Critical Care Cardiac NCLEX

2. The treatment of choice for a patient with ventricular fibrillation is: A. defibrillation. B. transesophageal pacing. C. synchronized cardioversion. D. administration of epinephrine.

Answer: A. Patients with ventricular fibrillation are in cardiac arrest and require defibrillation.

14. An 82-year-old woman is admitted with a diagnosis of rapid atrial fibrillation. The nurse has initiated telemetry monitoring per the physician's order. Two hours after initiation of monitoring, an alarm sounds at the central monitoring station: the client is in what appears to be ventricular tachycardia. Which of the following actions should the nurse take FIRST? 1. Call a code blue. 2. Silence the alarm and change the alarm parameters. 3. Notify the physician of a change in rhythm. 4. Assess the client and check lead placement.

(4) CORRECT: Assess the client first, then the equipment for disconnections or malfunctions. Check lead placement to determine if the monitoring results are indeed accurate, and not due to interference or an artifact. If assessment of the client reveals true ventricular tachycardia, follow advance directives as established by the client, including, but not limited to, calling a code.

17. A nurse is caring for a client following implantation of an automatic internal cardioverter- defibrillator (AICD). The nurse should first determine: n 1. Activation status of the device. n 2. Client's anxiety level. n 3. Provision of a medic-alert card. n 4. Postdischarge physical activity order.

1 After insertion of an AICD, the nurse assesses device settings. The nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. Anxiety level, medic alert card or bracelet, and postdischarge activity order are important considerations, but not the highest priority directly after insertion of the AICD.

13. A nurse is evaluating a client for cardiac tamponade immediately following a pericardiocentesis. The nurse should report which of the following to the HCP? n 1. Rising CVP. n 2. Increase in BP. n 3. Client expression of relief. n 4. Audible heart sounds.

1 Following pericardiocentesis, a rise in BP and a fall in CVP are expected; the nurse reports increased CVP as a sign of increasing fluid. The client expresses immediate relief of the symptoms such as dyspnea. Heart sounds are no longer muffled or distant

4. The client diagnosed with hypertension and chronic angina is receiving metoprolol (Lopressor). The current vital signs are: BP 132/80 and apical heart rate of 62. The nurse should: n 1. Administer the medication as ordered. n 2. Hold the drug until the vital signs are reported to the physician. n 3. Wait 1 hr and recheck vital signs, then decide whether to administer the drug. n 4. Withhold the drug because the vital signs are normal.

1 Metoprolol is a cardioselective beta blocker that decreases BP and heart workload through blocking beta 1 receptors, which decreases heart rate and force of contraction. Client's BP is high normal range and heart rate is greater than 60; the drug can safely be given by the nurse. The client requires treatment to maintain a normal BP and prevent angina. (D)

49.A nurse is teaching a group of nursing students about dilated cardiomyopathy (DCM). Which statements, made by the students, would indicate that teaching was effective? Select all that apply. 1."Pregnancy may play a role in developing this form of cardiomyopathy." 2."Initial symptoms of DCM are often increasing fatigue and dyspnea." 3."Management of DCM focuses on decreasing cardiac workload. 4."DCM is a rare form of cardiomyopathy." 5."Obesity is a possible risk factor for DCM." 6."DCM is curable with prompt, effective treatment."

1, 2, 3, 5. DCM, the most common form of cardiomyopathy, is associated with risk factors that include pregnancy and obesity. Initial symptoms include increasing fatigue, dyspnea and activity intolerance as well as the classic symptoms of heart failure. While DCM is a chronic, non-curable disease, management focuses on decreasing cardiac workload.

14.The nurse is caring for a client receiving digoxin. Which symptoms would the nurse anticipate with a digoxin level of 2.3 ng/dl (0.08 nmol/l)? Select all that apply. 1.Nausea 2.Drowsiness 3.Photophobia 4.Increased appetite 5.Increased energy level 6.Seeing halos around bright objects

1, 2, 3, 6. Digoxin is a cardiac glycoside used to manage and treat heart failure, control ventricular rate in clients with atrial fibrillation, and treat and prevent recurrent paroxysmal atrial tachycardia. The therapeutic range of digoxin is 0.8 to 2.0 ng/dl (0.03 to 0.07 nmol/l). Signs of toxicity include gastrointestinal disturbances, neurological abnormalities, facial pain, personality changes, and ocular disturbances such as photophobia.

67.A client is experiencing chest pain at rest. The pain is unresponsive to nitroglycerine. The client is diagnosed with unstable angina, and the nurse immediately begins intervention. Which treatment is most appropriate for this client? 1.Cardiac catheterization 2.Echocardiogram 3.Heart transplantation 4.Percutaneous transluminal coronary angioplasty (PTCA)

1. Cardiac catheterization is a diagnostic tool used to locate the blockage causing the angina. PTCA can alleviate the blockage and restore blood flow and oxygenation, but would not be done without the information provided by cardiacatheterization. An echocardiogram is a non-invasive diagnostic test used to identify various abnormalities in the heart muscle and valves. Heart transplantation involves replacing the client's heart with a donor heart, and is a treatment for end-stage cardiac disease.

133.A client, admitted with angina, reports severe chest pain and suddenly appears to lose consciousness and pulse. After calling for help and establishing unresponsiveness, which action should the nurse take next? 1.Deliver chest compressions 2.Open the client's airway 3.Check for breathing 4.Check for signs of circulation

1. Compressions, airway, breathing guidelines state, immediately after calling out for help, and establishing unresponsiveness, the nurse should deliver chest compressions at a depth of at least two inches and at a rate of 100 compressions/min. After delivering 30 compressions, the nurse should open the airway by tilting the client's forehead back and lifting the chin. The nose should be pinched shut with forefinger and thumb, a normal-depth breath should be delivered over a one-second period of time, being sure the client's chest rises with each breath. After delivering two breaths, chest compressions should be continued. The nurse should deliver cycles of 30 compressions followed by two breaths until help arrives to supple the breaths and/or delivery an automatic external defibulator.

18.A client is experiencing myocardial-infarction-induced heart failure. When assessing this client, the nurse should carefully auscultate for: 1.a third heart sound (S3). 2.a fourth heart sound (S4). 3.an aortic murmur. 4.aortic regurgitation

1. This client's condition can result in rapidly filling ventricles resulting in ventricular dilation. This can be auscultated as a third heart sound (S3). Systemic hypertension, or increased atrial contraction, can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur while aortic regurgitation is the result of an incompetent aortic valve.

41.A client, who experienced a myocardial infarction, has received a thrombolytic agent. What is the most important nursing intervention during the next 24 hours? 1.Assessing for bleeding 2.Monitoring the client's potassium levels 3.Maintaining the client a supine position 4.Encouraging the client to ingest fluids

1. Thrombolytic agents are declotting agents that place the client at risk for hemorrhage from puncture wounds. All unnecessary needle sticks and invasive procedures should be avoided. The potassium level should be monitored in all cardiac clients, not just those receiving a thrombolytic agent. Although no specific position is required, most cardiac clients prefer semi-Fowler's position. The client's fluid balance must be carefully monitored. Encouraging fluids may be inappropriate at this time.

18. A client is admitted to the ICU with a MI. Which assessment indicates to the nurse the development of cardiogenic shock? n 1. Bradycardia. n 2. Increased BP. n 3. Oliguria. n 4. Warm, flushed skin.

18.3 Cardiogenic shock occurs with severe damage (greater than 40%) to the left ventricle. Classic signs include hypotension, rapid pulse that becomes weaker, decreased urine output, and cool, clammy skin. (A)

12. During a home visit, the nurse assesses a client who is taking hydrochlorothiazide (HydroDIURILl) and lisinopril (Prinivil) for the treatment of hypertension. Which symptom would indicate a need to inform the physician of a need to change medication therapy? n 1. BP is 132/80. n 2. Persistent cough. n 3. Potassium level is 4.1 mEq/L. n 4. Waking up at night to void.

2 A persistent cough is a side effect of the ACE inhibitor that may warrant a change to another antihypertensive medication. BP and potassium are within normal limits. The nurse assesses when the drug is taken and changes to an earlier time of administration

14. The nurse is providing care for a client after a mechanical aortic valve replacement. The nurse determines the need for further discharge teaching when the client tells the nurse: n 1. "I will avoid alcohol now that I am taking my daily warfarin (Coumadin)." n 2. "I will limit my physical activity to avoid stress on my new valve." n 3. "I will need prophylactic antibiotic therapy prior to any surgery." n 4. "I will start a cardiac rehabilitation program on discharge.

2 Physical activity is gradually increased and encouraged. Alcohol potentiates warfarin (Coumadin) and alters PT/INR levels. Antibiotics are used prophylactically prior to any invasive medical or dental procedures. Cardiac rehabilitation is started once the client is stable. (H)

15. Following open heart surgery, a nurse is administering sodium nitroprusside (Nipride) to a client by IV drip. The nurse should assess the client for which of the following? n 1. LOC. n 2. BP. n 3. Pulse oximetry. n 4. Breath sounds.

2 Sodium nitroprusside causes the release of intravascular nitric oxide and is considered a potent vasodilator of arteries and veins. Frequent monitoring of BP is needed to achieve optimal effect and prevent unwanted hypotension. Changes in LOC may result, but typically secondary to severe hypotension. Monitoring pulse oximetry and breath sounds are unrelated to sodium nitroprusside therapy.

3. A client with a diagnosis of unstable angina is going to have a cardiac catheterization. Prior to the procedure the nurse should: n1. Administer a dose of nitroglycerin. n 2. Assess and record peripheral pulses. n 3. Verify the client had an echocardiogram. n 4. Insert a central line.

2 Prior to a cardiac catheterization, baseline vital signs and peripheral pulses are assessed and recorded. Catheter access to the left side of the heart is through arterial insertion. A decrease or absence of peripheral pulse warrants investigation. Nitroglycerin and an echocardiogram may have been provided in client care, but are not prerequisites for a cardiac catheterization. A central line is not required, but peripheral IV access is needed for the procedure. (R)

5.The nurse is assessing a client who is experiencing substernal chest pain. Which report of symptoms support a diagnosis of stable angina pectoris rather than a possible myocardial infarction? Select all that apply. 1."The pain began while I was watching television." 2."The pain goes up and down my left arm." 3."The pain lasts less than five minutes." 4."The pain started when I was eating breakfast and continued all morning." 5."One nitroglycerine tablet relieved the pain."

2, 3, 5. Stable angina pectoris is a temporary imbalance between the coronary artery's ability to supply oxygen, and the cardiac muscle's demand for oxygen. The substernal chest pain that occurs in this stable angina pectoris may radiate to an arm, is precipitated by exertion or stress, is relieved by rest or nitroglycerin, and lasts less than 15 minutes. Myocardial infarction occurs when myocardial tissue is abruptly and severely deprived of oxygen. The substernal chest pain that occurs in myocardial infarction radiates to the left arm, back, or jaw. It occurs without cause, usually in the morning, and is only relieved by opioids; and lasts 30 minutes or longer.

2.A client is at risk for developing cardiogenic shock. Which is a presenting symptom of this condition? 1.Decreased heart rate 2.Decreased cardiac index 3.Decreased blood pressure 4.Decreased cerebral blood flow

2. A client's cardiac index is calculated by dividing the cardiac output by the client's body surface area. It is used to determine if cardiac output is meeting a client's needs. Heart rate, blood pressure, and decreased cerebral blood flow are less useful in determining the risk of cardiogenic shock

21.What is the priority nursing intervention for a client experiencing a myocardial infarction (MI)? 1.Administering morphine 2.Administering oxygen 3.Administering sublingual nitroglycerin 4.Obtaining an electrocardiogram (ECG)

2. Administering supplemental oxygen to the client is the priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are also used to treat MI, but are commonly administered after oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

35.A client's cardiac rhythm strip shows a regular rhythm with atrial and ventricular rates of 70 beats per minute, a PR interval of 0.24 seconds, and a QRS duration of 0.08 seconds. The nurse interprets this rhythm as: 1.Normal sinus rhythm (NSR) 2.NSR with first-degree atrioventricular (AV) block 3.Sinus arrhythmia 4.Accelerated junctional rhythm.

2. An increased PR interval is indicative of a first-degree AV block. NSR and sinus arrhythmia have normal PR intervals. The PR interval, if present, is less than 0.12 seconds in accelerated junctional rhythm.

121.A client is receiving CPR from paramedics as he arrives in the emergency department (ED). The paramedics are ventilating the client through an endotracheal tube placed prior to transport. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of 55 bpm with a palpable pulse. Which action should the nurse take first? 1.Start an IV line and administer amiodarone 2.Check ET tube placement 3.Obtain an arterial blood gas (ABG) sample 4.Administer 1 mg atropine IV

2. Endotracheal tube placement should be confirmed as soon as the client arrives in the ED. Once the airway is verified, oxygenation and ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse oximetry. Next, the nurse should establish IV access. If the client experiences symptomatic bradycardia, atropine should be administered as ordered. The ABG sample would verify effectiveness of CPR ventilations. Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial flutter.

65.A nurse is preparing a client for cardiac catheterization. What is the nurse's priority assessment? 1.Weight and height 2.Known allergies 3.Apical heart rate 4.Cardiac rhythm

2. Since cardiac catheterization involves the injection of a radiopaque dye. It is most important for the nurse to determine if this client has allergies to iodine or shellfish. The other three parameters are also part of the assessment, but are not the priority.

135.A client comes to the emergency department with acute shortness of breath and a cough that produces pink, frothy sputum. The client is restless and extremely anxious. Admission assessment reveals crackles and wheezes, a blood pressure of 82/45 mmHg, a heart rate of 120 bpm, and a respiratory rate of 38 breaths/min. The client's medical history includes hypertension, and heart failure. What is the nurse's priority intervention? 1.Providing supplemental oxygen 2.Elevating the head of the bed 3.Initiating intravenous access 4.Providing emotional support

2. The most important intervention would be to facilitate air exchange. The priority action would be to elevate the head of the bed. Application of supplemental oxygen would be the next action. IV access and emotional support would follow.

33.What is the priority nursing intervention for a client experiencing a dysrhythmia that continues to deteriorate and requires converting? 1.Administer 1 mg of epinephrine IV 2.Defibrillate 3.Initiate CPR 4.Administer vasopressin 40 units IV

2. To attempt to convert the rhythm, the nurse should first defibrillate the client. If this is unsuccessful, then CPR should be initiated. Epinephrine and vasopressin may be given, but only after two defibrillation attempts.

8. A client with acute HF is receiving IV antibiotics mixed in 100-ml bags of fluid every 4 hr. The nurse should monitor the client for signs and symptoms of: n 1. Decrease in afterload. n2 Reduction in preload. n 3. Increase in cardiac workload. n 4. Improvement in pulmonary gas exchange.

3 The amount of IV fluids may increase rather than decrease preload and thus increase the workload of the heart in a client with HF. Pulmonary congestion may interfere with gas exchange. A decrease in afterload results from vasodilation of the arterioles.

.The nurse has just admitted a client to the telemetry floor with reports of acute chest pain radiating down the left arm. Which laboratory studies should the nurse order to evaluate myocardial damage? Select all that apply. 1.Hemoglobin and hematocrit 2.Serum glucose 3.Creatinine phosphokinase (CK-MB) 4.Troponin T and troponin I 5.Myoglobin 6.Blood urea nitrogen (BUN)

3, 4, 5. Levels of CK-MB, troponin T, and troponin I rise because of cellular damage. Myoglobin elevation is an early indicator of myocardial damage. Neither hemoglobin, hematocrit, serum glucose, nor BUN levels provide information related to myocardial ischemia

24.A client who experienced a myocardial infarction (MI) 48 hours ago is most at risk for the developing: 1.cardiogenic shock. 2.heart failure. 3.arrhythmias. 4.pericarditis.

3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur one week after a MI

132.A client develops cardiac tamponade as a result of a motor vehicle collision. The provider performs a pericardiocentesis. Which assessment finding would indicate that this procedure has achieved the expected outcome? 1.Neck vein distention 2.Pulsus paradoxus 3.Increased blood pressure 4.Muffled heart sounds

3. Cardiac tamponade is associated with decreased cardiac output, which in turn reduces blood pressure. By removing a small amount of blood from the pericardium, pericardiocentesis will increase blood pressure. Neck vein distention, pulsus paradoxus, and muffled heart sounds indicate persistent cardiac tamponade, and that pericardiocentesis hasn't been effective

10.A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms and a report of chest pain. What priority question should the nurse ask this client? 1."Can you describe the pain to me?" 2."Have you ever had this pain before?" 3."What makes the pain intensify?" 4."Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

3. Chest pain is assessed by using the standard pain assessment parameters such as characteristics, location, duration, intensity, precipitating factors, and associated symptoms. Asking the client to describe the pain, if the pain has happened before, and to rate the pain are appropriate questions. These questions; however, do not help determine the cause of pain. Knowing what intensifies the pain will assist the nurse in determining a cause.

38.A client with an abdominal aortic aneurysm is admitted to a step-down unit. The nurse should intervene immediately if this client experiences: 1.a migraine-like headache. 2.cramping in the legs. 3.sudden, severe back pain. 4.diaphoresis.

3. If expansion and impending rupture of an abdominal aneurysm is suspected, the nurse should assess for acute and severe pain in the back or lower abdomen, which may radiate to the groin. None of the other options indicate a change in the status of the client's aneurysm

6. When assessing a client with HF, which of the following findings does the nurse report to the HCP? Select all that apply. n 1. Bibasilar crackles. n 2. BP 108/62, heart rate 88. n 3. O2 saturation 94%. n 4. 2-pound weight gain in 5 days. n 5. Urine output 20 ml/hr. n 6. Confusion.

4, 5 The nurse reports signs of decreased tissue perfusion to the HCP; these include a decrease in urine output and confusion. Crackles, edema, and weight gain are monitored closely, but are not as high a priority as decreasing tissue perfusion. Vital signs and oxygen saturation are within normal limits. (M)

75.The nurse is planning care for a client in cardiogenic shock. What is the priority outcome for this client? 1.Correct hypoxia 2.Prevent infarction 3.Correct metabolic acidosis 4.Increase myocardial oxygen supply

4. A balance must be maintained between oxygen supply and demand. In a shock state, the myocardium requires more oxygen. If it can't get more oxygen, the effects of shock increase. Increasing oxygen will play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn't an appropriate goal for this condition.

119.A paradoxical pulse occurs in a client who had coronary artery bypass graft (CABG) surgery two days ago. Which surgical complication would the nurse suspect? 1.Left-sided heart failure 2.Aortic regurgitation 3.Complete heart block 4.Pericardial tamponade

4. A paradoxical pulse can indicate pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans. Aortic regurgitation may cause bisferious pulse. Complete heart block may cause a bounding pulse

77.What is the nurse's most important tool for monitoring the severity of a shock state? 1.Arterial line 2.Indwelling urinary catheter 3.Electrocardiogram (ECG) monitor 4.Pulmonary artery catheter

4. A pulmonary artery catheter will give accurate pressure measurements within the heart, that help determine the course of treatment. An arterial line, an indwelling urinary catheter, and an ECG monitor all provide valuable information related to the severity of a shock state but aren't the most important tools.

60.After undergoing a cardiac catheterization, a client has a large puddle of blood under his buttocks. What is the nurse's priority action? 1.Call for help 2.Obtain vital signs 3.Ask the client to "lift up" 4.Assess the groin site

4. Assessment of the groin site is the priority. This establishes the source of the blood, and determines how much blood has been lost. The goal is to stop the bleeding. The nurse would call for help if needed after the assessment of the situation. After determining the extent of the bleeding, vital sign assessment is important. The nurse should never move the client, in case a clot has formed. Moving can disturb the clot and cause re-bleeding.

61.A client diagnosed with angina pectoris has a stat electrocardiogram (ECG) performed during an episode of chest pain. The nurse reviews the ECG and notes myocardial ischemia. How would myocardial ischemia be represented on an ECG? 1.Increased QRS duration 2.Shortened PR interval 3.Pathological Q-wave formation 4.T-wave inversion.

4. Ischemic changes are represented on an ECG by T-wave inversion. An increased QRS duration suggests a bundle-branch block. A shortened PR interval indicates a junctional rhythm. Pathological Q waves are present with myocardial infarction.

130.A client comes to the emergency department stating, "My heart suddenly began to race." Cardiac monitoring identifies regular atrial and ventricular rhythm, a heart rate of 210 bpm, with the P wave hidden in the T wave. Which arrhythmia does the nurse identify from these characteristics? 1.Atrial flutter 2.Atrial fibrillation 3.Sinus tachycardia 4.Supraventricular tachycardia

4. With supraventricular tachycardia, the rhythm is regular, the P wave is hidden in the preceding T wave, and the heart rate ranges from 140 to 250 bpm. A ventricular rate that varies with the degree of atrioventricular block, along with sawtooth P waves, characterizes atrial flutter. Irregular ventricular response, and absent P waves, characterize atrial fibrillation. Regular and equal atrial and ventricular rhythms and a rate of 100 to 160/bpm characterize sinus tachycardia.

73.The nurse is assessing a client who is displaying the earliest sign of cardiogenic shock. The nurse would document this assessment finding as: 1.cyanosis. 2.decreased urine output. 3.presence of fourth heart sound (S4). 4.altered level of consciousness

73.4. A decrease in cardiac output would initially result in decreased cerebral blood flow resulting in restlessness, agitation, or confusion. Cyanosis, decreased urine output, and the presence of an S4 are all later signs of shock

8. Passive stretching exerted by blood on the ventricular muscle at the end of diastole is referred to as: A. preload. B. afterload. C. the atrial kick. D. cardiac output.

Answer: A. Preload is the passive stretching exerted by blood on the ventricular muscle at the end of diastole. It increases with an increase in venous return to the heart.

3. The normal pacemaker of the heart is the: A. SA node. B. AV node. C. bundle of His. D. Purkinje fibers.

Answer: A. The SA node is the normal pacemaker of the heart, firing at an intrinsic rate of 60 to 100 times per minute.

10. A client comes into the emergency department with a dissecting aortic aneurysm. The client is at greatest risk for: 1. septic shock. 2. anaphylactic shock. 3. cardiogenic shock. 4. hypovolemic shock.

Answer: 4. A dissecting aortic aneurysm is a precursor to aortic rupture, which leads to hemorrhage and hypovolemic shock. Septic shock results from an uncontrolled infection. Anaphylactic shock results from exposure to an allergen. Cardiogenic shock results from cardiac damage.

1. A patient is suspected of having a decreased cardiac output due to dysrhythmias.Which of the following assessments would be included in a decreased cardiac output? Select all that apply. A. Elevated jugular venous distention B. Polyuria C. Full and bounding pulses D. Diaphoresis E. Constricted pupils F. Crackles and gurgles G. Muffled heart sounds

A, C, D, and F are associated with fluid buildup in the body from a lack of pumping (cardiac) action. Patients have oliguria due to poor kidney perfusion, dilated pupils due to sympathetic activation, and do not usually have muffled heart sounds, which is associated with cardiac tamponade.

3. Good conduction of electricity from the patient's heart to the monitor requires that the critical care nurse A. Periodically change electrode pads for good conduct. B. Place electrodes over the ribs as they are excellent conductors. C. Place electrodes with contacts on their anterior and posterior surfaces.

A. Electrodes dry out rather quickly, so replace them periodically, especially if the patient is febrile. They are placed anteriorly over intercostal spaces with all surfaces making good contact. To avoid respiratory movement, place the electrodes closer together.

2. For a patient with symptomatic sinus bradycardia, appropriate nursing interventions include establishing I.V. access to administer: A. atropine. B. anticoagulants. C. calcium channel blocker. D. beta-adrenergic blocker.

Answer: A. Atropine or epinephrine are standard treatments for sinus bradycardia.

4. A 42-year-old man with a history of two MI incidents is diagnosed with acute pulmonary edema. He has severe dyspnea with noisy, wet respirations. The nurse's initial action should be to: 1. place the client in high Fowler's position. 2. perform nasotracheal suctioning to relieve congestion. 3. determine the cause of the attack. 4. monitor cardiac rhythm.

Answer: 1. High Fowler's position reduces venous congestion and eases dyspnea. Suctioning isn't a priority. After the client is stabilized, further assessments can be made to determine the cause of the attack. Although appropriate, cardiac monitoring isn't the nurse's priority in this situation.

3. A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care? 1. Improving myocardial oxygenation and reducing cardiac workload 2. Confirming a suspected diagnosis and preventing complications 3. Reducing anxiety and relieving pain 4. Eliminating stressors and providing a nondemanding environment

Answer: 1. The client is exhibiting clinical signs and symptoms of a myocardial infarction (MI); therefore, nursing care should focus on improving myocardial oxygenation and reducing cardiac workload. Confirming the diagnosis of MI and preventing complications, reducing anxiety and relieving pain, and providing a nondemanding environment are secondary to improving myocardial oxygenation and reducing workload. Stressors can't be eliminated, only reduced.

3. A client reports substernal chest pain. Test results show electrocardiographic changes and an elevated cardiac troponin level. What should be the focus of nursing care? 1. Improving myocardial oxygenation and reducing cardiac workload 2. Confirming a suspected diagnosis and preventing complications 3. Reducing anxiety and relieving pain 4. Eliminating stressors and providing a nondemanding environment

Answer: 1. The client is exhibiting clinical signs and symptoms of an MI. Nursing care should focus on improving myocardial oxygenationand reducing cardiac workload. Confirming the diagnosis of MI, preventing complications, reducing anxiety, relieving pain, and providing a nondemanding environment are secondary interventions. Stressors can be reduced but not eliminated.

2. A client is prescribed diltiazem (Cardizem) to manage his hypertension. The nurse should tell the client the diltiazem will: 1. lower his blood pressure only. 2. lower his heart rate and blood pressure. 3. lower his blood pressure and increase his urine output. 4. lower his heart rate and blood pressure and increase his urine output.

Answer: 2. Diltiazem (Cardizem), a calcium channel blocker, will reduce both the heart rate and blood pressure. It doesn't directly affect urine output.

5. A client with unstable angina receives routine applications of nitroglycerin ointment. The nurse should delay the next dose if the client has: 1. atrial fibrillation. 2. a systolic blood pressure below 90 mm Hg. 3. a headache. 4. skin redness at the current site.

Answer: 2. Nitroglycerin is a vasodilator and can lower arterial blood pressure. As a rule, when the client's systolic blood pressure is below 90 mm Hg, the nurse should delay the dose and notify the physician. Nitroglycerin isn't contraindicated in a client with atrial fibrillation. Headache, a common occurrence with nitroglycerin, can be treated with an analgesic and isn't a cause for withholding a dose. Sites should be changed with each dose, especially if skin irritation occurs.

6. A male client has been admitted to the coronary care unit to rule out MI. Which symptoms during the health interview would indicate that he may be developing an MI? 1. Epigastric pain and heartburn 2. Fatigue and headache 3. Diaphoresis and substernal pain 4. Dizziness and nausea

Answer: 3. Diaphoresis and substernal or radiating chest pain are classic signs of an MI. Epigastric pain and heartburn are more indicative of indigestion or esophagitis. Fatigue and headache typically aren't reported in clients with MI. Although dizziness and nausea may accompany MI, they aren't common symptoms.

1. Which sign is characteristic of cardiac tamponade? A. Shortness of breath B. Beck's triad C. Holosystolic murmur D. Bounding peripheral pulse

Answer: B. Beck's triad comprises the three classic signs of cardiac tamponade: elevated CVP with jugular vein distention, muffled heart sounds, and a drop in systolic blood pressure.

1. Which sign or symptom would the nurse expect to assess in a patient who's admitted to the ED with a diagnosis of cardiac tamponade? A. Shortness of breath B. Pulsus paradoxus C. Holosystolic murmur D. Bounding peripheral pulse

Answer: B. Pulsus paradoxus (inspiratory drop in systemic blood pressure greater than 15 mm Hg) is one of the three classic signs of cardiac tamponade. The other classic signs are elevated CVP with jugular vein distention and muffled heart sounds.

4. The preferred treatment for symptomatic third-degree AV block is: A. atropine. B. a pacemaker. C. epinephrine. D. dopamine.

Answer: B. Use of either a transcutaneous or transvenous pacemaker is recommended for symptomatic third-degree AV block until a permanent pacemaker can be inserted.

4. When performing synchronized cardioversion, the nurse understands that the electrical charge is delivered at which point? A. Initiation of the QRS complex B. During the ST segment C. At the peak of the R wave D. Just before the onset of the P wave

Answer: C. Synchronized cardioversion delivers an electrical charge to the myocardium at the peak of the R wave.

2. A patient receiving IV nitroprusside for treatment of hypertensive crisis develops blurred vision and tinnitus. The nurse also notes that LOC has decreased. Which action is most appropriate? A. Increase the rate of nitroprusside infusion. B. Obtain an order for an antiarrhythmic. C. Obtain a serum thiocyanate level. D. Increase the flow rate of supplemental oxygen.

Answer: C. The patient is exhibiting signs and symptoms of thiocyanate toxicity, which include fatigue, nausea, tinnitus, blurred vision, and delirium. Therefore, the nurse must obtain a serum thiocyanate level and notify the practitioner if the level is greater than 10 mg/dL.

9. A patient admitted with an acute MI has a heart rate of 36 beats/minute. Based on this finding, which area of the heart is most likely serving as the pacemaker? A. SA node B. AV node C. Bachmann's bundle D. Purkinje fibers

Answer: D. If the SA node (which fires at a rate of 60 to 100 times per minute) and the AV node (which takes over firing at 40 to 60 times per minute) are damaged, the Purkinje fibers take over firing at a rate of 20 to 40 times per minute.

3. Immediate treatment of ventricular fibrillation includes: A. epinephrine, defibrillation, and procainamide. B. defibrillation, CPR, atropine, and lidocaine. C. epinephrine, defibrillation, and atropine. D. defibrillation, CPR, defibrillation, CPR, epinephrine or vasopressin, and resume CPR and defibrillation.

Answer: D. Perform defibrillation, resume CPR for 2 minutes, defibrillate, and then resume CPR. Then administer epinephrine or vasopressin. Resume attempts at CPR and defibrillation.

5. Persistent tachycardia in a patient who has had an MI may signal: A. chronic sick sinus syndrome. B. pulmonary embolism or stroke. C. the healing process. D. impending heart failure or cardiogenic shock.

Answer: D. Sinus tachycardia occurs in about 30% of patients after acute MI and is considered a poor prognostic sign because it may be associated with massive heart damage.

8. A patient is being taught how to care for his pacemaker site by the critical care nurse. Which of the following indicates that this patient understands safe care of the device? A. "I will not handle the pacemaker leads at the same time as the toaster." B. "I will obtain a medic alert tag as soon as I can." C. "Since it was implanted in the OR I do not have to worry about infection." D. "I must not be around a home microwave."

B. The patient needs to get a medical alert tag as health care providers need to avoid the generator box site during defibrillation. There are no external wires, so electrical safety is not an issue. All surgical sites need to be monitored for infection, and home microwaves do not interfere with newer permanent pacers.

9. The nurse prepares to administer an ACE inhibitor to a patient with an acute MI for which reason? A. To minimize platelet aggregation B. To reduce preload and afterload C. To reduce myocardial oxygen consumption D. To decrease myocardial oxygen demand

Correct answer: B ACE inhibitors reduce preload and afterload. Antiplatelet drugs minimize platelet aggregation (Option A). Nitrates reduce myocardial oxygen consumption (Option C). Beta-adrenergic blockers reduce the workload of the heart and myocardial oxygen demand (Option D).

1. While auscultating the heart sounds of a patient with mitral insuffi ciency, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this extra heart sound as: A. a fi rst heart sound (S1). B. a third heart sound (S3). C. a fourth heart sound (S4). D. a mitral murmur.

Correct answer: B An S3 is heard following an S2, indicating that the patient is experiencing heart failure and results from increased filling pressures. Option A (S1) is a normal heart sound made by the closing of the mitral and tricuspid valves. Option C (S4) is heard before S1 and is caused by resistance to ventricular fi lling. Option D (murmur of mitral insufficiency) occurs during systole and is heard when there's turbulent blood flow across the valve.

4. A patient is receiving captopril for heart failure. The nurse should notify the practitioner that the medication therapy is ineffective if an assessment reveals: A. a skin rash. B. peripheral edema. C. a dry cough. D. postural hypotension.

Correct answer: B Peripheral edema is a sign of fluid volume overload and worsening heart failure. The other options (a skin rash, dry cough, and postural hypotension) are adverse reactions to captopril, but they don't indicate that therapy isn't effective.

3. The nurse is administering warfarin (Coumadin) to a patient with deep vein thrombophlebitis. Which laboratory value indicates warfarin is at therapeutic levels? A. PTT 1ó to 2 times the control B. PT 1ó to 2 times the control C. INR of 3 to 4 D. Hematocrit of 32%

Correct answer: B Warfarin is at therapeutic levels when the patient's PT is 1ó to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, and lower values indicate increased risk of blood clot formation. Option A is incorrect because heparin, not warfarin, prolongs PTT. Option C is incorrect because although the INR may also be used to determine if warfarin is at a therapeutic level, an INR of 2 to 3 is considered therapeutic. Option D is incorrect because hematocrit doesn't provide information on the effectiveness of warfarin; however, a falling hematocrit in a patient taking warfarin may be a sign of hemorrhage.

2. A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work site health screening. What should the nurse do? A. Consider this to be a normal finding for his age and race. B. Recommend he have his blood pressure rechecked in 1 year. C. Recommend he have his blood pressure rechecked within 2 weeks. D. Recommend he go to the emergency department for further evaluation.

Correct answer: C A blood pressure of 150/90 mm Hg should be rechecked within 2 weeks according to current recommendations. If confi rmed, assessment and treatment should be initiated by the practitioner. Option A is incorrect because although hypertension is more prevalent among blacks, a blood pressure of 150/90 mm Hg isn't considered normal. Option B is incorrect because a person with a blood pressure of 150/90 mm Hg shouldn't wait as long as 1 year to have it rechecked. Option D is incorrect because he doesn't need to be treated on an emergency basis, but he should have his blood pressure monitored.

10. Which of the following conditions can cause right-sided heart failure? A. A ventricular septal defect B. An anterior MI C. An atrial septal defect D. Constrictive pericarditis

Correct answer: C An atrial septal defect can lead to right-sided heart failure. Left-sided heart failure can result from a ventricular septal defect (Option A), an anterior MI (Option B), or constrictive pericarditis (Option D).

5. A 60-year-old male patient is suspected of having coronary artery disease. Which noninvasive diagnostic method would the nurse expect to be ordered to evaluate cardiac changes? A. Cardiac biopsy B. Cardiac catheterization C. MRI D. Pericardiocentesis

Correct answer: C MRI is a noninvasive procedure that aids in the diagnosis and detection of thoracic aortic aneurysm and evaluation of coronary artery disease, pericardial disease, and cardiac masses. Cardiac biopsy (Option A), cardiac catheterization (Option B), and pericardiocentesis (Option D) are invasive techniques used to evaluate cardiac changes.

8. When caring for a patient with arterial occlusive disease, which of the following home health care instructions is most appropriate for the nurse to give to the patient? A. "You should massage your legs to relieve pain." B. "It's best to sit and rest for several hours a day." C. "Make sure the head of your bed is slightly elevated when sleeping." D. "It's best to wear tight socks instead of no socks."

Correct answer: C The patient should make sure the head of the bed is slightly elevated to aid perfusion to the lower extremities. The patient shouldn't massage his legs (Option A) because doing so could further damage tissue. Sitting for several hours a day (Option B) isn't recommended. The patient should wear loose clothing, not constrictive clothing such as socks with tight elastic (Option D), to avoid compressing the vessels in the legs.

6. When evaluating an ECG strip of a patient on a telemetry unit, the nurse notices the patient is having premature ventricular contractions (PVCs). What criterion on the ECG strip does the nurse use to evaluate the presence of PVCs? A. An indiscernible PR interval B. P waves that appear erratic C. P waves that have a sawtooth confi guration D. A QRS complex followed by a compensatory pause

Correct answer: D In PVCs, the ECG shows a QRS complex followed by a compensatory pause that ends when the underlying rhythm resumes. Options A and B are ECG criteria used to evaluate atrial fibrillation. Option C is used to describe criteria for atrial fl utter.

1. Which isoenzyme most quickly reflects that a patient has suffered an acute and recent myocardial infarction? A. LDH B. CK-MM C. SGOT D. Troponin

D. This enzyme is found in cardiac tissue and will rapidly increase with the onset of a myocardial infarction.

7. A 65-year-old client is admitted for heart failure. The physician orders daily administration of furosemide (Lasix). Which intervention should the nurse perform every day before administering the medication? 1. Check the client's weight. 2. Check the client's apical heart rate. 3. Ask the client whether he's experiencing any numbness. 4. Provide the client with extra fluids.

heart can't move blood as quickly as it should. This decreases urine output and increases weight. Therefore, the client should be weighed daily. Checking the client's apical heart rate isn't indicated before administering furosemide. Clients may have numbness in the extremities because of increased peripheral edema, but numbness doesn't inhibit the administration of the medication. The nurse shouldn't provide the client with extra fluids because clients with heart failure are commonly on fluid restrictions.