Test #3- 351 study guide

A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse? "Moderation is the key to everything." "Ask your physician to prescribe the new reverse lipid drug." "Increase the soy in your diet." "Exercise, keep your blood sugar in check, and manage your stress."

"Exercise, keep your blood sugar in check, and manage your stress."

A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving anticoagulant therapy. Which response by the charge nurse is best? "It's just a coincidence; most clients with atrial fibrillation don't receive anticoagulants." "Anticoagulant therapy controls heart rate in the client with atrial fibrillation." " Anticoagulant therapy prevents atrial fibrillation from progressing to a lethal arrhythmia." " Anticoagulant therapy prevents clot formation in the atria of clients with atrial fibrillation."

" Anticoagulant therapy prevents clot formation in the atria of clients with atrial fibrillation."

Cather ____________ therapy is a treatment that destroys specific cells that are the cause or central conduction route of a tachydysrhythmia that did not respond to medications and is not suitable for antitachycardia pacing.

ABLATION

The most common cause of cardiovascular disease in the United States is ___________, an abnormal accumulation of lipid, or fatty substances and fibrous tissue in the lining of arterial blood vessel walls.

ATHEROSCLEROSIS

The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial fibrillation? Sinusoidal Triangular Absent Square

Absent

Assessing vision and smell is done during what part of the neurological assessment? A. Glasgow Coma Scale assessment B. Cranial nerve assessment C. Health concern assessment D. Babinski sign assessment

B. Cranial nerve assessment

The delivery of an electrical current to treat a tachydysrhythmia that is timed so that it is synchronized with the electrical events of myocardial cells is called ______________.

CARDIOVERSION

Systole

Contraction of the heart

_______________ is the treatment of choice for the patient in ventricular fibrillation.

DEFIBRILLATION

The four primary modifiable risk factors for coronary artery disease and its complications are as follows: cholesterol abnormalities, tobacco use, hypertension and ______________.

DIABETES

10. A client with a neurological disorder has difficulty swallowing. The nurse should take special care with the client's diet because of a potential risk of imbalanced nutrition. Which measure may be taken by the nurse to ensure that the client's diet allows for easy swallowing? Instruct the client to lie on the bed when eating Offer liquids frequently, in large quantities Help the client sit upright when eating and feed slowly Allow optimum physical activity before meals to expedite digestion

Help the client sit upright when eating and feed slowly

Angina pectoris is chest pain resulting from myocardial _________ of the heart muscle.

ISCHEMIA

Diastole

Relaxation of the heart

20. The Family Nurse Practitioner is assessing a 55-year-old who came to the clinic complaining of being "unsteady" on their feet. What would be a test for equilibrium? Walking and turning abruptly Carlsburg test Romberg test Heel-to-toe test

Romberg test

The total cholesterol level (normal value should be less than 200 mg/dL) is a clear predictor of coronary events.

T

P wave

atrial depolarization (contracting) -SA node

Synchronized Cardioversion

the passage of an electric current through the heart during a specific part of the cardiac cycle to terminate certain kinds of dysrhythmias -correlate with R wave

blood pressure

the pressure that is exerted by the blood against the walls of blood vessels

QRS wave

ventricular depolarization and atrial repolarization

T wave

ventricular repolarization

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? "When I finish the rehabilitation program I'll never have to worry about heart trouble again." "I won't be able to jog again even with rehabilitation." "Rehabilitation will help me function as well as I physically can." "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."

"Rehabilitation will help me function as well as I physically can."

12. A client who has experienced an initial transient ischemic attack (TIA) states: "I'm glad it wasn't anything serious." Which is the best nursing response to this statement? "I sense that you are happy it was not a stroke". "People who experience a TIA will develop a stroke". "TIA symptoms are shortlived and resolve within 24 hours". "TIA is a warning sign. Let's talk about lowering your risks."

"TIA is a warning sign. Let's talk about lowering your risks."

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? "Everything will be fine. Your family is here for you." "Don't cry; you have the best team of doctors." "Would you like something to calm your nerves?" "Tell me what concerns you most."

"Tell me what concerns you most."

The nurse is providing care to a client who has just undergone an electrophysiologic (EP) study. The client states that she is nervous about "things going wrong" during the procedure. What is the nurse's best response? "This is basically a risk-free procedure." "Thousands of clients undergo EP every year." "Remember that this is a step that will bring you closer to enjoying good health." "The whole team will be monitoring you very closely for the entire procedure."

"The whole team will be monitoring you very closely for the entire procedure."

ECG interpretation

-heart rate (60-100bpm) -heart rhythm (regular/irregular) - P wave (present? look the same?) - PR interval (3-5 small boxes 0.12-0.20sec) - QRS interval (1-3 small boxes 0.04-0.12sec)

3. An elderly client is being discharged home. The client lives alone and has atrophy of his olfactory organs. The nurse tells the client's family that it is essential that the client have what installed in the home? Grab bars Nonslip mats Baseboard heaters A smoke detector

A smoke detector

A patient is admitted to a telemetry unit with a new diagnosis of atrial fibrillation (AF). The patient states, "I feel fine, this rhythm won't hurt me." Which nursing response is appropriate? A. "AF can cause clots to form from the irregular blood flow in the heart." B. "It's important to monitor the AF for 24 hours." C. "AF leads the death of the heart muscle." D. "AF can cause cardiac output to increase."

A. "AF can cause clots to form from the irregular blood flow in the heart."

1. The nurse is caring for a male client who is scheduled for a neurologic examination that uses a radiopaque dye. Before the test, the nurse assesses the allergy history of the client and finds the client is allergic to seafood. What should the nurse relate the allergy to seafood as? An allergy to antihistamines An allergy to radiation exposure An allergy to morphine An allergy to iodine

An allergy to iodine

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment? A blood pressure cuff A cell phone to call 911 An automatic external defibrillator A stethoscope

An automatic external defibrillator

15. Which term refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? Atherosclerosis Angina pectoris Atheroma Ischemia

Angina pectoris

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? Atropine Dobutamine Amiodarone Lidocaine

Atropine

Your patient requires immediate cardioversion, which is defined as which of the following? A. A controlled electrical shock that is triggered by and fires on the P wave B. A controlled electrical shock that is triggered by and fires on the R wave C. A controlled electrical shock that is triggered by and fires on the T wave D. An electrical shock that fires randomly during the cardiac cycle

B. A controlled electrical shock that is triggered by and fires on the R wave

16. The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified? Gender, obesity, family history, and smoking Inactivity, stress, gender, and smoking Cholesterol levels, hypertension, and smoking Stress, family history, and obesity

Cholesterol levels, hypertension, and smoking

A patient presents to the ED and is diagnosed with an acute MI. The patient's spouse asks what type of damage has been caused by the "heart attack." What is the appropriate nursing response? A. "The pain is controlled, so there is no damage." B. "It will take years to know the extent of the damage to the heart muscle." C. "The medication will dilate the blood vessels and any damage will be corrected." D. "A heart attack evolves over several hours. We won't know the extent of the damage immediately."

D. "A heart attack evolves over several hours. We won't know the extent of the damage immediately."

6. A patient has a deficiency of the neurotransmitter serotonin. The nurse is aware that this deficiency can lead to: Myasthenia gravis. Depression. Seizures. Parkinson's disease.

Depression.

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. The nurse knows elective cardioversion prevents what? Disrupting the heart during the critical period of atrial repolarization. Disrupting the heart during the critical period of ventricular repolarization. Disrupting the heart during the critical period of ventricular depolarization. Disrupting the heart during the critical period of atrial depolarization.

Disrupting the heart during the critical period of ventricular depolarization.

A patient with a permanent pacemaker should be instructed not to use a cellular phone.

F

Beta-blockers, such as Lopressor and Toprol, are the standard treatment for angina pectoris.

F

Myocardial dysfunction occurs when irreversibly damaged heart muscle is replaced by adipose tissue.

F

The P wave represents atrial depolarization and atrial repolarization.

F

cardiac output

Heart rate x stroke volume the overall performance of the heart

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation? In many clients a heart rate slower than 60 beats per minute is considered too slow to maintain an adequate cardiac output. Sinus bradycardia means your heart is not beating fast enough to keep you alive. Sinus bradycardia is nothing to worry about. In many clients a heart rate slower than 70 beats per minute is considered too slow to maintain an adequate cardiac output.

In many clients a heart rate slower than 60 beats per minute is considered too slow to maintain an adequate cardiac output.

4. What is the function of cerebrospinal fluid (CSF)? It cushions the brain and spinal cord. It acts as an insulator to maintain a constant spinal fluid temperature. It acts as a barrier to bacteria. It produces cerebral neurotransmitters.

It cushions the brain and spinal cord.

17. Which of the following is an age-related change in the nervous system? Loss of neurons in the brain More efficient temperature regulation Increased myelin Increased cerebral blood flow

Loss of neurons in the brain

24. 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. Reduces myocardial oxygen consumption Decreases the urge to use tobacco Dilates blood vessels Decreases ischemia Relieves pain

Reduces myocardial oxygen consumption Dilates blood vessels Decreases ischemia Relieves pain

20. The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. Avoid handheld screening devices in airports Refrain from walking through anti-theft devices Check pulse daily, reporting sudden slowing or increase Avoid the usage of microwave ovens and electronic tools Wear a medical alert, noting the presence of a pacemaker

Refrain from walking through anti-theft devices Check pulse daily, reporting sudden slowing or increase Wear a medical alert, noting the presence of a pacemaker

25. A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to the client? Select all that apply. Remove the transdermal patch at night and reapply in the morning. Store the patch in its original container when not in use. Cover the patch in plastic wrap after applying. Seek emergency treatment if flushing or nausea occurs.

Remove the transdermal patch at night and reapply in the morning. Seek emergency treatment if flushing or nausea occurs.

stroke volume

The amount of blood ejected from the heart in one ventricular contraction. -influenced by preload, afterload, contractility

The nurse is working with a client who had an MI and is now active in rehabilitation. The nurse should teach this client to cease activity if which of the following occurs? The client experiences chest pain, palpitations, or dyspnea. The client experiences a noticeable increase in heart rate during activity. The client's oxygen saturation level drops below 96%. The client's respiratory rate exceeds 30 breaths/min.

The client experiences chest pain, palpitations, or dyspnea.

The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason? The delivered shock must be synchronized with the client's QRS complex. The defibrillator won't deliver a shock if the synchronizer switch is turned on. The defibrillator won't deliver a shock if the synchronizer switch is turned off. The shock must be synchronized with the client's T wave.

The defibrillator won't deliver a shock if the synchronizer switch is turned ON.

Afterload

The force or resistance against which the heart pumps.

7. The nurse is assessing the client's pupils following a sports injury. Which of the following assessment findings indicates a neurologic concern? Select all that apply. Unequal pupils Pupil reaction quick Pinpoint pupils Absence of pupillary response Pupil reacts to light

Unequal pupils Pinpoint pupils Absence of pupillary response

2. A client experienced a stroke that damaged the hypothalamus. The nurse should anticipate that the client will have problems with: body temperature control. balance and equilibrium. visual acuity. thinking and reasoning.

body temperature control.

6. The nurse is caring for a client who is having chest pain associated with a myocardial infarction (MI). What medication will the nurse administer intravenously to reduce pain and anxiety? fentanyl hydromorphone hydrochloride morphine sulfate codeine sulfate

morphine sulfate

atrial kick

slight pause of impulse between SA and AV so the blood has time to push into the ventricles

Preload

volume of blood in ventricles at end of diastole

18. Which nursing diagnosis statements are matched with appropriate interventions for a client with a stroke? Select all that apply. Impaired physical mobility: Provide wide-grip utensils during meals. Impaired swallowing: Provide a pureed diet. Self-care deficit: Instruct the client on use of a walker. Disturbed sensory perception: Stand on the client's unaffected side. Impaired verbal communication: Repeat words and instructions.

-Impaired swallowing: Provide a pureed diet. -Disturbed sensory perception: Stand on the client's unaffected side. -Impaired verbal communication: Repeat words and instructions.

causes of dysrhythmias

-cause decreased bloodflow -electrolyte disturbances -respiratory problems -age -meds -surgical procedures

14. Thrombolytic therapy should be initiated within what time frame of an ischemic stroke to achieve the best functional outcome? 3 hours 6 hours 9 hours 12 hours

3 hours

A patient has VF. The nurse understands that the most effective treatment besides CPR is which of the following? A. Antiarrhythmics B. Defibrillation C. Ventilation D. Epinephrine

B. Defibrillation

A patient returning from heart catheterization has a slight increase in serum creatinine from 1.0 to 1.2 mg/dL and a blood urea nitrogen (BUN) of 30 mg/dL (previously 22 mg/dL). The nurse anticipates an order for which medication? A. Nitroglycerin B. IV fluids C. Dialysis D. Furosemide

B. IV fluids

Sinus ___________ occurs when the SA node creates an impulse at a rate less than 60 beats per minute in an adult.

BRADYCARDIA

14. When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize? Core body temperature Heart rate and rhythm Blood pressure Oxygen saturation level

Heart rate and rhythm

A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, what condition should the nurse suspect? Myocardial infarction (MI) Deep vein thrombosis (DVT) Stroke Intracerebral hemorrhage

Myocardial infarction (MI)

The emergency department nurse is caring for a patient who has gone into cardiac arrest. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure? Gel pads are placed anteriorly, over the apex, and posteriorly for better conduction. No one is to be touching the patient at the time shock is delivered. Continue to ventilate the patient via endotracheal tube during the procedure. Second shock cannot be administered for 1 minute to allow recharging.

No one is to be touching the patient at the time shock is delivered.

A ___________ provides structural support to a coronary artery following angioplasty to minimize the risk of vessel stenosis.

STENT

The electrical stimulation of the cardiac muscle cells is called depolarization; the mechanical contraction is called _____________.

SYSTOLE

8. A patient has been diagnosed with damage to Broca's area of the left frontal lobe. To document the extent of damage, the nurse would assess the patient's: Speech. Vision. Hearing. Balance.

Speech.

A patient with atrial fibrillation is at high risk for thrombus formation.

T

For a patient to be considered a candidate for a coronary artery bypass graft (CABG), the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if the affected artery is the left main coronary artery).

T

The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation.

T

The pathophysiology of atherosclerosis involves an inflammatory response to arterial wall injury.

T

Ventricular tachycardia is considered an emergency situation because the patient is usually (but not always) unresponsive and pulseless.

T

The health care provider prescribes esmolol for a client with supraventricular tachycardia. During esmolol therapy, what should the nurse monitor? body temperature. heart rate and blood pressure. ocular pressure. cerebral perfusion pressure.

heart rate and blood pressure.

The nurse reviews the patient's history. Which factors increases this patient's risk for coronary artery disease (CAD)? Select all that apply. Hypertension Prediabetes Colon polyps Bone fractures Cigarette smoking 2 to 3 drinks per month Job stress Family with heart disease BMI 37 Age of 59 years

hypertension cigarette smoking job stress Family with heart disease BMI 37 Age of 59 years

5. The nurse is caring for a client in the emergency department with a diagnosis of head trauma secondary to a motorcycle accident. The nurse aide is assigned to clean the client's face and torso. The nurse would provide further instruction after seeing that the nurse aide: used mild soapy water to clean the face. moved the client's head to clean behind the ears. cleaned the eye area from the inner to outer eye area. cleaned the neck and upper chest area.

moved the client's head to clean behind the ears.

The nurse is documenting priority medication administration of the patient. Complete the sentences. Reports shoulder and back pain of 7 out of 10. Administered ____________. (aspirin, nitroglycerin, morphine, metoprolol, morphine) Pain reassessed and now 6 out of 10. Reassessed ______________. (RR, BP, heart rate, oxygen)

nitroglycerin, BP

cardiac ablation

procedure in which a catheter is inserted through a vein in the groin and threaded to the heart to correct structural problems in the heart that cause an arrhythmia -either freeze or burn the area

13. A physician orders aspirin, 325 mg P.O. daily for a client who has experienced a transient ischemic attack (TIA). The nurse should teach the client that the physician has ordered this medication to: control headache pain. enhance the immune response. prevent intracranial bleeding. reduce the chance of blood clot formation.

reduce the chance of blood clot formation.

23. A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? "I'll keep a log of each time my ICD discharges." "I can't wait to get back to my football league." "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I need to stay at least 10 inches away from the microwave."

"I need to stay at least 10 inches away from the microwave."

The nurse is caring for a patient who is being transported to the emergency department with clinical manifestations of stroke. Which is the priority action upon arrival to the hospital? A. Establish the time that the patient was last known to be without symptoms. B. Draw blood for coagulation studies. C. Perform an electrocardiogram. D. Perform an EEG.

A. Establish the time that the patient was last known to be without symptoms.

The nurse has just received a report on assigned patients. Which of the following patients should be assessed first? A. The patient with indigestion and increased troponin levels B. The patient with indigestion and increased CK levels C. The patient admitted 2 days ago with a BNP of 75 pg/mL D. The patient admitted 2 days ago with increased LDLs and C-reactive protein

A. The patient with indigestion and increased troponin levels

19. 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. Balance rest with activity. Stop smoking. Avoid all physical activity. Carry nitroglycerin at all times. Follow a diet high in saturated fats.

Balance rest with activity. Stop smoking. Carry nitroglycerin at all times.

9. A nurse is communicating with a client who has aphasia after having a stroke. Which action should the nurse take? Use one long sentence to say everything that needs to be said. Keep the television on while she speaks. Talk in a louder than normal voice. Face the client and establish eye contact.

Face the client and establish eye contact.

16. A nurse is performing a neurologic assessment on a client with a stroke and cannot elicit a gag reflex. This deficit is related to cranial nerve (CN) X, the vagus nerve. What will the nurse consider a priority nursing diagnosis? Risk for falls Risk for aspiration Risk for impaired skin integrity Decreased intracranial adaptive capacity

Risk for aspiration

19. In reviewing a client's history and physical examination, a nurse finds that the client was found positive for ataxia during the physician's neurological testing. Which nursing diagnosis will be a priority for this client? Risk for infection Deficient fluid volume Autonomic dysreflexia Risk for falls

Risk for falls

11. A nurse is completing discharge teaching for the client who has left-sided hemiparesis following a stroke. When investigating the client's home environment, the nurse should focus on which nursing diagnosis? Risk for injury Ineffective coping Noncompliance Diarrhea

Risk for injury

A client reports chest pain and palpitations during and after jogging in the mornings. The client's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk? Protein-rich diet Liquid diet Smoking cessation Mild meals

Smoking cessation

15. A client is following up after a visit to the emergency department where testing indicated that the client had suffered a transient ischemic attack. To prevent the occurrence of a stroke, which lifestyle changes should the nurse expect the neurologist to prescribe? Select all that apply Smoking cessation blood pressure control weight loss antiplatelet or anticoagulant therapy alcohol intake modification

Smoking cessation blood pressure control weight loss antiplatelet or anticoagulant therapy alcohol intake modification