exm 6
The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) after hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?
"I should reduce the amount of green, leafy vegetables that I eat."
When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that:
Additional diagnostic testing will be required
The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?
Bilateral crackles in the mid-lower lobes.
A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next?
Call the health care provider before giving scheduled metoprolol (Lopressor).
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to best determine whether the patient has had an AMI?
Cardiac Specific Troponin
A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which nursing diagnosis is a priority for the patient?
Decreased cardiac output related to cardiogenic shock
A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first?
Electrocardiogram (ECG)
Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias?
Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block
Which is probably the most important criterion on which to base the decision to report suspected child abuse?
Incompatibility between the history and injury observed
An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
Increase the rate for the sodium nitroprusside infusion.
Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?
No change in the patient's reported level of chest pain.
The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
Obtain vital signs
The nurse is admitting a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question?
Omeprazole drug therapy
When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?
Report of severe chest pain
Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?
ST-segment Elevation
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?
Serum potassium of 2.9 mEq/L
The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is caused by an acute myocardial infarction (AMI)?
The pain has lasted longer than 30 minutes
When admitting a patient for a cardiac catheterization and coronary angiogram, which information about the patient is most important for the nurse to communicate to the health care provider?
The patient is allergic to shellfish
The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The laboratory test result most helpful in indicating myocardial damage will be:
Troponins T and I
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the patient's cardiac rhythm as:
Ventricular fibrillation
A nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which finding indicates that the drug is effective?
Warm, pink and dry skin
A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?
What time did your chest pain begin?
Nursing consideration when caring for an infant with FTT
a. Establish a structured routine and follow it consistently.
The standard policy on the cardiac unit states, "Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg." The nurse will need to call the health care provider about the:
postoperative patient with a BP of 116/42 mm Hg.
A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?
sildenafil (Viagra)
The nurse should instruct a patient taking alteplase to immediately report which symptom(s) to the health care provider?
1. Nosebleeds 2. Tarry stools 3. Bleeding gums
During the administration of the thrombolytic agent to a patient with an acute myocardial infarction, the nurse should stop the drug infusion if the patient experiences:
A decrease in level of consciousness
Which nursing observation would indicate that the nurse hold the medication warfarin (Coumadin)?
An INR of 4.8
A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom?
Auscultate for a pericardial friction rub.
Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?
Pallor and weakness of the right hand
Children who are at risk for abuse
a. Unintentionally contributes to the abusing situation
Clinical manifestations of failure to thrive caused by behavioral problems resulting in inadequate intake of calories include:
a. avoidance of eye contact.
A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next?
Apply the transcutaneous pacemaker (TCP) pads.
After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective?
"I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart."
Which statement by a patient indicates additional teaching is required about the medication warfarin?
"I will increase the intake of green, leafy vegetables for a more healthful diet."
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?
"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?
"It is important not to suddenly stop taking the carvedilol."
A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?
"What do you think caused your chest pain?"
A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first?
Preform immediate defibrillation
A 198-lb patient is to receive a dobutamine infusion at 5 mcg/kg/min. The label on the infusion bag states: dobutamine 250 mg in 250 mL of normal saline. When setting the infusion pump, the nurse will set the infusion rate at how many milliliters per hour?
27
After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first?
A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about:
Anticoagulant therapy
When titrating IV nitroglycerin for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the drug?
Ask about chest pain
When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?
Attach the heart monitor
Which is a common characteristic of those who sexually abuse children?
Pressure victim into secrecy
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to best determine whether the patient has had an AMI?
Cardiac-specific troponin
