EXAM 2 Med Surg ATI and Lacharity

What are common treatments for dysrhythmias?

Bradycardia (any rhythm less than 60/min). Treat if the client is symptomatic. Medication: Atropine and isoproterenol. Electrical management: Pacemaker Atrial fibrillation; Supraventricular tachycardia; Ventricular tachycardia with pulse. Medication: Amiodarone, adenosine, and verapamil Electrical management: Synchronized cardioversion Ventricular tachycardia without pulse or ventricular fibrillation. Medication: Amiodarone, lidocaine, and epinephrine. Electrical management: Defibrillation

INDICATIONS for an ECG includes dysrhythmias ... but what are examples of dysrhythmias?

Sinus bradycardia and tachycardia Atrioventricular (AV) blocks, Atrial fibrillation, Ventricular asystole, Premature atrial complexes (PACs) and premature, ventricular complexes (PVCs), Supraventricular tachycardia, Ventricular tachycardia, & Ventricular fibrillation

For clients receiving continuous ECG monitoring, what are some key important teaching points to be shared with the patient? *Hint* ABC's

Inform clients receiving continuous ECG monitoring that the monitoring will not detect shortness of breath, chest pain, or other manifestations of acute coronary syndrome. The client should be instructed to report new or worsening symptoms.

A nurse is caring for a client in a clinic who asks the nurse why her provider prescribed 1 aspirin per day. Which of the following is an appropriate response but he nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relives the pain dye to myocardial ischemia." C. "Aspirin dissolves clots that are forming in your coronary arteries." D. "Aspirin relives headaches that are caused by other medications."

A. "Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A. "I will notify the airport screeners about my pacemaker." B. "I will expect to have occasional hiccups." C."I will have to disconnect my garage door opener." D."I will take my pulse every 2 to 3 days."

A. "I will notify the airport screeners about my pacemaker."

1. You are working in the emergency department (ED) when a client arrives reporting substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be most useful in determining whether you should anticipate implementing the acute coronary syndrome (ACS) standard protocol? 1. Creatine kinase MB level 2. Troponin I level 3. Myoglobin level 4. C-reactive protein level

1. Ans: 2. Troponin I level Cardiac troponin levels are elevated 3 hours after the onset of ACS (unstable angina or myocardial infarction [MI]) and are very specific to cardiac muscle injury or infarction. Although levels of creatine kinase MB and myoglobin also increase with MI, the increases occur later and/or are not as specific to myocardial damage as troponin levels. Elevated C-reactive protein levels are a risk factor for coronary artery disease but are not useful in detecting acute injury or infarction. Focus: Prioritization

10. You are working in the ED caring for a client who was just admitted with left anterior chest pain, possible ACS. Which action will you take first? 1. Insert an IV catheter. 2. Auscultate heart sounds. 3. Administer sublingual nitroglycerin. 4. Draw blood for troponin I measurement.

10. Ans: 3. Administer sublingual nitroglycerin. The priority for a client with unstable angina or MI is treatment of pain. It is important to remember to assess vital signs before administering sublingual nitroglycerin. The other activities also should be accomplished rapidly but are not as high a priority. Focus: Prioritization

11. An 80-year-old client on the coronary step-down unit tells you that he does not want to take the ordered docusate (Colace) because he does not have any problems with constipation. Which action is most appropriate? 1. Document the medication on the client's chart as "refused." 2. Mix the medication with food and administer it to the client. 3. Explain that his decreased activity level may cause constipation. 4. Reinforce that the docusate has been prescribed for a good reason.

11. Ans: 3. Explain that his decreased activity level may cause constipation. The best option in this situation is to educate the client about the purpose of the docusate (to counteract the negative effects of immobility and narcotic use on peristalsis). Charting the medication as "refused" or telling the client that he should take the docusate simply because it was prescribed are possible actions but are not as appropriate as client education. It is unethical to administer a medication to a client who is unwilling to take it, unless someone else has health care power of attorney and has authorized use of the medication. Focus: Prioritization

12. You have given morphine sulfate 4 mg IV to a client who has an acute MI. When you evaluate the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action? 1. Blood pressure decrease from 114/65 to 106/58 mm Hg 2. Respiratory rate drop from 18 to 12 breaths/min 3. Cardiac monitor indicating sinus rhythm at a rate of 96 beats/min 4. Persisting chest pain at a level of 1 (on a scale of 0 to 10)

12. Ans: 4. Persisting chest pain at a level of 1 (on a scale of 0 to 10) The goal in pain management for the client with an acute MI is to completely eliminate the pain. Even pain rated at a level of 1 out of 10 should be treated with additional morphine sulfate (although possibly a lower dose). The other data indicate a need for ongoing assessment for the possible adverse effects of hypotension, respiratory depression, and tachycardia but do not require further action at this time. Focus: Prioritization

13. You are preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had an MI and her husband. The client says, "I don't see why I need any teaching. I don't think I need to change anything right now." Which response is most appropriate? 1. "Do you think your family may want you to make some lifestyle changes?" 2. "Can you tell me why you don't feel that you need to make any changes?" 3. "You are still in the stage of denial, but you will want this information later on." 4. "Even though you don't want to change, it's important that you have this teaching."

13. Ans: 2. "Can you tell me why you don't feel that you need to make any changes?" For behavior to change, the client must be aware of the need to make changes. This response acknowledges the client's statement and asks for further clarification. This will give you more information about the client's feelings, current diet, and activity levels and may increase the willingness to learn. The other responses (although possibly accurate) indicate an intention to teach whether the client is ready or not and are not likely to lead to changes in lifestyle. Focus: Prioritization

14. You are caring for a hospitalized client with heart failure who is receiving captopril (Capoten) and spironolactone (Aldactone). Which laboratory value will be most important to monitor? 1. Sodium level 2. Blood urea nitrogen level 3. Potassium level 4. Alkaline phosphatase level

14. Ans: 3. Potassium level Hyperkalemia is a common adverse effect of both ACE inhibitors and potassium-sparing diuretics. The other laboratory values may be affected by these medications but are not as likely or as potentially life threatening. Focus: Prioritization

15. The health care provider telephones you with new prescriptions for a client with unstable angina who is already taking clopidogrel (Plavix). Which medication is most important to clarify further with the health care provider? 1. Aspirin (Ecotrin) 162 mg daily 2. Omeprazole (Prilosec) 20 mg daily 3. Metoprolol (Lopressor) 50 mg daily 4. Nitroglycerin patch (Nitrodur) 0.4 mg/hr

15. Ans: 2. Omeprazole (Prilosec) 20 mg daily Since proton pump inhibitors such as omeprazole affect the metabolism of clopidogrel and decrease its effectiveness, the health care provider may want to discontinue the omeprazole in this client with unstable angina. The other medications should also be verified, but current national guidelines for clients with unstable angina indicate that providers should consider avoiding proton pump inhibitors in those who require clopidogrel. Focus: Prioritization

16. At 10:00 AM, a hospitalized client receives a new order for transesophageal echocardiography (TEE) as soon as possible. Which action will you take first? 1. Put the client on "nothing by mouth" (NPO) status. 2. Teach the client about the procedure. 3. Insert an IV catheter in the client's forearm. 4. Attach the client to a cardiac monitor.

16. Ans: 1. Put the client on "nothing by mouth" (NPO) status. Because TEE is performed after the throat is numbed using a topical anesthetic and possibly after IV sedation, it is important that the client be placed on NPO status for several hours before the test. The other actions also will need to be accomplished before the TEE but do not need to be implemented immediately. Focus: Prioritization

17. You assess a client who has just returned to the recovery area after undergoing coronary arteriography. Which information is of most concern? 1. Blood pressure is 144/78 mm Hg 2. Pedal pulses are palpable at +1 3. Left groin has a 3-cm bruised area 4. Apical pulse is 122 beats/min and regular

17. Ans: 4. Apical pulse is 122 beats/min and regular The most common complication after coronary arteriography is hemorrhage, and the earliest indication of hemorrhage is an increase in heart rate. The other data may also indicate a need for ongoing assessment, but the increase in heart rate is of most concern. Focus: Prioritization

18. You are working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to an experienced UAP? 1. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated 2. Checking blood pressure and pulse every 10 minutes in a client who is undergoing exercise testing 3. Obtaining information about allergies from a client who is scheduled for left leg contrast venography 4. Providing brief client teaching for a client who will undergo a right subclavian vein Doppler study

18. Ans: 1. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated Measurement of ankle and brachial blood pressures for ankle-brachial index calculation is within the UAP's scope of practice. Calculating the ankle-brachial index and any referrals or discussion with the client are the responsibility of the supervising RN. The other clients require more complex assessments or client teaching, which should be done by an experienced RN. Focus: Delegation

19. While working on the cardiac step-down unit, you are serving as preceptor to a newly graduated RN who has been in a 6-week orientation program. Which client will be best to assign to the new graduate? 1. 19-year-old with rheumatic fever who needs discharge teaching before going home with a roommate today 2. 33-year-old admitted a week ago with endocarditis who will be receiving ceftriaxone (Rocephin) 2 g IV 3. 50-year-old with newly diagnosed stable angina who has many questions about medications and nursing care 4. 75-year-old who has just been transferred to the unit after undergoing coronary artery bypass grafting yesterday

19. Ans: 2. 33-year-old admitted a week ago with endocarditis who will be receiving ceftriaxone (Rocephin) 2 g IV The new RN's education and hospital orientation would have included safe administration of IV medications. The preceptor will be responsible for the supervision of the new graduate in assessments and client care. The other clients require more complex assessment or client teaching by an RN with experience in caring for clients with these diagnoses. Focus: Assignment

2. You are monitoring a 53-year-old client who is undergoing a treadmill stress test. Which client finding will require the most immediate action? 1. Blood pressure of 152/88 mm Hg 2. Heart rate of 134 beats/min 3. Oxygen saturation of 91% 4. Chest pain level of 3 (on a scale of 10)

2. Ans: 4. Chest pain level of 3 (on a scale of 10) Chest pain in a client undergoing a stress test indicates myocardial ischemia and is an indication to stop the testing to avoid ongoing ischemia, injury, or infarction. Moderate elevations in blood pressure and heart rate and slight decreases in oxygen saturation are a normal response to exercise and are expected during stress testing. Focus: Prioritization

20. You are monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need immediate intervention? 1. Client admitted with heart failure who has atrial fibrillation with a rate of 88 beats/min while at rest 2. Client with a newly implanted demand ventricular pacemaker who has occasional periods of sinus rhythm at a rate of 90 to 100 beats/min 3. Client who has just arrived on the unit with an acute MI and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions 4. Client who recently started taking atenolol (Tenormin) and has a first-degree heart block, with a rate of 58 beats/min

20. Ans: 3. Client who has just arrived on the unit with an acute MI and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions Premature ventricular contractions occurring in the setting of acute myocardial injury or infarction can lead to ventricular tachycardia and/or ventricular fibrillation (cardiac arrest), so rapid treatment is necessary. The other clients also have dysrhythmias that will require further assessment, but these are not as immediately life threatening as the premature ventricular contractions in the setting of MI. Focus: Prioritization

21. Ventricular fibrillation is identified in an unresponsive 50-year-old client who has just arrived in the ED. Which action will you take first? 1. Defibrillate at 200 J. 2. Start cardiopulmonary resuscitation (CPR). 3. Administer epinephrine (Adrenalin) 1 mg IV. 4. Intubate and manually ventilate.

21. Ans: 1. Defibrillate at 200 J. Research indicates that rapid defibrillation improves the success of resuscitation in cardiac arrest. If defibrillation is unsuccessful in converting the client's rhythm into a perfusing rhythm, CPR should be initiated. Administration of medications and intubation are later interventions. Determining which of these interventions will be used first depends on other factors, such as whether IV access is available. Focus: Prioritization

22. Two weeks ago, a 63-year-old client with heart failure received a new prescription for carvedilol (Coreg) 3.125 mg orally. When evaluating the client in the cardiology clinic, you obtain the following data. Which finding is of most concern? 1. Reports of increased fatigue and activity intolerance 2. Weight increase of 0.5 kg over a 1-week period 3. Sinus bradycardia at a rate of 48 beats/min 4. Traces of edema noted over both ankles

22. Ans: 3. Sinus bradycardia at a rate of 48 beats/min Research indicates that mortality is decreased when clients with heart failure use beta-blocking medications such as carvedilol. When beta-blocker therapy is started for clients with heart failure, heart failure symptoms may initially become worse for a few weeks, so increased fatigue, activity intolerance, weight gain, and edema are not indicative of a need to discontinue the medication at this time. However, the slow heart rate does require further follow-up, because bradycardia may progress to more serious dysrhythmias such as heart block. Focus: Prioritization

23. You have just received a change-of-shift report about these clients on the coronary step-down unit. Which one will you assess first? 1. 26-year-old with heart failure caused by congenital mitral stenosis who is scheduled for balloon valvuloplasty later today 2. 45-year-old with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change 3. 56-year-old who underwent coronary angioplasty and stent placement yesterday and has reported occasional chest pain since the procedure 4. 77-year-old who was transferred from the intensive care unit 2 days ago after coronary artery bypass grafting and has a temperature of 100.6° F (38.1° C)

23. Ans: 2. 45-year-old with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change The client's symptoms indicate acute hypoxia, so immediate further assessments (such as assessment of oxygen saturation, neurologic status, and breath sounds) are indicated. The other clients also should be assessed soon, because they are likely to require nursing actions such as medication administration and teaching, but they are not as acutely ill as the dyspneic client. Focus: Prioritization

24. As the charge nurse in a long-term care facility that employs RNs, LPNs/LVNs, and UAPs, you have developed a plan for the ongoing assessment of all residents with a diagnosis of heart failure. Which activity included in the plan is most appropriate to delegate to an LPN/LVN team member? 1. Weighing all residents with heart failure each morning 2. Listening to lung sounds and checking for edema each week 3. Reviewing all heart failure medications with residents every month 4. Updating activity plans for residents with heart failure every quarter

24. Ans: 2. Listening to lung sounds and checking for edema each week LPN/LVN education and scope of practice include data collection such as listening to lung sounds and checking for peripheral edema when caring for stable clients. Weighing the residents should be delegated to a UAP. Reviewing medications with residents and planning appropriate activity levels are nursing actions that require RN-level education and scope of practice. Focus: Delegation

25. During a home visit to an 88-year-old client who is taking digoxin (Lanoxin) 0.25 mg daily to treat heart failure and atrial fibrillation, you obtain this assessment information. Which finding is most important to communicate to the health care provider? 1. Apical pulse of 68 beats/min and irregularly irregular 2. Digoxin taken with meals 3. Vision that is becoming "fuzzy" 4. Lung crackles that clear after coughing

25. Ans: 3. Vision that is becoming "fuzzy" The client's visual disturbances may be a sign of digoxin toxicity. The nurse should notify the health care provider and obtain an order to measure the digoxin level. An irregularly irregular pulse is expected with atrial fibrillation; there are no contraindications to taking digoxin with food; and crackles that clear with coughing are indicative of atelectasis, not worsening of heart failure. Focus: Prioritization

26. You are ambulating a cardiac surgery client who has a telemetry cardiac monitor when another staff member tells you that the client has developed supraventricular tachycardia at a rate of 146 beats/min. In which order will you take the following actions? 1. Call the client's physician. 2. Have the client sit down. 3. Check the client's blood pressure. 4. Administer PRN oxygen by nasal cannula. _____, _____, _____, _____

26. Ans: 2, 4, 3, 1 2. Have the client sit down. 4. Administer PRN oxygen by nasal cannula. 3. Check the client's blood pressure. 1. Call the client's physician. The primary goal is to decrease the cardiac ischemia that may be causing the client's tachycardia. This would be most rapidly accomplished by decreasing the workload of the heart and administering supplemental oxygen. Changes in blood pressure indicate the impact of the tachycardia on cardiac output and tissue perfusion. Finally, the physician should be notified about the client's response to activity, because changes in therapy may be indicated. Focus: Prioritization

27. A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. You note that no pulse is palpable in the left foot and that it is cold and pale. Which action should you take next? 1. Lower the client's left foot below heart level. 2. Administer oxygen at 4 L/min to the client. 3. Notify the client's physician about the change in status. 4. Reassure the client that embolization is common in endocarditis.

27. Ans: 3. Notify the client's physician about the change in status. The client's history and symptoms indicate that acute arterial occlusion has occurred. Because it is important to return blood flow to the foot rapidly, the physician should be notified immediately so that interventions such as balloon angioplasty or surgery can be initiated. Changing the position of the foot and improving blood oxygen saturation will not improve oxygen delivery to the foot. Telling the client that embolization is a common complication of endocarditis will not reassure a client who is experiencing acute pain. Focus: Prioritization

28. A resident in a long-term care facility who has venous stasis ulcers is treated with an Unna boot. Which nursing activity included in the resident's care is best for you to delegate to the UAP? 1. Teaching family members the signs of infection 2. Monitoring capillary perfusion once every 8 hours 3. Evaluating foot sensation and movement each shift 4. Assisting the client in cleaning around the Unna boot

28. Ans: 4. Assisting the client in cleaning around the Unna boot Assisting with hygiene is included in the role and education of UAP. Assessments and teaching are appropriate activities for licensed nursing staff members. Focus: Delegation

29. During the initial postoperative assessment of a client who has just been transferred to the postanesthesia care unit after repair of an abdominal aortic aneurysm, you obtain these data. Which finding has the most immediate implications for the client's care? 1. Arterial line indicates a blood pressure of 190/112 mm Hg. 2. Cardiac monitor shows frequent premature atrial contractions. 3. There is no response to verbal stimulation. 4. Urine output is 40 mL of amber urine.

29. Ans: 1. Arterial line indicates a blood pressure of 190/112 mm Hg. Elevated blood pressure in the immediate postoperative period puts stress on the graft suture line and could lead to graft rupture and/or hemorrhage, so it is important to lower blood pressure quickly. The other data also indicate the need for ongoing assessments and possible interventions but do not pose an immediate threat to the client's hemodynamic stability. Focus: Prioritization

3. The health care provider prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to delegate to an experienced LPN/LVN who is working with you in the ED? (Select all that apply.) 1. Attaching cardiac monitor leads 2. Giving heparin 5000 units IV push 3. Administering morphine sulfate 4 mg IV 4. Obtaining a 12-lead electrocardiogram (ECG) 5. Asking the client about pertinent medical history 6. Having the client chew and swallow aspirin 162 mg

3. Ans: 1, 4, 6 1. Attaching cardiac monitor leads 4. Obtaining a 12-lead electrocardiogram (ECG) 6. Having the client chew and swallow aspirin 162 mg Attaching cardiac monitor leads, obtaining an ECG, and administering oral medications are within the scope of practice for LPN/LVNs. An experienced ED LPN/LVN would be familiar with these activities. Although anticoagulants and narcotics may be administered by LPNs/LVNs to stable clients, these are high-alert medications that should be given by the RN to this unstable client. Obtaining a pertinent medical history requires RN-level education and scope of practice. Focus: Delegation

30. You are developing a standardized care plan for the postoperative care of clients undergoing cardiac surgery. Which nursing activity included in the care plan will need to be performed by RN staff members? 1. Removing chest and leg dressings on the second postoperative day and cleaning the incisions with antibacterial swabs 2. Reinforcing client and family teaching about the need to deep breathe and cough at least every 2 hours while awake 3. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes 4. Administering oral analgesic medications as needed before helping the client out of bed on the first postoperative day

30. Ans: 3. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes Development of plans for client care or teaching requires RN-level education and is the responsibility of the RN. Wound care, medication administration, assisting with ambulation, and reinforcing previously-taught information are activities that can be delegated to other nursing personnel under the supervision of the RN. Focus: Delegation

31. You are preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? 1. Famotidine (Pepcid) 20 mg IV 2. Furosemide (Lasix) 40 mg IV 3. Digoxin (Lanoxin) 0.25 mg PO 4. Warfarin (Coumadin) 2.5 mg PO

31. Ans: 4. Warfarin (Coumadin) 2.5 mg PO Anticoagulant medications are high-alert medications and require special safeguards, such as double-checking of medications by two nurses before administration. Although the other medications require the usual medication safety procedures, double-checking is not needed. Focus: Prioritization

32. A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be most useful to monitor? 1. Serum potassium 2. B-type natriuretic peptide 3. Blood urea nitrogen 4. Hematocrit

32. Ans: 2. B-type natriuretic peptide Research indicates that B-type natriuretic peptide levels increase in clients with poor left ventricular function and symptomatic heart failure and can be used to differentiate heart failure from other causes of dyspnea and fatigue such as pneumonia. The other values should also be monitored, but do not indicate whether the client has heart failure. Focus: Prioritization

4. Based on this information in a client's medical record, which topic will you plan on including in the initial teaching plan for a client who has a new diagnosis of stage 1 hypertension? Health History- Denies any chronic health problems, currently takes no medications. Physical Exam- 5'6" , 115lbs, BMI 18.6. Social and Diet HX- Accountant, 1 glass of wine 1-2 times week, Eats fast food frequently. 1. Benefits and adverse effects of beta-blockers 2. Adverse effects of alcohol on blood pressure 3. Methods for decreasing dietary caloric intake 4. Low-sodium food choices when eating out

4. Ans: 4. Low-sodium food choices when eating out Research indicates that reducing sodium intake will lower blood pressure. Lifestyle management is appropriate initial therapy for this client with stage 1 hypertension and no cardiovascular disease or risk factors. Antihypertensive medications would not be prescribed unless lifestyle changes were attempted for several months without a decrease in blood pressure. This client's assessment data indicate that she is not overweight and does not drink alcohol excessively, so discussing changes in these risk factors would not be appropriate. Focus: Prioritization

5. You make a home visit to evaluate a hypertensive client who has been taking enalapril (Vasotec). Which finding indicates that you need to contact the health care provider about a change in the drug therapy? 1. Client reports frequent urination. 2. Client's blood pressure is 138/86 mm Hg. 3. Client coughs often during the visit. 4. Client says, "I get dizzy sometimes."

5. Ans: 3. Client coughs often during the visit. A persistent and irritating cough (caused by accumulation of bradykinin) is a possible adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril and is a common reason for changing to another medication category such as the angiotensin II receptor blockers. The other assessment data indicate a need for more client teaching and ongoing monitoring but would not require a change in therapy. Focus: Prioritization

6. While admitting a client, you obtain this information about her cardiovascular risk factors: Her mother and two siblings have had myocardial infarctions (MIs). The client smokes and has a 20 pack-year history of cigarette use. Her work as a mail carrier involves a lot of walking. She takes metoprolol (Lopressor) for hypertension, and her blood pressure has been in the range of 130/60 to 138/85 mm Hg. Which interventions will be important to include in the discharge plan for this client? (Select all that apply.) 1. Referral to community programs that assist in smoking cessation 2. Teaching about the impact of family history on cardiovascular risk 3. Education about the need for a change in antihypertensive therapy 4. Assistance in reducing the stress associated with her cardiovascular risk 5. Discussion of the risks associated with having a sedentary lifestyle

6. Ans: 1, 2 1. Referral to community programs that assist in smoking cessation 2. Teaching about the impact of family history on cardiovascular risk The client's major modifiable risk factor is her ongoing smoking. The family history is significant, and she should be aware that this increases her cardiovascular risk. The goal when treating hypertension with medications is reduction of blood pressure to under 140/90 mm Hg. There is no indication that stress is a risk factor for this client. The client's work involves moderate physical activity; although leisure exercise may further decrease her cardiac risk, this is not an immediate need for this client. Focus: Prioritization

7. You are the charge nurse for the coronary care step-down unit. Which client is best to assign to a float RN who has come for the day from the general medical-surgical unit? 1. Client requiring discharge teaching about coronary artery stenting before going home today 2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure 3. Client who just transferred in from the radiology department after a coronary angioplasty 4. Client just admitted with unstable angina who has orders for a heparin infusion and aspirin

7. Ans: 2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure An RN who worked on a medical-surgical unit would be familiar with left ventricular failure, the administration of IV medications, and ongoing monitoring for therapeutic and adverse effects of furosemide. The other clients need to be cared for by RNs who are more familiar with the care of clients who have ACS and with collaborative treatments such as coronary angioplasty and coronary artery stenting. Focus: Assignment

8. At 9:00 pm, you admit a 63-year-old with a diagnosis of acute MI. Which finding is most important to communicate to the health care provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator (alteplase [Activase]) for the client? 1. The client was treated with alteplase about 8 months ago. 2. The client takes famotidine (Pepcid) for esophageal reflux. 3. The client has ST-segment elevations on the 12-lead ECG. 4. The client has had continuous chest pain since 8:00 AM.

8. Ans: 4. The client has had continuous chest pain since 8:00 AM. Because continuous chest pain lasting for more than 12 hours indicates that reversible myocardial injury has progressed to irreversible myocardial necrosis, fibrinolytic drugs are not recommended for clients with chest pain that has lasted for more than 12 hours. The other information is also important to communicate but would not impact the decision about alteplase use. Focus: Prioritization

9. You are working with an experienced UAP and an LPN/LVN on the telemetry unit. A client who had an acute MI 3 days ago has a nursing diagnosis of Activity Intolerance related to fatigue and chest pain. Which nursing activity included in the care plan is best delegated to the LPN/LVN? 1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client activities 2. Monitoring pulse, blood pressure, and oxygen saturation before and after client ambulation 3. Teaching the client energy conservation techniques to decrease myocardial oxygen demand 4. Explaining the rationale for alternating rest periods with exercise to the client and family

9. Ans: 1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client activities Administration of nitroglycerin and appropriate client monitoring for therapeutic and adverse effects are included in LPN/LVN education and scope of practice. Monitoring of blood pressure, pulse, and oxygen saturation should be delegated to the UAP. Client teaching requires RN-level education and scope of practice. Focus: Delegation

A nurse preparing to care for a client following chest tube placement. Which of the following items should be available in the client's room? (Select all that apply) A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing

A, B, C, E Oxygen should be readily available in case the client develops respiratory distress following chest tube placement. If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal Hemostat clamps should be available for the nurse to use to check air leaks Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax

A nurse is reviewing the health records of five clients. Which of the following clients are at risk for developing acute respiratory distress syndrome (ARDS)? (Select all that apply) A. A client who experienced a near-drowning incident B. A client following coronary artery bypass graft surgery C. A client who has a hemoglobin of 15.1 mg/dL D. A client who has dysphagia E. A client who experienced a drug overdose

A, B, D, E A client who experienced a near-drowning incident has had trauma to the lungs and cerebral edema A client following coronary artery bypass graft surgery has had trauma to the chest A client who has dysphagia has difficulty swallowing and is at a risk for aspiration A client who experienced a drug overdose has damage to the central nervous system

A nurse is caring for a client who is receiving hemodynamic monitoring readings: PAS 34 mm Hg, PAD 21 mm Hg, PAWP 16 mm Hg, CVP 12 mm Hg. For which of the following is the client at risk? (Select all that apply) A. Heart Failure B. Cor pulmonale C. Hypovolemic shock D. Pulmonary hypertension E. Peripheral edema

A, B, D, E A. Heart failure is associated with left ventricular failure and would be indicated by elevated hemodynamic readings B. Cor pulmonale is associated with the right side of the heart, and pulmonary problems would be indicated by elevated hemodynamic readings D. Pulmonary hypertension is associated with high blood pressure in the pulmonary arteries, affects the right side of the heart, and would be indicated by elevated hemodynamic readings E. Peripheral edema is associated with left ventricular failure and would be indicated by elevated hemodynamic readings

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply) A. Encourage the client to cough every 2 hours B Check for continuous bubbling in the suction chamber C. Strip the drainage tubing every 4 hours D. Clamp the tube once a day E. Obtain a chest x ray

A, B, E Cough every 2 hours to promote oxygenation and lung reexpansion Check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level A chest x ray is obtained following the procedure to verify chest tube placement

A nurse is reviewing a new prescription to administer 0.9% NaCl IV at 50 ml/hr to a client who is receiving hemodynamic monitoring and has an indwelling IV catheter in the left hand. Which of the following sites can be used for administering this solution? (Select all that apply) A. Peripheral saline lock B. Port on the arterial line C. Port on proximal (CVP) lumen of pulmonary artery (PA) catheter D. Port on distal lumen of PA catheter E. Balloon inflation port

A, C A. IV fluid administration can occur via a lock on a peripheral IV catheter C. The proximal (CVP) lumen of a PA catheter is used for hemodynamic monitoring and can also be used for IV fluid administration.

A nurse is caring for a client who is receiving vecuronium (Norcuron) for acute respiratory distress syndrome (ARDS). Which of the following medications should the nurse anticipate administering with this medication? (Select all that apply) A. Fentanyl (Duragesic) B. Furosemide (Lasix) C. Midazolam (Versed) D. Famotidine (Pepcid) E. Dexamethasone (Decadron)

A, C Fentanyl is a pain medication used to treat clients who has ARDS when a neuromuscular blocking agent us administered Midazolam (Versed) is a sedative medication used when a neuromuscular blocking agent is administered

A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review? A. "This means the pacemaker fires in an asynchronous pattern." B. "This means the pacemaker fires only when the heart rate is below a certain rate." C."The pacemaker can automatically adjust to a client's increased activity level." D."The pacemaker activity is triggered by heart muscle activity."

A. "This means the pacemaker fires in an asynchronous pattern."

A nurse working on a cardiac unit is admitting a client who is to undergo a cardioversion and is reviewing the health record. Which of the following data requires that the nurse notify the provider to cancel the procedure? (Review the data below for additional client information.) MAR Ferrous Sulfate 200 mg PO 0800 and 2000 Diazepam 2 mg PO 0800 and 2000 Isosorbide 2.5 mg PO 4 times a day AC and HS VITAL SIGNS 0800: T 99° F (37.2° C), Blood pressure 142/86 mm Hg Heart rate 88/min and irregular, Respirations 20/min HISTORY AND PHYSICAL Bariatric surgery 10 years ago Dyspnea with exertion for 3 years Atrial fibrillation began 3 years ago Client reports taking the following medications for the past 6 weeks: iron supplement, multivitamin, antilipemic, and nitroglycerin A.Respiratory history B.Vital signs C.Medication history D.Medications to be administered

A. A client who has a dysrhythmia often has a history of lung disease, which can make him a candidate for cardioversion. B. A client who has a dysrhythmia might have an irregular pulse, which can make him a candidate for cardioversion. C. CORRECT: A client who is to undergo cardioversion needs to be on anticoagulant therapy for 4 to 6 weeks prior to the procedure. D. A client who has a dysrhythmia often has a history of cardiac disease and angina, which can make him a candidate for cardioversion.

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolves in less than 15 minutes. C. The type of activity that causes an MI can be identified. D. Angina can occur for longer than 30 minutes.

A. Angina can be relieved with rest and nitroglycerin.

A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply.) A. A client who has metabolic alkalosis B. A client who has a serum potassium level of 4.3 mEq/L C. A client who has an SaO2 of 96% D. A client who has COPD E. A client who underwent stent placement in a coronary artery

A. CORRECT: A client who has an acid‐base imbalance such as metabolic alkalosis is at risk for a dysrhythmia. B. A serum potassium of 4.3 mEq/L is within the expected reference range and does not increase the risk of a dysrhythmia. C. SaO2 of 96% is within the expected reference range and does not increase the risk of a dysrhythmia. D. CORRECT: A client who has lung disease, such as COPD, is at risk for a dysrhythmia. E. CORRECT: A client who has cardiac disease and underwent a stent placement is at risk for a dysrhythmia.

A nurse is caring for a client who has a new diagnosis of hypertension and a new prescription for spironolactone (Aldactone) 25 mg/day. Which of the following statements by the client indicates a need for further teaching? A. "I should eat a lot of fruits and vegetables, especially bananas and potatoes." B. "I will report any changes in heart rate or rhythm." C. "I should use a salt substitute that is low in potassium." D. "I will continue to take this medication even if I am feeling better."

A. CORRECT: Potatoes and bananas are high in potassium, and spironolactone is a potassium-sparing diuretic. Consuming these foods can lead to hyperkalemia. B. INCORRECT: The client should report any changes in heart rate or rhythm. C. INCORRECT: Using salt substitutes that are low in potassium prevents hyperkalemia. D. INCORRECT: The client should be instructed to continue taking her medication even if she is symptom-free.

A nurse is providing discharge teaching for a client who has a prescription for furosemide (Lasix) 40 mg PO daily. What time of day should the nurse encourage the client to take this medication? A. Morning B. Immediately after lunch C. Immediately before dinner D. Bedtime

A. CORRECT: The client should take furosemide, a diuretic, in the morning so that the peak action and duration of the medication occurs during waking hours. B. INCORRECT: Taking furosemide, a diuretic, at this time increases the likelihood of interruption of the client's sleep due to the need to urinate. C. INCORRECT: Taking furosemide, a diuretic, at this time increases the likelihood of interruption of the client's sleep due to the need to urinate. D. INCORRECT: Taking furosemide, a diuretic, at this time increases the likelihood of interruption of the client's sleep due to the need to urinate.

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (Select all that apply.) A. Follow‐up ECG B. Energy settings used C. IV fluid intake D. Urinary output E. Skin condition under electrodes

A. CORRECT: The client's ECG rhythm is documented following the procedure. B. CORRECT: Energy settings used during the procedure are documented. C. IV fluid intake is not documented during defibrillation. D. Urinary output is not documented during defibrillation. E. CORRECT: The condition of the client's skin where electrodes were placed is documented.

A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for coronary artery bypass grafting with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply.)

A. CORRECT: The use of cardiopulmonary bypass reduces the client's demand for oxygen, which reduces the risk of inadequate oxygenation of vital organs. B. CORRECT: Motion of the heart ceases during cardiopulmonary bypass to allow for placement of the graft near the affected coronary artery. C. CORRECT: The core body temperature is lowered forthe procedure, and rewarming then occurs through heatexchanges on the cardiopulmonary bypass machine

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Cool and clammy foot with capillary refill of 5 seconds B. Observed pacing spike followed by a QRS complex C. Persistent hiccups D. Heart rate 84/min E. Blood pressure 104/62 mm Hg

A. Cool and clammy foot with capillary refill of 5 seconds C. Persistent hiccups

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client? A. Defibrillation B. Pacemaker insertion C. Synchronized cardioversion D. Administration of IV lidocaine

A. Defibrillation is used when a client has ventricular fibrillation or pulseless ventricular tachycardia. B. CORRECT: A client who has bradycardia is a candidate for a pacemaker to increase his heart rate. C. Synchronized cardioversion is used when a client has a dysrhythmia such as atrial fibrillation, supraventricular tachycardia (SVT), or ventricular tachycardia with pulse. D. The administration of IV lidocaine is used in clients who have a pulseless ventricular dysrhythmia to stimulate cardiac electrical function.

A nurse is caring for a client who is admitted to the emergency department with a blood pressure of 266/147 mm Hg. The client reports a headache and states that she is seeing double. The client states that she ran out of her diltiazem (Cardizem) 3 days ago, and she has not been able to purchase more. Which of the following nursing interventions should the nurse expect to perform first? A. Administer acetaminophen for headache. B. Provide teaching in regard to the importance of not abruptly stopping an antihypertensive. C. Obtain IV access and prepare to administer an IV antihypertensive. D. Call social services for a referral for financial assistance in obtaining prescribed medication.

A. INCORRECT: Administering acetaminophen is an appropriate action, but it is not the first action. B. INCORRECT: Providing teaching regarding medication administration is an appropriate action, but it is not the first action. C. CORRECT: The greatest risk to the client is injury due to a blood pressure of 266/147 mm Hg, which can be life-threatening and should be lowered as soon as possible. Obtaining IV access will permit administration of an IV hypertensive, which will act more rapidly than by the oral route. D. INCORRECT: Calling social services is an appropriate action, but it is not the first action.

A nurse in an urgent care clinic is obtaining a history from a client who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in two weeks that the client experienced hypoglycemia. Which of the following data should the nurse report to the provider? A. Takes psyllium hydrophilic muccilloid (Metamucil) daily B. Drinks skim milk daily C. Takes metoprolol (Lopressor) daily D. Drinks grapefruit juice daily

A. INCORRECT: Adverse effects of Metamucil do not include hypoglycemia. This does not need to be reported to the provider. B. INCORRECT: Skim milk will increase blood glucose levels and lower cholesterol. This does not need to be reported to the provider. C. CORRECT: Lopressor can mask the effects of hypoglycemia in clients with diabetes mellitus. This should be reported to the provider. D. INCORRECT: Grapefruit juice will increase blood glucose levels. This does not need to be reported to the provider.

A nurse is screening a client for hypertension. Which of the following actions by the client increase his risk for hypertension? (Select all that apply.) A. Drinking 8 oz of nonfat milk daily B. Eating popcorn at the movie theater C. Walking 1 mile daily at 12 min/mile pace D. Consuming 36 oz of beer daily E. Getting a massage once a week

A. INCORRECT: Consuming low-fat beverages and foods lowers the risk for developing hypertension. B. CORRECT: Popcorn at a movie theater contains a large quantify of sodium and fat, which increases the risk for hypertension. C. INCORRECT: Engaging in regular exercise, such as walking, lowers the risk of developing hypertension. D. CORRECT: Consuming more than 24 oz of beer per day can contribute to weight gain, which increases the risk for hypertension. E. INCORRECT: Stress management activities, such as a massage, lowers the risk of hypertension.

A student nurse is observing a cardioversion procedure and hears the team leader call out, "Stand clear." The student should recognize the purpose of this action is to alert personnel that A. the cardioverter is being charged to the appropriate setting. B. they should initiate CPR due to pulseless electrical activity. C. they cannot be in contact with equipment connected to the client. D. a time‐out is being called to verify correct protocols.

A. The cardioverter is charged prior to the delivery of the shock during cardioversion. B. The team leader calls out "Initiate CPR" when members of the team are to begin CPR. C. CORRECT: A safety concern for personnel performing cardioversion is to "stand clear" of the client and equipment connected to the client when a shock is delivered to prevent them from also receiving a shock. D. A "time‐out" is called by personnel during a procedure to verify that proper protocols are being followed.

A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following nursing actions should the nurse use to promote client safety? (Select all that apply.) A. Wear gloves when handling pacemaker leads. B. Ensure electronic equipment has three‐pronged grounding plugs. C. Minimize the client's shoulder movements. D. Hold the lead wires taut when turning the client. E. Keep extra pacemaker batteries at least 300 ft away from the client.

A. Wear gloves when handling pacemaker leads. C. Minimize the client's shoulder movements.

A nurse is caring for a client who is 4 hr postop following coronary artery bypass grafting (CABG) surgery. The client is able to inspire 200 mL with the incentive spirometer, then declines to try to cough becasue of fatigue and pain. Which of the following actions should the nurse take?

Administer IV bolus analgesic, and return in 15 minutes

A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the client's chest tube was accidentally removed. Which of the following actions should the nurse take first? A. Place the tubing in sterile water to restore the water seal B. Apply sterile gauze to the insertion site C. Place tape around the insertion site D. Assess the client's respiratory status

B. Using ABC priority framework, the application of a sterile gauze to the site should be the first action for the nurse to take. This allows the air to escape and reduces the risk of the tension pneumothorax

A nurse is orienting a newly licensed nurse who is caring for a client who is receiving mechanical ventilation and is on pressure support ventilation (PSV) mode. Which of the following statements by the newly licensed nurse indicates an understanding of PSV? A) "It keeps the alveoli open and prevents atelectasis." B) "It allows preset pressure delivered during spontaneous ventilation" C) "It guarantees minimal minute ventilator" D) "It delivers a preset ventilatory rate and tidal volume to the client."

B) "It allows preset pressure delivered during spontaneous ventilation"

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations o hypoxemia should the nurse recognize? (select all that apply) A) Confusion B) Pale skin C) Bradycardia D) Hypotension E) Elevated blood pressure

B) Pale skin E) Elevated blood pressure

A nurse is planning care for a client who is receiving mechanical ventilation. Which of the following modes of ventilation that increases the effort of the client's respiratory muscles should the nurse include in the plan of care? Select all that apply. A) Assist control B) Synchronized intermittent mandatory ventilation C) Continuous positive airway pressure D) Pressure support ventilation E) Independent lung ventilation

B) Synchronized intermittent mandatory ventilation C) Continuous positive airway pressure D)Pressure support ventilation

A nurse is caring for a client who has dyspnea and will receive oxygen continuously. Which of the following oxygen devices should the nurse use to deliver a precise amount of oxygen to the client? A) Nonrebreather mask B) Venturi mask C) Nasal Cannula D) Simple face mask

B) Venturi mask

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply) A. Continuous bubbling in the water seal chamber B. Gentle constant bubbling in the suction control chamber C. Rise and fall in the level of water in the water seal chamber with inspiration D. Exposed sutures without dressing E. Drainage system upright at chest level

B, C Gentle bubbling in the suction control chamber is an expected finding as air is being removed A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicate that the drainage system is functioning properly

A nurse is caring for a client following a coronary artery bypass graft (CABG). Hemodynamic monitoring has been initiated. Which of the following actions by the nurse facilitate correct monitoring readings? (Select all that apply) A. Place the client in high-Fowler's position B. Level transducer to phlebostatic axis C. Zero transducer to room air D. Observe trends in readings E. Compare readings to physical assessment

B, C, D, E B. The level of the transducer should be at the phlebostatic axis (right atrium) to ensure an accurate reading is obtained C. The transducer is zeroed to room air to ensure an accurate reading is obtained. Hemodynamic pressure lines should be calibrated to read atmospheric pressure as zero. D. The trend of the client's pressure reading assists in providing appropriate medical treatment E. Readings are compared to the client's physical assessment findings to evaluate the client's condition and the appropriate treatment provided.

A nurse is planning care for a client who has severe acute respiratory distress syndrome (SARS). Which of the following should be included in the plan of care for this client? (Select all that apply) A. Administration of antibiotics B. Providing supplemental oxygen C. Administration of antiviral medications D. Administration of bronchodilators E. Maintaining ventilatory support

B, D, E Oxygen is administered to treat hypoxemia Bronchodilators are given to vasodilate the airway Intubation may be required to maintain a patent airway

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern? (Select all that apply.)

B. CORRECT: Capillary refill greater than 2 to 4 seconds is outside the expected reference range and should be reported to the provider. C. CORRECT: Mottled appearance of the affected extremity is an unexpected finding and should be reported to the provider.

A nurse is orienting a newly licensed nurse on the purpose of administering vecuronium (Norcuron) to a client who has acute respiratory distress syndrome. Which of the following statements by the newly licensed nurse indicates understanding of the teaching? A. This medication is given to treat infection B. This medication is given to facilitate ventilation C. This medication is given to decrease inflammation D. This medication is given to reduce anxiety

B. Vecuronium is a neuromuscular blocking agent given to facilitate ventilation and decrease oxygen consumption

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A. Diet medication B. Relaxation exercises C. Smoking cessation D. Taking omega-3 capsules

C. Smoking cessation

A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the infarction occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin

C. Troponin T

A nurse in the emergency department is assessing a client who was in a motor vehicle crash. Findings include absent breath in the left lower lobe with dyspnea, blood pressure 118/68, HR 124/min, RR 38/min, temp 38.6 (101.4), and SaO2 92% on room air. Which of the following actions should the nurse take first? A. Obtain a chest x ray B. Prepare for chest tube insertion C. Administer oxygen via a high flow mask D. Initiate IV access

C. According to ABCs, administering oxygen via high flow mask is priority.

A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect?

C. CORRECT: Bleeding is occurring from the incision site and then draining under the client. The nurse should assess the incision for hematoma, apply pressure, monitor the client, and notify the provider.

How might a patient in need of an ECG present themselves?

Cardiovascular disease; Myocardial infarction (MI); Hypoxia; Acid-base imbalances; Electrolyte disturbances; Kidney failure, liver, or lung disease; Pericarditis; Drug or alcohol use; Hypovolemia; Shock

What is an important consideration prior to cardioversion therapy?

Clients who have atrial fibrillation of unknown duration must receive adequate anticoagulation for 4 to 6 weeks prior to cardioversion therapy to prevent dislodgment of thrombi into the bloodstream. -AND- Digoxin is held for 48 hr prior to elective cardioversion.

A nurse is orienting a newly licensed nurse on performing routine assessment of a client who is receiving mechanical ventilation via an endotracheal tube. Which of the following information should the nurse include in the teaching? A) Apply a vest restraint if self-extubation is attempted B) Monitor ventilator settings every 8 hr C) Document tube placement in centimeters at the angle of jaw D)Assess breath sounds every 1-2 hrs

D) Assess breath sounds every 1-2 hours

A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do? A. Lie on his left side B. Use the incentive spirometer C. Cough at regular intervals D. Perform the Valsalva maneuver

D. The client should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism

A nurse is instructing a client who has angina about a new prescription for metaprolol tartrate (Lopressor). Which of the following statements by the client indicates understanding of the teaching? A. "I should place the tablet under my tongue." B. "I should have my clotting time checked weekly." C. "I will report any ringing in my ears." D. "I will call my doctor if my pulse rates less than 60."

D. "I will call my doctor if my pulse rates less than 60."

A nurse is orienting a newly licensed nurse on the care of a client who is receiving hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates the teaching was effective? A. "Air should be instilled into the monitoring system." B. "The client should be in the prone position." C. "The transducer should be level with the 2nd intercostal space" D. "A chest X-ray is needed to verify placement."

D. A chest x-ray is obtained to confirm proper placement of the lines

A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's heart rate is 34/min and blood pressure is 83/48 mm Hg. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A. Transport the client to the cardiovascular laboratory. B. Prepare the client for insertion of a permanent pacemaker. C. Obtain a signed informed consent form for a pacemaker. D. Apply transcutaneous pacemaker pads.

D. Apply transcutaneous pacemaker pads.

5. A nurse is completing the admission assessment of a clientwho will undergo peripheral bypass graft surgery on the leftleg. Which of the following findings should the nurse expect?

D. CORRECT: A client who has peripheral artery diseasemight report that numbness or burning pain in the extremity ceases with rest (intermittent claudication).

A nurse is teaching a client the importance of remaining still following angiography. Which of the following is an appropriate statement by the nurse? A. "Moving in bed raises your blood pressure." B. "Too much activity increases your risk for infection." C. "Moving in bed increases your risk of a complication due to anesthesia." D. "Too much activity places you at risk for bleeding."

D. Following angiography, it is important that the client lie still due to the increased risk for bleeding at the insertion site.

Post cardioversion procedure nursing considerations include?

Document the following: Post procedure rhythm; Number of defibrillation or cardioversion attempts, energy settings, time, and response; The client's condition and state of consciousness following the procedure; Skin condition under the electrodes. -AND- CLIENT EDUCATION: Teach the client and family how to assess pulse. Advise the client to report palpitations or irregularities.

How are dysrhythmias classifieds?

Dysrhythmias are classified by the following: Site of origin: sinoatrial (SA) node, atria, atrioventricular (AV) node, or ventricle

Cardioversion might damage heart tissue and impair heart function ... therefore nursing actions include ...

Monitor the client for signs of decreased cardiac output (hypotension, syncope, increased heart rate) and heart failure (dyspnea, productive cough, edema, venous distention). Provide medications to increase output (inotropic agents) and to decrease cardiac workload.