hypovolemia, the circulating blood volume would be significantly decreased. Therefore, the PAWP would be lower than 8 to 10 mm Hg. The normal CVP reading (2 to 8 mm Hg) would be decreased. The heart rate would be increased and the blood pressure decreased.
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates A. an evolving MI. B. variant angina. C. an old MI. D. a cardiac dysrhythmia.
C. an old MI. An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.
A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client? A. cardiac catheterization B. cardiac graft procedure C. balloon valvuloplasty D. balloon angioplasty
C. balloon valvuloplasty Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for symptomatic aortic stenosis.
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? A. chest pain of increased frequency, severity, and duration B. radiating chest pain that lasts 15 minutes or less C. chest pain that occurs at rest and usually in the middle of the night D. prolonged chest pain that accompanies exercise
C. chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.
The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? A. cerebral bleeding B. skeletal muscle damage due to a recent fall C. myocardial necrosis D. I.M. injection
C. myocardial necrosis An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? A. weight gain of 6 ounces B. bilateral rales and rhonchi C. potassium level of 6 mEq/L D. serum glucose of 124 mg/dL
C. potassium level of 6 mEq/L Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed.
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? A. shellfish allergy B. recent consumption of a meal C. prior intracranial hemorrhage D. use of heparin
C. prior intracranial hemorrhage History of a prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy. An allergy to iodine, shellfish, radiographic dye, and latex are of primary concern before a cardiac catheterization but not a known contraindication for thrombolytic therapy. Administration of a thrombolytic agent with heparin increases risk of bleeding; the primary healthcare provider usually discontinues the heparin until thrombolytic treatment is completed.
A client has a blockage in the proximal portion of a coronary artery and decides to undergo percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse expect to administer during the procedure? A. metoprolol B. hydrochlorothiazide C. ticagrelor D. ceftriaxone
C. ticagrelor During PTCA, the client receives heparin, an anticoagulant (ticagrelor), as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses do not routinely give antibiotics such as ceftriaxone during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive like metoprolol and a diuretic like hydrochlorothiazide may cause hypotension, which should be avoided during the procedure.
What causes inadequate blood supply that deprives the cardiac muscles cells of oxygen needed for their survival?
CAD causes. the condition is ischemia
Ronald is a 46-year-old who has developed congestive heart failure. He has to learn to adapt his diet and you are his initial counselor. Which of the following should you tell him to avoid?
Canned peas There are a wide variety of foods that Ronald can still eat. The key is they have to have low-salt content. Canned vegetables are usually very high in salt or sodium, unless they have labels such as low-salt or sodium free or salt free. The key is to read the food labels and look for foods that contain <300 mg sodium/serving.
d (Inadequate tissue perfusion The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion.)
Cardiogenic shock is pump failure that primarily occurs because of which of the following? a) Coronary artery stenosis b) Right atrial flutter c) Myocardial ischemia d) Inadequate tissue perfusion
The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce?
Changing positions slowly related to possible hypotension
Clinical Manifestations and Diagnosis
Chest pain, other symptoms ECG Laboratory testsbiomarkers 1) CK-MB 2) Myoglobin 3) Troponin T or I
The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)?
Congestion in the peripheral tissues
A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?
Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?
Continuous IV infusion
The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is which of the following?
Contrast phlebography Also known as venography, contrast phlebography involves injecting a radiopaque contrast agent into the venous system. If a thrombus exists, the x-ray image reveals an unfilled segment of vein in an otherwise completely filled vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In a lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A. "The pain got worse when I took a deep breath." B. "The pain resolved after I ate a sandwich." C. "The pain lasted about 45 minutes." D. "The pain occurred while I was mowing the lawn."
D. "The pain occurred while I was mowing the lawn." Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain.
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? A. 60 minutes B. 15 minutes C. 30 minutes D. 3 minutes
D. 3 minutes Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch) and ideally alleviates the pain of ischemia within 3 minutes.
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A. Minimal oozing of blood from the IV site B. Presence of reperfusion dysrhythmias C. Chest pain 2 of 10 (on a 1-to-10 pain scale) D. Altered level of consciousness
D. Altered level of consciousness A client receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding, and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low and indicates the client's chest pain is subsiding, an expected outcome of this therapy.
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A. Blood vessels B. Bronchi C. Uterus D. Heart
D. Heart Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
Which of the following is inconsistent as a condition related to metabolic syndrome? A. Dyslipidemia B. Insulin resistance C. Abdominal obesity D. Hypotension
D. Hypotension A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.
A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? A. Urinary incontinence B. Hyperactive bowel sounds C. Hypertension D. Hypotension
D. Hypotension The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A. Isosorbide mononitrate (Isordil) B. Nitroglycerin transdermal patch C. Meperidine hydrochloride (Demerol) D. Morphine sulfate (Morphine)
D. Morphine sulfate (Morphine) Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A. To dilate coronary arteries B. To decrease homocysteine levels C. To prevent angiotensin II conversion D. To decrease workload of the heart
D. To decrease workload of the heart Beta-adrenergic blockers are used in the treatment of CAD to decrease the myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and Bvitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A. Remove hair from skin insertion sites. B. Inform client of diagnostic tests. C. Assess distal pulses. D. Withhold anticoagulant therapy.
D. Withhold anticoagulant therapy. The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? A. penicillin V or erythromycin. B. pentoxifylline or acetaminophen. C. aspirin or acetaminophen. D. aspirin or clopidogrel.
D. aspirin or clopidogrel. After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available? A. protamine sulfate B. adenosine C. heparin D. atropine sulfate
D. atropine sulfate Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine sulfate on hand to increase the client's heart rate if this occurs. Heparin changes clotting of blood; clients should stop taking it before the sheath removal. Protamine sulfate is an antidote to heparin, but the nurse shouldn't administer it during sheath removal. Adenosine treats tachydysrhythmias.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: A. low LDL level. B. normal LDL level. C. fasting LDL level. D. high LDL level.
D. high LDL level. LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is A. extremely high. B. low. C. normal. D. high.
D. high. If the LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered to be high. The goal is to decrease the LDL level below 100 mg/dL.
A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? A. hyperglycemia B. severe muscle pain C. hyperuricemia D. increased liver enzymes
D. increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statin Lipitor. Hyperuricemia occurs when too much uric acid is present in the blood; it is not a side effect of the statins. Hyperglycemia is increased blood glucose, which is not a side effect of the statins. Severe muscle pain is an adverse effect of statins, but it does not require monitoring.
What is the primary underlying disorder of pulmonary edema?
Decreased left ventricular pumping
As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client?
Demonstrate how to apply and remove elastic support stockings.
As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client?
Demonstrate how to apply and remove elastic support stockings. The nurse demonstrates how to apply and remove elastic support stockings. Varicose veins do not require the nurse to demonstrate how to self-administer IV infusions. Varicose veins require the client to elevate legs regularly and perform leg exercises. However, it does not involve bleeding or skin lesions.
Which of the following are characteristics of arterial insufficiency?
Diminished or absent pulses
Which of the following are characteristics of arterial insufficiency?
Diminished or absent pulses A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses
The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics?
Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.
You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for?
Dizziness
A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?
Dorsiflex the foot while the leg is elevated to check for calf pain.
A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?
Dorsiflex the foot while the leg is elevated to check for calf pain. Homan's sign is indicated by pain in the calf after the foot is sharply dorsiflexed.
A nurse educator is providing information about hypertension to a small group of clients. A participant asks what she can do to decrease her blood pressure and thus her risk for heart problems. The nurse describes modifiable and nonmodifiable risk factors. Which of the following risk factors can the client modify?
Dyslipidemia
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session?
Engage in aerobic activity at least 30 minutes/day most days of the week.
A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best?
Green pepper stuffed with diced tomatoes and chicken
Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed?
Heart failure Heart transplantation involves replacing a person's diseased heart with a donor heart. This is an option for advanced HF patients when all other therapies have failed. A ventricular access device, ICD, and cardiac resynchronization therapy would be tried prior to a heart transplant.
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
Leg edema
The nurse is preparing to administer hydralazine and isosorbide dinitrate (Dilatrate). When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?
Hold the medication and call the physician A combination of hydralazine and isosorbide dinitrate may be another alternative for patients who cannot take ACE inhibitors (ICSI, 2011). Nitrates (e.g., isosorbide dinitrate) cause venous dilation, which reduces the amount of blood return to the heart and lowers preload. Hydralazine lowers systemic vascular resistance and left ventricular afterload. If these medications lead to severe hypotension, the nurse should hold the medication and call the physician.
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?
Hyperkalemia
Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency
Which of the following would be inconsistent as a component of metabolic syndrome?
Hypotension
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest?
IV
The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin?
In 3 to 5 days
The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin?
In 3 to 5 days Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).
c (Leg edema)
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? a) Productive cough b) Cyanosis of the lips c) Leg edema d) Bilateral crackles
Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?
Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.
Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause?
Increased ability to exert diastolic pressure
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time?
Ineffective peripheral tissue perfusion related to venous congestion Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.
Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity?
Intermittent claudication The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.
Which of the following would be inconsistent with a hypertensive urgency?
Intracranial hemorrhage
A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize?
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.
A nurse is assessing a patient with congestive heart failure for jugular vein distension (JVD). Which of the following observations is important to report to the physician?
JVD is noted 3 cm above the sternal angle. JVD is assessed with the patient sitting at a 45° angle. Jugular vein distention greater than 3 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure.
The nurse identifies which of the following symptoms as a characteristic of right-sided heart failure?
Jugular vein distention (JVD)
A new client has been admitted with right-sided heart failure. The nurse knows to look for which of the following assessment findings when assessing this client?
Jugular venous distention
Which of the following is the hallmark of systolic heart failure?
Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the patient's symptoms.
A nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?
Low serum potassium level
The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest?
Lowering the limb so that it is dependent Persistent pain in the forefoot (i.e., the anterior portion of the foot) when the patient is resting indicates a severe degree of arterial insufficiency and a critical state of ischemia. Known as rest pain, this discomfort is often worse at night and may interfere with sleep. This pain frequently requires that the extremity be lowered to a dependent position to improve perfusion to the distal tissues.
A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover?
Maintaining a low-sodium diet
Which of the following techniques is used to surgically revascularize the myocardium?
Minimally invasive direct coronary bypass Explanation: There are several techniques used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the patient is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.
A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following?
Moderate to severe arterial insufficiency
Myocardium
Muscle layer of the heart responsible for the pumping action of the heart.
Medications
Nitroglycerin Beta-adrenergic blocking agents Calcium channel blocking agents Antiplatelet and anticoagulant medications Aspirin Clopidogrel and ticlopidine Heparin Glycoprotein IIB/IIIa agents Nitroglycerin dilates EVERYTHING. Side effect is syncopy and headache. The dilation increases the pressure in the head. Can give it IV, sublingual and transdermal. Make sure somebody is not taking sex drugs, because those also vasodilate. Women take Cialis too..for some off reason Beta blockers decrease the HR. Same with CA channel blockers
A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?
Noncompliance (nonadherence to therapeutic regimen)
A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment?
Numbness, cool skin temperature, and pallor Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include normal sensation and warm skin with normal return of skin color after blanching.
Patient with angina pectoris - assessment
Pain, quality, radiating, severity time (PQRST) What makes it better, what makes it worse, has this happened to you before
A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities?
Participate in a regular walking program.
Systole
Period of ventricle or contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta.
A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess?
Peripheral pulses every 15 minutes following surgery
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?
Potassium level of 2.8 mEq/L
The nurse is preparing to administer furosemide (Lasix) to a client with severe heart failure. What lab study should be of most concern for this client while taking Lasix?
Potassium level of 3.1
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description?
Protamine sulfate
A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs?
Prothrombin time (PT)
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client?
Pulmonary congestion
A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms?
Raynaud's disease
A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important?
Recent pelvic surgery The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.
Systemic vascular resistance
Resistance to blood flow out of the left ventricle created by the systemic circulatory system.
The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock?
Restlessness and confusion Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).
Repolarization
Return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell.
A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure?
Right-sided heart failure
Which of the following is the most effective intervention for preventing progression of vascular disease?
Risk factor modification
Which of the following statements is accurate regarding Reynaud's disease?
Risk factor modification
Hypertension that can be attributed to an underlying cause is termed which of the following?
Secondary
A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include?
Seven to eight whole grain products per day
A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client?
Stop smoking.
During the physical assessment of a client with hypertension, what would you expect to be the most obvious finding?
Sustained increase of either one or both systolic or diastolic measurements.
Clinical Manifestations
Symptoms are due to myocardial ischemia Symptoms and complications are related to the location and degree of vessel obstruction Angina pectoris - Chest pain that is brought about by myocardial ischemia. The most common manifestation of myocardial ischemia. Myocardial infarction Heart failure Sudden cardiac death The most common symptom of myocardial ischemia is chest pain;however, some individuals may be asymptomatic or have atypical symptoms such as weakness, dyspnea, and nausea. Atypical symptoms are more common in women and in persons who are older, or who have a history of heart failure or diabetes.
A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details?
The client can walk about 50 feet before getting pain in the right lower leg Intermittent claudication is caused by the inability of the arterial system to provide adequate blood flow to the tissues when increased demands are made for oxygen and nutrients during exercise. Pain is then experienced. When the client rests and decreases demands, the pain subsides. The client can then walk the same distance and repeat the process.
Following abdominal surgery, which factor predisposes a client to deep vein thrombosis?
The client will be immobile during and shortly after surgery.
c (Pitting edema The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response.)
The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following? a) Decreased O2 saturation levels b) Oliguria c) Pitting edema d) S3 ventricular gallop sign
b (Dyspnea on exertion)
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? a) Hypotension b) Dyspnea on exertion c) Tachycardia d) Decreased urinary output
d (Potassium level of 3.1)
The nurse is preparing to administer furosemide (Lasix) to a client with severe heart failure. What lab study should be of most concern for this client while taking Lasix? a) Sodium level of 135 b) BNP of 100 c) Hemoglobin of 12 d) Potassium level of 3.1
c (Restlessness and confusion Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).)
The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) Hyperactive bowel sounds b) High blood pressure c) Restlessness and confusion d) Increased urinary output
a (Restlessness and confusion)
The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) Restlessness and confusion b) Increased urinary output c) High blood pressure d) Hyperactive bowel sounds
A patient is receiving enoxaparin (Lovenox) and warfarin (Coumadin) therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin (Lovenox) can be discontinued?
The patient's international normalized ratio (INR) is 2.5. Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)
Telemetry
The process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the patient.
The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way?
The results will be falsely elevated.
Treatment and Patient Teaching of Angina Pain
Treatment of angina pain is a priority nursing concern. Patient is to stop all activity and sit or rest in bed. Assess the patient while performing other necessary interventions. Assessment includes VS, and observation for respiratory distress, and assessment of pain. In the hospital setting, the ECG is assessed or obtained. Administer oxygen. Administer medications as ordered or by protocol, usually NTG. Anxiety: 1) Use a calm manner 2) Stress-reduction techniques 3) Patient teaching 4) Addressing patient spiritual needs may assist in allaying anxieties 5) Address both patient and family needs Lifestyle changes and reduction of risk factors Explore, recognize, and adapt behaviors to avoid to reduce the incidence of episodes of ischemia Teaching regarding disease process Medications Stress reduction When to seek emergency care They should know WHEN to seek emergency care. If the chest pain is different than normal and not going away with 1 nitro If stable angina, want to discuss lifestyle change and adherence Complaint of chest pain get some nitro and EKG ready. Chest pain is indicative of tissue not getting what they need. Always throw oxygen on the patient too
The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for?
Ulceration
The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following?
Vasospasm Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke or chew tobacco must be fully informed of the effects of nicotine on circulation and be encouraged to stop.
A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect?
Venous insufficiency Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.
a (Decrease in renal perfusion)
Which of the following body system responses correlates with systolic heart failure (HF)? a) Decrease in renal perfusion b) Increased blood volume ejected from ventricle c) Vasodilation of skin d) Dehydration
d (Fatigue)
Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure? a) Pedal edema b) Nocturia c) Irregular pulse d) Fatigue
c (Heart transplant)
Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed? a) Cardiac resynchronization therapy b) Ventricular access device c) Heart transplant d) Implantable cardiac defibrillator (ICD)
During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect:
a drop in the client's heart rate. Explanation: During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes
a vasospasm.
10. The scientific rationale supporting the administration of beta-adrenergic blockers is the drugs' ability to: a. block sympathetic impulses to the heart. b. elevate blood pressure. c. increase myocardial contractility. d. induce bradycardia.
a. block sympathetic impulses to the heart.
The nurse is assessing the client newly prescribed Lasix 20mg daily for 3+ pitting edema. To evaluate the effectiveness of diuretic therapy, which of the following would be documented? a) Edema b) Blood pressure c) Urine output d) Weight
a) Edema The best method to evaluate the effectiveness of diuretic therapy is to note a decrease in edema. Weight, blood pressure, and urine output all are affected by diuretic therapy, but the therapeutic goal is to decrease the edema.
Identify which of the following as an age-related change associated with conduction system of the heart? a) Heart block b) Murmur c) Thrills d) Tachycardia
a) Heart block Age-related changes to the conduction system may include bradycardia and heart block. Age-related changes to the heart valves include the presence of a murmur or thrill.
Contractility
ability of the cardiac muscle to shorten in response to an electrical impulse
Automaticity
ability to initiate an electrical impulse
Excitability
ability to respond to an electrical impulse
What are collaborative problems of MI?
acute pulmonary edema, heart failure, cardiogenic shock, dysrhythmias and cardiac arrest, pericardial effusion and cardiac tamponade
When assessing a client with left-sided heart failure, the nurse expects to note:
air hunger. With left-sided heart failure, the client typically has air hunger and other signs of pulmonary congestion. Ascites, jugular vein distention, and pitting edema of the legs are signs of right-sided heart failure.
Stroke volume(SV)
amount of blood ejected with each heartbeat
Cardiac output (CO)
amount of blood pumped by ventricle in liters per minute.
10. The key, diagnostic indicator for myocardial infarction seen on an electrocardiogram is: ________________________.
an elevated ST segment in two contiguous leads
What is a priority nursing concern?
angina pain
What is the pain that is brought about by myocardial infarction?
angina pectoris
What prevents platelets from sticking together?
antiplatelet meds
Semilunar valves
aortic and pulmonic
What is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen?
athersclerosis
The nurse practitioner inspects the patient's skin during a physical examination. She is looking for any abnormalities, especially skin findings associated with cardiovascular disease. The nurse notes a bluish tinge in the buccal mucosa and the tongue. She knows this is probably due to: a) Intermittent arteriolar vasoconstriction. b) Congenital heart disease. c) Peripheral vasoconstriction. d) Blood leaking outside the blood vessels.
b) Congenital heart disease. Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and cardiogenic shock, this sign is indicative of congenital heart disease. Refer to Table 12-3 in the text.
2. Lumen narrowing with atherosclerosis is caused by: a. atheroma formation on the intima. b. scarred endothelium. c. thrombus formation. d. all of the above.
b. scarred endothelium.
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? a) Lanoxin b) Dobutrex c) Lopressor d) Intropin
c) Lopressor Contractility is depressed by beta-adrenergic blocking medications. The other choices all enhance contractility.
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: a) Quiet but readily heard. b) Easily heard with no palpable thrill. c) Loud and may be associated with a thrill sound similar to (a purring cat). d) Very loud; can be heard with the stethoscope half-way off the chest.
c) Loud and may be associated with a thrill sound similar to (a purring cat). Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.
A nurse is caring for a dying client following myocardial infarction. The client is experiencing apnea with a falling blood pressure of 60 per palpation. Which documentation of pulse quality does the nurse anticipate? a) A pulse deficit b) Weak pulse c) Thready pulse d) Bounding pulse
c) Thready pulse The nurse is most correct to anticipate a thready (barely palpable) pulse quality. A bounding pulse indicates a strong cardiac output. A weak pulse indicates a lower pulse quality. A pulse deficit occurs when the pulses between the apex of the heart differs from the radial pulse.
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? a) CK-MB b) Brain natriuretic peptide (BNP) c) Troponin T and I d) Myoglobin
c) Troponin T and I After myocardial injury, these biomarkers rise early (within 3 to 4 hours), peak in 4 to 24 hours, and remain elevated for 1 to 3 weeks. These early and prolonged elevations may make very early diagnosis of acute myocardial infarction (MI) possible and allow for late diagnosis in patients who have delayed seeking care for several days after the onset of acute MI symptoms. CK-MB returns to normal within 3 to 4 days. Myoglobin returns to normal within 24 hours. BNP is not considered a cardiac biomarker. It is a neurohormone that responds to volume overload in the heart by acting as a diuretic and vasodilator.
18. The most common vasodilator used to treat myocardial pain is: a. amyl nitrite. b. Inderal. c. nitroglycerine. d. Pavabid HCl.
c. nitroglycerine.
1. The leading cause of death in the United States for men and women of all ethnic and racial groups is: __________________________________.
cardiovascular disease
What is the leading cause of death in the US for women and men of all racial and ethnic groups?
cardiovascular disease
The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "The first test I am getting is an echocardiography. I am glad that it is not painful." b) "I had an ECG already. It provided information on my heart rhythm. c) "I am able to have a nuclide study because I do not have any allergies." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."
d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker." A magnetic resonance imaging (MRI) test is prohibited on clients with various metal devices within their body. External metal objects must be removed. All other options are correct statements not needing clarification.
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? a) Bok choy, cooked leeks, alfalfa sprouts b) Cranberries, apples, popcorn c) Asparagus, blueberries, green beans d) Apricots, dried peas and beans, dates
d) Apricots, dried peas and beans, dates Apricots, dried peas and beans, dates, and kiwi contain high amounts of potassium. The other foods listed contain minimal amounts.
The health care provider documents that the patient's pulse quality is a +1 on a scale of 0 to 4. The nurse knows that this describes a pulse that is: a) Full, easy to palpate, and cannot be obliterated. b) Diminished, but cannot be obliterated. c) Strong and bounding and may be abnormal. d) Difficult to palpate and is obliterated with pressure.
d) Difficult to palpate and is obliterated with pressure. The quality of pulses is reported using descriptors and a scale of 0 to 4. The lower the number, the weaker the pulse and the easier it is to obliterate it. A +1 pulse is weak and thready and easily obliterated with pressure.
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? a) Thallium b) Ativan c) Diazepam d) Dobutamine
d) Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.
Which of the following is an early warning symptom of acute coronary syndrome (ACS) and heart failure (HF)? a) Hypotension b) Change in level of consciousness c) Weight gain d) Fatigue
d) Fatigue Fatigue is an early warning symptom of ACS, heart failure, and valvular disease. Other signs and symptoms of cardiovascular disease are hypotension, change in level of consciousness, and weight gain.
5. Hypertension is repeated blood pressure measurements exceeding: a. 110/80 mm Hg. b. 120/80 mm Hg. c. 130/90 mm Hg. d. 140/90 mm Hg.
d. 140/90 mm Hg.
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:
forcing blood into the deep venous system.
A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience:
headache, hypotension, dizziness, and flushing. Explanation: Headache, hypotension, dizziness, and flushing are classic adverse effects of nitroglycerin, a vasodilator. Vasodilators, beta-adrenergic blockers, and calcium channel blockers are three major classes of drugs used to treat angina pectoris. Nausea, vomiting, depression, fatigue, and impotence are adverse effects of propranolol, a beta-adrenergic blocker. Sedation, nausea, vomiting, constipation, and respiratory depression are common adverse effects of morphine, an opioid analgesic that relieves pain associated with acute myocardial infarction. Flushing, dizziness, headache, and pedal edema are common adverse effects of nifedipine, a calcium channel blocker.
It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine
increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.
What happens to CK-MB during an MI?
increases within a few hrs and peaks within 24 hrs
What are nursing diagnoses for angina pectoris?
ineffective cardiac tissue perfusion, death anxiety,m deficient knowledge, noncompliance (ineffective management)
What are nursing diagnoses for MI?
ineffective cardiac tissue perfusion, risk for fluid imbalance, risk for ineffective tissue perfusion, death anxiety, deficient knowledge
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time?
ineffective peripheral tissue perfusion related to venous congestion
Endocardium
inner layer; consists of endothelial tissue and lines the inside of the heart and valves
6. A positive diagnosis of metabolic syndrome occurs when three of the following six conditions are met: ____________________________ ______________________________ ____________________________ ______________________________ ____________________________ ______________________________
insulin resistance, central obesity, dyslipidemia, hypertension (130/85 mm Hg), increased levels of C-reactive protein (proinflammation), and elevated fibrinogen levels (prothrombotic)
A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should:
keep the affected leg level or slightly dependent.
A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should:
keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.
Mitrial (bicuspid) valve (atrioventricular)
lies between the left atrium and left ventricle
AV node
light switch, usually a delay from SA node triggers, the AV node holds off to beep rest of heart
Myocardium
middle layer; made up of muscle fibers and is responsible for the pumping action
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:
myocardial necrosis. Explanation: An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
What are medications used to treat angina?
nitro, beta blockers, calcium channel blockers, antiplatelets, anticoagulants
When the nurse observes that the patient has increased difficulty breathing when lying flat, the nurse records that the patient is demonstrating
orthopnea.
Heart valves
permit blood to flow in only one direction; composed of thin leaflets of fibrous tissue; they open and close in response to the movement of blood and pressure changes within the chambers; two types - AV and semilunar
What increases myocardial oxygen demand?
physical exertion and emotional stress increase
SA node
primary pacemaker; located at the junction of the superior vena cava and the right atrium
AV valves
separate the atria from the ventricles; tricuspid and mitral valve
Tricuspid valve (atrioventricular)
separates the right atrium and the right ventricle
What is the most notable risk factor for angina?
weight loss (oxygen will go to the muscle instead of the fat)
Activity & Exercise
-Intensity, frequency, and duration of exercise -Tolerance -Changes in activity in past 6-12 months -Barriers
Lipid profile
-LDL < 160 mg/dL -HDL > 35 mg/dL -Total Cholesterol < 200 mg/dL -Triglycerides 100-200 mg/dL
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement?
"I sleep on three pillows each night." Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.
General Appearance
-Level of consciousness -Size of patient -Height, Weight, BMI -Waist circumference
Arterial Pulses
-Locations -Rate -Rhythm -Quality
The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation?
"Walk to the point of pain, rest until the pain subsides, then resume ambulation."
The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation?
"Walk to the point of pain, rest until the pain subsides, then resume ambulation." The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.
During a routine physical examination, the nurse assesses a blood pressure reading of 150/90 mm Hg. The patient's blood work indicates several abnormal results. The health care provider informs the nurse that he suspects that the patient has metabolic syndrome. The nurse knows that this diagnosis is associated with three classic signs/symptoms. Select all that apply.
-A blood pressure reading greater than 130/85 mm Hg -Dyslipidemia and/or abdominal obesity -Insulin resistance
Continuous EKG Monitoring
-Alarms set -Print out available -Telemetry -Holter monitors
The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)
-Heart rate -Heart rhythm -Character of apical and peripheral pulses
Lung Assessment
-Hemoptysis -Cough -Crackles -Wheezes
Health History
-How does the patient perceive his/her cardiovascular health? -Can he recognize cardiac s/s that need immediate care and obtain such care?
Family History of Cardiovascular Disease
-Immediate family members diagnosed? --Parents --Siblings --Children -At what age? --Before age 55 (males)? --Before age 65 (females)? -Sudden death of any family member? --Age --Diagnosis
Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply.
-Impairing the synthesis of norepinephrine. -Modifying the rate of myocardial contraction. -Decreasing renal absorption of sodium.
Control of stroke volume
-Preload: Frank-Starling Law -Afterload: affected by systemic vascular resistance, pulmonary vascular resistance
Roles and Relationships
-Primary caregiver -Support person / significant other -Change in family role -Insurance / services
Blood Pressure
-Pulse pressure -Postural B/P changes --Supine --Sitting --Standing
Sleep Habits
-Recent changes -Sleeping position -Awakening with chest pain or dyspnea
Psychosocial Considerations
-Roles and Relationships -Sexuality and Reproduction -Stress Management / Coping Mechanisms
Stress Management / Coping Mechanisms
-Stressors -Coping mechanisms -Indicators of depression -Consultations
Computed Tomography (CT) or Computerized Axial Tomography (CAT) scan
-Uses x-ray (with or without IV iodinated contrast medium) -Produces cross-sectional 3-D images of chest (heart & vessels) -Provides information about cardiac chambers and pulmonary vessels as well as coronary artery status
A client is receiving furosemide (Lasix), a loop diuretic, to prevent fluid overload. The order is for 50 mg intraveneous now. The pharmacy supplies Lasix 80 mg per 2 mL. How many mL will the nurse give the client? Enter the correct number ONLY.
1.25
When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of:
1.5 to 2.5 times the baseline control.
When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of:
1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero?
10 minutes
d (Check the client's potassium level. The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the physician. Because the client is taking furosemide (Lasix), a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the physician with a more complete database. The physician will need to be notified after the nurse checks the latest potassium level. Calling the nurse-manager is not indicated at this time. Administering potassium requires a physician's order.)
A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next? a) Summon the nurse-manager. b) Administer potassium. c) Call the physician. d) Check the client's potassium level.
d (Echocardiogram)
A client has been symptomatic for several months and is seeing a cardiologist for diagnostics to determine the cause of his cardiac symptoms. You review the diagnostic procedures the cardiologist will perform. How will the client's ejection fraction be measured? a) Cardiac ultrasound b) Cardiac catheterization c) Electrocardiogram d) Echocardiogram
d (It reduces ventricular ejection volume.)
A client in the hospital informs the nurse he ?"feels like his heart is racing and can''t catch his breath." ?What does the nurse understand occurs as a result of a tachydysrhythmia? a) It increases preload. b) It increases afterload. c) It causes a loss of elasticity in the myocardium. d) It reduces ventricular ejection volume.
a (Pulmonary congestion)
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client? a) Pulmonary congestion b) Jugular venous distention c) Nausea d) Pedal edema
c (Ventricularassistdevice (VAD) VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transport, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.)
A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? a) Implanted cardioverter-defibrillator (ICD) b) Pacemaker c) Ventricularassistdevice (VAD) d) Intra-aortic balloon pump (IABP)
c (peripheral edema)
A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: a) postural hypotension. b) dry cough. c) peripheral edema. d) skin rash.
c (peripheral edema. Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.)
A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: a) postural hypotension. b) skin rash. c) peripheral edema. d) dry cough.
a (Bibasilar crackles Bibasilar crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload and indicate left-sided heart failure. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.)
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Bibasilar crackles b) Dependent edema c) Jugular vein distention d) Right upper quadrant pain
a (Bibasilar crackles)
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Bibasilar crackles b) Right upper quadrant pain c) Dependent edema d) Jugular vein distention
b (Bibasilar crackles)
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Dependent edema b) Bibasilar crackles c) Right upper quadrant pain d) Jugular vein distention
b (Class I (Mild) Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.)
A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? a) Class IV (Severe) b) Class I (Mild) c) Class II (Mild) d) Class III (Moderate)
b (weight. Heart failure typically causes fluid overload, resulting in weight gain. Therefore, weight is the best indicator of this client's status. One pound gained or lost is equivalent to 500 ml. Fluid intake and output and vital signs are less accurate indicators than weight. Urine specific gravity reflects urine concentration, indicating overhydration or dehydration. Numerous factors can influence urine specific gravity, so it isn't the most accurate indicator of the client's status.)
A client with heart failure must be monitored closely after starting diuretic therapy. The best indicator for the nurse to monitor is: a) urine specific gravity. b) weight. c) vital signs. d) fluid intake and output.
b (Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. To determine pulsus paradoxus, the nurse should measure blood pressure in either arm as the client slowly exhales and then as the client breathes normally. Unless the client has cardiac tamponade, the two measurements are usually less than 10 points apart.)
A nurse is assessing a client with suspected cardiac tamponade. How should the nurse assess the client for pulsus paradoxus? a) Measure the blood pressure in right arm as the client inhales slowly, then measure the blood pressure in the left arm as the client exhales slowly. b) Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. c) Measure blood pressure in the right arm, then in the left arm as the client slows the pace of his inhalations and exhalations. d) Measure blood pressure in either arm with the client holding his breath, then with the client breathing normally.
c (Decompensated heart failure with pulmonary edema)
A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems? a) Bilateral pneumonia b) Acute exacerbation of chronic obstructive pulmonary disease c) Decompensated heart failure with pulmonary edema d) Tuberculosis
c (2.0 mg/mL For many years, digitalis (digoxin) was considered an essential agent for the treatment of HF, but with the advent of new medications, it is not prescribed as often. Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node. It improves contractility, increasing left ventricular output.)
A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? a) 4.0 mg/mL b) 0.25 mg/mL c) 2.0 mg/mL d) 3.2 mg/mL
a (The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The IABP uses internal counterpulsation through the regular inflation and deflation of the balloon to augment the pumping action of the heart. It inflates during diastole, increasing the pressure in the aorta during diastole and therefore increasing blood flow through the coronary and peripheral arteries. It deflates just before systole, lessening the pressure within the aorta before left ventricular contraction, decreasing the amount of resistance the heart has to overcome to eject blood and therefore decreasing left ventricular workload.)
A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? a) The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. b) The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. c) The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. d) The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium.
b, c, e (The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.)
A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) a) Jugular vein distention b) Cough c) Pulmonary crackles d) Ascites e) Dyspnea
a (Decrease in central venous pressure (CVP) A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.)
A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which of the following indicates that cardiac tamponade has been relieved? a) Decrease in central venous pressure (CVP) b) Decrease in blood pressure c) Increase in CVP d) Absence of cough
b (Head of the bed elevated at 45 degrees and lower arms supported by pillows Preload is the amount of blood presented to the ventricle just before systole. The patient is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the patient may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the patient's weight on the shoulder muscles.)
A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload? a) Head of the bed elevated at 30 degrees and legs elevated on pillows b) Head of the bed elevated at 45 degrees and lower arms supported by pillows c) Prone with legs elevated on pillows d) Supine with arms elevated on pillows above the level of the heart
b (Head of the bed elevated at 45 degrees and lower arms supported by pillows)
A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload? a) Supine with arms elevated on pillows above the level of the heart b) Head of the bed elevated at 45 degrees and lower arms supported by pillows c) Prone with legs elevated on pillows d) Head of the bed elevated at 30 degrees and legs elevated on pillows
A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand.
A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction? A. "Client walks 4 miles in 1 hour every day." B. "Client performs relaxation exercises three times per day to reduce stress." C. "Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." D. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol."
A. "Client walks 4 miles in 1 hour every day." Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises, following a low-fat, low-cholesterol diet, and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? A. "Client will verbalize the intention to stop smoking." B. "Client will verbalize the intention to avoid exercise." C. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." D. "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
A. "Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? A. "What color is your urine?" B. "How is your appetite?" C. "Is your skin drier than normal?" D. "Do you have any breathing problems?"
A. "What color is your urine?" The patient receiving anticoagulation therapy should be monitored for signs and symptoms of bleeding, such as changes in the color of the stool or urine. Anticoagulation therapy should not cause dry skin. The anticoagulation therapy should not change the client's breathing or appetite.
An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? A. Assess for factors that may be causing the client's delirium. B. Educate the family about how confusion is expected in older adults postoperatively. C. Reorient the client to place and time. D. Document the early signs of dementia and ensure the client's safety.
A. Assess for factors that may be causing the client's delirium. Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare, it is not considered to be an expected part of recovery.
The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. A. Avoid elevating the knees on the bed. B. Initiate passive exercises. C. Encourage the client to cross their legs. D. Place pillows in the popliteal space. E. Apply antiembolism stockings.
A. Avoid elevating the knees on the bed B. Initiate passive exercises. E. Apply antiembolism stockings. Preventive measures used to prevent venous stasis include application of sequential pneumatic compression devices; discouraging crossing of legs; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; and beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.
The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. What instruction does the nurse include about managing this condition? Select all that apply. A. Balance rest with activity. B. Carry nitroglycerin at all times. C. Stop smoking. D. Follow a diet high in saturated fats. E. Avoid all physical activity.
A. Balance rest with activity. B. Carry nitroglycerin at all times C. Stop smoking. Managing angina pectoris at home includes balancing rest with activity, participating in a regular daily program of activities that do not induce angina pain, stopping smoking, carrying nitroglycerin at all times, and following a diet low in saturated fat.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. A. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. B. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. C. Renew the supply every 6 months. D. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. E. Take the tablet in anticipation of any activity that can produce pain. F. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed.
A. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. C. Renew the supply every 6 months. E. Take the tablet in anticipation of any activity that can produce pain. F. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. Nitroglycerine is very unstable and should be carried securely in its original container (capped, dark, glass bottle). The tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerine is also volatile and is inactivated by heat, moisture, air, light, and time. Therefore, storage and replacement is recommended every 6 months. Refer to Box 14-3 in the text.
The nurse is providing education about the nutrient content of the Therapeutic Lifestyle Changes (TLC) diet to a community group. What information will the nurse provide? Select all that apply. A. Carbohydrates should make up 50% to 60% of the total calories. B. Cholesterol should be less than 1 gram per day. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. E. Total fat should make up only 5% of the total calories.
A. Carbohydrates should make up 50% to 60% of the total calories. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. According to the nutrient content of the TLC diet, cholesterol should make up less than 200 mg/day, carbohydrates should make up 50% to 60% of the total calories, dietary fiber should be 20 to 30 grams per day, protein should make approximately 15% of the total calories, and fat should make up 25% to 30% of the total calories.
Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? A. Cardiac tamponade B. Hypothermia C. Hypertension D. Fluid overload
A. Cardiac tamponade Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high pulmonary artery wedge pressure, central venous pressure, and pulmonary artery diastolic pressure, as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A. Carvedilol B. Digoxin C. Nitroprusside D. Furosemide
A. Carvedilol A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? A. Elevated ST segment B. Absent Q wave C. Prolonged PR interval D. Widened QRS complex
A. Elevated ST segment Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.
An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? A. Leads V3 and V4 B. Leads II, III, and aVF C. Leads I, aVL, V5, and V6 D. Leads V1 and V2
A. Leads V3 and V4 Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.
Which technique is used to surgically revascularize the myocardium? A. Minimally invasive direct coronary bypass B. Balloon bypass C. Peripheral bypass D. Gastric bypass
A. Minimally invasive direct coronary bypass Several techniques are used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the client is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.
A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? A. Relieved by rest and nitroglycerin B. Associated with nausea and vomiting C. Accompanied by diaphoresis and dyspnea D. Described as crushing and substernal
A. Relieved by rest and nitroglycerin One characteristic that can differentiate the pain of angina from a myocardial infarction is pain that is relieved by rest and nitroglycerine. There may be some exceptions (unstable angina), but the distinction is helpful especially when combined with other assessment data.
A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to to the client? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Seek emergency treatment if flushing or nausea occurs. C. Store the patch in its original container when not in use. D. Cover the patch in plastic wrap after applying.
A. Remove the transdermal patch at night and reapply in the morning. C. Store the patch in its original container when not in use. Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea.
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A. ST elevation B. Frequent premature atrial contractions (PACs) C. Isolated premature ventricular contractions (PVCs) D. Sinus tachycardia
A. ST elevation The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.
The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A. pericardial friction rub B. hypothermia C. decreased erythrocyte sedimentation rate (ESR) D. Decreased white blood cell (WBC) count
A. pericardial friction rub Postpericardiotomy syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR. Hypothermia is not a symptom of postpericardiotomy syndrome.
Coronary artery stent
After PTCA the area that has been treated may close off partially or completely, a process called restenosis. The intima of the coronary artery has been injured and responds by initiating an acute inflammatory process A stent is a metal mesh that provides structural support to a vessel at risk of acute closure. Stent positioned over the angioplasty balloon and when the balloon is removed the stent is left permanently in the artery. Some stents have medication on them
A patient in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete?
Attempt to palpate the dorsalis pedis and posterior tibial pulses. Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. A thorough assessment of the patient's skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? A. "I should expect bruising at the catheter site for up to 3 weeks." B. "I should expect a low-grade fever and swelling at the site for the next week." C. "I should avoid prolonged sitting." D. "I should avoid taking a tub bath until my catheter site heals."
B. "I should expect a low-grade fever and swelling at the site for the next week." Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.
The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure? A. Avoid subcutaneous injections B. Avoid continuous BP monitoring C. Use an electric toothbrush D. Avoid the use of nail clippers
B. Avoid continuous BP monitoring The client receiving heparin receives bleeding precautions, which can include applying pressure to the site of any needle punctures for a longer time than usual, avoiding intramuscular injections, and avoiding tissue injury and bruising from trauma or constrictive devices (e.g., continuous use of an automatic BP cuff). Subcutaneous injections are permitted; a soft toothbrush should be used, and the client may use nail clippers, but with caution.
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Diltiazem B. Clopidogrel C. Felodipine D. Amlodipine
B. Clopidogrel Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.
A client is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? A. The same type of activity that caused previous angina episodes. B. Coronary artery spasm. C. An unpredictable amount of activity. D.Activities that increase myocardial oxygen demand.
B. Coronary artery spasm. Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.
A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. A. Body mass index (BMI) of 23 B. Family history of coronary heart disease C. Elevated C-reactive protein D. Age greater than 45 years for men E. African-American descent
B. Family history of coronary heart disease C. Elevated C-reactive protein D. Age greater than 45 years for men E. African-American descent Risk factors for coronary heart disease (CHD) include family history of CHD, age older than 45 years for men and 65 years for women, African-American race, BMI of 25 or greater, and elevated C-reactive protein.
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? A. Obesity B. Hypertension C. Hyperlipidemia D. Glucose intolerance
B. Hypertension Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.
Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy? A. a nonambulatory client B. a client with a chronic, nonhealing skin lesion C. a client whose ulcer includes necrotic tissue D. a client with an infected stasis ulcer
B. a client with a chronic, nonhealing skin lesion Chronic, nonhealing skin lesions are treated with topical hyperbaric oxygen therapy. This approach delivers oxygen above atmospheric pressure directly to the wound rather than to the full body as with other disorders such as carbon monoxide poisoning. Necrotic tissue is debrided from a stasis ulcer. A client's infection is treated with an application of Silvadene, an antibacterial cream, or an antibiotic ointment and an occlusive transparent dressing such as Tegaderm that traps moisture and speeds healing.
The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? A. an hourly urine output of 50 to 70 mL B. a serum BUN of 70 mg/dL C. a serum creatinine of 1.0 mg/dL D. a urine specific gravity reading of 1.021
B. a serum BUN of 70 mg/dL These four laboratory results should always be assessed after cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. Urine output needs to be greater than 30 mL/hr. Normal urine specific gravity is 1.005-1.030. Normal serum creatinine values are between 0.5-1.2 mg/dL.
A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
Blood pressure 84/52 mm Hg Explanation: Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
The nurse recognizes which of the following lab tests is a key diagnostic indicator of heart failure?
Brain natriuretic peptide (BNP)
Which of the following is a key diagnostic indicator of heart failure (HF)?
Brain natriuretic peptide (BNP)
Telemetry
Brown in middle Right: White sky over green grass Left: black smoke over red fire
The nurse is teaching the client about coronary artery damage after an abnormal fasting lipid profile. The client asks the nurse what type of lipid is most troublesome. What is the nurse's best response? A. "The higher the high-density lipoproteins (HDL), the more at risk you are for heart damage or a stroke." B. "The total cholesterol level of 252 mg/dL warrants medication treatment alone." C. "The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke." D. "The triglycerides levels measure good fat, so the higher the level, the less risk you are for a heart attack or stroke."
C. "The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke." When there is an excess of LDL, these particles adhere to vulnerable points in the arterial endothelium. Here, macrophages ingest them, leading to the formation of foam cells and the beginning of plaque formation. A harmful effect is exerted on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. The cholesterol level should be <200 mg/dL but it is not the only indication for treatment. The lower the HDL, the more the client is at risk for heart attack or stroke. The combination of the client's triglycerides, LDL, and HDL levels is used to direct treatment.
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? A. 280-300 mg/dL B. 210-240 mg/dL C. 160-190 mg/dL D. 250-275 mg/dL
C. 160-190 mg/dL Simvastatin is a statin frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.
Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? A. .25 to .75 B. .75 to 1.5 C. 2.0 to 2.5 D. 2.5 to 3.0
C. 2.0 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained during the follow-up to any alteration of dosage. The client's aPTT value would have to be greater than .25 to .75 or .75 to 1.5 times normal to be considered therapeutic. An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic.
The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? A. 2 to 3 hours after admission B. 12 to 18 hours after admission C. 4 to 6 hours after pain D. 30 minutes to 1 hour after pain
C. 4 to 6 hours after pain Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? A. CK-MM B. Troponin C level C. Creatinine kinase-myoglobin (CK-MB) level D. Myoglobin level
C. Creatinine kinase-myoglobin (CK-MB) level Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (as a result of thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. Three isomers of troponin exist: C, I, and T. Troponins I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? A. Decreases platelet aggregation B. Increases cardiac output C. Decreases resting heart rate D. Decreases cholesterol level
C. Decreases resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A. Instruct the client to renew the nitroglycerin supply every 3 months. B. Instruct the client to place nitroglycerin tablets in a plastic pill box. C. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. D. Instruct the client not to crush the tablet.
C. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.
While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? A. Stop the heparin infusion immediately. B. Administer a coumarin derivative, as ordered, to counteract heparin. C. Notify the health care provider. D. Reassure the client that bleeding gums are a normal effect of heparin.
C. Notify the health care provider. Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the health care provider, who will evaluate the client's condition. The health care provider should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the health care provider orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.
A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography (EBCT). The nurse understands that the primary advantage of this radiologic test is which of the following? A. Clear images B. Less invasive procedure C. Quantifies calcified plaque D. Less exposure to radiation
C. Quantifies calcified plaque The primary advantage of EBCT is to detect and quantify calcified plaque in the coronary arteries even before symptoms arise. EBCT is noninvasive and provides clearer images with less exposure to radiation than a CT scan but not the primary reason for use.
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A. The abrupt stop can trigger a migraine headache. B. The abrupt stop can lead to formation of blood clots. C. The abrupt stop can cause a myocardial infarction. D. The abrupt stop will precipitate internal bleeding.
C. The abrupt stop can cause a myocardial infarction. Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? A. The nurse should explain that the client most likely wants extra attention. B. The nurse should instruct the nursing assistants to avoid answering his call light. C. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. D. The nurse should report the incident to her supervisor immediately.
C. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. Sometimes clients are concerned about resuming sexual activity but are afraid to ask. Making inappropriate sexual comments provides a forum for asking questions. It isn't necessary to report the incident to the nursing supervisor immediately without investigating the situation further. The client's call light must be answered in a timely fashion. More information is needed before assuming that the client is asking for extra attention.
The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain? A. complete closure of an artery B. incomplete blockage of a major coronary artery C. a lack of oxygen in the heart muscle that causes the death of cells D. a destroyed part of the heart muscle
C. a lack of oxygen in the heart muscle that causes the death of cells Impeded blood flow, due to blockage in a coronary artery, deprives the cardiac muscle cells of oxygen, thus leading to a condition known as ischemia. Artery blockage or closure leads to myocardial death. The destroyed part of the heart is a myocardial infarction.
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order?
Carvedilol (Coreg) Explanation: A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next?
Check the client's potassium level.
Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is:
Cigarette smoking.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?
Clopidogrel (Plavix) Explanation: Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers
What are examples of anitplatelet meds?
Clopidogrel (plavix), aspirin
Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? A. Direct manual pressure B. Application of a vascular closure device C. Application of a mechanical compression device D. Application of a sandbag to the area
D. Application of a sandbag to the area Applying a sandbag to the sheath insertion site is ineffective in reducing the incidence of bleeding and is not an acceptable standard of care. Application of a vascular closure device (Angio-Seal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (a C-shaped clamp) are all appropriate methods used to induce hemostasis after removal of a peripheral sheath.
Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? A. Direct manual pressure B. Application of a sandbag to the area C. Application of a pneumatic compression device (e.g., FemoStop) D. Application of a vascular closure device such as Angio-Seal or VasoSeal
D. Application of a vascular closure device such as Angio-Seal or VasoSeal Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site and application of a pneumatic compression device after PTCA have been demonstrated to be effective; the former was the first method used to induce hemostasis after PTCA. Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.
After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A. Notify the health care provider. B. Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. C. Decrease anticoagulant or antiplatelet therapy. D. Apply manual pressure at the site of the insertion of the sheath.
D. Apply manual pressure at the site of the insertion of the sheath. The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified.
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? A. Elevated central venous pressure B. Hypothermia C. Hypertension D. Cardiac tamponade
D. Cardiac tamponade Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a goal of rehabilitation for the client with an MI? A. Prevention of another cardiac event B. Ability to return to work and a preillness functional capacity C. Limitation of the effects and progression of atherosclerosis D. Improvement in quality of life
D. Improvement in quality of life Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of a client with an MI patient are to limit the effects and progression of atherosclerosis, to return the client to work and a preillness lifestyle, and to prevent another cardiac event.
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? A. Mental alertness B. Blood glucose concentration C. Activity intolerance D. Inadequate tissue perfusion
D. Inadequate tissue perfusion The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for clients undergoing cardiac surgery.
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? A. Variant B. Intractable C. Refractory D. Unstable
D. Unstable Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? A. Heart rate of 100 bpm B. Potassium level of 4.0 mE/qL C. Dried blood at the puncture site D. Urine output of 40 mL
D. Urine output of 40 mL Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The client is expected to have a minimum urine output of 30 mL/h. Dried blood at the insertion site is a finding that warrants no acute intervention. A serum potassium level of 4.0 mEq/L is within the normal range. The heart rate of 100 bpm is within the normal range and indicates no acute distress.
A nurse is teaching a client about maintaining a healthy heart. What information will the nurse include with the teaching? A. Exercise one or two times per week. B. Smoke in moderation. C. Consume a diet high in saturated fats. D. Use alcohol in moderation.
D. Use alcohol in moderation. The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.
A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? A. Within 12 hours B. Within 24 to 48 hours C. Within 5 to 7 days D. Within 6 hours
D. Within 6 hours For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Health care providers initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.
The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump?
Echocardiogram
Frequently, what is the earliest symptom of left-sided heart failure?
Dyspnea on exertion
Depolarization
Electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell.
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?
Elevated ST segment Explanation: Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.
A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time?
Epinephrine Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.
Which of the following statements is accurate regarding Reynaud's disease?
Episodes may be triggered by unusual sensitivity to cold Episodes of Reynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.
Which of the following statements is accurate regarding Reynaud's disease?
Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.
A 76-year-old client has a significant history of congestive heart failure. During his semiannual cardiology examination, for what should you, as his nurse, specifically assess? Select all that apply.
Examine the client's neck for distended veins. Monitor the client for signs of lethargy or confusion.
A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD), and distant (muffled) heart sounds. Increased pericardial pressure, reduced venous return to the heart, and decreased carbon dioxide result in cardiac tamponade (eg, compression of the heart).
A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound?
Hyperbaric oxygen Hyperbaric oxygenation (HBO) may be beneficial as an adjunct treatment in patients with diabetes with no signs of wound healing after 30 days of standard wound treatment. HBO is accomplished by placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen. Treatment regimens vary from 90 to 120 minutes once daily for 30 to 90 sessions. The process by which HBO is thought to work involves several factors. The edema in the wound area is decreased because high oxygen tension facilitates vasoconstriction and enhances the ability of leukocytes to phagocytize and kill bacteria. In addition, HBO is thought to increase diffusion of oxygen to the hypoxic wound, thereby enhancing epithelial migration and improving collagen production.
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances?
Hypermagnesemia Explanation: Untreated hypomagnesemia may result in coma, apnea, and cardiac arrest. Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves). Signs of hyperkalemia include: mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval). Signs and symptoms of hypomagnesemia include: paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension
Which of the following in an inconsistent manifestation of metabolic syndrome?
Hypotension Explanation: Metabolic syndrome consists of insulin resistance, dyslipidemia, hypertension, and chronic inflammation.
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?
Inability to speak. Explanation: Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?
Inadequate tissue perfusion Explanation: The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.
The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following?
Left ventricular function
Coronary artery bypass graft
Major indications for CABG are: 1) Alleviation of angina that cannot be controlled with medication or PCI (percutaeneous coronary intervention) 2) Treatment of left main coronary artery stenosis or multivessel CAD 3) Prevention and treatment of MI, dysrhythmias or heart failure 4) Treatment for complications from an unsuccessful PCI Done in men more than in women because compared to men, women referred for this surgery tend to be older and have more comorbidities, they have higher risk of surgical complications and they have smaller coronary arteries. CABG is done to bypass the arteries. Take a vein from the leg. Place a graft below the obstruction. Stop anti-coagulant, anti-htn meds They need to stay on a vent because its crazy invasive, so you want to stop the workload as much as possible. Don't want to extubate then immediately re-intubate because they coded NG or OG tube for gastric decompression, don't want them to aspirate. We breathe through negative pressure. Central venous line to measure hemodynamics. CVP monitors Transcutaneous pacing wires Chest tubes because there will be extra blood in chest cavity that needs to be drained Foley catheter to check urine output SCD to prevent DVT
A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following?
Moderate to severe arterial insufficiency Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.
Aortic dissection may be mistaken for which of the following disease processes?
Myocardial infarction (MI) Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.
You are working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for you to closely monitor an older adult receiving digitalis preparations for cardiac disorders?
Older adults are at increased risk for toxicity. Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma.
A patient diagnosed with coronary artery disease is being placed on nitroglycerin. The nurse understands that the premise behind administration of nitrates in this patient population includes which of the following?
Preload is reduced. Explanation: Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload ) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain
While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?
Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.
A patient who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly develops complaints of chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the patient for other signs and symptoms of which of the following problems?
Pulmonary embolism Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction where emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.
A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?
Recommend he have his blood pressure rechecked within 2 weeks.
When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe?
Red, swollen skin with inflammation spreading to surrounding tissues
When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe?
Red, swollen skin with inflammation spreading to surrounding tissues Cellulitis, an inflammation of soft tissues, can extend to surrounding tissues. The skin becomes reddened, warm, swollen, and sometimes painful. The skin wouldn't be cold, pale, or necrotic.
A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
Acute coronary syndrome
Refers to rupture of a plaque and a diseased coronary artery, which rapidly form an obstructive thrombus.
What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis?
Teach the patient how to apply a graduated compression stocking. In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the patient how to apply a graduated compression stocking. The nurse informs the physician if the temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.
The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension?
Renal disease
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
Renal dysfunction resulting from atherosclerosis
Pulmonary vascular resistance
Resistance to blood flow out of the right ventricle created by the pulmonary circulatory system.
Which of the following is the most effective intervention for preventing progression of vascular disease?
Risk factor modification Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.
b (Canned peas There are a wide variety of foods that Ronald can still eat. The key is they have to have low-salt content. Canned vegetables are usually very high in salt or sodium, unless they have labels such as low-salt or sodium free or salt free. The key is to read the food labels and look for foods that contain <300 mg sodium/serving.)
Ronald is a 46-year-old who has developed congestive heart failure. He has to learn to adapt his diet and you are his initial counselor. Which of the following should you tell him to avoid? a) Angel food cake b) Canned peas c) Dried peas d) Ready-to-eat cereals
On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend?
Taking daily walks Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.
A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?
The client demonstrates ability to tolerate more activity without chest pain. Explanation: The ability to tolerate more activity without chest pain indicates a favorable response to therapy in a client who is recovering from an MI or who has a history of coronary artery disease. The client should have a normal electrocardiogram with no arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a cardiovascular risk factor that the client must be willing to eliminate. A client who responds favorably to therapy shouldn't have chest pain
A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema?
The client says his rings have become tight and are difficult to remove.
b (Left ventricular function The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.)
The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? a) Right atrial function b) Left ventricular function c) Left atrial function d) Right ventricular function
Pulse deficit
The difference between the apical and radial pulse rates.
S1
The first heart sound produced by closure of the atrioventricular (mitral and tricuspid) valves.
A nurse is administering lanoxin, which she knows increases contractility as well as cardiac output. Contractility refers to which of the following?
The force of the contraction related to the status of the myocardium
The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for?
Ulceration Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.
d (Call for help and begin chest compressions. Following the recognition of unresponsiveness, a protocol for basic life support is initiated. This includes activation of the emergency response team for help and performance of high-quality cardiopulmonary resuscitation (CPR), which includes beginning chest compressions.)
The nurse hears the alarm sound on the telemetry monitor and observes a flat line. The patient is found unresponsive, without a pulse, and no respiratory effort. What is the first action by the nurse? a) Administer epinephrine 1:10,000 10 mL IV push. b) Deliver breaths with a bag-valve mask. c) Defibrillate the patient with 360 joules. d) Call for help and begin chest compressions.
d (Withhold the medication and notify the physician of the heart rate)
The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse? a) Administer the medication and inform the charge nurse about the rate. b) Administer atropine to speed the heart rate and then administer the digoxin. c) Administer the medications and then notify the physician. d) Withhold the medication and notify the physician of the heart rate
d (Brain natriuretic peptide (BNP))
The nurse recognizes which of the following lab tests is a key diagnostic indicator of heart failure? a) Blood urea nitrogen (BUN) b) Complete blood count (CBC) c) Creatinine d) Brain natriuretic peptide (BNP)
What are the symptoms a nurse should assess for in a patient with lymphedema as a result of impaired nutrition to the tissue?
Ulcers and infection in the edematous area
S2
The second heart sound produced by closure of the semi lunar (aortic and pulmonic) valves.
Treatment for angina pectoris
Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply Medications Oxygen Reduce and control risk factors Reperfusion therapy may also be done Decrease the myocardial oxygen demand by giving patient rest, vasodilators, beta-blockers. Slow down heart rate (negative chronotropy) and vasodilate to get as much oxygen to tissue as possible Reduce risk factors 1) Smoking 2) Exercise 3) Change the diet LOW LDL (below 100)and HIGH HDL (Above 40)
c (Natrecor)
Which of the following medications is a human brain natriuretic peptide (BNP) preparation? a) Captopril b) Metoprolol c) Natrecor d) Enalapril
What are the symptoms a nurse should assess for in a patient with lymphedema as a result of impaired nutrition to the tissue?
Ulcers and infection in the edematous area In a patient with lymphedema, the tissue nutrition is impaired from the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scaring does not occur in patients with lymphedema, and cyanosis is a bluish discoloration of the skin and mucous membranes.
Radioisotopes
Unstable atoms that give all small amount of energy in the form of gamma rays as they decay; using cardiac nuclear medicine studies.
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour?
Up to 25%
a (Tissue hypertension)
Which of the following is a classic sign of cardiogenic shock? a) Tissue hypoperfusion b) Increased urinary output c) High blood pressure d) Hyperactive bowel sounds
a (Brain natriuretic peptide (BNP) The BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of HF. A BUN, creatinine, and CBC are included in the initial workup.)
Which of the following is a key diagnostic indicator of heart failure (HF)? a) Brain natriuretic peptide (BNP) b) Creatinine c) Complete blood count (CBC) d) Blood urea nitrogen (BUN)
b (Low ejection fraction (EF))
Which of the following is the hallmark of systolic heart failure? a) Basilar crackles b) Low ejection fraction (EF) c) Limitation of activities of daily living (ADLs) d) Pulmonary congestion
a (Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the patient's symptoms.)
Which of the following is the hallmark of systolic heart failure? a) Low ejection fraction (EF) b) Basilar crackles c) Limitation of activities of daily living (ADLs) d) Pulmonary congestion
The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse?
Withhold the medication and notify the physician of the heart rate. Digitalis drugs are withheld if the heart rate is less than 60 or more than 120 beats/minute until a physician is consulted. The other choices would have the nurse administer the drug, which would not be the standard of practice.
d (Acute pulmonary edema Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock.)
You are caring for a client with left-sided heart failure. When you go in to do your shift assessment, you find your client is wheezing, restless, tachycardic, and has severe apprehension. You know that these are symptoms of what? a) Progressive heart failure b) Cardiogenic shock c) Pulmonary hypertension d) Acute pulmonary edema
Electrocardiography (ECG or EKG)
a graphic display of the electrical activity of the heart, consisting of waves: P, Q, R, S, T, and sometimes U.
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? a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." b) "The medications will prevent your husband from having an erection." c) "It is usually better to just give up sex after a heart attack." d) "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it."
a) "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.
The nurse is interviewing a client who is complaining of chest pain. Which of the following questions related to the client's history are most important to ask? Select all that apply. a) How would you describe your symptoms? b) Do you have any children? c) How did your mother die? d) Are you allergic to any medications or foods?
a) How would you describe your symptoms? c) How did your mother die? d) Are you allergic to any medications or foods? During initial assessment, the nurse should obtain important information about the client's history that focuses on a description of the symptoms before and during admission, family medical history, prescription and nonprescription drug use, and drug and food allergies.
The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following? a) Hypervolemia b) Excessive blood loss c) Overdiuresis d) Left-sided heart failure (HF)
a) Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.
Age-related changes associated with the cardiac system include which of the following? Select all that apply. a) Increased size of the left atrium b) Myocardial thinning c) Endocardial fibrosis d) Increase in the number of SA node cells
a) Increased size of the left atrium c) Endocardial fibrosis Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening.
The nurse is caring for a client on the cardiac unit. Which change of condition may indicate potential increasing of right-side heart failure? Select all that apply. a) Increased weakness on ambulation b) Jugular vein distention c) Edema changed from a 3+ to a 1+ d) One-pound weight loss e) Increased palpitations f) Increased dyspnea
a) Increased weakness on ambulation b) Jugular vein distention e) Increased palpitations f) Increased dyspnea A change in assessment finding may indicate an increase in heart failure. Right-sided heart failure symptoms include jugular vein distention, increased dyspnea, increased palpitations, and an increased weakness on ambulation. Edema is a common sign of right-sided heart failure, but changing from a 3+ to 1+ is improvement in condition. Weight loss is also improvement in condition.
The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart. Which of the following actions should the nurse complete prior to the patient undergoing the procedure? Select all that apply. a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. d) Sedate the patient prior to the procedure. e) Position the patient on his/her stomach for the procedure.
a) Remove the patient's jewelry. b) Offer the patient a headset to listen to music during the procedure. c) Remove the patient's Transderm Nitro patch. Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm, Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or thumping that can be annoying is generated by the magnetic coils, so the patient may be offered a headset to listen to music.
14. The classic ECG changes that occur with an MI include all of the following except: a. an absent P wave. b. an abnormal Q wave. c. T-wave inversion. d. ST-segment elevation.
a. an absent P wave.
The nurse is aware that age-related changes in the heart muscle put the elderly at risk for dyspnea, angina, and syncope. Which of the following is an age-related change in the cardiovascular system that affects the sympathetic nervous system? a) An increased contractility response to exercise b) A decreased response to beta-blockers c) Decreased time for the heart rate to return to baseline d) Tachycardia
b) A decreased response to beta-blockers The sympathetic nervous system exhibits structural and functional changes that are age-related. Heart rate will decrease, and it will take longer for the heart rate to return to baseline. Refer to Table 12-1 in the text.
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a) Call the physician and obtain an order for a fluid bolus. b) Continue to monitor the client as ordered. c) Call the physician and obtain an order for a diuretic. d) Rezero the equipment and take another reading.
b) Continue to monitor the client as ordered. Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to rezero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg. Administering a diuretic would be appropriate if the client had excess fluid, as demonstrated by a CVP greater than 7 mm Hg.
Which of the following is a true statement regarding the role of baroreceptors? a) Increases in heart rate b) Initiates the parasympathetic response c) Initiates the sympathetic response d) Increases blood pressure
b) Initiates the parasympathetic response During elevations of blood pressure, the baroreceptors increase their rate of discharge. This initiates parasympathetic activity and inhibits sympathetic response, lowering the heart rate and blood pressure.
The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage? a) Rash b) Orthostatic hypotension c) Dry mouth d) Nausea
b) Orthostatic hypotension A common side effect of Nitrostat, especially at higher dosages, is orthostatic hypotension. The action of the medication is to dilate the blood vessels to improve circulation to the heart. The side effect of the medication is orthostatic hypotension. A rash, nausea, and dry mouth are not common side effects.
A 24-year-old obese woman describes her symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm his suspected diagnosis. What diagnostic would you expect him to prescribe? a) Radionuclide angiography b) Transesophageal echocardiography c) Electrocardiography d) Chest radiograph
b) Transesophageal echocardiography TEE involves passing a tube with a small transducer internally from the mouth to the esophagus to obtain images of the posterior heart and its internal structures from the esophagus, which lies behind the heart. TEE provides superior views that are not possible using standard transthoracic echocardiography. Clients whose chests are rotund or who are obese are candidates for TEE. Chest radiography and fluoroscopy determine the size and position of the heart and condition of the lungs. The radionuclide technetium-99m is used to detect areas of myocardial damage. The radionuclide thallium-201 is used to diagnose ischemic heart disease during a stress test. Electrocardiography (ECG) is the graphic recording of the electrical currents generated by the heart muscle.
9. Patient education includes telling someone who takes nitroglycerin sublingually that he or she should take 1, then go quickly to the nearest emergency department if no relief has been obtained after taking ______ tablet(s) at 5-minute intervals. a. 1 b. 2 c. 3 d. 4 to 5
c. 3
6. The incidence of coronary artery disease tends to be equal for men and women after the age of: a. 45 years. b. 50 years. c. 55 years. d. 65 years.
c. 55 years.
4. Which of the following findings is not a significant risk factor for heart disease? a. Cholesterol, 280 mg/dL b. LDL, 160 mg/dL c. High-density lipoproteins (HDL), 80 mg/dL d. A ratio of low-density lipoproteins (LDL) to HDL, 4.5 to 1.0
c. High-density lipoproteins (HDL), 80 mg/dL
27. Extremity paresthesia, dysrhythmias (peaked T waves), and mental confusion after cardiac surgery are signs of electrolyte imbalance related to the level of: a. calcium. b. magnesium. c. potassium. d. sodium.
c. potassium.
A patient's heart rate is observed to be 140 bpm on the monitor. The nurse knows that the patient is at risk for what complication? a) A stroke b) Right-sided heart failure c) A pulmonary embolism d) Myocardial ischemia
d) Myocardial ischemia As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially patients with coronary artery disease.
20. The need for surgical intervention in coronary artery disease (CAD) is determined by the: a. amount of stenosis in the coronary arteries. b. myocardial area served by the stenotic artery. c. occurrence of previous infarction related to the affected artery. d. all of the above.
d. all of the above.
