NUR213 - cardio practice questions

__________________ work by slowing the heart rate and lowering blood pressure, thereby decreasing the oxygen demand on the heart.

Beta-blockers

A nurse is preparing to administer digoxin (Lanoxin) to an infant with heart failure. Before administering the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute, and obtains a rate of 88 beats/minute. Based on this finding, which is the appropriate nursing action? 1.Withhold the medication. 2.Administer the medication. 3.Double-check the apical heart rate and administer the medication. 4.Check the blood pressure and respirations and administer the medication.

1 Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure. A primary concern is digoxin toxicity and the nurse needs to monitor closely for signs of toxicity and monitor digoxin blood levels. The medication is effective within a narrow therapeutic digoxin range (1.0 to 2.0 ng/mL). Safety in administration is achieved by double-checking the dose and counting the apical heart rate for 1 full minute. If the heart rate is less than 100 beats/minute in an infant, the nurse would withhold the dose and contact the health care provider. Therefore, options 2, 3, and 4 are incorrect actions; it would be harmful to administer the medication.

Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child is a registered nurse and asks the nurse why the child needs the medication. What is the most appropriate response to the mother about the action of the medication? 1.Prevents blue (tet) spells 2.Maintains adequate cardiac output 3.Maintains an adequate hormonal level 4.Maintains the position of the great arteries

2 Rationale: A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increase blood mixing if systemic and pulmonary mixing are inadequate to maintain adequate cardiac output. The remaining options are incorrect. In addition, tet spells occur in tetralogy of Fallot, not in transposition of the great arteries.

The nurse is caring for an infant with a diagnosis of tetralogy of Fallot. The infant suddenly becomes cyanotic, and the nurse recognizes that the infant is experiencing a hypercyanotic spell (blue or tet spell). The nurse immediately places the infant in what position? 1.Prone position 2.Knee-chest position 3.High Fowler's position 4.Reverse Trendelenburg's position

2 Rationale: Tetralogy of Fallot includes four defects-ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. If pulmonary vascular resistance is higher than systemic resistance, the shunt is from right to left; if systemic resistance is higher than pulmonary resistance, the shunt is left to right. If a hypercyanotic spell occurs, the nurse immediately places the infant in a knee-chest position. This position improves systemic arterial oxygen saturation. All other options will not improve systemic arterial oxygen saturation.

A nurse is reviewing the health record of an infant with a diagnosis of congenital heart disease. The nurse notes documentation in the record that the infant has clubbing of the fingers. The nurse understands that this finding is caused by which problem? 1.Chronic fatigue 2.Poor oxygenation 3.Poor sucking ability 4.Consistent sucking on the fingers

2 Rationale: The child with congenital heart disease may develop clubbing of the fingers. Clubbing of the fingers is thought to be caused by anoxia or poor oxygenation. Options 1, 3, and 4 are unrelated to this occurrence.

Which ventricular dysrhythmias can cause mental status​ changes? ​(Select all that​ apply.) Ventricular fibrillation Premature junctional contractions Ventricular tachycardia Premature ventricular contractions Torsades de pointes

Ventricular​ tachycardia, torsades de​ pointes, and ventricular fibrillation can cause mental status changes. Premature ventricular contractions do not cause mental status changes. Premature junctional contractions are not a ventricular dysrhythmia and do not cause a change in mental status.

Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? 1. Aortic stenosis 2.Atrial septal defect 3.Patent ductus arteriosus 4.Ventricular septal defect

3 Rationale: A patent ductus arteriosus is failure of the fetal ductus arteriosus (artery connecting the aorta and the pulmonary artery) to close. A characteristic machinery-like murmur is present, and the infant may show signs of heart failure. Aortic stenosis is a narrowing or stricture of the aortic valve. Atrial septal defect is an abnormal opening between the atria. Ventricular septal defect is an abnormal opening between the right and left ventricles.

A child with a diagnosis of tetralogy of Fallot exhibits an increased depth and rate of respirations. On further assessment, the nurse notes increased hypoxemia. The nurse interprets these findings as indicating which situation? 1.Anxiety 2.A temper tantrum 3.A hypercyanotic episode 4.The need for immediate health care provider (HCP) notification

3 Rationale: Children with tetralogy of Fallot or similar physiology may experience hypercyanotic episodes, or tet spells. These episodes are characterized by increased respiratory rate and depth and increased hypoxia. Immediate HCP notification is not required unless other appropriate nursing interventions are unsuccessful. Options 1 and 2 are unrelated to tetralogy of Fallot.

A nurse is assigned to care for an infant with tetralogy of Fallot. The mother of the infant calls the nurse to the room because the infant suddenly seems to be having difficulty breathing. The nurse enters the room and notes that the infant is experiencing a hypercyanotic episode. What is the initial action by the nurse? 1.Place the infant in a prone position. 2.Call a code and notify the supervisor. 3.Place the infant in a knee-chest position. 4.Contact the respiratory therapy department

3 Rationale: If a hypercyanotic episode occurs, the infant is placed in a knee-chest position. The knee-chest position is thought to increase pulmonary blood flow by increasing systemic vascular resistance. This position also improves systemic arterial oxygen saturation by decreasing venous return, so that smaller amounts of highly saturated blood reach the heart. Toddlers and children squat to obtain this position and relieve chronic hypoxia. Therefore, options 1, 2, and 4 are incorrect.

The nurse is caring for a child with a diagnosis of a right-to-left cardiac shunt. On review of the child's record, the nurse should expect to note documentation of which most common assessment finding? 1.Severe bradycardia 2.Asymptomatic findings 3.Bluish discoloration of the skin 4.Higher than normal body weight

3 Rationale: The child with a right-to-left shunt will be considerably sicker than a child with a left-to-right shunt. Many of these children will present with symptoms in the first week of life. The most common assessment finding in these children is bluish discoloration of the skin, known as cyanosis. The child may also become dyspneic after feeding, crying, and other exertional activities. Options 1 and 2 are inaccurate findings. Many children with a left-to-right shunt may remain asymptomatic. Option 4 is incorrect because these children usually have lower than normal body weight.

A nurse is caring for an infant with congenital heart disease. Which, if noted in the infant, should alert the nurse to the early development of heart failure (HF)? 1.Paleness of the skin 2.Strong sucking reflex 3.Diaphoresis during feeding 4.Slow and shallow breathing

3 Rationale:The early symptoms of HF include tachypnea, poor feeding, and diaphoresis during feeding. Tachycardia would occur during feeding. Paleness of the skin, pallor, may be noted in the infant with HF, but it is not an early symptom. A strong sucking reflex is unrelated to the development of HF.

When caring for a client with heart​ failure, the nurse will notify the healthcare provider when urine output is less than how many​ mL/hour? 30 60 50 40

30 When caring for a client with heart​ failure, the nurse would notify the healthcare provider for urine output of less than 30​ mL/hour.

A nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1. Serum sodium level of 145 mEq/L 2. Serum chloride level of 98 mEq/L 3. Serum calcium level of 10 mg/dL 4. Serum potassium level of 2.8 mEq/L

4 Rationale: The nurse should check the client's serum laboratory study results for hypokalemia. The client may experience PVCs in the presence of hypokalemia, because this electrolyte imbalance increases the electrical instability of the heart. The values noted in the remaining options are normal.

The nurse is assessing a newborn with heart failure before administering the prescribed digoxin (Lanoxin). In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of 2.4 ng/mL and an apical heart rate of 98 beats/min. The mother also tells the nurse that the newborn just vomited her formula. Which intervention should the nurse take? 1.Retake the apical pulse. 2.Administer the medication. 3.Withhold the medication for 1 hour. 4.Withhold the medication and notify the health care provider.

4. Withhold the medication and notify the health care provider. Rationale: The apical pulse rate for a newborn is 120 to 140 beats/min. The therapeutic digoxin level ranges from 0.5 to 2.0 ng/dL. Because the apical rate is low and the digoxin blood level is elevated, indicating toxicity, the nurse would withhold the medication and notify the health care provider. Therefore options 1, 2, and 3 are incorrect.

Mr. Carter is a​ 63-year-old marathon runner who was admitted to the hospital with chest pain. Several hours after​ admission, Mr.​ Carter's cardiac monitor alarm sounds. When you enter his room you notice that he is asleep and that his cardiac monitor is showing sinus bradycardia with a heart rate of 59 beats per minute. His blood pressure is​ 122/82 and his pulse oximeter is reading​ 99%. Which action is most​ appropriate? Allow Mr. Carter to continue sleeping. Start cardiopulmonary resuscitation. Obtain a​ 12-lead ECG. Notify the healthcare provider.

Allow Mr. Carter to continue sleeping. Mr. Carter is exhibiting sinus​ bradycardia, which is a normal finding during​ sleep, especially for​ well-conditioned athletes.​ Therefore, you would allow Mr. Carter to continue sleeping. His vital signs appear​ stable, so a​ 12-lead ECG and cardiopulmonary resuscitation do not need to be​ initiated, and the healthcare provider does not need to be notified.

_______________ are utilized to relieve pain in the client with AMI.

Analgesics

Ms. Nguyen is a​ 22-year-old woman who is brought to the emergency department by paramedics for syncope. The paramedics report that they found her in ventricular​ tachycardia, which resolved after administration of amiodarone. Currently Ms. Nguyen is awake and alert and her vital signs are stable. Her cardiac monitor is showing sinus rhythm. Which item would you ask Ms. Nguyen about while taking her​ history? High blood pressure Anorexia nervosa Chronic use of caffeine Cigarette smoking

Anorexia nervosa A history of anorexia nervosa is a risk factor for ventricular tachycardia. Chronic use of caffeine is a risk factor for premature junctional contractions and atrial flutter. Cigarette smoking is a risk factor for premature ventricular contractions. A history of hypertension is a risk factor for a​ bundle-branch block.

The nurse is caring for a client admitted with a possible myocardial infarction​ (MI). Which assessment findings are consistent with this​ diagnosis? ​(Select all that​ apply.) ST segment depression Anxiety Q wave changes Tachypnea Vomiting

Anxiety Q wave changes Tachypnea Vomiting Rationale: Clinical manifestations of an MI include​ tachypnea, anxiety, vomiting and ECG changes in the Q wave. A client experiencing an MI would experience ST segment​ elevation, not depression.

____________________ functions as an antiplatelet aggregate; platelets become "less sticky" and flow smoother through the vessels.

Aspirin

A client's electrocardiogram shows that the atrial and ventricular rhythms are irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? Atrial flutter Atrial fibrillation Third-degree AV block First-degree atrioventricular (AV) block

Atrial fibrillation Rationale: With atrial fibrillation, the atrial and ventricular rhythms are irregular and there are usually no discernible P waves. In atrial flutter, the QRS complexes may be either regular or irregular, and the P waves occur as flutter waves.

Which is a dysrhythmia that originates in the upper chambers of the heart​ (chambers from which blood is passed to the​ ventricles) before the SA node​ fires? Atrial fibrillation Junctional escape rhythm Torsade de pointes Mobitz II​ second-degree block

Atrial fibrillation is an atrial dysrhythmia in that it originates in the atria​ (the upper chambers of the heart from which blood is passed to the​ ventricles) before the SA node fires. Mobitz II​ second-degree block is a conduction block dysrhythmia. A junctional escape rhythm is a junctional dysrhythmia. Torsade de pointes is a ventricular dysrhythmia.

Which best describes incidences of​ dysrhythmias? Select all that​ apply.) Atrial flutter can be a postsurgical complication after heart surgery. ​Bundle-branch block occurs in those with a history of lung cancer. Sick sinus syndrome is common in older clients. ​Wolff-Parkinson-White syndrome occurs in those who use liquid protein diets. Sinus arrhythmias are common in very young and very old clients.

Atrial flutter can be a postsurgical complication after heart surgery. Sick sinus syndrome is common in older clients. Sinus arrhythmias are common in very young and very old clients. Sinus arrhythmias are common in very young and very old clients. Atrial flutter can be a postsurgical complication after heart surgery. Starvation and the use of liquid protein diets are associated with torsade de​ pointes, a ventricular dysrhythmia.​ Wolff-Parkinson-White syndrome is a congenital ventricular dysrhythmia. A history of hypertension and​ congenital, rheumatic, or syphilitic heart disease are associated with​ bundle-branch block, a conduction block dysrhythmia. Sick sinus​ syndrome, an atrial​ dysrhythmia, is more common in older adults.

A nurse is auscultating a 56 year old adult client's apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 48 beats/minute. Which action should the nurse take? A. Withhold the digoxin, and reevaluate the heart rate in 4 hours. B. Administer half the prescribed dose to avoid a further decrease in heart rate. C. Withhold the digoxin; assess for signs of decreased cardiac output and digoxin toxicity. D. Administer the digoxin. The heart rate would be considered normal because of the client's age.

C Rationale: The normal heart rate is 60 to 100 beats/min in an adult. If the nurse notes a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would further evaluate the client for signs and symptoms of digoxin toxicity. When clients are bradycardic, they may have symptoms of decreased cardiac output so this would also be assessed

The nurse is providing care to a client admitted to the coronary care unit for a suspected heart attack. Which diagnostic tests does the nurse anticipate to confirm the​ diagnosis? ​(Select all that​ apply.) ​CK-MB WBC CBC CPK ECG

CK-MB CPK ECG Rationale: When the healthcare provider believes that a client has experienced a heart​ attack, or myocardial infarction​ (MI), diagnostic tests will include cardiac markers including CPK and​ CK-MB and an ECG. A CBC and WBC will not be useful to confirm the diagnosis of an MI.

___________________ work to reduce blood pressure, and in some cases, reduce heart rate.

Calcium channel blockers

Cardiac output is determined by the amount of blood that pumps through the ventricles in what time​ frame? 45 seconds 15 seconds 60 seconds 30 seconds

Cardiac output is determined by the amount of blood pumped from the ventricles in 60​ seconds, or 1 minute.

The cardiac registered nurse is a member of the medical team caring for a client diagnosed with atrial fibrillation. Which therapy could the team offer the client to eliminate ectopic foci and how does that therapeutic technology​ work? Cardiac mapping Defibrillation Conduction block Catheter ablation

Catheter ablation Rationale: Catheter ablation is used to treat atrial fibrillation and​ flutter, supra-ventricular​ tachycardia, and,​ sometimes, paroxysmal ventricular tachycardia. Catheter ablation​ isolates, removes, or destroys an ectopic focus. Intracardiac and extra-cardiac catheter electrodes and computer technology can pinpoint the ectopic site. The same catheters are used for the ablative intervention. Most​ commonly, ablation uses radio frequency energy produced by high frequency alternating current. The current creates heat as it passes through tissue. Cardiac mapping is used prior to the ablation procedure to locate the site of an ectopic focus. Conduction block is a type of​ dysrhythmia, not a therapy. Defibrillation is not a therapy. It is an emergency procedure that has been shown to improve survival for clients with atrial fibrillation. The procedure delivers direct current that is not synchronized with the cardiac cycle.

You are completing preprocedure teaching on a client scheduled for an emergent angiogram. Which assessment finding is most important to report to the primary care​ provider? Client had an angiogram 7 years ago. Client is expressing concern over the impending procedure. Client has eaten within the last 30 minutes. Client is allergic to shellfish.

Client is allergic to shellfish. The dye used for angiograms normally has iodine in​ it, which is also found in​ shellfish, and a shellfish allergy must be reported promptly. The emergent need for the angiogram supersedes the client eating within the last 30 minutes. Monitor for emesis and nausea. When the client expresses concerns over the​ procedure, the nurse should allow the client to express those concerns and answer any questions that the client may have within the​ nurse's scope of practice before notifying the primary healthcare provider. The angiogram done 7 years ago is not relevant to the emergent need for the angiogram.

A nurse is providing education about heart failure to a community group. Which risk factors should the nurse include in the​ presentation? ​(Select all that​ apply.) Pituitary adenoma Coronary heart disease Sleep apnea Hypertension Diabetes mellitus

Coronary heart disease Sleep apnea Hypertension Diabetes mellitus ​Rationale: When providing education to a community​ group, the nurse needs to include the following risk factors for heart​ failure: coronary heart​ disease, hypertension, diabetes​ mellitus, and sleep apnea. Pituitary adenoma is not a risk factor for heart failure.

The nurse is providing care for a client who demonstrates a tachydysrhythmia. Which treatment option does the nurse anticipate for this​ client? Countershock Pacemaker Cardiac ablation ECG

Countershock Rationale: Countershock delivers a direct current charge that depolarizes all cardiac cells at the same time. This may stop a tachydysrhythmia and allow the SA node to regain control of impulse formation. A pacemaker is a pulse generator that provides electrical stimulus to the heart when it does not provide its own stimulus sufficient to maintain cardiac output. An ECG is a diagnostic test that measures the electrical activity of the​ heart, not a therapy. Medical teams use cardiac mapping and cardiac ablation to locate and destroy an ectopic focus.

The nurse is caring for a client diagnosed with torsades de pointes. Which information might the nurse anticipate finding in the​ client's admission​ history? ​(Select all that​ apply.) Currently on liquid protein diet Massive cardiac muscle damage Taking prescribed diuretics Overdose of cardiac medication Experiencing starvation

Currently on liquid protein diet Taking prescribed diuretics Experiencing starvation Rationale Incidence of torsades de pointes is common in individuals who are on liquid protein​ diets, experiencing​ starvation, or taking prescribed diuretics. The incidence of asystole is associated with massive cardiac muscle damage. The incidence of pulseless electrical activity is associated with overdose of cardiac medication.

The nursing team is caring for a client diagnosed with a​ second-degree heart block. Which prescribed medication found in the​ client's medical record may have caused this​ diagnosis? A calcium channel blocker Digoxin A​ beta-blocker Amiodarone

Digoxin Rationale: Chronic use of digoxin is a risk factor for developing a​ second-degree heart block.Chronic use of​ amiodarone, beta-blockers, and​ calcium-channel blockers is a risk factor for developing a​ third-degree heart​ block, not a​ second-degree heart block.

The nurse is caring for a client newly diagnosed with heart failure. Which medication order does the nurse anticipate receiving from the healthcare​ provider? Benzodiazepine Proton pump inhibitor Diuretic Selective serotonin reuptake inhibitor

Diuretic Rationale: Heart failure is treated with a variety of medications based on the severity and progression of disease. The nurse should anticipate an order for a diuretic.​ Benzodiazepine, proton pump​ inhibitors, and selective serotonin reuptake inhibitors are not used to treat heart failure.

Ms. Fortune has been diagnosed with narrowing of the coronary arteries. What would be the​ appropriate, conservative initial treatment for this​ condition? Exercise 3 times a week for 30 minutes Cut smoking by half the amount Eat a diet with a minimum of​ 20% fat Take statins as prescribed

Exercise 3 times a week for 30 minutes Conservative treatment would include regular physical exercise such as walking at a brisk pace. Fat should be no more than​ 10% of the daily diet. Smoking should be totally​ eliminated, usually through a cessation program or the use of assistive drugs such as nicotine patches. By controlling​ cholesterol, the client can help control CAD. The statins are one group of medications used to decrease circulating cholesterol.

The nurse is developing a plan of care for a client with coronary artery disease. Which mechanism contributes to a decreased blood flow to the​ client's coronary​ arteries? Fat and fibrin deposits on the arterial walls Increased vasodilation of the arteries Decreased platelet aggregation Injury to arterial walls from increased arterial pressures

Fat and fibrin deposits on the arterial walls Rationale: Fat and fibrin deposits on the arterial walls are called plaque. They cause the artery to become thick and hardened with narrowing of the lumen and decreased blood flow.Platelet aggregation​ (clumping together)​ increases, not​ decreases, leading to the formation of clots that narrow the lumen of the arterial vessel.​ Vasodilation, or opening of the​ arteries, would increase blood flow. The walls of the arteries become hardened and have decreased​ elasticity, which makes vasodilation more difficult. Spasms of the arterial vessels cause constriction and narrowing of the vessels. Injury that occurs from increased arterial pressure causes an increased risk of the formation of fibrin plaques. The injury does not cause a decrease in blood flow.

__________ are drugs that dissolve or break up blood clots.

Fibrinolytics

The nurse is developing a plan of care for a client with coronary artery disease. Which mechanism does not contribute to decreased blood flow to the​ client's coronary​ arteries? Increased vasodilation of the arteries Fat and fibrin deposits on the arterial walls Spasms of normal or already narrowed arterial vessels Increased platelet aggregation

Increased vasodilation of the arteries Rationale: Platelet aggregation or clumping together​ increases, leading to the formation of clots which narrow the lumen of the arterial vessel.​ Vasodilation, or opening of the​ arteries, increases blood flow. Fat and fibrin deposits on the arterial walls are called plaque. They cause the artery to become thick and hardened with narrowing of the lumen and decrease blood flow. Spasms of normal or already narrowed arterial vessels narrow the lumen and decrease blood flow.

Ms.​ Wolfe, who has coronary artery​ disease, is leaving the hospital to go home. Which aspect of home care is most important for her to focus​ on? Safety concerns ​Follow-up care Return to normal activity Lifestyle changes

Lifestyle changes The most important focus for a patient with coronary artery disease is on lifestyle changes. The most appropriate are​ diet, exercise, and how to use prescribed medications. Safety concerns need to be assessed for the home environment prior to her return home. When to return to normal activity will be part of the discharge instructions written by the healthcare provider.

The nurse is caring for a client being evaluated for atrial fibrillation. Which medical conditions should the nurse inquire about during the health history interview with the​ client? ​(Select all that​ apply.) Mitral regurgitation ​Long-standing hypertension Heart failure Cor pulmonale Mitral valve prolapse

Mitral regurgitation ​Long-standing hypertension Heart failure Rationale: Medical conditions associated with atrial fibrillation include​ long-standing hypertension, mitral​ regurgitation, mitral​ stenosis, acute myocardial​ infarction, and heart failure. Mitral valve prolapse is associated with development of premature atrial contractions. Cor pulmonale is associated with development of premature atrial contractions and atrial flutter.

A client was recently diagnosed with acute heart failure. The nurse anticipates that which cardiac disorder led to this ​diagnosis? Cardiomyopathy Coronary heart disease Valvular disease Myocardial infarction

Myocardial infarction Rationale Acute heart failure is a sudden decrease in cardiac function and is caused by myocardial infarction. Chronic heart failure is a gradual decrease in cardiac function. Cardiac disorders that lead to chronic heart failure include​ cardiomyopathy, valvular​ disease, and coronary heart disease.

The client with a history of atherosclerosis has chest pain that is unrelated to​ activity, unpredictable, and often occurs while at rest. The client reports the pain has been becoming more frequent and​ severe, rating the current pain as 9 on a scale of 1 to 10. You recognize that the client is at severe risk of which​ disorder? Coronary artery disease Prinzmetal angina Stable angina Myocardial infarction

Myocardial infarction Rationale: Prinzmetal​ (variant) angina occurs unpredictably and often at night. The client is currently experiencing either Prinzmetal or unstable angina and is at severe risk of a myocardial infarction. Stable angina is a predictable form of​ angina, which usually occurs when the work of the heart is increased by physical​ exertion, exposure to​ cold, or stress. This​ client's angina is unpredictable and occurs at rest. Coronary artery disease is the cause of​ angina, not the disorder which develops as a result of it.

______________ may be used to dilate the smooth muscles of arteries and veins. By dilating veins, preload can be reduced, thus allowing the heart to work less.

Nitrates

The nurse is caring for a pediatric client diagnosed with an atrial dysrhythmia. Assessment findings reveal rapid pulse with frequent episodes of palpitations and decreased blood pressure. Which diagnosis does the nurse anticipate based on these assessment​ findings? The client has premature atrial contractions. The client has wandering atrial pacemaker. The client has​ Wolff-Parkinson-White syndrome The client has sick sinus syndrome.

The client has​ Wolff-Parkinson-White syndrome Rationale: The​ client's assessment findings support the diagnosis of​ Wolff-Parkinson-White syndrome. The​ client's assessment findings do not support the other diagnoses.

A nurse is providing care for a client with pulmonary edema subsequent to heart failure. Which finding indicates that the interventions implemented have resolved the gas exchange​ problem? Oxygen saturation is​ 94% with oxygen supplementation. ​Client's respirations are 26​ breaths/min with intercostal retractions. Client is restless and sitting upright to breathe. Lung sounds indicate bilateral crackles and a cough productive of​ frothy, pink sputum.

Oxygen saturation is​ 94% with oxygen Rationale: An oxygen saturation of​ 94% is within normal limits. Supplemental oxygen is expected in the care of a client with pulmonary edema. Normal oxygen saturation even with supplemental oxygen indicates that the gas exchange problem is resolved. Restlessness and orthopnea are signs of ineffective oxygenation with cerebral hypoxia. The client is sitting upright in an attempt to improve oxygenation. The normal range for respirations is​ 12-20 breaths/min. The​ client's respirations are too rapid. The use of accessory​ muscles, such as the intercostal​ muscles, indicates that the client is experiencing respiratory distress. Bilateral crackles and a congested cough with​ frothy, pink sputum indicate the client is not clearing secretions. The sputum is caused by fluid leaking into the alveoli from fluid​ overload, rather than an infectious process.

Mr. Silverstein is a​ 48-year-old man who is admitted with a large inferior myocardial infarction. His healthcare provider tells you that Mr. Silverstein is at high risk for developing complete heart block. What might you expect to see in Mr.​ Silverstein's electrocardiogram? PR interval that prolongs until a QRS complex is dropped P waves that are not associated with QRS complexes Intermittently absent QRS complexes PR interval greater than 0.20 seconds

P waves that are not associated with QRS complexes If Mr. Silverstein were to develop complete heart​ block, his electrocardiogram would show P waves that are not associated with QRS complexes. A Mobitz II​ second-degree block would result in intermittently absent QRS complexes. A PR interval greater than 0.20 seconds would be found on an electrocardiogram of a client with a​ first-degree AV block. A PR interval that prolongs until a QRS complex is dropped would be found on an electrocardiogram of a client with a Mobitz I​ second-degree block.

Which items will the nurse include in the physical examination portion of the nursing assessment for a client diagnosed with heart​ failure? ​(Select all that​ apply.) Reviewing current medications Palpating peripheral pulses Inspecting for jugular vein distention Inspecting for edema Taking vital signs

Palpating peripheral pulses Inspecting for jugular vein distention Inspecting for edema Taking vital signs When conducting the physical examination portion of the nursing assessment for a client diagnosed with heart​ failure, the nurse will assess vital​ signs, inspect for​ edema, inspect for jugular vein​ distention, and palpate peripheral pulses. The nurse would review current medications during the health history portion of the nursing assessment.

What are common manifestations of heart​ failure? ​(Select all that​ apply.) Paroxysmal nocturnal dyspnea Dyspnea at rest Edema Weight loss Nocturia

Paroxysmal nocturnal dyspnea Dyspnea at rest Edema Nocturia Common manifestations of heart failure include paroxysmal nocturnal​ dyspnea, which is when the client awakes at night short of breath. Other manifestations include​ edema, nocturia​ (voiding two or more times a​ night), and dyspnea at rest. A client with heart failure will experience weight​ gain, not weight loss.

The nurse is explaining the phases of cardiac rehabilitation to a client being prepared for discharge. What is a goal of phase 1 for the​ client? Decreases anxiety Improves psychosocial status Performs own bathing routine Increases exercise at home

Performs own bathing routine Rationale: Phase 1 has the client moving from bed rest to providing​ self-care. An example of this is performing his own bathing. Phase2 of cardiac rehabilitation is characterized by increased​ activity, improvement of psychosocial​ status, and treatment of anxiety. In phase 3 the client is progressing independently in an exercise routine at home.

The nurse is planning the education for a client being prepared for a coronary angiogram. What is appropriate information for the nurse to​ include? (Select all that​ apply.) Pressure is applied to the insertion site Requires the insertion of a catheter Will require the use of radiography Allows ambulation within an hour of the procedure Can eat after the procedure

Pressure is applied to the insertion site Requires the insertion of a catheter Will require the use of radiography Can eat after the procedure Rationale: A coronary​ angiogram, obtained through a procedure known as cardiac​ catheterization, is a radiographic study of the circulation of the coronary arteries. The client will be on bed rest for up to 8 hours after the​ procedure, with pressure applied to the insertion site. Food and drink are allowed as tolerated.

The nurse is caring for a client with a​ bundle-branch block. Which clinical manifestation and history finding support this​ diagnosis? Pulse and blood pressure within normal limits with history of hypertension ​Rapid, weak pulse with low blood pressure and a history of rheumatic heart disease Irregular pulse with decreased blood pressure and history of chronic use of digoxin Normal pulse with normal blood pressure with no identified risk factors in healthy​ individuals, including athletes

Pulse and blood pressure within normal limits with history of hypertension Rationale: Clients with a​ bundle-branch block will have a pulse and blood pressure within normal limits. Risk factors include a history of hypertension or of​ congenital, rheumatic, or syphilitic heart disease. Irregular pulse with decreased blood pressure is a clinical manifestation of​ second-degree and​ third-degree heart blocks.​ First-degree AV block presents with normal pulse and normal blood pressure. A​ rapid, weak pulse with low blood pressure is a clinical manifestation of ventricular tachycardia.

You are developing a plan of care for a client with coronary artery disease. Which pharmacological treatment would help increase blood flow to the​ client's coronary​ arteries? Use of salicylic acid daily Discontinue the use of statins Use an analgesic to control chest pain Discontinue the use of daily ibuprofen

Use of salicylic acid daily Rationale: To increase the​ client's blood​ flow, one goal is to prevent the aggregation of platelets in the arteries. Salicylic acid​ (aspirin) is a pharmacological measure to control the aggregation. Statins are used to decrease cholesterol and would be a part of the​ client's protocol unless the client experienced side effects. Analgesics are given for chest​ pain, but do not increase blood flow. Nitrates for angina would increase blood flow. There is no reason to discontinue the use of daily ibuprofen as a means of increasing blood flow to the coronary arteries.

A nurse is reviewing diagnostic tests for a client newly diagnosed with heart failure. The nurse is concerned that the client is experiencing renal issues in addition to the heart failure. Which diagnostic tests would the nurse focus on to help determine renal​ function? ​(Select all that​ apply.) Serum creatinine Blood urea nitrogen​ (BUN) Urinalysis Chest​ x-ray ​B-type natriuretic​ peptide(BNP)

Serum creatinine Blood urea nitrogen​ (BUN) Urinalysis ​Rationale: High urine pH and red blood cells are associated with renal disease. A high specific gravity can be associated with concentrated​ urine, which is found in clients who are retaining fluid. Creatinine is excreted by the kidneys. Serum creatinine is a better indicator of renal function than BUN. Elevated BUN can be a sign of dehydration. If the client is not​ dehydrated, then elevated blood urea nitrogen can be a sign of renal function. Creatinine does not elevate with dehydration. Creatinine rises when the kidneys are unable to excrete it. The chest​ x-ray will show enlarged heart and fluid in the lung. A chest​ x-ray is not diagnostic for renal problems. BNP is produced in the cardiac ventricles. It rises in response to stretch and overload. It is related to heart failure but not renal function.

The nurse is planning a presentation for staff members regarding sinus bradycardia. Which statement is the most accurate for the nurse to include in the​ presentation? Sinus bradycardia occurs with use of​ over-the-counter (OTC) cold remedies. Sinus bradycardia is an expected finding during sleep. Sinus bradycardia occurs with alcohol intake. Sinus bradycardia is a result of a hypersensitive carotid sinus reflex.

Sinus bradycardia is an expected finding during sleep. Rationale: Sinus bradycardia is a normal finding during sleep and in​ well-conditioned athletes. Sinus tachycardia occurs with use of OTC cold remedies and alcohol intake. Sinus arrest can result from a hypersensitive carotid sinus reflex.

The nurse is caring for a client with a history of atherosclerosis. The client has chest pain that occurs with physical exertion or stress and is relieved with sublingual nitroglycerin. The nurse recognizes that the client is most likely experiencing which​ disorder? Acute coronary syndrome Myocardial infarction Stable angina Prinzmetal angina

Stable angina Rationale: Stable angina is a predictable form of​ angina, which usually occurs when the work of the heart is increased by physical​ exertion, exposure to​ cold, or stress. Prinzmetal​ (variant) angina occurs unpredictably and often at night. The client is currently experiencing a predictable form of angina. Clinical manifestations of myocardial infarction include pain that is less​ predictable, more​ prolonged, and unrelieved by sublingual nitroglycerin. Clinical manifestations of acute coronary syndrome include pain that is more severe and longer than previously experienced. The pain is not predictable and is unrelieved by sublingual nitroglycerin.

______________ work by lowering the client's cholesterol, specifically removing the "bad" cholesterol from the blood (LDL).

Statins

You expect what client reaction during a coronary artery​ spasm? Acute reduction in level of consciousness Sudden onset of acute chest pain Gradual increase in peripheral edema Gradual increase in systolic blood pressure

Sudden onset of acute chest pain The nurse would expect a sudden onset of acute chest pain from a coronary artery​ spasm, which is characteristic of Prinzmetal​ angina, in which there is an acute reduction in coronary blood flow. An acute reduction in level of consciousness indicates neurological involvement. A gradual increase in peripheral edema is a sign of heart failure. A gradual increase in systolic blood pressure can have multiple causes.

The nurse is caring for a client with a history of angina. Which assessment findings would support the diagnosis of a myocardial infarction​ (MI)? Pain radiating to the left arm Sudden onset of burning chest pain Substernal chest pain Pain at rest

Sudden onset of burning chest pain Rationale: The client with acute coronary syndrome would exhibit substernal chest pain that occurs at rest and radiates to the left arm. The client experiencing a myocardial infarction would experience a sudden onset of burning chest pain.

The nurse is caring for an older adult client who presents with her family at the emergency department​ (ED) and is diagnosed with a sinus dysrhythmia. Which assessment findings related to decreased cardiac output would require immediate​ intervention? ​(Select all that​ apply.) Seizures Syncope Dizziness Shortness of breath Nausea and vomiting

Syncope Dizziness Shortness of breath Rationale: Assessment findings of​ syncope, dizziness, shortness of​ breath, angina, and generalized weakness are indicative of decreased cardiac output related to the cardiac dysrhythmia. You would speak honestly and sensitively to the client and family. You would tell them that healthcare providers must immediately intervene because decreased cardiac output can be life threatening. Nausea and vomiting are not clinical manifestations associated with decreased cardiac output related to sinus dysrhythmia. Seizures are a clinical manifestation in clients with ventricular​ dysrhythmia, particularly with torsades de​ pointes, ventricular​ fibrillation, and pulseless electrical activity.

The nurse is caring for an adolescent client who is brought to the emergency department​ (ED) experiencing torsades de pointes. Which clinical manifestations found during the nursing assessment support this​ diagnosis? ​(Select all that​ apply.) Tachycardia Seizures Epistaxis Bradypnea Hypotension

Tachycardia Seizures hypotension Rationale: Clinical manifestations of torsades de pointes include​ tachycardia, seizures, and hypotension. Epistaxis and bradypnea are not assessment findings that support this​ client's diagnosis.

A nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion? The cardiac output is above the normal range. The cardiac output is below the normal range. The cardiac output is in the low-normal range. The cardiac output is in the high-normal range.

The cardiac output is below the normal range. Rationale: The normal cardiac output for the adult can range from 4 to 7 L/min. Therefore a cardiac output of 3.2 L/min is below normal range.

The below are signs of ______ sided heart failure Shortness of breath Tachypnea Respiratory crackles Fatigue and activity intolerance are common early manifestations Dizziness and syncope

left-sided heart failure

The below are signs of ______ sided heart failure Distended neck veins Liver enlargement Anorexia and nausea Edema in the feet and legs or, if the client is bedridden, in the sacrum

right-sided heart failure

You are providing post-procedure instructions to the client who requires an emergent angiogram. What client statement indicates the need for further​ instruction? ​"I will be able to return to full duty at work within 24​ hours." ​"I will need to lie still for up to 8 hours after the​ procedure." ​"I will need to use the call light when I need toileting​ assistance." ​"I will need to let you know if there is moisture under me after the​ procedure."

​"I will be able to return to full duty at work within 24​ hours." The client needs more instruction because returning to work is usually allowed within 72​ hours; 24 hours is too soon. All of the other statements are important teaching points that the client must be informed of prior to an angiogram being​ performed, and the client must demonstrate proper understanding.

A​ 58-year-old client who has a strong family history of coronary artery disease asks the​ nurse, "How can I decrease my chances of developing problems with my​ arteries?" Which response by the nurse is​ appropriate? ​(Select all that​ apply.) ​"Keeping your blood pressure within normal levels will decrease the risk of injury to your​ arteries." ​"With your age and family​ history, there is little you can do besides take medication to prevent coronary artery​ disease." ​"You can reduce your risk by making some changes in your lifestyle such as moderate​ exercise." ​"Diets high in​ fruits, vegetables and unsaturated fatty acids appear to have a protective effect on the​ arteries." ​"As long as your cholesterol is​ normal, your arteries will remain​ clear."

​"Keeping your blood pressure within normal levels will decrease the risk of injury to your​ arteries." ​​"You can reduce your risk by making some changes in your lifestyle such as moderate​ exercise." ​"Diets high in​ fruits, vegetables and unsaturated fatty acids appear to have a protective effect on the​ arteries." ​ Rationale: The causes of atherosclerosis are not known but research has shown a connection with modifiable risk factors such as​ cholesterol, triglycerides, lack of​ exercise, smoking,​ obesity, blood​ pressure, diet,​ stress, and diabetes. Elevated cholesterol is only one of the factors that can contribute to the development of plaque in the arteries. Excessive pressures within the arterial system can cause injury to the arterial endothelium. Endothelial damage promotes platelet adhesion and​ aggregation, and attracts leukocytes to the area. Risk factors such as​ age, gender, and heredity cannot be modified. The exact cause is​ unclear, but it is believed that​ fruits, vegetables, whole​ grains, and unsaturated fatty acids have nutrients that help protect the arteries from injury.

The nurse is teaching a client about coronary artery disease. Which responses by the client reflect an understanding of coronary artery​ disease? (Select all that​ apply.) ​"Plaque impairs the ability of a vessel to dilate in response to increased oxygen​ demands." ​"Damage to the linings of my arteries can cause clots and​ blockage." ​"It decreases quality of life but does not increase a​ client's risk of​ death." ​"It affects more than 13 million people in the United​ States." ​"The increased levels of​ high-density lipoproteins​ (HDLs) decrease the risk of​ atherosclerosis."

​"Plaque impairs the ability of a vessel to dilate in response to increased oxygen​ demands." ​"Damage to the linings of my arteries can cause clots and​ blockage." ​"It affects more than 13 million people in the United​ States." ​"The increased levels of​ high-density lipoproteins​ (HDLs) decrease the risk of​ atherosclerosis." Rationale: Coronary artery disease affects 13.2 to 16.8 million people in the United States and causes more than​ 607,000 deaths annually. A lack of oxygenated blood to the coronary arteries will decrease a​ client's ability to function and increase their risk of death.​ High-density lipoproteins attract​ cholesterol, returning it from peripheral tissues to the liver. Endothelial damage causes the body to send platelets to seal the area and leukocytes to fight inflammation. These protective mechanisms also contribute to the formation of fibrous plaque. Fibrous plaque protrudes into the arterial lumen and invades the muscular media layer of the vessel as well as the inner wall of the intima. This results in a decreased ability of the vessel to dilate.

A nurse is assessing a client with heart failure. The nurse is concerned the client is experiencing poor tissue perfusion based on which assessment​ findings? ​(Select all that​ apply.) Capillary refill time is increasing. Blood pressure is​ 126/72 mmHg. Urinary output is 20​ mL/hr for the past 2 hours. Level of consciousness is decreasing. Oxygen saturation is​ 93% on room air.

​Capillary refill time is increasing. Urinary output is 20​ mL/hr for the past 2 hours. Level of consciousness is decreasing. Rationale: Urinary output of less than 30​ mL/hr for 2 hours suggests decreased renal tissue perfusion. A blood pressure of​ 126/72 mmHg is within normal limits and indicates adequate tissue perfusion. An increased capillary refill time can indicate decreased cardiac​ output, which can cause poor tissue perfusion. A decreased level of consciousness indicates that the brain tissue is not being adequately perfused. An oxygen saturation of​ 93% is within normal limits.​ Therefore, there is sufficient oxygen for tissue perfusion.

The nurse is caring for a client diagnosed with myocardial infarction. For which cardiac dysrhythmia would the nurse monitor the​ client? Atrial flutter Ventricular tachycardia ​Bundle-branch block ​Second-degree heart block

​Second-degree heart block Rationale: ​Second-degree heart blocks commonly occur following acute myocardial infarction. Atrial flutter is seen in older clients with rheumatic heart or valvular disease and is associated with​ anxiety, caffeine, and alcohol intake. Right​ bundle-branch block can occur in healthy individuals without cardiac disease. Ventricular tachycardia can occur with emotional stress or moderate to excessive intake of alcohol.

Benny​ Spencer, a​ 57-year-old man, arrives in the emergency department reporting persistent chest pain for the last 48 hours. The chest pain is rated as a 7 on a​ 1-10 scale, and it radiates up the​ client's neck. What lab values will be the most important for the nurse to​ monitor? ​BMP, CPK, and troponin CBC and CPK ​PTT, CBC, and​ Ck-MB ​Troponin, CPK, and​ Ck-MB

​Troponin, CPK, and​ Ck-MB The​ troponin, CPK, and​ Ck-MB are collectively known as cardiac enzymes and must be monitored closely to evaluate for cardiac damage. The other labs listed are important to monitor the​ client's status, but the cardiac enzymes together are more important to monitor for cardiac damage.