NUR 202 Cardiology Quiz

A client with left ventricular heart failure is taking digoxin 0.25 mg daily. What changes does the nurse expect to find if this medication is therapeutically effective? Select all that apply.

Diuresis Decreased edema Decreased pulse rate

A client with heart disease has been reading on the Internet about the anatomy and physiology of the heart and tells the nurse, "I'm so confused." The nurse reinforces the pattern of circulation in the body. Which client statement indicates a correct understanding?

"Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta."

A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority?

Decrease the workload on the heart and promote maximum coronary artery filling With a myocardial infarction, circulation of blood to cardiac muscle is reduced, depriving it of oxygen; therefore the oxygen demands of the body need to be decreased to reduce stress on the heart and reduce cardiac output. Increased coronary artery filling allows more blood and therefore oxygen to reach cardiac muscle; this increases myocardial efficiency. Increasing left ventricular filling increases the workload of the heart. Oxygenation of vital organs must be maintained. Decreasing oxygen to vital organs of the body may interfere with their ability to function. Increasing venous return to the right atrium increases the workload of the heart.

A client is prescribed prolonged bed rest after surgery. The nurse expects which complication to possibly occur secondary to a compromised circulation from the calf veins?

Pulmonary embolism The pulmonary capillary beds are the first small vessels that the embolus encounters once it is released from the calf veins. Pressure on the popliteal space causes venous stasis, promoting thrombus formation. Dry gangrene occurs when the arterial rather than the venous circulation is compromised. The other complications (cerebral embolism and coronary vessel occlusion) will not occur because the embolus will enter the pulmonary system first.

A nurse is caring for a client after cardiac surgery. Which signs will cause the nurse to suspect cardiac tamponade? Select all that apply.

Pulsus paradoxus Muffled heart sounds Jugular vein distention Pulsus paradoxus is present in cardiac tamponade. Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid, thready pulse and muffled heart sounds. The increased venous pressure associated with cardiac tamponade causes jugular vein distention. Tamponade causes hypotension, not hypertension, and a narrowed pulse pressure. As the heart becomes more inefficient, there is a decrease in kidney perfusion and therefore a decrease in urine output.

A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect?

"I have trouble breathing when I walk rapidly." Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "I am tired at the end of the day" is not specific to left ventricular heart failure. The statement "When I eat a large meal, I feel bloated" is not specific to left ventricular heart failure.

A client is scheduled to have a coronary artery bypass graft (CABG). The client's spouse asks what the benefit of the surgery is. How should the nurse respond?

"This surgery significantly decreases symptoms in most clients." The majority of those who have this surgery have marked relief from their symptoms because the flow of blood to myocardial cells is increased. Whether the procedure will enable the client to return to work depends on the client's presurgical condition and occupation, not the surgery itself. So far, studies have failed to show that coronary artery bypass surgery affects life span. The surgery itself does not affect the disease process; clients must reduce risk factors (obesity, smoking, and high-fat/high-cholesterol diet) as well.

While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the healthcare provider to prescribe?

Atropine sulfate Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increased heart rate. Digoxin slows the heart rate; hence it would not be indicated in this situation. Lidocaine decreases myocardial sensitivity and will not increase the heart rate. Amiodarone is an antidysrhythmic drug used for ventricular tachycardia; it will not stimulate the heart rate.

A client who is receiving a cardiac glycoside, a diuretic, and a vasodilator has been placed on bed rest. The client's apical pulse rate is 44 beats per minute. The nurse concludes that the decreased heart rate most likely is a result of which drug?

Cardiac glycoside A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. A bed rest regimen does not drastically reduce the heart rate.

The nurse is caring for a client who is admitted with the diagnosis of mild heart failure. Which type of lung sounds should the nurse expect to hear?

Crackles Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration. Stridor is not heard in heart failure, but with tracheal constriction or obstruction. Wheezes are not heard with heart failure, but with asthma. Friction rubs are not heard with heart failure, but with pleurisy.

A client is experiencing tachycardia. Which adverse hemodynamic effects will the nurse consider when planning care for this client? Select all that apply.

Decreased ventricular filling time Decreased cardiac output Tachycardia is a fast heart rate; the fast heart rhythm may cause a decrease in cardiac output because of the decreased filling time for the ventricles. There is also a decreased, not increased, time for coronary artery filling during diastole. During atrial systole, a bolus of atrial blood is ejected into the ventricles; this step is called the atrial kick, and it contributes more blood to the cardiac output of the ventricles. With fast heart rates, there is less time for the atria to fill, and therefore less blood (atrial kick) to pump.

A healthcare provider prescribes morphine for a client being treated for myocardial infarction. What physiologic response will occur if the client experiences the intended therapeutic effect of morphine?

Decreased workload of the heart Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Decreasing the size of the clot blocking the coronary artery is the action of antithrombolytic therapy. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.

An older adult client is diagnosed with left-sided congestive heart failure. Which assessments should the nurse expect to find? Select all that apply.

Dyspnea Crackles Hacking Cough The left ventricle pumps oxygen-rich blood to the rest of the body. Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents the body from getting enough oxygen-rich blood. The blood backs up into the lungs instead, which causes a buildup of fluid. Common symptoms may include: dyspnea, shallow respirations, crackles, dry, hacking cough, and frothy, pink-tinged sputum. Right-sided heart failure occurs when the right side of the heart can't perform its job effectively. Common symptoms of right-sided heart failure include peripheral edema, weight gain, and jugular distention.

While instructing a community group regarding risk factors for coronary artery disease, the nurse provides a list of risk factors that cannot be modified. What should be included on the list?

Heredity Heredity refers to genetic makeup and cannot be changed. Cigarette smoking is a lifestyle habit that involves behavior modification. Hypertension and diabetes mellitus are risk factors of coronary artery disease that can be controlled with diet, medication, and exercise.

A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client?

Increase oxygen concentration to heart cells Administration of oxygen increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, usually is associated with myocardial infarction. Although administering oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a myocardial infarction from a coronary occlusion.

A client is brought to the emergency department with chest pain. The client asks why an electrocardiogram (ECG) has been prescribed. What does the nurse explain that the ECG will do?

Indicates acutely impaired blood flow to the heart muscle The ECG waveform can indicate myocardial ischemia or injury as evidenced by ST waveform depression or elevation, respectively. Ischemia or injury is caused by an acute lack of blood flow through the coronary arteries that supply oxygenated blood to the heart muscle. Auscultation can detect various heart sounds. Blood flow to the heart muscle is assessed during a cardiac catheterization. Spatial relationships of structures within the heart are assessed via an echocardiogram.

A client admitted to the hospital for chest pain is diagnosed with stable angina. Which information should the nurse include in the teaching session?

It is relieved by rest. Anginal pain commonly is relieved by immediate rest because rest decreases the cardiac workload and oxygen need. Angina usually is precipitated by exertion, emotion, or a heavy meal. Anginal pain usually is described as tightness, indigestion, or heaviness. Nitroglycerin, a vasodilator and a standard treatment for angina, dilates coronary arteries, which increases oxygen to the myocardium, decreasing pain.

A nurse prepares a client for insertion of a pulmonary artery catheter. What information can be obtained from monitoring the pulmonary artery pressure?

Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated. Information on stroke volume, the amount of blood ejected by the left ventricle with each contraction, is not provided by a pulmonary catheter. Although a central venous pressure reading can be obtained with the pulmonary catheter, it is not as specific as a pulmonary wedge pressure, which reflects pressure in the left side of the heart. The patency of the coronary arteries usually is evaluated by cardiac catheterization.

A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply?

Relieves pain and reduces cardiac oxygen demand Morphine is a specific central nervous system depressant used to relieve the pain associated with myocardial infarction; it also decreases apprehension and reduces cardiac oxygen demand by decreasing cardiac workload. Dilating coronary blood vessels is not the reason for the use of morphine. Decreasing anxiety and restlessness is not the primary reason for the use of morphine. Lidocaine is given intravenously to prevent fibrillation of the heart.

A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question?

Slows and strengthens cardiac contractions Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

A client with a long history of cardiovascular problems, including angina and hypertension, is scheduled to have a cardiac catheterization. During preprocedure teaching, what does the nurse explains to the client is the major purpose for catheterization?

To visualize the disease process in the coronary arteries Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization. Although pressures can be obtained, they are not the priority for this client; this assessment is appropriate for those with valvular disease. Determining the existence of congenital heart disease is appropriate for infants and young adults with cardiac birth defects. Measuring the oxygen content of various heart chambers is appropriate for infants and young children with suspected septal defects.

The spouse of a patient who had emergency coronary artery bypass surgery asks why there is a dressing on the patient's left leg. How should the nurse explain the dressing?

"A vein in the leg was used to bypass the coronary artery." The response that a vein in the leg was used to bypass the coronary artery provides information and reduces anxiety. The nurse understands that the greater saphenous vein of the leg is used to bypass the diseased coronary artery, and one surgical team obtains the vein while another team performs the chest surgery; this shortens the surgical time and decreases the risks of surgery. The internal mammary arteries are the grafts of choice, but the surgery is usually longer because of the necessity of dissecting the arteries from the chest wall. In addition, the internal mammary arteries may have been used in a previous bypass surgery. Cardiopulmonary bypass (extracorporeal circulation) is accomplished by placement of a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body; blood is returned to the body via a cannula in the aorta or the femoral artery. Off-pump surgery is used for minimally invasive surgical techniques. A filter is not inserted in the leg to prevent embolization during a coronary artery bypass graft (CABG). The arteries in the extremities are not examined during a CABG.

A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply.

weight smoking Obesity is a modifiable risk factor that is associated with coronary artery disease (CAD); an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is a modifiable risk factor for CAD. The incidence of CAD does increase with age. However, age is not a modifiable risk factor. Height is unrelated to the incidence of CAD. Family history is not a modifiable risk factor for CAD because one cannot control heredity.

During auscultation of the heart, where does the nurse expect the first heart sound (S 1) to be the loudest?

Apex of the heart The first heart sound is produced by closure of the mitral and tricuspid valves; it is heard best at the apex of the heart. The base of the heart is where the second heart sound (S 2) is best heard; S 2 is produced by closure of the aortic and pulmonic valves. The left lateral border covers a large area; the auscultatory areas that lie near it are the pulmonic and mitral areas. The right lateral border covers a large area; the only auscultatory area near it is the aortic area.

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication?

Aspirin Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better; hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and is not the drug of choice to relieve the pain associated with an MI. Midazolam HCl is a sedative-hypnotic that is used for its calming effect, but it will not relieve the pain of an MI. Alprazolam is an anxiolytic that is used for its calming effect, but it will not relieve the pain of an MI.

A woman comes to the emergency department reporting signs and symptoms that are determined by the primary healthcare provider to be caused by a myocardial infarction. The nurse obtains a health history. Which reported symptoms does the nurse determine are specifically related to a myocardial infarction in women? Select all that apply.

Severe fatigue Sense of unease A myocardial infarction in women may be asymptomatic, atypical, or mild. Unique symptoms include overwhelming fatigue, a sense of uneasiness, indigestion, and shoulder tenderness. A sense of unease is a unique characteristic of a myocardial infarction in women. The client knows something is not right but cannot identify what it is. This uneasiness often is disregarded by the client. A choking sensation occurs in both men and women with a myocardial infarction. Chest pain relieved by rest occurs in both men and women with angina; it is caused by coronary artery spasms leading to myocardial ischemia. Angina frequently is a precursor to a myocardial infarction. Pain radiating down the left arm occurs in both men and women. It can radiate also to the neck, lower jaw, left arm, left shoulder, and, less frequently, the right arm and back.

A client is admitted for a coronary artery bypass graft. The client states that the preoperative teaching materials contain information about pacemaker wires being inserted during surgery as a precautionary measure. The client asks, "What is the purpose of the pacemaker?" What is the best response by the nurse?

"In case of too slow of a heart rate, the epicardial leads are attached to a pacemaker to maintain a normal rate." Epicardial pacing involves attaching an atrial and ventricular pacing lead to the epicardium during heart surgery. The leads are passed through the chest wall and attached to the external power source. Epicardial pacing leads are placed prophylactically in case any bradydysrhythmias or tachydysrhythmias occur in the early postoperative period. Vagal stimulation during surgery may cause a severe bradycardia; in anticipation, pacemaker wires are inserted into the right atrium to be used to initiate impulses if the natural rate decreases below the preset rate of the pacemaker. This will ensure that the heart beats at the rate set for the pacemaker. This pacemaker initiates an impulse if the heart rate drops below a certain rate; the concept underlying this pacemaker is to speed up the heart, not to slow it down. There are no data to support the fact that this is a defibrillator pacemaker. The pacemaker wires are not used for defibrillation; defibrillator paddles are placed so that electricity affects the entire heart muscle. The rhythm can be irregular; however, if the pause between two beats is too long, the pacemaker will initiate an impulse.

A client who is suspected of having had a silent myocardial infarction has an electrocardiogram (ECG) prescribed by the primary healthcare provider. While the nurse prepares the client for this procedure, the client asks, "Why was this test prescribed?" Which is the best reply by the nurse?

"This test will reflect any heart damage." Changes in an ECG will reflect the area of the heart that is damaged because of hypoxia. A stethoscope is used to detect heart sounds. Medical interventions, such as cardioversion or cardiac medications, not an ECG, can alter heart rhythm. An ECG will reflect heart rhythm, not change it. Identifying how much stress a heart can tolerate is accomplished through a stress test; this uses an ECG in conjunction with physical exercise.

A nurse is preparing medications. Which client's health problem motivates the nurse to question a prescription for a beta blocker?

Acute heart failure Beta blockers reduce cardiac output and must be started slowly, so they are contraindicated for clients with acute heart failure. Beta blockers are used to treat coronary artery disease because they decrease myocardial oxygen demand by reducing peripheral resistance and cardiac contractility. Beta blockers are used to treat essential hypertension because they cause vasodilation and decrease cardiac contractility. Beta blockers lower heart rate.

A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug? <p>A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug?</p>

Amiodarone Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs). It works directly on the heart tissue and slows the nerve impulses in the heart. Atropine blocks vagal stimulation; it increases the heart rate and is used for bradycardia, not PVCs. Epinephrine increases myocardial contractility and heart rate; therefore, it is contraindicated in the treatment of PVCs. Sodium bicarbonate increases the serum pH level; therefore, it combats metabolic acidosis.

A client is admitted to the hospital with atrial fibrillation. A diagnosis of mitral valve stenosis is suspected. The nurse concludes that it is most significant if the client presents with what history?

Childhood strep throat Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve. Group A streptococcal antigens bind to receptors on heart cells, where an autoimmune response is triggered damaging the heart. Cystitis usually is caused by Escherichia coli, which does not affect heart valves. Pleurisy usually follows pulmonary problems unrelated to streptococcal infection; it does not result in damage to heart valves. The rubella virus does affect the valves of the heart.

A nurse is caring for a client with the diagnosis of right ventricular failure. Which condition unrelated to cardiac disease is the major cause of right ventricular failure?

Chronic obstructive pulmonary disease (COPD) COPD causes destruction of capillary beds around the alveoli, interfering with blood flow to the lungs from the right side of the heart. As the heart continues to strain against this resistance, heart failure eventually results. Renal disease causes stress on the left side of the heart. Hypovolemic shock will not cause stress on the right side of the heart. Severe systemic infection probably will produce greater stress on the left side of the heart.

A nurse is conducting a health class for adolescents. What modifiable risk factor, most closely associated with the development of coronary heart disease (CHD) in both men and women, should the nurse discuss?

Cigarette smoking Nicotine in cigarette smoke constricts blood vessels, including coronary arteries, which contributes to the occurrence of angina and CHD. Opioid use is not a risk factor for CHD. Judicious alcohol intake may promote relaxation, decreasing stress and limiting the development of CHD. Inactivity, not moderate exercise, is a risk factor for CHD. Exercise decreases hypertension, blood clotting, and heart rate. Exercise also increases metabolism, the plasma level of high-density lipoprotein cholesterol, and cardiac capillary blood flow.