Med-Surg Chapter 31

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. The nurse identifies that what age-related change contributes to this finding?

An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. Valvular rigidity of aging causes murmurs and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

The nurse assesses a patient and finds that the patient is experiencing prolonged oxygen deficiency. Which findings support this conclusion? Select all that apply.

Prolonged oxygen deficiency is characterized by cyanosis and clubbing of the nails. Therefore the presence of a bluish or purplish tinge in the central areas of the tongue and an obliteration of the normal angle between the base of the nail and the skin indicates that the patient has an oxygen deficiency. Presence of erythematous rashes on the extremities indicates that the patient has a skin infection but not an oxygen deficiency. A pulse rate of 70 beats/minute and blood pressure of 120/80 mm Hg are normal findings and do not indicate that the patient has an oxygen deficiency. Deficiency of oxygen results in hypothermia and may make the patient's hands and feet cooler than normal. A respiratory rate of 20 breaths/minute is a normal finding.

The nurse observes blanching of a patient's nail beds for two seconds after release of pressure. Which does the nurse recognize as the potential cause of the assessment finding?

Reduced arterial capillary perfusion results in a decreased amount of oxygen supply to body parts, which results in blanching of nail beds for two seconds after release of pressure. Hands and feet that are warmer than normal indicate thyrotoxicosis. When the hands and feet are cold to the touch, it indicates intermittent claudication. Visible finger pitting on application of firm pressure indicates interruption of venous return to the heart.

A nurse is auscultating a patient's heart sounds and hears an S4 heart sound. Which condition may be present?

S4 is an extra heart sound caused by atrial contraction. It can be normal in older adults. The common pathologies that cause this sound are cardiomyopathy, left ventricular hypertrophy, atrial stenosis, or coronary artery disease (CAD). Hypertension is increased blood pressure and postural hypotension is a fall in blood pressure after standing, and these conditions do not cause S4. Angina pectoris is pain in the chest region and is not accompanied by S4.

A patient's baseline heart rate is 85 beats/minute. The nurse recognizes that the sympathetic nervous system is stimulated in the patient when what heart rate is assessed?

Stimulation of the sympathetic nervous system increases heart rate. The normal heart rate is in the range of 60 to 100 beats/minute. Therefore the patient with heart rate of 110 beats/minute has a stimulated sympathetic nervous system. Stimulation of the sympathetic nervous system does not decrease the patient's heart rate. Therefore the heart rate of 50 beats/minute does not indicate stimulation of the patient's sympathetic nervous system. The heart rates of 70 and 80 beats/minute are normal findings and do not indicate stimulation of the patients' sympathetic nervous systems.

While reviewing a patient's electrocardiogram reports, the nurse finds that the U wave is present. The nurse suspects that the patient has what condition?

The U wave appears and exceeds the T-wave amplitude in the electrocardiogram if the serum potassium level in the blood is less than 3 mEq/L. Because the normal potassium levels in the blood are in the range of 3.5 to 5.0, the presence of a U wave indicates hypokalemia. The presence of a U wave does not indicate altered body temperature or hypothermia. A U wave may be seen during hypercalcemia but not during hypocalcemia. A U wave does not indicate decreased thyroxine levels or hypothyroidism.

The patient reports being confused about how there can be a blockage in the left anterior descending artery (LAD) although there is damage to the right ventricle. What explanation should the nurse give?

The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.

During a physical examination of a patient, the nurse performs a capillary refill test. What test finding should the nurse consider as normal?

The capillary refill test assesses arterial flow to the extremities. The fingernail is pressed and the time required for refilling of blood is noted. This refill is appreciated by the change in the color of the nail bed. This should occur in less than 2 seconds with normal tissue perfusion and cardiac output. Capillary refill times of four seconds, six seconds, and eight seconds indicate an underlying defect in circulation.

The nurse is reviewing the function of the vascular system. What portion of the vascular system exchanges cellular nutrients and metabolic end products?

The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.

The nurse assesses a patient's heart sounds and auscultates the left midclavicular line at the fifth intercostal space (ICS). This is the best location for hearing sounds from which heart valve?

The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS). The aortic area is best heard at the right second intercostal space. Tricuspid area is assessed best at the midleft sternal border. Pulmonic is heard best at the left second intercostal space.

What techniques should the nurse use while assessing the heart sounds of a patient? Select all that apply.

The nurse listens to the S1 and S2 sounds with the diaphragm of the stethoscope because they are high pitched. S3 and S4 are extra heart sounds. If these sounds are present, then they can be detected with the bell of the stethoscope. The nurse instructs the patient to lean forward while sitting. This helps her to listen to the enhanced sounds from the second intercostal space. The nurse listens to friction rubs when the patient sits in an upright position and leans forward following expiration. The patient is positioned in a left side-lying position to enhance the sounds at the mitral area.

When measuring the blood pressure of a patient, the nurse should perform the steps of the procedure in what order?

The nurse should first place the appropriate size of cuff on the upper arm. This is because the brachial artery is the recommended site for measuring blood pressure, and the wrong cuff size can give an inaccurate reading. The cuff is then inflated to a pressure 20 to 30 mm Hg above the most recently recorded SBP. This causes the blood flow in the artery to cease. The nurse should then lower the pressure in the cuff while auscultating the artery and also note the first phase of the Korotkoff sound. It is a tapping sound caused by the spurt of blood into the constricted artery. This is the SBP. Finally, when the sound disappears, the nurse notes the diastolic pressure.

A patient is admitted to a hospital with chest pain and is scheduled for a stress test. What instructions should the nurse give to the patient regarding the test? Select all that apply.

The patient scheduled for a stress test should not smoke for three hours before the test. Smoking may alter the oxygen-carrying capacity of the blood and result in an increased workload of the heart. This can interfere with accurate test results. Engaging in strenuous exercise also increases the activity of the heart and interferes with the stress test. The patient should wear comfortable clothes and shoes for walking and running during the test. The patient should immediately report any discomfort experienced during the test, which can indicate undue stress on the heart. In such a case, the test would need to be discontinued. Caffeine-containing foods and fluids should be avoided for 24 hours before the test, because they can interfere with the test results.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE) and should perform which interventions? Select all that apply.

The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation also are important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels; therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

The nurse identifies a U wave on a patient's electrocardiogram. Which dietary instruction will be beneficial to the patient?

The presence of a U wave in the patient's electrocardiogram may indicate hypokalemia or repolarization of the Purkinje fibers. Hypokalemia can be caused by excessive sweating, diarrhea, or excessive laxative use. Bananas are a rich source of potassium. Therefore increasing the consumption of bananas will be beneficial for the patient. Coconut oil increases digestion and bowel function. Raw and virgin coconut oil have a laxative effect and should not be recommended. Milk and milk products like cheese are rich in sodium but not in potassium. Omega-3 oils help flush toxins out of the body. Therefore increasing the consumption of omega-3 oils would produce a laxative effect in the patient and potentiate hypokalemia.

A patient's pulmonary artery is blocked and damaged. The nurse recalls that the first consequence of this condition will be what type of impaired blood flow?

The pulmonary artery carries deoxygenated blood from the right ventricle of the heart to the lungs. Therefore damage to the pulmonary artery leads to impaired flow of deoxygenated blood from the right side of the heart initially (on its way to the lungs). Subsequently, it impairs the flow of oxygenated blood away from the lungs, and from the systemic aorta to all other body parts. The pulmonary artery does not carry deoxygenated blood from the right atrium to the right ventricle. Therefore damage to pulmonary artery does not affect blood flow between the right atrium and the ventricle.

Which blood vessel carries oxygenated blood toward the heart from the lungs?

The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart.

What initiates the action potential in the heart?

The sinoatrial node is called the pacemaker of the heart, and it initiates the electrical impulse, or action potential, in the heart. By way of the Purkinje fibers, the action potential moves through the walls of ventricles, but it is not initiated at this point. The action potential moves from the atrioventricular node through the bundle of His and the right and left bundle branches, but it is not initiated at these points.

The nurse is reviewing the mechanism of blood pressure (BP). What are the main factors that influence blood pressure? Select all that apply.

The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence blood pressure

The nurse assesses a patient with cardiac problems. The nurse measures the circumference of the calves and finds that they are asymmetrical. What might this finding imply? Select all that apply.

There may be asymmetries in the circumference of two limbs in disorders like lymphedema, varicose veins, and thromboembolism. In these disorders, the affected limb is generally increased in circumference. Hypertension doesn't cause swelling of the limbs. Similarly, angina pectoris refers to pain in the chest and doesn't cause changes in the circumference of lower extremities.

While assessing the cardiovascular status of a patient, what technique should the nurse use to assess for the presence of a pulse deficit?

To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.

Which instructions should the nurse provide to a patient who is scheduled for a transesophageal echocardiogram (TEE)? Select all that apply.

Transesophageal echocardiogram (TEE) is a diagnostic test for cardiovascular assessment in which a probe with a transducer at the tip is swallowed and the primary health care provider controls the angle and depth. The patient should be on NPO status for six hours before the test to minimize the risk of vomiting and aspiration. The patient should remove dentures prior to the test to prevent partial airway obstruction by dislodgement of dentures. Light meals can be taken between scans during exercise nuclear imaging, not during TEE. Patients should refrain from tobacco use for 24 hours before undergoing positron emission tomography (PET), not before TEE. Caffeine products should be withheld for 12 hours before pharmacologic nuclear imaging, not before TEE.

The nurse provides information to a patient that is scheduled for a transesophageal echocardiography (TEE) related to potential complications. What should the nurse include in the education? Select all that apply.

Transesophageal echocardiography (TEE) evaluates mitral valve disease and endocarditis vegetation in the patient. Complications of this procedure include tearing of the esophagus, hemorrhage, dysrhythmias, and transient hypoxemia. Some contrast media cause nephrotoxicity in patients; however, transesophageal echocardiography does not involve the injection of contrast medium into the patient's heart. Increased levels of lactate dehydrogenase is not a complication of the procedure.

A patient presents to the emergency department reporting chest pain. The nurse recalls that what component of the patient's blood work is most clearly indicative of an acute myocardial infarction (MI)?

Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.

The nurse is caring for the patient with cardiac disease. The nurse expects that which blood studies will be prescribed? Select all that apply.

Troponin, homocysteine, and C-reactive protein are laboratory tests that may help provide clues to cardiovascular health and possible indicators for cardiac disease. Thyroid stimulating hormone evaluates the thyroid, and blood urea nitrogen evaluates the kidney function; these may not be pertinent initially to a focused cardiovascular assessment.

Auscultation of a patient's heart reveals the presence of a murmur. The nurse recalls that the finding is the result of what abnormality?

Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults? Select all that apply.

Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease with age related to cellular aging and fibrosis of the conduction system. The aging patient experiences decreased cardiac reserve as a result of myocardial hypertrophy, increased collagen and scarring, and decreased elastin.

While reviewing the laboratory reports of a patient, the nurse notes that the homocysteine level is 17 μmol/L. The nurse anticipates that which treatment will be prescribed?

When a patient's homocysteine levels are greater than 10.4 μmol/L, it indicates that the patient has hyperhomocysteinemia. Hyperhomocysteinemia is caused by a deficiency in folic acid, vitamin B12, and vitamin B6; therefore administering folic acid and vitamin B12 supplements will be beneficial for the patient. Nesiritide helps to increase b-Type natriuretic peptide (BNP), but it does not treat deficiencies of folic acid, vitamin B12, and vitamin B6. Estrogen + progestin helps to increase estrogen levels in the blood, but does not reduce homocysteine levels. Homocysteine levels increase because of folic acid and vitamin B deficiencies, but are unrelated to vitamins C and K.

The nurse does not have information about a patient's typical systolic blood pressure. The nurse is preparing to take the patient's blood pressure using a sphygmomanometer and a stethoscope. What action should the nurse take?

While measuring blood pressure with the sphygmomanometer and a stethoscope, if systolic blood pressure is not known, then the nurse should palpate the brachial pulse and inflate the cuff until the pulse ceases. Using a larger-sized cuff cannot give accurate results for blood pressure. Applying extra pressure can increase the pressure on the brachial artery, which can give inaccurate test results. When a blood pressure measurement is scheduled, the nurse should be timely and take the patient's blood pressure, using the appropriate technique.

A nurse is preparing a patient for a transesophageal echocardiogram (TEE). What intervention does the nurse perform for this patient?

While preparing a patient for a TEE, the nurse asks the patient to remove the dentures and places a bite block in the mouth. This is done because an ultrasound transducer will need to be swallowed and passed through the esophagus. When preparing the patient for a chest x-ray, the nurse provides lead shielding to areas that are exposed to radiation. If the patient is undergoing ambulatory ECG, then the nurse asks him to carefully observe possible symptoms of skin irritation. The patient will receive IV sedation; general anesthesia is not used for the procedure.

A nurse provides education to a patient that is scheduled for exercise testing to evaluate the patient's cardiovascular function. What should the nurse include in the instructions?

β-blockers may be held 24 hours before the test because they blunt the HR and limit the patient's ability to achieve maximal HR. . The nurse informs the patient not to consume caffeine-containing foods (and caffeine-containing fluids) for 24 hours before the test. The nurse also instructs the patient to avoid strenuous exercise and smoking for three hours before the test.

When taking care of a patient with a probable diagnosis of acute coronary syndrome (ACS), the nurse expects what finding when assessing objective data?

Biomarkers are useful in the diagnosis of acute coronary syndrome (ACS), and troponin is the biomarker of choice. Acute heart palpitations and shortness of breath are subjective data used in the assessment of probable diagnosis of ACS. C-reactive protein (CRP) has been linked with the presence of atherosclerosis and prediction of future heart event risks in patients with myocardial infarction (MI).

The nurse assesses a patient for cardiovascular abnormalities. The nurse recalls that the blood flows through the heart in what order?

Blood flows (from the body via the superior and inferior vena cava) into the right atrium. Blood passes from the right atrium (through the tricuspid valve) into the right ventricle, then (via the pulmonic valve into the pulmonic artery) the lungs. Blood flows back from the lungs (via the pulmonary veins) into the left atrium. Blood flows from the left atrium through the mitral valve into the left ventricle and then (via the aortic valve) to the aorta and the body.

The nurse assesses the vital signs of a patient and should use which artery to check the blood pressure?

Blood pressure is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking blood pressure is the brachial artery. This artery is on the arm near the elbow. The radial artery is on the wrist. The carotid artery is in the neck region, and the femoral artery is around the groin. Any other site other than the brachial artery is not suitable for checking blood pressure with a sphygmomanometer.

While assessing a patient with cardiovascular disease who is sitting at a 45-degree angle, the nurse observes distended neck veins. What reason does the nurse suspect behind this finding?

Bulging of the external jugular vein is known as jugular vein distention. When the arterial pressure in the right atrium increases, the pressure in the jugular vein increases; this results in distention of the veins. Vasoconstriction causes peripheral cyanosis. Poor venous return causes ulcers. Incompetent valves in veins lead to varicose veins.

The nurse recognizes that which blood component is a marker of inflammation in a patient with cardiovascular disease?

C-reactive protein (CRP) is a marker of inflammation that can predict the risk of cardiac events and cardiac diseases. Myoglobin is a low-molecular-weight protein that is sensitive to myocardial injury. NT-Pro-BNP helps in assessing the severity of heart failure. B-type natriuretic peptide (BNP) is a peptide that causes natriuresis and its elevation distinguishes a cardiac versus respiratory cause of dyspnea.

The nurse provides information to a group of nursing students about cardiac output. What information should be included in the teaching?

Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a one-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. The nurse suspects what diagnosis?

Creatine kinase (CK-BB) enzymes are present in the cardiac muscle and are released into the blood due to cell injury. An increase in creatine kinase (CK-MB) enzymes indicates the onset of symptoms of myocardial infarction (MI). Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, coronary artery disease (CAD), and peripheral vascular disease (PVD).

A patient with a history of cardiovascular disease reports symptoms of erectile dysfunction (ED). The patient tells the nurse, "I am really frustrated and embarrassed." How should the nurse respond? Select all that apply

ED may be a symptom of peripheral vascular disease, or it can be a side effect of a cardiac medication, such as a beta-blocker or a diuretic. A full cardiovascular assessment should be performed prior to making assumptions about medication therapy, particularly when medications for ED are contraindicated if the patient is also taking a nitrate. A history of the patient's sexual routine is important to cardiac assessment, as there are many symptoms of cardiac conditions that could impede sexual activity, such as shortness of breath or chest pain. However, taking this history should wait until the nurse has explained the connection between ED and vascular disease. Validating the patient's frustrations may help diffuse the situation after the link has been explained. It is not necessary to have a male colleague complete the assessment.

A nurse examines a patient with cardiovascular problems and assesses for the presence of pitting edema. What is the best location to assess for edema?

Edema is a common and early symptom of cardiovascular conditions. The nurse should look for edema by depressing the skin over the tibia or medial malleolus for 5 seconds. This edema is commonly seen in dependent areas, such as on the feet and the ankle, due to gravity. Edema on the face, wrist, or chest may be due to other, noncardiac conditions.

What is the order of the events in which the blood flows through the heart?

First, the deoxygenated blood from the inferior and superior venae cavae and the coronary sinus enters the right atrium. Then the blood flows through the tricuspid valve and enters the right ventricle. From the right ventricle, blood flows through the pulmonic valve into the pulmonary artery and to the lungs. Then the oxygenated blood enters into the left atrium through the pulmonary veins. After flowing through the mitral value of the left atrium, the blood enters the left ventricle. From the left ventricle, the blood is ejected through the aortic valve into the aorta and then into the systemic circulation.

When assessing the cardiovascular system of an 83-year-old patient, what symptoms should the nurse expect to find? Select all that apply.

Gerontologic differences in the assessment of the cardiovascular system include the presence of a systolic murmur, diminished pedal pulses, increased systolic blood pressure, and difficulty in isolating the apical pulse. The pulse pressure may be widened, not narrowed.

A patient with pericarditis is admitted to the hospital. The nurse recognizes that what is the best method of auscultation in this patient?

In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions such as supine or standing.

The nurse reviews an elderly patient's electrocardiogram and recognizes that what finding indicates cellular aging and fibrosis of the conduction system?

Lengthened QT intervals in an elderly patient's electrocardiogram indicate cellular aging and fibrosis of the conduction system. The patient with cellular aging and fibrosis of the conduction system is characterized by irregular cardiac rhythms, lengthened PR, QRS complex, and a decreased amplitude of QRS complex.

A nurse is caring for a patient who is a smoker with a two-year history of using oral contraceptives. Based on the findings, the patient should be assessed for which condition?

Long-term use of oral contraceptives can lead to serious side effects. In addition, smoking enhances the risk of developing complications such as venous thromboembolism. Hypotension is not an effect of oral contraceptives. Similarly, contraceptives do not affect the muscles of the heart and do not cause cardiomyopathy. Dependent edema is not a common side effect of oral contraceptives.

The nurse obtains laboratory results for a patient that presents to an emergency department with angina. Which parameters in the laboratory report indicate myocardial infarction? Select all that apply.

Many chemical parameters may indicate and confirm the presence of a myocardial infarction. Cardiac-specific troponin levels are specific to heart muscles. Their levels are usually very low, and any increase indicates myocardial injury. Creatinine kinase (CK) is a protein found skeletal muscle, brain and nervous tissue, and the heart. CK-MB is heart specific and high levels of this protein are indicative of myocardial infarction. A high cholesterol level indicates an increased risk of cardiovascular diseases but is not suggestive of myocardial infarction. C-reactive protein is elevated during inflammation. Homocysteine levels may be elevated in people having a high risk of coronary artery disease.

A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure?

Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120 + 2 x 60)/3 which is equal to (120 + 120)/3 = 80 mm Hg.

During a physical examination of a patient with cardiovascular disease, the nurse auscultates murmurs. How should the nurse interpret the finding?

Murmurs are heard when the blood flow is turbulent due to dysfunctional valves. The valves may get affected due to accumulation of lipids, degeneration of collagen, and fibrosis. A decreased compliance of ventricles during filling would result in the S4 heart sound. A pericardial friction rub is usually heard as a high-pitched, scratchy sound. High blood pressure does not cause murmurs.

The nurse teaches a caregiver about the plan of care for an elderly patient with orthostatic hypotension. Which action by the caregiver will be most beneficial to the patient?

Orthostatic hypotension, or postural hypotension, is low blood pressure that occurs in patients when they stand up from sitting or lying down. Patients with orthostatic hypotension are at an increased risk of falls. Therefore the caregiver should monitor for falls in the patient. The caregiver can encourage laughter therapy and treadmill exercises, but these measures are not as beneficial as monitoring the patient for falls. The caregiver can take the patient out for recreation, but it is not as beneficial as monitoring the patient's risk of falls.

The patient is admitted to the hospital with reports of awakening during the night with sudden shortness of breath. How should the nurse document this assessment finding?

Paroxysmal nocturnal dyspnea is defined as "attacks of shortness of breath, especially at night," which awaken the patient. Orthopnea is the need to sleep in an upright position. Atrial fibrillation is a conduction abnormality of the heart. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle.

The nurse provides education to a patient that is scheduled for a transesophageal echocardiogram (TEE). Which statement made by the patient indicates the need for more instruction?

Patient instructions for a transesophageal echocardiogram (TEE) include remaining nothing by mouth (NPO) for at least six hours before the test, removing dentures, and having a designated driver if the patient has the test as an outpatient. The patient may not eat or drink until the gag reflex has returned.

While assessing a patient for orthopnea, what is an appropriate question for the nurse to ask?

Patients with heart failure often experience orthopnea. This refers to a condition in which patients may feel the need to sleep with their head elevated and use several pillows to sleep upright. When assessing a patient for nocturia, the nurse asks how frequently the patient gets up at night to urinate. When assessing the patient for paroxysmal nocturnal dyspnea, the nurse asks if the patient wakes up at night due to shortness of breath at night. When checking for shortness of breath during daily activities, the nurse asks the patient whether the patient is comfortable while walking and talking at the same time.

The nurse provides care for a patient with right-sided heart failure and expects what assessment findings? Select all that apply.

Patients with right-sided heat failure may present with pitting edema of the lower extremities due to interruption of venous return to the heart. The tricuspid valve is located in the right side of the heart; its regurgitation results in the back-up of blood. Jugular vein distention is the result of blood back-up on the right side of the heart. Splinter hemorrhages are often caused by infective endocarditis. A pericardial friction rub is indicative of pericarditis.

The nurse auscultates a pericardial friction rub when assessing a patient's heart sounds. What would cause an increase in friction between the heart layers during contraction?

Pericardial fluid between the pericardial layers prevents friction between the layers as the heart contracts. Approximately 10 to 15 mL of pericardial fluid is sufficient to reduce the friction. Therefore 5 mL of pericardial fluid indicates that the patient experiences greater friction between the pericardial layers. The wall of each chamber of a normal heart is a different thickness; it does not cause greater friction. If the atrial myocardium is thinner than the ventricle, it also indicates normal heart anatomy. Pericardial fluid of 12 mL is a normal finding and does not indicate friction between the pericardial layers.

An older patient presents to the emergency department with recent weight gain, pitting edema to the bilateral lower extremities, and distended neck veins. The nurse expects what other assessment findings? Select all that apply.

Pitting bilateral lower extremity edema, weight gain, and jugular venous distention (JVD) are all hallmarks of heart failure. Lower extremity cyanosis, a third heart sound, and displaced PMI are all symptoms that are often found in the patient with heart failure. Irregular heart rate is a hallmark of atrial fibrillation. A high-pitched scratching sound during or between normal heart sounds is indicative of a pericardial friction rub and more commonly indicates pericarditis, not heart failure.

A 75-year-old patient is experiencing a sinus dysrhythmia. The nurse identifies that the patient is at risk for dysrhythmias due to what physiologic change that occurs with aging?

A 75-year-old patient is experiencing a sinus dysrhythmia. The nurse identifies that the patient is at risk for dysrhythmias due to what physiologic change that occurs with aging?

The nurse observes a bluish tinge around the ears of a patient with cardiovascular disease. What does the nurse suspect is the likely reason behind the assessment finding?

A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels due to the contraction of muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of nail beds. Venous thromboembolism results in asymmetry in limb circumference.

A wheelchair-bound patient is scheduled for a multigated acquisition (MUGA) scan to aid in the diagnosis of coronary artery disease (CAD). The nurse most expects which revisions in the test procedure will be made?

A multigated acquisition (MUGA) scan is a common nuclear imaging test for heart wall motion during systole and diastole. Because the patient is unable to exercise, IV adenosine (Adenocard) will be given to dilate the coronary arteries and simulate the effect of exercise. The nurse will monitor vital signs, but this is not the priority action at this time. A 12-lead ECG will not be performed at this time. The patient will not be prepared for the treadmill, because he or she is unable to exercise.

A patient's blood pressure is 180/100 mm Hg. To assess cardiovascular status, which question related to nutrition is appropriate for the nurse to ask?

A person's food habits impact the cardiovascular system greatly. A patient with hypertension needs to limit consumption of salt, because salt is known to increase blood pressure. Hence asking the patient about approximate consumption of salt in a day is important when assessing cardiovascular status. Consuming salads is good for overall health, but is not a definitive query for a patient with hypertension. Chili can cause gastrointestinal issues, but it is not an important factor in cardiovascular health. Meat is not an important factor for hypertension.

A 78-year-old patient experiences cardiac sinus dysrhythmias. The nurse recalls that a reduction in which type of cells leads to this condition?

A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks

The nurse assesses a thready pulse in a patient with cardiovascular disease and recognizes that the finding may indicate the presence of what conditions? Select all that apply.

A thready pulse is a weak, slowly rising pulse observed in patients with aortic valve disease and peripheral arterial disease. Hyperthyroidism and hyperkinetic states are associated with a bounding pulse. An irregular pulse is observed in patients with cardiac dysrhythmias.

A patient with cardiovascular disease is scheduled for a triglyceride test. What is appropriate for the nurse to include in the preprocedural instructions? Select all that apply.

A triglyceride test should be performed in a fasting state, but the patient can drink water. Alcohol consumption will raise the triglyceride blood levels by producing more fatty acids from the liver. Therefore the nurse should instruct the patient to drink water and to withhold alcohol for 24 hours before the test. Voiding will not affect the triglyceride levels in the blood. Tobacco should be withheld for 24 hours before positron emission tomography (PET). The test should be performed on the patient in a fasting state for 12 hours, and the patient should avoid milk or food except water.

While palpating the arteries of a patient with cardiovascular disease, the nurse rates the force of the pulse as weak. How should the nurse document the assessment finding?

A weak pulse in a patient with cardiovascular disease is indicated by 1+. Absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse.