Cardiac HESI focus

A client comes to the ambulatory surgery unit on the morning of an elective surgical procedure. The client reports shortness of breath, dizziness, and palpitations. The nurse observes profuse diaphoresis and is concerned that the client may be having either a panic attack or a myocardial infarction. Which assessments support the conclusion that the client may be experiencing a myocardial infarction? Multiple selection question Anxiety Chest pain Irregular pulse Fear of losing control Feelings of depersonalization

Anxiety Chest pain Irregular pulse Anxiety is associated with both myocardial infarctions and panic attacks. The overwhelming chest pain that usually accompanies a myocardial infarction, due to myocardial ischemia, precipitates a feeling of impending death. Most people who have panic attacks eventually recognize that they are not going to die as a result of the attack. Chest pain is associated with both myocardial infarctions and panic attacks. Chest pain is associated with a myocardial infarction because of myocardial ischemia. It is often described as "viselike" or "crushing" in nature. The chest discomfort during a panic attack usually is not as severe as the pain associated with a myocardial infarction. Fear of losing control usually is not a characteristic associated with a myocardial infarction. Fear of losing control or of going crazy is among the criteria for the diagnosis of panic attacks. A feeling of depersonalization is not a characteristic associated with a myocardial infarction. Depersonalization (feeling detached from the self) and derealization (feelings of unreality) are among the criteria for the diagnosis of panic attacks.

Which anatomic changes result in thermodysregulation in elderly people? Multiple selection question Increased metabolic rate Increased shivering response Decreased circulation of blood Decreased number of sweat glands Decreased vasoconstrictive response

Decreased circulation of blood Decreased number of sweat glands Decreased vasoconstrictive response As aging occurs, body temperature tends to fluctuate because of the body's decreased ability to regulate its temperature. These fluctuations in temperature occur because of decreased blood circulation, decreased number and efficiency of the sweat glands, and decreased vasoconstrictive response. Increased metabolic rate and shivering response do not result in thermodysregulation; they contribute to fluctuations in the body temperature.

A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure? Multiple selection question Dependent edema Swollen hands and fingers Collapsed neck veins Right upper quadrant discomfort Oliguria

Dependent edema Swollen hands and fingers Right upper quadrant discomfort The other two are key features for L HF (collapsed neck veins and oliguria)

A nurse is caring for a client with hypertension. Which assessment finding most significantly indicates that a client is hypertensive? Multiple choice question Tachycardia Extended Korotkoff sound Sustained systolic pressure ranging from 110 to 120 mm Hg Diastolic blood pressure that remains higher than 90 mm Hg

Diastolic blood pressure that remains higher than 90 mm Hg A sustained diastolic pressure that exceeds 90 mm Hg reflects pathology and indicates hypertension. Tachycardia reflects the heart rate, not the pressures within the arteries. Extended Korotkoff sound is heard when measuring blood pressure by auscultation; it is unrelated to hypertension. Sustained systolic pressure ranging from 110 to 120 mm Hg is an expected systolic blood pressure.

A healthcare provider makes the diagnosis that an obese client has primary hypertension. Which priority information should the nurse include when preparing a teaching plan for this client? Multiple choice question Causes of the hypertension Need for exercise three times a week Foods recommended on a low-calorie and low-sodium diet Complications that involve the vascular and neurologic systems

Foods recommended on a low-calorie and low-sodium diet - it reduces their HTN

The nurse is creating a teaching plan for a client who has been prescribed a 2-gram sodium diet. Which low-sodium foods should the nurse include in the plan? Multiple choice question Meat and fish Fruits and juices Milk and cheese Dry cereals and grains

Fruits and juices Of all the basic food groups, fresh fruits and juices are the lowest in sodium. Meat and fish contain more sodium than fruits and juices. Dairy products are high in sodium and should be avoided. Dry cereals and grains contain more sodium than fruits and juices.

A client is brought into the emergency department with reports of chest pain. Which conditions does the nurse assess for in this client? Pleurisy Pneumonia Gastroenteritis Costochondritis Myocardial infarction

Pleurisy Pneumonia Costochondritis Myocardial infarction gastro causes abdominal pain = dont mistake it for gerd = gerd does cause chest pain from acid reflux

A client has a femoropopliteal bypass graft. The nurse assesses vital signs, and the client's blood pressure is 200/110 mm Hg. The nurse notifies the surgeon. What is the rationale for the nurse's action? Multiple choice question Graft is leaking. Venous return is compromised. Leg may be developing compartment syndrome. Femoropopliteal arteries are becoming occluded.

Graft is leaking. Hypertension increases pressure on the suture lines, which can affect the integrity of the graft causing leaking or rupture. A compromised venous return is evidenced by lower extremity edema, not an increase in blood pressure. Compartment syndrome is associated with circulatory, sensory, and motor alterations related to excessive interstitial fluid, the presence of which is not indicated in the question. Occluded femoropopliteal arteries were the reason that the client had the surgery; the graft bypasses the occluded area.

A client admitted to the hospital for chest pain is diagnosed with stable angina. Which information should the nurse include in the teaching session? Multiple choice question It is relieved by rest. It is precipitated by light activity. It is described as sharp or knifelike. It is unaffected by the administration of vasodilator

It is relieved by rest. Anginal pain commonly is relieved by immediate rest because rest decreases the cardiac workload and oxygen need. Angina usually is precipitated by exertion, emotion, or a heavy meal. Anginal pain usually is described as tightness, indigestion, or heaviness. Nitroglycerin, a vasodilator and a standard treatment for angina, dilates coronary arteries, which increases oxygen to the myocardium, decreasing pain.

A nurse is monitoring a client admitted with a diagnosis of myocardial infarction (MI) for dysrhythmias. Which reason for increased incidence of dysrhythmias in this client should the nurse monitor? Multiple choice question Metabolic alkalosis Myocardial hypoxia Decreased catecholamine secretion Increased parasympathetic nervous system stimulation

Myocardial hypoxia Dysrhythmias are common and result from decreased oxygen to the cells of the myocardium. Myocardial infarction with tissue necrosis results in metabolic acidosis, not metabolic alkalosis. When physical or emotional stress is experienced, such as in an MI, catecholamine secretion increases; this is part of the "fight or flight" mechanism. Increased sympathetic, not parasympathetic, nervous system stimulation may contribute to the development of dysrhythmias.

A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider? Multiple choice question Hematocrit 46% Hemoglobin 14.1 g/dL (141 mmol/L) Potassium 3.0 mEq/L (3.0 mmol/L) White blood cell 9200/mm 3 (9.2 × 10 9/L)

Potassium 3.0 mEq/L (3.0 mmol/L) A potassium level of 3.0 mEq/L (3.0 mmol/L) is indicative of hypokalemia. Normal values for an adult are 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Potassium, calcium, and magnesium control the rate and force of heart contractions. Diuretics often are used to reduce fluid volume, so the heart does not work as hard. Furosemide is a potassium-losing diuretic. Hypokalemia can result in death from dysrhythmia; therefore this must be addressed. The hematocrit level of 46% is within the normal range. A hemoglobin of 14.1 (141 mmol/L) is within normal values. White blood cell level of 9200 cells/mm 3is within the normal range of 4000 to 11,000 cells/mm 3 (4 to 11 × 10 9/L)

The treatment regimen for a female diagnosed with Hodgkin disease, stage III, will start with nodal irradiation. Because the client and her husband have been trying to conceive a child, the client becomes visibly anxious when she learns that the radiation therapy includes the pelvic nodal area. The nurse refers the client to the primary healthcare provider when the client starts to question the treatment. What is the rationale for the nurse's actions? Multiple choice question Radiation used is not radical enough to destroy ovarian function. Intermittent radiation to the area does not cause permanent sterilization. Reproductive ability may be preserved through a variety of interventions. Ovarian function will be destroyed temporarily but will return in about six months.

Reproductive ability may be preserved through a variety of intervention Reproductive ability may be preserved through shielding the ovaries or harvesting ova. Radiation can influence or destroy ovarian functioning. Sterilization can occur. Women in the childbearing years should be informed of all options available to preserve ovarian function. Once ova are destroyed, they cannot regenerate.

During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. Which response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movements? Multiple choice question Increasing pulse rate Slowing of the heart Dilating the bronchioles Reducing gastric acid secretions

Slowing of the heart Disimpaction can cause vagal stimulation, which slows the heart. The vagus is the principal nerve of the parasympathetic portion of the autonomic nervous system. Increased pulse rate is an action of the sympathetic nervous system. Stimulation of the sympathetic nervous system dilates bronchioles in the lungs; the vagus nerve constricts them. Vagus nerve stimulation increases gastric secretions.

A nurse is teaching a client with Hodgkin disease about responses to whole-body radiation. Which clinical indicator increase should the nurse include in the teaching session? Multiple choice question Blood viscosity Susceptibility to infection Red blood cell (RBC) production Tendency for pathologic fractures

Susceptibility to infection Radiation exposure may lead to depression of the bone marrow, with subsequent insufficient white blood cells (WBCs) to combat infection. There is no increase in the number of cells; therefore viscosity is not increased. RBC production is decreased by radiation. Pathologic fractures are not associated with radiation treatments.

The nurse at a health fair has taken a client's blood pressure twice, 10 minutes apart, in the same arm while the client is seated. The nurse records the two blood pressures of 172/104 mm Hg and 164/98 mm Hg. What is the appropriate nursing action in response to these readings? Multiple choice question Refer the client to a nutritionist after providing health teaching about a low-sodium diet. Place the client in a recumbent position and call the paramedics for transport to the hospital. Talk with the client to assess whether there is stress in the client's life and refer to a counseling service. Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible.

Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible. According to the United States Department of Health and Human Services (Canada: Canadian Heart and Lung Association), both of these readings indicate hypertension and thus require further evaluation by a healthcare provider; having a baseline for both arms can assist the healthcare provider with the medical diagnosis. Teaching about a low-sodium diet is an inadequate intervention. An appointment with a healthcare provider, not a nutritionist, should be scheduled as soon as possible. There are insufficient data to support this emergency intervention (calling the paramedics). The client's elevated blood pressure needs to be evaluated by a healthcare provider and then medical therapy implemented. Although emotional stress can precipitate hypertension, physical causes should be ruled out first.

The primary healthcare provider prescribes warm intravenous fluids for a client with a body temperature of 28 °C. During administration of the fluids, it is important for the nurse to continuously monitor what? Multiple choice question The client's liver function The client's cardiac function The client's red blood cell count The client's blood platelet count

The client's cardiac function Body temperature less than 30 °C indicates the need of core rewarming. Core rewarming is done by administering warm intravenous solutions, gastric lavage with warm fluid, peritoneal lavage with warm fluid, and by allowing inhalation of warmed oxygen. Core rewarming may result in cardiac dysrhythmias; therefore, the nurse monitors for cardiac function continuously to ensure safety in the client. Administration of warm intravenous fluids may not disturb liver function; therefore, there is no need to monitor liver function. Core rewarming with warm intravenous fluids may not decrease the red blood cell count and blood platelet count; therefore, there is no need to monitor the blood cell count.

A client with a long history of bilateral varicose veins questions a nurse about the brownish discoloration of the skin on the lower extremities. What should the nurse include in the response to the client's question? Multiple choice question The arterial blood supply is inadequate. There is delayed healing in the area after an injury. The production of melanin in the area has increased. There is leakage of red blood cells (RBCs) through the vascular wall.

There is leakage of red blood cells (RBCs) through the vascular wall. Increased venous pressure alters the permeability of the veins, allowing extravasation of RBCs; lysis of RBCs causes brownish discoloration of the skin. Varicose veins do not affect the arterial circulation. Although healing may be delayed, the brownish discoloration does not result from trauma. There is no increase in melanocyte activity in individuals with varicose veins.

After several months of chemotherapy treatment, a client with the diagnosis of multiple myeloma comes to the emergency department because of confusion, muscle weakness, and diarrhea. The nurse reviews the client's electronic medical record. Which complication associated with chemotherapy does the nurse suspect that the client is experiencing? her potassium was 5.8 HR 68 slightly hypothermic of 37.2 RR 22/min hyper active bowel peaking T wave, flat P wave n widening QRS complex Septic shock Tumor lysis syndrome Superior vena cava syndrome Disseminated intravascular coagulation

Tumor lysis syndrome Hyperkalemia occurs when large quantities of tumor cells are destroyed, releasing potassium and purines more rapidly than the body can manage them (tumor lysis syndrome). A serum potassium of 5.8 mEq/L (5.8 mmol/L) is more than the expected range of 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L), resulting in the abnormal ECG results. Hyperkalemia can cause a pulse in the lower range of that expected for an adult, numbness in the extremities, flaccid paresis, hyperactive bowel sounds, and diarrhea. There are no adaptations indicating septic shock. The white blood cell count (WBC) and vital signs are all within the expected range. A rapid, weak pulse, rapid respirations, increased temperature, hypotension, and warm flushed skin are associated with septic shock. Superior vena cava syndrome occurs when a tumor obstructs or compresses the superior vena cava, resulting in blockage of blood flow to the venous system of the head, neck, and upper trunk and in edema of the face (especially periorbital edema) and distention of veins of the head, neck, and chest. With disseminated intravascular coagulation (DIC) there is abnormal coagulation, resulting in bleeding from many sites, clot formation, and decreasing blood flow to major organs. Decreased circulation to organs causes pain, dyspnea, tachycardia, oliguria, bowel necrosis, and multiple organ failure.

The client reports a "fluttering in my chest." The nurse analyzes the client's heart rhythm and notices that there are three P waves for each QRS complex. The waves have a sawtooth appearance. The atrial rate is 240 beats per minute, but the ventricular rate is only 80 beats per minute. The nurse notifies the primary healthcare provider for which rhythm? Multiple choice question Atrial flutter Atrial fibrillation Ventricular fibrillation Atrial flutter with rapid ventricular response

a flutter Atrial flutter arises from a single irritable focus in the atria. The atrial focus fires at an extremely rapid, regular rate between 200 and 350 beats per minute. The P waves are called flutter waves and may have a sawtooth appearance. The ventricular response may be regular or irregular. Atrial fibrillation arises from multiple ectopic foci in the atria, causing chaotic quivering of the atria and ineffectual atrial contraction (325-600 times/min). Ventricular fibrillation (VF), sometimes called "V fib," is the result of electrical chaos in the ventricles and is life threatening. Impulses from many irritable foci fire in a totally disorganized manner so that ventricular contraction cannot occur. There are no recognizable ECG deflections. Atrial flutter with rapid ventricular response occurs when atrial impulses cause a ventricular response greater than 100 beats per minute.

When monitoring a client for hyponatremia, which assessment findings should the nurse consider significant? Multiple selection question Thirst Seizures Erythema Confusion Constipation

seizures n confusion Confusion and seizures are associated with hyponatremia. Cellular swelling and cerebral edema are associated with hyponatremia; as extracellular sodium level decreases, the cellular fluid becomes relatively more concentrated and pulls water into cerebral cells, leading to confusion and seizures. Thirst is a symptom of hypernatremia; it may indicate dehydration. Erythema is not associated with hyponatremia. Diarrhea, not constipation, is associated with hyponatremia.