PREP U QUESTIONS CV
A client is being discharged from the hospital with a permanent cardiac pacemaker that is set at 72 beats/minute. The nurse should instruct the client to report which pulse rate immediately to the physician?
64 beats/minute Explanation: A demand pacemaker guarantees approximately 72 beats/minute. Whenever a client's rate falls below this mark, the pacemaker initiates a beat. A rate about 72 beats/minute is normal and indicates that the client's heart is initiating the beats. A rate below 72 beats/minute should be reported because it means that the pacemaker isn't functioning at the preset rate.
Which medical treatment should be administered to treat intermittent claudication?
Cilostazol (Pletal) Explanation: Cilostazol works by increasing blood flow into the legs and decreasing the stickiness of platelets. Analgesics are administered for pain relief. Warfarin and heparin are anticoagulants.
The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are:
fine crackles Explanation: Fine crackles are caused by fluid in the alveoli and commonly occur in clients with heart failure. Tracheal breath sounds are auscultated over the trachea. Bronchial breath sounds are heard over the mainstem bronchi. Friction rubs occur with pleural inflammation.
Which characteristic should a nurse expect to see on a normal cardiac rhythm strip obtained from an adult client?
Heart rate of 88 beats/minute Explanation: The normal adult heart rate is between 60 and 100 beats/minute. The normal PR interval is 0.12 to 0.20 second. In a normal cardiac cycle, there should be one P wave preceding each QRS complex. A normal QRS complex should be less than 0.10 second.
In which disorder would a nurse expect to assess sacral edema in a bedridden client?
Right-sided heart failure Explanation: Sacral, or dependent, edema is secondary to right-sided heart failure. The most accurate area on the body to assess dependent edema in a bedridden client is the sacral area. Diabetes mellitus, pulmonary emboli, and renal disease aren't directly linked to sacral edema.
Septal involvement occurs in which type of cardiomyopathy?
Hypertrophic Explanation: In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.
Which condition most commonly causes cardiogenic shock?
Acute myocardial infarction (MI) Explanation: Of all clients with an acute MI, 15% suffer cardiogenic shock secondary to the myocardial damage and decreased function. CAD causes MI. Hypotension is the result of a reduced cardiac output produced by the shock state. A decreased hemoglobin level is a result of bleeding.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Cardiac chest pain is caused by myocardial ischemia. Administering supplemental oxygen increases the myocardial oxygen supply. Cardiac monitoring helps detect life-threatening arrhythmias. The nurse should ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain by taking vital signs. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team before completing the initial assessment is premature.
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects which medication to be administered to the patient?
Anticoagulant Explanation: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. An antibiotic isn't given routinely during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics afterward to reduce the risk of infection. An antihypertensive agent may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.
Which interventions are appropriate when caring for a client with acute thrombophlebitis?
Apply warm soaks and elevate the client's legs higher than the level of the heart. Explanation: To help treat thrombophlebitis, the nurse should prevent venostasis with measures such as applying warm soaks and elevating the client's legs. The client should remain on bed rest during the acute phase, after which the client may begin to walk while wearing antiembolism stockings. Treatment for thrombophlebitis may also include anticoagulants to prolong clotting time.
A 47-year-old female client who recently experienced a myocardial infarction (MI) is admitted to the hospital. A nurse who's aware of the most common complication of an MI would monitor this client closely for which condition?
Arrhythmias Explanation: Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection.
Which drug class protects the ischemic myocardium by decreasing catecholamines and sympathetic nerve stimulation?
Beta-adrenergic blockers Explanation: Beta-adrenergic blockers work by decreasing catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the heart's workload. Calcium channel blockers reduce workload by decreasing the heart rate and dilating arteries. Opioids reduce myocardial oxygen demand. Nitrates reduce myocardial oxygen consumption and decrease blood pressure
Which condition is the most direct cause of a myocardial infarction (MI)?
Coronary artery thrombasis Explanation: Coronary artery thrombosis causes an occlusion of the artery, leading to MI. Smoking is the leading modifiable risk factor for developing coronary heart disease. Diabetes mellitus and hypertension may contribute to the development of coronary heart disease but aren't direct causes.
A client is admitted with the following vital signs: temperature, 102° F (38.9° C); heart rate, 144 beats/minute and irregular; and respiratory rate, 22 breaths/minute. Which nursing diagnosis takes highest priority when planning this client's care?
Decreased cardiac output Explanation: A heart rate of 144 beats/minute indicates decreased diastolic filling time and a reduced blood volume ejected with each contraction, resulting in decreased cardiac output. The client's temperature and respiratory rate are elevated but not enough for a diagnosis of Ineffective thermoregulation or Ineffective breathing pattern to take precedence over one of Decreased cardiac output. The client's vital signs don't suggest a diagnosis of Ineffective renal tissue perfusion.
Which drug is most commonly used to treat cardiogenic shock?
Dopamine Explanation: Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows the heart rate and lowers blood pressure, neither of which is a desired effect in the treatment of cardiogenic shock.
A 52-year-old client is admitted to the emergency department with chest discomfort, diaphoresis, and nausea. Suspecting possible myocardial infarction (MI), the nurse would expect the physician to order which common diagnostic test to quickly determine myocardial damage?
Electrocardiogram (ECG) Explanation: ECG is the quickest, most accurate, and most widely used tool to diagnose MI. Cardiac enzymes also are used to diagnose MI, but the results can't be obtained as quickly. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease.
Which action is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?
Enhance myocardial oxygenation Explanation: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin dilates the coronary vessels to increase blood flow, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
Which of the following signs and symptoms suggest that a client's abdominal aortic aneurysm is extending?
Increased abdominal and back pain Explanation: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.
When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are found in the carotid sinus and aorta. Which other area should the nurse mention as a site of arterial baroreceptors?
Left ventricular wall Explanation: Arterial baroreceptors are found in the left ventricular wall as well as the carotid sinus and aorta. None exist in the brachial artery, radial artery, or right ventricular wall.
When a client experiences chest pain during an acute anginal episode, the nurse should expect which form of nitroglycerin to be administered first?
Metered buccal nitroglycerin spray, 0.4 mg/spray
Medical treatment of coronary artery disease (CAD) includes which procedure?
Oral medication administration Explanation: Oral medication administration is a noninvasive, medical treatment for CAD. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and PTCA are invasive, surgical treatments.
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for adverse effects of heparin, especially bleeding. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that's specific to heparin. Which agent fits this description?
Protamine sulfate Explanation: Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's sometimes used to treat clients in shock.
Which is the most important instrument used as a diagnostic and monitoring tool for determining the severity of a shock state?
Pulmonary artery (PA) catheter Explanation: A PA catheter is used to give accurate pressure measurements within the heart, which aids in determining the course of treatment. An arterial line is used to directly assess blood pressure continuously. An indwelling urinary catheter is used to drain the bladder. An IABP is an assistive device used to rest the damaged heart.
A client with mitral stenosis is scheduled for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?
Pulmonary hypertension Explanation: Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation. This may lead to low cardiac output, pulmonary hypertension, edema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vital organs. Myocardial ischemia may occur in a client with coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis
Which treatment is the definitive one for a ruptured aneurysm?
Surgical intervention Explanation: When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.
After a client recovers from an episode of acute pulmonary edema, the nurse teaches him that enalapril maleate (Vasotec) has been ordered for which reason?
To decrease workload of the heart Explanation: Enalapril maleate is an angiotensin-converting enzyme inhibitor that reduces blood pressure and decreases the workload of the heart. Diuretics are given to decrease circulating fluid volume. Inotropic agents increase cardiac contractility. Negative inotropic agents decrease cardiac contractility.
Which parameter is the major determinant of diastolic blood pressure?
Vascular resistance Explanation: Vascular resistance is the impedance of blood flow by the arterioles that predominantly affects the diastolic pressure. Baroreceptors are nerve endings that are embedded in the blood vessels and respond to the stretching of vessel walls. They don't directly affect diastolic blood pressure. Cardiac output determines systolic blood pressure. Renal function helps control blood volume and indirectly affects diastolic blood pressure.
Which noninvasive diagnostic test demonstrates the backward flow of blood through incompetent venous valves?
Venous duplex Doppler ultrasonography Explanation: Venous duplex ultrasound is a noninvasive method that visualizes veins and measures the speed, direction, and pattern of blood flow in real time. Ascending and descending venography are invasive tests of the veins that use injected contrast medium and ionizing radiation. Segmental pulse volume recordings are noninvasive tests of the peripheral arteries.
When prioritizing care, which client should the nurse assess first?
a 33-year-old client with a recent diagnosis of Guillain-Barré syndrome Explanation: Guillain-Barré syndrome is characterized by ascending paralysis and potential respiratory failure. The order of client assessment should follow client priorities, with disorders of airway, breathing, and then circulation. There's no information to suggest the post-MI client has an arrhythmia or other complication. There's no evidence to suggest hemorrhage or perforation for the remaining clients as a priority of care.
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of:
acute pulmonary edema. Explanation: Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock would show signs of hypotension and tachycardia.
Which drug class is most widely used in the treatment of cardiomyopathy?
Beta-adrenergic blockers Explanation: By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease car-diac output in clients who are commonly already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren't as effective as beta-adrenergic blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.
A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
Blood pressure Explanation: Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above- normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
A client is evaluated for hypertension. The physician prescribes atenolol (Tenormin), 50 mg by mouth daily. Atenolol should have which therapeutic effect on the client?
Decreased cardiac output and systolic and diastolic blood pressure Explanation: As a long-acting, selective beta1 blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blocking agents, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.
A client is diagnosed with pericarditis. The nurse anticipates that the client may exhibit which signs and symptoms?
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. All other symptoms may result from acute renal failure.
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
Leg edema Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, neck vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.
A client comes to the emergency department complaining of headache, malaise, chills, fever, and a stiff neck. Vital sign assessment reveals a temperature elevation, increased heart and respiratory rates, and normal blood pressure. On physical examination, the nurse notes confusion, a petechial rash, nuchal rigidity, Brudzinski's sign, and Kernig's sign. What does Brudzinski's sign indicate?
Meningeal irritation Explanation: Brudzinski's sign indicates meningeal irritation, as in meningitis. Other signs of meningeal irritation include nuchal rigidity and Kernig's sign. Brudzinski's sign doesn't indicate increased ICP, cerebral edema, or low CSF pressure.
A client is scheduled for magnetic resonance imaging (MRI) of the head. Which area is essential to assess before the proce-dure?
Metal fillings, prostheses, or a pacemaker Explanation: Strong magnetic waves may dislodge metal in the client's body, causing tissue injury. Although the client may be told to restrict food for 8 hours, particularly if contrast is used, metal is an absolute contraindication for this procedure. Voiding beforehand would make the client more comfortable and better able to remain still during the procedure, but it isn't essential for the test. Having carotid artery disease isn't a contraindication to having an MRI.
The nurse is taking the health history of a 49-year-old female client, when the client mentions that her heart sometimes seems to race. The nurse should be especially vigilant to monitor this client for which life-threatening cardiac arrhythmia?
Ventricular fibrillation Explanation: Ventricular fibrillation is a life-threatening arrhythmia. It occurs when the ventricle fibrillates, failing to fully contract and pump blood through the heart. Sinus tachycardia, atrial fibrillation, and atrial flutter are arrhythmias that may require treatment but are not considered life-threatening.
The most common site of aneurysm formation is in the:
abdominal aorta, just below the renal arteries. Explanation: About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the ascending aorta and aortic arch. Debakey type III aneurysms are found in the descending aorta.
A client is admitted for treatment of Prinzmetal's angina. When developing the plan of care, the nurse keeps in mind that this type of angina is triggered by:
coronary artery spasm. Explanation: Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger other types of angina. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; however, anginal pain is increasingly severe.
When obtaining a health history from a client admitted with hypertension, the nurse should expect the client to report which symptom?
Headache Explanation: An occipital headache is typical of hypertension owing to increased pressure in the cerebral vasculature. Blurred vision (due to arteriolar changes in the eye) and epistaxis (nosebleed) are far less common than headache, but can also be diagnostic signs. Peripheral edema can occur from an increase in sodium and water retention, but it's usually a latent sign.
A client with a history of atrial arrhythmia is receiving propranolol (Inderal), 10 mg by mouth three times per day. The nurse knows that propranolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
Heart Explanation: Beta1-receptor sites are mainly located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
