Cardio EAQ HW #2

The healthcare provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond?

"It improves oxygen supply to heart tissue." Isosorbide dinitrate dilates the coronary vasculature, improving the supply of oxygen to the hypoxic myocardium.

When assessing a client with heart failure, the nurse asks what aggravates the problem. Which activity should the nurse expect will cause the client the greatest distress?

Climbing a flight of stairs to the bedroom

A nurse is caring for a client who just had coronary artery bypass graft surgery. For which complication should the nurse monitor the client in the immediate postoperative period?

Dysrhythmias, especially atrial fibrillation Dysrhythmias such as atrial fibrillation, bradydysrhythmias, or heart block must be closely monitored for in the client immediately after surgery.

A nurse in the coronary care unit (CCU) identifies ventricular fibrillation on a client's cardiac monitor. What intervention is the priority?

Immediate defibrillation When ventricular fibrillation is verified, the first intervention is defibrillation; it is the only measure that will terminate this lethal dysrhythmia.

A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client?

Increase oxygen concentration to heart cells

A client who recently had a myocardial infarction is admitted to the cardiac care unit. How can the nurse best determine the effectiveness of the client's ventricular contractions?

Monitoring urinary output hourly

A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply.

Nausea, Yellow vision, Irregular pulse Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse.

What does a nurse who is caring for a client experiencing anginal pain expect to observe about the pain?

Relieved by sublingual nitroglycerin.

A client who is recovering from an acute myocardial infarction reports not being happy about the lack of salt with meals. Which information should the nurse share with the client about the purpose of salt restriction?

This prevents further fluid accumulation, which increases the workload of the heart

After an acute coronary syndrome a client begins a supervised, progressive jogging regimen and asks the nurse how to tell whether it is helping. What is the best response by the nurse?

"You will be able to run progressively longer distances before tiring."

A client receives a prescription for nitroglycerin sublingual as needed for anginal pain. What should the nurse include in the teaching about this medication?

Place the tablet under the tongue or between the cheek and gum.

A male client with aortic stenosis is scheduled for a valve replacement in two days. He tells the nurse, "I told my wife all she needs to know if I don't make it." What response is most therapeutic?

"You are worried about dying."

A client is admitted to the hospital with atrial fibrillation. A diagnosis of mitral valve stenosis is suspected. The nurse concludes that it is most significant if the client presents with a history of what?

Childhood strep throat Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve. Group A streptococcal antigens bind to receptors on heart cells, where an autoimmune response is triggered, damaging the heart.

A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply.

Distended abdomen, Dependent, edema, Urinating at night. Right-sided heart failure is associated with increased systemic venous pressures and congestion, as manifested by a distended abdomen, dependent edema, and urinating at night.

The nurse is preparing a care plan for a client with fatigue, angina, anxiety, and pale, cool skin. Which nursing intervention will help reduce fatigue in this client?

Encouraging diversionary activities A client with fatigue, angina, anxiety, and pale, cool skin may have decreased cardiac output. Unusual fatigue is an early symptom of myocardial infarction. Therefore the nurse should encourage the client to engage in diversionary activities as a means of conserving energy, thereby decreasing fatigue.

To manage heart failure a client has been taking several medications, including furosemide 40 mg by mouth twice a day. The client develops severe muscle cramps and fatigue, and laboratory tests confirm the presence of hypokalemia. Potassium chloride intravenously (IV) and ECG monitoring have been prescribed. Which ECG change associated with hypokalemia should the nurse expect to observe?

Flattened T waves

The nurse in the intensive care unit is monitoring a client who had an aortic valve replacement. What can a slow pulse rate during the early postoperative period after open heart surgery indicate?

Heart block During open heart surgery the conductive system of the heart can be damaged because of trauma, causing heart block.

A client is admitted to the hospital for replacement of the mitral valve. The primary purpose of the nurse frequently checking the pulses in the client's legs frequently after surgery is to detect what?

Peripheral thrombophlebitis Because blood pools in the extremities, there is an increased hazard of peripheral emboli in clients who have received a mitral valve replacement.

A primary healthcare provider prescribes atenolol 20 mg by mouth four times a day for a client who has had double coronary artery bypass surgery. What information is most important for the nurse to include in the discharge teaching plan for this client?

Avoid abruptly discontinuing the medication. An abrupt discontinuation of atenolol may cause an acute myocardial infarction.

After ordinary physical activity, a client with cardiac insufficiency reports fatigue and dyspnea that is relieved by rest. According to the New York Heart Association Heart Failure Classification, into which category of heart failure does this client fit?

Class II A client with class II heart failure may experience fatigue, palpitations, and dyspnea after ordinary physical activity. Class II heart failure is mild cardiac insufficiency that may be relieved with rest.

A client with heart failure is digitalized (given a loading dose of digoxin) and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved?

Diuresis and decreased pulse rate. Digoxin slows the heart rate, which is reflected in a slowing of the pulse; it also increases kidney perfusion, which promotes urine formation, resulting in diuresis and decreased edema.

What is the most common warning symptom of myocardial infarction in women?

Fatigue

What are the clinical manifestations of chronic mitral valve regurgitation? Select all that apply.

Fatigue, Exertional dyspnea, Holosystolic murmur

A client with Streptococcus viridans infection of a heart valve and poor oral hygiene has a persistent body temperature of 104°F, chills, and undue fatigue. While collecting data, the nurse finds that the client is experiencing symptoms of heart failure. Which nursing intervention is most beneficial for the client?

Advising the client to start complete bed rest. Streptococcus viridans infection of a heart valve associated with poor oral hygiene, a persistent body temperature of 104°F, chills, and undue fatigue has endocarditis. The nurse may recommend complete bed rest to the client with endocarditis and heart failure as a means of decreasing cardiac workload and fatigue.

A client with inflammation of the membranous sac surrounding the heart has muscle aches, fatigue, and dyspnea. The client reports chest pain that radiates to the shoulder and neck. Which condition does the client have?

Pericarditis