NCLEX 3000-Cardio

The nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?

Heart failure

When a client is started on oral or I.V. diltiazem (Cardizem), the nurse should monitor for which adverse reaction?

Heart failure

Which of the following complications is most common after an abdominal aortic aneurysm resection?

Hemorrhage and shock

The physician prescribes several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?

Heparin sodium

A white male, age 43, is admitted to an acute care facility with a tentative diagnosis of infective endocarditis. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years ago and an aortic valve replacement 2 years ago. Which history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement

A nurse is attempting to administer lisinopril to a client. The client refuses to take the pill, stating that in the past he developed a rash as an allergic reaction to the medication. Which of the following is the best response by the nurse?

I will call the physician with this information

(SELECT ALL THAT APPLY) The nurse is preparing a teaching plan for a client who recently underwent surgery for insertion of a permanent pacemaker. Which instructions should the nurse include in the teaching plan?

(1) Check heart rate for 1 minute daily (4) Report redness, swelling, or discharge at insertion site. (6) Avoid magnetic resonance imaging (MRI) diagnostic studies.

"(SELECT ALL THAT APPLY) Which of the following signs and symptoms should the nurse expect to find in a client with angina?

(1) Chest tightness (3) Chest pressure (4) Jaw pain

(SELECT ALL THAT APPLY) A client is prescribed furosemide (Lasix) to manage his heart failure. What laboratory values should be monitored while the client receives this medication?

(1) Complete blood count and (2) Serum potassium

The nurse is assessing a client who is at risk for cardiac tamponade due to chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if his blood pressure is 108/82 mm Hg?

26

A client is being discharged from the hospital with a permanent cardiac pacemaker that is set at 72 beats/minute. The nurse should instruct the client to report which pulse rate immediately to the physician?

64 beats/minute

A disaster drill is in progress in the hospital. In preparation for potential admissions, the charge nurse on a cardiac step-down unit asks a nurse which one of her clients could potentially be discharged. Which is the best response?

A 52-year-old client who had an endovascular graft placed for an abdominal aortic aneurysm 3 days ago

A team conference has been called to discuss alternative treatment for a Jehovah's Witness client who has a hemoglobin level of 5.5 g/dl. Which of the following facts regarding the religious beliefs of a Jehovah's Witness should be explained to the team during the conference?

A Jehovah's Witness is forbidden from receiving blood products.

An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician prescribes a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine if the client has other major risk factors for CAD, the nurse should assess for:

A history of diabetes mellitus

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as:

A third heart sound (S3)

A client comes to the emergency department with chest pain, dyspnea, and an irregular heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate at this time?

Anxiety related to the threat of death

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and prescribes sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, the nurse should provide which instruction?

Be sure to take safety precautions because nitroglycerin may cause orthostatic hypotension

A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the prescribed cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?

Client walks 4 miles in 1 hour every day

The most common site of aneurysm formation is in the?

Abdominal aorta, just below the renal arteries.

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of:

Acute pulmonary edema

For a client who has had an acute myocardial infarction (MI), which of the following interventions should be included in the plan of care to assist with bowel elimination and prevent straining?

Administer a stool softener

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

When assessing a client with left-sided heart failure, the nurse expects to note

Air hunger

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?

Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.

A client who has been experiencing severe chest pain tells the nurse that the pain has diminished and asks to go to the bathroom to have a bowel movement. What action should the nurse take?

Allow the use of a bedside commode

A client comes to the physician's office for a complete physical examination required for employment. The physician assesses the client's arms and legs for evidence of peripheral vascular disease. What is the most commonly used overall indicator of arm and leg circulation?

Ankle-brachial index

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is probably:

Anterior

Which interventions are appropriate when caring for a client with acute thrombophlebitis

Apply warm soaks and elevate the client's legs higher than the level of the heart.

The nurse correctly instructs a client with peripheral vascular disease that stress-reduction techniques

Are helpful because stress stimulates the release of vasoconstricting catecholamines

Which measurement can best be used to monitor the respiratory status of a client with pulmonary edema

Arterial blood gas (ABG) analysis

A client admitted to the hospital for an abdominal aneurysm repair tells a nurse that he has an advance directive. What action should the nurse take?

Ask the client for a copy of the advance directive to place on his chart.

An 84-year-old male is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?

Bibasilar fine crackles

A client is in hemorrhagic shock. What data reflects the effectiveness of fluid replacement therapy?

Blood pressure

The physician prescribes pentoxifylline (Trental), 400 mg by mouth three times daily with meals, for a client with intermittent claudication and a history of adult-onset diabetes mellitus. The nurse knows that pentoxifylline is a:

Blood viscosity-reducing agent.

When measuring the radial pulse of a client with known aortic insufficiency, the nurse detects a "water-hammer" or Corrigan's pulse. What are the characteristics of this pulse?

Bounding, with a rapid rise and fall

In caring for a client with vasovagal syncope, the nurse should know that the associated temporary loss of consciousness is most commonly related to:

Bradyrhythmia

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should be instructed to avoid which of the following?

Caffeine-containing products

A client is admitted for treatment of Prinzmetal's angina. When developing the plan of care, the nurse keeps in mind that this type of angina is triggered by:

Coronary artery spasm.

A client is evaluated for hypertension. The physician prescribes atenolol (Tenormin), 50 mg by mouth daily. Atenolol should have which therapeutic effect on the client?

Decreased cardiac output and systolic and diastolic blood pressure

For a client with cardiomyopathy, the most important nursing diagnosis is

Decreased cardiac output related to reduced myocardial contractility.

A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene

Instruct the client to flex the calf muscles and then sit up for several minutes before standing

A hospitalized client experiences digoxin- (Lanoxin-) induced premature ventricular contractions (PVCs). Which type of effect do such contractions represent?

Latrogenic

A client develops atrial fibrillation after an acute myocardial infarction. The physician prescribes digoxin (Lanoxin), 0.125 mg I.M. daily. The nurse clarifies the order with the physician because I.M. administration of digoxin leads to:

an increased serum creatine kinase (CK) level.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects which medication to be administered to the patient?

Anticoagulant

A client with chest pain receives aspirin and nitroglycerin (Nitrostat) on the way to the acute care facility. Based on an electrocardiogram obtained on admission, the physician suspects a myocardial infarction (MI) and prescribes I.V. morphine to relieve continuing pain. A primary goal of nursing care for this client is to recognize life-threatening complications of an MI. The major cause of death after an MI is:

Cardiac arrhythmia

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's plan of care, the nurse should include which expected outcome

Client will verbalize the intention to stop smoking.

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?

Decreased cardiac output related to depressed myocardial function, deficient fluid volume, or impaired electrical conduction

Which of the following signs and symptoms suggest that a client's abdominal aortic aneurysm is extending?

Decreased pulse rate and blood pressure

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals which of the following?

Dependent pallor

A nurse educator in the cardiac care unit is assigned to orient a newly hired nurse from the Middle East. Included in the orientation is the medication administration system. What is the best way to determine if the nurse understands the medication system?

Have the nurse demonstrate the procedure.

A client with a history of atrial arrhythmia is receiving propranolol (Inderal), 10 mg by mouth three times per day. The nurse knows that propranolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?

Heart

Before administering digoxin (Lanoxin) to a client, a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the:

Kidneys

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. On a 12-lead ECG, which leads record electrical events in the septal region of the left ventricle?

Leads V3 and V4

A client who suffered blunt chest trauma in a car accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, the nurse should encourage the client to assume which position?

Leaning forward while sitting

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?

Leg edema

The nurse is teaching a client how to take nitroglycerin (Nitrostat) to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse informs the client that nitroglycerin may cause

headache, hypotension, dizziness, and flushing

The nurse is explaining the use of transdermal nitroglycerin (Transderm-Nitro), which is to be applied twice daily. The client demonstrates understanding when he states:

My wife should be careful not to touch the patch with her fingers if she helps me

An increase in the creatine kinase-MB isoenzyme (CK-MB) can be caused by

Myocardial necrosis

The nurse reviews a client's medication history before administering a cholinergic blocking agent. Which of the following drugs may have delayed absorption because of the adverse effects of a cholinergic blocking agent?

Nitroglycerin (Nitrostat)

A cognitively alert client is scheduled for a coronary artery bypass graft surgery in the morning. The nurse checks the chart for preoperative orders and finds that the surgical consent form hasn't been signed. Which of the following is the best action for the nurse to take?

Notify the surgeon

The nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms would suggest circulatory impairment?

Numbness, cool skin temperature, and pallor

The nurse is educating a client who's at risk for coronary artery disease (CAD). The nurse tells the client that CAD has many risk factors. Risk factors that can be controlled or modified include:

Obesity, inactivity, diet, and smoking.

Which characteristic suggests that the client's chest pain is pleuritic?

The pain increases with deep inspiration and decreases when the client leans forward.

A male client has been complaining of chest pain and shortness of breath for the past 2 hours. He has a temperature of 99° F (37.2° C), a pulse of 96 beats/minute, respirations that are irregular and 16 breaths/minute, and a blood pressure of 140/96 mm Hg. He's placed on continuous cardiac monitoring to:

Assess for potentially dangerous arrhythmias

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which statement by the client most strongly suggests angina pectoris?

The pain occurred while I was mowing the lawn.

The nurse administers basic cardiac life support to a client in cardiac arrest after establishing unresponsiveness. Which action does the nurse perform during basic life support?

Assessing the patency of the airway

A nurse is assigned the care of an 87-year-old client with multiple ulcerations, which require dressing changes. The nurse is also assigned the care of a 50-year-old client, who is ordered to receive 2 units of packed red blood cells. Which task can the nurse delegate to the nursing assistant?

Assisting the clients with bathing

To avoid a falsely elevated serum digoxin level, the nurse should wait how long after administering oral digoxin (Lanoxin) to draw a blood sample?

At least 8 hours

The licensed practical nurse discovers a client with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication would the registered nurse use to treat the client's bradycardia?

Atropine

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate?

The severity of discomfort isn't related to the size of varicosities.

The night shift nurse reports that a client admitted with a myocardial infarction has normal capillary refill. What capillary refill time would the nurse expect to find if the client's refill time remains normal?

1 to 3 seconds

(SELECT ALL THAT APPLY) The nurse is caring for a client who just underwent cardiac catheterization through a femoral access site. Which nursing interventions should the nurse include in the care plan for the next 8 hours?

(1) Maintain pressure over the femoral access site. (3) Check the dressing and access site for bleeding. (5) Keep the extremity straight.

(SELECT ALL THAT APPLY) The nurse advises a client recovering from a myocardial infarction to decrease his fat and sodium intake. Which foods should the nurse instruct the client to avoid?

(1) Pepperoni Pizza (3) Bacon (4) Cheese (6) Soft Drinks

(SELECT ALL THAT APPLY) The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)?

(2) Serum troponin (3) Serum myoglobin

(SELECT ALL THAT APPLY) A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure?

(3) Orthopnea (4) Cough (6) Crackles

(SELECT ALL THAT APPLY) A client is receiving heparin I.V. for the treatment of thrombophlebitis. Which laboratory value should the nurse monitor throughout heparin therapy?

(3) Partial thromboplastin time (PTT) (5) Platelet count

A client is prescribed flecainide (Tambocor) to treat atrial fibrillation. How soon after administering flecainide orally can the nurse expect the drug to reach its peak concentration?

2 to 3 hours

How long after oral administration can the nurse expect to see digoxin's (Lanoxin) peak effect?

2 to 6 hours

A client is admitted to the coronary care unit with a suspected diagnosis of acute myocardial infarction. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain?

4 to 6 hours

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:

Aspirin

At a staff meeting, a nurse-manager states that the unit performance improvement committee will perform a concurrent audit of the documentation of all coronary artery bypass clients' clinical pathways weekly for 4 weeks. A nurse asks why this is necessary. Which response is the best explanation of the audit's purpose?

Audits are an evaluation tool used to improve compliance with hospital policy and standards

The nurse is teaching a client who will be discharged with a prescription for warfarin (Coumadin). The nurse should include which statement in discharge teaching?

Avoid aspirin while taking warfarin.

Echocardiography reveals vegetation on a client's heart valves. The nurse knows that this finding indicates:

Bacterial invasion.

A client with chronic heart failure is examined in the outpatient department to investigate recent onset of peripheral edema and increased shortness of breath. Physical findings include bilateral crackles, a third heart sound (S3), distended neck veins, elevated blood pressure, and pitting edema of the ankles. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema?

Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours

A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?

Blood pressure

Before discharge, which instruction should the nurse give to a client receiving digoxin (Lanoxin)?

Call the physician if you have a rapid heart rate.

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 164/92 mm Hg and notes a 5-lb (2.3-kg) weight gain over the past 6 months. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?

Noncompliance (nonadherence to therapeutic regimen)

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic indicates myocardial ischemia?

Elevated ST segment

A nurse is caring for a client who has been administered digoxin (Lanoxin) 0.125 mg by mouth daily. The client develops sinus bradycardia with a heart rate of 50 beats/minute. His vital signs are stable. Which of the following actions should the nurse take first?

Notify the physician

A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and family to expect which common, spontaneously resolving symptom?

Depression

The nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse can anticipate using:

Diuretics.

The nurse is caring for a client with rheumatic fever and a nursing diagnosis of Activity intolerance related to reduced cardiac reserve and enforced bed rest. Before the nurse can eliminate this nursing diagnosis, the client must meet which outcome measurement criterion?

Erythrocyte sedimentation rate returns to normal

The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first

Establish unresponsiveness

A client is diagnosed with pericarditis. The nurse anticipates that the client has which signs and symptoms?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)

The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are

Fine crackles

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, the nurse should include which instruction?

Flex your calf muscles, avoid alcohol, and change positions slowly.

The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by:

Forcing blood into the deep venous system.

A nurse is caring for a hypertensive client who has been placed on a low-sodium diet. Which menu selection demonstrates the client's understanding of this diet?

Fresh green beans and chicken salad

A client is admitted to the acute care facility for treatment of heart failure. The nurse expects the physician to prescribe which drug?

Furosemide (Lasix)

An elderly client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism?

Homans

The physician prescribes digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which electrolyte imbalance may predispose the client to digoxin toxicity?

Hypokalemia

A client is recovering from surgical repair of a dissecting aortic aneurysm. The nurse should evaluate the client for signs of bleeding or recurring dissection. These signs include:

Hypotension and tachycardia.

A male client has arteriosclerosis with intermittent claudication. The nurse has worked with him to develop a walking program. Which statement by the client indicates that he understands the program?

I should walk until pain occurs, then rest

The nurse knows that client teaching about hypertension has been effective when the client states:

I shouldn't adjust my medication without my physician's advice.

The physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test may be used to determine a client's response to oral anticoagulant drugs?

International Normalized Ratio (INR)

Within hours after suffering a massive myocardial infarction, a client experiences cardiogenic shock. All vital functions are being monitored closely; an intra-arterial catheter has been inserted to detect changes in arterial blood pressure. Which statement comparing intra-arterial and cuff blood pressure readings is accurate?

Intra-arterial readings should be at least 10 mm Hg higher than cuff readings.

While receiving a heparin infusion to treat deep vein thrombosis, a client reports that the gums bleed when brushing the teeth. What should the nurse do first?

Notify the physician.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, and cold left calf. While the physician determines the appropriate therapy, the nurse should:

Keep the affected leg level or slightly dependent.

When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are found in the carotid sinus and aorta. Which other area should the nurse mention as a site of arterial baroreceptors?

Left ventricular wall

The nurse is teaching a client who receives nitrates for the relief of chest pain. Which of the following instructions should the nurse emphasize?

Lie down or sit in a chair for 5 to 10 minutes after taking the drug.

A client is diagnosed with prehypertension. Which of the following would most likely be included in the client's treatment plan?

Lifestyle modification instructions

Before discharge, which instruction should the nurse give to a client receiving flecainide (Tambocor) to reduce the risk of heart failure?

Limit fluid intake

Before discharge, which instruction should the nurse give to a client receiving flecainide (Tambocor) to reduce the risk of heart failure

Limit your fluid intake

A male client is receiving digoxin (Lanoxin) and furosemide (Lasix) to treat heart failure. He complains of feeling weak and having muscle cramps. His apical pulse is 76 beats/minute; respirations, 16 breaths/minute; and blood pressure, 148/86 mm Hg. What action should the nurse take?

Look at the chart for his last potassium level and contact the physician.

A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs

Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation.

The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

Low serum potassium level

A client is experiencing an acute myocardial infarction (MI) and I.V. morphine is prescribed. Morphine is given because it

Lowers resistance, reduces cardiac workload, and decreases myocardial oxygen demand

The nurse may expect to be instructed to obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?

Magnesium and potassium

A client hospitalized for treatment of hypertension is being prepared for discharge. The nurse should be sure to cover which teaching topic?

Maintaining a low-sodium diet

The nurse is assessing a client with heart failure. Which heart valve sound will the nurse hear best at the fifth left intercostal space at the midclavicular line?

Mitral

A client who complained of chest pain received sublingual nitroglycerin (Nitrostat). Which statement by the client indicates that this drug is producing its therapeutic effect?

My chest pain is decreasing.

A client with a history of I.V. drug abuse is admitted to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has

Osler's nodes and splinter hemorrhages

A client is recovering from an acute myocardial infarction (MI). During the first week of recovery, the nurse should stay alert for which abnormal heart sound?

Pericardial friction rub

A client is receiving captopril (Capoten) for heart failure. Which finding indicates that the medication isn't producing the desired treatment outcome and requires the nurse to notify the physician?

Peripheral edema

A male client has been admitted to the hospital with heart failure. On entering the room, the nurse notices that the client is having difficulty breathing. Which position would be the most appropriate to help his breathing?

Place the client in high Fowler's position

The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should

Place the client in high Fowler's position

The nurse is caring for a client with hemiparesis caused by a stroke. Which intervention takes highest priority

Placing the client on the affected side

A client is admitted to the cardiac unit with a diagnosis of heart failure. The physician prescribes furosemide (Lasix) and digoxin (Lanoxin) to manage the condition. Which laboratory value should be monitored during hospitalization?

Potassium

A client, age 59, complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks ago. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and prescribes pentoxifylline (Trental), 400 mg by mouth three times daily with meals. The nurse should provide which instruction concerning long-term care?

Practice meticulous foot care.

The nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should

Press the right upper abdomen

The most important reason for the nurse to encourage a client with peripheral vascular disease to initiate a walking program is because it:

Promotes collateral circulation.

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for adverse effects of heparin, especially bleeding. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that's specific to heparin. Which agent fits this description?

Protamine sulfate

A nurse is developing a plan of palliative care for a client with end-stage cardiomyopathy. Which action is appropriate to include in the care plan?

Provide nonpharmacological measures to reduce discomfort

A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?

Pulmonary hypertension

An average-weight client complains of generalized steady abdominal pain. The nurse should suspect an abdominal aortic aneurysm, if the abdominal pain is accompanied by which finding?

Pulsating mass in the periumbilical area

A client with mitral valve prolapse is advised to have elective mitral valve replacement. Because the client is a Jehovah's Witness, she declares in her advance directive that no blood products are to be administered. As a result, the consulting cardiac surgeon refuses to care for the client. It would be most appropriate for the nurse caring for the client to:

Realize the surgeon has the right to refuse to care for the client.

A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?

Recommend he have his blood pressure rechecked within 2 months.

After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg by mouth daily. The nurse should teach the client that this medication has been prescribed to:

Reduce platelet agglutination

After receiving nitroglycerin (Nitrostat), a client verbalizes relief of chest pain. The physician prescribes transdermal nitroglycerin (Nitro-Dur), 5-mg patch daily, as prophylaxis for angina pectoris. When teaching the client how to apply the transdermal system, the nurse should provide which instruction?

Report skin irritation or other adverse reactions.

Because of a staffing shortage, a nurse is reassigned to a cardiovascular unit for a 4-hour shift. The nurse has never worked on a cardiovascular unit and doesn't feel that she can safely care for clients on this unit. Which of the following is the most appropriate initial action for the nurse?

Report to the unit and discuss her assignment with the charge nurse to identify tasks that she can perform safely.

Continual assessment is an important component in cardiopulmonary resuscitation (CPR). Before initiating CPR, the nurse should always assess for:

Responsiveness.

The nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, the nurse should consider which finding significant?

Rheumatic fever

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis is appropriate?

Risk for injury

During digoxin (Lanoxin) therapy, the nurse should closely monitor the client's:

Serum potassium and magnesium levels

A client reports recent onset of sporadic chest pain with exertion. The client also has fatigue and mild ankle swelling, which is worst at the end of the day. The nurse suspects a cardiovascular disorder. When exploring the chief complaint, the nurse should find out if the client has any other common cardiovascular symptoms, such as:

Shortness of breath

The physician has ordered digoxin for a client with pulmonary edema. The nurse knows that digoxin has a direct and beneficial effect on myocardial contraction in the failing heart. This effect:

Slows the conduction of impulses through the atrioventricular (AV) node

A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, the nurse formulates interventions with which goal in mind?

Stabilizing the heart rate and blood pressure and easing anxiety

Considering a client's atrial fibrillation, the nurse must administer digoxin (Lanoxin) with caution because it

Stimulates the parasympathetic division of the autonomic nervous system, increasing vagal tone

When assisting with an electrocardiogram (ECG), the nurse would expect to place the client in which position?

Supine

A client is admitted to the hospital with a diagnosis of angina. As part of the discharge plan, a nurse should include which of the following instructions to reduce the risk of angina?

Take frequent rest breaks during the day.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports stopping smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, the nurse should recommend which additional measure?

Taking daily walks

The nurse is evaluating a client who had a myocardial infarction (MI) 7 days ago. Which outcome indicates that the client is responding favorably to therapy?

The client demonstrates the ability to tolerate increasing activity without chest pain.

A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Data collection findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. This data may reflect that:

The client is going into cardiogenic shock.

A nurse walking down the hospital corridor hears a call for help from a client who was admitted with vascular insufficiency. She finds the client lying on the floor. The nurse assesses the client and notifies the physician of the incident. What information should the nurse chart on the incident report form?

The client was observed on the floor.

After abdominal surgery, which factor would predispose a client to deep vein thrombosis?

The client will be immobile during and shortly after surgery

A nurse is caring for a client with a diagnosis of pericarditis. Which statement might indicate a violation of client confidentiality?

The nurse discussed the client's diagnosis with a family friend over the telephone.

The nurse should advise the client with an axillofemoral bypass graft to avoid

Tight belts

Which treatment would be the best therapy for a stable client with digoxin toxicity?

Time and symptomatic treatment

A 43-year-old man was transferring a load of firewood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which immediate order by the physician?

Tissue plasminogen activator (tPA)

A client newly diagnosed with heart failure is placed on bed rest. What is the most appropriate rationale for this action

To reduce the heart's workload

A client with severe angina and electrocardiogram changes is seen in the emergency department. In terms of serum testing, the nurse can expect which laboratory test to be ordered?

Troponin

A client with a history of severe angina is being seen in the emergency department for chest pain. In terms of diagnostic laboratory testing, it's most important for the nurse to advocate ordering a:

Troponin level

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension?

Untreated hypertension

The nurse is teaching a client about maintaining a healthy heart. The nurse should include which recommendation

Use alcohol in moderation

The nurse suspects that a 68-year-old client has digoxin toxicity. The nurse should assess fo

Vision changes

A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity also may cause:

Visual disturbances

A 40-year-old female client who is taking nifedipine (Procardia) for hypertension tells the nurse that she has noticed a "little swelling" in her ankles. What should be the nurse's first response?

When did you first notice this?

A client with chest pain doesn't respond to nitroglycerin (Nitrostat). On admission to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

Within 3 to 6 hours

A client who has just been diagnosed with myocardial infarction (MI) begins to cry and tells the nurse that his brother died of a heart attack last year. Which response by the nurse is most appropriate?

You sound as though you think you're going to die.