Cardiac Review

A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? Answers: a. Diminished distal peripheral pulses b. Coolness and pallor of the affected limb c. Increased calf circumference d. Bilateral edema

Answer: c. Increased calf circumference Rationale: The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a complication.

The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? Answers: a. Blood pressure b. Oxygen flow rate c. Status of airway d. Level of consciousness

Answer: c. Status of airway Rationale: Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection.

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse anticipate in this client if PVCs are occurring? Answers: a. Inverted P waves before the QRS complexes b. A P wave preceding every QRS complex c. QRS complexes that are short and narrow d. Premature beats followed by a compensatory pause

Answer: d. Premature beats followed by a compensatory pause Rationale: PVCs are abnormal ectopic beats originating in the ventricles. They are characterized by an absence of P waves, the presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy.

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking? Answers: a. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years." b. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." c. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year." d. "Because most of the damage has already been done, it will be all right to cut down a little at a time."

Answer: a. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years." Rationale: The risks to the cardiovascular system from smoking are noncumulative and are not permanent. Three to 4 years after cessation, a client's cardiovascular risk is similar to that of a person who never smoked. In addition, tobacco use and passive smoking from "secondhand smoke" (also called environmental smoke) substantially reduce blood flow in the coronary arteries. The statements in the remaining options are incorrect.

Atorvastatin has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? Answers: a. "It decreases low-density lipoproteins (LDLs)." b. "It increases plasma triglycerides." c. "It increases plasma cholesterol." d. "It decreases high-density lipoproteins (HDLs)."

Answer: a. "It decreases low-density lipoproteins (LDLs)." Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. It decreases LDL cholesterol and plasma triglycerides and increases HDL cholesterol (the good cholesterol). The remaining options are not actions of this medication.

A nursing student who is researching a medication at the nurses' station asks the registered nurse (RN) what the function of an alpha-adrenergic receptor is, and where the receptors are primarily found. The RN educates the nursing student. Which statement by the nursing student indicates that teaching has been effective? Answers: a. "The peripheral arteries and veins; when stimulated they cause vasoconstriction." b."Several tissues; when stimulated they cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation." c. "The heart; when stimulated it causes an increase in heart rate, atrioventricular node conduction, and contractility." d. "Arterial and bronchial walls; when stimulated they cause vasodilation and bronchodilation."

Answer: a. "The peripheral arteries and veins; when stimulated they cause vasoconstriction." Rationale: Found in the peripheral arteries and veins, alpha-adrenergic receptors cause a powerful vasoconstriction when stimulated. The remaining options are incorrect statements.

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority? Answers: a. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver b. Knowledge of restrictions on postdischarge physical activity c. Anxiety level of the client and family d. Presence of a MedicAlert card for the client to carry

Answer: a. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver Rationale: The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.

A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? Answers: a. Assist the client to shave using an electric razor. b. Monitor the prothrombin time (PT) every 4 hours. c. Tell the client that brushing the teeth is not allowed. d. Allow the client to sit only at the bedside.

Answer: a. Assist the client to shave using an electric razor. Rationale: Clients receiving heparin are at risk for bleeding. An electric razor rather than a straight blade razor is used for shaving. Allowing the client to only sit on the side of the bed and prohibiting brushing of the teeth are inappropriate and unnecessary nursing actions. It is not necessary to monitor laboratory values every 4 hours when the client is taking subcutaneous heparin. The PT is monitored when the client is taking warfarin.

The nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is unrelated to the aneurysm? Answers: a. Hyperactive bowel sounds in the area b. Pulsatile abdominal mass c. Subjective sensation of "heart beating" in the abdomen d. Systolic bruit over the area of the mass

Answer: a. Hyperactive bowel sounds in the area Rationale: Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.

The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do? Answers: a. Lie down with the legs elevated and avoid sitting. b. Cross the legs at the ankle only, not at the knee. c. Walk for as long as possible each day. d. Sit in a chair 3 times a day for 3 hours at a time.

Answer: a. Lie down with the legs elevated and avoid sitting. Rationale: The client who has had vein ligation and stripping should avoid standing or sitting for prolonged periods. The client should remain lying down unless performing a specific activity for the first few days after the procedure. Prolonged standing or sitting increases the risk of edema in the legs by decreasing blood return to the heart. The client should avoid crossing the legs at any level for the same reason.

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider (HCP) will most likely prescribe which option? Answers: a. Maintain activity level as prescribed. b. Apply cool packs to the affected leg for 20 minutes every 4 hours. c. Maintain the affected leg in a dependent position. d. Administer an opioid analgesic every 4 hours around the clock.

Answer: a. Maintain activity level as prescribed. Rationale: Standard management for the client with DVT includes maintaining the activity level as prescribed by the health care provider; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Recent research is showing that ambulation, as previously thought, does not cause pulmonary embolism and does not cause the existing DVT to worsen. Therefore, the nurse should maintain the prescribed activity level, which could be bed rest or ambulation. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen.

Lisinopril has been prescribed for a client. What should the nurse instruct the client about this medication? Answers: a. Rise slowly from a reclining to a sitting position. b. Expect to note a full therapeutic effect immediately. c. Take the medication with food only. d. Discontinue the medication if nausea occurs.

Answer: a. Rise slowly from a reclining to a sitting position. Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor used in the treatment of hypertension. The client should be instructed to rise slowly from a reclining to a sitting position and to dangle the legs from the bed for a few moments before standing to reduce the hypotensive effect. It is not necessary to take the medication with food. If nausea occurs, the client should drink a noncola carbonated beverage and eat salted crackers or dry toast. A full therapeutic effect may be achieved in 1 to 2 weeks.

The nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? Answers: a. Sinoatrial (SA) node b. Atrioventricular (AV) node c. Purkinje fibers d. Bundle of His

Answer: a. Sinoatrial (SA) node Rationale: The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity.

The health care provider (HCP) has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure? Answers: a. Tells the client that the procedure is painless and takes 30 to 60 minutes b. Has the client sign an informed consent form for an invasive procedure c. Questions the client about allergies to iodine or shellfish d. Keeps the client on nothing by mouth (NPO) status for 2 hours before the procedure

Answer: a. Tells the client that the procedure is painless and takes 30 to 60 minutes. Rationale: Echocardiography is a noninvasive, risk-free, pain-free test that involves no special preparation. It commonly is done at the bedside or on an outpatient basis. The client must lie quietly for 30 to 60 minutes while the procedure is being performed. It is important to provide adequate information to eliminate unnecessary worry on the part of the client.

The home health nurse visits a client recovering after an episode of cardiogenic shock secondary to an anterior myocardial infarction (MI) and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? Selected Answer: Correctb. "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily." Answers: a. "I exercise every day after breakfast." b. "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily." c. "I've gained 8 pounds (3.6 kg) since discharge." d. "I take an antacid when I experience epigastric pain."

Answer: b. "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily." Rationale: The client recovering from an episode of cardiogenic shock secondary to an MI will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated MI. The complication of cardiogenic shock increases the recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing. It is best to allow the meal to settle prior to activity in order to improve circulation to the heart during exercise. Epigastric pain or a weight gain of 8 pounds (3.6 kg) is significant and should be reported to the health care provider, at which point follow-up should occur.

The nurse has completed an educational course covering first-degree heart block. Which statement by the nurse indicates that teaching has been effective? Answers: a. "Presence of Q waves indicates first-degree heart block." b. "Prolonged, equal PR intervals indicates first-degree heart block." c. "Widened QRS complexes indicate first-degree heart block." d. "Tall, peaked T waves indicate first-degree heart block."

Answer: b. "Prolonged, equal PR intervals indicates first-degree heart block." Rationale: Prolonged and equal PR intervals indicate first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An electrocardiogram (ECG) taken during a pain episode is intended to capture ischemic changes, which also include ST segment elevation or depression.

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? Answers: a. Urinary tract infection b. Acute kidney injury c. Glomerulonephritis d. Hypovolemia

Answer: b. Acute kidney injury Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal reference levels are BUN, 10-20 mg/dL (3.6-7.1 mmol/L), and creatinine, male, 0.6-1.2 mg/dL (53-106 mcmol/L) and female 0.5-1.1 mg/dL (44-97 mcmol/L). The client may need medications to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question indicate the presence of hypovolemia, glomerulonephritis, or urinary tract infection.

A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer? Answers: a. Ad lib activities as tolerated b. Bathroom privileges and self-care activities c. Strict bed rest for 24 hours after transfer d. Unsupervised hallway ambulation for distances up to 200 feet (60 meters)

Answer: b. Bathroom privileges and self-care activities Rationale: On transfer from CCU to an intermediate care or general medical unit, the client is allowed self-care activities and bathroom privileges. Activities ad lib as tolerated is premature at this time and potentially harmful for this client. It is unnecessary and possibly harmful to limit the client to bed rest. The client should ambulate with supervision in the hall for brief distances, with the distances being gradually increased to 50, 100, and 200 feet (15, 30 and 60 meters).

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take? Answers: a. Continue to monitor for any rhythm change. b. Check vital signs. c. Check laboratory test results. d. Notify the health care provider.

Answer: b. Check vital signs. Rationale: Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring between 0.12 and 0.20 seconds and 0.04 and 0.10 seconds, respectively. There are no irregularities in this rhythm currently, so there is no immediate need to check vital signs or laboratory results, or to notify the health care provider. Therefore, the nurse would continue to monitor the client for any rhythm change.

A client who has begun taking betaxolol demonstrates an effective response to the medication as indicated by which nursing assessment finding? Answers: a. Increase in edema to 3+ b. Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg c. Weight gain of 5 pounds d. Decrease in pulse rate from 74 beats/min to 58 beats/min

Answer: b. Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg Rationale: Betaxolol is a beta-adrenergic blocking agent used to lower blood pressure, relieve angina, or decrease the occurrence of dysrhythmias. Side and adverse effects include bradycardia and signs and symptoms of heart failure, such as increased edema and weight gain.

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? Answers: a. Glipizide b. Metformin c. Repaglinide d. Regular insulin

Answer: b. Metformin

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? Answers: a. Assessing pain b. Moving slowly from a sitting to a standing position c. Avoiding over-the-counter (OTC) medications d. Administering vasodilators

Answer: b. Moving slowly from a sitting to a standing position Rationale: Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls. Vasodilators normally are not prescribed for the client with cardiomyopathy. Although important, pain assessment and avoiding OTC medications are not directly related to the issue of safety.

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition? Answers: a. Atrial fibrillation b. Myocardial infarction c. Ventricular tachycardia d. Heart failure

Answer: b. Myocardial infarction Rationale: Cardiac troponin T or cardiac troponin I have been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction. The test is not used to diagnose heart failure, ventricular tachycardia, or atrial fibrillation.

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? Answers: a. Sodium level of 135 mEq/L (135 mmol/L) b. Potassium level of 6.8 mEq/L 6.8 mmol/L) c. Chloride level of 98 mEq/L (98 mmol/L) d. Magnesium level of 1.6 mEq/L (0.8 mmol/L)

Answer: b. Potassium level of 6.8 mEq/L 6.8 mmol/L) Rationale: Hyperkalemia can cause tall, peaked, or tented T waves on the ECG. Levels of potassium 5.0 mEq/L (5.0 mmol/L) or greater indicate hyperkalemia. Options 1, 2, and 4 are normal levels.

The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu? Answers: a. Coffee b. Raspberry juice c. Cola d. Tea

Answer: b. Raspberry juice Rationale: A client with a diagnosis of MI should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect, leading to further cardiac ischemia. Coffee, tea, and cola all contain caffeine and need to be avoided in the client with MI.

A client is having a follow-up health care provider (HCP) office visit after vein ligation and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which would be an appropriate action by the nurse based on evaluation of the client's comment? Answers: a. Instruct the client to apply warm packs. b. Report the complaint to the HCP. c. Reassure the client that this is only temporary. d. Advise the client to take acetaminophen until it is gone.

Answer: b. Report the complaint to the HCP. Rationale: Hypersensitivity or a sensation of pins and needles in the surgical limb may indicate temporary or permanent nerve injury following surgery. The saphenous vein and saphenous nerve run close together in the distal third of the leg. Although complications from this surgery can occur, they are relatively rare so this symptom should be reported. The actions in the remaining options are incorrect and could be harmful; in addition, they delay the possible need for intervention about the client's complaint. Although nerve damage can occur and is usually temporary and minimal and resolves within a few months, it is not appropriate to tell the client that this occurrence is only temporary. The complaint needs to be further assessed.

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? Answers: a. Oxygen saturation decreased from 96% to 91%. b. Respiratory rate increased from 16 to 19 breaths per minute. c. Pulse rate increased from 80 to 104 beats per minute. d. Blood pressure decreased from 140/86 to 112/72 mm Hg.

Answer: b. Respiratory rate increased from 16 to 19 breaths per minute. Rationale: Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.

Digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.5 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? Answers: a. Serum potassium level b. Serum magnesium level c. Serum calcium level d. Serum creatinine level

Answer: b. Serum magnesium level Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L) and the results in the correct option are reflective of hypomagnesemia.

A client is prescribed nicotinic acid for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? Answers: a. "The medication should be taken with meals to decrease flushing." b. "It is not necessary to avoid the use of alcohol." c. "Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing." d. "Clay-colored stools are a common side effect and should not be of concern."

Answer: c. "Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is an adverse effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the health care provider (HCP) immediately.

The nurse is listening to a lecture about angina. Which statement by the nurse indicates that the teaching has been effective? Answers: a. "Unstable angina is not a life-threatening condition." b. "Intractable angina rarely limits the client's lifestyle." c. "Stable angina is chronic." d. "Variant angina is caused by emotional stress."

Answer: c. "Stable angina is chronic." Rationale: Stable angina is triggered by a predictable amount of effort or emotion and is a chronic condition. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than in classic angina and tend to occur early in the day and at rest. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Intractable angina is chronic and incapacitating and is refractory to medical therapy.

The registered nurse (RN) is listening to a lecture on pulmonary edema. Which statement by the RN indicates that the teaching has been effective? Answers: a. "The client may have mild anxiety." b. "The client will not experience anxiety." c. "The client will experience extreme anxiety." d. "The client will only experience anxiety in a stressful environment."

Answer: c. "The client will experience extreme anxiety." Rationale: Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning, suffocation, or smothering. Therefore, the client will experience extreme anxiety.

The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective? Answers: a. "Oxygen has a calming effect." b. "Oxygen will prevent the development of any thrombus." c. "The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." d. "Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle."

Answer: c. "The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." Rationale: The pain associated with angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more oxygen demand on heart muscle. Supplemental oxygen will help meet the added demands on the heart muscle. Oxygen does not dilate blood vessels or prevent thrombus formation and does not directly calm the client.

The nurse employed in a cardiac unit determines that which client is the least likely to have an implanted cardioverter-defibrillator (ICD) inserted? Answers: a. A client with 3 episodes of cardiac arrest unrelated to myocardial infarction b. A client with ventricular dysrhythmias despite medication therapy c. A client with an episode of cardiac arrest related to myocardial infarction d. A client with syncopal episodes related to ventricular tachycardia

Answer: c. A client with an episode of cardiac arrest related to myocardial infarction Rationale: An ICD detects and delivers an electrical shock to terminate life-threatening episodes of ventricular tachycardia and ventricular fibrillation. This device is implanted in clients who are considered high risk, including those who have syncopal episodes related to ventricular tachycardia, those who are refractive to medication therapy, and those who have survived sudden cardiac death unrelated to myocardial infarction.

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions and short runs of ventricular tachycardia. The nurse plans to have which medication available for immediate use to treat the ventricular tachycardia? Answers: a. Acebutolol b. Verapamil c. Amiodarone d. Digoxin

Answer: c. Amiodarone Rationale: Amiodarone is an antidysrhythmic that may be used to treat ventricular dysrhythmias. Digoxin is a cardiac glycoside; verapamil is a calcium channel-blocking agent; acebutolol is a beta-adrenergic blocking agent. Digoxin can be used to treat supraventricular dysrhythmias, but is inactive against ventricular dysrhythmias. Verapamil is used to slow the ventricular rate for a client with atrial fibrillation or atrial flutter, or to terminate supraventricular tachycardia. Acebutolol is a beta blocker used to treat dysrhythmias.

The nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item? Answers: a. Cantaloupe b. Broccoli c. Antacids d. Bananas

Answer: c. Antacids Rationale: The sodium level can increase with the use of several types of products, including toothpaste and mouthwash; over-the-counter medications such as analgesics, antacids, laxatives, and sedatives; and softened water and mineral water. Clients are instructed to read labels for sodium content. Water that is bottled, distilled, deionized, or demineralized may be used for drinking and cooking. Fresh fruits and vegetables are low in sodium.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? Answers: a. Call a code. b. Call the health care provider. c. Check the client's status and lead placement. d. Press the recorder button on the electrocardiogram console.

Answer: c. Check the client's status and lead placement. Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms? Answers: a. Right ventricle b. Left atrium c. Left ventricle d. Right atrium

Answer: c. Left ventricle Rationale: Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the chambers that are primarily responsible for this disease process, although these chambers may be affected as the disease becomes more chronic.

A client with cardiac disease has begun taking propranolol, and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop? Answers: a. Drowsiness and nightmares b. Insomnia and headache c. Night cough and dyspnea d. Nausea and constipation

Answer: c. Night cough and dyspnea Rationale: Propranolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, antidysrhythmic, and antimigraine medication. It may precipitate heart failure or myocardial infarction in clients with cardiac disease. Signs of heart failure include dyspnea (particularly on exertion or lying down), night cough, peripheral edema, and distended neck veins. If signs of heart failure occur, the HCP should be notified. The symptoms noted in the remaining options identify effects of this medication that do not warrant HCP notification if they occur.

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? Answers: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus tachycardia d. Sinus dysrhythmia

Answer: c. Sinus tachycardia Rationale: Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? Answers: a. Withhold prescribed digoxin if slight respiratory distress occurs. b. Take a double dose of the diuretic if peripheral edema is noted. c. Weigh self on a daily basis. d. Sleep with the head of the bed flat.

Answer: c. Weigh self on a daily basis. Rationale: The client can best determine fluid status at home by weighing himself or herself on a daily basis. Increases of 2 to 3 lb (0.9 to 1.4 kg) in a short period are reported to the health care provider (HCP). The client should sleep with the head of the bed elevated. During recumbent sleep, fluid (which has seeped into the interstitium with the assistance of the effects of gravity) is rapidly reabsorbed into the systemic circulation. Sleeping with the head of the bed flat is therefore avoided. The client does not modify medication dosages without consulting the HCP.

A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect? Answers: a. Cough accompanied by other signs of respiratory infection b. Sudden increase in appetite c. Weight gain of 2 to 3 lb in a few days d. Increased urine output during the day

Answer: c. Weight gain of 2 to 3 lb in a few days Rationale: Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. An increase in urine output during the day is expected with diuretic therapy. A cough resulting from respiratory infection does not necessarily indicate that heart failure is worsening.

The nurse is assessing a client's legs for the presence of edema. The nurse notes that the client has mild pitting with slight indentation and no perceptible swelling of the leg. How should the nurse define and document this finding? Answers: a. 3+ edema b. 4+ edema c. 2+ edema d. 1+ edema

Answer: d. 1+ edema Rationale: Edema is accumulation of fluid in the intercellular spaces and is not normally present. To check for edema, the nurse would imprint his or her thumbs firmly against the ankle malleolus or the tibia. Normally, the skin surface stays smooth. If the pressure leaves a dent in the skin, pitting edema is present. Its presence is graded on the following 4-point scale: 1+, mild pitting, slight indentation, no perceptible swelling of the leg; 2+, moderate pitting, indentation subsides rapidly; 3+, deep pitting, indentation remains for a short time, leg looks swollen; 4+, very deep pitting, indentation lasts a long time, leg is very swollen.

The nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin notes that the heart rate is 52 beats/min. The nurse should make which interpretation of this information? Answers: a. Normal, as a result of the effects of digoxin b. Normal, because this is the reason the client is receiving digoxin c. Normal, because of the client's age d. Abnormal, requiring further assessment

Answer: d. Abnormal, requiring further assessment Rationale: The normal heart rate is 60 to 100 beats/min in an adult. On auscultating a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the health care provider for further instruction. The remaining options are incorrect interpretations because the heart rate of 52 beats/min is not normal.

The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? Answers: a. Hyperkalemia, hypoglycemia, penicillin allergy b. Increased risk of osteoporosis c. Hypouricemia, hyperkalemia d. Hypokalemia, hyperglycemia, sulfa allergy

Answer: d. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A client admitted to the hospital is taking atenolol. The nurse monitors the client for which sign or symptom of an adverse effect of the medication? Answers: a. Tachycardia b. Diaphoresis c. Nausea d. Hypotension

Answer: d. Hypotension Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. Adverse effects include profound bradycardia or hypotension. The remaining options are not adverse effects of this medication. Nausea and diaphoresis are side effects of the medication.

The nurse is preparing to ambulate a client on the third day after cardiac surgery. What should the nurse plan to do to enable the client to best tolerate the ambulation? Answers: a. Provide the client with a walker. b. Encourage the client to cough and breathe deeply. c. Remove telemetry equipment. d. Premedicate the client with an analgesic.

Answer: d. Premedicate the client with an analgesic. Rationale: The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation. Providing the client with a walker and encouraging the client to cough and breathe deeply will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? Answers: a. Pain management clinic b. Dietitian c. Medical social worker d. Smoking cessation program

Answer: d. Smoking cessation program Rationale: Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking cessation program may be helpful for many clients. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops. A dietitian, a medical social worker, and a pain management clinic are not specifically associated with the lifestyle changes required in this disorder, although they may be needed if secondary problems arise.

The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? Answers: a. Use nail polish to protect the nail beds from injury. b. Wear gloves for all activities involving the use of both hands. c. Always wear warm clothing, even in warm climates, to prevent vasoconstriction. d. Stop smoking because it causes cutaneous blood vessel spasm.

Answer: d. Stop smoking because it causes cutaneous blood vessel spasm. Rationale: Raynaud's disease is peripheral vascular disease characterized by abnormal vasoconstriction in the extremities. Smoking cessation is one of the most important lifestyle changes that the client must make. The nurse should emphasize the effects of tobacco on the blood vessels and the principles involved in stopping smoking. The nurse needs to provide information to the client about smoking cessation programs available in the community. It is not necessary to wear gloves for all activities, nor should warm clothing be worn in warm climates.

The health care provider (HCP) prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply. Answers: a. Place sequential compression boots on the client. b. Place thigh-length elastic stockings on the client. c. Encourage coughing with deep breathing. d. Encourage increased oral intake of water daily. e. Place in high Fowler's position for eating. f. Encourage the intake of dark green, leafy vegetables.

Answers: b. Place thigh-length elastic stockings on the client. c. Encourage coughing with deep breathing. d. Encourage increased oral intake of water daily. Rationale: The client with DVT may require bed rest to prevent embolization of the thrombus resulting from skeletal muscle action, anticoagulation to prevent thrombus extension and allow for thrombus autodigestion, fluids for hemodilution and to decrease blood viscosity, and elastic stockings to reduce peripheral edema and promote venous return. While the client is on bed rest, the nurse prevents complications of immobility by encouraging coughing and deep breathing. Venous return is important to maintain because it is a contributing factor in DVT, so the nurse maintains venous return from the lower extremities by avoiding hip flexion, which occurs with high Fowler's position. The nurse avoids providing foods rich in vitamin K, such as dark green, leafy vegetables, because this vitamin can interfere with anticoagulation, thereby increasing the risk of additional thrombi and emboli. The nurse also would not include use of sequential compression boots for an existing thrombus. They are used only to prevent DVT, because they mimic skeletal muscle action and can disrupt an existing thrombus, leading to pulmonary embolism.

Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. Answers: a. Obtain an intravenous (IV) infusion pump. b. Ensure that the bag is labeled so that it reads the volume of potassium in the solution c. Prepare the medication for bolus administration. d. Monitor urine output during administration. e. Ensure that the medication is diluted in the appropriate volume of fluid.

a. Obtain an intravenous (IV) infusion pump. b. Ensure that the bag is labeled so that it reads the volume of potassium in the solution d. Monitor urine output during administration. e. Ensure that the medication is diluted in the appropriate volume of fluid. f. Monitor the IV site for signs of infiltration or phlebitis.