p Test # 2 CAD & ACS: Ch 34 from E
c. Obtain the patient's vital signs including oxygen saturation.
A pt who is complaining of a "racing" heart & feeling "anxious" comes to the ED. The nurse places the pt on a heart monitor & obtains the following (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the pt perform the Valsalva maneuver. c. Obtain the pt's V/S including oxygen saturat. d. Prepare to give a beta blocker med to slow the HR.
When analyzing an (ECG) rhythm strip of a pt w/a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____.
ANS: 50 There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.
26. A pt who has recently started taking pravastatin (Pravachol) & niacin reports several symp's to the nurse. Which information is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness with rapid position changes c. Nausea when taking the drugs before meals d. Flushing and pruritus after taking the drugs
ANS: A Muscle aches and pains may indicate myopathy & rhabdomyolysis, which have caused acute kidney injury & death in some pts who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued.
A pt who is being admitted to the ED w/intermittent chest pain gives the following list of daily meds to the nurse. Which med has the most immediate implications for the pt's care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Captopril (Capoten) d. Warfarin (Coumadin)
ANS: A The nurse will need to avoid giving nitrates to the pt because nitrate admin is contraindicated in pts who are using viagra because of the risk of severe hypotension caused by vasodilation.
19. Three days after experiencing a (MI), a pt who is scheduled for discharge asks for assistance w/hygiene activities, saying, "I am too nervous about my heart to be alone while I get washed up." Based on this information, which nursing diagnosis is appropriate? a. Ineffective coping related to anxiety b. Activity intolerance related to weakness c. Denial related to lack of acceptance of the MI d. Disturbed personal identity related to understanding of illness
ANS: A The patient data indicate anxiety about the impact of the MI is a concern. The other nursing diagnoses may be appropriate for some patients after an MI, but the data for this patient do not support denial, activity intolerance, or altered body image.
A few days after experiencing a (MI) & successful percutaneous coronary intervention, the pt states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? a. "What do you think caused your chest pain?" b. "Where are you planning to go for your vacation?" c. "Sometimes plans need to change after a heart attack." d. "Recovery from a heart attack takes at least a few weeks."
ANS: A When the pt is experiencing denial, the nurse should assist the pt in testing reality until the pt has progressed beyond this step of the emotional adjustment to MI.
When caring for a pt who has just arrived on the telemetry unit after having cardiac cath, which nursing intervention should the nurse delegate to a (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication. b. Perform the initial assessment of the catheter insertion site. c. Teach the patient about the usual postprocedure plan of care. d. Titrate the heparin infusion according to the agency protocol.
ANS: A Administration of oral medications is within the scope of practice for LPNs/LVNs. The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN).
25. The nurse is caring for a pt who was admitted to the coronary care unit following an (AMI) & percutaneous coronary intervention the previous day. Teaching for this pt would include a. when cardiac rehabilitation will begin. b. the typical emotional responses to AMI. c. information regarding discharge medications. d. the pathophysiology of coronary artery disease.
ANS: A Early after an AMI, the pt will want to know when resumption of usual activities can be expected. At this time, the patient's anxiety level or denial will interfere with good understanding of complex information such as the pathophysiology of coronary artery disease. .
33. When admitting a pt w/a non-ST-segment-elevation myocardial infarction (NSTEMI) to the ICU, which action should the nurse perform first? a. Attach the heart monitor. c. Assess the peripheral pulses. b. Obtain the blood pressure. d. Auscultate the breath sounds.
ANS: A Dysrhythmias are the most common complication of (MI), the first action should be to place the pt on a heart monitor. The other actions are also important and should be accomplished as quickly as possible.
When preparing to defibrillate a pt. In which order will the nurse perform the following steps? a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the paddles on the pt's chest. e. Check the location of other staff and call out "all clear."
ANS: A, C, D, E, B This order will result in rapid defibrillation without endangering hospital staff.
15. After an acute MI, a pt ambulates in the hospital hallway. When the nurse evaluates the pt's response to the activity, which data would indicate that the exercise level should be decreased? a. O2 saturation drops from 99% to 95%. b. Heart rate increases from 66 to 92 beats/min. c. Respiratory rate goes from 14 to 20 breaths/min. d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
ANS: B A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in O2 saturation, are normal responses to exercise.
When caring for a pt who is recovering from a sudden cardiac death (SCD) event & has no evidence of an acute MI, the nurse will anticipate teaching the pt that a. sudden cardiac death events rarely reoccur. b. additional diagnostic testing will be required. c. long-term anticoagulation therapy will be needed. d. limiting physical activity will prevent future SCD events.
ANS: B Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the poss. cause of the SCD & tx options. SCD is likely to recur. Anticoag. therapy won't have any effect on the incidence of SCD, & SCD can occur even when the patient is resting.
10. The nurse suspects that the patient with stable angina is experiencing a side effect of the prescribed drug metoprolol (Lopressor) if the a. patient is restless and agitated. b. blood pressure is 90/54 mm Hg. c. patient complains about feeling anxious. d. heart monitor shows normal sinus rhythm of 61 beats/minute.
ANS: B Patients taking -adrenergic blockers should be monitored for hypotension and bradycardia. Because this class of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, & anxiety will not be side effects. Normal sinus rhythm is a normal and expected heart rhythm.
39. To improve the physical activity level for a mildly obese 71-yr-old pt, which action should the nurse plan to take? a. Stress that wt loss is a major benefit of increased exercise. b. Determine what kind of physical activities the pt usually enjoys. c. Tell the pt that older adults should exercise for no more than 20 minutes at a time. d. Teach the pt to include a short warm-up period at the beginning of physical activity.
ANS: B Pts are more likely to continue physical activities they already enjoy. Nurse will plan to ask the pt about preferred activities. Goal is 30 minutes of mod activity most days, longer warm-up per. Benefits such as improved activity tolerance, should be emphasized
23. A pt who is recovering from an (AMI) asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best? a. "Most pts are able to enjoy intercourse without any complications." b. "Sexual activity uses about as much energy as climbing two flights of stairs." c. "The dr will provide sexual guidelines when your heart is strong enough." d. "Holding and cuddling are good ways to maintain intimacy after a heart attack."
ANS: B Sexual activity places about as much physical stress on the cardio system as most moderate-energy activities such as climbing two flights of stairs.
Which assessment finding by the nurse caring for a pt who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision
ANS: B The changes in the right hand indicate compromised blood flow, which requires immediate evaluation & actions such as prescribed calcium channel blockers or surgery. The other changes are expected or require nursing interventions.
13. When titrating IV nitroglycerin for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the drug? a. Monitor heart rate. c. Check blood pressure. b. Ask about chest pain. c. Check blood pressure. d. Observe for dysrhythmias.
ANS: B The goal of IV nitro admin in MI is relief of chest pain by improving balance between myocardial oxygen supply & demand. The nurse will also monitor H/R & BP & observe for dysrhythmias, but they wont indicate if med is effective.
When eval. the effectiveness of preop. teaching with a pt scheduled for (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the pt says which of the following? a. "They will circulate my blood with a machine during surgery." b. "I will have small incisions in my leg where they will remove the vein." c. "They will use an artery near my heart to go around the area that is blocked." d. "I will need to take an aspirin every day after the surgery to keep the graft open."
ANS: B When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.
40. Which pt at the cardio clinic requires the most immediate action by the nurse? a. Pt with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Pt w/stable angina whose chest pain has recently increased in frequency c. Pt with familial hypercholesterolemia & a ttl cholesterol of 465 mg/dL d. Pt w/chronic HTN whose blood pressure today is 172/98 mm Hg
ANS: B The hx of more freq chest pain suggests that the pt may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac cath & possible percutaneous coronary intervention.
34. Which info about a pt who has been receiving thrombolytic therapy for an AMI is most important for the nurse to communicate to the HCP? a. An increase in troponin levels from baseline b. A large bruise at the patient's IV insertion site c. No change in the patient's reported level of chest pain d. A decrease in ST-segment elevation on the electrocardiogram
ANS: C Continued chest pain suggests that the thrombolytic therapy is not effective & that other interventions such as percutaneous coronary intervention may be needed.
12. Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? a. Heparin enhances platelet aggregation at the plaque site. b. Heparin decreases the size of the coronary artery plaque. c. Heparin prevents the development of new clots in the coronary arteries. d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.
ANS: C Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.
41. A pt with DM & chronic stable angina has a new order for captopril . The nurse should teach the pt that the primary purpose of captopril is to a. lower heart rate. b. control blood glucose levels. c. prevent changes in heart muscle. d. reduce the frequency of chest pain.
ANS: C Purpose for (ACE) inhibitors in pts w/chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina.
A pt with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication? a. Administer the med at the pt's usual bedtime. b. Have the pt take the colesevelam 1 hour before breakfast. c. Give the pt's other meds 2 hours after colesevelam. d. Have the pt take the dose at the same time as the prescribed aspirin.
ANS: C The bile acid interferes w/ absorption of many other drugs & giving other medications at the same time should be avoided. Taking aspirin w/it may increase incidence of gastro s/e's such as heartburn. For maximum effect, colesevelam should be administered w/meals.
35. The nurse obtains the following data when assessing a pt who experienced an ST- (STEMI) 2 days previously. Which information is most important to report to the HCP? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs).
ANS: C The crackles indicate that the pt may be developing HF, a poss. complication of (MI). The HCP may need to order meds such as diuretics or angiotensin-converting enzyme inhibitors for the pt. Elevation in troponin level is expected.
17. A patient recovering from a (MI) develops chest pain on day 3 that increases when taking a deep breath & is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom? a. Assess the feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias.
ANS: C The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms.
In preparation for discharge, the nurse teaches a pt w/chronic stable angina how to use the prescribed short-acting & long-acting nitrates. Which pt statement indicates that the teaching has been effective? a. "I will check my pulse rate before I take any nitroglycerin tablets." b. "I will put the nitroglycerin patch on as soon as I get any chest pain." c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." d. "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin."
ANS: C The pt should sit down b4 taking the nitro to decrease cardiac workload & prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain & can be used concurrently w/sublingual nitroglycerin. Although the nurse should check BP B4 giving , pts do not need to check the pulse rate before taking nitrates.
31. When caring for a pt with acute coronary syndrome who has returned to the coronary care unit after having angioplasty w/stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse? a. Heart rate 102 beats/min b. Pedal pulses 1+ bilaterally c. Blood pressure 103/54 mm Hg d. Chest pain level 7 on a 0 to 10 point scale
ANS: C The pt's chest pain indicates that restenosis of the coronary artery may be occurring & requires immediate actions, such as admin. of oxygen & nitro, by the nurse.
14. A patient with ST-segment elevation in 3 contiguous ecg leads is admitted to the ED & diagnosed as having an ST-segment-elevation MI. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. "Do you have any allergies?" b. "Do you take aspirin on a daily basis?" c. "What time did your chest pain begin?" d. "Can you rate your chest pain using a 0 to 10 scale?"
ANS: C Thrombolytic therapy should be started w/i 6 hrs of the onset of the MI, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment.
9. Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will a. reduce heart palpitations. b. prevent coronary artery plaque. c. decrease coronary artery spasms. d. increase contractile force of the heart.
ANS: C Prinzmetal's angina is caused by coronary artery spasm. CCB's (e.g., diltiazem, amlodipine [Norvasc]) are first-line therapy for this type of angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), & adrenergic blockers decrease sympat stim of the heart (i.e., palpitations). Meds or activities that increase myocardial contractility will increase the incidence of angina by increasing O2 demand.
37. A pt who has chest pain is admitted to the (ED), & all of the following are ordered. Which one should the nurse arrange to be completed first? a. Chest x-ray b. Troponin level c. Electrocardiogram (ECG) d. Insertion of a peripheral IV
ANS: C Priority for pt is to determine if an (AMI) is occurring so that the approp therapy can begin quickly. ECG changes occur rapidly after coronary artery occlusion, & an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours.
16. During the administration of the thrombolytic agent to a pt with an acute MI, the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. increase in blood pressure. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.
ANS: C The change in LOC indicates that the pt may be exper. intracranial bleeding, a possible complication of thrombolytic therapy. Bleeding gums is expected A decrease in BP could indicate internal bleeding. A non-sustained episode of V-Tach is a common reperfusion dysrhythmia & may indicate that the therapy is effective.
Which (ECG) change is most important for the nurse to report to the HCP when caring for a pt with chest pain? a. Inverted P wave b. Sinus tachycardia c. ST-segment elevation d. First-degree atrioventricular block
ANS: C The pt is likely to be experiencing an ST-elevation MI. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage.
38. After receiving change-of-shift rpt about the following 4 pts on the cardiac care unit, which pt should the nurse assess first? a. A 39-y/o pt with pericarditis who is compln of sharp, stabbing chest pain b. A 56-y/o pt w/variant angina who is sched. to receive nifedipine (Procardia) c. A 65-y/o pt who had a (MI) 4 days ago & is anxious about today's discharge d. A 59-y/o pt w/unstable angina who has just returned after a percutaneous coronary intervention (PCI)
ANS: D After PCI, the pt is at risk for hemorrhage from the arterial access site. The nurse should assess the pt's BP, pulses, & the access site immediately. The other Pts should also be assessed as quickly as possible, but assessment of this pt has the highest priority.
32. A pt admitted to the coronary care unit (CCU) w/an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The BP 86/40 mm Hg, HR 132 beats/min. Based on this information, which nursing dx is a priority for the pt? a. Acute pain related to myocardial infarction b. Anxiety related to perceived threat of death c. Stress overload related to acute change in health d. Decreased cardiac output related to cardiogenic shock
ANS: D All the nursing dx's may be appropriate for this pt, but the hypotension & tachy indicate decreased cardiac output & shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority.
Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. "I will switch from whole milk to 1% milk." b. "I like salmon and I will plan to eat it more often." c. "I can have a glass of wine with dinner if I want one." d. "I will miss being able to eat peanut butter sandwiches."
ANS: D Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monounsaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the TLC diet.
4. Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? a. "The pain wakes me up at night." b. "The pain is level 3 to 5 (0 to 10 scale)." c. "The pain has gotten worse over the last week." d. "The pain goes away after a nitroglycerin tablet."
ANS: D Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina.
11. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and heart rate. b. fewer complaints of having cold hands and feet. c. improvement in the strength of the distal pulses. d.ability to participate in daily activities without chest pain.
ANS: D Effectiveness is indicated if the patient is able to accomplish ADLs w/o chest pain. BP & heart rate may decrease, but these data do not indicate that the goal of decreased angina has been met.
36. A pt had a non-ST-(NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is appropriate for the (RN) to delegate to an experienced (LPN/LVN)? a. Evaluation of the patient's response to walking in the hallway b. Completion of the referral form for a home health nurse follow-up c. Education of the patient about the pathophysiology of heart disease d. Reinforcement of teaching about the purpose of prescribed medications
ANS: D LPN/LVN can reinforce edu. that was previously been done by the RN.
5. After the nurse has finished teaching a pt about sublingual nitroglycerin (Nitrostat), which patient statement indicates that teaching has been effective? a. "I can expect nausea as a side effect of nitroglycerin." b. "I should only take nitroglycerin when I have chest pain." c. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart." d. "I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart."
ANS: D The emergency response system (ERS) should be activated when chest pain or other symptoms are not completely relieved after three sublingual nitroglycerin tablets taken 5 minutes apart.
8. A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to best determine whether the patient has had an AMI? a. Myoglobin b. Homocysteine c. C-reactive protein d. Cardiac-specific troponin
ANS: D Troponin levels increase about 4-6 hrs after onset of (MI) & are highly specific indicators for MI. Myoglobin is released w/i 2 hrs of MI, but lacks specificity & its use is limited.
ANS: D Pulmonary congestion suggests that the patient may be developing heart failure, a complication of myocardial infarction (MI). Hyperglycemia is common after MI because of the inflammatory process that occurs with tissue necrosis. Troponin levels will be elevated for several days after MI. Q waves often develop with ST-segment-elevation MI.
After reviewing a pt's hx, V/S, physical assess, & lab data, which info is most important for the nurse to communicate to the HCP? a. Q waves on ECG b. Elevated troponin levels c. Fever and hyperglycemia d. Tachypnea and crackles in lungs
c. Dietary changes to improve lipid levels
Review medical record of a 43-y/o pt, which risk factor modification for CAD should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Ongoing cardiac risk associated with history of tobacco use
A 20-y/o has a mandatory (ECG) before participating on a college soccer team has sinus bradycardia, rate 52. (BP) is 114/54, & the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further diagnostic testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student's family health history.
a. Allow the student to participate on the soccer team.
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patient's heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions
a. Increase in the patient's heart rate
Which action by a new (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias? a. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia b. Obtains the defibrillator & quickly brings to the bedside of a pt whose monitor shows asystole c. Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a pt with new-onset type II second degree AV block
a. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia
Which action will the nurse include in the plan of care for a pt who was admitted w/syncopal episodes of unknown origin? a. Instruct the pt to call for assistance before getting out of bed. b. Explain the association between various dysrhythmias and syncope. c. Educate the pt about need to avoid caffeine & other stimulants. d. Tell the pt about the benefits of implantable cardioverter-defibrillators.
a. Instruct the patient to call for assistance before getting out of bed.
The nurse administers prescribed therapies for a pt w/cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heave or thrills over the heart. d. Review hemoglobin and hematocrit values.
a. Observe for distended neck veins.
To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patient's a. P wave. b. Q wave. c. P-R interval. d. QRS complex.
a. P wave.
A pt's cardiac monitor shows a pattern of undulations of varying contours and amplitude w/no measurable ECG pattern. The pt is unconscious & pulseless. Which action should the nurse take first? a. Perform immediate defibrillation. b. Give epinephrine (Adrenalin) IV. c. Prepare for endotracheal intubation. d. Give ventilations with a bag-valve-mask device.
a. Perform immediate defibrillation.
The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. Peripheral edema b. Elevated temperature c. Clubbing of the fingers d. Complaints of chest pain
a. Peripheral edema
Which intervention by a new nurse who is caring for a pt who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of pts with ICDs? a. The nurse assists the pt to do active ROM exercises for all extremities. b. The nurse assists the pt to fill out the application to get a Medic Alert ID. c. The nurse gives amiodarone (Cordarone) to the pt w/o 1st consulting w/the HCP. d. The nurse teaches the pt that sexual activity can usually be resumed once the surgical incision is healed.
a. The nurse assists the patient to do active range of motion exercises for all extremities.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about a. anticoagulant therapy. b. permanent pacemakers. c. electrical cardioversion. d. IV adenosine (Adenocard).
a. anticoagulant therapy.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of a. echocardiography. b. daily blood cultures. c. cardiac catheterization. d. 24-hour Holter monitor.
a. echocardiography.
The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. note when Korotkoff sounds are auscultated during both inspiration & expiration. b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP). c. check the (ECG) for variations in rate during the respiratory cycle. d. listen for a pericardial friction rub that persists when the pt is instructed to stop breathing.
a. note when Korotkoff sounds are auscultated during both inspiration and expiration.
The standard policy on the cardiac unit states, "Notify the HCP for mean arterial pressure (MAP) less than 70 mm Hg." The nurse will need to call the health care provider about the a. postoperative pt with a BP of 116/42. b. newly admitted pt with a BP of 150/87. c. pt with left ventricular failure who has a BP of 110/70. d. pt with a myocardial infarction who has a BP of 140/86.
a. postoperative patient with a BP of 116/42.
7. After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. "Carvedilol will help my heart muscle work harder." b. "It is important not to suddenly stop taking the carvedilol." c. "I can expect to feel short of breath when taking carvedilol." d. "Carvedilol will increase the blood flow to my heart muscle."
b. "It is important not to suddenly stop taking the carvedilol." Pts taking -adrenergic blockers can develop angina if the med is suddenly stopped. Carvedilol (Coreg) decreases myocardial contractility. SOB that occurs when taking -adrenergic blockers for angina may be due to bronchospasm.
The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-y/o pt w/cystic fibrosis who has pulm. funct testing scheduled b. A 46-y/o pt on bed rest who is complaining of sudden onset of shortness of breath c. A 77-y/o pt w/(TB) who has 4 antitubercular medications due in 15 minutes d. A 35-y/o pt who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)
b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath
A 19-y/o student comes to the student health center complaining that, "My heart is skipping beats." An (ECG) shows occasional (PVCs). What action should the nurse take next? a. Start supplemental O2 at 2 to 3 L/min via nasal cannula. b. Ask the pt about current stress level & caffeine use. c. Ask the pt about any hx CAD d. Have the pt taken to the hospital (ED).
b. Ask the patient about current stress level and caffeine use.
Which action should the nurse perform when preparing a pt with supra- ventricular tachy for cardioversion who is alert and has a BP of 110/66 mm Hg? a. Turn the synchronizer switch to the "off" position. b. Give a sedative b4 cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.
b. Give a sedative before cardioversion is implemented.
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes? a. Inform the pt about a diet containing no saturated fat and minimal salt. b. Help the pt modify favorite high-fat recipes by using monounsaturated oils. c. Emphasize increased risk for heart problems unless the pt makes the dietary changes. d. Give the pt a list of low-sodium, low-cholesterol foods that should be included in the diet.
b. Help the patient modify favorite high-fat recipes by using monounsaturated oils. Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences. The highest percentage of calories from fat should come from monounsaturated or polyunsaturated fats.
A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6
b. II
After receiving the following information about 4 Pts during change-of-shift report, which pt should the nurse assess first? a. Pt with acute pericarditis who has a pericardial friction rub b. Pt who has just returned to the unit after balloon valvuloplasty c. Pt who has hypertrophic cardiomyopathy and a heart rate of 116 d. Pt with a mitral valve replacement who has an anticoagulant scheduled
b. Patient who has just returned to the unit after balloon valvuloplasty
The nurse & (UAP) on the telemetry unit are caring for 4 pts. Which nursing action can be delegated to the UAP? a. Teaching a pt scheduled for exercise electrocardiography about the procedure b. Placing electrodes in the correct position for a pt who is to receive ECG monitoring c. Checking the cath insertion site for a pt who is recovering from a coronary angiogram d. Monitoring a pt who has just returned to the unit after a transesophageal echocardiogram
b. Placing electrodes in the correct position for a patient who is to receive ECG monitoring
A pt whose heart monitor shows sinus tachycardia, rate 132, is apneic & has no palpable pulses. What is the first action that the nurse should take? a. Perform synchronized cardioversion. b. Start (CPR). c. Administer atropine per agency dysrhythmia protocol. d. Provide supplemental oxygen via non-rebreather mask.
b. Start cardiopulmonary resuscitation (CPR).
Which assessment data suggest that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases w/deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.
b. The pain has lasted longer than 30 minutes. Chest pain that lasts for 20 minutes or more is characteristic of AMI.
When admitting a pt for a cardiac cath & coronary angiogram, which information about the pt is most important for the nurse to communicate to the HCP? a. The patient's pedal pulses are +1. b. The patient is allergic to shellfish. c. The patient had a heart attack a year ago. d. The patient has not eaten anything today.
b. The patient is allergic to shellfish.
7. A pt is sched. for a cardiac cath w/ coronary angiography. Before the test, the nurse informs the pt that a. it will be important to lie completely still during the procedure. b. a flushed feeling may be noted when the contrast dye is injected. c. monitored anesthesia care will be provided during the procedure. d. arterial pressure monitoring will be required for 24 hours after the test.
b. a flushed feeling may be noted when the contrast dye is injected.
An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which assessment data indicate to the nurse that the goals of treatment with the IABP are being met? a. Urine output of 25 mL/hr b. Heart rate of 110 beats/minute c. Cardiac output (CO) of 5 L/min d. Stroke volume (SV) of 40 mL/beat
c. Cardiac output (CO) of 5 L/min
A pt who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea & chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead (ECG). b. Notify the HCP of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the pt's VS including o2 saturation.
c. Give supplemental O2 at 2 to 3 L/min via nasal cannula.
Which assessment finding obtained by the nurse when assessing a pt w/acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 168/94 c. Jugular venous distention (JVD) to jaw level d. Level 6 (0 to 10 scale) chest pain with a deep breath
c. Jugular venous distention (JVD) to jaw level
Which nursing action can the (RN) delegate to experienced (UAP) working as a telemetry technician on the cardiac care unit? a. Decide whether a pt's HR of 116 requires urgent treatment. b. Monitor a pt's LOC during synchronized cardioversion. c. Observe cardiac rhythms for multiple pts who have telemetry monitoring. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.
c. Observe cardiac rhythms for multiple patients who have telemetry monitoring.
The nurse is reviewing the lab results for newly admitted pts on the cardiovascular unit. Which pt lab result is most important to communicate as soon as possible to the HCP? a. Pt whose triglyceride level is high b. Pt who has very low homocysteine lvl c. Pt w/increase in troponin T and troponin I level d. Pt w/elevated high-sensitivity C-reactive protein level
c. Patient with increase in troponin T and troponin I level
Which information obtained by the nurse who is admitting the pt for (MRI) will be most important to report to the HCP before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent ventricular pacemaker. d. The patient took all the prescribed cardiac medications today.
c. The patient has a permanent ventricular pacemaker.
Which info will the nurse include when teaching a pt who is scheduled for a radiofrequency cath ablation for tx of atrial flutter? a. The procedure will prevent/minimize the risk for sudden cardiac death. b. The procedure will use cold therapy to stop the formation of flutter waves. c. The procedure will use electrical energy to destroy areas of the conduction system. d. The procedure will stimulate the growth of new conduction pathways between the atria.
c. The procedure will use electrical energy to destroy areas of the conduction system.
The nurse has received the lab results for a pt who developed chest pain 4 hours ago and may be having a MI. The most important lab result to review will be a. myoglobin. b. low-density lipoprotein (LDL) cholesterol. c. troponins T and I. d. creatine kinase-MB (CK-MB).
c. troponins T and I.
The nurse has received change-of-shift report about the following pts on the PCU. Which pt should the nurse see first? a. A pt who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hrs ago b. A pt w/new onset A-Fib, rate 88, who has 1st dose of warfarin (Coumadin) due c. A pt w/second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating d. A pt whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due
d. A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due
A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pads.
d. Apply the transcutaneous pacemaker (TCP) pads.
To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Troponin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP)
d. B-type natriuretic peptide (BNP)
A patient's cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next? a. Place the transcutaneous pacemaker pads on the patient. b. Administer atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Document the patient's rhythm and assess the patient's response to the rhythm. d. Call the health care provider before giving the next dose of metoprolol (Lopressor).
d. Call the health care provider before giving the next dose of metoprolol (Lopressor).
A pt w/a poss pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a HR 142 bts/min, BP 100/60 mmHg, and resp 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therap. b. Notify the pt's health care provider. c. Prepare pt for a spiral (CT). d. Elevate the head of the bed to a semi-Fowler's position.
d. Elevate the head of the bed to a semi-Fowler's position.
After providing a pt with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the pt states a. I will avoid cooking with a microwave oven or being near one in use." b. It will be 1 month before I can take a bath or return to my usual activities." c. I will notify the airlines when I make a reservation that I have a pacemaker." d. I won't lift the arm on the pacemaker side up very high until I see the doctor."
d. I won't lift the arm on the pacemaker side up very high until I see the doctor."
When the nurse is monitoring a pt who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse? a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg d. Newly inverted T waves on the electrocardiogram
d. Newly inverted T waves on the electrocardiogram
While assessing a pt who was admitted with HF, the nurse notes that the pt has (JVD) when lying flat in bed. Which action should the nurse take next? a. Document this finding in the patient's record. b. Obtain vital signs, including oxygen saturation. c. Have the patient perform the Valsalva maneuver. d. Observe for JVD with the patient upright at 45 degrees.
d. Observe for JVD with the patient upright at 45 degrees.
A pt admitted w/a MI experiences a 45-sec episode of ventricular tachycardia, then converts to sinus rhythm with a HR of 98 bts/min. Which of the following actions should the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Perform synchronized cardioversion per agency dysrhythmia protocol. d. Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.
d. Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.
When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. P-R interval of 0.18 second. c. Q-T interval of 0.38 second. d. QRS interval of 0.14 second.
d. QRS interval of 0.14 second.
Which lab result for a pt w/multifocal PVCs) is most important for the nurse to communicate to the HCP? a. Blood glucose 243 mg/dL b. Serum chloride 92 mEq/L c. Serum sodium 134 mEq/L d. Serum potassium 2.9 mEq/L
d. Serum potassium 2.9 mEq/L
The nurse needs to quickly estimate the HR 4 a pt w/a regular heart rhythm. Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Calculate the number of small squares between one QRS complex and the next and divide into 1500. d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
A pt has normal cardiac rhythm & HR of 72 bts/min. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the HCP immediately. b. give atropine per agency dysrhythmia protocol. c. prepare the Pt for temp. pacemaker insertion. d. document the finding & cont to monitor the pt.
d. document the finding and continue to monitor the patient.
When developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease (CAD), the nurse should focus primarily on the a. family history of coronary artery disease. b. increased risk associated with the patient's gender. c. increased risk of cardiovascular disease as people age. d. elevation of the patient's low-density lipoprotein (LDL) level.
d. elevation of the patient's low-density lipoprotein (LDL) level
The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. connect the recorder to a computer once daily. b. exercise more than usual while the monitor is in place. c. remove the electrodes when taking a shower or tub bath. d. keep a diary of daily activities while the monitor is worn.
d. keep a diary of daily activities while the monitor is worn.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a pt with acute pericarditis. The priority intervention by the nurse for this problem is to a. teach the pt to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. remind the pt to request opioid pain medication every 4 hours. d. place the pt in Fowler's position, leaning forward on the overbed table.
d. place the patient in Fowler's position, leaning forward on the overbed table.
The nurse obtains a rhythm strip on a pt who has an MI & makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide & distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.
d. ventricular tachycardia.
