Heart Failure / Myocardial Infarction

A patient is in the CCU with cardiomyopathy and asymptomatic right-sided chronic heart failure. What finding will the nurse most most likely consider in their assessment of this patient? A. Mitral regurgitation murmur B. Cheyne-Stokes respiratory pattern C. Unilateral crackles D. Rales

A) Mitral regurgitation murmur

A patient with chronic cardiac failure is on an ACE inhibitor but still has significant pitting edema in his extremities. Which medication, in addition to the ACE inhibitor, is the physician likely to prescribe to this patient? A. Digoxin B. A loop diuretic C. Beta-blocker D. Calcium channel blocker

B) A loop diuretic

A CCU nurse who works frequently with cardiac patients is putting together a teaching plan to follow when she instructs these patients on how to live with heart failure. Which points should she include in this plan? SATA A. Discontinue medications once you are feeling better, to avoid adverse effects B. Take your medications about the same time every day C. Avoid pepper and spices D. Remove the saltshaker from your table E. The best time to weigh yourself is in the afternoon F. Try to perform 15 to 20 minutes of continuous activity each day

B) Take your medications about the same time every day D) Remove the saltshaker from your table F) Try to perform 15 to 20 minutes of continuous activity each day

A nurse just received a shift report for a group of clients on the telemetry unit. Which client should the nurse assess first? A. The client with a history of cardioversion for sustained ventricular tachycardia 2 days ago B. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block C. The client with a history of heart failure who has bibasilar crackles and pitting edema in both feet D. The client admitted for unstable angina who underwent percutaneous coronary intervention (PCI) with stenting yesterday

B) The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block Exp. - The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block).

A nurse in the CCU must assess a cardiac patients fluid status. Which of the following is the best method for them to use? A. Having the patient measure and record all liquids taken in and all urine excreted B. Weighing the patient daily C. Pulse oximetry D. Radionuclide ventriculography

B) Weighing the patient daily

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as: A. a first heart sound (S1) B. a third heart sound (S3) C. a fourth heart sound (S4) D. a murmur

B. a third heart sound (S3) Exp. - An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.

A patient newly diagnosed with atherosclerosis wants to know what the plaque building up in his arteries actually consists of. Which of the following should the nurse mention? SATA A. Fatty substances B. Osteocytes C. Epithelial tissue D. Cholesterol E. Cellular waste products F. Collagen and elastic fibers

A / D / E / F

A young patient who seems perfectly healthy is displaying symptoms of angina pectoris. Which of the following are possible underlying causes of the patient's condition? SATA A. Atherosclerotic narrowing of the coronary arteries B. Hemophilia C. Use of aspirin D. Spasm of a coronary artery E. Arterial inflammation F. Tachycardia

A / D / E / F

A patient in the CCU with chronic heart failure is prescribed an ACE inhibitor. What side effects should the nurse mention to him? SATA A. Angioedema B. Cough C. Rebound tachycardia D. Hyperkalemia E. Night sweats F. Anxiety

A) Angioedema B) Cough D) Hyperkalemia

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address? A. blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL B. sodium (Na+) of 145 mEq/L and potassium (K+) of 5.0 mEq/L C. creatine phosphokinase (CPK) of 21 U/L D. white blood cell count (WBC) 9,000 cells/mm3

A) BUN of 26 mg/dL and serum creatinine of 2.35 mg/dL Exp. - Nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the antihypertensive effect of ACE inhibitors and predispose clients to the development of acute renal failure.

A patient presents to the CCU with acute, decompensated heart failure. The nurse observes that this patient has COPD and hypotension. She eats a low-sodium diet and drinks alcohol excessively. Which of the following are contributing factors to this patient's heart failure? A. Chronic obstructive pulmonary disease B. Hypotension C. Low-sodium diet D. Excessive alcohol intake

A) Chronic obstructive pulmonary disease

The patient has been found to be at high risk for cardiovascular disease after a highly sensitive C-reactive protein (CRP) blood test indicated a value of 3.0 mg/dL. The patient would like to know what this test measures. What would be the best answer for the nurse to give? A. Systemic inflammation related to atherosclerosis B. Cardiac output following myocardial infarction C. Blood pressure related to congestive heart failure D. Lipid levels in connection with stress response

A) Systemic inflammation related to atherosclerosis

After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first? A. the client with heart failure who is having some difficulty breathing B. the anxious client who was diagnosed with an acute myocardial infarction (MI) 2 days ago, and was transferred from the coronary care unit today C. the coronary bypass client asking for pain medication for "11 of 10" pain in the donor site D. the client admitted during the previous shift with new-onset controlled atrial fibrillation, who has a call light on

A) the client with heart failure who is having some difficulty breathing Exp. - The registered nurse should care for the client with heart failure who is experiencing difficulty breathing. Breathing takes precedence over the other client needs.

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving intravenous heparin sodium at 1,000 units per hour. During the second postprocedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. What should the nurse do first? A. Don gloves and apply direct pressure over the site B. Observe and document the bleeding C. Notify the health care provider (HCP) D. Prepare protamine sulfate for intravenous administration

A. Don gloves and apply direct pressure over the site Exp. - The nurse should first don gloves and apply direct pressure over the site to stop blood loss from the femoral artery. While the nurse will later observe the site for further bleeding and record the extent of bleeding, this is not the first action that is needed. If the bleeding cannot be controlled, the HCP who performed the procedure should be contacted, but first an attempt to manually stop the bleeding with direct pressure is warranted. Protamine sulfate is the antidote for heparin sodium, but this is not an initial action to control the bleeding.

A client prescribed propranolol calls the clinic to report a weight gain of 3 lb (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse's best action? A. Have the client come to the clinic in order to assess the lungs B. Assess the client's dietary intake for the past 24 hours C. Review medication administration with the client D. Assess the client's knowledge of expected effects of the drug

A. Have the client come to the clinic in order to assess the lungs Exp. - The client needs to be assessed for the heart failure, a potential adverse effect of beta blockers.

A patient with atherosclerosis acknowledges that he is a smoker but does not understand how this contributes to his atherosclerosis. Which response would be best for the nurse to give him? A. Smoking causes stress, which increases his lipid levels B. Smoking in him triggers a craving for high-cholesterol C. Smoking injures the inner layers of his arteries, facilitating plaque build up D. Smoking causes vasoconstriction

C)

A patient presents to the CCU with shortness of breath on exertion. Which diagnostic study would be best for ruling out pneumonia or COPD as the cause of the patient's symptoms? A. Echocardiography B. Radionuclide ventriculography C. Pulse oximetry D. Chest radiography

C) Chest radiography

The nurse is administering an IV potassium chloride supplement to a client who has heart failure. What should the nurse consider when developing a plan of care for this client? A. Hyperkalemia will intensify the action of the client's digoxin preparation. B. The client's potassium levels will be unaffected by a potassium-sparing diuretic. C. The administration of the IV potassium chloride should not exceed 10 mEq/h or a concentration of 40 mEq/L. D. Metabolic alkalosis will increase the client's serum potassium levels.

C) The administration of the IV potassium chloride should not exceed 10 mEq/h or a concentration of 40 mEq/L. Exp. - When administering IV potassium chloride, the administration should not exceed 10 or a concentration of 40 via a peripheral line. These limits are extremely important to prevent the development of hyperkalemia and the possibility of cardiac dysrhythmias.

The nurse instructs a client on the use of transdermal nitroglycerin 0.2 mg/hour patch for angina pectoris. Which client statement indicates that teaching was effective? A. "I should apply the patch to the same area every day." B. "I should touch the medication pad before applying to my skin." C. "I should report any skin irritation to the healthcare provider." D. "I should store the supply of transdermal pads in the refrigerator."

C. "I should report any skin irritation to the healthcare provider." Exp. - Because transdermal nitroglycerin can cause skin irritation, this should be reported to the healthcare provider.

Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? A. Monitor the laboratory values B. Observe neurologic function every 15 minutes C. Observe the puncture site for swelling and bleeding D. Monitor skin warmth and turgor

C. Observe the puncture site for swelling and bleeding Exp. - Assessment of circulatory status, including observation of the puncture site, is of primary importance after a cardiac catheterization.

A 78-year-old woman in the CCU complains of shortness of breath, along with prolonged chest pain unrelieved by rest or sublingual nitroglycerin. The nurse recognizes that this patient is most likely experiences which condition? A. Stable angina pectoris B. Atherosclerosis C. Classic angina D. Myocardial infarction

D) Myocardial infarction

A nurse in the telemetry unit is caring for a client with diagnosis of postoperative coronary artery bypass graft (CABG) surgery from 2 days ago. On assessment, the nurse notes a paradoxical pulse of 88. Which surgical complication would the nurse suspect? A. left-sided heart failure B. aortic regurgitation C. complete heart block D. pericardial tamponade

D) pericardial tamponade Exp. - A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans (a pulse amplitude alteration from beat to beat, with a regular rhythm). Aortic regurgitation may cause a bisferious pulse (an increased arterial pulse with a double systolic peak). Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).

A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? A. magnesium level of 2.5 mg/dl (0.1 mmol/L) B. calcium level of 7.5 mg/dl (0.4 mmol/L) C. sodium level of 152 mEq/L (152 mmol/L) D. potassium level of 3.1 mEq/L (3.1 mmol/L)

D) potassium level of 3.1 mEq/L (3.1 mmol/L) Exp. - Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

A client with aortic stenosis tells the nurse, "I have been feeling so tired lately that I take a nap in my recliner every afternoon." On assessment, the nurse notes apical heart sounds 2 cm left of the midclavicular line, crackles in lower lung fields during respiration, blood pressure 110/90 mm Hg, and weight gain of 2.5 kg (5.5 lb) in 24 hours. Which assessment requires further action? A. apical heart sounds 2 cm to the left of midclavicular line B. crackles in lower lung fields during inspiration C. blood pressure 110/90 mm Hg D. weight gain of 2.5 kg (5.5 lb) in 24 hours

D) weight gain of 2.5 kg (5.5 Ib) in 24 hours Exp. - Aortic stenosis leads to left ventricular enlargement and eventually to heart failure. Signs of heart failure include rapid weight gain, a shift of the apical pulse to the left of the midclavicular line, narrowed pulse pressure, and adventitious lung sounds. The nurse must intervene for rapid weight gain of more than 1 kg in 24 hours, which indicates fluid retention from worsening heart failure.

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? A. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs B. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider C. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team D. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin

D. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin Exp. - Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain.

The nurse is evaluating a client who received tissue plasminogen activator (t-PA) following a myocardial infarction (MI). What is the expected outcome of this drug? A. Control chest pain B. Reduce coronary artery vasospasm C. Control the arrhythmias associated with MI D. Revascularize the blocked coronary artery

D. Revascularize the blocked coronary artery Exp. - The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI.

A patient in the CCU complains of pain and a squeezing sensation in his chest. He says that it typically affects him in the middle of the night, waking him from sleep. The nurse recognizes that this patient is most likely experiencing which of the following? A. Stable angina B. Unstable angina C. Classic angina D. Variant angina

D) Variant angina

A client with heart failure is taking furosemide, digoxin, 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. What other sign should the nurse assess next? A. hyperkalemia B. digoxin toxicity C. fluid deficit D. pulmonary edema

B. digoxin toxicity Exp. - 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.

A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? A. pulse rate of 84 beats/minute B. respiration 26 breaths/minute C. blood pressure 84/52 mm Hg D. temperature of 100.2° F (37.9° C)

C) blood pressure 84/52 mm Hg Exp. - Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range.

The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client: A." This drug will constrict your blood vessels and keep your blood pressure from getting too low." B." This drug will slow your heart rate down." C." This drug will dilate your blood vessels and lower your blood pressure." D." This drug helps your heart beat more forcefully."

C. " This drug will dilate your blood vessels and lower your blood pressure." Exp. - angiotensin-converting enzyme inhibitors prevent conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and also contributes to aldosterone secretion.

A client has received thrombolytic treatment for an ischemic stroke. The nurse should notify the health care provider (HCP) if there is a rapid increase in which vital sign? A. pulse B. respirations C. blood pressure D. temperature

C. blood pressure Exp. - Control of blood pressure is critical during the first 24 hours after treatment because an intracerebral hemorrhage is the major adverse effect of thrombolytic therapy.