Cardiac Prep-U
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?
High-density lipoprotein (HDL), 80 mg/dL
When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality?
Hyperkalemia
A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure?
Hypertension causes the heart's chambers to enlarge and weaken.
A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?
Hypertrophic
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?
Hypertrophic
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?
Hypokalemia
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension
While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following?
Hypovolemia and fever
A patient with endocarditis is being discharged home. In evaluating the effectiveness of patient teaching about how to prevent recurrence of the infection, the student nurse would expect the patient to state:
I will ask for antibiotics whenever I have dental work done."
A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist?
IV bolus of atropine or temp pacing
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?
IV morphine
Which rhythm is also termed a ventricular escape rhythm?
Idioventricular rhythm
A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes?
Implantable cardioverter defibrillator
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime?
Improve venous return
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 to slow to maintain an adequate cardiac output.
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.
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?
Inadequate fluid volume
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first?
Initiate transcutaneous pacing
A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient?
Insertion of a pacemaker
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?
Instruct the client to restrict food and oral intake
The nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following?
Ischemic heart disease
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?
It is used to eliminate ventricular dysrhythmias.
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.)
It is viselike and radiates to the shoulders and arms. It is sudden in onset and prolonged in duration. It is substernal in location.
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician?
JVD is noted 4 cm above the sternal angle.
During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct?
"A mechanical valve is thought to be more durable and so requires replacement less often."
The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response?
"A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."
A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?
"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."
A patient has been scheduled for cardioversion in the treatment of a tachyarrhythmia but is unclear about the particulars of the procedure after signing the necessary informed consent. How can the nurse best explain this procedure to the patient?
"Cardioversion will essentially 'reset' the cells in your heart that control the electrical activity."
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?
Lead wire dislodgement
A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume?
Leaning forward while sitting
A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?
Left ventricular assist device
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?
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?
Left ventricular function
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?
Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
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?
"Client walks 4 miles in 1 hour every day."
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?
"Client will verbalize the intention to stop smoking."
An asymptomatic client questions the nurse about mitral regurgitation and inquires about continuing exercises. Which is the most appropriate response by the nurse?
"Continue exercising until mild symptoms develop."
The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?
"Have you been to the dentist recently?"
The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?
"I have to call my doctor so I can get antibiotics before seeing the dentist."
When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful?
"I may have to take prophylactic antibiotics for up to 10 years."
The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse?
"I need to stay away from microwaves."
A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching?
"I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD."
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?
"I should expect a low-grade fever and swelling at the site for the next week."
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement?
"I sleep on three pillows each night."
The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. What statement made by the patient demonstrates understanding?
"I will avoid caffeine, alcohol, and smoking."
A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client understands what is required to help minimize rejection?
"I will need to take three different types of medications for the rest of my life to help prevent rejection."
Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following?
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
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."
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?
"Removing the patch at night prevents drug tolerance while keeping the benefits."
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?
"Spike" on the rhythm strip
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?
"The pain occurred while I was mowing the lawn."
A nurse working in the medical intensive care unit has a patient admitted with mitral stenosis. The nurse is precepting a new graduate and explains the pathophysiology of the condition. Which of the following statements made by the new graduate would reflect an appropriate understanding of the disease process? Choose all that apply.
"There is a narrowing between the left atrium and left ventricle." "Increased blood flow in the left atrium causes left atrial hypertrophy."
The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following?
"This test will show any blood clots in the heart and if it is safe to do a cardioversion."
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?
"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
The nurse cares for a 56-year-old client who received an implantable cardioverter defibrillator (ICD) 2 days prior. The client tells the nurse "My wife and I can never have sex again now that I have this ICD." What is the nurse best response by the nurse?
"You seem apprehensive about resuming sexual activity."
The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching?
"i can still drink coffee and tea"
As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid.
Low-density lipoproteins (LDL)
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?
0.12-0.20 seconds
Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds?
0.2
A client is receiving morphine to relieve chest pain. The order is for 4 mg IV now. The pharmacy supplies morphine sulfate at 5 mg per mL. How many mL will the nurse give the client?
0.8
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
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first?
12-lead ECG
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?
The development of left-sided heart failure
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
A nurse caring for a patient with mitral stenosis understands that the initial cause of disruption to the normal flow of blood through the heart is due to:
The increased resistance of a narrowed orifice between the left atrium and the left ventricle.
What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)?
The level of physical activity each allows
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?
The need to have regular blood levels drawn
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?
The nurse knows that what PR interval presents a first-degree heart block?
The nurse knows that what PR interval presents a first-degree heart block?
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)?
The patient has at least a 70% occlusion of a major coronary artery.
A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant?
The patient reports shortness of breath when walking.
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?
Magnesium and potassium
Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?
Maintain the client on bed rest
The triage nurse in the emergency department assesses a 66-year-old male patient who has presented to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects a myocardial infarction (MI). The nurse is aware that, because of the length of time the patient has been experiencing symptoms, the following may have happened to the myocardium:
May have developed an increased area of infarction
A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended?
Maze procedure
Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone?
Monitor blood pressure frequently
A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply.
Monitor the client for signs of lethargy or confusion. Examine the client's neck for distended veins.
A patient has missed 2 doses of digitalis. What laboratory results would indicate to the nurse that the patient is within therapeutic range?
2.0
Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal?
2.0 to 2.5
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
Monitor vital signs and cardiac rhythm
The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm?
20 to 40
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse?
3 minutes
A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider?
3.8
A client has had an echocardiogram to measure ejection fraction. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects?
55%
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as
60 bpm.
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)?
60 minutes
A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis?
A client 4 days postoperative after mitral valve replacement
The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first?
A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?
A client with atrial dysrhythmias
The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?
A defibrillator
The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to:
A lack of oxygen in the heart muscle that causes the death of cells.
The nurse is obtaining a history from a patient diagnosed with hypertrophic cardiomyopathy. What information obtained from the patient is indicative of this form of cardiomyopathy?
A parent has the same disorder
Antibiotic prophylaxis is recommended for the prevention of infective endocarditis (IE). The nurse must advise the patient with which of the following medical condition that prophylaxis is essential?
A prosthetic valve
Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure.
A serum BUN of 70 mg/dL
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?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take?
Administer the medication as ordered.
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains afterload to the student and then asks the student what nursing interventions might cause decreased afterload. The student correctly answers which of the following?
Administration of a vasodilating drug (as ordered by a physician)
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following?
Administration of a vasodilating drug (as ordered by a physician)
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse?
Altered level of consciousness
The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?
Altered patterns frequently affect the heart's ability to pump blood effectively.
What is the drug of choice for a stable client with ventricular tachycardia?
Amiodarone
The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?
Aortic regurgitation
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block?
More P waves than QRS complexes
A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?
Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?
Ask the patient to lean forward and listen again.
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
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?
Assess for factors that may be causing the client's delirium.
A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing intervention?
Assess oxygen saturation
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
Assess the characteristics of chest pain.
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 will the nurse suspect?
Myocardial infarction (MI)
Which of the following medications is a human brain natriuretic peptide (BNP) preparation?
Natrecor
A nurse understands that a patient with hypertrophic cardiomyopathy (HCM) would not be treated with which of the following drug classifications?
Nitrates
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experieincing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician?
Nitroglycerin SL
A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment?
Assessing the patient for signs and symptoms of hemorrhage
A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. What action by the nurse will provide this information?
Assist the client in identifying life areas over which the client still has control.
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication?
Atelectasis
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?
Atherosclerosis
Which condition most commonly results in coronary artery disease (CAD)?
Atherosclerosis
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?
Atrial fibrillation
A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what?
Atrial rate of 300 to 400
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?
Atropine
Which medication is the drug of choice for sinus bradycardia?
Atropine
The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed.
Atropine sulfate
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.
Avoid elevating the knees on the bed. Apply antiembolism stockings. Initiate passive exercises.
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 Check pulse daily, reporting sudden slowing or increase Wear a medical alert, noting the presence of a pacemaker
A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.)
Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation.
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker?
Avoid sources of electrical interference
A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker?
Avoid sources of electrical interference.
The Cardiac Nurse Clinician is teaching a group of clients with heart failure about self-management of their disease. What dietary advice should the Nurse Clinician give to clients with severe heart failure until edema resolves?
Avoid the intake of processed and commercially prepared foods.
After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker?
Avoid undergoing magnetic resonance imaging (MRI).
Which of the following is a key diagnostic laboratory test for heart failure?
B-type natriuretic peptide
A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure?
BNP
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client?
BP and pulse measurements every 15 to 30 minutes
A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed?
Balloon percutaneous valvuloplasty
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
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?
Bigeminy
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
The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure?
Brain natriuretic peptide (BNP)
A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient's signs and symptoms of HF. How can the nurse best monitor the patient's fluid balance?
By performing daily weights at the same time each day
Which is a diagnostic marker for inflammation of vascular endothelium?
C-reactive protein (CRP)
CH 28
CH 28
CH 29
CH 29
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.
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?
Cardiac tamponade
Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which statement does the nurse note is not correct?
Cardioversion uses more electrical energy than defibrillation.
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?
Central venous pressure reading of 1
Ch 27
Ch 27
chapter 26
Chapter 26
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.
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?
Chest discomfort not relieved by rest or nitroglycerin
A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis?
Chest pain
The nurse is caring for a client in the hospital with chronic heart failure that has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, he becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)?
Class III (Moderate)
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients?
Clients with recurrent life-threatening tachydysrhythmias
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin?
Clopidogrel (plavix)
The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)?
Congestion in the peripheral tissues
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis
Constant chest pain
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?
Notify the health care provider.
The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman's sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding?
The woman may be experiencing an exacerbation of right-sided HF.
The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following?
Obtaining a throat culture
A client with infective endocarditis (IE) and a fever is admitted to the intensive care unit. Which of these physician orders should the nurse implement first?
Order blood cultures drawn from two sites
patient with angina is beginning nitroglycerin. Before administering the drug, the nurse informs the patient that, immediately after administration, the patient may experience what?
Throbbing headache or dizziness
Which is a classic sign of cardiogenic shock?
Tissue hypoperfusion
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?
To decrease workload of the heart
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?
P wave
A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply.
P wave P-R interval T wave
A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.
Tobacco use Obesity Hyperlipidemia
Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following:
Pace maker site infection
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration?
Paroxysmal atrial tachycardia
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low?
U wave
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?
Unstable
A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding?
Peaked T waves
Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?
Pericardial friction rub
A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?
Pericarditis
The client with cardiac failure is taught to report which symptom to the physician or clinic immediately?
Persistent cough
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)
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?
Potassium
The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?
Potassium level of 3.1
The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported.
Potassium level of 6 mEq/L
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?
Potassium levels
The instructor is talking with a nursing student who is caring for a client with pericarditis. The instructor asks the student to name the main characteristic of pericarditis. What should be the student's answer?
Precordial pain
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response?
Premature atrial complex
The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia?
Premature ventricular contraction
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?
Ventricular fibrillation
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?
Ventricular fibrillation
The nurse knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following?
Ventricular repolarization
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery?
Warfarin
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?
Premature ventricular contraction (PVC)
A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient?
Prepare for pericardiocentesis.
Which mitral valve condition generally produces no symptoms?
Prolapse
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?
Prothrombin time (PT) or international normalized ratio (INR)
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.)
Pulmonary crackles Cough Dyspnea
Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure?
Push fluids
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
The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload?
When resting, sit up with the legs down to pool blood in the legs.
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be
A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?
Question the client about alcohol and illicit drug use.
A nursing student is assigned to the medical intensive care unit for the first time. The nurse preceptor asks the student to listen to a water-hammer pulse. The nursing student knows that the sound will resemble which of the following?
Quick, sharp strokes that suddenly collapse
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?
RR interval
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?
Reassure the client by informing him or her that the lump will disappear with time.
Which is not a likely origination point for cardiac dysrhythmias?
Which is not a likely origination point for cardiac dysrhythmias?
Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic?
Reports of constant chest pain
Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion?
Rest and sleep in a chair or sit in bed with head elevated
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
Withhold anticoagulant therapy.
A nurse is conducting a heath history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis?
Rheumatic endocarditis
What is the most common cause of mitral stenosis?
Rheumatic endocarditis
A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease?
Rheumatic fever
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?
Right side of sternum, fourth intercostal space
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
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?
Risk for infection
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?
ST elevation
In arteriosclerosis, commonly referred to as hardening of the arteries, the rigid arterial vessels fail to stretch. This has the potential for what?
Sending a reduced volume of oxygenated blood to the major organs of the body
A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result?
Severe heart failure
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion?
Shortness of breath
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?
Shortness of breath
The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe?
Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
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?
Smoking cessation
Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)?
Spironolactone
Which is a potassium-sparing diuretic used in the treatment of heart failure?
Spironolactone
Which is a manifestation of right-sided heart failure?
Systemic venous congestion
Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community?
Teach individuals in the community to seek medical treatment for streptococcal pharyngitis.
The nurse is administering nitroglycerin, which he knows decreases preload as well as afterload. Preload refers to which of the following?
The amount of blood presented to the ventricles just before systole
The nurse is discussing cardiac hemodynamics with a nursing student, who understands the the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The nursing student asks what determines heart rate. The correct response by the nurse is which of the following?
The autonomic nervous system controls the heart rate.
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.
A patient converts from normal sinus rhythm at 80 beats/min to atrial fibrillation with a ventricular response at 166 beats/min. Blood pressure is 162/74. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the primary goal of treatment is what?
Control ventricular rate
You are taking a pre-nursing pharmacology class. Today you are learning about anti-dysrhythmic drugs. What drug is a potassium channel blocker?
Cordarone
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 you suspect in this client?
Coronary artery disease
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?
Coronary artery disease
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?
Coronary artery spasm.
Before using a defibrillator to terminate ventricular fibrillation, a nurse should check the synchronizer switch. Why is this check so important?
The defibrillator won't deliver a shock if the synchronizer switch is turned on.
Which of the following body system responses correlates with systolic heart failure (HF)?
Decrease in renal perfusion
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension?
Decreased cardiac output and decreased systolic and diastolic blood pressure
For a client with cardiomyopathy, the most important nursing diagnosis is:
Decreased cardiac output related to reduced myocardial contractility.
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?
Decreases resting heart rate
After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following?
Defibrillation
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way?
Diet therapy and smoking cessation
The nurse is caring for a patient diagnosed with myocarditis. The nurse is aware that patients with myocarditis are sensitive to what medication?
Digoxin
Which medication reverses digitalis toxicity?
Digoxin immune FAB (Digibind)
The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)?
Dizziness
Which is a cerebrovascular manifestation of heart failure?
Dizziness
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response?
Document the findings and continue to monitor the client
A patient is given a prescription for Lopressor, a beta-blocker, after being examined by his health care provider. Select the most important information the nurse should provide.
Don't suddenly stop taking the medication without calling your health care provider.
The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include?
During the procedure, the arrhythmia will be reproduced under controlled conditions.
A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure?
Dyspnea, orthopnea, pulmonary edema
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
A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis?
Echocardiography
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?
Echocardiography
A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia?
Elective cardioversion
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?
Elective cardioversion
A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client?
Elective electrical cardioversion
Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply.
Elevated white blood cell (WBC) count Elevated erythrocyte sedimentation rate (ESR) Elevated c-reactive protein
A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention?
Eliminate caffeine and alcohol
The nurse is asked to explain ventricular bigeminy to a patient. The nurse explains that it is a conduction defect in which:
Every other complex is a PVC.
In providing nursing management to a client post-varicose vein surgery, the nurse would include which of the following teaching measures? Select all that apply.
Exercise Elastic stockings
A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?
Exertional dyspnea, orthopnea, pulmonary edema
The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse?
Extra heart sound
Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure?
Fatigue
What is a characteristic of atherosclerosis?
Fatty deposits in the lumen of arteries
Which signs and symptoms accompany a diagnosis of pericarditis?
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?
Fluttering
A young mother brings her 4-year-old in to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The mother states the child has been healthy until about 3 weeks ago when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis?
Group A beta-hemolytic strep
patient with a prosthetic heart valve is diagnosed with subacute infective endocarditis. The nurse knows that the majority of these infections are caused by:
Group A, beta-hemolytic Streptococcus
A patient experiences a faster-than-normal heart rate when she drinks more than two cups of coffee in the morning. The nurse knows that an indicator of sinus tachycardia on an ECG would be which of the following?
HR 118
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
Heart
Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a:
Heart rate of 42 beats per minute (bpm).
Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed?
Heart transplant
A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following?
Heart transplantation
A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern?
Hematocrit of 30%
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?
Within 6 hours
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.
An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is:
an expected part of the aging process.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?
anticoagulant
A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following?
anything that stimulates the sympathetic nervous system (positive chronotropy)
A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response?
asses client and monitor leads
A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:
assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin.
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?
atrial depolarization
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?
atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?
atrial flutter
A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?
atropine
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to
avoid caffeinated beverages
A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?
begin CPR
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug?
calcium-channel blocker
A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid:
canned peas
A client who has been diagnosed with Prinzmetal's angina will present with which symptom?
chest pain that occurs at rest and usually in the middle of the night
After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following?
defib
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
delayed conduction, producing prolonged PR
The nurse is caring for a patient diagnosed with myocarditis. The nurse is aware that patients with myocarditis are sensitive to what medication?
digoxin
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?
double check monitoring equipment
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
Which diagnostic study is usually performed to confirm the diagnosis of heart failure?
echocardiogram
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?
electrocardiogram`
A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of
embolic stroke.
The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to:
enhance myocardial oxygenation.
A nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first:
establish unresponsiveness.
Which medication is categorized as a loop diuretic?
furosemide
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
high
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a:
high LDL level.
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
high.
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
ill keep a log of each time my ICD discharges
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:
inherent rhythmicity of cardiac muscle tissue.
A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client
is able to discuss the prognosis freely.
One of the most common causes of mitral valve regurgitation in people living in developed countries is
ischemia of the left ventricle.
A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following?
it increases the force of myocardial contraction
Which is a characteristic of right-sided heart failure?
jvd
Which of the following types of diuretic is the first-line treatment for those diagnosed with heart failure (HF)?
loop
If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected?
mitral valve
A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client?
nausea and vomiting
The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:
occur at rate of more than six per minute
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?
p wave
The nurse has entered the room of a patient and found the patient diaphoretic, panicked, and clutching his chest. What action should the nurse first perform?
perform rapid assmt of pt
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
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what action should the nurse perform?
place in high fowlers
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?
preload
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?
prior intracranial hemorrhage
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain?
pulm crackles
A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of
pulmonary embolism
A client with a recent history of atrial fibrillation has been prescribed warfarin. When confirming whether the prescribed dose is safe and appropriate for the client, the nurse should:
review the client's international normalized ratio (INR).
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have?
sinus bradycardia
When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating
sinus dysrhythmia.
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?
sinus tachycardia
A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose?
supraventricular tachycardia
The nurse is caring for a client with dysrhythmia. What would be an important procedure to teach a client with dysrhythmia to perform to evaluate his or her response to treatment?
technique for palpating and counting radial pulse
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated?
the RN administering atropine sulfate IV
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?
the pt with atrial dysrhythmias
When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block?
third degree
The nurse knows which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other?
third degree AV block
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes:
treating the underlying cause
A patient, who is resting quietly in a step-down cardiac care unit, reports chest pain. The cardiac monitor indicates the presence of reversible ST-segment elevation. The nurse understands that the patient may be experiencing coronary artery vasospasm. This is a type of angina known as:
variant
A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents:
ventricular depolarization
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during
ventricular depolarization.
A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity?
visual disturbances.
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?
warfarin
A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor?
weight
The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include?
your family and friends may want to take a CPR class
