MS 17, 18
The nurse is assessing a female patient with a family history of coronary artery disease (CAD). Which report is most concerning to the nurse
"I stay tired all of the time, and it feels like my bra is too tight."
The nurse is caring for a patient who is scheduled to undergo a stress echocardiogram. Which statement indicates that the nurse's teaching about preparation for the test has been successful
"I will have to move extremely quickly from the treadmill to the table."
The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB). Which statement indicates that the patient needs further instruction
"It frightens me to think that my heart will be stopped for a long time during surgery."
The nurse is educating a patient on a low-fat, low-cholesterol diet after a myocardial infarction (MI). Which food choice should the nurse recommend
"Replace a serving of red meat with a serving of fish.
The nurse is caring for a post-myocardial infarction (MI) patient. The patient questions the reason for a stool softener and denies constipation. Which statement indicates that the patient accurately understands the nurse's teaching
"Stool softeners help me keep from straining during bowel movements, which can lower my heart rate."
The nurse is caring for a patient on lisinopril (Zestril). The patient asks how this medication affects blood pressure. Which response best explains the medications effect
"This medication lowers blood pressure by blocking an enzyme that causes blood vessels to constrict."
The 60-year-old female in the post-coronary care unit confides to the nurse, "My life is over. I'll never be able to care for my family, take a vacation, or work in my garden." Which response is most supportive
"You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems."
The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate
"You will most likely be able to ambulate within a few hours if your doctor uses an arterial closure device at the catheter insertion site."
Which factors may affect the volume of cardiac output
(Select all that apply) Heart rate, Preload, Contraction strength, Afterload
Which modifiable risk factors increase a patient's risk for heart disease
(Select all that apply) Smoking, Obesity, Sedentary lifestyle
Which disorder(s) is/are examples of congenital heart defects
(Select all that apply.) Coarctation of the aorta, Septal defects, Valvular defects
The nurse is aware that a positive diagnosis of a myocardial infarction (MI) is based on which diagnostic test finding(s)
(Select all that apply.) ECG, Elevated levels of troponin
The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium. Which factors are causative agents for angina
(Select all that apply.) Exertion, Emotional excitement, Eating heavy meals, Exposure to cold
The nurse cautions the patient with uncontrolled hypertension that the consequences of the disease will include
(Select all that apply.) a. threat of a stroke. b.possible kidney failure.c.risk for heart attack.d.probability of congestive heart failure.
Which preventative measure(s) may protect against development of cardiovascular disease
(Select all that apply.) a.Exercising regularly for at least 30 minutes a dayb.Maintaining high-density lipoprotein (HDL) greater than 50 mg/dL c.Refraining from smoking d.Obtaining and maintaining a healthy weight
The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a myocardial infarction (MI) involves the use of which therapies
(Select all that apply.) aspirin, morphine, nitrates, oxygen
The nurse in a long-term care facility designs a teaching program for the residents to help prevent peripheral vascular disease (PVD) caused by age-related changes, which include
(Select all that apply.) decreasing blood viscosity.loss of elasticity in vessel walls. sedentary practices.weakened leg muscles.
Which herbs and supplements lower cholesterol
(Select all that apply.) garlic, oatmeal, soy products
Peripheral vascular disease (PVD) is characterized by
(Select all that apply.) narrowing of arteries, obstruction of veins, defective valve function, production of thrombophlebitis
The nurse encourages the patient who has had a myocardial infarction (MI) to enroll in the outpatient cardiac rehabilitation in order to receive which service(s)
(Select all that apply.) nutritional counseling, supervised progressive exercise, stress reduction
The nurse is caring for a 38-year-old African American patient with diabetes. The patient manages her diabetes with dietary control, takes oral contraceptives, and is a nonsmoker. Which characteristic(s) in this patient's history increase the patient's risk for coronary artery disease (CAD)
(Select all that apply.) race, diabetes, use of oral contraceptives
The nurse outlines methods of prevention of peripheral vascular disease (PVD), which include
(Select all that apply.) relieving stress, controlling diabetes, maintaining appropriate weight. Routinely exercising, stopped smoking
During the acute phase following a myocardial infarction (MI), the nurse anticipates that the patient may require a temporary pacemaker in which situation(s)
(Select all that apply.) the patient experiences complete heart block, the patients pulse rate remains below 40 beats/min
Hypertension is diagnosed by the finding of a blood pressure reading greater than
140/90 twice, two weeks apart
The nurse is caring for a patient with a blood pressure of 140/90, an apical pulse of 82, and a radial pulse of 76. Which value indicates that the nurse accurately calculated the patient's pulse pressure
50
The nurse is caring for several patients on a cardiac care unit. The nurse is aware that the patient who is most likely to have the disorder of aortic stenosis is which patient
86 year old with history of atherosclerosis
The student nurse is planning a presentation on hypertension to present in a community setting. Which group of individuals should the student identify as having the highest incidence of hypertension
African Americans
The patient asks if it is harmful for him to drink a glass of wine with dinner on a daily basis. Which is the nurse's best response
As long as it is okay with your physician, moderate alcohol intake can be beneficial to your cardiovascular health."
When using a 0 to 4+ scale to grade pulse quality, how should the nurse record a normal volume pulse
C- 3+
The nurse is planning the care for a patient who is to have a saphenous vein stripping. What will be the priority intervention
Bed rest and leg elevation for the first 12 to 24 hours
The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). Which statement accurately describes the purpose of this medication
"Alteplase (t-PA) dissolves the obstruction in the coronary artery."
The nurse is caring for a patient with a history of hypertension. Which information is most important for the nurse to obtain
"Do you use over-the-counter decongestants or diet pills"
The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which response is best for the nurse to make
"Every patient has different circumstances, but the average 5-year survival rate is 79%."
The nurse is caring for a post-myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse's teaching has been successful
"I should call my doctor if I experience unexplained muscle pain."
The 65-year-old patient complains of leg pain that disappears at rest after having walked a short distance. The nurse recognizes that the patient's symptoms are consistent with which problem
Claudication
If a nurse is caring for pt. w/ AAA c/o intense abdominal pain, lightheadedness, BP drops, the pulse is rising you should
Contact Physician Immediately!
The nurse is caring for a patient diagnosed with an abdominal aortic aneurysm. The patient is complaining of intense abdominal pain and lightheadedness. The patients blood pressure has dropped and pulse is rising. What is the priority nursing intervention
Contact the physician immediately.
The 75-year-old diabetic patient has an inflamed area at the shin caused by scratching. Which intervention should the nurse perform first
Cover with clear occlusive dressing.
What is the acute symptom most experienced by African americans when having a MI
Dyspnea
he nurse who uses a regular sized adult blood pressure cuff on a large adult will get a blood pressure reading that is falsely
Elevated or high
The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is soft with no palpable hematoma. Which post procedure care is most important for the patient at this time
Encourage increased fluid intake.
The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease. Which finding is most concerning to the nurse
Fatigue
The nurse assessing a patient with a deep venous thrombosis (DVT) becomes concerned when the patient demonstrates which sign or symptom
Hemoptysis
The patient has been prescribed a low-sodium diet. Which food omissions from the diet will indicate the patient has an adequate understanding of the recommended diet
Hot dogs
The nurse evaluates the need for further instruction on reduction of caffeine when the patient who has an arrhythmia says
I've switched from 5 cups of coffee to 5 cups of tea
The patient who is on daily doses of warfarin is instructed in the use of a coagulation monitoring device. The patient is taught that the device will monitor which blood clotting time
INR
The nurse is initiating the care plan for a patient with peripheral arterial disease, who complains of pain in the lower extremities at a 3/10, has a 0.5 cm 1 cm ulcer on the left lower leg, and the lower legs are shiny and hairless bilaterally. What is the priority nursing diagnosis
Impaired skin integrity related to ulcer on lower extremities
The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor
Inadequate blood flow and poor oxygen supply
The nurse uses a diagram to show how obstruction of an artery has caused an area of necrosis called a(n) _________
Infarction
The 85-year-old patient with a newly diagnosed heart murmur expresses concern that he has never been notified of this finding before. What is the most likely cause of this patient's heart murmur
Insufficient valves
The nurse is outlining a teaching program for diabetic patients. Which teaching point about heart disease prevention should the nurse emphasize most
Keep blood sugar below 100 mg/dL
The nurse is caring for an older adult patient. While auscultating the patient's apical pulse, the nurse notices an irregular rhythm. The nurse suspects which causative factor for the patient's dysrhythmia
Loss of cells in the sinoatrial (SA) nodes
The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful. Which reply is best
Low-dose aspirin helps reduce clotting.
The nurse is providing patient teaching to a pregnant patient who works as a cashier in a grocery store. Which suggestion by the nurse will help most in preventing varicose veins
March in place while standing at the counter.
The nurse is aware that the patient's cardiac rehabilitation levels of physical activity are designated through ____________ units
Metabolic equivalent MET
Which layer of the heart contains muscle fibers that contract to pump blood
Myocardium
A patient who presented to the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, and hypotensive. What action should the nurse take first
Notify the physician immediately.
The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI). The nurse recognizes this finding indicates which problem
Pericarditis
In a blood pressure of 120/80, what does the "80" indicate
Pressure in the relaxed ventricles
The nurse is caring for a 50-year-old patient who complains of tingling in his toes. Which other assessment finding would cause the nurse to suspect arterial insufficiency
Shiny, hairless legs
The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin. What information is most important for the nurse to include in the teaching plan
Store nitroglycerin tablets in a cool, dark location.
The nurse is aware that certain risk factors increase the chance of a person developing cardiomyopathy. which of the circumstances increase the risk for cardiomyopathy
Systemic hypertension, chronic excessive alcohol consumption, pregnancy, systemic infection
The home health nurse is assessing the home bound patient with heart failure. Which assessment finding is of most concern to the nurse
The nurse notes a 3 lb weight gain over the course of a week
The nurse is caring for a patient who just returned from a transradial heart catheterization. Which action indicates the priority care for the postprocedure period
The nurse places the pulse oximeter on the thumb or first digit of the affected hand.
While performing a focused cardiac assessment, the nurse auscultates an abnormal swooshing sound. Which action is most appropriate to clarify the nurse's finding
The nurse uses the bell of the stethoscope while asking the patient to lean forward.
The nurse is teaching a patient about the purpose of his telemetry. Which statement indicates that the nurse's teaching has been successful
The nurses will be able to monitor my heart rate and rhythm."
An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks so thick. Which is the most accurate response by the nurse
The valves in the vessels in your legs arent working as well as they used to, which causes the discoloration and thickening of your skin.
Which statement accurately describes the purpose of a Doppler flow
To visualize obstructions in leg vessels
The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results. Which laboratory value should the nurse report immediately
Troponin of 2.4 mcg/
The nurse is caring for a patient with uncontrolled hypertension, diabetes, asthma, and gastroesophageal reflux disease (GERD). Which problem serves as a contraindication for a thrombolytic agent
Uncontrolled
The nurse is explaining the difference between exertional angina and unstable angina. Which statement about unstable angina is accurate
Unstable angina occurs unpredictably, even in sleep.
The nurse is educating a female patient with a family history of coronary artery disease (CAD) about risk factors and prevention of heart disease in women. Which information is most important for the nurse to include
Women should incorporate stress reduction techniques into their daily lifestyle.
The nurse will instruct a patient with an automatic implantable cardioverter defibrillator (AICD) to avoid
airport security detection devices
The nurse caring for a patient with congestive heart failure will include which intervention in the plan of care
alternate rest with activity
The patient is instructed that the most common and effective antiplatelet aggregation agent is
aspirin
If there are several tiny spikes in place of P waves on the ECG, the nurse recognizes the arrhythmia as
atrial flutter/ fibrillation
Which teaching point will the nurse include when providing discharge instructions to the patient with a new permanent pacemaker
avoid lifting heavy objects for as long as your physician prescribes
How does a myocardial infarction (MI) alter the pumping efficiency of the heart
b. An MI causes myocardial necrosis.
saphenous vein stripping priority intervention is
bed rest and leg elevation for the first 24 hours
The patient who is taking digitalis for his heart condition becomes extremely dehydrated and has scant using output. the nurse will assess regularly for the complaint of
blurred vision
When the nurse assess an apical pulse of 52, the finding of this arrhythmia is known as
bradycardia
right sided heart failure
causes swelling in extremities (edema)
hemoptysis
coughing up blood
Left sided heart failure
crackles in the lungs (pulmonary edema)
The patient with a deep venous thrombosis is on a protocol of IV urokinase. The nurse clarifies that this drug will
dissolve the clot.
The patient with tachycardia who has a heart rate of 115 complains of shortness of breath. the nurse interprets this complaint as being related to which problem
drop in cardiac output
The nurse would anticipate that the patient with right sided heart failure would exhibit
edema
The Unna paste boot is wrapped in a variety of directions to make the most of muscular action. These dressings are usually changed
every 2 to 3 days.
The independent interventions the nurse may employ when the 80 yr old pt in the long term care facility develops acute pulmonary edema are to
give oxygen at 2 L position in high fowlers position
The nurse expresses concern to the 80 yr old resident in a long term care facility who is attempting to jog on a treadmill. the nurse is aware that the exceptional oxygen and metabolic demand is brought on by the exercise might cause
heart failure
The nurse caring for a patient who is taking amiodarone (cordarone) will plan to assess the vital signs carefully for which common side effect
hypotension
The nurse caring for the patient with a temporary transvenous pacemaker will include which intervention
informing the the patient that they may experience uncomfortable muscle contractions as current passes through the chest
The nurse explains that the calcium channel blocker verapamil assists to correct an arrhythmia by
inhibiting transmission of the impulse from the AV node
The nurse adds an intervention to the care plan of a patient who has just been prescribed a thiazide diuretic, which is to increase
intake of foods containing potassium.
The patient with severe congestive heart failure does not want to take the morphine ordered, stating that he is not in pain and he is fearful of becoming addicted. the nurse can allay his anxiety by explaining the morphine
is used to relieve anxiety and air hunger
The home health nurse is alarmed that the hypertensive patients blood pressure has risen to 200/160, but he denies any discomfort. The nurse interprets these assessments as being indicative of
malignant hypertension
The nurse assessing the heart places the stethoscope between the fifth and sixth ribs at the mid-clavicular line to hear the point of
maximal impulse
The nurse points out the characteristics of normal sinus rhythm (NSR) which are
one atrial contraction (P wave)one ventricular contraction (QRS wave)one T wave heart rate 60-100
6 P's of arterial disease
pain, pulselessness, poikilothermic (coldness), Pallor, parathesis, paralysis
The patient with a fib asks why she needs to take warfarin: the most effective response by the nurse is that warfarin will
prevent clots from forming in the atria
When the nurse uses the PQRST tool for pain assessment, the "R" prompts an inquiry about the __________ of the pain
radiation
The patient suffering from ventricular tachydysrhythmia may benefit from _________ when medications are not effectively treating the disorder
radiofrequency catheter ablation
The patient who has a history of smoking and Alcohol abuse is most likely to develop
secondary hypertension
The nurse explains to the patient that the implanted cardioverter-defibrilator (ICD) will
shock the arrhythmias into sinus rhythm
Because of reduced sensitivity of the baroreceptors in the older adult who is also on a diuretic, the nurse instructs the patient to
sit on the side of the bed before standing
The patient scheduled for a percutaneous angioplasty (PTA) is instructed that a ________ is left in the artery to keep it patent
stent
The nurse recognizes the disorganized ECG pattern of the most fatal of all arrhythmia as
ventricular fibrillation
What is INR used to monitor coagulation with
warfarin administration
The nurse anticipates that on auscultation of the chest of an older adult with left sided congestive heart failure, the major adventitious sound will be
wheezing