Exam 2: Perfusion

Dual Lead Pacemakers

AV & SA node Stimulates atria and ventricles

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: A. skeletal muscle damage due to a recent fall. B. I.M. injection. C. Myocardial necrosis. D. Cerebral bleeding.

C. Myocardial necrosis.

Manifestations of Right-Sided Heart Failure

- Peripheral edema - Nausea - Anorexia - Liver engorgement (causing RUQ pain) - Distended neck veins

What are some contraindications for tPA use?

- Recent major surgery - Hemorrhage - Severe HTN - CPR for a long time - Pregnancies - Trauma - Aortic dissection

Secondary Hypertension

Elevated BP resulting from an identifiable underlying process - Kidney disease - Endocrine disorders - Neurological disorders - Drug use - Pregnancy

Manifestations of Left-Sided Heart Failure

- Cough - Dyspnea - SOB - Dizziness - Syncope - Orthopnea - Cyanosis - Fatigue - Crackles - S3 gallop

Aortic Balloon Pump

- last resort refractory CHF - small incision groin, local sedation, in *descending aorta* - *inflates during diastole* - increases CA flow, retrograde - *deflates during systole* - creates negative pressure, decreasing afterload - increases CO by 1-2L/minute - assists them until their heart recovers (24-48 hours max) - biggest problem = *limb ischemia*(amputate toe/leg) MONITOR PEDAL PULSES

Therapeutic Serum Digoxin Levels

0.5-2 ng/mL

How do you administer tPA?

0.9 mg/kg for a maximun dose of 90 mg 10% is administered through IV bolus over one minute Remaining 90% is given by IV infusion over 60 minutes

A patient comes into the ED with chest pain... what are your first interventions?

1. Oxygen administration 2. Baby aspirin (if the pt. hasn't already taken one) 3. Put an 18-gauge needle in to draw labs (troponin levels) 4. Get an ECG within 10 min

In a stroke, thrombolytics must be administered in what time frame?

3-4.5 hours

Heparin, Warfarin, & Lavanox: Are what type of drugs?

Anticoagulants

What assessment should be done before digoxin administration?

Assess apical pulse & hold if HR is below 60 bpm

Before a stroke patient is cleared to eat, what assessments should be done?

Assess the patient's ability to shallow (testing cranial nerve 12-hypoglossal) A speech pathologist must also clear the patient

What does the P wave represent?

Atrial depolarization (contraction)

A common side effect of nitroglycerin is A. nausea B. headache C. hypertension D. chest discomfort

B. headache

Complication for tPA

Bleeding (brain bleed especially)- this is why the neurological assessment is so important

Which diagnostic is a marker for inflammation of vascular endothelium?

C-reactive protein (CRP) Rationale: C-reactive protein (CRP) is a marker for inflammation of vascular endothelium. LDL, HDL, and triglycerides are not marker of vascular endothelium inflammation. They are elements of fat metabolism.

What is angina?

Chest pain caused by ischemia to the myocardium, typically lasting 5-15 minutes

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Diltiazem (Cardizem) b) Amlodipine (Norvasc) c) Clopidogrel (Plavix) d) Felodipine (Plendil)

Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.

Prinzmetal angina is caused by...

Coronary artery spasm

The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage?

Creatine kinase MB Rationale: There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.

In completing a health assessment to identify nonmodifiable risk factors for coronary artery disease, the nurse assesses: A. Cigarette smoking. B. Blood cholesterol. C. Blood pressure. D. Family history.

D. Family history.

The purpose of a chest x-ray for a patient having an acute MI is to: A. To assess coronary vessel occlusion B. To determine the size of the MI as far as how much tissue damage has occurred C. To determine if a patient is having an MI. D. Identify if the cause of a patients chest pain is an aortic dissection

D. Identify if the cause of a patients chest pain is an aortic dissection

Therapeutic use of Statins:

Decrease cholesterol synthesis and lower LDL cholesterol

A nurse caring for a client with acute coronary artery disease (CAD) identifies which priority nursing diagnosis? a. Ineffective Tissue Perfusion b. Anxiety c. Ineffective Health Maintenance d. Decreased Cardiac Output

a. Ineffective Tissue Perfusion

What are depolarization & replorization referring to?

Deplorization: Contracting Replorization: Resting

What medication is used to treat Digoxin toxicity?

Digoxin Immune Fab (digibind)

What therapeutic effect would a small dose of 1-3 mcg/kg/min of dopamine have?

Dilates renal system (kidneys), increasing renal perfusion, causing a patient to pee a lot

If BP is low but CVP is high... do you give fluids?

Don't give fluids because CVP is high

CO= ___ x ___

HR x SV

What therapeutic effect would a small/medium dose of 3-5 mcg/kg/min of dopamine have?

Has a positive chronotropic effect, increasing heart rate

Therapeutic Effect of Digoxin

Increases cardiac output (positive inotropic effect) & slows the heart rate (negative chronotropic effect)

What therapeutic effect would a medium dose of 5-10 mcg/kg/min of dopamine have?

Increases heart rate even more, patient should be monitored for tachycardia

How long do you have to perform an ECG when a patient comes in with chest pain?

Less than 10 minutes

Hemorrhagic Stroke

Occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

Before administering tPA: What should be obtained?

Patient consent

What is a sign that the patient's pace maker is not working?

Syncope

What test is specific to the heart, sensitive to heart function?

Troponin test

What therapeutic effect would a large dose of 10-20 mcg/kg/min of dopamine have?

Vasoconstrictor & vasopressor

What does the QRS complex represent?

Ventricular depolarization (contraction)

What does the T wave represent?

Ventricular repolarization and relaxation

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

Within 6 hours Rationale: For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? a) Fatty deposits in the lumen of arteries b) Blood clots in the arteries c) Emboli in the veins d) Cholesterol plugs in the lumen of veins

a) Fatty deposits in the lumen of arteries

Before administering tPA, what lab values should be monitored?

aptt, INR & PT

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol." b) "Client will verbalize the intention to stop smoking." c) "Client will verbalize the intention to avoid exercise." d) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours."

b) "Client will verbalize the intention to stop smoking."

Define Preload

volume of blood in ventricles at end of diastole (filling period before contraction)

A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myo-cardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given I.V. The nurse should first: 1. Administer the morphine. 2. Obtain a 12-lead ECG. 3. Obtain the blood work. 4. Order the chest radiograph

1. Although obtaining the ECG, chest radio-graph, and blood work are all important, the nurse's priority action should be to relieve the crushing chest pain. Therefore, administering morphine sulfate is the priority action.

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

1. An S3 heart sound occurs early in diastole as the mitral and tricuspid valves open and blood rushes into the ventricles.

When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following? 1. Cardiac arrhythmias. 2. Hypertension. 3. Seizure. 4. Hypothermia.

1. Cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperfusion of the cardiac tissue. Hypotension is commonly observed with administra-tion of t-PA. Seizures and hypothermia are not gener-ally associated with reperfusion of the cardiac tissue.

A 68-year-old female client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The first nursing action should be to: 1. Inquire about the onset, duration, severity, and precipitating factors of the heaviness. 2. Administer oxygen via nasal cannula. 3. Offer pain medication for the chest heaviness. 4. Inform the physician of the chest heaviness.

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

A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect. 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect. 3. Taking the nitroglycerin with a few glasses of water will reduce the problem. 4. The client should lie in a supine position to alleviate the headache.

1. Headache is a common side effect of nitro-glycerin that can be alleviated with aspirin, acetaminophen or ibuprofen. The sublingual nitroglycerin needs to be absorbed in the mouth, which will be disrupted with drinking. Lying fl at will increase blood flow to the head and may increase pain and exacerbate other symptoms, such as shortness of breath.

The physician orders continuous I.V. nitro-glycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the medication. 2. Monitoring blood pressure every 4 hours. 3. Monitoring urine output hourly. 4. Obtaining serum potassium levels daily.

1. I.V. nitroglycerin infusion requires an infusion pump for precise control of the medica-tion. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

The nurse should teach the client that signs of digoxin toxicity include which of the following? 1. Rash over the chest and back. 2. Increased appetite. 3. Visual disturbances such as seeing yellow spots 4. Elevated BP.

3. Colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abdominal pain, anorexia, nausea, and vomiting are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrhythmias, such as atrial fi brilla-tion or bradycardia. Rash, increased appetite, and elevated blood pressure are not associated with digoxin toxicity.

The nurse's discharge teaching plan for the client with heart failure should stress the importance of which of the following? 1. Maintaining a high-fiber diet. 2. Walking 2 miles every day. 3. Obtaining daily weights at the same time each day. 4. Remaining sedentary for most of the day.

3. Heart failure is a complex and chronic condition. Education should focus on health promotion and preventive care in the home environment. Signs and symptoms can be monitored by the client. Instructing the client to obtain daily weights at the same time each day is very important. The client should be told to call the physician if there has been a weight gain of 2 lb. or more. This may indicate fluid overload, and treatment can be prescribed early and on an outpatient basis, rather than waiting until the symptoms become life-threatening.

During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client prevent this problem? 1. Visit her friend early in the day. 2. Rest for at least an hour before climbing the stairs. 3. Take a nitroglycerin tablet before climbing the stairs. 4. Lie down once she reaches the friend's apartment.

3. Nitroglycerin may be used prophylacti-cally before stressful physical activities such as stair-climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? 1. Cancer. 2. Hypertension. 3. Liver disease. 4. Myocardial damage.

4. Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about 1 hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction. Myoglobin does not help diagnose cancer, hypertension, or liver disease.

The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease? 1. A 32-year-old female with mitral valve pro-lapse who quit smoking 10 years ago. 2. A 43-year-old male with a family history of CAD and cholesterol level of 158. 3. A 56-year-old male with an HDL of 60 who takes atorvastatin (Lipitor). 4. A 65-year-old female who is obese with an LDL of 188.

4. The woman who is 65 years old, over-weight and has an elevated LDL is at greatest risk. Total cholesterol > 200, LDL > 100, HDL < 40 in men, HDL < 50 in women, men 45 years and older, women 55 years and older, smoking and obesity increase the risk of CAD. Atorvastatin is a medica-tion to reduce LDL and decrease risk of CAD. The combination of postmenopausal, obesity, and high LDL cholesterol places this client at greatest risk.

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

A. Troponin result and when the next troponin level is due to be collected

Four hours after the onset of pain from an MI, a nurse should expect an increase in the: A. creatine kinase-MB (CK-MB). B. leukocyte count. C. alkaline phosphatase (ALP). D. lactate dehydrogenase (LHD).

A. creatine kinase-MB (CK-MB).

The nurse is administering thrombolytic therapy to a client who had a myocardial infarction. Which intervention does the nurse implement to reduce the risk of complications in this client? a. Administer prescribed heparin. b. Apply ice to the injection site. c. Place the client in Trendelenburg position. d. Instruct the client to take slow deep breaths.

ANS: A Following clot lysis, large amounts of thrombin are released, increasing the risk of vessel reocclusion. To maintain vessel patency, IV or low-molecular-weight heparin and aspirin are prescribed. The other interventions are not appropriate for this client.

The nurse is caring for a client who had a myocardial infarction. The client develops increased pulmonary congestion; an increase in heart rate from 80 to 102 beats/min; and cold, clammy skin. Which action does the nurse implement before notifying the health care provider? a. Administer oxygen. b. Increase the IV flow rate. c. Place the client in supine position. d. Prepare the client for surgery.

ANS: A The nurse recognizes these manifestations as impending cardiogenic shock. Oxygen is needed to prevent further deterioration. The provider is notified immediately so that efforts can be made to reverse this condition because it has a mortality rate of 65% to 100%. IV fluids would enhance the respiratory edema. The client should be placed in high Fowler's position to assist with respirations. The client does not need surgery.

While evaluating a client's electrocardiogram (ECG) before surgery, the preoperative nurse identifies large, wide Q waves. What is the nurse's best interpretation of this finding? a. An acute myocardial infarction is occurring. b. The client had a myocardial infarction in the past. c. The ventricles are enlarged and failing. d. The ECG is a common variation of normal sinus rhythm.

ANS: B A wide and large Q wave develops as a result of myocardial infarction and necrotic ventricular cells that do not conduct electrical impulses. This change is usually permanent. When it appears alone, it indicates a past MI. The other interpretations are not correct.

The nurse is assessing a client who has a history of stable angina. The client describes a recent increase in the number of attacks and in the intensity of the pain. Which question does the nurse ask to assess the client's change in condition? a. "How many cigarettes do you smoke daily?" b. "Do you have pain when you are resting?" c. "Do you have abdominal pain or nausea?" d. "How frequently are you having chest pain?"

ANS: B An increase in the number of anginal attacks and an increase in the intensity of pain characterize unstable angina. Chest pain or discomfort also occurs at rest. The nurse should assess for this characteristic of unstable angina. The other questions would not be helpful in assessing for unstable angina.

The nurse is assisting a client to walk in the hall on the third day after a myocardial infarction. Which clinical manifestation indicates to the nurse that the client is not ready to advance to the next level of activity? a. Facial flushing b. Onset of chest pain c. Heart rate increase of 10 beats/min at completion of the activity d. Systolic blood pressure increase of 10 mm Hg at completion of the activity

ANS: B Chest pain on ambulation indicates poor tolerance to activity and is an indication that the heart is not ready for progression. The other manifestations indicate that the client is tolerating the activity.

The nurse is assessing a client who is 6 hours postoperative from coronary artery bypass graft surgery. The client's mediastinal tubes are not draining. Which action does the nurse implement at this time? a. Replace the drainage tubing. b. Check for kinks in the tubing. c. Irrigate the tubing with normal saline. d. Document the finding.

ANS: B Sudden cessation of mediastinal drainage could result in cardiac tamponade from accumulation of blood around the heart. If the tubing is kinked, this can be addressed quickly. If the tubing is not kinked, immediate notification of the provider is required. The other actions do not correctly address the problem.

The nurse is taking the history of a client with suspected coronary artery disease (CAD). Which situation correlates with stable angina? a. Chest discomfort at rest and inability to tolerate mowing the lawn b. Chest discomfort when mowing the lawn and subsiding with rest c. Indigestion and a choking sensation when mowing the lawn d. Jaw pain that radiates to the shoulder after mowing the lawn

ANS: B The client with stable angina reports chest discomfort that occurs with moderate, prolonged exertion. This discomfort is typically relieved with nitroglycerin or rest. The other experiences do not correlate with stable angina.

The nurse administers intravenous dobutamine (Dobutrex) to a client who has heart failure. Which clinical manifestations indicate that the client's status is improving? Select all that apply. a. Decreased heart rate b. Increased heart rate c. Increased contractility d. Decreased contractility e. Increased respiratory rate

ANS: B, C Dobutamine is a positive inotropic agent that works by stimulating beta-adrenergic receptor sites. The result of this stimulation is an increase in the rate and force of the myocardial contraction. Dobutamine has no effect on respiratory rate.

A client who is post percutaneous transluminal coronary angioplasty (PTCA) reports severe chest pain. Which action does the nurse take first? a. Administer the prescribed IV morphine. b. Administer the prescribed sublingual nitroglycerin. c. Assess the client's vital signs and notify the health care provider. d. Perform an immediate 12-lead ECG.

ANS: C After PTCA, a small percentage of clients experience acute restenosis (closure) of the affected coronary artery. Chest pain similar to that experienced before the procedure may indicate acute restenosis. The client will need to return to the catheterization laboratory to have the procedure repeated and may need stent placement to maintain a patent vessel lumen. The nurse may relieve pain with morphine or nitroglycerin after contacting the provider. The provider may request an ECG.

The nurse is caring for an 80-year-old client who has had coronary artery bypass graft surgery. Which assessment does the nurse prioritize for this client? a. Skin b. Otoscopic c. Mental status d. Gastrointestinal

ANS: C Assessment of mental status is important because older adults are more likely to experience transient neurologic deficits as compared with younger adults. The other assessments are not a priority for this client.

The emergency department nurse is assessing an 82-year-old client for a potential myocardial infarction. Which clinical manifestation does the nurse monitor for? a. Pain on inspiration b. Posterior wall chest pain c. Disorientation or confusion d. Numbness and tingling of the arm

ANS: C In older adults, disorientation or confusion may be the major manifestation of myocardial infarction caused by poor cardiac output. Pain manifestations could also be related to the myocardial infarction. However, the nurse is more concerned about the new onset of disorientation or confusion caused by decreased perfusion.

The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease? a. "Would you please state your full name and birth date?" b. "Have you ever had an exercise tolerance stress test?" c. "In what activities do you participate on a daily basis?" d. "Does anyone in your family have a history of heart disease?"

ANS: C Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). A stress test would not provide any information about risk factors.

The nurse teaches a client who is newly diagnosed with coronary artery disease. Which instruction does the nurse include to minimize complications of this disease? a. "Rest is the best medicine at this time. Do not start an exercise program." b. "You are a man; therefore there is nothing you can do to minimize your risks." c. "You should talk to your provider about medications to help you quit smoking." d. "Decreasing the carbohydrates in your diet will help you lose weight."

ANS: C Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). The nurse needs to encourage the client to stop smoking because this is a proven risk factor for coronary artery disease development. The nurse should also encourage weight loss and moderate exercise.

Eight hours after presentation to the emergency department with reports of substernal chest pain, a client's laboratory results demonstrate myoglobin levels of 55 ng/mL. What does the nurse do next? a. Prepare the client for an emergency coronary bypass graft surgery. b. Administer nitroglycerin to prevent further myocardial cell death. c. Assess the client to identify another potential cause of the chest pain. d. Provide client education related to complications of myocardial infarctions.

ANS: C Myoglobin is a heme protein found in skeletal and cardiac muscle. With myocardial injury, myoglobin levels rise within 3 to 6 hours. If myoglobin levels have not risen within that time, the client has not experienced a myocardial infarction. The nurse should assess the client to identify a potential cause for the chest pain, besides an MI.

A client who presented with an acute myocardial infarction is prescribed thrombolytic therapy. The client had a stroke 1 month ago. Which action does the nurse take? a. Administer the medication as prescribed. b. Perform a CT scan before administering the medication. c. Contact the health care provider to discontinue the prescribed therapy. d. Administer the therapy with a normal saline bolus.

ANS: C Recent stroke (within 2 months) is an absolute contraindication to thrombolytic therapy. The nurse should not give the medication under any conditions. The provider must be notified and made aware of the client's stroke history. None of the other options are appropriate.

The nurse is planning discharge education for a client after coronary artery bypass graft surgery. Which instruction does the nurse include in this client's teaching? a. "Remember to drink at least 3 liters of fluid daily." b. "You should abstain from sexual activity for 6 months." c. "Take your pulse before, midway through, and after exercising." d. "Stop taking your antihyperlipidemic medication at this time.

ANS: C The client is instructed to begin a walking program that gradually lengthens in distance. The client is advised to take his or her pulse before exercising, midway through exercising, and after exercising. The client should stop exercising if the target rate is exceeded or if angina develops. The client should not take in large quantities of fluids or stop taking antihyperlipidemic medications. The client does not need to abstain from sexual activity.

The nurse is assessing a client who has been prescribed a nonselective beta-blocking agent. Which adverse effect does the nurse monitor for in this client? a. Headache b. Postural hypotension c. Nonproductive cough d. Wheezing

ANS: D Nonselective beta blockers can cause bronchoconstriction and impair respiratory effort. Clients with pre-existing pulmonary problems should not take nonselective beta-blocking agents. Clients who develop bronchoconstriction should have their therapy changed. The other manifestations are not adverse effects of this medication.

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

C. "I will monitor my heart rate and blood pressure while taking this medication."

Which nursing diagnosis would the nurse select for the client who has been treated for hypertension and continues to have high blood pressure? a. Anxiety b. Noncompliance with treatment regimen c. Ineffective coping d. Grieving

b. Noncompliance with treatment regimen

Which of the following conditions is most commonly responsible for myocardial infarction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 4. Renal failure

3. Coronary artery thrombosis Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. Option A: An aneurysm is an outpouching of a vessel and doesn't cause an MI. Option B: Heart failure is usually a result from an MI. Option D: Renal failure can be associated with MI but isn't a direct cause.

A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? A. Improve venous return B. Improve arterial flow C, Jncrease venous congestion D. Strengthen venous valves

A. Improve venous return

To assess the point of maximum impulse, the nurse should place the finger tips over which chamber of the patient's heart? A. Left ventricle B. Right atrium C. Left atrium D. Right ventricle

A. Left ventricle

Assessment of the patient with pericarditis may reveal which of the following signs and symptoms? A. Pericardial friction rub; pain B. Frequent premature ventricular contractions. C. Pericardial tamponade; widened pulse pressure D. Ventricular gallop; substernal chest pain

A. Pericardial friction rub; pain

Upon auscultating the patient's precordium, the nurse hears third and fourth heart sounds. These are: A. Possible signs of heart failure. B. Normal occurrences in older adults. C. Easily managed with cardiac medications. D. Caused by congenital valve problems.

A. Possible signs of heart failure.

A 65-year-old male client with CAD has been prescribed a transdermal nitroglycerin patch. The nurse's instructions to the client would include which of the following? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use. C. Cover the patch in plastic wrap after applying. D. Seek emergency treatment if flushing or nausea occurs

A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use.

A 64-year-old client is seen in the emergency room for palpitations and mild shortness of breath. The ECG reveals a normal P wave, P-R interval, and QRS complex with a regular rhythm and rate of 108. The nurse should recognize this cardiac rhythm as: A. Sinus tachycardia B. Ventricular tachycardia C. Junctional Tachycardia D. Nodal Tachycardia

A. Sinus tachycardia

The nurse is monitoring the electrocardiogram (ECG) of a client who has a myocardial infarction. Which changes does the nurse expect to see in the ECG tracing? Select all that apply. a. ST-segment depression b. T-wave inversion c. Normal Q waves d. ST-segment elevation e. T-wave elevation f. Abnormal Q wave

ANS: B, D, F When myocardial infarction occurs, the changes usually seen on an ECG tracing are ST-segment elevation, T-wave inversion, and an abnormal Q wave.

The nurse is teaching a client prescribed sublingual nitroglycerin for chest pain. Which statement indicates that the client needs further teaching? a. "I carry my medicine around in a clear plastic bag so that I can get to it easily if I have chest pain." b. "Even if I have not used any of the nitroglycerin from one refill, I get another refill every 3 months." c. "If I still have chest pain after I have taken 3 nitroglycerin tablets, I will go to the hospital." d. "When my nitroglycerin tablet tingles under my tongue, I know that it is strong enough to work."

ANS: A The shelf life of nitroglycerin is short. It deteriorates quickly in the presence of light or moisture. A clear plastic bag does not provide sufficient protection to ensure potency of the drug. Nitroglycerin tablets should be replaced every 3 to 5 months. If chest pain continues after taking nitroglycerin, the client should call EMS. Nitroglycerin is given sublingual.

The nurse is planning a community health promotion program for cardiovascular disease. Which risk factors of coronary artery disease (CAD) does the nurse include in the education? Select all that apply. a. Cigarette smoking b. Use of alcohol c. Insomnia d. Hypertension e. Obesity f. Depression

ANS: A, D, E Teach about lifestyle risk factors of CAD, such as obesity, smoking, positive family history, cholesterol management, and diagnosis and treatment of hypertension.

The nurse is assessing a client who has a serum potassium level of 4.5 mEq/L after coronary artery bypass graft (CABG) surgery. Which action does the nurse take? a. Notify the health care provider. b. Document the finding. c. Administer prescribed diuretics. d. Administer prescribed potassium replacements.

ANS: B The client who is postoperative from a CABG is at risk for hypokalemia from hemodilution, nasogastric suction, or diuretic therapy. Therefore, the potassium level is maintained between 4 and 5 mEq/L to avoid dysrhythmias. This value is at the desired level for this client. The finding requires documentation only.

The nurse is assessing a client who has left ventricular failure secondary to a myocardial infarction. Which clinical manifestation of poor organ perfusion does the nurse monitor for in this client? a. Headache b. Hypertension c. Urine output of less than 30 mL/hr d. Heart rate of 55 to 60 beats/min

ANS: C The nurse should remain alert for signs of poor organ perfusion that are the result of decreased cardiac output. When the kidneys are not well perfused, urine output drops to less than 30 mL/hr. Other signs include changes in mental status; cool, clammy extremities with decreased or absent pulses; fatigue; and recurrent chest pain. The other manifestations do not indicate poor organ perfusion.

The nurse is assessing a client who had percutaneous transluminal coronary angioplasty (PTCA) 1 hour ago. Which complication does the nurse monitor for? a. Hypertensive crisis b. Hyperkalemia c. Infection d. Bleeding

ANS: D In the first few postprocedure hours, the nurse monitors for complications such as bleeding from the insertion site, hypotension, acute closure of the vessel, dye reaction, hypokalemia, and dysrhythmias. The other problems are not complications in the immediate post-PTCA period.

The nurse is providing care for a client admitted to the hospital with reports of chest pain. After receiving a total of three nitroglycerin sublingual tablets, the client states, "The pain has not gotten any better." What does the nurse do next? a. Place the client in a semi-Fowler's position. b. Administer intravenous nitroglycerin. c. Begin supplemental oxygen at 2 L/min. d. Notify the health care provider.

ANS: D When a client experiences chest discomfort unrelieved by nitroglycerin, the client may be experiencing a myocardial infarction. The provider should be notified and the client prepared for transfer to a unit prepared to provide specialized cardiac care.

Primary Hypertension

Also known as "Essential HTN", persistently elevated systemic BP that is not traced back to a cause

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? A. 210-240 mg/dL B. 160-190 mg/dL C. 280-300 mg/dL D. 250-275 mg/dL

B. Simvastatin (Zocor) is a statin Frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.

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

B. The most common cause of a myocardial infarction is NOT coronary spasm from illicit drug use or hypertension.

When assessing a client who has congestive heart failure, which of these findings should indicate to a nurse that the client has right-sided heart failure? A. Constant orthopnea. B. Edema in lower extremities. C. Sinus bradycardia. D. Weight loss.

B. Edema in lower extremities.

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy? A. The client states that sublingual nitroglycerin usually relieves his chest pain. B. The client demonstrates ability to tolerate more activity without chest pain. C. The client exhibits a heart rate above 100 beats/minute. D. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking.

B. The client demonstrates ability to tolerate more activity without chest pain.

Which client will have an increased risk for coronary artery disease based on their ethnic background? A. Caucausian male B. Japanese male C. African american male D. Chinese female

C. African american male

Which valve, when open, allows oxygenated blood to move into the body systems? A. Mitral valve B. Pulmonic value C. Aortic valve D. Tricuspid valve

C. Aortic valve

What is CVP (central venous pressure)?

CVP is the BP in the superior vena cava, it reflects the amount of blood returning to the heart and ability of the heart to pump back to the atrial system

What class of drug is used for prinzmetal angina?

Calcium Channel Blockers

A nurse assesses a patient on day 3 after an anterior wall MI. The nurse hears an S3 heart sound which is new. Before calling the physician the nurse would perform what other physical assessments to present a complete verbal picture of the patient's condition to the physician? A. Peripheral pulse strength and amplitude B. Bowel sounds C. Cranial nerve check D. Lung sound assessment

D. Lung sound assessment

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: A. Aspirin B. Statin C. Angiotensin-converting enzyme (ACE) inhibitor D. Morphine IV

D. Morphine IV Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.

The nurse hears a scratchy, grating sound in the patient's chest during systole and diastole. The nurse would document which of the following? A. S3 heart sound. B. A pleural friction rib. C. Pulsus parodoxus. D. Pericardial friction rub.

D. Pericardial friction rub

The best position for the patient when jugular venous distention (JVD) is to be assessed is: A. Reclined at 45 to 60 degrees. B. Supine C. Reclined at 90 degrees. D. Reclined at 30 to 45 degrees.

D. Reclined at 30 to 45 degrees.

If a patient still has chest pain after nitro administration but the patient's BP is dropping too much, what should be administered?

Morphine (2 mg)

Side effects to watch out for in Statins

Muscle pain (Rhabdo) Monitor liver enzymes (Hepatotoxic)

Which of the following nursing diagnoses would be appropriate for a client with systolic heart failure? Select all that apply. 1. Ineffective peripheral tissue perfusion related to a decreased stroke volume. 2. Activity intolerance related to impaired gas exchange and perfusion. 3. Dyspnea related to pulmonary congestion and impaired gas exchange. 4. Decreased cardiac output related to impaired cardiac filling. 5. Impaired renal perfusion related to a decreased cardiac output.

1, 2, 3, 5. A decrease in cardiac output occurs from a decreased stroke volume with impaired contractility in systolic heart failure. This impairs peripheral and renal perfusion. The impaired perfusion and impaired oxygenation cause the symptoms of activity intolerance. The decreased systolic function causes an increase in residual volume and pressure in the left ventricle. A retrograde buildup of pressure from the left ventricle to left atria increases hydrostatic pressure in the pulmonary vasculature. This causes a leakage of fluid into the interstitial tissue of the lungs resulting in pulmonary symptoms. With diastolic heart failure, there is impaired ventricular filling due to a rigid ventricle and reduced ventricular relaxation.

When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. 1. Becoming increasingly short of breath at rest. 2. Weight gain of 2 lb or more in 1 day. 3. High intake of sodium for breakfast. 4. Having to sleep sitting up in a reclining chair. 5. Weight loss of 2 lb in 1 day.

1, 2, 4. The client stating that he would call the physician with increasing shortness of breath, weight gain over 2 lb in 1 day, and having to sleep sitting up, indicates that he has understood the teaching because these signs and symptoms suggest worsening of the client's heart failure. Although the client will most likely be placed on a sodium-restricted diet, the client would not need to notify the physician if he or she had consumed a high-sodium breakfast. Instead the client would need to be alert for possible signs and symptoms of worsening heart failure and work to reduce sodium intake for the rest of that day and in the future.

A nurse is assessing a client with heart failure. The nurse should assess the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply. 1. Ventricular hypertrophy. 2. Parasympathetic nervous stimulation. 3. Renin-angiotensin-aldosterone system. 4. Jugular venous distention. 5. Sympathetic nervous stimulation

1, 3, 5. When the heart begins to fail, the body activates three major compensatory systems: ventricular hypertrophy, the renin-angiotensin- aldosterone system, and sympathetic nervous stimulation. Parasympathetic stimulation and jugular venous distention are not compensatory mechanisms associated with heart failure.

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a new systolic murmur at the apex. The nurse should first: 1. Assess for changes in vital signs. 2. Draw an arterial blood gas. 3. Evaluate heart sounds with the client leaning forward. 4. Obtain a 12 Lead electrocardiogram.

1. Infarction of the papillary muscles is a potential complication of an MI causing ineffective closure of the mitral valve during systole. Mitral regurgitation results when the left ventricle con-tracts and blood flows backward into the left atrium, which is heard at the fifth intercostal space, left midclavicular line. The murmur worsens during expiration and in the supine or left-side position. Vital sign changes will reflect the severity of the sudden drop in cardiac output: decrease in blood pressure, increase in heart rate, and increase in respirations. A 12-lead ECG views the electrical activity of the heart; an echocardiogram views valve function.

Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations

1. Chest pain The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Option C: Edema is a later sign of heart failure, often seen after an MI. Option D: Palpitations may result from reduced cardiac output, producing arrhythmias.

What is the first intervention for a client experiencing MI? 1. Administer morphine 2. Administer oxygen 3. Administer sublingual nitroglycerin 4. Obtain an ECG

2. Administer oxygen Administering supplemental oxygen to the client is the first 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. Options A and C: Morphine and nitro are also used to treat MI, but they're more commonly administered after the oxygen. Option D: An ECG is the most common diagnostic tool used to evaluate MI.

The physician orders continuous I.V. nitro-glycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the medication. 2. Monitoring blood pressure every 4 hours. 3. Monitoring urine output hourly. 4. Obtaining serum potassium levels daily.

1. I.V. nitroglycerin infusion requires an infusion pump for precise control of the medica-tion. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction

1. Left-sided heart failure The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Options B, C, and D: Pulmonic and tricuspid valve malfunction cause right-sided heart failure.

Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following? 1. Age greater than 60 years. 2. History of cerebral hemorrhage. 3. History of heart failure. 4. Cigarette smoking.

2. A history of cerebral hemorrhage is a contraindication to administration of t-PA because the risk of hemorrhage may be further increased. Age greater than 60 years, history of heart failure, and cigarette smoking are not contraindications.

The nurse has completed an assessment on a client with a decreased cardiac output. Which fi nd-ings should receive the highest priority? 1. BP 110/62, atrial fi brillation with HR 82, bibasilar crackles. 2. Confusion, urine output 15 mL over the last 2 hours, orthopnea. 3. SpO2 92 on 2 liters nasal cannula, respirations 20, 1+ edema of lower extremities. 4. Weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise.

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

The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to: 1. Open and dilate blocked coronary arteries. 2. Assess the extent of arterial blockage. 3. Bypass obstructed vessels. 4. Assess the functional adequacy of the valves and heart muscle.

2. Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage. A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.

Which of the following is not a risk factor for the development of atherosclerosis? 1. Family history of early heart attack. 2. Late onset of puberty. 3. Total blood cholesterol level greater than 220 mg/dL. 4. Elevated fasting blood glucose concentration.

2. Late onset of puberty is not generally con-sidered to be a risk factor for the development of ath-erosclerosis. Risk factors for atherosclerosis include family history of atherosclerosis, cigarette smoking, hypertension, high blood cholesterol level, male gen-der, diabetes mellitus, obesity, and physical inactivity.

Aspirin is administered to the client experiencing an MI because of its: 1. Antipyretic action 2. Antithrombotic action 3. Antiplatelet action 4. Analgesic action

2. Antithrombotic action Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management

2. Ineffective tissue perfusion; cardiopulmonary MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary). Options A, C, and D: Anxiety, acute pain, and ineffective therapeutic regimen management are appropriate but don't take priority.

If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by: 1. Explaining how the old behavior leads to poor health. 2. Withholding praise until the new behavior is well established. 3. Rewarding the client whenever the acceptable behavior is performed. 4. Instilling mild fear into the client to extinguish the behavior.

3. A basic principle of behavior modification is that behavior that is learned and continued is behavior that has been rewarded. Other reinforcement techniques have not been found to be as effective as reward

A client with angina has been taking nifedipine. The nurse should teach the client to: 1. Monitor blood pressure monthly. 2. Perform daily weights. 3. Inspect gums daily. 4. Limit intake of green leafy vegetables.

3. The client taking nifedipine should inspect the gums daily to monitor for gingival hyperplasia. This is an uncommon adverse effect but one that requires monitoring and intervention if it occurs. The client taking nifedipine might be taught to monitor blood pressure, but more often than monthly. These clients would not generally need to perform daily weights or limit intake of green leafy vegetables.

The nurse is tracking data on a group of clients with heart failure who have been discharged from the hospital and are being followed at a clinic. Which of the following data indicate that nursing interventions of monitoring and teaching have been effective? 1. 90 percent of clients have not gained weight. 2. 75 percent of the clients viewed the educational DVD. 3. 80 percent of the clients reported that they are taking their medications. 4. 5 percent of the clients required hospitalization in the last 90 days.

4. The goals of managing clients outside of the hospital are for the clients to maintain health and prevent readmission, thus interventions, such as monitoring and teaching appear to have contributed to the low readmission rate in this group of clients. Although it is important that clients do not gain weight, view educational material and continue to take their medication, the primary indicator of effectiveness of the program is the lack of re-hospitalization.

What is the primary reason for administering morphine to a client with an MI? 1. To sedate the client 2. To decrease the client's pain 3. To decrease the client's anxiety 4. To decrease oxygen demand on the client's heart

4. To decrease oxygen demand on the client's heart Morphine is administered because it decreases myocardial oxygen demand. Options A, B, and C: Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons.

Which of the following types of angina is most closely related with an impending MI? 1. Angina decubitus 2. Chronic stable angina 3. Nocturnal angina 4. Unstable angina

4. Unstable angina Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.

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

A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders.

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

A. Losartan

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

A. Neutrophils

The nurse evaluates diagnostic results for a client who has chest pain. Which laboratory test is most specific for acute coronary syndromes? a. Troponin markers b. Serum lactate dehydrogenase (LDH) c. Serum myoglobin d. Creatine kinase (CK)-MB isoenzyme

ANS: A Although all these laboratory tests are appropriate to confirm or rule out a myocardial infarction, the one most specific for acute coronary syndromes is troponin T. When elevated, it serves to identify the development of unstable angina, subendocardial MI, or MI.

The nurse is caring for a patient who is having chest pain associated with a myocardial infarction (MI). What medication should the nurse administer intravenously to reduce pain and anxiety?

Morphine sulfate Rationale: The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine is the drug of choice to reduce pain and anxiety. It also reduces preload and afterload, decreasing the work of the heart.

When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by: 1. Left ventricular overload. 2. Impending circulatory collapse. 3. Extracellular electrolyte imbalances. 4. Insufficient oxygen reaching the heart muscle.

4. An MI interferes with or blocks blood circulation to the heart muscle. Decreased blood supply to the heart muscle causes ischemia, or poor myocardial oxygenation. Diminished oxygenation or lack of oxygen to the cardiac muscle results in ischemic pain or angina.

The major goal of therapy for a client with heart failure and pulmonary edema should be to: 1. Increase cardiac output. 2. Improve respiratory status. 3. Decrease peripheral edema. 4. Enhance comfort.

1. Increasing cardiac output is the main goal of therapy for the client with heart failure or pulmo-nary edema. Pulmonary edema is an acute medical emergency requiring immediate intervention. Respi-ratory status and comfort will be improved when cardiac output increases to an acceptable level. Peripheral edema is not typically associated with pulmonary edema.

Clients with heart failure are prone to atrial fibrillation. During physical assessment, the nurse should suspect atrial fibrillation when palpation of the radial pulse reveals: 1. Two regular beats followed by one irregular beat. 2. An irregular pulse rhythm. 3. Pulse rate below 60 bpm. 4. A weak, thready pulse.

2. Characteristics of atrial fi brillation include pulse rate greater than 100 bpm, totally irregular rhythm, and no defi nite P waves on the ECG. During assessment, the nurse is likely to note the irregular rate and should report it to the physician. A weak, thready pulse is characteristic of a client in shock. Two regular beats followed by an irregular beat may indicate a premature ventricular contraction.

A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? 1. Dilated coronary arteries. 2. Increased myocardial contractility. 3. Decreased cardiac arrhythmias. 4. Decreased electrical conductivity in the heart.

2. Digoxin is a cardiac glycoside with posi-tive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increases output of blood from the left ventricle. Digoxin does not dilate coronary arteries. Although digoxin can be used to treat arrhythmias and does decrease the electrical conductivity of the myocardium, these are not primary reasons for its use in clients with heart failure and pulmonary edema.

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: 1. Decrease circulatory overload. 2. Improve the myocardial workload. 3. Prevent thrombus formation. 4. Regulate cardiac rhythm.

3. Coumadin is an anticoagulant, which is used in the treatment of atrial fi brillation and decreased left ventricular ejection fraction (less than 20%) to prevent thrombus formation and release of emboli into the circulation. The client may also take other medication as needed to manage the heart failure. Coumadin does not reduce circulatory load or improve myocardial workload. Coumadin does not affect cardiac rhythm.

In which of the following positions should the nurse place a client with suspected heart failure? 1. Semi-sitting (low Fowler's position). 2. Lying on the right side (Sims' position). 3. Sitting almost upright (high Fowler's position). 4. Lying on the back with the head lowered (Trendelenburg's position).

3. Sitting almost upright in bed with the feet and legs resting on the mattress decreases venous return to the heart, thus reducing myocardial work-load. Also, the sitting position allows maximum space for lung expansion. Low Fowler's position would be used if the client could not tolerate high Fowler's position for some reason. Lying on the right side would not be a good position for the client in heart failure. The client in heart failure would not tolerate the Trendelenburg's position.

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs? 1. Take one tablet every 2 to 5 minutes until the pain stops. 2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. 3. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets. 4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

3. The correct protocol for nitroglycerin use involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of three tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.

What is the most common complication of an MI? 1. Cardiogenic shock 2. Heart failure 3. arrhythmias 4. Pericarditis

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

Which activity would be appropriate to delegate to unlicensed personnel for a client diagnosed with a myocardial infarction who is stable? 1. Evaluate the lung sounds. 2. Help the client identify risk factors for CAD. 3. Provide teaching on a 2 g sodium diet. 4. Record the intake and output

4. Unlicensed personnel are able to measure and record intake and output. The nurse is respon-sible for client teaching, physical assessments, and evaluating the information collected on the client.

The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a: 1. Low sodium level. 2. High glucose level. 3. High calcium level. 4. Low potassium level.

4. A low serum potassium level (hypokalemia) predisposes the client to digoxin toxicity. Because potassium inhibits cardiac excit-ability, a low serum potassium level would mean that the client would be prone to increased cardiac excitability. Sodium, glucose, and calcium levels do not affect digoxin or contribute to digoxin toxicity.

Which of the following is an expected out-come for a client on the second day of hospitalization after a myocardial infarction (MI)? The client: 1. Has severe chest pain. 2. Can identify risk factors for MI. 3. Agrees to participate in a cardiac rehabilitation walking program. 4. Can perform personal self-care activities with-out pain.

4. By day 2 of hospitalization after an MI, cli-ents are expected to be able to perform personal care without chest pain. Severe chest pain should not be present on day 2 after and MI. Day 2 of hospitaliza-tion may be too soon for clients to be able to identify risk factors for MI or to begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program.

The nurse notices that a client's heart rate decreases from 63 to 50 beats per minute on the monitor. The nurse should first: 1. Administer Atropine 0.5 mg I.V. push. 2. Auscultate for abnormal heart sounds. 3. Prepare for transcutaneous pacing. 4. Take the client's blood pressure.

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

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

ADEGH A. Obtain a 12-lead EKG D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula

The nurse is assessing a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) and is ordered to receive an IV infusion of abciximab (ReoPro). Which clinical manifestation does the nurse monitor for in this client? a. Bleeding b. Joint pain c. Pedal edema d. Excessive thirst

ANS: A Administration of glycoprotein (GP) IIa/IIIb inhibitors is common during the first few hours after PTCA. The nurse should monitor the client closely for bleeding and hypersensitivity reactions, which can include angioedema, urticaria, and even anaphylaxis. The other manifestations are not associated with the administration of GP IIa/IIIb inhibitors.

The nurse is teaching a client who is prescribed a calcium channel blocking agent after a percutaneous transluminal coronary angioplasty (PTCA). Which instruction does the nurse include in this client's teaching? a. "Change position slowly." b. "Avoid crossing your legs." c. "Weigh yourself daily." d. "Decrease salt intake."

ANS: A Calcium channel blocking agents cause systemic vasodilation and postural (orthostatic) hypotension. The client should avoid crossing legs, should weigh daily, and should decrease salt intake, but these are not associated with teaching for a calcium channel blocker.

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

B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle.

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

C. 10 days

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

D. Pericarditis

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

D. Platelets 135,000

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

D. Troponin

The primary purpose of a soft, high-fiber diet immediately following a myocardial infarction (MI) is to: A. promote easy digestion. B. lower cholesterol levels. C. maintain bowel health to decrease gas. D. create a high-bulk, soft stool to minimize Valsalva maneuver.

D. create a high-bulk, soft stool to minimize Valsalva maneuver.

Etiology of heart failure after MI is related to the: A. increased myocardial workload. B. increased oxygen demands of the myocardium. C. inability of the heart chambers to fill adequately. D. impairment of the contractile function of the ventricle.

D. impairment of the contractile function of the ventricle.

A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client? Select all that apply. 1. Reduces myocardial oxygen consumption. 2. Promotes reduction in respiratory rate. 3. Prevents ventricular remodeling. 4. Reduces blood pressure and heart rate. 5. Reduces anxiety and fear.

1, 4, 5. Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial oxygen con-sumption, blood pressure, and heart rate. Morphine also reduces anxiety and fear due to its sedative effects and by slowing the heart rate. It can depress respirations; however, such an effect may lead to hypoxia, which should be avoided in the treatment of chest pain. Angiotensin-converting enzyme-inhibitor drugs, not morphine, may help to prevent ventricular remodeling.

An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: 1. Left ventricular atrophy. 2. Irregular heartbeats. 3. Peripheral vascular occlusion. 4. Pacemaker placement.

1. In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle. Decreased car-diac output, cardiac hypertrophy, and heart failure are examples of the chronic conditions that may develop in response to inactivity, rather than in response to the aging process.

The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first? 1. Assess respiratory status. 2. Draw blood for laboratory studies. 3. Insert a Foley catheter. 4. Weigh the client.

1. The ankle edema suggests fl uid volume overload. The nurse should assess respiratory rate, lung sounds, and SpO2 to identify any signs of respiratory symptoms of heart failure requiring immediate attention. The nurse can then draw blood for laboratory studies, insert the Foley catheter, and weigh the client.

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? 1. A change in the pattern of her pain. 2. Pain during sexual activity. 3. Pain during an argument with her husband. 4. Pain during or after an activity such as lawn-mowing.

1. The client should report a change in the pattern of chest pain. It may indicate increasing severity of coronary artery disease. Pain occurring during stress or sexual activity would not be unex-pected, and the client may be instructed to take nitroglycerin to prevent this pain. Pain during or after an activity such as lawn-mowing also would not be unexpected; the client may be instructed to take nitroglycerin to prevent this pain or may be restricted from doing such activities.

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

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

Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of myocardial infarction? 1. Liquids as desired. 2. Small, easily digested meals. 3. Three regular meals per day. 4. Nothing by mouth.

2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better tolerated.

When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explains that the purpose of the drug is to: 1. Help keep him well hydrated. 2. Dissolve clots that he may have. 3. Prevent kidney failure. 4. Treat potential cardiac arrhythmias

2. Thrombolytic drugs are administered within the fi rst 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tab-lets, 0.3 mg given sublingually. This drug's principal effects are produced by: 1. Antispasmodic effects on the pericardium. 2. Causing an increased myocardial oxygen demand. 3. Vasodilation of peripheral vasculature. 4. Improved conductivity in the myocardium.

3. Nitroglycerin produces peripheral vasodi-lation, which reduces myocardial oxygen consump-tion and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood fl ow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

The client who experiences angina has been told to follow a low-cholesterol diet. Which of the following meals should the nurse tell the client would be best on her low-cholesterol diet? 1. Hamburger, salad, and milkshake. 2. Baked liver, green beans, and coffee. 3. Spaghetti with tomato sauce, salad, and coffee. 4. Fried chicken, green beans, and skim milk

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

A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time? 1. Monitor daily weights and urine output. 2. Permit unrestricted visitation by family and friends. 3. Provide client education on medications and diet. 4. Reduce pain and myocardial oxygen demand.

4. Nursing management for a client with a myocardial infarction should focus on pain manage-ment and decreasing myocardial oxygen demand. Fluid status should be closely monitored. Client education should begin once the client is stable and amenable to teaching. Visitation should be based on client comfort and maintaining a calm environment.

Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: 1. Control chest pain. 2. Reduce coronary artery vasospasm. 3. Control the arrhythmias associated with MI. 4. Revascularize the blocked coronary artery.

4. The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when adminis-tered within the fi rst 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhyth-mias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and reestablish a blood supply to the area.

The nurse determines that teaching has been effective when a client with coronary artery disease (CAD) identifies which priority modifiable risk factor? a. Obesity b. Diet c. Stress d. Smoking

d. Smoking

When assessing a client diagnosed with left-sided heart failure, the nurse anticipates which finding? a. Edema of the feet and ankles b. Shortness of breath c. Liver enlargement d. Abdominal distention

b. Shortness of breath

For a client experiencing hypertension what is an appropriate outcome that the nurse should observe? a. The client returns to normal activities of daily living. b. The client identifies two modifiable risk factors. c. The client lowers blood pressure by 10%. d. The client discontinues lifestyle modifications.

b. The client identifies two modifiable risk factors.

The nurse is reviewing the laboratory results for a patient diagnosed with coronary artery disease (CAD). The patient's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as which of the following? a) Critically high b) Low c) Within normal limits d) High

High The normal LDL range is 100 mg/dL to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk patients).

A 69-year-old female has a history of heart failure. She is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first? 1. Blood pressure. 2. Skin breakdown. 3. Serum potassium level. 4. Urine output

1. It is a priority to assess blood pressure first because people with pulmonary edema typically experience severe hypertension that requires early intervention. The client probably does not have skin breakdown on admission; however, when the client is stable, the nurse should inspect the skin. Potassium levels are not the first priority. The nurse should monitor urine output after the client is stable.

After the administration of t-PA, the assessment priority is to: 1. Observe the client for chest pain. 2. Monitor for fever. 3. Monitor the 12-lead electrocardiogram (ECG) every 4 hours. 4. Monitor breath sounds.

1. Although monitoring the 12-lead ECG and monitoring breath sounds are important, observing the client for chest pain is the nursing assessment priority because closure of the previously obstructed coronary artery may recur. Clients who receive t-PA frequently receive heparin to prevent closure of the artery after administration of t-PA. Careful assessment for signs of bleeding and monitoring of partial thromboplastin time are essential to detect complications. Administration of t-PA should not cause fever

Normal CVP range

2-6 mmHg

A client has a history of heart failure and has been taking several medications, including furosemide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which condition? 1. Hyperkalemia. 2. Digoxin toxicity. 3. Fluid deficit. 4. Pulmonary edema.

2. Early symptoms of digoxin toxicity include anorexia, nausea, and vomiting. Visual disturbances can also occur, including double or blurred vision and visual halos. Hypokalemia is a common cause of digoxin toxicity associated with arrhythmias because low serum potassium can enhance ectopic pacemaker activity. Although vomiting can lead to fl uid defi cit, given the client's history, the vomiting is likely due to the adverse effects of digoxin toxic-ity. Pulmonary edema is manifested by dyspnea and coughing.

What diagnostic test is used for a stroke patient to determine if they can get tPA?

A CT scan, to determine if it is a hemorrhagic stroke or an ischemic stroke (tPA is not given for hemorrhagic stroke)

Which complication of cardiac surgery occurs when there is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? A. Cardiac tamponade B. Fluid overload C. Hypertension D. Hypothermia

A Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high PAWP, CVP, and pulmonary artery diastolic pressure as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.

What is the pacemaker of the heart?

A battery power source that is placed under the skin to stimulate the heart and regulate rate & rhythm (used to treat severe bradycardia)

A patient is given a prescription for Lopressor, a beta-blocker, after being examined by his health care provider. Select the most important information the nurse should provide. A. Don't suddenly stop taking the medication without calling your health care provider. B. Take the medication at the same time each day. C. If dizziness occurs, adjust the medication. D. Dress warmly. Blood circulation may be reduced in the extremities.

A. Don't suddenly stop taking the medication without calling your health care provider.

Ischemic Stroke

A type of stroke that occurs when the flow of blood to the brain is blocked

A nurse is caring for an adult client diagnosed with left-sided heart failure. The nurse should recognize that the client's primary symptom(s) will be: A. Dyspnea on exertion B. Signs of hepatomegaly C. Edema of the legs and feet D. Anorexia, nausea, and vomiting

A. Dyspnea on exertion

An 80-year-old male client who has been informed by his physician that he has arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is a: A. Expected part of the aging process B. High level of blood fat C. Vascular occlusive disease D. Condition in which the lumen of arteries fill with plaque

A. Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes.

A 40 year old male with chest pain has been admitted to the emergency room to rule out acute myocardial infarction. Which statement by the client is most suggestive of angina pectoris? A. "The pain occurred while I was mowing the lawn". B. "The pain resolved after I ate a sandwich". C. "The pain became worse when I took a deep breath". D. "The pain lasted about 45 minutes".

A. "The pain occurred while I was mowing the lawn".

A nurse hears a rapid irregular heart rhythm that is new to this patient. Before calling the health care provider the nurse would collect a focused assessment. Which of the following assessments and/or diagnostic tests would the nurse perform? Select all that apply. A. 12 lead EKG B. Oxygen saturation C. Bowel sounds D. Romburg Test E. Blood sugar F. Vital signs

A. 12 lead EKG B. Oxygen saturation F. Vital signs

During bathing, the nurse observes that the patient's legs are pale and the skin is shiny. There is very sparse hair growth over the entire area. This is a sign of: A. Arterial vascular disease. B. Venous insufficiency. C. Impaired skin integrity. D. Personal hygiene deficit.

A. Arterial vascular disease.

In addition to decreasing high cholesterol foods, dietary changes to lower serum cholesterol levels would include: A. Consuming adequate or increased amounts of fresh fruits and vegetables. B. Decreasing whole grain products. C. Using natural sweeteners instead of artificial ones. D. Increasing whole milk, cheese and yogurt.

A. Consuming adequate or increased amounts of fresh fruits and vegetables.

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? A. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction B. Disabled family coping related to knowledge deficit and a temporary change in family dynamics C. Anxiety related to an actual threat to health status, invasive procedures, and pain D. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time

A. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? A. Heart B. Blood vessels C. Bronchi D. Uterus

A. Heart

In auscultating heart sounds, the nurse identifies a murmur and recognizes that murmurs are frequently due to: A. Turbulent flow of blood across a valve B. Accumulation of fluid in the alveoli. C. Fluid volume overload. D. Pericardial surfaces rubbing together

A. Turbulent flow of blood across a valve

A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation? A.Prothrombin time (PT) or international normalized ratio (INR) B. Urine output C. Vascular sites for bleeding D. Hourly IV infusion

A.Prothrombin time (PT) or international normalized ratio (INR)

A patient with a possible stroke has left side hemiparesis and speech difficulty. The physician has ruled out contraindications for thromoblytic therapy. The nurse would explain that the thrombolytic therapy will help the patient in what way? A. To help with the resolution of the transient ischemic attach B. To revitalize all cells in the affected area of the brain C. Prevent the blood clot from moving and causing further damage to the patient's central nervous system D. To restore blood flow to cells in the penumbra

D. To restore blood flow to cells in the penumbra

What class of drugs are Plavix & Aspirin?

Antiplatelet

Stage IV Heart Failure

Any degree of physical activity results in increased discomfort, even at rest patient experiences symptoms of cardiac insufficiency

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) Prepare the client for pulmonary artery catheterization. b) Assess the client's level of pain and administer prescribed analgesics. c) Assess the client's level of anxiety and provide emotional support. d) Ensure that the client's family is kept informed of his status.

Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

To assess for intravascular volume depletion, the nurse evaluates the patient for: A. Apical radial pulse deficit. B. Orthostatic hypotension. C. Widening pulse pressure. D. Capillary refill time

B. Orthostatic hypotension.

A sixty year old male client is admitted with shortness of breath, fatigue, and a oxygen saturation of 87% on room air. The patient had a heart attack two weeks ago. Based on this assessment data the nurse would enter a care plan that would deal with caring for a patient with: A. Angina B. Electrolyte Imbalance C. Congestive Heart Failure D. Cardiac Dysrhythmias

C. Congestive Heart Failure

A nurse is preparing to administer Lasix 40 mg IVP to a client with CHF. The patient is on a venturi-mask at 55% and does not tolerate activity without significant shortness of breath. The nurse would call the physician for which of the following orders based on this patient condition and expected response from this medication? A. Hilrom pulmonary rotation bed to prevent pneumonia B. Sequential compression stockings to prevent deep vein thrombosis C. Foley catheter insertion D. Order for ativan 1 mg po prn q6h anxiety

C. Foley catheter insertion

The patient prescribes clopidogrel (Plavix) for a patient with cerebral atherosclerosis. The nurse teaches the patient that an expected outcome of this would be best described by which of the following statements? A. Breakdown of clots that have formed in cerebral arteries B. healing of sites where blood is oozing our of cerebral arteries C. Prevention of platelet clumps around atherosclerotic plaques D. Maintaining blood pressure at 140/80's

C. Prevention of platelet clumps around atherosclerotic plaques

The nurse assesses pulse pressure by: A. Subtracting the apical pulse rate from the radial pulse rate. B. Subtracting the radial pulse rate from the apical pulse rate. C. Subtracting the diastolic blood pressure from the systolic blood pressure. D. Taking bilateral radial pulses for 1 minute and finding the difference.

C. Subtracting the diastolic blood pressure from the systolic blood pressure.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. The nurse should tell the client that: A. his cholesterol is within the recommended guidelines and he doesn't need to lower it. B. he should take his statin medication and not worry about his cholesterol. C. she'll ask the dietitian to talk with him about modifying his diet. D. he should begin a running program, working up to 2 miles per day.

C. she'll ask the dietitian to talk with him about modifying his diet.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A. "You do not need the effects of nitroglycerine while you sleep." B. "Nitroglycerine causes headaches, but removing the patch decreases the incidence." C."Removing the patch at night prevents drug tolerance while keeping the benefits." D. "Contact dermatitis and skin irritations are common when the patch remains on all day."

C."Removing the patch at night prevents drug tolerance while keeping the benefits."

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a) CVP reading: 1 mmHg b) Blood pressure: 110/68 mmHg c) Heart rate: 66 bpm d) Pain score: 5/10.

CVP reading: 1 mmHg The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.

Digoxin is what class of drug?

Cardiac glycoside

The nurse is aware that a client who has been diagnosed with Prinzmetal's angina will present with which of the following symptoms? a) Chest pain of increased frequency, severity, and duration b) Chest pain that occurs at rest and usually in the middle of the night c) Radiating chest pain that lasts 15 minutes or less d) Prolonged chest pain that accompanies exercise

Chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8 AM, is sporadic over 3-6 months, and diminishes over time. Client with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Client with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A. Sodium B. Magnesium C. Calcium D. Potassium

D. Potassium

The nurse observes that the patient's jugular veins distend in the semi-upright position to more than 5 cm above the sternal angle. This is an indication of: A. Left ventricular dysfunction B. Decreased central venous pressure. C. Pulmonary insufficiency. D. Right sided fluid volume overload.

D. Right sided fluid volume overload.

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? A. Within 12 hours B. Within 24 to 48 hours C. Within 5 to 7 days D. Within 6 hours

D. Within 6 hours

A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a) Decreases cholesterol level b) Decreases resting heart rate c) Decreases platelet aggregation d) Increases cardiac output

Decreases resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available.

A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: a) Decreased LDH levels b) Decreased myoglobin levels c) Elevated troponin levels d) Increased C-reactive protein levels

Elevated troponin levels Troponin is present only in myocardial tissue; therefore, it is the gold standard for determining heart damage in the early stages of an MI. LDH1 and LDH2 may be elevated in response to cardiac or other organ damage during an MI. Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage during an MI. C-reactive protein, erythrocyte sedimentation rate, and the WBC count increase on about the third day following MI because of the inflammatory response that the injured myocardial cells triggered. These levels would not be elevated during the MI event

What is important with administration of Captopril?

Have the patient lay down for at least 3 hours after the 1st dose to reduce postural hypotension

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? a) Urinary incontinence b) Hypertension c) Hypotension d) Hyperactive bowel sounds

Hypotension The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.

CVP is used to determine:

If the patient needs more fluids

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? a. Leads V1 and V2 b. Leads II, III, and aVF c. Leads I, aVL, V5, and V6 d. Leads V3 and V4

Leads V3 and V4 Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.

Stage I Heart Failure

Mild No physical limitation of physical activity and patient is comfortable at rest. Asymptomatic.

Stage II Heart Failure

Mild/Moderate Some physical limitations due to fatigue, SOB, palpitations Patient is comfortable at rest

Stage III Heart Failure

Moderate Increased physical limitations, fatigue, SOB, and palpitations Patient is still comfortable at rest

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? a) Meperidine hydrochloride (Demerol) b) Morphine sulfate (Morphine) c) Isosorbide mononitrate (Isordil) d) Nitroglycerin transdermal patch

Morphine sulfate (Morphine) Morphine not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as Isordil) have a large first-pass effect, and transdermal patch is used for long-term management. Demerol is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

Symptoms of Digoxin Toxicity

Nausea, vomiting, headache, somnolence, altered color vision (YELOW HALOS), arrhythmias

What assessment is important to conduct before tPA administration?

Neurological assessment- assess level of consciousness & pupil size

Cardiac Tamponade

Pressure on the heart caused by fluid in the pericardial space

What do anticoagulants do?

Prevent clot formation

What are Troponins?

Proteins released during an MI, with necrosis of cardiac muscle. They remain in the blood 10-14 days after an MI (making it useful to diagnose when treatment is delayed).

The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is:

Relieved by rest and nitroglycerin

For patient's with pace makers, what assessment other than cardiovascular assessment is important?

Skin assessment (to assess for breakdown and if there is, then pacemaker is switched to the other side)

What two classes of drugs do you want to avoid grapefruit juice?

Statins & Calcium Channel Blockers

Single Pacemaker

Stimulates ventricles only

Define Afterload

The force needed to eject blood into the circulation, the force must be great enough to overcome arterial pressures

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? a) The patient has had angina longer than 3 years. b) The patient has an ejection fraction of 65%. c) The patient has compromised left ventricular function. d) The patient has at least a 70% occlusion of a major coronary artery.

The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).

To help a stroke patient shallow, what intervention can be done?

Thicken fluids

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks?

Troponin Rationale: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

What is stroke volume?

Volume of blood ejected with each heart beat. Determined by preload, after load, and myocardial contractility.

The nurse concludes that further teaching is needed when visiting the home of a client who has recovered from a cerebrovascular accident (CVA). Which finding indicates the client is at risk of Ineffective Tissue Perfusion? a. The commode is at the bedside. b. Oxygen canister is in the closet. c. Hand weights are next to the couch. d. Metamucil is on the kitchen counter.

b. Oxygen canister is in the closet.

The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. a. Bilateral rales and rhonchi b. Potassium level of 6 mEq/L c. Serum glucose of 124 mg/dL d. Weight gain of 6 ounces

b. Potassium level of 6 mEq/L

A 33-year-old client complains of chest pain as a 3 out of 5. All vital signs are stable and the client denies any other physical complaints. What is the best therapy the nurse can offer the client at this time? a. Provide the client with morphine. b. Provide the client with oxygen. c. Withhold all foods and liquids. d. Ask the client about his day.

b. Provide the client with oxygen.

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Internal bleeding b) Worsening angina c) Thrombocytopenia d) Formation of blood clots

Worsening angina Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia.

Adverse effect of Beta Blockers

Worsening heart failure - assess lung sounds, daily weights, edema and vitals

At the end of treatment, a patient should report a pain rating of at least:

ZERO

A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? a) Coronary artery disease b) Venous occlusive disease c) Raynaud's disease d) Cardiogenic shock

a) Coronary artery disease The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.

During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk? a) Smoking cessation b) Antioxidant supplements c) Exercise avoidance d) Protein-rich diet

a) Smoking cessation

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? a. "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." b. "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses." c. "A burning sensation after administration indicates that the nitroglycerin tablets are potent." d. "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh."

a. "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect? a. "My chest pain is decreasing" b. "I haven't been able to have a bowel movement for three days" c. "I feel less anxious" d. "My chest pain is radiating to my jaw"

a. "My chest pain is decreasing"

A 43-year-old client comes into the clinic following a "minor car accident" 2 days ago. During the assessment, the nurse notes that the client seems lethargic. The client admits to having headaches and feeling "dizzy." Which action is priority following the nurse's initial assessment? a. Call the physician. b. Give the client Tylenol for his headache. c. Tell the client to go home, lie down, and rest. d. Check the client's O2 saturation level.

a. Call the physician.

The nurse receives an 82-year-old client with a history of A-fib from the angiography department. What priority actions will the nurse do next? Select all that apply. a. Check the groin for bleeding or hematoma. b. Place the client supine for several hours. c. Apply heat to the calf of the leg. d. Elevate the foot of the bed or place pillows under the legs. e. Place a sandbag on the femoral site.

a. Check the groin for bleeding or hematoma. b. Place the client supine for several hours. e. Place a sandbag on the femoral site. The client undergoing angiography has a large-bore catheter inserted through the femoral artery, so the priority of care is to monitor and prevent bleeding. The client will lie flat for several hours and the groin will be checked regularly. A sandbag may be placed to maintain constant pressure on the arterial puncture site. Elevating the foot of the bed would increase pressure and blood flow to the groin and increase the risk of bleeding, as would applying heat to the leg.

The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following? a. Count the respiratory rate for bradypnea. b. Measure urinary output for dehydration. c. Check the radial pulse for arrhythmias. d. Measure the blood pressure for hypertension.

a. Count the respiratory rate for bradypnea.

The nurse is conducting a teaching clinic for senior citizens about risk factors for stroke. Although the nurse includes all of the following as risk factors, which presents the greatest risk for stroke? a. Hypertension b. Diabetes c. High cholesterol level d. Heart disease

a. Hypertension

An 80-year-old client is admitted to the emergency room with "chest pain and a racing heart." The client also complains of SOB when walking 50 feet or less. During an initial assessment, which abnormal finding does the nurse find that is consistent with the client's diagnosis of pulmonary hypertension? a. Increase in amplitude with apical impulse assessment b. Pansystolic murmur during murmur assessment c. High-pitched bowel sounds during abdominal assessment d. Loud S1 during heart sound assessment

a. Increase in amplitude with apical impulse assessment

The client undergoing an ECG is diagnosed with a dysrhythmia. The nurse performs what priority intervention after the test? a. Obtains a baseline blood pressure b. Gives the client a mild sedative c. Tells the client to stop smoking d. Tells the client to maintain a daily BP log

a. Obtains a baseline blood pressure

A nurse is teaching a family with several members at risk for hypertension about measures that can be taken to help prevent hypertension. What priority action should the nurse include in the teaching? Select all that apply. a. Reduce cholesterol intake. b. Eat a diet rich in fruits and vegetables. c. Increase sodium intake. d. Stop smoking. e. Engage in isometric exercises.

a. Reduce cholesterol intake. b. Eat a diet rich in fruits and vegetables. d. Stop smoking.

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Select all that apply. a. Tobacco use b. Obesity c. Hyperlipidemia d. Race e. Family history

a. Tobacco use b. Obesity c. Hyperlipidemia

The nurse caring for a client undergoing pulmonary artery pressure monitoring for heart failure provides appropriate care when the nurse: a. calibrates and levels the system every shift. b. reports waveform dampening during wedge pressure measurements. c. secures IV tubing to the bed linens. d. maintains flush solution flow by gravity.

a. calibrates and levels the system every shift. Calibrating and leveling the system every shift ensures accuracy and consistency of measurements. The IV tubing is secured to the patient, not the bed linens. The arterial flush will not work with only gravity because it needs to be under pressure. Dampening of the waveform during measurement is the expected finding.

Which clinical manifestation would alert the nurse that the client has experienced a transient ischemic attack (TIA)? a. Loss of sensation and reflexes in both legs b. Numbness and tingling at the corner of the mouth c. Complete paralysis of the right arm and leg d. Sudden severe pain over the left eye

b. Numbness and tingling at the corner of the mouth Numbness and tingling at the mouth that disappears within minutes or hours is a manifestation of temporary occlusion of the middle cerebral artery. Sudden eye pain, paralysis, and loss of sensation are manifestations of stroke.

A nurse wishes to auscultate the patient's chest for suspected third and fourth heart sounds. To amplify or increase these sounds the nurse would: a. utilize the bell of the stethescope at the apex of the heart with the patient in a left sidelying position. b. use the diaphragm of the stethescope placed firmly against the apex of the heart. c. have the patient take deep breathes during the auscultation process using the diaphragm of the stethescope at the third intercostal space left sternal border. d. utilize the bell of the stethescope with patient sitting up in high fowlers position at the apex of the heart. .

a. utilize the bell of the stethescope at the apex of the heart with the patient in a left sidelying position.

A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a) Cool, clammy, diaphoretic, and pale appearance b) Chest discomfort not relieved by rest or nitroglycerin c) Intermittent nausea and emesis for 3 days d) Anxiousness, restlessness, and lightheadedness

b) Chest discomfort not relieved by rest or nitroglycerin

The nurse is planning discharge instructions for a client diagnosed with coronary artery disease (CAD). The client, who is to take nitroglycerin at home for substernal chest pain, asks the nurse what to do if there is still pain after taking the medication. What is the appropriate response made by the nurse? a. "Take an aspirin and call 911." b. "Take another nitroglycerin tablet." c. "Wait for 10 minutes before taking a second pill." d. "Apply oxygen at 10 liters per minute."

b. "Take another nitroglycerin tablet." Nitroglycerin is ordered to be taken every 5 minutes 3 times for pain. Waiting 10 minutes between doses is not appropriate if the client is in pain. Ten liters of oxygen is an unsafe dose. The nurse instructs the client to call 911 if the pain does not subside after 3 doses.

A 76-year-old hospitalized client is diagnosed with pneumonia for the second time this year. The nurse knows that this increase in hospitalization is due to which factor? a. Not receiving the flu shot yearly b. Age-related changes c. Going outside with hair wet in the winter d. Not receiving the pneumonia vaccine at age 65

b. Age-related changes

The nurse plays an important role in monitoring and managing potential complications in the patient who has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which of the following respiratory complications? a. Urinary tract infection b. Atelectasis c. Hyperkalemia d. Elevated blood glucose level

b. Atelectasis

A client with coronary artery disease (CAD) has had bypass surgery and is about to be discharged home on several new medications, including digoxin (Lanoxin) and furosemide (Lasix). The client complains of nausea and anorexia. Which action will the nurse do first? a. Check the PT/INR. b. Check the digoxin level. c. Call the physician. d. Check the sodium level.

b. Check the digoxin level.

The nurse in a long-term care facility is talking with the family of a client diagnosed with heart failure, diabetes, hypertension, and chronic renal failure. The nurse notes mild edema of the ankles while the client is sitting in the chair. Breath sounds are clear, equal, and with good chest excursion, and the client denies any feeling of shortness of breath. The nurse reviews the medical record and sees no significant change in the client's daily weights over the last week. What are the nurse's priority interventions for this client? Select all that apply. a. Review the client's BUN and creatinine. b. Encourage the client to elevate feet when sitting. c. Apply antiembolism stockings. d. Review the client's diet to determine sodium intake. e. Call the doctor for an order to increase the client's diuretic.

b. Encourage the client to elevate feet when sitting. c. Apply antiembolism stockings.

A 55-year-old woman comes to the clinic complaining of chest pain. What priority assessment is important for this client? a. Hematocrit of 30 g/dL b. Estrogen level of 5 pg/ml c. Testosterone level of 10 ng/dL d. Iron level of 12 g/dL

b. Estrogen level of 5 pg/ml

The nurse is administering oxygen to a client experiencing a stroke in order to prevent hypoxia and hypercapnia. The nurse expects this treatment to decrease the risk for: a. Rebleeding b. Increased intracranial pressure (ICP) c. Pulmonary emboli. d. Fluid accumulation in the lungs.

b. Increased intracranial pressure (ICP) Preventing hypoxia and hypercapnia through administration of oxygen will prevent further ischemia of cerebral tissues and ICP. Fluid in the lungs and pulmonary emboli are unrelated to stroke. Administering oxygen will not prevent rebleeding.

A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a. Elevated hematocrit b. Low blood pressure c. Decreased heart rate d. High blood pressure

b. Low blood pressure

The nurse caring for a diabetic client with chronic renal failure classifies the client's hypertension as: a. Genetic b. Secondary c. Malignant d. Primary

b. Secondary

In assessing a client admitted 24 hours ago with heart failure, the nurse notes that the client has lost 2.5 pounds, heart rate is down from 105 to 88, and there are fine crackles only in the bases of the lungs. The nurse correctly interprets these data as indicating: a. Heart failure has resolved. b. The treatment regimen is achieving the desired effect. c. A need for more aggressive treatment. d. The client's condition is unchanged.

b. The treatment regimen is achieving the desired effect.

A client tells the nurse that the anginal pain is unpredictable but usually occurs at night. The nurse questions the client and family further about precipitating factors at home; however, there does not appear to be any environmental or emotional cause for the pain. The nurse concludes that the client should contact the physician to facilitate admission to the hospital, because the client has which type of angina? a. Nonanginal pain b. Variant angina c. Unstable angina d. Stable angina

b. Variant angina

In reviewing the physician's admitting notes for a client with heart failure, the nurse notes that the client has an ejection fraction of 25%. What is the appropriate interpretation of the nurse's findings? a. The amount of blood ejected from the ventricles is within normal limits. b. Ventricular function is severely impaired. c. 25% of the blood in the ventricle remains after systole. d. Cardiac output is greater than normal.

b. Ventricular function is severely impaired. Normal ejection fraction is 60%; 25% ejection indicates severe dysfunction. The percentage represents the amount of blood ejected from the ventricle, not the amount retained. Cardiac output is decreased in heart failure.

The nurse is aware that reduction of stress is an important part of controlling hypertension. The nurse encourages the client with hypertension to involve family members and talk about reducing stress. Which stress management technique is an appropriate way to reduce stress? a. Working from home b. Weekly visits to a massage therapist c. Eating food when angry d. Repressing anger

b. Weekly visits to a massage therapist

The physician orders morphine 2 mg to 5 mg IV as needed for pain and dyspnea for an 80-year-old client with pulmonary edema from heart failure. The nurse appropriately: a. questions the order because the order does not have a time interval. b. administers the drug as ordered, monitoring respiratory function. c. administers the drug only when the client complains of chest pain. d. withholds the medication until respiratory status improves.

b. administers the drug as ordered, monitoring respiratory function.

The clinic nurse assesses a client with a history of transient ischemic attacks (TIA) who was advised to lose weight, change diet to lower cholesterol, and maintain treatment of hypertension. The client has chosen not to take this advice, leading the nurse to conclude the client is at increased risk for: a. vasovagal syndrome. b. cerebrovascular accident (CVA). c. aneurysm. d. myasthenia gravis.

b. cerebrovascular accident (CVA).

You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Coronary thrombosis b) Arteriosclerosis c) Atherosclerosis d) Raynaud's disease

c) Atherosclerosis

You are caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? a) Examine for pain around the shoulder and neck region. b) Examine the extremities for skin lesions. c) Examine the legs for color, capillary refill time, and tissue integrity. d) Examine the client's mental and emotional status.

c) Examine the legs for color, capillary refill time, and tissue integrity.

When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality? a) Hypercalcemia b) Hyponatremia c) Hyperkalemia d) Hypomagnesemia

c) Hyperkalemia

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Blood glucose level b) Activity intolerance c) Inadequate tissue perfusion d) Mental alertness

c) Inadequate tissue perfusion

Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. a. A serum creatinine of 1.0 mg/dL b. An hourly urine output of 50 to 70 mL c. A serum BUN of 70 mg/dL d. A urine specific gravity reading of 1.021

c. A serum BUN of 70 mg/dL

An African American male client with a history of diabetes and stroke returns from coronary angioplasty with stent placement. Which priority action will the nurse perform at this time? a. Treating chest pain with intravenous morphine as needed b. Securing chest tubes to the bedding c. Discontinuing intravenous lines when taking oral fluids d. Maintaining leg extension on the affected side

d. Maintaining leg extension on the affected side

A nurse is caring for a client with a history of hypertension who is treated with metoprolol (Lopressor), hydrochlorothiazide (Hydrodiuril), and captopril (Capoten). The client's current blood pressure is 120/80 with a heart rate of 48. Which is the best action by the nurse? a. Administer the metroprolol and the hydrochlorothiazide, hold the captopril, and notify the physician. b. Withhold all medications and notify the physician. c. Administer the captopril and the hydrochlorothiazide, hold the metoprolol, and notify the physician. d. Administer all medications and notify the physician.

c. Administer the captopril and the hydrochlorothiazide, hold the metoprolol, and notify the physician.

The nurse is reviewing the orders of a client experiencing a thrombotic stroke and notes an order for the administration of tissue plasminogen within the first 3 hours after the stroke. The nurse concludes that the reason for this order is to: a. Decrease the risk of infection. b. Reduce the risk of vasospasm. c. Cause fibrinolysis of the clot. d. Increase platelet aggregation.

c. Cause fibrinolysis of the clot.

A 76-year-old client has been brought to the emergency department by ambulance with a suspected stroke. Initial vital signs are BP 150/100, pulse 90, and respirations 20. After 30 minutes, vital signs have changed to BP 170/90, pulse 78 and respirations of 24. Which action should the nurse initiate next? a. Offer the client clear liquids to prevent dehydration. b. Ask how the client feels. c. Get an order to decrease IV fluids. d. Check the client's phenytoin (Dilantin) level.

c. Get an order to decrease IV fluids.

The nurse is examining a client in the clinic for follow-up care for heart failure. Which factor, if reported by the client, would not be associated with exacerbating heart failure? a. Nutritional anemia b. Atrial fibrillation c. Peptic ulcer disease d. Recent upper respiratory infection

c. Peptic ulcer disease

A client is diagnosed with cardiovascular disease. Which activity does the nurse suggest for this client? a. Karate b. Kick-boxing c. Tai chi d. Jazzercise

c. Tai chi

The nurse is obtaining a blood pressure for a 65-year- old client with primary hypertension. Which action should the nurse avoid to ensure accuracy of the blood pressure? a. Using a cuff that covers 80% of the limb. b. Measuring the blood pressure after the client has rested for 5 minutes. c. Taking the blood pressure within 10 minutes of the client ingesting caffeine. d. Placing the arm in a supportive position, bare-armed, and at the level of the heart.

c. Taking the blood pressure within 10 minutes of the client ingesting caffeine.

The nurse is teaching a group of clients in a clinic about hypertension. Which client is at highest risk for hypertension? a. The female adolescent African American b. The Caucasian middle-aged adult who smokes c. The African American woman who enjoys traditional cultural foods and is above a healthy weight d. The Caucasian woman with central obesity who drinks 2-3 drinks per day

c. The African American woman who enjoys traditional cultural foods and is above a healthy weight

The nurse is assigned to care for a client who has had an acute ischemic stroke of a left cerebral vessel. The chart reveals that the client has contralateral deficits. The nurse explains to the family that this means: a. The client will have neurological deficits on the left side. b. Both sides of the client's body are involved. c. The client will have neurological deficits on the right side. d. Deficits will be present below the level of the stroke.

c. The client will have neurological deficits on the right side The motor pathways of the nervous system cross at the medulla and spinal cord, so that damage to a cerebral vessel on one side will manifest neurologic deficits in the opposite, or contralateral, side. This client will exhibit deficits on the right side.

A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease? a) Assess the physical history of the patient b) Assess the blood pressure and administer aspirin c) Not important to assess the patient or to notify the physician d) Assess chest pain and administer prescribed drugs and oxygen

d) Assess chest pain and administer prescribed drugs and oxygen

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? a) Digoxin b) Protamine sulfate c) Sodium nitroprusside d) Atropine

d) Atropine

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Refractory b) Intractable c) Variant d) Unstable

d) Unstable

A client is placed on furosemide (Lasix) and hydrochlorothiazide (HCTZ) for high blood pressure. What priority intervention by the nurse is the most appropriate? a. Assess for angioedema. b. Monitor pulse rate. c. Monitor CBC. d. Assess hydration status.

d. Assess hydration status.

The nurse in the clinic assesses a client with stable angina. What expectations does the nurse have for this client? a. Weak peripheral pulses b. Increasing nocturnal pain c. Persistent ECG changes d. Correlation between activity level and pain

d. Correlation between activity level and pain

The nurse is caring for a client diagnosed with heart failure who is taking digoxin and furosemide. Which laboratory values will the nurse monitor closely? a. Calcium b. Sodium c. Phosphorus d. Potassium

d. Potassium