NCLEX-PN Chapter 3 'Cardiovascular Disorders'

A client diagnosed with acute arterial occlusive disease is scheduled to undergo an atherectomy. What is the priority nursing intervention for this client immediately after the procedure?

Atherectomy is a surgical treatment used for acute arterial occlusive disease. After the procedure, the client should be monitored frequently for bleeding at the catheter site and vital signs should be taken every 15 minutes times four, and then every hour for the first few hours.

A nurse is monitoring a client with asthma taking atenolol. Which finding would indicate a potential complication associated with atenolol?

Audible wheezing may indicate serious bronchospasm, especially in clients with asthma or obstructive pulmonary disease.

A client with coronary artery disease comes to the clinic with an elevated total serum cholesterol level above 240. Which medication does the nurse expect the health care provider to prescribe?

Cholestyramine and Lovastatin help to lower total cholesterol.

An older adult client is newly diagnosed with left-sided heart failure. Which sign most commonly associated with this type of heart failure would the nurse expect to find when obtaining data for this client?

Crackles - classic sign of left-sided heart failure, these sounds are caused by fluid backing up into the pulmonary system.

A client is admitted to the emergency department with chest discomfort, diaphoresis, and nausea. Suspecting possible myocardial infarction, the nurse would anticipate the health care provider to prescribe which diagnostic test to quickly determine myocardial damage?

Electrocardiogram (ECG) - the quickest, most accurate, and most widely used tool to diagnose MI.

Which action by the nurse is the priority for a client exhibiting signs and symptoms of coronary artery disease?

Enhancing myocardial oxygenation is always the priority when a client exhibits signs or symptoms of cardiac compromise.

A nurse obtaining data from a client observes jugular vein distention (JVD). Which condition does the nurse suspect this client to have?

Heart Failure - Elevated venous pressure, exhibited as JVD, indicates the heart's failure to pump.

A client demonstrates signs of cardiogenic shock. Which medications should the nurse expect the healthcare provider to prescribe for this client?

Medications for cardiogenic shock include a cardiac glycoside (digoxin), a cardiac inotropic agent (dopamine), a diuretic (furosemide), and a vasodilator (nitroprusside sodium).

A client has just had a myocardial infarction and the nurse is preparing to administer morphine. What is the primary reason for administering morphine to this client?

Morphine is administered as analgesia because chest pain stimulates the sympathetic nervous system, leading to an increase in heart rate and vasoconstriction, so to relieve chest pain is the main reason.

An older client is admitted to an acute care floor with the diagnosis of heart failure. Upon further workup the health care provider informs the nurse that the client has right-sided heart failure. Which symptom should the nurse expect to find in this client?

Signs of right sided heart failure include dependent edema, jugular vein distention and weight gain. Crackles are a sign of left sided heart failure and weight loss is not an indication of heart failure.

When reinforcing education for the client about the importance of smoking cessation, which statement made by the client indicate understanding?

Smoking is the leading modifiable risk factor for developing coronary heart disease. Smoking causes the platelets of the blood to clump together, causes spasms in the coronary arteries, lowers good cholesterol, and reduces the amount of oxygen carried in the red blood cells.

A nurse receives a report on a client reporting weight gain, nausea, and decreased urine output. Which condition should the nurse expect?

Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure.

The client is informed that elevated serum total cholesterol levels significantly increases the risk of coronary artery disease? Which intervention is best for the nurse to suggest to a client who has an elevated serum total cholesterol level?

A change in diet would be the best intervention and should include limited fats and carbohydrates. Total cholesterol levels above 200 mg/dL are considered borderline high; they require dietary restrictions and perhaps medication.

What should be the nurse's FIRST intervention for a client experiencing a myocardial infarction?

Administering Oxygen - supplemental oxygen to the client is the first priority of care, the myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage.

A nurse is screening clients for their risk of developing cardiovascular disease. The nurse identifies which clients to be at the greatest risk?

African Americans are two to three times more likely to develop hypertension than Caucasians. Males have more myocardial infarctions than women until women are post menopause when their risk increases.

The nurse is auscultating the client's heart and identifies a third heart sound. Which complication does the nurse expect to be the cause of the third heart sound (S3)?

An S3 sound occurs when the ventricles are resistant to filling and is heard just after the S2 when the atrioventricular valves open.

A nurse is about to administer Digoxin to a client with heart failure. Which parameter should the nurse check before administering the medication?

Apical Pulse - essential for accurately assessing the client's heart rate before administering digoxin as it is the most accurate pulse point in the body.

A client who recently experienced a myocardial infarction is admitted to the hospital. Aware of the most common complication of MI, the nurse would monitor this client closely for which condition.

Arrhythmias - caused by oxygen deprivation to the myocardium, are the most common complication of MI.

A client is placed on several medications after having a myocardial infarction. Which drug class is part of the medication regimen for this client that will protect the ischemic myocardium by decreasing catecholamines and sympathetic nerve stimulation?

Beta-blockers- they work by decreasing catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce risk of another infarction by decreasing the heart's workload.

The nursing student is caring for a client who is symptomatic for coronary artery disease. Which symptom does the student expect to find when obtaining data for this client.

Chest pain, arm pain, jaw pain, and back pain are key signs and symptoms of Coronary artery disease. These can occur after exertion, emotional stress, or exposure to cold but can also develop when the client is at rest.

A client is seen in the emergency department and the health care provider suspects an abdominal aortic aneurysm. Which nursing actions should be performed?

The nurse should monitor and record vital signs, monitor input and output as well as lab values, and observe client for hypovolemic shock in case the aneurysm has ruptured.

A client is hospitalized to rule out an acute myocardial infarction. Laboratory studies indicate a normal lactate dehydrogenase level and an elevated troponin I level. The nurse enters the client's room and finds the client pacing the floor. What is the best way to respond to this?

Given the laboratory data, especially the elevated troponin I level, the nurse should realize that the client probably had an MI and that he needs to lie down and rest his heart. However, the nurse should also realize the need to respond to the client's emotional distress by acknowledging his feelings and offering to discuss the situation.

A nurse receives a report on a client who has been diagnosed with an abdominal aortic aneurysm (AAA). The nurse should expect the client to have which underlying disease?

Atherosclerosis is linked to 75% of all AAA's. Plaque damages the wall of the artery and weakens it, causing an aneurysm.

The nurse is monitoring laboratory studies for a client that had a myocardial infarction. Which test will the nurse monitor that is most indicative of cardiac damage?

Creatine Kinase Isoenzymes (CK-MB) isoenzymes are present in the blood, these spill into the plasma when cardiac tissue is damaged.

A client is admitted to the hospital displaying sinus bradycardia, nausea, anorexia, and blurred vision. What should the nurse suspect this client to be experiencing?

Digoxin Toxicity

A client who had an anterior wall myocardial infarction would have a greater risk for exhibiting crackles in the lungs related to which disorder?

Left Sided Heart Failure - the left ventricle is responsible for most of the cardiac output, an anterior wall MI may result in a decrease in left ventricular function.

A client is placed on a medication to stimulate the sympathetic nervous system. Which response should the nurse expect from this medication?

Stimulation of the sympathetic nervous system causes tachycardia, or an increase in heart rate. This response causes an increase in contractility which compensates for the response.

An older adult client with heart failure and 2+ pitting edema is prescribed furosemide. Due to the effects of furosemide, which supplemental medication would the nurse expect to see on board for this client?

Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of the diuretic.

The nurse is obtaining data from a client who has just been diagnosed with coronary artery disease. Which findings does the nurse anticipate observing?

Symptoms for coronary artery disease occur when the artery is occluded to the point that inadequate blood supply to the muscle occurs. Assessment findings include possible normal findings during asymptomatic progression, chest pain, palpitations, syncope, and excessive fatigue.

A client is suspected to be experiencing a myocardial infarction. Which symptom reported by the client would lead the nurse to this conclusion?

The most common symptom of an MI is chest pain resulting from the deprivation of oxygen to the heart.

A client with a family history of heart disease is diagnosed with coronary artery disease. The client asks the nurse, "How it can affect my future health status?" What is the nurse's best response?

Coronary artery disease causes decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply which can cause hypertension, angina, MI, heart failure or death.

A client with pulmonary edema is given digoxin. What is the MOST direct effect on myocardial contraction due to digoxin in the failing heart?

Digoxin's physiological effect on the heart slows impulse conduction through the AV node. Digoxin increases cardiac output and ventricular emptying capacity and also promotes diuresis, thereby decreasing the circulating blood volume.

The client is prescribed a calcium channel blocker. Which primary actions should the nurse discuss with the client?

Dilation of Arteries, Decreases peripheral vascular resistance, reduces after load - these blockers inhibit calcium influx through the coronary arteries, causing arterial dilation and decreasing peripheral vascular resistance, which reduces afterload.

Which symptom does the nurse expect a client with right-sided heart failure to exhibit?

During right-sided heart failure, the right ventricle fails to empty adequately, cause a back up of blood in systemic blood vessels. This can lead to Jugular vein distention, peripheral edema, and hepatomegaly.

A client recently had a myocardial infarction. Which finding does the nurse identify to be a normal metabolic change occurring after an MI?

Glucose and fatty acids are metabolites whose levels increase after an MI. Slow conduction of impulse through the AV node is an electrophysiologic change. Hematologic changes affect the blood cells and platelets. Ejection fraction measure the mechanical pumping action of the heart.

The nurse explains to the client who has coronary artery disease that there are different types of treatment for the disease. Which method of treatment is considered to be the initial treatment for coronary artery disease?

Oral medication administration is a noninvasive, medical treatment for CAD and is usually the initial treatment for coronary artery disease.

A client has been diagnosed with left sided heart failure. Which symptoms should the nurse expect to see?

Syncope and Orthopnea (discomfort when breathing from a laying position) - Left-sided heart failure causes decreased cardiac output and increases pulmonary congestion. Decreased cardiac output may cause a decrease in cerebral perfusion, resulting in syncope. Orthopnea is caused by pulmonary congestion.

The nursing student voices an understanding of correct anatomy when properly identifying the following areas on the precordium that are used for auscultation of heart sounds.

The correct landmarks that can be used for auscultation of heart sounds are the aortic area, pulmonic area, ERB point, tricuspid area and mitral area. 'APETM' acronym to remember, 'All People Enjoy Time Magazine'.