NUR 213 Test 1, Cardiac

What are normal Troponin levels?

between 0 and 0.04 ng/mL

What is the normal range for the QRS complex?

0.06 - 0.12 sec (or less than 0.12)

What is serum Magnesium's normal range

1.5 - 2.5 mg/dL

What is serum Sodium normal range?

135 - 145 mEq/L

What is the normal range for HCO3?

22 - 26 mEq/L

What is the normal range for CO2?

25 - 30 mEq/L

What is the normal range for PaCO2?

35- 45mm/Hg

The nurse is caring for a client with a serum potassium level of 3.5. The client is placed on a monitor and receives 40mEq potassium chloride in 1000mL of D5W. Which of the following ECG patterns indicates to the nurse that the infusion should be discontinued? A. Narrowed QRS Complex B. Shortened PR interval C. Tall peaked T waves D. Prominent U waves

C. Tall peaked T waves are an indication of Hyperkalemia. The infusion should be discontinued and the HCP should be notified

What is the normal range for the PR interval?

0.12 - 0.2 sec

When reading an electrocardiogram, what are the five items taught to be measured in order?

1. Heart Rate 2. Rhythm (regular or irregular) 3. P waves; are they a 1:1 ratio with QRS 4. PR interval; Is it within normal limits (0.12 - 0.2 sec) 5. QRS complex; is it within normal limits (0.06 - 0.12sec)

What is the normal range for pH?

7.35 - 7.45

What is serum Calcium's normal range?

8.6 - 10.3 mg/dL

Which of the following drugs are significantly affected by the consumption of grapefruit juice? A. Amiodarone B. Atorvastatin C. Diphenhydramine D. Gentamicin E. Acetaminophen

A, B Amiodarone and Atorvastatin are both affected by grapefruit juice - It leads to increased bioavailability and serum drug levels and potential toxicity

The nurse is documenting care in the medical record of a client who has just received cardioversion. The nurse should include which of the following information in the documentation? A. The clients ECG rhythm after the cardioversion B. Energy settings used during the procedure C. Restocking the defibrillator after the procedure D. Recharging of the defibrillator after the procedure E. Condition of the clients skin under the electrodes, following the procedure

A, B, E

A nurse is reviewing the lab values of four patients. The nurse should identify which of the following are indicators that the patient is at risk for developing heart disease? SATA A. Total cholesterol 245 mg/dL B. HDL 90 mg/dL C. LDL 140mg/dL D. Triglycerides 125 mg/dL E. C-reactive protein 0.5 mg/L

A, C A client who has a total cholesterol level of greater than 200 mg/dL and a client who has an LDL of 140mg/dL are at increased risk of developing heart disease

Which of the following risk factors from Mrs. Smith's history would suggest a possible cardiac problem to the nurse? A. Hypertension for 12 years B. Gallbladder surgery 1 year ago C. Smoked for 43 years, but quit 1 year ago D. Mrs. Smith's father died at age 42 from MI E. She eats fast food 3 - 5 times a week

A, C, D, E Risk factors include HTN, family Hx, Obesity and a diet high in fats

Mrs. Smith has returned from a cardiac catheterization and PCI procedure. Which follow up care orders should the nurse assign to an experienced LPN/LVN? SATA A. Reminding the patient to stay in bed with the insertion site extremity straight B. Preparing a teaching plan that includes activity restrictions and risk factor modification C. Measuring the patients vitals q 15 min for the first hour D. Assessing catheter insertion site for bleeding or hematoma formation E. Monitoring peripheral pulses, skin temperature and skin color with each measurement of vital signs F. Administering two tablets of Acetaminophen for pain

A, C, D, E, F All of these are within the scope of an experienced LPN/LVN' practice. Preparing a teaching is in the RN's scope.

A nurse is caring for five clients. The nurse should identify that which of the following clients is at risk for developing dysrhythmia? SATA A. A client who has metabolic acidosis B. A client with a total serum calcium level of 9.5mg/dL C. A client with an SaO2of 96% D.A client with COPD E. A client who had a stent placement in a coronary artery

A, D, E A client with an acid-base imbalance is at risk for dysrhythmias such as Atrial Tachycardia and PVC due to depressed RR and hypokalemia. A client with lung disease is at risk for dysrhythmia such as tachycardia due to hypoxia. A client with a stent placement is at risk for Ventricular Tachycardia due to heart muscle irritation.

A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client? Select all that apply. A. Reduces myocardial oxygen consumption. B. Promotes reduction in respiratory rate. C. Prevents ventricular remodeling. D. Reduces blood pressure and heart rate. E. Reduces anxiety and fear.

A, D, E Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial oxygen con- sumption, blood pressure, and heart rate. Morphine also reduces anxiety and fear due to its sedative effects and by slowing the heart rate. It can depress respirations; however, such an effect may lead to hypoxia, which should be avoided in the treatment of chest pain. Angiotensin-converting enzyme- inhibitor drugs, not morphine, may help to prevent ventricular remodeling.

The client has chronic atrial fibrillation. Which discharge instructions should the nurse discuss with this client? A. Instruct the client to us soft-bristled toothbrushes B. Discuss the importance of getting monthly PTT C. Teach each client about the signs of pacemaker malfunctions D. Explain to the client the procedure for synchronized cardioversion

A. A client with chronic atrial fibrillation will be taking an anticoagulant to help prevent clot formation. Therefore, the client is at risk for bleeding and should be instructed to use a soft-bristle toothbrush.

A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given I.V. The nurse should fi rst: A. Administer the morphine. B. Obtain a 12-lead ECG. C. Obtain the blood work. D. Order the chest radiograph.

A. Although obtaining the ECG, chest radio- graph, and blood work are all important, the nurse's priority action should be to relieve the crushing chest pain. Therefore, administering morphine sul- fate is the priority action.

Which of the following types of cardiomyopathy can be associated with childbirth A. Dilated B. Hypertrophic C. Myocarditis D. Restrictive

A. Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a pre-existing cardiomyopathy not apparent prior to pregnancy.

The nurse on the telemetry unit has just received the A.M. shift report. Which client should the nurse assess first? A. The client diagnosed with myocardial infarction who has an audible S3 heart sound. B. The client diagnosed with congestive heart failure who has 4! sacral pitting edema. C. The client diagnosed with pneumonia who has a pulse oximeter reading of 94%. D. The client with chronic renal failure who has an elevated creatinine level.

A. An S3 heart sound indicates left ventricular failure, and the nurse must assess this client first because it is an emergency situation.

The nurse is assessing a patient who is taking oral amiodarone for atrial fibrillation. Which of the following should the nurse identify as an adverse reaction to this medication? A. Ataxia B. Dysuria C. Hypokalemia D. Hypertension

A. Ataxia, involuntary movements, peripheral neuropathy and tremor are all adverse effects of oral amiodarone

Which of the following conditions most commonly results in CAD? A. Atherosclerosis B. DM C. MI D. Renal failure

A. Atherosclerosis, or plaque formation, is the leading cause of CAD.

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A. Beta-adrenergic blockers B. Calcium channel blockers C. Narcotics D. Nitrates

A. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand.

A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider? A. Blood pressure 94/60 mm Hg B. Heart rate 76 bpm C. Urine output 50 ml/hour D. Respiratory rate 16 bpm

A. Blood Pressure 94/60 mmHg. Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60-100; systolic BP over 100) in order to safely administer both medications.

Nurse Patricia finds a female client who is post-myocardial infarction (MI) slumped on the side rails of the bed and unresponsive to shaking or shouting. Which is the nurse's next action? A. Call for help and note the time B. Clear the airway C. Give two sharp thumps to the precordium and check the pulse D. Administer two quick blows

A. Having established, by stimulating the client, that the client is unconscious rather than sleep, the nurse should immediately call for help. This may be done by dialing the operator from the client's phone and giving the hospital code for cardiac arrest and the client's room number to the operator, or if the phone is not available, by pulling the emergency call button. Noting the time is important baseline information for cardiac arrest procedures.

A nurse is caring for a patient who is receiving both Digoxin and Hydrochlorothiazide. The nurse understands which of the following in an adverse reaction to Hydrochlorothiazide? A. Hypokalemia B. Hyperkalemia C. Hyponatremia D. Oliguria

A. Hypokalemia

A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as: A. Normal sinus rhythm B. Sinus bradycardia C. Sick sinus syndrome D. First-degree heart block

A. Measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively. Sinus rhythms originate in the SA node. The SA node is located in the right atrium and is the heart's natural pacemaker. The normal rate of the SA node is between 60 and 100. On ECG, sinus rhythm is represented by monomorphic P waves before each QRS complex and is regular.

What is the normal range for hematocrit? A. Men: 41 - 50% Women: 36 - 48% B. Men: 36 - 48% Women: 41 - 50% C. Men: 32 - 42% Women: 32 - 42% D. Men: 48 - 52% Women: 40 - 42%

A. Normal range for men 41 - 50% Normal range for Women 36 - 48%

A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question? A. Call for urine output < 30 mL/hour for 2 consecutive hours. B. Metoprolol (Lopressor) 5 mg I.V. push. C. Prepare for a pulmonary artery catheter insertion. D. Titrate Dobutamine (Dobutrex) to keep systolic BP > 100.

A. Oliguria occurs during cardiogenic shock because there is reduced blood fl ow to the kidneys. Typical signs of cardiogenic shock include low blood pressure, rapid and weak pulse, decreased urine output, and signs of diminished blood fl ow to the brain, such as confusion and restlessness. Cardiogenic shock is a serious complication of MI, with a mortality rate approaching 90%. Fever is not a typical sign of cardiogenic shock.

Which of the following complications would most likely to occur following cardioversion? A. Stroke B. Hypertension C. Nausea and Vomiting D. Urinary incontinence

A. Stroke. A stroke may occur if a clot in the atrium embolizes and travels to the brain. Anticoagulant medications are indicated prior to cardioversion in clients who undergo cardioversion for A FIB of unknown duration since blood clots may form from stasis if contraction of the atrium is ineffective

The client's telemetry reading shows a P-wave before each QRS complex and the rate is 78. Which action should the nurse implement? A. Document this as normal sinus rhythm. B. Request a 12-lead electrocardiogram. C. Prepare to administer the cardiotonic digoxin po. D. Assess the client's cardiac enzymes.

A. The P-wave represents atrial contraction, and the QRS complex represents ventricu- lar contraction—a normal telemetry read- ing. A rate between 60 and 100 indicates normal sinus rhythm. Therefore, the nurse should document this as normal sinus rhythm and not take any action.

A charge nurse on the unit is assigning clients. Which of the following clients should be assigned to the most experienced nurse? A. A client with a serum potassium level of 6.0mEq/L who has peaked T waves B. A diabetic client who has a blood glucose level of 280 mg/dL C. A client with CHF who is scheduled for an echocardiogram D. A client with COPD who has ABGs: pH 7.38, PaO2 78, PaCO2 42, HCO3 24

A. The client with serum potassium level of 6.0 and peaked t waves has hyperkalemia which can lead to life threatening arrhythmias like V Fib.

A client has developed atrial fibrillation, which has a ventricular rate of 150 beats per minute. A nurse assesses the client for: A. Hypotension and Dizziness B. Nausea and vomiting C. Hypertension and headache D. Flat neck veins

A. The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. A physical exam should always begin with the assessment of airway breathing and circulation as it is going to affect the decision making regarding management. On general physical examination, patients may have tachycardia with an irregularly irregular pulse.

The client is exhibiting ventricular tachycardia. Which intervention should the nurse implement first? A. Administer lidocaine, an antidysrhythmic, IVP. B. Prepare to defibrillate the client at 200 joules. C. Assess the client's apical pulse and blood pressure. D. Start basic cardiopulmonary resuscitation.

A. The nurse must assess the apical pulse and blood pressure to determine if the client is in cardiac arrest and then treat as ventricu- lar defibrillation. If the client's heart is beating, the nurse would then administer lidocaine.

Which of the following complications is indicated by a third heart sound (S3)? A. Ventricular dilation B. Systemic hypertension C. Aortic valve malfunction D. Increased atrial contractions

A. Ventricular dilation. Rapid filling of the ventricles causes vasodilation that is auscultated as S3. The third heart sound (S3) is a low-frequency, brief vibration occurring in early diastole at the end of the rapid diastolic filling period of the right or left ventricle

The patient is in V Fib. Which interventions should the nurse implement? SATA A. Start CPR B. Prepare to administer adenosine C. Prepare to defibrillate client D. Bring crash cart to client E. Prepare to administer amiodarone

A. Ventricular fibrillation indicates the client does not have a heartbeat. Therefore CPR should be instituted. C. Defibrillation is the treatment of choice for ventricular fibrillation. D. The crash cart has the defibrillator and is used when performing advanced cardiopulmonary resuscitation. E. Amiodarone is an antidysrhythmic that is used in ventricular dysrhythmias.

Mrs. Smith's cardiac telemetry monitor shows a rhythm of sinus tachycardia with frequent premature ventricular contractions, Which drug should the nurse anticipate administering first? A. Amiodarone, IV push B. Nitroglycerine, SL C. Morphine Sulfate IV push D. Atenolol IV push

A. With frequent PVCs, the client is at risk for life-threatening dysrhythmias such as v tach or v fib. Amiodarone is an antidysrhythmic drug used to control dysrhythmias

The nurse understands which of the following are Joint Commission's national patient safety goals for 2022. SATA A. Identify patients correctly, using 2 identifiers B. Improve Staff communication, C. Give medications safely D. Use alarms safely E. Prevent Infections F. Identify Patient safety risks G. Prevent mistakes in surgery

All are correct. A. Use 2 patient identifiers. B. Get important information to the right person in a timely manner. C. Label medications correctly with special care of blood thinners. Make sure home medications are reconciled. D. Make sure that alarms are working and can be heard and responded to in timely manner. E. Use hand cleaning guidelines provided by CDC/WHO to prevent infections. F. Identify and reduce safety risks like falls and suicide. G. Ensure the correct surgery is done on the correct patient in the correct place - mark location of surgical site - pause before surgery to ensure accuracy

A nurse is caring for a client who just had a coronary artery bypass graft surgery. The nurse knows not to rewarm the patient too rapidly due to risk of which of the following complications? A. Septicemia B. Hypotension C. Tissue Necrosis D. Hypertension

B Hypotension. During the procedure, the client is maintained in a hypothermic state to reduce the metabolic demand of the heart and vital organs to prevent ischemia. Rewarming begins immediately after completion of the procedure but clients often have residual hypothermia even after the extended warming on the cardiopulmonary bypass. A warming rate of no more than 1.8 degrees F per hour is recommended to prevent rapid vasodilation, hypotension and shock

A patient has a serum potassium level of 2.8mmol/L. What symptoms would the nurse expect to see? SATA A. Bradycardia B. Hypotension C. Polyuria D. U waves on ECG E. Muscle cramps

B, C, D, E A patient with hypokalemia would most likely be tachycardic, hypotensive with polyuria and muscle cramping and U waves on the ECG.

When do coronary arteries primarily receive blood flow? A. During inspiration B. During Diastole C. During expiration D. During Systole

B. Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole.

Which client problem has priority for the client with a cardiac dysrhythmia? A. Alteration in comfort. B. Decreased cardiac output. C. Impaired gas exchange. D. Activity intolerance.

B. Any abnormal electrical activity of the heart causes decreased cardiac output.

Atherosclerosis impedes coronary blood flow by which of the following mechanisms? A. Plaques obstruct the vein B. Plaques obstruct the artery C. Blood clots form outside the vessel wall D. Hardened vessels dilate to allow the blood to flow through

B. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification.

A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is A. Start Peripheral IV B. Initiate High Quality Chest Compressions C. Establish an Airway D. Obtain Crash Cart

B. As per new guidelines, the American Heart Association recommends beginning CPR with chest compression (rather than checking for the airway first). Start CPR with 30 chest compressions before checking the airway and giving rescue breaths. Starting with chest compressions first applies to adults, children, and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm

A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: A. Sinus tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Ventricular fibrillation

B. Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled). Atrial fibrillation is the most common type of cardiac arrhythmia. It is the leading cardiac cause of stroke. Risk factors for atrial fibrillation include advanced age, high blood pressure, underlying heart and lung disease, congenital heart disease, and increased alcohol consumption.

Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? A. Antihypertensive B. Beta-adrenergic blockers C. Calcium channel blockers D. Nitrates

B. By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy.

Which of the following types of cardiomyopathy does not affect cardiac output? A. Dilated B. Hypertrophic C. Restrictive D. Obliterative

B. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Three explanations for the systolic anterior motion of the mitral valve have been offered, as follows: (1) the mitral valve is pulled against the septum by contraction of the papillary muscles, which occurs because of the valve's abnormal location and septal hypertrophy altering the orientation of the papillary muscles; (2) the mitral valve is pushed against the septum because of its abnormal position in the outflow tract; (3) the mitral valve is drawn toward the septum because of the lower pressure that occurs as blood is ejected at high velocity through a narrowed outflow tract (Venturi effect).

According to the ACLS algorithm, what is the first intervention when a patient is in asystole? A. Defibrillation B. Cardiopulmonary Resuscitation C. Administer Adenosine D. Administer Epinephrine

B. Cardiopulmonary Resuscitation followed quickly by epinephrine.

A client with acute Pericarditis is undergoing a nursing assessment. Which of the following findings should prompt immediate notification of the healthcare provider? A. Pericardial friction rub when auscultating the heart that is loudest at the left sternal border B. BP that is 88/60 and jugular venous distention C. Chest pain that increases with reclining position D. Widespread ST segment on ECG

B. Inflammation of the pericardium can result in pericardial effusion which can result in cardiac tamponade. Signs and symptoms of cardiac tamponade are distant/muffled heart sounds, reduced CO, hypotension, jugular venous distension, tachycardia, narrow pulse pressure and pulsus paradoxus (a drop in systolic pressure by >10 mmHg).

A nurse who usually works the medical surgical unit is floated to the cardiac step-down unit during a day shift. Which client is the most appropriate for the charge nurse to assign her? A. A client who has just returned from a catheterization B. A client with CHF who is hospitalized for a DVT and is on Heparin drip C. A client who is scheduled for a cardioversion for a fib later this afternoon D. A client who is receiving thrombolytic therapy for an MI yesterday and has had several runs of V tach

B. Monitoring the CHF patient on a heparin drip is the least specialized task and is the most appropriate to assign the med/surge nurse.

While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse's first course of action should be to: A. Increase the IV infusion rate. B. Notify the physician promptly. C. Increase the oxygen concentration. D. Administer a prescribed analgesic.

B. PVCs are often a precursor of life-threatening dysrhythmias, including ventricular tachycardia and ventricular fibrillation. An occasional PVC is not considered dangerous, but if PVCs occur at a rate greater than 5 or 6 per minute in the post-MI client, the physician should be notified immediately. More than 6 PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine.

A nurse caring for a client who has been resuscitated after cardiac arrest with pulseless electrical activity. When considering the causes of PEA, what are the H's associated with this condition? A. Hypervolemia, Hypoxia, hypothermia, hypokalemia and Hydrogen Ions B. Hypovolemia, hypoxia, hypothermia, hyperkalemia, hypokalemia and hydrogen ions C. Hypovolemia, hypoxia, hypercalcemia, hypokalemia and hydrogen ions D. Hypovolemia, hypoxia, hypothermia, hyperkalemia, hypokalemia and oxygen ions

B. The classic H's associated with PEA are hypovolemia, hypoxia, hypothermia, either hypokalemia or hyperkalemia and hydrogen ions

A nurse in the cardiac care unit makes rounds on four clients. The nurse will notify the HCP immediately about which of these clients? A. A client with endocarditis who is receiving IV antibiotics with chills and a temp of 102*F B. A client 4 hours post PCI with placement of coronary artery stent through the femoral approach with back pain and bruising on the flanks C. A client with pneumonia and a temperature of 103*F with sinus tachy and a HR of 110/min while resting D. A client who has undergone CABG 4 days ago and now has unilateral swelling in the leg from which the donor vessel was harvested

B. The client has undergone PCI with placement of an intracoronary stent. When the femoral artery is used to thread the catheter to the heart, there is a risk of retroperitoneal hemorrhage from the femoral artery. Bleeding in the retroperitoneum may result in a positive Grey-Turner sign, which refers to bruising on the flanks. Other symptoms are hypotension, back pain and diminished pulses distal to the injury

Which of the following landmarks is the correct one for obtaining an apical pulse? A. Left intercostal space, midaxillary line B. Left fifth intercostal space, midclavicular line C. Left second intercostal space, midclavicular line D. Left seventh intercostal space, midclavicular line

B. The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex.

A male client was on warfarin (Coumadin) before admission and has been receiving heparin I.V. for 2 days. The partial thromboplastin time (PTT) is 68 seconds. What should Nurse Carla do? A. Stop the I.V. infusion of heparin and notify the physician. B. Continue treatment as ordered. C. Expect the warfarin to increase the PTT. D. Increase the dosage, because the level is lower than normal.

B. The effects of heparin are monitored by the PTT is normally 30 to 45 seconds; the therapeutic level is 1.5 to 2 times the normal level.

An 89-year-old female patient who has been admitted to the medical unit with new-onset angina also has a diagnosis of Alzheimer's disease. The patient's husband reports to you that he rarely gets a good night's sleep because he needs to make sure his wife does not wander during the night. He insists on checking each of the medications you give her to be sure they are the same as the ones she takes at home. Based on this information, which nursing diagnosis is most appropriate for this patient? A. Decreased Cardiac Output related to poor myocardial contractility B. Caregiver Role Strain related to continuous need for providing care C. Ineffective Therapeutic Regimen Management related to poor patient memory D. Risk for Falls related to patient wandering behavior during the night

B. The husband's statement about lack of sleep and anxiety over whether the patient is receiving the correct medications are behaviors that support this diagnosis.

The monitor technician informs the nurse that the client has started having premature ventricular contractions every other beat. Which is the priority nursing action? A. Activate the rapid response team. B. Assess the client's orientation and vital signs. C. Call the physician. D. Administer a bolus of lidocaine.

B. The priority action is to assess the client and determine whether the rhythm is life-threatening. More information, including vital signs, should be obtained and the physician should be quickly notified. A bolus of lidocaine may be ordered to treat this arrhythmia. This is not a code-type situation unless the client has been determined to be in a life-threatening situation.

A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: A. Premature ventricular contractions B. Ventricular tachycardia C. Ventricular fibrillation D. Sinus tachycardia

B. Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular. Ventricular tachycardia is characterized as a wide complex (QRS duration greater than 120 milliseconds) tachyarrhythmia at a heart rate greater than 100 beats per minute. It is classified by duration as non-sustained or sustained. Non-sustained ventricular tachycardia is defined as more than 3 beats of ventricular origin at a rate greater than 100 beats per minute that lasts less than 30 seconds in duration.

An older adult client is scheduled for treatment with flecainide (Tambocor). Which of the following statements is correct about this medication? SATA A. Used to treat HTN B. It belongs to a class IB Antiarrhythmics C. It slows impulse conduction and velocity D. Treats SVT E. Treats Heart Block F. Blocks Sodium Channel G. Can Cause Kidney Damage

C, D, F It is a class IC antiarrhythmic that is used to treat SVT and Ventricular Tachycardia. It is a sodium channel blocker and it acts specifically to slow impulse conduction velocity in the heart.

What is the therapeutic range PTT for a patient on a heparin drip? A. 10 -12 sec B. 35- 45 sec C. 50 -70 sec D. 70 - 80 sec

C. 50 - 70 seconds

A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? A. Aortic B. Mitral C. Pulmonic D. Tricuspid

C. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Murmurs of the cardiac system develop due to alterations in blood flow or mechanical operation. Murmurs develop from a multitude of mechanisms. Typical cases include low blood viscosity from anemia, septal defects, failure of the ductus arteriosus to close in newborns, excessive hydrostatic pressure on cardiac valves causing valve failure, hypertrophic obstructive cardiomyopathy, and valvular specific pathologies.

You are providing care for a patient with an acute hemorrhage stroke. The patient's husband has been reading a lot about strokes and asks why his wife did not receive alteplase. What is your best response? A. Your wife was not admitted within the time frame that alteplase is usually given." B. "This drug is used primarily for patients who experience an acute heart attack." C. "Alteplase dissolves clots and may cause more bleeding into your wife's brain." D. "Your wife had gallbladder surgery just 6 months ago and this prevents the use of alteplase."

C. Alteplase is a clot buster. With a patient who has experienced a hemorrhagic stroke, there is already bleeding into the brain. A drug like alteplase can worsen the bleeding.

A client is given amiodarone (Cordarone) in the emergency department for a dysrhythmia. Which of the following indicates the drug is having the desired effect? A. The ventricular rate is increasing. B. The absent pulse is now palpable. C. The number of premature ventricular contractions is decreasing. D. The fine ventricular fibrillation changes to coarse ventricular fibrillation.

C. Amiodarone is used for the treatment of premature ventricular contractions, ventricular tachycardia with a pulse, atrial fi brillation, and atrial fl utter. Amiodarone is not used as initial therapy for a pulseless dysrhythmia.

The client has an implantable cardioverter defibrillator (ICD). Which discharge instructions should the nurse teach the client? A. Do not lift or carry more than 23 kg. B. Have someone drive the car for the rest of your life. C. Carry the cell phone on the opposite side of the ICD. D. Avoid using the microwave oven in the home.

C. Cell phones may interfere with the functioning of the ICD if they are placed too close to it.

A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? A. Immediately defibrillate. B. Prepare for pacemaker insertion. C. Administer Amiodarone Intravenously D. Administer epinephrine (Adrenaline) intravenously

C. First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of antidysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Procainamide will terminate between 50% and 80% of ventricular tachycardias, and it will slow the conduction of those that it does not terminate. Amiodarone will convert about 30% of patients to sinus rhythm but is very effective in reducing the reversion rate of refractory SMVT.

During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to: A. Increase fluids that are high in protein B. Restrict all fluids C. Force fluids and reassess BP D. Limit fluids to non-caffeinated beverages

C. Force fluids and reassess BP. Orthostatic hypotension, a decrease in systolic blood pressure of more than 15 mmHg and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency

Septal involvement occurs in which type of cardiomyopathy? A. Congestive B. Dilated C. Hypertrophic D. Restrictive

C. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum - not the ventricle chambers - is apparent. Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease. It is defined by an increase in left ventricular wall thickness that is not solely explained by abnormal loading conditions. This disorder is caused by a mutation in cardiac sarcomere protein genes and is most frequently transmitted as an autosomal dominant trait.

Nurse John is caring for a male client receiving lidocaine I.V. Which factor is the most relevant to the administration of this medication? A. Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter B. Increase in systemic blood pressure C. Presence of premature ventricular contractions (PVCs) on a cardiac monitor D. Increase in intracranial pressure (ICP)

C. Lidocaine drips are commonly used to treat clients whose arrhythmias haven't been controlled with oral medication and who are having PVCs that are visible on the cardiac monitor.

What is the normal range for Hemoglobin? A. Men: 12 - 12.5, Women 13.5 - 17.5 B. Men: 17.5 - 21, Women: 14.5 - 17.5 C. Men: 13.5 - 17.5, Women: 12 - 15.5 D. Men: 10 - 12.5, Women: 13.5 - 14

C. Men: 13.5 - 17.5 Women: 12- 15.5

The nurse is caring for a client who just had a CABG. Which intervention does the nurse plan to implement when planning care for this clients? A. Avoid extreme temperatures B. Use pursed lip breathing C. Prevent Thrombophlebitis D. Administer Antibiotics

C. Preventing Thrombophlebitis. A cardiac surgical client is at risk for developing Thrombophlebitis, PE, Dysrhythmias, HF and electrolyte imbalances

A nurse is caring for a client who has just returned from recovery following placement of a temporary pacemaker. The most important initial nursing assessment is A. Rate, type and settings of the pacemaker B. Clients emotional status C. Clients cardiac status D. The teaching the client has received

C. The client's cardiac status. Because duh.

Which of the following arteries primarily feeds the anterior wall of the heart? A. Circumflex artery B. Internal mammary artery C. Left anterior descending artery D. Right coronary artery

C. The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.

The client shows VFIB on the telemetry at the nurse's station. Which action should the tele nurse implement first? A. Administer Epi B. Prepare to defib client C. Call STAT code D. Start cardiopulmonary resuscitation

C. The nurse needs to call a code - that will activate the crash cart being brought to the room and a team of healthcare providers that will care for the patient according to an established protocol

A client complains of feeling "lightheaded" after a radiofrequency catheter ablation. His monitor reveals a dissociation of P waves and QRS complexes. Which of the following is the most appropriate first nursing intervention? A. Call a rapid response team B. Notify HCP and prepare to administer atropine C. Notify Cardiologist and prepare for transcutaneous or transvenous pacing D. Document the rhythm and assessment in clients chart and monitor for further changes

C. This is 3rd degree heart block, a medical emergency that requires temporary or permanent pacing. Symptoms that clients report are often Lightheadedness, dizziness, fainting, confusion, bradycardia, hypotension and heart failure.

The client is experiencing Sinus Bradycardia, is complaining of syncope and weakness and has a BP of 98/60. Which collaborative treatment should the nurse anticipate? A. Admin thrombolytic medication B. Assess the clients cardiovascular status C. Prepare for insertion of pacemaker D. Obtain permit for synchronized cardioversion

C. This patient will likely need a pacemaker

102. Upon assessment of third degree heart block on the monitor, the nurse should first: A. Call a code. B. Begin cardiopulmonary resuscitation. C. Have transcutaneous pacing ready at the bedside. D. Prepare for defi brillation.

C. Transcutaneous pads should be placed on the client with third degree heart block. For a client who is symptomatic, transcutaneous pacing is the treatment of choice. The hemodynamic stability and pulse should be assessed prior to calling a code or initiating CPR. Defibrillation is performed for ventricular fibrillation or ventricular tachycardia with no pulse.

The nurse in an intensive care unit is giving report to the nurse in a cardiac step-down unit about a client who had coronary artery bypass surgery. Which of the following is the most effective way to ensure that essential information about the client is reported? A. Give the report face to face with both nurses in a quiet room B. Audiotape the report for future reference and documentation. C. Use a printed checklist with information individualized for the client D. Document essential transfer information in the clients electronic health record

C. Using an individualized checklist ensures that all key information is reported; the checklist can serve as a record that the nurse can refer to later

A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect? A. Left-sided heart failure B. Aortic regurgitation C. Complete heart block D. Pericardial tamponade

D. A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Cardiac tamponade is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock.

Which of the following cardiac conditions does a fourth heart sound (S4) indicate? A. Dilated aorta B. Normally functioning heart C. Decreased myocardial contractility D. Failure of the ventricle to eject all the blood during systole

D. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decreased compliance of the ventricle

After myocardial infarction, serum glucose levels and free fatty acids are both increased. What type of physiologic changes are these? A. Electrophysiologic B. Hematologic C. Mechanical D. Metabolic

D. Both glucose and fatty acids are metabolites whose levels increase after myocardial infarction. Acute myocardial infarction evokes a characteristic neurohumoral response: Catecholamine release is increased, plasma contents of free fatty acids and glucose are elevated and glucose tolerance is diminished.

A client with a bundle branch block is on a cardiac monitor. The nurse should expect to observe: A. Sagging ST segments. B. Absence of P wave configurations. C. Inverted T waves following each QRS complex D. Widening of QRS complexes to 0.12 sec o greater

D. Bundle branch block interferes with the conduction of impulses from the AV node to the ventricle supplied by the affected bundle. Conduction through the ventricles is delayed, as evidenced by a widened QRS complex. Rhythm must be of supraventricular origin (EG: ventricular activation coming from atrial or AV nodal activation). Lead V1 should have either a QS or a small r wave with large S wave. Lead V6 should have a notched R wave and no Q wave.

A patient's chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? A. Decreased HR B. Paresthesias C. Muscle weakness of the extremities D. Migraines

D. Migraines are not a symptom of hyperkalemia

What is the primary reason for administering morphine to a client with myocardial infarction? A. To sedate the client B. To decrease the client's pain C. To decrease the client's anxiety D. To decrease oxygen demand on the client's heart

D. Morphine is administered because it decreases myocardial oxygen demand. Morphine to relieve pain during a myocardial infarction (MI) has been in use since the early 1900s. In 2005, an observational study raised some concerns, but there are very few effective alternatives. Morphine is a potent opioid; it decreases pain, which in turn leads to a decrease in the activation of the autonomic nervous system. These are desirable effects when a patient is having an MI.

A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time? A. Monitor daily weights and urine output. B. Permit unrestricted visitation by family and friends. C. Provide client education on medications and diet. D. Reduce pain and myocardial oxygen demand.

D. Nursing management for a client with a myocardial infarction should focus on pain management and decreasing myocardial oxygen demand. Fluid status should be closely monitored. Client education should begin once the client is stable and amenable to teaching. Visitation should be based on client comfort and maintaining a calm environment.

The client that is one (1)-day postoperative coronary artery bypass surgery is exhibiting sinus tachycardia. Which intervention should the nurse implement? A. Assess the apical heart rate for one (1) full minute. B. Notify the client's cardiac surgeon. C. Prepare the client for synchronized cardioversion. D. Determine if the client is having pain.

D. Sinus tachycardia means the sino-atrial node is the pacemaker, but the rate is greater than 100 because of pain, anxiety, or fever. The nurse must determine the cause and treat appropriately. There is no specific medication for sinus tachycardia.

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit? A. Vitamin K B. Aminocaproic acid C. Potassium chloride D. Protamine sulfate

D. The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Protamine is a medication used to reverse and neutralize the anticoagulant effects of heparin. Protamine is the specific antagonist that neutralizes heparin-induced anticoagulation. Protamine is a strongly alkaline (nearly two-thirds of the amino acid composition is arginine) polycationic low-molecular-weight protein found in salmon sperm that is also currently available in a recombinant form.

In evaluating the effect of nitroglycerin, Nurse Arthur should know that it reduces preload and relieves angina by: A. Increasing contractility and slowing heart rate B. Increasing AV conduction and heart rate C. Decreasing contractility and oxygen consumption D. Decreasing venous return through vasodilation

D. The significant effect of nitroglycerin is vasodilation and decreased venous return, so the heart does not have to work hard

Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? A. Pericarditis B. Hypertension C. Obliterative D. Restrictive

D. These are the classic symptoms of heart failure. Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure.

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure? A. Intake and output B. Baseline peripheral pulse rates C. Height and weight D. Allergy to iodine or shellfish

D. This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure. Allergic reactions can be related to the use of local anesthetic, contrast agents, heparin or other medications used during the procedure. Reactions to the contrast agents can occur in up to 1% of the patients, and people with prior reactions are pretreated with corticosteroids and antihistamines.

Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease? A. 100 mg/dl B. 150 mg/dl C. 175 mg/dl D. 200 mg/dL

D. Total Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD. The normal level of serum cholesterol is within 125 to 200 mg/dl.

A client receives fibrinolytic therapy upon admission following a myocardial infarction. He is now receiving an I.V. infusion of heparin sodium at 1,200 units/hour. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive?

D/H x Q (1200/ 25000) x 500 = 24mL/hr

Medication order: Heparin 400u/hr Medication label: 20,000u Heparin in 2000mL NS How many mL will be administered per hour?

D/H x Q (400/20,000) x 2000 = 40mL/hr

Medication order: Heparin 600u/hr. Medication Label: 20,000u heparin in 1000 mL NS How many mL will be administered per hour?

D/H x Q (600/20000) x 1000 = 30mL/hr

Medication order: Heparin 200u/hr Medication Label: 25,000u in 500mL D5W How many mL will be administered per hour?

D/H x Q (200/25,000) x 500 = 4mL/hr

The nurse is teaching basic cardiopulmonary resuscitation (CPR) to individuals in the community. Which is the order of basic CPR? List in order of performance. A. Perform head tilt chin lift. B. Give two (2) rescue breaths. C. Look, listen, and feel for breathing. D. Begin cardiac compressions. E. Shake and shout.

E, A, C, B, D

A patient with alcoholic dilated cardiomyopathy is admitted to the hospital and receives IV digoxin. A few hours later, the patient dies as a result of ventricular tachyarrhythmia. Which of the ejection fraction values did the patient most likely have on admission. A. 90% B. 85% C. 65% D. 55% E. 35%

E. 35% The ejection fraction refers to the amount of blood in the Left Ventricle that is pumped with each heartbeat. EF can be calculated via electrocardiogram using the equation EF=(SV/EDV)x100. EF of 55-75% is considered normal.

What is the normal range for HDL?

Greater than 60 mg/dL This is the "good" cholesterol. LDL should be less than 130mg/dL