Exam II

When analyzing an electrocardiographic (ECG) rhythm strip of a patent with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculated the patients heart rate as____?

50

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? a. Heparin enhances platelet aggregation at the plaque site. b. Heparin decreases the size of the coronary artery plaque. c. Heparin prevents the development of new clots in the coronary arteries. d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.

C. Heparin prevents the development of new clots in the coronary arteries.

An intraaortic balloon pump is being used for a patient who is in cariogenic shock. Which data would indicate to the nurse that the goals of IABP treatment are being met? a. cardiac output (CO) of 5L/min b. heart rate of 110 beats/min c. urine output of 25 mL/hr d. stroke volume (SV) of 40 ml/hr

a. cardiac output (CO) of 5L/min

A patient had a myocardial infarction (MI) in the 24 hours. Which potential complication would the nurse assign the highest priority for monitoring? a. dysrhthmias b. medication side effects c. metabolic acidosis d. anxiety and fear

a. dysrhthmias

Jane, a 58-year-old female, is admitted to the intensive care unit (ICU) with a diagnosis of non ST-segment-elevation myocardial infarction (NSTEMI). She presents with a history of hypertension and a complaint of severe chest pain last for several hours. Jane is anxious, diaphoretic, and reports a sensation of pressure in her chest. Her initial vital signs show a heart rate of 100 bpm, blood pressure 160/90 mm Hg, respiratory rate of 20 breaths/min, and oxygen saturation of 96% on room air. Upon admitting Jane with NSTEMU to the ICU, what should the nurse prioritize as the initial action? a. Initiating continuous cardiac monitoring b. administering aspirin to the patient c. administering sublingual nitroglycerin for chest pain relief d. obtaining a detailed medical history for the patient

a. Initiating continuous cardiac monitoring

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a. Instruct patient to call for help before getting out of bed b. teach the patient to avoid caffeine and other stimulants. c. tell the patient about implantable cardiovert-defibrillators d. explain the association between dysrhythmias and syncope

a. Instruct patient to call for help before getting out of bed

After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient would the nurse assess first? a. a patient who has new onset confusion and restlessness b. a patient who has dizziness after a dose of captopril c. a patient who is receiving oxygen and has crackles in the bilateral lung bases d. a patient who is receiving IV nesiritide (Natrecor), with a BP of 100/62

a. a patient who has new onset confusion and restlessness

A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and reports feeling faint. Which action would the nurse take? a. apply transcutaneous pacemaker (TCP) pads. b. give the scheduled dose of diltiazem (Cardizem). c. reposition patient on the left side. d. Have the patient perform the Valsalva maneuver

a. apply transcutaneous pacemaker (TCP) pads.

The nurse reviews the laboratory test results for a patient with acute infective endocarditis. Which test result is significant for determining the plan of treatment? a. blood cultures b. erythrocyte sedimentation rate c. white blood cell count d. C-reactive protein

a. blood cultures

After receiving change-of-shift report on four patients, which patient would the nurse assess first? a. patient with acute aortic regurgitation who's blood pressure is 86/54 mm Hg. b. Patient will rheumatic fever who has sharp chest pain with a deep breath. c. Patient with infective endocarditis who has a murmur and splinter hemorrhages. d. patient with dilated cardiomyopathy who has bilateral crackles in at the lung bases.

a. patient with acute aortic regurgitation who's blood pressure is 86/54 mm Hg.

A patient who was admitted with a myocardial infarction has a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action would the nurse take next? a. prepare to give IV amiodarone per agency dysrhythmia protocol b. immediately notify the health care provider c. document the rhythm and continue to monitor the patient d. prepare for synchronized cardio version per agency protocol.

a. prepare to give IV amiodarone per agency dysrhythmia protocol

While assessing an older adult patient, the nurse notes jugular vein distention (JVD) with the head of the patient's bed elevated at 45 degrees. What does this finding indicate? a. right-sided heart failure or elevated central venous pressure b. aortic valve stenosis or regurgitation c. a normal finding due to the patient's age and body position. d. left-sided heart failure or pulmonary edema.

a. right-sided heart failure or elevated central venous pressure

Which laboratory result for a patient with multifocal premature ventricular contractions (PVC's) is most important for the nurse to communicate to the health care provider? a. serum potassium 2.9 mEq/L b. serum chloride of 92mEq/L c. blood glucose of 243mg/dL d. serum sodium 134 mEq/L

a. serum potassium 2.9 mEq/L

A patient who has heart failure recently started taking digoxin in addition to furosemide as captopril. Which finding by the home health nurse is a priority to communicate to the health care provider? a. serum potassium level 3.0 mEq/L after 1 week of therapy b. palpable liver edge 2 cm below to ribs on the right side c. weight increase from 120 pounds to 122 pounds over 3 days d. presence of 1+ to 2+ edema in the feet and ankles.

a. serum potassium level 3.0 mEq/L after 1 week of therapy

The nurse is caring for a patient with mitral valve regurgitation. Which information obtained by the nurse would be reported to the health care provider immediately? a. the patient has diffuse bilateral crackles b. the patient has 4+ peripheral edema c. the patient has a loud systolic murmur across the precordium d. the patient has a palpable thrill felt over the left anterior chest

a. the patient has diffuse bilateral crackles

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide

Which patient statement indicates that discharge teaching about management of a new pacemaker was effective? a. "I will avoid cooking with a microwave oven or being near one in use." b. "I won't lift the arm on the incision side until I see the health care provider." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "It will be several weeks before I can return to my usual activities?"

b. "I won't lift the arm on the incision side until I see the health care provider."

Which statement made by the nurse indicates effective understanding of diagnostic studies used for acute coronary syndrome? a. "A pathogenic Q wave is always present in the electrocardiogram (ECG) of patients with unstable angina." b. "Serum cardiac markers are proteins that are released from necrotic heart muscle." c. "A nitroprusside stress echocardiogram is used for patients with acute pericarditis" d. "Coronary angiography is not used unless myocardial infarction is suspected."

b. "Serum cardiac markers are proteins that are released from necrotic heart muscle."

A patient who reports a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action would the nurse take next? a. have the patient perform the Valsalva maneuver b. Obtain the patient's vital signs including O2 saturation c. Administer morphine 4mg IV d. Prepare to give a B-blocker medication to slow the heart rate.

b. Obtain the patient's vital signs including O2 saturation

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

b. Patient with stable angina whose chest pain has recently increased in frequency

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Diltiazem (Cardizem) b. Sildenafil (Viagra) c. Warfarin (Coumadin) d. Furosemide (Lasix)

b. Sildenafil (Viagra)

A patient's electrocardiogram (ECG) shows a heart rate of 150 beats/min and a normal P wave preceding each QRS complex. Which interpretation would the nurse make of these findings? a. Atrial Fibrillation b. Sinus Tachycardia c. Premature Atrial Contractions d. Ventricular Fibrillation

b. Sinus Tachycardia

A patient is apneic and has no palpable pulses. The heart monitor shows sinus tachycardia, rate 132. What action should the nurse take next? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Give atropine per agency dysrhythmia protocol. d. Apply supplemental O2 via non-rebreather mask.

b. Start cardiopulmonary resuscitation (CPR).

While awaiting heart transplantation, a critically ill patient with severe cardiomyopathy has a left ventricular assist device (LVAD) implanted as a bridge to transplantation. Which action should the nurse prioritize when developing the plan of care for this complex situation? a. collaborate with the physical therapist to initiate a progressive resistance training program for the patient. b. administer prophylactic antibiotics to prevent infection related to the LVAD driveline c. evaluate the patient's psychosocial well-being and readiness for transplantation. d. monitor daily weight to assess for signs of fluid retention and congestion.

b. administer prophylactic antibiotics to prevent infection related to the LVAD driveline

A patient who has had chest pain for several house is admitted with a diagnosis of rule out myocardial infarction (AMI). Which laboratory test is most specific fir the nurse to monitor in determining whether the patient has had an AMI? a. myoglobin b. cardiac-specific troponin c. C-reactive protein d. homocysteine

b. cardiac-specific troponin

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make dietary changes? a. emphasize the increased cardiac risk unless the patient makes dietary changes b. help the patient modify favorite high-fat recipes by using monounsaturated oils c. Inform the patient about a diet containing no saturated fat and minimal salt. d. give the patient a list of low-sodium, low-cholesterol, foods to include in the diet.

b. help the patient modify favorite high-fat recipes by using monounsaturated oils

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient? a. elevating the legs above the heart will help relieve dyspnea b. notify the health care provider about worsening symptoms c. careful compliance with diet and medications will prevent heart failure d. A heart transplant should be scheduled as soon as possible.

b. notify the health care provider about worsening symptoms

Which patient will need the nurse to plan discharge teaching about prophylactic antibiotic before dental procedures? a. patient admitted with a large acute myocardial infarction b. patient who had a mitral valve replacement with a mechanical valve c. patient being treated for rheumatic fever after a streptococcal infection d. patient being discharged after an exacerbation of heart failure

b. patient who had a mitral valve replacement with a mechanical valve

The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective. a. patient denies experiencing chest pain or chest pressure. b. reduced dyspnea with the head of the bed at 30 degrees c. weight loss of 2 lbs in 24 hours d. hourly urine output greater than 60mL

b. reduced dyspnea with the head of the bed at 30 degrees

Which assessment finding for a patient with infective endocarditis is consistent with emboli zed vegetations for the tricuspid valve? a. splenomegaly b. shortness of breath c. mental status changes d. flank pain.

b. shortness of breath

Which action by a nurse caring for a patient after an implantable cardioverter-defibrillator (ICD) insertion indicated a need for more teaching about the care of patients with ICDs? a. the nurse teaches the patient that sexual activity can be resumed when the incision is healed b.the nurse encourages the patient to do active range of motion exercises for all extremities c. the nurse helped the patient fill out the application for obtaining a Medic-Alert bracelet d. the nurse administers amiodarone (Cordarone) to the patient

b.the nurse encourages the patient to do active range of motion exercises for all extremities

The nurse obtains a health history from an older adult with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse helps identify a risk factor for IE? a. "Do you have a history of a heart attack?" b. "Do you have a family history of endocarditis?" c. "Have you have dental work done recently?" d. "Have you had any recent immunizations?"

c. "Have you have dental work done recently?"

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs).

c. Bilateral crackles in the mid-lower lobes.

Diltiazem is prescribed for a patient newly diagnosed with Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan? a. Reduces heart palpitations. b. Prevents coronary artery plaque. c. Decreases coronary artery spasms. d. Increases contractile force of the heart.

c. Decreases coronary artery spasms.

The nurse reviews information shown in the accompanying figure from the medical records of a 43-year-old patient. Which risk factor modification for coronary artery disease should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Cardiac risk associated with previous tobacco use

c. Dietary changes to improve lipid levels

A patient who received a maximum dose of nitroglycerin continues to report chest pain. Which medication would the nurse anticipate administering to this patient next? a. Ticagrelor b. Esmolol c. Morphine sulfate d. Docusate

c. Morphine sulfate

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires immediate action by the nurse? a. urine output of 50 mL over 2 hours b. heart rate of 106 beats/min c. O2 saturation of 88% d. Weight gain of 1 kg (2.2 lb)

c. O2 saturation of 88%

Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider? a. Inverted P wave b. Sinus tachycardia c. ST-segment elevation d. First-degree atrioventricular block

c. ST-segment elevation

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient would the nurse assess first? a. a 39-year-old patient with pericarditis who is complaining of sharp, stabbing, chest pain. b. a 65-year-old patient who has a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. c. a 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI). d. a 56-year-old with variant angina who is scheduled to receive nifedipine (Procardia).

c. a 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

To ensure the safety of the patient with an implanted ventricular assist device (VAD) being prepared fro discharge, of which interventions would the nurse verify completion prior to the patient leaving the hospital? a. oxygen condenser delivered to the home b. home care referral initiated c. battery charger available in the home d. diet and activity teaching completed

c. battery charger available in the home

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. elevated troponin b. hyperglycemia c. bilateral crackles d. Q waves on ECG

c. bilateral crackles

While assessing a patient with acute pericarditis, which specific clinical finding, if observed by the nurse, should trigger an immediate notification to the healthcare provider? a. new-onset, transient visual disturbances with photophobia. b. presence of widespread, non-pruritic urticarial rash on the skin. c. election in cardiac troponin levels indicating myocardial injury. d. a localized sharp, pleuritic chest pain that worsens with coughing.

c. election in cardiac troponin levels indicating myocardial injury.

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one would the nurse arrange to be completed first? a. troponin level b. chest x-ray c. electrocardiogram (ECG) d. insertion of peripheral IV

c. electrocardiogram (ECG)

The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action would the nurse include in the plan of care? a. position the patient supine with the head flat at all times. b. provide passive range of motion for all extremities. c. monitor the patient's urinary output every hour. d. avoid the use of anticoagulant medications.

c. monitor the patient's urinary output every hour.

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? a. a large bruise at the patients IV insertion site b. a decrease in ST-segment elevation on the elcetrocardiogram c. no change in the patients reported level of chest pain d. an increase in troponin levels from base line

c. no change in the patients reported level of chest pain

Which assessment finding in a patient who has has coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? a. redness on both sides of the sternal incision b. fine crackles heard at both lung bases c. pallor and weakness of the right hand d. complaints of incisional pain.

c. pallor and weakness of the right hand

After receiving information about four patients during change-of-shift report, which patient would the nurse assess first? a. patient who has hypertrophic cardiomyopathy and a heart rate of 116 b. patient with a mitral valve replacement who has an anticoagulant scheduled. c. patient who has just returned to the units after balloon valvuloplasty d. patient with acute pericarditis who has a pericardial friction rub.

c. patient who has just returned to the units after balloon valvuloplasty

A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG patterns. The patient is unconscious, apneic, and pulseless. Which action would the nurse take first> a. Give epinephrine (Adrenaline) IV b. Ventilate with a bad-valve-mask device c. perform immediate defibrillation d. prepare for endotracheal intubation.

c. perform immediate defibrillation

The nurse is assessing a patient with myocarditis before giving a scheduled dose of digoxin (Lanoxin) Which finding is most important for the nurse to communicate to the health care provider? a. generalized myalgia b. fatigue c. leukocytosis d. irregular pulse

d. irregular pulse

A 63-year-old patient with a history of dilated cardiomyopathy has recently developed new onset atrial fibrillation that has been unresponsive to drug therapy for the past four day. The healthcare team has decided to initiate anticoagulant therapy for stroke prevention. Which topic would the nurse plan to include in patient teaching? a. demonstrating home exercises to manage atrial fibrillation symptoms b. explaining the importance of maintaining strict bed rest to conserve energy c. providing information on anticoagulation therapy and its role in stroke prevention. d. discussing the benefits of regular aerobic activities for overall heart health.

c. providing information on anticoagulation therapy and its role in stroke prevention.

The echocardiography report of a patient with infective endocarditis (IE) indicated the presence of a vegetative mass in the right ventricle. Which complication could result from this condition? a. central embolization b. renal embolization c. pulmonary embolization d. liver embolization

c. pulmonary embolization

Apteint with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? a. Pedal pulses 1+ bilaterally b. blood pressure 103/54 mm Hg c. report of chest pain d, heart rate 102 beats/min

c. report of chest pain

Which assessment finding in a patient who is admitted with infective endocarditis (IE). is most important to communicate to the health care provider? a. Janeway's lesions on the palms b. temperature 100.7 F (38.1 C) c. right flank pain d. muscle aching

c. right flank pain

The nurse is caring for a patient with aortic stenosis. Which assessment data would be most important to report to the health care provider? a. a thrill is palpated at the second intercostal space, right sternal border. b. the point of maximum impulse (PMI) is at the left midclavicular line. c. the patient reports chest pressure when ambulating d. a loud systolic murmur is heard along the right sternal border.

c. the patient reports chest pressure when ambulating

Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective? a. "I can expect to feel short of breath when taking carvedilol" b. "Carvedilol will increase the blood flow to my heart muscle" c. "Carvedilol will help my heart muscles work harder" d. "It is important not to suddenly stop taking the carvedilol"

d. "It is important not to suddenly stop taking the carvedilol"

After explaining intraaortic balloon pump (IABP) therapy to the family of a patient with an acute mitral valve dysfunction, which statement indicates that a family member understood the nurse's teachings? a. "The pump inflates when the heart is ejecting blood into the body systems" b. "The pump causes extra blood to be kept in the heart after each beat." c. "The pump increases the heart rate to provide the body oxygen." d. "The pump inflates when the heart is resting between beats."

d. "The pump inflates when the heart is resting between beats."

A nurse has received change-of-shift report about the following patients on the PCU. Which patient would the nurse see first. a. A patient who is in sinus rhythm, rate of 98 and regular, recovering from an elective cardio version 2 hours ago. b. A patient with second degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating. c. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due. d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due

d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due

What would the nurse measure to determine whether there is a delay in electric impulse through the patient's ventricles? a. PR interval b. P wave c. Q wave d. QRS complex

d. QRS complex

A 28-year-old male patient presents to the emergency department with complaints of a fever, fatigue, and a new-onset heart murmur. He has a history of intravenous drug use and has been using contaminated needles. The nurse suspects infective endocarditis (IE) based on the patients history and clinical presentation. Which finding would the nurse expect when assessing this young adult with infective endocarditis (IE)? a. Clubbed fingers b. Swollen ankles c. Petechiae on the skin d. a new regurgitation murmur

d. a new regurgitation murmur

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action would the nurse take first? a. ask about the patients allergies b. check the capillary refill c. auscultate the abdomen d. auscultate the breath sounds

d. auscultate the breath sounds

Two days after an acute myocardial infarction (MI), a patient reports stabbing chest pain that increases with deep breath. Which action will the nurse take first? a. notify the patient's health care provider b. check the patient's temperature c. give PRN acetaminophen (Tylenol) d. auscultate the heart sounds

d. auscultate the heart sounds

Which topic with the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)? a. need to begin an anaerobic exercise program several times weekly b. importance of making an annual appointment with the health care provider c. use of salt substitutes to replace table salt when cooking and at the table d. benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

d. benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. document the finding and monitor the patient. c. give atropine per agency dysrhythmia protocol. d. continue to monitor the patient's cardiac status.

d. continue to monitor the patient's cardiac status.

Which admission prescription written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement? a. schedule a transesophageal echocardiogram b. give acetaminophen (Tylenol) PRN for fever. c. Administer an IV antibiotic d. draw blood cultures from two sites

d. draw blood cultures from two sites

A patient admitted to the coronary care unit (CCU) with an ST-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? a. health maintenance alteration b. acute pain c. deficient knowledge d. impaired cardiac function

d. impaired cardiac function

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (CMP). Which information obtained by the nurse is most important in planning care? a. the patient reports using cocaine "a few times" as a teenager. b. the patient has a family history of coronary artery disease. c. the patient had a recent upper respiratory infection. d. the patient's 29-yr-old brother died from a sudden cardiac arrest.

d. the patient's 29-yr-old brother died from a sudden cardiac arrest.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

d. ventricular tachycardia.