CARDIAC PT 1

The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty with femoral artery access. In which order, from first to last, should the nurse obtain information about the client? All options must be used. 1. vital signs and oxygen saturation 2. pedal pulses 3. color and sensation of extremity 4. catheterization site

1,2,4,3. When a client returns from having a transluminal balloon angioplasty with femoral access, the nurse should first obtain baseline vital signs and oxygen saturation to determine evidence of bleeding or decreased tissue perfusion. The nurse should next assess the pedal pulses to determine if the client has adequate peripheral tissue perfusion. Next the nurse should inspect the catheterization site and then determine color and sensation in the affected leg.

The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure? 1. An elevated B-type natriuretic peptide (BNP). 2. An elevated creatine kinase (CK-MB). 3. A positive D-dimer. 4. A positive ventilation/perfusion (V/Q) scan

1. BNP is a specific diagnostic test. Levels higher than normal indicate congestive heart failure, with the higher the number, the more severe the CHF.

A 68-year-old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The nurse should first: 1. inquire about the onset, duration, severity, and precipitating factors of the heaviness. 2. administer oxygen via nasal cannula. 3. offer pain medication for the chest heaviness. 4. inform the healthcare provider (HCP) of the chest heaviness.

1. Further assessment is needed in this situation. It is premature to initiate other actions until further data have been gathered. Inquiring about the onset, duration, location, severity, and precipitating factors of the chest heaviness will provide pertinent information to convey to the HCP

An older adult with a history of heart failure is admitted to the emergency department with pulmonary edema. On admission, what should the nurse assess first? 1. blood pressure 2. skin breakdown 3. serum potassium level 4. urine output

1. It is a priority to assess blood pressure first because people with pulmonary edema typically experience severe hypertension that requires early intervention. The client probably does not have skin breakdown, but when the client is stable and when the nurse obtains a complete health history, the nurse should inspect the client's skin for any signs of breakdown; however, when the client is stable, the nurse should inspect the skin. Potassium levels are not the first priority. The nurse should monitor urine output after the client is stable

A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports (see lab report). The nurse should report which elevated laboratory value to the healthcare provider (HCP) prior to the stress test? 1. cholesterol level 2. erythrocyte sedimentation rate 3. prothrombin time 4. troponin

4. The elevated troponin level should be reported to the HCP prior to the stress test as this change indicates myocardial damage. Sending the client to walk on a treadmill for stress testing would be contraindicated with evidence of recent myocardial injury and could further extend the damage. The other blood levels are helpful but not critical to this client's welfare at this point in time

The nurse notices that a client's heart rate decreases from 63 to 50 bpm on the monitor. The nurse should first: 1. administer atropine 0.5 mg IV push. 2. auscultate for abnormal heart sounds. 3. prepare for transcutaneous pacing. 4. take the client's blood pressure

4. The nurse should first assess the client's tolerance to the drop in heart rate by checking the blood pressure and level of consciousness and - determine if atropine is needed. If the client is symptomatic, atropine and transcutaneous pacing are interventions for symptomatic bradycardia. Once the client is stable, further physical assessments can be done

Which client is at greatest risk for coronary artery disease? 1. a 32-year-old female with mitral valve prolapse who quit smoking 10 years ago 2. a 43-year-old male with a family history of CAD and cholesterol level of 158 (8.8 mmol/L) 3. a 56-year-old male with an HDLof 60 (3.3 mmol/L) who takes atorvastatin 4. a 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L)

4. The woman who is 65 years old, is overweight, and has an elevated LDLis at greatest risk. Total cholesterol >200 (11.1 mmol/L), LDL >100 (5.5 mmol/L), HDL<40 (2.2 mmol/L) in men, HDL<50 (2.8 mmol/L) in women, men 45 years and older, women 55 years and older, smoking, and obesity increase the risk of CAD. Atorvastatin reduces LDLand decreases risk of CAD. The combination of postmenopausal, obesity, and high LDL places this client at greatest risk.

The client is scheduled to have a cardiac catheterization. Which findings will cause the nurse to question the safety of the test proceeding? Select all that apply. 1. Elevated C-reactive protein level 2. History of previous reaction to IV contrast 3. Prolonged PR interval on electrocardiogram 4. Serum creatinine of 2.5 mg/dL (221 µmol/L) 5. Took metformin today for type 2 diabetes

ANS : 2,4,5 Allergic reaction: Clients with a previous allergic reaction to IV contrast may require premedication (eg, corticosteroids, antihistamines) or another contrast medium (Option 2). However, clients with renal impairment (eg, serum creatinine >1.3 mg/dL [115 µmol/L]) should not receive IV contrast unless absolutely necessary (Option 4). Metformin is usually discontinued 24-48 hours before exposure and restarted after 48 hours, when stable renal function is confirmed (Option 5). (Option 1) C-reactive protein, produced during acute inflammation, may reflect an elevated risk for coronary artery disease. However, it does not indicate an acute event and is not a safety concern for this procedure. (Option 3) First-degree atrioventricular block (ie, PR interval >0.20 second) may precede more serious conditions. However, clients are usually asymptomatic and do not require treatment except for stopping the causative medication (eg, beta blockers, digoxin). This would not prevent the test from proceeding.

A cardiac catheterization was performed on a client 2 hours ago. The catheter was inserted into the left femoral artery. What signs of potential complications should the nurse report immediately to the health care provider (HCP)? Select all that apply. 1. Bleeding at the catheterization site 2. Client lying down and quietly watching television 3. Client taking only sips of fluids 4. Left foot remarkably cooler than right foot 5. Urine output of 100 mL since the procedure

ANS ; 1,4 Arterial bleeds can lead to hypovolemic shock and death if not treated immediately. Reduced warmth in the lower extremity of the insertion site is a sign of decreased perfusion (lack of oxygenated blood flow) to the extremity and can result in tissue necrosis of the affected area. (Option 2) The client may lie flat for several hours and is encouraged to engage in quiet activities for 24 hours after the procedure to prevent dislodging the clot at the insertion site. (Option 3) Although clients are encouraged to drink fluids to flush dyes out of their system and prevent dehydration, decreased fluid intake would not warrant notifying the HCP. (Option 5) Urine output in this client is above 30 mL/hr and considered to be within the normal range.

The nurse is providing care for a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? A) High HDL values and high triglyceride values B) Absence of detectable total cholesterol levels C) Elevated blood lipids, fasting glucose less than 100 D) Low LDL values and high HDL values

Ans: D Feedback: The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.

Acetylsalicylic acid (aspirin) is prescribed for a client diagnosed with coronary artery disease before a percutaneous transluminal coronary angioplasty (PTCA). The nurse administers the medication understanding that it is prescribed for what purpose? 1. Relieve postprocedure pain. 2. Prevent thrombus formation. 3. Prevent postprocedure hyperthermia. 4. Prevent inflammation of the puncture site.

Answer: 2 Rationale: Before PTCA, the client is usually given an anticoagulant, commonly aspirin, to help reduce the risk of occlusion of the artery during the procedure because the aspirin inhibits platelet aggregation. Options 1, 3, and 4 are unrelated to the purpose of administering aspirin to this client

The nurse teaches a client at risk for coronary artery disease about lifestyle changes needed to reduce his risks. The nurse determines that the client understands these necessary lifestyle changes if the client makes which statements? Select all that apply. 1. "I will attempt to stop smoking." 2. "I will be sure to include some exercise such as walking in my daily activities." 3. "I will work at losing some weight so that my weight is at normal range for my age." 4. "I will limit my sodium intake every day and avoid eating high-sodium foods such as hot dogs." 5. "It is acceptable to eat red meat and cheese every day as I have been doing, as long as I cut down on the butter." 6. "I will schedule regular doctor appointments for physical examinations and monitoring my blood pressure."

Answer: 2, 3, 4, 6 Rationale: Coronary artery disease affects the arteries that provide blood, oxygen, and nutrients to the myocardium. Modifiable risk factors include elevated serum cholesterol levels, cigarette smoking, hypertension, impaired glucose tolerance, obesity, physical inactivity, and stress. The client is instructed to stop smoking (not cut down), and the nurse should provide the client with resources to do so. The client is also instructed to maintain a normal weight and include physical activity in the daily schedule. The client needs to limit sodium intake and foods high in cholesterol, including red meat and cheese. The client must follow up with regular primary health care provider appointments for physical examinations and monitoring blood pressure

A cardiac catheterization, using the femoral artery approach, is performed to assess the degree of coronary artery thrombosis in a client. Which priority safety actions should the nurse implement in the postprocedure period? Select all that apply. 1. Restricting visitors 2. Checking the client's groin for bleeding 3. Encouraging the client to increase fluid intake 4. Placing the client's bed in the high-Fowler's position 5. Instructing the client to move the toes when checking circulation, motion, and sensation

Answer: 2, 3, 5 Rationale: Immediately after a cardiac catheterization with the femoral artery approach, the client should not flex or hyperextend the affected leg to avoid blood vessel occlusion or hemorrhage. The groin is checked for bleeding, and if any occurs, the nurse immediately places pressure on the site and asks another staff member to contact the primary health care provider. Fluids are encouraged to assist in removing the contrast medium from the body. Asking the client to move the toes is done to assess motion, which could be impaired if a hematoma or thrombus was developing. There is no need to restrict visitors. Placing the client in the high-Fowler's position (flexion) increases the risk of occlusion or hemorrhage.

The nurse is reviewing the assessment data of a client. Which finding is most important for the client to modify to lessen the risk for coronary artery disease (CAD)? 1. Elevated triglyceride levels 2. Elevated serum lipase levels 3. Elevated serum testosterone level 4. Elevated low-density lipoprotein (LDL) levels

Answer: 4 Rationale: LDLs are more directly associated with CAD than are other lipoproteins. LDL levels, along with levels of cholesterol, have a higher predictive association with CAD than levels of triglycerides. Lipase is a digestive enzyme that breaks down ingested fats in the gastrointestinal tract. Low rather than high levels of testosterone have a significant negative influence on CAD.

The intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement? 1. Notify the health-care provider immediately. 2. Elevate the head of the client's bed. 3. Document this as a normal and expected finding. 4. Administer morphine intravenously.

1. An S3 indicates left ventricular failure and should be reported to the health-care provider. It is a potential life-threatening complication of a myocardial infarction.

When assessing an older adult, the nurse finds the apical impulse below the fifth intercostal space. The nurse should further assess the client for: 1. left atrial enlargement. 2. left ventricular enlargement. 3. right atrial enlargement. 4. right ventricular enlargement.

2. A normal apical impulse is found over the apex of the heart and is typically located and auscultated in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement.

The nurse is caring for a patient recovering from a coronary angioplasty with stent placement. Which intervention is a priority for the patient at this time? 1. Securing chest tubes to bedding 2. Maintaining leg extension on the affected side 3. Discontinuing intravenous lines when taking oral fluids 4. Treating chest pain with intravenous morphine as needed

2. The cardiac catheter used to insert the stent is usually inserted via the femoral artery, a large, high-pressure vessel. The leg is maintained in extension for a prescribed period after the procedure to reduce the risk of bleeding, hematoma formation, or clot formation at the insertion site.

Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? 1. Monitor the laboratory values. 2. Observe neurologic function every 15 minutes. 3. Observe the puncture site for swelling and bleeding. 4. Monitor skin warmth and turgor.

3. Assessment of circulatory status, including observation of the puncture site, is of primary importance after a cardiac catheterization. Laboratory values and skin warmth and turgor are important to monitor but are not the most important initial nursing assessment. Neurologic assessment every 15 minutes is not required

The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse? 1. The client's BP is 110/70 and pulse is 90. 2. The client's groin dressing is dry and intact. 3. The client refuses to keep the leg straight. 4. The client denies any numbness and tingling.

3. If the client bends the leg, it could cause the insertion site to bleed. This is arterial blood and the client could bleed to death very quickly, so this requires immediate intervention.

The nurse has just completed discharge teaching for a client recently diagnosed with hypertension. Which of the following statements by the client indicate understanding of the Dietary Approaches to Stop Hypertension (DASH) diet? Select all that apply. 1. "I need to eat less red meat and more fresh vegetables." 2. "I'll limit drinking soda to only one at a time as an occasional treat." 3. "I'm going to replace potato chips with fruit during meals and snacking." 4. "I'm really going to miss drinking as much milk as I normally do." 5. "Taking the salt shaker off the table should be enough to reduce my sodium intake."

ANS : 1,2,3 Choosing meats lower in cholesterol (eg, fish, poultry) and alternate protein sources (eg, legumes) instead of red meats (Option 1) Limiting intake of sweets, foods high in sodium (eg, potato chips, frozen meals, canned foods), and sugary beverages to the occasional treat (Options 2 and 3) (Option 4) Limiting milk intake is unnecessary; however, the nurse may need to educate the client about choosing low-fat or skim milk over whole milk. (Option 5) Taking the salt shaker off the table may be a good first step in reducing sodium intake. However, it will not be enough as salt is found in many foods.

The nurse reviews laboratory data for a client admitted to the emergency department with chest pain. Which serum value requires the most immediate action by the nurse? 1. Glucose 200 mg/dL (11.1 mmol/L) 2. Hematocrit 38% (0.38) 3. Potassium 3.4 mEq/L (3.4 mmol/L) 4. Troponin 0.7 ng/mL (0.7 mcg/L)

ANS : 4 Troponin is a highly specific cardiac marker for the detection of MI. It has greater sensitivity and specificity for myocardial injury than creatine kinase (CK) MB

A client returns from a left heart catheterization. The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client? 1. anterior to the right tibia 2. dorsal surface of the right foot 3. posterior to the right knee 4. right mid inguinal area

2. To best monitor that the client's circulation remains intact, the dorsal surface of the right foot should be palpated. When the left side of the heart is catheterized, the cannula enters via an artery. In this instance, the right femoral artery was accessed. While all options assess arterial points of the right leg, the dorsal surface of the right foot (the pedal pulse) is the most distal. If this pulse point is present and unchanged from before the procedure, the other pulse points should also be intact

A client arrives in the emergency department complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse determines that this result indicates which finding? 1. A normal level 2. A low value that indicates possible gastritis 3. A level that indicates a myocardial infarction 4. A level that indicates the presence of possible angina

3 Rationale: Troponin is a regulatory protein found in striated muscle. The troponins function together in the contractile apparatus for striated muscle in skeletal muscle and in the myocardium. Increased amounts of troponins are released into the bloodstream when an infarction causes damage to the myocardium. A troponin T value that is higher than 0.1 to 0.2 ng/mL is consistent with a myocardial infarction. A normal troponin I level is lower than 0.6 ng/mL

The client who experiences angina has been told to follow a low cholesterol diet. Which meal would be best? 1. hamburger, salad, and milk shake 2. baked liver, green beans, and coffee 3. spaghetti with tomato sauce, salad, and coffee 4. fried chicken, green beans, and skim milk

3. Pasta, tomato sauce, salad, and coffee would be the best selection for the client following a low-cholesterol diet. Hamburgers, milk shakes, liver, and fried foods tend to be high in cholesterol.

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)? 1. Creatine kinase (CK-MB). 2. Lactate dehydrogenase (LDH). 3. Troponin. 4. White blood cells (WBCs).

3. Troponin is the enzyme that elevates within 1 to 2 hours.

A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as: 1. heart rate irregular with S3 . 2. heart rate irregular with S4 . 3. heart rate irregular with aortic regurgitation. 4. heart rate irregular with mitral stenosis.

1. An S3 heart sound occurs early in diastole as the mitral and tricuspid valves open and blood rushes into the ventricles. To distinguish an S3 from a physiologic S2 split, a split S2 occurs during inspiration and S3 remains constant during the respiratory cycle. Its pitch is softer and best heard with the bell at the apex, and it is one of the first clinical findings in left ventricular failure. An S4 is heard in late diastole when atrial contraction pumps volume into a stiff, noncompliant ventricle. An S4 is not heard in a client with atrial fibrillation because there is no atrial contraction. Murmurs are sounds created by turbulent blood flow through an incompetent or stenotic valve.

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. The nurse should first: 1. assess for changes in vital signs. 2. draw an arterial blood gas. 3. evaluate heart sounds with the client leaning forward. 4. obtain a 12-lead electrocardiogram.

1. The nurse should first obtain vital signs as changes in the vital signs will reflect the severity of the sudden drop in cardiac output: decrease in blood pressure, increase in heart rate, and increase in respirations. Infarction of the papillary muscles is a potential complication of an MI causing ineffective closure of the mitral valve during systole. Mitral regurgitation results when the left ventricle contracts and blood flows backward into the left atrium, which is heard at the fifth intercostal space, left midclavicular line. The murmur worsens during expiration and in the supine or left-side position and can best be heard when the client is in these positions, not with the client leaning forward. A 12-lead ECG views the electrical activity of the heart; an echocardiogram views valve function.

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority? 1. BP 110/62 mm Hg, atrial fibrillation with HR 82, bilateral basilar crackles 2. confusion, urine output 15 mL over the last 2 hours, orthopnea 3. SpO2 92 on 2 L nasal cannula, respirations 20, 1+ edema of lower extremities 4. weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise

2. A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of left-sided heart failure. Crackles, edema, and weight gain should be monitored closely, but the levels are not as high a priority. With atrial fibrillation, there is a loss of atrial kick, but the blood pressure and heart rate are stable.

Which food should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? 1. apples 2. canned tomato juice 3. whole wheat bread 4. beef tenderloin

2. Canned foods and juices such as tomato juice are typically high in sodium and should be avoided in a sodium-restricted diet. Canned foods and juices in which sodium has been removed or limited are available. The client should be taught to read labels carefully. Apples and whole wheat breads are not high in sodium. Beef tenderloin would have less sodium than canned foods or tomato juice.

A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip? 1. Serum potassium is 3.5 mEq/L(3.5 mmol/L). 2. Blood pressure is 88/46 mm Hg. 3. ST elevation is present on the electrocardiogram. 4. Heart rate is 61 bpm

2. Nitroglycerin is a vasodilator that will lower blood pressure. The client is having chest pain, and the ST elevation indicates injury to the myocardium, which may benefit from nitroglycerin. The potassium and heart rate are within normal range

.Which is the most appropriate diet for a client during the acute phase of myocardial infarction? 1. liquids as desired 2. small, easily digested meals 3. three regular meals per day 4. nothing by mouth

2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better tolerated. Fluids are given according to the client's needs, and sodium restrictions may be prescribed, especially for clients with manifestations of heart failure. Cholesterol restrictions may be prescribed as well. Clients are not prescribed diets of liquids only or restricted to nothing by mouth unless their condition is very unstable.

The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure? 1. Perform passive range-of-motion exercises. 2. Assess the client's neurovascular status. 3. Keep the client in high Fowler's position. 4. Assess the gag reflex prior to feeding the client.

2. The nurse must make sure that blood is circulating to the right leg, so the client should be assessed for pulses, paresthesia, paralysis, coldness, and pallor.

The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse? 1. The client is keeping the affected extremity straight. 2. The pressure dressing to the right femoral area is intact. 3. The client is complaining of numbness in the right foot. 4. The client's right pedal pulse is 3+ and bounding.

3. Any neurovascular assessment data that are abnormal require intervention by the nurse; numbness may indicate decreased blood supply to the right foot.

A client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. The nurse can coach this client to improve health by: 1. explaining how the risk factors lead to poor health. 2. withholding praise until the client changes the risky behavior. 3. helping the client establish a wellness vision to reduce the health risks. 4. instilling mild fear into the client about the potential outcomes of the risky health behaviors.

3. In health coaching, unlike traditional client education techniques in which the nurse provides information, the goal of coaching is to encourage the client to explore the reasons for the behavior and establish a vision for health behavior and the way he or she can make changes to improve their health behavior and reduce or eliminate health risks. When coaching a client, the nurse does not provide information, withhold praise, or instill fear.

The nurse is caring for a client who, 30 minutes ago, underwent an ablation procedure for supraventricular tachycardia in the cardiac catheterization laboratory. The client has a dressing over the femoral insertion site with a small amount of oozing blood. Which action by the nurse causes the charge nurse to intervene? 1. Applies pressure above the femoral insertion site 2. Assesses bilateral pedal pulses frequently 3. Assists client to sit on the side of the bed to use the urinal 4. Reports client chest pain of 2 on a scale of 0-10 to health care provider

ANS : 3 After cardiac catheterization, clients must remain supine with the head of the bed at ≤30 degrees and the affected extremity straight to prevent bleeding from the catheter insertion site. The charge nurse should intervene if the nurse is assisting the client to sit on the side of the bed to use the urinal (Option 3). (Option 1) A small amount of bleeding can be expected after the catheter is removed. It is appropriate to apply pressure above the insertion site to control bleeding. The nurse should continue to closely monitor the site for further bleeding. (Option 2) It is important to verify adequate perfusion to the affected limb by frequently palpating the pedal pulses. Bilateral pulses should be palpated for comparison. (Option 4) Chest pain after ablation may be due to cardiac muscle damage but could also be caused by cardiac ischemia. This should be reported immediately to the health care provider.