232 exam 1 questions

are characterized by a QRS of longer than 0.12 second and by a wide, notched, or slurred QRS complex

PVC

_____ are characterized by a QRS of longer than 0.10 second and by a wide, notched, or slurred QRS complex. There is no P wave related to the QRS complex, and the T wave is usually inverted

PVCs

which heart block is an arrhythmia which shows increasing prolongation of the PR interval, just before a QRS complex drops or disappears.

Second degree AV type I

________ is where there is no conduction through the AV node what cardiac abnormality

Third degree AV block or complete heart block

is characterized by absent P waves, wide QRS complexes and a rate between 100 and 250 impulses per minute

Ventricular tachycardia (V-Tach)

normal apical impulse is found over the _______ of the heart and is typically located and auscultated in the left fifth intercostal space in the midclavicular line

apex

This ECG indicates the client has _______ _______ There is no P wave and PR interval; these are replaced with a fine wavy lines.

atrial fibrillation.

The nurse is caring for a client who is on a telemetry monitor, which reveals several saw-toothed P waves between QRS complexes

atrial flutter

saw tooth patten

atrial flutter

is a serious complication of MI, with a mortality rate approaching 90%

cardiogenic shock

Bigeminy may occur with (3)

electrolyte imbalances, ischemia, and medications

Third left intercostal space left of sternum, mid clavicular line. This is where S1 and S2 can both be auscultated.

erbs point

Tachybrady syndrome

heart beats too fast, and too slow, seen in a fib patients

what causes pvc

hypokalemia and 3 s's

Typical signs of cardiogenic shock include

low blood pressure, rapid and weak pulse, decreased urine output, and signs of diminished blood flowto the brain, such as confusion and restlessness.

Nitroglycerin is a vasodilator that does what to vital signs

lower bp

Cholesterol levels

over 200

p wave seen or hidden in t waves

premature atrial contraction

what sound is heard in late diastole when atrial contraction pumps volume into a stiff, noncompliant ventricle

s4

Early ventricular depolarization is represented by which area of the ECG strip?

st segment

who gets a pacemaker

symptomatic bradycardia, junctional rhythm, heart blocks, idoventricular rhythm, tachybrady syndrome

patient who has hypomagnesaemia and hypokalemia reveals which abnormality

torsades de pointe

Furosemide is a loop diuretic that acts to increase

urine output.

patient has pacemaker

what does this show

pvc, hypokalemia

what is it and what can be causing it

st elevation

what is present

what characteristics does a bundle branch have

wide qrs

QRS complex measures

0.04 - 0.10

PR interval measures

0.12 - 0.20 second

A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: 1. acetaminophen or ibuprofen can be taken for this common side effect. 2. nitroglycerin should be avoided if the client is experiencing this serious side effect. 1. vital signs and oxygen saturation 3. taking the nitroglycerin with a few glasses of water will reduce the problem. 4. the client should lie in a supine position to alleviate the headache.

1

A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60 mm Hg. The nurse should first: 1. prepare for transcutaneous pacing. 2. prepare to defibrillate the client at 200 J. 3. administer an IV lidocaine infusion. 4. schedule the operating room for insertion of a permanent pacemaker.

1

A client is having preoperative tests for a pending cholecystectomy. The preoperative electrocardiogram (ECG) reveals sinus bradycardia, heart rate of 55 bpm, and a PR interval of 0.26 second as indicated on the ECG below: The rhythm confirms the finding of: 1. first degree heart block 2. mobitz type II heart block 3. wandering pacemaker 4. second degree av block

1

A nurse is caring for a client following a coro- nary artery bypass graft. Which assessment finding in the immediate postoperative period should be most concerning to the nurse? No chest tube output for 1 hour when previously it was copious Client temperature of 99.1°F (37.2°C) Arterial blood gas (ABG) results show pH 7.32; Pco2 48; HCO3 28; Po2 80 Urine output of 160 mL in the last 4 hours

1

When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because - reperfusion of the cardiac tissue can result in: 1. cardiac arrhythmias. 2. hypertension.3. seizure.4. hypothermia

1

Which symptom should the nurse teach the client with unstable angina to report immediately to the healthcare provider (HCP)? 1. a change in the pattern of the chest pain 2. pain during sexual activity3. pain during an argument4. pain during or after a physical activity

1

A nurse should anticipate instructing a client scheduled for a coronary artery bypass graft to: SELECT ALL THAT APPLY. discontinue taking aspirin prior to surgery. perform postoperative cardiac rehabilitation exercises and stress management strategies. wash with an antimicrobial soap the evening prior to surgery. shave the chest and legs and then shower to remove the hair. resume normal activities when discharged from the hospital. expect close monitoring after surgery, several intravenous (IV) lines, a urinary catheter, endotracheal tube, and chest tubes.

1 2 3 6

The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply. 1. The client should report unexpected bleeding or bleeding that lasts a long time. 2. The client should take clopidogrel with food.3. The client may bruise more easily and may experience bleeding gums. 4. Clopidogrel works by preventing platelets from sticking together and forming a clot.5. The client should drink a glass of water after taking clopidogrel.

1 3 4

The nurse should assess the client with left-sided heart failure for which findings? Select all that apply. 1. dyspnea2. jugular vein distention (JVD)3. crackles4. right upper quadrant pain5. oliguria6. decreased oxygen saturation levels

1 3 5 6

When teaching a client about self-care following placement of a new permanent pacemaker to the left upper chest, the nurse should include which information? Select all that apply. 1. Take and record daily pulse rate. 2. Avoid air travel because of airport security alarms. 3. Immobilize the affected arm for 4 to 6 weeks. 4. Avoid using a microwave oven .5. Avoid lifting anything heavier than 3 lb (1.36 kg).

1 5

A client with acute chest pain is receiving IV morphine sulfate. Which is an expected effect of morphine? Select all that apply. 1. reduces myocardial oxygen consumption 2. promotes reduction in respiratory rate 3. prevents ventricular remodeling4. reduces blood pressure and heart rate 5. reduces anxiety and fear

1 4 5

A client has potassium level of 2.4 mEq/L. The nurse understands that electrocardiogram (ECG) changes may occur which may include (select all that apply): 1. st depression 2. shallow flat inverted t wave 3. prominent u wave 4. absent u wave

1, 2, 3

A nurse is planning care for a client admitted with a new diagnosis of persistent atrial fibrillation with rapid ventricular response. Although the client has had no previous cardiac problems, the client has been in atrial fibrillation for more than 2 days. The nurse should anticipate that the health-care provider is likely to initially order: SELECT ALL THAT APPLY. 1oxygen. 2immediate cardioversion. 3administration of amiodarone (Cordarone®). 4initiation of a IV heparin infusion. 5mmediate catheter-directed ablation of the AV node. 6administration of a calcium channel antagonist such as diltiazem (Cardizem®).

1346

A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which prescription from the healthcare provider should the nurse verify before implementing? 1. Call for urine output < 30 mL/h for 2 consecutive hours. 2. Administer metoprolol 5 mg IV push.3. Prepare for a pulmonary artery catheter insertion.4. Titrate dobutamine to keep systolic BP > 100 mm Hg.

2

A client experiences cardiac arrest at home and is successfully resuscitated. Following placement of an implantable cardioverter-defibrillator (ICD), a nurse is evaluating the effectiveness of teaching for the client. Which statement, if made by the client, indicates that further teaching is needed? 1."The ICD will monitor my heart activity and provide a shock to my heart if my heart goes into ventricular fibrillation again." 2."When I feel the first shock I should tell my family to start cardiopulmonary resuscitation (CPR) and call 911." 3. "I am fearful of my first shock since my friend stated his shock felt like a blow to the chest." 4."I will need to ask my physician when I can resume driving because some states disallow driving until there is a 6-month discharge-free period."

2

A middle-aged client being admitted to the hospital has a history of hypertension and informs the nurse that his father died from a heart attack at age 60. The client reports having "indigestion." The nurse connects the client to a cardiac monitor, which reveals eight premature ventricular contractions (PVCs) per minute. The nurse should next: 1. call the healthcare provider (HCP). 2. start an IV line.3. obtain a portable chest radiograph. 4. draw blood for laboratory studies.

2

During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when palpation of the radial pulse reveals: 1. two regular beats followed by one irregular beat. 2. an irregular rhythm with pulse rate > 100. 3. pulse rate below 60 bpm. 4. a weak, thready pulse.

2

A nurse is teaching a client newly diagnosed with chronic stable angina. Which instructions should the nurse incorporate in the teaching session on measures to prevent future angina? SELECT ALL THAT APPLY. 1.Increase isometric arm exercises to build endurance. 2.Wear a face mask when outdoors in cold weather. 3.Take nitroglycerin before a stressful situation even though pain is not present. 4.Perform most exertional activities in the morning. 5.Avoid straining at stool. 6. Eliminate tobacco use.

2 3 5 6

A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this client's preoperative teaching plan? Select all that apply. 1. "If you have a hearing aid, you will need to remove it prior to leaving for the procedure." 2. "If you have chest pain during this procedure, please tell the staff when or if this should occur." 3. "The stitches at your right groin will be able to be removed in 7 to 10 days following the procedure." 4. "You will be given general anesthesia and will be asleep for throughout this procedure." 5. "You will need to remain flat during the procedure and for 3 to 6 hours after the procedure." 6. "You will need to keep your right leg in a flexed position for 1 to 2 hours following the procedure."

2 5

The nurse is developing a teaching plan for a client who will be starting a prescription for simvastatin 40 mg/day. What instructions should the nurse give the client? Select all that apply. 1. "Take once a day in the morning."2. "If you miss a dose, take it when you remember it."3. "Limit greens such as lettuce in the diet to prevent bleeding." 4. "Be sure to take the pill with food."5. "Report muscle pain or tenderness to your healthcare provider." 6. "Continue to follow a diet that is low in saturated fats."

2 5 6

. A client is scheduled for the insertion of an implantable cardioverter- defibrillator (ICD). The spouse expresses anxiety about what would happen if the device discharges during physical contact. What should the nurse tell the spouse? 1. Physical contact should be avoided whenever possible.2. They will not feel the countershock.3. The shock would feel like a "tingle," but it would not cause any harm. 4. A warning device sounds before countershock, so there is time to move

3

A client with angina is taking nifedipine. What instruction should the nurse give the client? 1. Monitor blood pressure monthly.2. Perform daily weights.3. Inspect gums daily.4. Limit intake of green leafy vegetables.

3

A nurse on the telemetry unit is caring for a client with a potassium of 5.6 mEq/L. The nurse anticipates changes in the ECG which would include the following finding: 1. prolonged qt interval 2. delayed sa note impulse activity 3. peaked t waves 4. inverted u wave

3

A nursing student understands that a patient with which arrhythmia will be the most likely to need an immediate pacemaker? 1. v fib 2. a fib 3. 3rd degree av block 4. 1st degree av block

3

In atrial fibrillation, the atrial rate is bpm

300 to 600

. A nurse, assessing a client hospitalized following a myocardial infarction (MI), obtains the following vital signs: blood pressure (BP) 78/38 mm Hg, heart rate (HR) 128, respiratory rate (RR) 32. For which life-threatening complication should the nurse care- fully monitor the client? 1. Pulonary embolism 2. Cardiac tamponade 3. Cardiomyopathy 4. Cardiogenic shock

4

A client is admitted to the hospital for evaluation of recurrent episodes of ventricular tachycardia as observed on Holter monitoring. The client is scheduled for electrophysiology studies (EPS) the following morning. Which statement should the nurse include in a teaching plan for this client? 1. "You will continue to take your medications until the morning of the test." 2. "You might be sedated during the procedure and will not remember what has happened." 3. "This test is a noninvasive method of determining the effectiveness of your medication regimen." 4. "During the procedure, the healthcare provider will insert a special wire to increase the heart rate and produce the irregular beats that caused your signs and symptoms."

4

A nurse collects the following assessment data on a client who has no known health problems: blood pressure (BP) 135/89 mm Hg; body mass index (BMI) 23; waist circumference 34 inches; serum creatinine 0.9 mg/dL; serum K 4.0 mEq/L; low-density lipopro- tein (LDL) cholesterol 200 mg/dL; high-density lipoprotein (HDL) cholesterol 25 mg/dL; and triglyc- erides 180 mg/dL. Which order from the client's health-care provider should the nurse anticipate? 1,500-calorie regular diet. No added salt, low saturated fat, low-potassium diet. Hydrochlorothiazide (HydroDIURIL®) 25 mg twice daily. Atorvastatin (Lipitor®) 20 mg daily.

4

Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: 1. control chest pain.2. reduce coronary artery vasospasm.3. control the arrhythmias associated with MI. 4. revascularize the blocked coronary artery.

4

A nurse notes that a client, who experienced a myo- cardial infarction (MI) 3 days ago, seems unusually fatigued. Upon assessment, the nurse finds that the client is dyspneic with activity, has a heart rate (HR) of 110 beats per minute (bpm), and has generalized edema. Which action by the nurse is most appropriate? Administer high-flow oxygen Encourage the client to rest more Continue to monitor the client's heart rhythm Compare the client's admission weight with the client's current weight & WHY?

4 A complication of MI is heart failure.

Which are indications that a client with a history of left-sided heart failure is developing pulmonary edema? Select all that apply. 1. distended jugular veins 2. dependent edema3. anorexia4. coarse crackles 5. tachycardia

4 5

if PVCs occur at a rate greater than per minute in the post-MI client, the HCP should be notified immediately.

5 or 6

More than __ PVCs in a minute is serious.

6

A MAP of less than ______ mm Hg indicates that there is inadequate per- fusion to organs.

60

A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse should wedge the catheter to gain information about: 1. cardiac output.2. right atrial blood flow.3. left end-diastolic pressure. 4. cardiac index.

A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse should wedge the catheter to gain information about: 1. cardiac output.2. right atrial blood flow.3. left end-diastolic pressure. 4. cardiac index.

A FIB TREATMENT

ABCDE

Points of Auscultation

Aortic, Pulmonic, Right Ventricular Area (Erbs), Epigastric (Tricuspid), Mitral (Bicuspid),

is used to manage hypercholesterolemia.

Atorvastatin

______ ________ block occurs when an impulse is blocked as it travels through the bundle branches.

Bundle branch