Cardiovascular Compilation

2. TRUE or FALSE: Ventricular fibrillation (V-fib) is a lethal rhythm that results in the quivering of the ventricles which leads to a rapid fall in cardiac output.

True

6. True or False: If a patient has been in atrial fibrillation for more than 48 hours, anticoagulation is needed prior to a cardioversion due to blood clot risks. True False

True

The client comes to the emergency department complaining of pain in the left lower leg following a puncture wound from a nail in a board. The left lower leg is reddened with streaks, edematous, and hot to the touch, and the client has a temperature of 100.8o F. Which condition would the nurse suspect the client is experiencing? 1. Cellulitis. 2. Lyme disease. 3. Impetigo. 4. Deep vein thrombosis.

+++++++1. Cellulitis is a bacterial infection of the subcutaneous tissue usually associated with a break in the skin,and the nurse would suspect this with these signs/ symptoms. 2. Lyme disease is caused by the bite of a tick, resulting in a bull's eye-appearing lesion. 3. Impetigo is characterized by large, fluid-filled blisters and is very contagious. 4. Deep vein thrombosis signs/symptoms are a reddened, warm calf and pain on ambulation, but thiscondition is not caused by a nail puncture; it is caused by immobility.

What medications should the nurse expect to include in the teaching plan to decrease the risk of cardiovascular events and death for PAD patients (select all that apply)? 1.Ramipril (Altace) 2. Cilostazol (Pletal) 3.Simvastatin (Zocor) 4.Clopidogrel (Plavix) 5.Warfarin (Coumadin) 6.Aspirin (acetylsalicylic acid)

+++++++1.Ramipril (Altace) 2. Cilostazol (Pletal) +++++++++3.Simvastatin (Zocor) +++++++++4.Clopidogrel (Plavix) 5.Warfarin (Coumadin) 6.Aspirin (acetylsalicylic acid) Angiotensin-converting enzyme inhibitors (e.g., ramipril [Altace]) are used to control hypertension. Statins (e.g., simvastatin [Zocor]) are used for lipid management. Aspirin is used as an antiplatelet agent. Cilostazol (Pletal) is used for intermittent claudication, but it does not reduce CVD morbidity and mortality risks. Clopidogrel may be used if the patient cannot tolerate aspirin. Anticoagulants (e.g., warfarin [Coumadin]) are not recommended to prevent CVD events in PAD patients.

The client with varicose veins asks the nurse, "What caused me to have these?" Which statement by the nurse would be most appropriate? 1. "You have incompetent valves in your legs." 2. "Your legs have decreased oxygen to the muscle." 3. "There is an obstruction in the saphenous vein." 4. "Your blood is thick and can't circulate properly."

+++++1 Varicose veins are irregular, tortuous veins with incompetent valves that do notallow the venous blood to ascend the saphenous vein. 2. Decreased oxygen to the muscle occurs with arterial occlusive disease. 3. This is the explanation for a deep vein thrombosis. 4. Thick, poorly circulating blood could be an explanation for diabetic neuropathy.

The client is receiving prophylactic low molecular weight heparin. There are no PT/PTT or INR results on the client's chart since admission three (3) days ago. Which action should the nurse implement? 1. Administer the medication as ordered. 2. Notify the health-care provider immediately. 3. Obtain the PT/PTT and INR prior to administering the medication. 4. Hold the medication until the HCP makes rounds

++++1. Subcutaneous heparin will not achieve a therapeutic level becauseof the short half-life of the medication; therefore, the nurse shouldadminister the medication. 2. There is no need to notify the HCP. 3. There is no need to monitor these laboratory tests. 4. There is no need to notify the HCP.

Which assessment data would support that the client has a venous stasis ulcer? 1. A superficial pink open area on the medial part of the ankle. 2. A deep pale open area over the top side of the foot. 3. A reddened blistered area on the heel of the foot. 4. A necrotic gangrenous area on the dorsal side of the foot

++++1. The medial part of the ankle usually ulcerates because of edema that leads to stasis, which, in turn, causes the skin to break down. 2. A deep, pale, open area over the top side of the foot describes an arterial ulcer. 3. A reddened blistered area on the heel describes a blister that may result from wearing shoes that are too tight or that rub on the heel. 4. Gangrene does not usually occur with venous problems; it occurs with arterial ulcers.

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Which instruction should the nurse discuss with the client diagnosed with Raynaud's phenomenon? 1. Explain exacerbations will not occur in the summer. 2. Use nicotine gum to help quit smoking. 3. Wear extra-warm clothing during cold exposure. 4. Avoid prolonged exposure to direct sunlight

1 During the summer, a sweater should be available when entering an air-conditioned room. 2. Nicotine of any type causes vasoconstriction and may induce attacks. +++++++++++3. Raynaud's phenomenon is a form of intermittent arteriolar vasoconstriction that results in coldness, pain, and pallor of fingertips or toes; therefore, the client should keep warm to prevent vasoconstriction of the extremities. 4. Sunlight does not cause an exacerbation of this disease.

Which discharge instruction should the nurse discuss with the client to prevent recurrent episodes of cellulitis? 1. Soak your feet daily in Epsom salts for 20 minutes. 2. Wear thick white socks when working in the yard. 3. Use a mosquito repellent when going outside. 4. Inspect the feet between the toes for cracks in the skin

1 Soaking the feet will not help prevent cellulitis; salt would be drying to the tissue, causing cracks that may lead to cellulitis. 2. Thick white socks do not prevent cellulitis. 3. Mosquito repellent would help to prevent encephalitis but not cellulitis. +++++++4. The key to preventing cellulitis is identifying the sites of bacterial entry. The most commonly overlooked areas are the cracks and fissures that occur between the toes.

Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease? 1. The client has 2+ pedal pulses. 2. The client is able to move the toes. 3. The client has numbness and tingling. 4. The client's feet are red when standing

1 These are normal pedal pulses and would not require any intervention. 2. Moving the toes is a good sign in a client with arterial occlusive disease. *******3. Numbness and tingling are paresthesia, which is a sign of a severely decreasedblood supply to the lower extremities. 4. Reddened extremities are expected secondary to increased blood supply when thelegs are in the dependent position.

The client diagnosed with diabetes mellitus type 2 is admitted to the hospital with cellulitis of the right foot secondary to an insect bite. Which intervention should the nurse implement first? 1. Administer intravenous antibiotics. 2. Apply warm moist packs every two (2) hours. 3. Elevate the right foot on two (2) pillows. 4. Teach the client about skin and foot care.

1 This would be an appropriate intervention but not before elevating the foot. 2. Warm, moist packs cause necessary dilation, but it is not the first intervention. ++++++3. Elevating the foot above the heart will decrease edema and thereby help decrease thepain. It is the easiest and first intervention for the nurse to implement. 4. Educating the client is important, but it is not the first intervention. The client will behospitalized for seven (7) to 14 days.

14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

14. C

1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

1. A, C, E

Which medication should the nurse expect the health-care provider to order for a client diagnosed with arterial occlusive disease? 1. An anticoagulant medication. 2. An antihypertensive medication. 3. An antiplatelet medication. 4. A muscle relaxant

1. An anticoagulant medication is prescribed for venous problems, such as deep vein thrombosis. 2. Arterial occlusive disease is caused by atherosclerosis, which may cause hypertension as well but antihypertensive medications are not prescribed for arterial occlusive disease. ++++3. Antiplatelet medications, such as aspirin or clopidogrel (Plavix), inhibit platelet aggregations in the arterial blood. 4. A muscle relaxant will not help the leg pain because the origin of the pain is decreased oxygen to the muscle.

The nurse is teaching the client with peripheral vascular disease. Which interventions should the nurse discuss with the client? Select all that apply. 1. Wash your feet in antimicrobial soap. 2. Wear comfortable, well-fitting shoes 3. Cut your toenails in an arch. 4. Keep the area between the toes dry. 5. Use a heating pad when feet are cold.

1. Antimicrobial soap is harsh and can dry the skin; the client should use mildsoap and room-temperature water. +++++2. Shoes must be comfortable to prevent blisters or ulcerations of the feet. 3. The toenails should be cut straight across; cutting in an arch increases therisk for ingrown toenails. +++++4. Moisture between the toes increases fungal growth, leading to skinbreakdown. 5. The client with PVD has decreased sensation in the feet and should not usea heating pad.

You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them? A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.

1. B

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? 1. Encourage the client to use a heating pad on the lower extremities. 2. Demonstrate to the client the correct way to apply elastic support hose. 3. Instruct the client to walk daily for at least 30 minutes. 4. Tell the client to check both feet for red areas at least once a week.

1. External heating devices are avoided to reduce the risk of burns. 2. Elastic support hose reduce the circulation to the skin and are avoided. +++++++++3. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. 4. The feet must be checked daily, not weekly.

1. True or False: Endocarditis only affects the atrioventricular and semi-lunar valves in the heart.

1. False

The client with peripheral venous disease is scheduled to go to the whirlpool for a dressing change. Which is the nurse's priority intervention? 1. Escort the client to the physical therapy department. 2. Medicate the client 30 minutes before going to the whirlpool. 3. Obtain the sterile dressing supplies for the client 4. Assist the client to the bathroom prior to the treatment.

1. The physical therapy department comes and gets the client; if not, theUAP should escort the client to physical therapy. ++++++++2. The client's pain is priority, and the nurse should premedicate prior totreatment. 3. The physical therapy department will have the supplies for dressing thewound. 4. This could be done, but it is not a priority for the nurse.

The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement? 1. Keep the right leg in the dependent position. 2. Apply sequential compression devices to lower extremities 3. Monitor the client's pedal pulses every shift 4. Assess the client's leg dressing every four (4) hours.

1. The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent deep vein thrombosis, but it should not be on the leg with an operative incision site. 3. The client is one (1) day postoperative, and the pedal pulses must be assessed more than once every eight (8) or 12 hours. ++++++4. The leg dressing needs to be assessed for hemorrhaging or signs of infection

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply: 1. Thick, tough 2. Thin, scaly 3. Hairless 4. Brown pigmented

1. Thick, tough 4. Brown pigmented This is commonly found in severe peripheralvenous disease. Options B and C are found inperipheral ARTERIAL disease.

15. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication? A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate

15. D

The nurse is caring for clients on a medical floor. Which client will the nurse assess first? 1. The client with an abdominal aortic aneurysm who is constipated. 2. The client on bedrest who ambulated to the bathroom. 3. The client with essential hypertension who has epistaxis and a headache 4. The client with arterial occlusive disease who has a decreased pedal pulse.

1. This is not a priority unless the client is actively having a bowelmovement and is performing the Valsalva maneuver. 2. This client needs to be addressed and orders need to beclarified, but this is not a priority. *****3. A bloody nose and a headache indicate the client isexperiencing very high blood pressure and should be assessedfirst because of a possible myocardial infarction or stroke. 4. A decreased pedal pulse is expected in this client.

The nurse is teaching a class on venous insufficiency. The nurse would identify which condition as the most serious complication of chronic venous insufficiency? 1. Arterial thrombosis. 2. Deep vein thrombosis. 3. Venous ulcerations. 4. Varicose veins.

1. Venous insufficiency is a venous problem, not an arterial problem. 2. Deep vein thrombosis is not a complication of chronic venous insufficiency, but it may be a cause. +++++3. Venous ulcerations are the most serious complication of chronic venous insufficiency. It is very difficult for these ulcerations to heal, and often clients must be seen in wound care clinics for treatment. 4. Varicose veins may lead to chronic venous insufficiency, but they are not a complication.

The nurse has just received the a.m. shift report. Which client would the nurse assess first? 1. The client with a venous stasis ulcer who is complaining of pain. 2. The client with varicose veins who has dull, aching muscle cramps. 3. The client with arterial occlusive disease who cannot move the foot. 4. The client with deep vein thrombosis who has a positive Homans' sign.

1.The client with a venous stasis ulcer should have pain, so this would be expected. 2. Dull, aching muscle cramps are expected with varicose veins. ++++++3. The inability to move the foot means that a severe neurovascular compromise hasoccurred, and the nurse should assess this client first. 4. A positive Homans' sign is expected in a client diagnosed with deep vein thrombosis.

10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time

10. A, D, E, G, H

10. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

10. D

11. In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention? A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient's blood pressure. D. All the options are incorrect.

11. A

11. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

11. C

12. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this? A. Coreg B. Cardizem C. Lovenox D. Lipitor

12. C

12. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

12. D

13. Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine." C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

13. B, C, D

13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of heparin therapy and requires intervention? A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000

13. D

14. A patient is experiencing Heparin-Induced Thrombocytopenia from heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication? A. Argatroban B. Lovenox C. Levophed D. Tridil

14. A edit- levophed is Norepinephrine tridil is nitroglycerin

15. Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

15. D

16. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug? A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice."

16. C

16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

16. D

17. A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect? A. Losartan B. Lisinopril C. Cardizem D. Lipitor

17. B

17. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

17. C

18. A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level? A. Losartan B. Norvasc C. Aspirin D. Cardizem

18. A

18. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin

18. D

19. Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY: A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression

19. B, C, D, F

19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

19. B, D

2. Which of the following patients are MOST at risk for developing endocarditis? Select-all-that-apply: A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. C. A 63 year old female who is newly diagnosed with hyperparathyroidism and is taking Aspirin. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

2. A, B, D

2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage? A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.

2. B

2. A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis? A. Pericardial effusion B. Acute pericarditis c. Constrictive pericarditis D. Effusion-Constrictive pericarditis

2. C

2. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

2. D

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for: 1.Familial tendency toward peripheral vascular disease 2.Smoking history 3.Recent exposures to allergens 4.History of insect bite

2.Smoking history The mixture of arterial and venous manifestations (claudication and phlebitis, respectively) in the young male client suggests Buerger's disease. This is an uncommon disorder characterized by inflammation and thrombosis of smaller arteries and veins. This disorder typically is found in young adult males who smoke. The cause is not known precisely but is suspected to have an autoimmune component.

20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

20. B

21. A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the Digoxin level. D. Hold this dose until the patient's potassium level is normal.

21. C

22. Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

22. B

23. The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

23. D

3. Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis? A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pai

3. B, C, F

3. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

3. B, D, F

3. A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? A. Janeway Lesions B. Roth Spots C. Osler's Nodes D. Trousseau's Sign

3. C

3. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis

3. D

4. A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What type of infective endocarditis is this classified as based on the information listed? A. Acute Infective Endocarditis B. Subacute Infective Endocarditis C. Non-infective endocarditis D. Pericarditis

4. A

4. After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue? A. 24 hours B. 2 days C. 10 days D. 6 hours

4. C

4. You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds

4. C

4. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left sided systolic dysfunction heart failure.

4. D

Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks: 1. cyanotic; rubor 2. rubor; pallor 3. cyanotic, pallor 4. pallor; rubor

4. pallor; rubor In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position(dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels)

5. 24-36 hours after a myocardial infarction _________ congregate at the site during the inflammation phase. A. Neutrophils B. Eosinophils C. Platelets D. Macrophages

5. A

5. A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis? A. Abdominal ultrasound B. Heart catheterization C. Transesophageal echocardiogram D. White blood cell count

5. C

5. You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicate the patient did NOT understand your education about how to take this medication? A. "I will make sure I take this medication with food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout.

5. C

5. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.

5. True

6. Select-all-that-apply: What are the typical signs and symptoms of infective endocarditis? A. Hyperthermia B. S4 gallop C. Enlarged Spleen D. Hyperkalemia E. Substernal pain that radiates to the back F. Heart failure G. Cardiac Murmur

6. A, C, F, G

6. A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis

6. D

6. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

6. E

7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

7. B

7. You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food

7. C

7. You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."

7. C

8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Oxygen saturation D. CK result and when the next CK level is due to be collected

8. A

8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

8. B

8. A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding? A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event

8. D

8. On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

8. D

9. A patient with endocarditis has listed in their medical history "Roth Spots". You know that this is a complication of infective endocarditis and presents as? A. Non-tender spots found on the feet and hands B. Red and tender lesions found in the eyes C. Retinal hemorrhages with white centers D. Purplish spots found on the forearms and groin

9. C

9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers. A. Myoglobin B. CK-MB C. CK D. Troponin

9. D

9. Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

9. D

A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? A. I will make sure I consume foods high in potassium. B. I will only take this medication if my blood pressure is high. C. I understand a dry cough is a common side effect with this medication. D. I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia.

A

A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem? A. Lisinopril B. Labetalol C. Losartan D. Hydrochlorothiazide

A

Which of the following drugs is NOT considered an Angiotension Receptor Blocker (ARBs) medication used in hypertension? A. Catapres B. Losartan C. Benicar D. Valsartan

A

Which of the following systems of the body are affected by hypertension? A. Cardiovascular, brain, kidney, eyes B. Cardiovascular, gastrointestinal, reproductive, and kidney C. Brain, respiratory, kidney, cardiovascular D. None of the above

A

Which classification of medications play a pivotal role in the management of HF caused by systolic dysfunction? A. ACE inhibitors B. Beta-blockers C. Diuretics D. Digitalis

A ACE inhibitors ACE inhibitors play a pivotal role in the management of HF caused by systolicdysfunction. Beta-blockers have been found to reduce mortality andmorbidity in patients with NYHA class II or III HF by reducing the adverseeffects from the constant stimulation of the sympathetic nervous system.Diuretics are prescribed to reduce excess extracellular fluid by increasing therate of urine produced in patients with signs and symptoms of fluid overload.Digitalis increases the force of myocardial contraction and slows conductionthrough the atrioventricular node

The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan? A. Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week) B. Eliminate alcoholic beverages from the diet C. Reduce sodium intake to no more than 200 mmol/day D. Maintain a normal body weight with BMI between 18 and 30 kg/m2

A Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week) Rationale: Exercise is recommended as above. Alcoholic beverages can be consumed in moderation. Sodium should be reduced to no more than 100 mmol/day, and the patient should maintain a normal body weight with a BMI between 18.5 and 24.9 kg/m2

Which of the following best defines stroke volume? A. The amount of blood ejected with each heartbeat B. Amount of blood pumped by the ventricle in liters per minute C. Degree of stretch of the cardiac muscle fibers at the end of diastole D. Ability of the cardiac muscle to shorten in response to an electrical impulse

A The amount of blood ejected with each heartbeat Rationale: Stroke volume is the amount of blood ejected with each heartbeat. Cardiac output is the amount of blood pumped by the ventricle in liters per minute. Preload is the degree of stretch of the cardiac muscle fibers at the end of diastole. Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse

For patients with uncomplicated hypertension and no specific indications for another medication, what is the initial medication? A. Thiazide diuretic B. Calcium channel blockers C. Vasodilators D. Angiotensin-converting enzyme inhibitors

A Thiazide diuretic For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medication is thiazide diuretics for most patients. If blood pressure does not fall to less than 140/90 mm Hg, the dose is increased gradually, and additional medications are included as necessary to achieve control

The nurse is completing a neurovascular assessment on the client with chronic venous insufficiency. What should be included in this assessment? Select all that apply. 1. Assess for paresthesia. 2. Assess for pedal pulses. 3. Assess for paralysis. 4. Assess for pallor. 5. Assess for polar (temperature).

ALL 1The nurse should determine if the client has any numbness or tingling. 2. The nurse should determine if the client has pulses, the presence of which indicatesthere is no circulatory compromise. 3. The nurse should determine if the client can move the feet and legs. 4. The nurse should determine if the client's feet are pink or pale. 5. The nurse should assess the feet to determine if they are cold or warm.

Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques? A. Dietary changes B. Multivitamins C. Smoking cessation D. Limiting caffeine

B

Which of the following patients does not have a risk factor for hypertension? A. A 25 year old male with a BMI of 35. B. A 35 year old female with a total cholesterol level of 100. C. A 68 year old male who reports smoking 2 packs of cigarettes a day. D. A 40 year old female with a family history of hypertension and diabetes.

B

Which of the following patients is not a candidate for a beta blocker medication? A. A 45 year old male with angina. B. A 39 year old female with asthma. C. A 25 year old female with migraines. D. A 55 year old male with a history of two heart attacks.

B

What evaluation most illustrates that the patient with HF has met outcomes for the nursing diagnosis "Activity intolerance related to decreased CO?" A. Exhibits decreased peripheral edema B. Maintains heart rate, blood pressure, respiratory rate, and pulse oximetry within the targeted range C. Avoids situations that produce stress D. Performs and records daily weights

B Maintains heart rate, blood pressure, respiratory rate, and pulse oximetrywithin the targeted range Rationale: Patients with HF who exhibit stable VS shows that they have been ableto adjust and plan activities to include rest and allow their bodies to adjust. Adecrease in peripheral edema illustrates a reduction of fluid, avoiding situationsthat produce stress shows a move toward decreasing anxiety, and performing andrecording daily weights shows adherence to the therapeutic regimen

The nurse is preparing a male patient to have a 12-lead ECG performed. When prepping the skin the nurse notices that the patient has abundant chest hair. What is the most appropriate nursing intervention to improve adhesion of the ECG leads? A. Use alcohol swabs to clean the skin before applying the leads B. Clip the chest hair with the patient's permission before applying the leads C. Apply the leads to the arms and legs only D. Reschedule the ECG

B. Clip the chest hair with the patient's permission before applying the leadsRationale: Clipping the patient's hair would provide access to the skin to assistwith adhesion. Alcohol should not be used to prep the skin because it increasesthe skin's electrical impedance, thereby hindering the detection of the cardiacelectrical signal. The ECG would not be performed correctly if the leads wereonly placed on the extremities, and there is no need to reschedule the ECG atthis time

A patient with restrictive cardiomyopathy taking digoxin presents with symptoms of anorexia, nausea, vomiting, headache, and malaise. What should the nurse expect to be included in the plan of care for this patient? A. The patient's digoxin will be changed to nifedipine B. The patient's digoxin dose will be decreased C. Nothing; these are signs of restrictive cardiomyopathy that are expected D. The patient will be admitted to an ICU

B. The patient's digoxin dose will be decreased. Rationale: Patients with restrictive cardiomyopathy are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise. This patient presents with symptoms of digoxin toxicity, so a decrease in dosage should be anticipated. These patients should avoid nifedipine, and they do not need to be admitted to the ICU

Central venous pressure (CVP) is a measurement of the pressure in which area of the heart? A. Left ventricle B. Vena cava or right atrium C. Pulmonary artery D. Left atrium

B. Vena cava or right atrium Rationale: CVP is a measurement of the pressure in the vena cava or right atrium. The pressure in the vena cava, right atrium, and right ventricle is equal at the end of diastole; thus, the CVP also reflects the filling pressure of the right ventricle (pre-load). The normal CVP is 2 to 6 mm Hg.

The nurse is providing education for a client diagnosed with mitral valve prolapse (MVP). What should be included in the teaching plan? (Select all that apply.) A. MVP is not hereditary B. Caffeine is tolerated in small amounts C. Avoid alcohol D. Stop use of tobacco products E. Prophylactic antibiotics are not prescribed before dental procedures

C. Avoid alcohol D. Stop use of tobacco products E. Prophylactic antibiotics are not prescribed before dental procedures Rationale: MVP may be hereditary, so first-degree relatives (e.g., parents, siblings) may be advised to have screening. The patient may be advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products. Most patients do not require medication, but some are prescribed antiarrhythmic medications. Prophylactic antibiotics are not recommended prior to dental or invasive procedures.

The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate chest pain. What side effect should concern the nurse the most? A. Dry mucous membranes B. Heart rate of 88 bpm C. Blood pressure of 86/58 mm Hg D. Complaints of headache

C. Blood pressure of 86/58 mm Hg Rationale: Nitroglycerin dilates vessels in the body. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. If the patient is hypovolemic, the decrease in filling pressure can cause a significant decrease in cardiac output and blood pressure. This patient was working outside on a hot day, and the possibility of dehydration and hypovolemia should be considered. Dry mucous membranes can cause poor absorption of sublingual nitroglycerin but is not the most concerning. B and D are insignificant findings

6. A patient is experiencing ventricular tachycardia and is unresponsive with no pulse. After activating the emergency response system, the nurse would immediately?(Required) A. Prep the patient for defibrillation B. Administer IV epinephrine C. Secure the airway D. Start chest compressions

D

A patient is scheduled to take Captopril. When is the best time to administer this medication? A. 30 minutes after a meal B. At bedtime C. In the morning D. 1 hour before a meal

D

Which family of drugs are the following medications considered: Amlodipine, Verapamil, Diltiazem? A. Beta blockers (BB) B. ACE Inhibitors (ACEI) C. Angiotension Receptor Blockers (ARBs) D. Calcium Channel Blockers (CCBs)

D

The nurse is caring for a patient after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis? A. Encourage crossing of legs B. Use pillows in the popliteal space to elevate the knees in the bed C. Discourage exercising D. Apply sequential pneumatic compression devices as prescribed

D. Apply sequential pneumatic compression devices as prescribed Rationale: Sequential pneumatic compression devices should be used when prescribed to help prevent venous stasis and clotting complications such as deep vein thrombosis and pulmonary embolism. Patients should be discouraged to cross their legs. Pillows should not be used in the popliteal space to elevate the knees; rather, this should be avoided. Exercises passive and active, should be encouraged.

The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin (Lipitor). What serum levels should be monitored in this patient? A. Complete blood count (CBC) B. Blood cultures C. Na and K levels D. Liver enzymes

D. Liver enzymes Rationale: Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor and is hepatotoxic. Therefore, liver enzymes should be monitored in patients taking this medication.

What is the main electrolyte involved in cardiomyopathy? A. Calcium B. Phosphorus C. Potassium D. Sodium

D. Sodium Rationale: Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure, which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels

1. True or False: The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layer

False

Which of the following is the primary pacemaker for the myocardium? A. Atrioventricular junction B. Bundle of His C. Purkinje fibers D. Sinoatrial node

Sinoatrial node Rationale: The sinoatrial node is the primary pacemaker for the myocardium

7. The following rhythm is noted in your patient. The patient is unresponsive and has no pulse. What order below would the nurse ask for clarification if received?(Required) A. IV Amiodarone B. IV Magnesium Sulfate C. Defibrillation D. IV epinephrine

The answer is A. The rhythm above is Torsades de Pointes. A common cause of this rhythm is due to a medication causing a prolonged QT interval. Amiodarone can prolong the QT interval and should not be used in this rhythm.

13. A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description? A. venous ulcer B. arterial ulcer C. diabetic ulcer

The answer is A. These findings are associated with a venous ulcer.

12. Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to? A. Assess the surgical site for excessive drainage B. Assess and grade lower extremity pulses bilaterally C. Apply compression stockings D. Elevate the lower extremity above heart level

The answer is B. A peripheral artery bypass is performed to treat severe cases of PAD. The surgeon will "bypass" the blockage in the lower extremity and have blood flow re-routed around the blockage. This will provide blood flow back to the lower extremity. It is PRIORITY that the nurse assesses and grades the lower extremity pulses bilaterally frequently. If the pulses diminish or become absent the nurse should notify the physician immediately.

4. Your patient's ECG shows atrial flutter. What complication can arise from this type of rhythm? A. Pericarditis B. Stroke C. Hypoglycemia D. Endocarditis

The answer is B. Atrial flutter can increase the patient's risk of developing a blood clot which can lead to a stroke. This is because the atria are not fully contracting but quivering. The quivering leads blood to pool in the atria which can coagulate and form a clot. The clot can leave the heart and travel to the brain or lungs and cause a stroke or pulmonary embolism.

15. You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A. "It is important I quit smoking." B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. C. "A walking program would be beneficial in treatment of my PAD." C. "I will avoid wearing tight socks or shoes."

The answer is B. The patient should try to prevent the feet and legs from getting too cold because this causes vasoconstriction, which impedes blood flow further. Therefore, they should dress warmly with LOOSE layers. However, they should AVOID using heating pads because of the reduce of sensation from compromised blood flow. A walking program is a great way to prevent intermittent claudication, lower the cholesterol, and improve oxygen levels in the blood....which are all great ways of treating PAD.

3. The patient's ECG shows the rhythm above. The patient is symptomatic and experiencing shortness of breath and chest pain. The patient's blood pressure in 80/44 with the heart rate fluctuating between 130-150s. The nurse calls a rapid response and prepares the patient for? A. Ablation B. Synchronized cardioversion C. Defibrillation D. Pacemaker implantation

The answer is B. The rhythm above is uncontrolled atrial fibrillation with a ventricular rate >100. The patient is experiencing signs and symptoms of decreased cardiac output, which can occur when atrial fibrillation when this rhythm is fast (hence out of control). The patient needs to be cardioverted so the rhythm can return back to normal sinus rhythm.

5. The patient is experiencing the rhythm above. The patient is presenting with a blood pressure of 70/42, mental status changes, and is clammy and pale. A pulse is present. The nurse preps the patient for?(Required) (v-tach) A. CPR B. Synchronized cardioversion C. Defibrillation D. Atropine IV

The answer is B. The rhythm above is ventricular tachycardia. The patient is unstable and demonstrating signs and symptoms related to decreased cardiac output. A pulse is present. The patient is currently unstable; therefore, synchronized cardioversion needs to be performed to convert the patient to a normal rhythm. An antiarrhythmic like Amiodarone may be started to maintain the normal rhythm.

6. You're patient is in ventricular fibrillation (v-fib). You've started CPR and the airway is supported. A rhythm checked in performed and shows the patient is still in ventricular fibrillation. The next action the code team will take in addition to performing high-quality CPR is to? A. Administer Atropine B. Defibrillate C. Administer Epinephrine D. Synchronized cardiovert

The answer is B. Ventricular fibrillation is a shockable rhythm. The team will continue CPR until the machine is ready to deliver a shock (hence defibrillate). Once the machine is ready for defibrillation, the team will shout clear (all members will remove themselves from the patient) and a shock will be delivered. Then CPR will be resumed.

3. Your patient is unresponsive and the cardiac monitor shows Torsades de Pointes as the patient's rhythm. As the code team is attempting to resuscitate the patient, you look through the patient's electronic health record to try to determine a potential cause for this rhythm. What found in the patient's record is a cause of this rhythm?(Required) A. Magnesium level 2 mg/dL B. Amiodarone C. Potassium 5 mEq/L D. Glyburide

The answer is B: Amiodarone... This medication can cause a prolonged QT interval, which is a common cause of Torsades de Pointes.

2. Which statement is correct about atrial flutter? A. The ventricular rate will always be irregular. B. P-waves will be present. C. This rhythm has a saw-tooth appearance. D. The PR interval will be >0.20 seconds.

The answer is C. A defining characteristic of atrial flutter is its saw-tooth appearance. This is formed by the abnormal p-waves called flutter waves. This is a key point with discerning a-fib from a-flutter. The ventricular rate can be regular or irregular with this rhythm.

4. True or False: Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue. The answer is TRUE. 5. The MOST common cause of peripheral arterial disease is? A. Diabetes B. Deep vein thrombosis C. Atherosclerosis D. Pregnancy

The answer is C. Atherosclerosis is the most common cause of PAD (peripheral arterial disease). This is the collection of fatty plaques on the artery wall. This blocks blood flow.

7. Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the? A. Dependent position B. Horizontal position C. Elevated position above heart level D. Knee-flexed position

The answer is C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient's lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.

2. The nurse is assessing an ECG strip. Which finding on the ECG strip is NOT a characteristic present in atrial fibrillation (a-fib)? A. fibrillary waves B. unmeasureable atrial rate C. saw-tooth appearance of f-waves D. irregular ventricular rate

The answer is C. Saw-tooth appearance of f-waves is found in atrial flutter (not a-fib). The other options are found in atrial fibrillation.

2. Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing? A. Low fat diet B. Blood glucose control C. Smoking cessation D. Blood pressure control

The answer is C. The most common cause of Buerger's Disease (thromboangiities obliterans) is tobacco usage (smoking). Buerger's Disease occurs when the blood vessels of the hands and feet become inflamed and clots form. The clots will block blood flow. The nurse should make it priority to educate the patient on smoking cessation.

4. The nurse sees the rhythm above on the ECG. (v-fib) The patient is unresponsive and has no pulse. The nurse calls a code blue and takes what step next? A. Prepare for defibrillation B. Administer Epinephrine C. Start high-quality CPR D. Notify the physician

The answer is C. The nurse would want to immediately start high-quality CPR and continue this until help arrives.

The patient is experiencing the rhythm above. (v-tach) You assess the patient and find the patient is having no symptoms and a pulse is present. What type of treatment do you anticipate will be ordered for this patient?(Required) A. CPR B. Defibrillation C. Amiodarone IV D. Digoxin IV

The answer is C. The patient is experiencing ventricular tachycardia. Currently, the patient has no symptoms and a pulse is present. Therefore, the patient is stable. When stable with no symptoms and has a pulse an anti-arrhythmic med like amiodarone IV can be ordered. If the patient doesn't convert to sinus rhythm synchronized cardioversion may be used.

. Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks: A. cyanotic; rubor B. rubor; pallor C. cyanotic, pallor D. pallor; rubor

The answer is D. In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels).

3. True or False: Atropine is the first-line treatment to help control the rate in a patient with atrial flutter.

The answer is FALSE. Atropine increases the heart rate, which is the opposite of what needs to happen in atrial flutter (the rate is too fast and irregular and needs to be slowed down). Calcium-channel blockers and beta-blockers are used to help control the rate in atrial flutter. These medications will help slow down the rate, which may help convert the patient back to normal sinus rhythm.

6. True or False: Peripheral venous disease can occur due to narrowing of the valves in the veins of the lower extremities.

The answer is FALSE. Peripheral venous disease can occur due to overstretched valves of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when the veins become damaged.

5. True or False: Treatment for unstable atrial flutter is synchronized cardioversion.

The answer is TRUE.

4. Which statements below best described a transesophageal echocardiogram (TEE) used in the treatment of atrial fibrillation? Select all that apply: A. It can be performed before a cardioversion to assess for blood clots in the heart. B. This procedure destroys electrical pathways in the heart to help return a patient's heart rhythm to normal. C. During this procedure, an ultrasound probe is inserted in the patient's mouth down through the esophagus where it takes ultrasound pictures of the heart. D. During the procedure, a transducer is placed on the chest that sends ultrasound waves through the skin so pictures can be obtained of the heart's blood flow.

The answers are A and C. A TEE can be performed before a cardioversion to assess for blood clots in the heart (for example before a cardioversion for the treatment of atrial fibrillation). In addition, during this procedure, an ultrasound probe is inserted in the patient's mouth down through the esophagus where it takes ultrasound pictures of the heart.

3. A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply: A. Raynaud's Disease is triggered by cold temperatures or stress. B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. D. Raynaud's Disease is prevented by glucose control.

The answers are A and C. Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. It can be prevented by keeping the toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as well that help prevent vasospasm

11. Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply: A. Thick, tough B. Thin, scaly C. Hairless D. Brown pigmented

The answers are A and D. This is commonly found in severe peripheral venous disease. Options B and C are found in peripheral ARTERIAL disease.

14. Select below all the characteristics that can present with an arterial ulcer: A. Found on the lateral malleolus, dorsum of foot, or end of toes B. Found on the medial malleolus or medial part of lower leg C. Deep, round, defined edges and has a "punched out" appearance D. Minimal drainage E. Edematous F. Brown pigmented skin surrounding the ulcer G. Wound base is pale

The answers are A, C, D, and G. Arterial ulcers have very little blood flow to them so they will be pale (little granulation) and have little (if any) drainage. They will be deep, round, and have a "punched out" appearance. They are most commonly found on the lateral malleolus, dorsum of foot, or end of toes.

8. You're assessing a patient's health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply: A. "I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." B. "If I stand or sit too long my legs start to feel heavy and achy." C. "It hurts to elevate my legs." D. "Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away."

The answers are A, C, and D. Peripheral arterial disease occurs when there is impediment of blood flow to the lower extremities (hence the lower extremities are being deprived of blood flow and this causes pain). The pain most commonly occurs at night and can wake up the patient. It is known as "rest pain". This occurs because when the legs are horizontal the blood flow is compromised and it causes pain...therefore the patient will report they dangle the leg off the bed to help ease the pain (the dependent position (dangling) will help blood flow down to the extremity). In addition, it hurts to elevate the legs (again because this further compromises blood flow). Option B occurs in peripheral venous disease. Option D is known as intermittent claudication and is a HALLMARK sign and symptom in PAD.

5. What complications can develop from uncontrolled atrial fibrillation that the nurse should monitor for? Select all that apply: A. Hypertension B. Stroke C. Heart failure D. Hyperglycemia

The answers are B and C. Remember from the lecture I discussed how atrial fibrillation leads to incomplete atrial contraction that causes the atria to quiver. This can lead to blood pooling in the atria. When blood pools it coagulates (hence forms clots). The clots can break off and travel through the body leading to a stroke. In addition, if the rate if too fast (not controlled) the heart's ability to pump blood throughout the body fails because it becomes overworked and tired. This leads to heart failure.

10. A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply: A. Elevate the lower extremities below heart level frequently B. Application of compression stockings C. Limit long periods of standing and sitting D. Use the knee-flexed position while lying in bed

The answers are B and C. The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.

5. What other medications can be administered to a patient experiencing Ventricular fibrillation (V-fib) during a code resuscitation attempt? Select all that apply: A. Atropine B. Epinephrine C. Amiodarone D. Lidocaine

The answers are B, C, D. Epinephrine, Amiodarone, and Lidocaine can be administered during a code for the treatment of v-fib...with Epinephrine being the first choice.

1. A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply: A. Pregnancy B. Being Female C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension F. Varicose veins G. Smoking

The answers are C, D, E, and G. High cholesterol, diabetes mellitus, uncontrolled hypertension, and smoking are risk factors for peripheral arterial disease (PAD). Pregnancy, being female, varicose veins are risk factors for peripheral venous disease.

True or False: Most patients with hypertension are asymptomatic.

True