WEEK 7 CARDIO ASSESSMENT

laboratory assessments - cardiac markers which is gold standard?

- troponin (gold standard) - creatine kinase - CK-MB - myoglobin

Magnesium lab value

1.5-2.5 mEq/L

potassium lab value

3.5-5.0 mEq/L

Triglycerides lab value

35-160 mg/dl

HDL:LDL ratio

3:1

HDL lab value

45-55 mg/dl

calcium lab value

8.4-10.5

LDL lab value

<130

cholesterol lab value

<200 mg/dL

Which nursing statement reflects appropriate cardiac physical assessment technique? A. "I will auscultate the aortic valve in the second intercostal space at the right sternal border." B. "I will palpate the apical pulse over the third intercostal space in the midclavicular line." C. "I will assess for orthostatic hypotension by moving the client from a standing to a reclining position." D. "I will assess for carotid bruit by auscultating over the anterior neck."

A. "I will auscultate the aortic valve in the second intercostal space at the right sternal border."

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? A. Potassium 3.0 mEq/L (3.0 mmol/L) B. Magnesium 2.1 mEq/L (1 mmol/L) C. International normalized ratio (INR) of 1.0 D. Calcium 8.5 mEq/L (4.25 mmol/L)

A. Potassium 3.0 mEq/L (3.0 mmol/L)

A client who is to undergo cardiac catheterization must be taught which essential information by the nurse? A. "Take your oral hypoglycemic with a sip of water on the morning of the procedure." B. "Keep your affected leg straight for 2 to 6 hours." C. "Do not take your blood pressure medications on the day of the procedure." D. "Monitor the pulses in your feet when you get home."

B. "Keep your affected leg straight for 2 to 6 hours."

A client with heart failure reports a 7.6-lb (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? A. Sodium restriction B. Daily weight monitoring C. Restricted activity D. Dietary consult

B. Daily weight monitoring

Which client assessment data is most consistent with cardiac pain requiring the nurse to notify the primary health care provider? A. Reports of abdominal pain and belching B. Reports of pressure in the upper abdomen and sternum and diaphoresis C. Apparent dyspnea on exertion (DOE) and an inability to sleep flat E. Reports claudication with ambulation and fatigue

B. Reports of pressure in the upper abdomen and sternum and diaphoresis

A client who is suffering from dyspnea on exertion and heart failure (HF) will most likely report which symptom during the health history? A. Brown discoloration of lower extremities B. Swelling of one leg C. Fatigue D. Slow heart rate

C. Fatigue

Which client has the highest risk for cardiovascular disease? A. Man who is sedentary and reports four episodes of strep throat. B. Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L). C. Man who smokes and whose father died at 49 of myocardial infarction (MI). D. Woman with abdominal obesity who exercises three times per week.

C. Man who smokes and whose father died at 49 of myocardial infarction (MI).

The nurse is teaching a class about mechanical properties of the heart. What teaching will the nurse include? A. Body size does not affect overall cardiac output. B. Cardiac output is the amount of blood ejected by the ventricles during each contraction. C. Preload is the degree of stretch in the myocardial fibers D. Stroke volume is the amount of blood pumped out of the heart each minute.

C. Preload is the degree of stretch in the myocardial fibers

Which laboratory finding is consistent with acute coronary syndrome (ACS)? A. Triglycerides 400 mg/dL (4.52 mmol/L) B. C-reactive protein 13 mg/dL (130 mg/L) C. Troponin 3.2 ng/mL (3.2 mcg/L) D. Lipoprotein-a 18 mg/dL (0.64 mcmol/L)

C. Troponin 3.2 ng/mL (3.2 mcg/L)

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus women. Which teaching will the nurse include? A. Men more than women tend to deny the importance of symptoms. B. Men do not tend to report chest pain. C. Women may experience extreme fatigue and dizziness as sole symptoms. D. Men are more likely than women to die after MI.

C. Women may experience extreme fatigue and dizziness as sole symptoms.

The client asks the nurse about modifiable risk factors for heart disease. What nursing response is appropriate? (Select all that apply.) Select all that apply. Cigarette smoking is one of the most significant modifiable risk factors. Your personal health over the past 10 years a modifiable risk. Your overall body mass index is nonmodifiable. Increasing physical exercise is a method to modify your risk. Diabetes mellitus is a modifiable risk factor.

Cigarette smoking is one of the most significant modifiable risk factors. Increasing physical exercise is a method to modify your risk.

A client recovering from cardiac angiography develops slurred speech. What will the nurse do first? A. Assess the site of the procedure for bleeding. B. Call in another nurse for a second opinion. C. Maintain NPO status until the slurred speech resolves. D. Perform a neurologic assessment and notify the primary care provider.

D. Perform a neurologic assessment and notify the primary care provider.

Which assessment data is most important for the nurse to report to the primary care provider prior to a coronary arteriogram? A. The client reports intermittent substernal chest pain for 6 months. B. The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate. C. The client reports that a previous arteriogram was negative for coronary artery disease. D. The client develops wheezes and dyspnea after eating crab or lobster.

D. The client develops wheezes and dyspnea after eating crab or lobster. contrast allergy

A client has been admitted to the hospital with chest pain radiating down the left arm. Which test result best confirms that the client sustained a myocardial infarction (MI)? A. C-reactive protein of 1 mg/dL (10 mg/L) B. Homocysteine level of 13 mcmol/L C. Creatine kinase (CK) of 125 units/L D. Troponin of 5.2 ng/mL (5.2 mcg/L)

D. Troponin of 5.2 ng/mL (5.2 mcg/L) The test results that best confirm that this client sustained a MI is a troponin of 5.2 ng/mL (5.2 mcg/L). The presence of elevated troponin indicates myocardial damage. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? A. Reassure the client that they will not feel pain. B. Teach the client about the reason for the TEE. C. Auscultate the client's precordium for murmurs. D. Validate that the client has remained NPO.

D. Validate that the client has remained NPO.

The nurse is teaching a class on risk factors for cardiovascular disease. Which risk factors will the nurse include? (Select all that apply.) Select all that apply. Smoking history Elevated high-density lipoprotein (HDL) level Decreased bone density Low blood pressure Family history of heart disease Fiber-rich diet Elevated C-reactive protein levels Diabetes Mellitus

Smoking history Family history of heart disease Elevated C-reactive protein levels Diabetes Mellitus

Which assessment data will the nurse associate with suspected pericarditis? (Select all that apply.) Select all that apply. Sudden-onset chest pain relieved by anti-inflammatory agents. Chest and abdominal pain relieved by antacids. Chest pain relieved by sitting upright. Squeezing, vise-like chest pain. Pain in the chest described as sharp or stabbing.

Sudden-onset chest pain relieved by anti-inflammatory agents. Chest pain relieved by sitting upright. Pain in the chest described as sharp or stabbing.

laboratory assessments - serum lipids

elevated levels increase risk for CAD - cholesterol - triglycerides - HDL -LDL - HDL:LDL

hypokalemia

increased electrical instability, ventricular dysrhythmias, increased risk for digitalis toxicity (fast heart)

Hypomagnesemia

prolongs the QT interval causing a specific type of ventricular tachycardia

hypercalcemia

shortens QT intervals and causes AV block, digitalis hypersensitivity, and cardiac arrest

hyperkalemia

slowed ventricular conduction, peaked T waves on the ECG, and contraction followed by asystole (slow heart)

hypocalcemia

ventricular dysrhythmias, a prolonged QT interval, cardiac arrest