Chapter 21 Prepu Med Surgical 2

The nurse accompanies a client to an exercise stress test. The client can achieve the target heart rate, but the electrocardiogram indicates ST-segment elevation. Which procedure will the nurse prepare the client for next? a. trans-esophageal echocardiogram b. telemetry monitoring c. cardiac catheterization d. pharmacologic stress test

Cardiac catheterization An elevated ST segment means an evolving myocardial infarction. A cardiac catheterization would be the logical next step.

The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition? a. catheter-related bloodstream infections b. hemorrhage c. pneumothorax d. air embolism

Catheter-related bloodstream infections (CRBSI)

The nurse is caring for a client with a damaged tricuspid valve. The nurse knows that the tricuspid valve is held in place by which of the following? a. Chordae tendineae b. Semilunar tendineae c. Atrioventricular tendons d. Papillary tendons

Chordae tendineae

The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current? a. Once the electrodes are applied, change them every 72 hours. b. Clip the client's chest hair prior to applying the electrodes. c. Apply baby powder to the client's chest prior to placing the electrodes. d. Clean the client's chest with alcohol prior to application of the electrodes.

Clip the client's chest hair prior to applying the electrodes.

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). The client's blood pressure is 104/68 mm Hg. The client's pulse rate is 76 beats/minute. The nurse detects weak pulses in the leg distal to the puncture site. The skin on the leg is cool to the touch. The puncture site is dry but swollen. What is the most appropriate action for the nurse to take? a. Document findings and check the client again in 1 hour. b. Contact the health care provider and report the findings. c. Slow the I.V. fluid to prevent any more swelling at the puncture site. d. Encourage the client to perform isometric leg exercises to improve circulation in the legs.

Contact the health care provider and report the findings. The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the health care provider immediately to preserve the blood flow in the client's leg.

A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a. Re-zero the equipment and take another reading. b. Call the physician and obtain an order for a diuretic. c. Continue to monitor the client as ordered. d. Call the health care provider and obtain an order for a fluid bolus.

Continue to monitor the client as ordered. Normal CVP ranges from 3 to 7 mm Hg. The nurse doesn't need to take any action other than to monitor the client. It isn't necessary to re-zero the equipment. Calling a physician and obtaining an order for a fluid bolus would be an appropriate intervention if the client has a CVP less than 3 mm Hg.

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? a. Crackles b. Coarseness c. Whistling d. Rhonchi

Crackles

The nurse is performing an assessment of a client's peripheral pulses and indicates that the pulse quality is +1 on a scale of 0-4. What does this documented finding indicate? a. Difficult to palpate and is obliterated with pressure. b. Diminished, but cannot be obliterated with pressure. c. Full, easy to palpate, and cannot be obliterated with pressure. d. Strong and bounding and may be abnormal.

Difficult to palpate and is obliterated with pressure. The quality of pulses is reported using descriptors and a scale of 0 to 4. The lower the number, the weaker the pulse and the easier it is to obliterate it. A +1 pulse is weak and thready and easily obliterated with pressure.

A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient? a. Clopidogrel b. Digoxin c. Heparin d. Enoxaparin

Digoxin Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.

The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for cardiac dysrhythmia. Which of the following assessment considerations is essential when caring for this client? a. Activity level b. Dyspnea c. Cardiac output d. Digoxin level

Digoxin level

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a. Thallium b. Ativan c. Diazepam d. Dobutamine

Dobutamine Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. Options A, B, and C would not dilate the coronary arteries.

The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers which explanation? a. Fluid that is held in the lungs during the day becomes part of the circulation at night and the kidneys produce an increased amount of urine. b. The blood pressure is lower when the client is recumbent and this causes the kidneys to work harder; therefore, more urine is produced. c. Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys. d. When the client is in the recumbent position, more pressure is put on the bladder with the result of an increased need to urinate.

Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys. Explanation: Nocturia is common in patients with heart failure. Fluid collected in dependent areas during the day is reabsorbed into circulation at night when the client is recumbent. The kidneys excrete more urine with the increased circulating volume.

Which area of the heart is located at the third intercostal space to the left of the sternum? a. epigastric area b. aortic area c. Erb point d. pulmonic area

Erb point

The nurse prepares to auscultate heart sounds. What nursing intervention will be most effective to assist with this procedure? a. Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard. b. Ask the client to sit on the edge of the bed and hold breath while the nurse listens. c. Insist that the family members leave the room if they must speak to each other while the nurse is auscultating heart sounds. d. Ask the client to take deep breaths through the mouth while the nurse auscultates heart sounds.

Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard.

Orthostatic (postural) hypotension is a sustained decrease of at least 10 mm Hg in systolic BP or 20 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting to a standing position. FALSE TRUE

FALSE

The patient undergoing nuclear imaging techniques with stress testing should be instructed not to eat or drink anything for at least 12 hours before the test. FALSE TRUE

False: correct time frame is 6 to 8 hours

The apical impulse, formerly called the point of maximum impulse (PMI), is normally palpable at the intersection of the midclavicular line of the left chest and at the_________________ intercostal space.

Fifth

The nurse instructor is teaching a group of nursing students about adventitious heart sounds. The instructor explains that auscultation of the heart requires familiarization with normal and abnormal heart sounds. What would the instructor tell these students a ventricular gallop indicates in an adult? a. Normal functioning b. Hypertensive heart disease c. Pericarditis d. Heart failure

Heart failure

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? a. Myocardial infarction b. Heart failure c. Pericarditis d. Pulmonary embolism

Heart failure An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.

The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 9 mm Hg and recognizes that this finding indicates the client is most likely experiencing which condition? a. excessive blood loss b. left-sided heart failure c. hypervolemia d. overdiuresis

Hypervolemia The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.

The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition? a. Enhanced sensitivity to digitalis b. Inclination to ventricular fibrillation c. Increased risk of heart block d. Impaired myocardial contractility

Impaired myocardial contractility Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate? a. complete blood count (CBC) b. Sodium c. international normalized ratio (INR) d. partial thromboplastic time (PTT)

International normalized ratio (INR)

The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which finding is a priority to report to the healthcare provider? a. Ca++ 9 mg/dL b. Na+ 140 mEq/L c. Mg++ 2 mEq/L d. K+ 3.1 mEq/L

K+ 3.1 mEq/L

The nurse is caring for a client scheduled for a transesophageal echocardiogram. What nursing intervention is a priority after the procedure? a. Keep the head of the bed elevated 45 degrees and keep NPO until return of the gag reflex. b. Observe for bloody urine and stools. c. Keep the client turned to the right side and watch for bleeding from the site. d. Monitor the puncture site and assess the affected extremity.

Keep the head of the bed elevated 45 degrees and keep NPO until the return of the gag reflex.

The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position? a. Left 5th intercostal space at the midclavicular line b. Right 2nd intercostal space at the midclavicular line c. Left 2nd intercostal space at the midclavicular line d. Right 3rd intercostal space at the midclavicular line

Left 5th intercostal space at the midclavicular line

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs? a. right atrium b. left ventricle c. right ventricle d. left atrium

Left atrium The left atrium receives oxygenated blood from the lungs. The left ventricle pumps that blood to all the cells and tissues of the body. The right atrium receives deoxygenated blood from the venous system. The right ventricle pumps that blood to the lungs to be oxygenated

________________changes are recommended to lower cholesterol levels.

Lifestyle

After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When auscultating a murmur, what does the nurse expect to hear? a. Loud and may be associated with a thrill sound similar to (a purring cat). b. Easily heard with no palpable thrill. c. Very loud; can be heard with the stethoscope half-way off the chest. d. Quiet but readily heard.

Loud and may be associated with a thrill sound similar to (a purring cat).

While the nurse is preparing a client for a cardiac catheterization, the client states that they have allergies to seafood. Which of the following medications may the nurse give prior to the procedure? a. Lorazepam b. Phenytoin c. Furosemide d. Methylprednisolone

Methylprednisolone If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed.

The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a. Diltiazem b. Metoprolol c. Propafenone d. Amiodarone

Metoprolol

The S1 heart sound results from closure of the __________ and tricuspid valves.

Mitral

Turbulent blood flow caused by a narrowed or malfunctioning valve is called a ______________, which can be heard during auscultation of the heart.

Murmur

The client's heart rate is observed to be 140 bpm on the monitor. The nurse knows to monitor the client for what condition? a. A stroke b. Myocardial ischemia c. A pulmonary embolism d. Right-sided heart failure

Myocardial ischemia As heart rate increases, diastolic time is shortened, which may not allow adequate time for myocardial perfusion. As a result, clients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardias (heart rate greater than 100 bpm), especially clients with coronary artery disease.

The student nurse is preparing a teaching plan for a client being discharged status post-MI. What should the nurse include in the teaching plan? Select all that apply. a. Need for careful monitoring for cardiac symptoms b. Need for early resumption of pre-diagnosis activity c. Need for dietary modifications d. Need for carefully regulated exercise e. Need for increased fluid intake

Need for careful monitoring for cardiac symptoms Need for carefully regulated exercise Need for dietary modifications Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing three major cardiovascular risk factors: hyperlipidemia, hypertension, and diabetes. There is no need to increase fluid intake and activity should be slowly and deliberately increased.

The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings? a. Assess the client for pitting edema. b. Assess the client's capillary refill. c. Obtain an oxygen saturation level. d. Obtain a 12-lead ECG tracing.

Obtain an oxygen saturation level.

You are working on a telemetry unit. Your client was admitted with a cardiac event and is now on a cardiac monitor. You know a cardiac monitor reveals the heart's electrical but not its mechanical activity. How would you assess the mechanical activity of the client's heart? a. Percuss the perimeter of the heart. b. Palpate a peripheral pulse. c. Auscultate the carotid artery. d. Take the blood pressure in both arms.

Palpate a peripheral pulse.

A nurse is assessing a client with heart failure. When assessing hepato-jugular reflux, what is the appropriate action for the nurse to take? a. lay the client flat in bed. b. press the right upper abdomen. c. press the left upper abdomen. d. elevate the client's head to 90 degrees.

Press the right upper abdomen. As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a client has positive hepatojugular reflux. Hepatojugular reflux, a sign of right-sided heart failure, is assessed with the head of the bed at a 45-degree, not 90-degree, angle.

The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? a. Pulse pressure b. Korotkoff sound c. Auscultatory gap d. Pulse deficit

Pulse pressure

The clinic nurse is assessing a client's pulse before outpatient diagnostic testing. What should the nurse document when assessing the client's pulse? a. Rate, quality, and rhythm b. Pressure, rate, and rhythm c. Quality, volume, and rate d. Rate, rhythm, and volume

Rate, quality, and rhythm

Central venous pressure is measured in which heart chamber? a. right atrium b. left ventricle c. left atrium d. right ventricle

Right atrium The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart. The left atrium receives oxygenated blood from the pulmonary circulation. The left ventricle receives oxygenated blood from the left atrium. The right ventricle is not the central collecting chamber of venous circulation.

The nurse is caring for a client with a nursing diagnosis of ineffective tissue perfusion. Which area of the heart would the nurse anticipate being compromised? a. Right atrium b. Pulmonary artery c. Aorta d. Right ventricle

Right ventricle There are four chambers to the heart. The right and left ventricles are the heart's major pumping chambers. The right ventricle pumps to the lungs to oxygenate the blood. The left ventricle pumps blood to the tissues and cells. The pulmonary artery and aorta are not of the heart.

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: a. Right ventricular pressure must be higher than pulmonary arterial pressure. b. Right ventricular pressure must decrease with systole. c. The atrioventricular valves must open. d. The pulmonic valve must be closed.

Right ventricular pressure must be higher than pulmonary arterial pressure. For the right ventricle to pump blood in need of oxygenation into the lungs via the pulmonary artery, right ventricular pressure must be higher than pulmonary arterial pressure.

The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this? S3 S2 S1 S4

S3

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by: a. An excess level of thyroid hormone. b. Stimulation of the vagus nerve. c. An increased level of catecholamines. d. Sympathetic nervous system stimulation.

Stimulation of the vagus nerve. Explanation: Parasympathetic impulses, which travel to the heart through the vagus nerve, can slow the cardiac rate.

An elevated blood level of the amino acid homocysteine is believed to indicate a high risk for coronary artery disease. FALSE TRUE

TRUE

During diastole, the tricuspid and mitral valves are open, allowing the blood in the atria to flow freely into the relaxed ventricles. FALSE TRUE

TRUE

The sinoatrial (SA) node, with an inherent firing rate of 60 to 100 impulses/min, is considered the primary pacemaker of the heart. FALSE TRUE

TRUE

A client needs additional information about a heart condition. The client asks the nurse, "What is considered the pacemaker of the heart?" a. The AV node b. The Purkinje fibers c. The SA node d. The bundle of HIS

The SA node

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. What priority reason will the nurse notify the healthcare provider? a. These values show a risk for dysrhythmias. b. The client is at risk for renal failure due to the contrast agent that will be given during the procedure. c. The client is at risk for bleeding. d. The client is overhydrated, which puts him at risk for heart failure during the procedure.

The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

A nurse is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which action would pose a threat to the client? a. The client asks questions. b. The client wears a watch. c. The client lies still. d. The client hears thumping sounds.

The client wears a watch.

A patient recently diagnosed with pericarditis asks the nurse to explain what area of the heart is involved. How does the nurse best describe the pericardium to the client? a. Exterior layer of the heart. b. Inner lining of the heart and valves. c. Heart's muscle fibers. d. Thin fibrous sac that encases the heart.

Thin fibrous sac that encases the heart.

During_________________ systole, contraction of the papillary muscles causes the chordae tendineae to become taut, keeping the valve leaflets approximated and closed.

Ventricular

The cardiologist has scheduled a client for drug-induced stress testing. What instructions should the nurse provide to prepare the client for this test? a. You will begin exercising at a slow speed. b. You may experience an onset of dizziness during the test. c. You will receive medication via IV administration. d. You will need to wear comfortable shoes to the test.

You will receive medication via IV administration. Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. Drugs may be used to stress the heart for clients with sedentary lifestyles or those with a physical disability, such as severe arthritis, that interfere with exercise testing. Drug-induced stress testing does not require the client to exercise. Instead, drugs are used to stress the heart. Clients performing exercise electrocardiography should report chest pain, dizziness, leg cramps, or weakness if they experience them during the test.

Age-related changes associated with the cardiac system include: a. increase in the number of SA node cells. b. decreased size of the left atrium. c. myocardial thinning. d. decreased elasticity of arteries.

decreased elasticity of arteries.

During an initial assessment, the nurse measures the client's apical pulse and compares it to the peripheral pulse. The difference between the two is known as pulse: a. volume. b. quality. c. deficit. d. rhythm.

deficit

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain? a. blood pressure in the left arm b. description of the pain c. sound of the apical pulses d. pulse rate in upper extremities

description of the pain

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? a. myocardium b. epicardium c. endocardium d. pericardium

endocardium

A client with a history of right-sided heart failure lives in a long-term care facility. In the daily assessment, the nurse is required to record the level of this client's peripheral edema. Which would be the main area for examination? a. knees and elbows b. feet and ankles c. lips and earlobes d. over the sacrum

feet and ankles

The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? a. myocardial infarction b. ventricular hypertrophy c. heart failure d. pulmonary edema

heart failure

The nurse is performing an assessment for an older adult client and auscultates an S3 heart sound. What condition does the nurse determine may correlate with this finding? a. heart failure b. aortic stenosis c. congenital heart disease d. coronary artery disease

heart failure

The electrical conduction system of the heart has several components, all of which are instrumental in maintaining the polarization, depolarization, and repolarization of cardiac tissue. Which of the conductive structures is known as the pacemaker of the heart? a. atrioventricular node b. sinoatrial node c. bundle branches d. bundle of His

sinoatrial node

The nurse is reviewing the laboratory results for a client with heart failure. Which laboratory value will the nurse report to the health care provider? a. potassium 3.9 mEq/L b. sodium 148 mEq/L c. calcium 9.8 mg/dL d. magnesium 2.5 mg/dL

sodium 148 mEq/L

During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? a. high-pitched sounds b. wheezes with wet lung sounds c. laborious breathing d. stridor

wheezes with wet lung sounds Explanation: If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does NOT reveal a high-pitched sound.

Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes no active gag reflex. What nursing action is a priority? position the client on his side. a. insert an oral airway. b. withhold food and fluids. c. introduce a nasogastric (NG) tube. d. position the client on his side.

withhold food and fluids.

The nurse admits an adult female client with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. What response by the nurse will be most appropriate? a. "The stroke volume from a woman's heart is lower than from a man's heart." b. "It takes longer for an electrical impulse to travel from the sinoatrial node to the atrioventricular node in a woman." c "A woman's resting heart rate is lower than a man's." d. "A woman's heart is smaller and has smaller arteries that become occluded more easily."

"A woman's heart is smaller and has smaller arteries that become occluded more easily."

The nurse cares for a client with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which questions? a. "What was your morning blood sugar reading?" b. "When was the last time you ate or drank?" c. "Are you having chest pain?" d. "Are you allergic to shellfish?"

"Are you allergic to shellfish?"

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse? a. "Current evidence indicates that estrogen replacement is not effective at preventing cardiovascular disease and carries some risks." b. "You need to research hormone replacement therapy and determine what you want to do." c. "Current research determines that estrogen replacement protects heart health for most women after menopause." d. "That's a great idea. You don't want to have a heart attack."

"Current evidence indicates that estrogen replacement is not effective at preventing cardiovascular disease and carries some risks."

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include? a. "Contact your primary care provider if you develop a temperature above 102°F." b. "If any discharge occurs at the puncture site, call 911 immediately." c. "You can take a tub bath or a shower when you get home." d. "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours."

Your client is being prepared for echocardiography when they ask you why they need to have this test. What would be your best response? a. "This test can tell us a lot about your heart." b. "This test will find any congenital heart defects." c. "Echocardiography is a way of determining the functioning of the left ventricle of your heart." d. "Echocardiography will tell your doctor if you have cancer of the heart."

"Echocardiography is a way of determining the functioning of the left ventricle of your heart." Echocardiography shows the functioning of the left ventricle and detects cardiac tumors, congenital defects, and changes in the tissue layers of the heart. All answers are correct. Option C is the best answer because it addresses the client's question without making him anxious or minimizing the question.

The nurse is administering a stool softener to a client who experienced a myocardial infarction. The client says, "I had a heart attack; I don't have a problem with constipation." What explanation will the nurse use to answer the client's question? a. "The heart attack sets you up for limited activity, so constipation is often a problem for clients after a heart attack." b. "Please talk this over with your healthcare provider for further information." c. "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." d. "The prescribed stool softener will decrease stress with a bowel movement and protect your heart from further injury."

"If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous."

The nurse is assessing the vital signs of a client who is 3 months status post myocardial infarction (MI). While the healthcare provider is examining the client, the client's spouse approaches the nurse and states "We are too afraid he will have another heart attack, so we just don't have sex anymore." What is the nurse's best response? a. "The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." b. "Having an orgasm is very strenuous and your husband must be in excellent physical shape before attempting it." c. "The medications will prevent your husband from having an erection." d. "It is usually better to just give up sex after a heart attack."

"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

The nurse is assessing a patient who reports feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding? a. An unchanged systolic pressure b. An increase of 10 mm Hg blood pressure reading c. A heart rate of more than 20 bpm above the resting rate d. An increase of 5 mm Hg in diastolic pressure

A heart rate of more than 20 bpm above the resting rate

The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" What is the appropriate response by the nurse? a. Asparagus, blueberries, green beans b. Cranberries, apples, popcorn c. Bok choy, cooked leeks, alfalfa sprouts d. Apricots, dried peas, and beans, dates

Apricots, dried peas, beans, dates (kiwi) The other foods listed contain minimal amounts.

The nurse is providing discharge education for a client going home after cardiac catheterization. What information is a priority to include when providing discharge education? a. Do not ambulate until the healthcare provider indicates it is appropriate. b. Returning to work immediately is okay. c. Avoid tub baths, but shower as desired. d. Expect increased bruising to appear at the site over the next several days.

Avoid tub baths, but shower as desired.

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? a. C-reactive protein (CRP) b. Platelet count c. B-type natriuretic peptide (BNP) d. Potassium

B-type natriuretic peptide (BNP)