Cardio PrepU 2

The dobutamine may need to be decreased.

A client in the intensive care unit (ICU) is on a dobutamine drip. During an assessment the client states, "I was feeling better but now my chest is tight and I feel like my heart is skipping." Physical assessment reveals a heart rate of 110 beats per minute and blood pressure of 160/98 mm Hg. What is the nurse's immediate concern for this client?

leaning forward while sitting

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?

stabilizing heart rate and blood pressure and easing anxiety

A physician admits a client to the healthcare facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind when formulating interventions?

diabetic neuropathy

Following cardiac bypass surgery, the client has been referred to a cardiac rehabilitation exercise program. The client has type 1 diabetes and has bilateral leg discomfort with walking. The client is exercising using a stationary bicycle. The nurse should evaluate the client's response to exercise by assessing the presence of which condition?

"I should report any skin irritation to the healthcare provider."

The nurse instructs a client on the use of transdermal nitroglycerin 0.2 mg/hour patch for angina pectoris. Which client statement indicates that teaching was effective?

mild to moderate insufficiency

The nurse is assessing the ankle-brachial index (ABI) for a client with peripheral vascular disease. The highest systolic pressure for each ankle is 80 mm Hg and the highest brachial pressure is 160 mm Hg. What does this client's ABI indicate?

Reorient frequently to time, place and situation. Arrange for familiar pictures or special items at bedside. Spend time with the client, establishing a trusting relationship

The nurse is caring for an older adult with mild dementia admitted with heart failure. What nursing care will be helpful for this client in reducing potential confusion related to hospitalization and change in routine? Select all that apply.

Tell the client that the cholesterol levels are within normal limits.

The nurse is preparing a teaching plan for a client who is being discharged after being admitted for chest pain. The client has had one previous myocardial infarction 2 years ago and has been taking simvastatin 40 mg for the last 2 years. After reviewing the lab results for the client's cholesterol levels (see chart), what should the nurse do?

the percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity

The nurse's unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught?

Assess the client's blood pressure.

The nurse observes a sudden dampening of the arterial waveform. What is the priority action by the nurse?

cerebrovascular accident

A client has atrial fibrillation. The nurse should monitor the client for which condition?

increase cardiac output.

A nurse knows that the major clinical use of dobutamine is to

the client with heart failure who is having some difficulty breathing

After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first?

myocardial necrosis.

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:

irregular rhythm with pulse rate greater than 100 bpm

During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when the nurse palpates the radial pulse and notices which signs?

increased pulmonary artery diastolic pressure

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?

taking daily walks

On a routine visit to the health care provider, a client with chronic arterial occlusive disease reports quitting smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend?

Renal insufficiency and failure.

The client has had hypertension for 20 years. The nurse should assess the client for?

abdominal aorta, just below the renal arteries.

The most common site of aneurysm formation is in the

"I will eat more liver with onions."

The nurse has been instructing the client about how to prepare meals that are low in fat. Which of these comments would indicate the client needs additional teaching?

OBTAIN MORE SLEEP

The nurse teaches a client with heart failure to take oral furosemide in the morning. What is the expected outcome for taking this drug in the morning? The client will:

anxiety related to altered body image

Three days after mitral valve replacement surgery, the client tells the nurse there is a "clicking" noise coming from the chest incision. The nurse's response should reflect the understanding that the client may be experiencing?

intra-aortic balloon pump

What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock?

early defibrillation in cases of ventricular fibrillation

A visitor to the hospital has a cardiac arrest. When determining to use an automated external defibrillator (AED), the nurse should consider that AEDs are used in cardiac arrest in which circumstances?

fatigue and shortness of breath

A young adult has been diagnosed with hypertrophic cardiomyopathy. The nurse should further assess the client for which complication?

a 29-year-old male with a 14-year history of cigarette smoking.

Which client is at greatest risk for Buerger's disease?

systolic blood pressure less than 90 mm Hg

Which indicates hypovolemic shock in a client who has had a 15% blood loss?

enhance myocardial oxygenation

Which should be the nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease?

a change in the pattern of the chest pain

Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider (HCP)?

Assess for a pulse deficit.

While auscultating the apical heart rate, the nurse notes an irregular heart rhythm at a rate of 120 beats/min. What is the nurse's next action?

Maintain the current rate of the heparin infusion.

The nurse reviews the morning laboratory results from a client admitted with a deep vein thrombosis. The client is receiving intravenous heparin. Based on the client's current laboratory values, what should the nurse do?

Administer oxygen via nasal cannula as prescribed.

A client is hospitalized following a report of dizziness, shortness of breath, and chest pain. Based on the ECG rhythm, the client is scheduled for a transesophageal echocardiogram (TEE) today. Which nursing intervention would be appropriate at this time?

peripheral edema.

A client is receiving captopril for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals

Withhold the digoxin.

A client is receiving digoxin, and the pulse range is normally 70 to 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should do what first?

pericardial friction rub

A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound?

Notify the health care provider.

A client prescribed enalapril reports symptoms of a persistent dry cough. What is the nurse's best action?

when other treatment alternatives have not been effective.

A client with Raynaud's phenomenon is considering having a sympathectomy. What information should the nurse give the client about this surgery? A sympathectomy is performed:

rheumatic fever

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

"Avoid sunburn during the summer." "Wear extra socks in the winter." "Choose loose, soft, cotton socks."

The nurse should give which discharge instructions about thermal injury to a client with peripheral vascular disease? Select all that apply.

Provide oxygen. Administer nitroglycerin. Administer aspirin. Administer morphine.

A client is admitted to the emergency department with sudden onset of chest pain. Which prescriptions should the nurse implement immediately? Select all that apply.

Increase the oxygen flow rate from 2 to 4 L/min.

A client is admitted to the hospital with a diagnosis of suspected pulmonary embolism. Prescriptions include oxygen 2 to 4 L/min per nasal cannula, oximetry at all times, and IV administration of 5% dextrose in water at 100 mL/h. The client has increasing dyspnea and has a respiratory rate of 32 breaths/minute. The oxygen flow rate is set at 2 L/min. What should the nurse do first?

sedimentation rate (ESR) 49 mm/hr

A client is admitted with chest pain, fever, and joint pain 4 weeks after experiencing an acute inferior wall myocardial infarction. Which laboratory value should the nurse address?

electrocardiogram (ECG) electrodes

The rapid response team arrives in the room of a client who has had a cardiac arrest. The nurse should first apply which piece of monitoring equipment?

a client 4 days postoperative after mitral valve replacement

A nurse is caring for 4 clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis?

B-type natriuretic peptide (BNP)

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal?

Use a printed checklist with information individualized for the client.

The nurse in the intensive care unit is giving a report to the nurse in a cardiac step-down unit about a client who had coronary artery bypass surgery. Which of the following is the most effective way to assure essential information about the client is reported?

"I will be relieved to have this surgery over with; I have a very busy schedule at work right now." "I had stopped smoking a month before the surgery; however, I will be able to start again once I have recovered."

The nurse is caring for a client admitted for a quadruple coronary artery bypass graft. Which statements by the client indicate that preoperative teaching has not been effective? Select all that apply.

a change in the intensity of the pulse from the baseline

The nurse is caring for a client with peripheral artery disease (PAD) who has just returned from having a percutaneous transluminal balloon angioplasty. Which finding requires immediate attention from the nurse?

restart the metoprolol.

A client with a history of hypertension and peripheral vascular disease underwent an aortobifemoral bypass graft. Preoperative medications included pentoxifylline, metoprolol, and furosemide. On postoperative day 1, the 1200 vital signs are: temperature 98.9° F (37.2° C); heart rate 132 bpm; respiratory rate 20 breaths/min; blood pressure 126/78 mm hg. Urine output is 50 to 70 mL/h. The hemoglobin and the hematocrit are stable. The medications have not been prescribed for administration after surgery. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse contacts the health care provider (HCP) and recommends to:

"Client will verbalize the intention to stop smoking."

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include?

keep the affected leg level or slightly dependent

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should

Contact the health care provider.

The nurse is evaluating a hemodynamically unstable client with an arterial line and notes that the client has tachycardia, cool and clammy skin, a pericardial friction rub, and the arterial waveform shows an inspiratory systolic pressure that is 15 mm Hg less than the expiratory systolic pressure. What is the priority intervention by the nurse?

The client will have a regular heart rhythm from destruction of errant tissue of the heart.

The nurse is evaluating the therapeutic goal of a client with history of cardiac dysrhythmias and newly completed radiofrequency catheter ablation. Which client-centered goal is most appropriate?

e-cigarette use hypertension stress

The nurse is planning the care for a client with risk factors for atherosclerosis. What should the nurse include in the teaching plan for this client as modifiable risk factors? Select all that apply.

Obtain more sleep.

The nurse teaches a client with heart failure to take oral furosemide in the morning. What is the expected outcome for taking this drug in the morning? The client will:

AORTA

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 located in the carotid sinus. Which other area should the nurse mention as a site of arterial baroreceptors?