NCLEX: Cardiac

Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension

1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated w/ both right- & left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility

2. Stimulation of the sympathetic nervous system causes tachycardia & increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.

A home care nurse is making a routine visit to a pt receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the pt for: 1. Thrombocytopenia & weight gain 2. Anorexia, nausea, & visual disturbances 3. Diarrhea & hypotension 4. Fatigue & muscle twitching

2. The first signs & symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, & other dysrhythmias.

A pt's electrocardiogram strip shows atrial & ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, & the QRS complex measures 0.08 second. The nurse interprets this rhythm is: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sinus tachycardia 4. Sinus dysrhythmia

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Which of the following nursing diagnoses would be appropriate for a pt with heart failure? Select all that apply. 1. Ineffective tissue perfusion R/T decreased peripheral blood flow secondary to decreased CI 2. Activity intolerance R/T increased cardiac output. 3. Decreased cardiac output R/T structural & functional changes. 4. Impaired gas exchange R/T decreased sympathetic nervous system activity.

1 & 3. HF is a result of structural & functional abnormalities of the heart tissue muscle. The heart muscle becomes weak & does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle & backs up into the left atrium, & eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation & ineffective tissue perfusion because of the decrease in blood flow to the other organs & tissues of the body. Typically, these pts have an ejection fraction of less than 50% & poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.

12) When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. Reflects electrical impulse beginning at the SA node Indicated electrical impulse beginning at the AV node Reflects atrial muscle depolarization Identifies ventricular muscle depolarization Has duration of normally 0.11 seconds or less.

1, 3, 5. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

10) A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first: Administer the morphine Obtain a 12-lead ECG Obtain the lab work Order the chest x-ray

1. Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.

4) A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? Review the intake and output records for the last 2 days Change the time of diuretic administration from morning to evening Request a sodium restriction of 1 g/day from the physician. Order daily weights starting the following morning.

1. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.

15) When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

1. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

5) A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: Check the client status and lead placement Press the recorder button on the electrocardiogram console. Call the physician Call a code blue

1. Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

Furosemide is administered intravenously to a pt with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? 1. 5 to 10 min 2. 30 to 60 min 3. 2 to 4 hours 4. 6 to 8 hours

1. After IV injection of furosemide, diuresis normally begins in about 5 minutes & reaches its peak w/in about 30 minutes. Med effects last 2 - 4 hours.

Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload

1. Afterload refers to the resistance normally maintained by the aortic & pulmonic valves, the condition & tone of the aorta, & the resistance offered by the systemic & pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

Which of the following types of cardiomyopathy can be associated with childbirth? 1. Dilated 2. Hypertrophic 3. Myocarditis 4. Restrictive

1. Although the cause isn't entirely known, cardiac dilation & heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated w/ childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.

Which of the following recurring conditions most commonly occurs in pts with cardiomyopathy? 1. Heart failure 2. Diabetes 3. MI 4. Pericardial effusion

1. Because the structure & function of the heart muscle is affected, heart failure most commonly occurs in pts w/ cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in pts w/ pericarditis.

Which of the following classes of meds protects the ischemic myocardium by blocking catecholamines & sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates

1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines & sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand promote vasodilation, & decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) & systemic vascular resistance (afterload).

Which of the following heart muscle diseases is unrelated to other cardiovascular disease? 1. Cardiomyopathy 2. Coronary artery disease 3. Myocardial infarction 4. Pericardial effusion

1. Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. CAD & MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated w/ Pericarditis & advanced heart failure.

An 18-year-old pt who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? 1. Erythema marginatum, subcutaneous nodules, & fever 2. Tachycardia, finger clubbing, & a load S3 3. Dyspnea, cough, & palpitations 4. Dyspnea, fatigue, & synocope

1. Diagnosis of rheumatic fever requires that the pt have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham's chorea, subcutaneous nodules, & erythema maginatum (transient, nonprurtic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, & a prolonged PR-interval on ECG.

The physician orders continuous intravenous nitroglycerin infusion for the pt with MI. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the med 2. Monitoring BP q4h 3. Monitoring urine output hourly 4. Obtaining serum potassium levels daily

1. IV nitro infusion requires an infusion pump for precise control of the med. BP monitoring would be done w/ a continuous system, & more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated w/ nitroglycerin infusion.

A pt admitted with angina compains of severe chest pain & suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? 1. Activate the resuscitation team 2. Open the pt's airway 3. Check for breathing 4. Check for signs of circulation

1. Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver & check for breathing (looking, listening, & feeling for no more than 10-seconds). If the pt isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.

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 & 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 dem&s on the myocardial muscle.

Toxicity from which of the following meds may cause a pt to see a green-yellow halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec)

1. One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other meds aren't associated w/ such an effect.

Which of the following actions is the appropriate initial response to a pt coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the pt

1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the pt is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow.

Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions

1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur.

Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress & anxiety 4. Reduction of associated risk factors

1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption & increasing oxygen supply. An infarction is permanent & can't be reversed.

A pt comes into the E.R. with acute shortness of breath & a cough that produces pink, frothy sputum. Admission assessment reveals crackles & wheezes, a BP of 85/46, a HR of 122 BPM, & a respiratory rate of 38 breaths/minute. The pt's medical history included DM, HTN, & heart failure. Which of the following disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus

1. SOB, tachypnea, low BP, tachycardia, crackles, & a cough producing pink, frothy sputum are late signs of pulmonary edema.

Which of the following interventions should be the first priority when treating a pt experiencing chest pain while walking? 1. Sit the pt down 2. Get the pt back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin

1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the pt down. An ECG can be obtained after the pt is sitting down. After the ECGm sublingual nitro would be administered. When the pt's condition is stabilized, he can be returned to bed.

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. 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 & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure.

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

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

Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina

2. The pain of stable angina is predictable in nature, builds gradually, & quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, & lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress.

When developing a teaching plan for a pt with endocarditis, which of the following points is most essential for the nurse to include? 1. "Report fever, anorexia, & night sweats to the physician." 2. "Take prophylactic antibiotics after dental work & invasive procedures." 3. "Include potassium rich foods in your diet." 4. "Monitor your pulse regularly."

1. The most essential teaching point is to report signs of relapse, such as fever, anorexia, & night sweats, to the physician. To prevent further endocarditis episodes, prophylactic antibiotics are taken before & sometimes after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassium-rich diet & daily pulse monitoring aren't necessary for a pt w/ endocarditis.

13) A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: Call for the doctor Start an intravenous line Obtain a portable chest radiograph Draw blood for laboratory studies

2. Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

3) A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? Strict bed rest for 24 hours after transfer Bathroom privileges and self-care activities Unsupervised hallway ambulation with distances under 200 feet Ad lib activities because the client is monitored.

2. On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).

11) When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: Help keep him well hydrated Dissolve clots he may have Prevent kidney failure Treat potential cardiac arrhythmias.

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

A nurse is preparing to ambulate a pt on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the pt to best tolerate the ambulation? 1. Encourage the pt to cough & deep breathe 2. Premedicate the pt with an analgesic 3. Provide the pt with a walker 4. Remove telemetry equipment because it weighs down the hospital gown.

2. The nurse should encourage regular use of pain med for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, & allow better participation in activities such as coughing, deep breathing, & ambulation. Options 1 & 3 will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.

9) A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

2. Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.

The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects: 1. Left atrial enlargement 2. Left ventricular enlargement 3. Right atrial enlargement 4. Right ventricular enlargement

2. A normal apical impulse is found under over the apex of the heart & is typically located & auscultated in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement.

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

2. Administering supplemental oxygen to the pt is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation & prevent further damage. Morphine & nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

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

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

Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? 1. Antihypertensives 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates

2. By decreasing the heart rate & contractility, beta-blockers improve myocardial filling & cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in pts who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers & cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.

Which of the following foods should the nurse teach a pt with heart failure to avoid or limit when following a 2-gram sodium diet? 1. Apples 2. Tomato juice 3. Whole wheat bread 4. Beef tenderloin

2. Canned foods & juices, such as tomato juice, are typically high in sodium & should be avoided in a sodium-restricted diet. BRING ON THE STEAK!

In which of the following types of cardiomyopathy does cardiac output remain normal? 1. Dilated 2. Hypertrophic 3. Obliterative 4. Restrictive

2. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. All of the rest decrease cardiac output.

A nurse is preparing for the admission of a pt with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following meds readily available for use? 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin) 3. Propranolol (Inderal) 4. Metoprolol (Lopressor)

2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the med of choice to treat heart failure. Diltiazem (calcium channel blocker) & propranolol & metoprolol (beta blockers) have a negative inotropic effect & would worsen the failing heart.

With which of the following disorders is jugular vein distention most prominent? 1. Abdominal aortic aneurysm 2. Heart failure 3. MI 4. Pneumothorax

2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. JVD isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure, however, in & of itself, an MI doesn't cause JVD.

Which of the following actions is the first priority of care for a pt exhibiting signs & symptoms of coronary artery disease? 1. Decrease anxiety 2. Enhance myocardial oxygenation 3. Administer sublingual nitroglycerin 4. Educate the pt about his symptoms

2. Enhancing myocardial oxygenation is always the first priority when a pt exhibits signs or symptoms of cardiac compromise. W/out adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the pt & decreasing anxiety are important in care delivery, neither are priorities when a pt is compromised.

A 55-year-old pt 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 pt? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management

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

Which of the following reflects the principle on which a pt's diet will most likely be based during the acute phase of MI? 1. Liquids as ordered 2. Small, easily digested meals 3. Three regular meals per day 4. NPO

2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the pt's needs, & sodium restrictions may be prescribed, especially for pts w/ manifestations of heart failure. Cholesterol restrictions may be ordered as well. Pts are not prescribed a diet of liquids only or NPO unless their condition is very unstable.

2) A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? "Have you ever had this pain before?" "Can you describe the pain to me?" "Does the pain get worse when you breathe in?" "Can you rate the pain on a scale of 1-10, with 10 being the worst?"

3. Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

16) The most important long-term goal for a client with hypertension would be to: Learn how to avoid stress Explore a job change or early retirement Make a commitment to long-term therapy Control high blood pressure

3. Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.

8) A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: The same as the client's own baseline level Lower than the needed therapeutic level Within the therapeutic range Higher than the therapeutic range

3. The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.

Which of the following positions would best aid breathing for a pt with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler's position 4. In semi-Fowler's position

3. A high Fowler's position promotes ventilation & facilitates breathing by reducing venous return. Lying flat & side-lying positions worsen the breathing & increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as the Fowler's position will.

Captopril may be administered to a pt with HF because it acts as a: 1. Vasopressor 2. Volume expander 3. Vasodilator 4. Potassium-sparing diuretic

3. ACE inhibitors have become the vasodilators of choice in the pt w/ mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure.

Which of the following would be a priority nursing diagnosis for the pt with heart failure & pulmonary edema? 1. Risk for infection related to stasis of alveolar secretions 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility

3. Activity intolerance is a primary problem for pts w/ heart failure & pulmonary edema. The decreased cardiac output associated w/ heart failure leads to reduced oxygen & fatigue. Pts frequently complain of dyspnea & fatigue. The pt could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the pt w/ HF & pulmonary edema, nor is constipation related to immobility.

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

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

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 causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel & doesn't cause an MI. Renal failure can be associated w/ MI but isn't a direct cause. Heart failure is usually a result from an MI.

A nurse is conducting a health history with a pt with a primary diagnosis of heart failure. Which of the following disorders reported by the pt is unlikely to play a role in exacerbating the heart failure? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib

3. Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, & hypervolemia.

Septal involvement occurs in which type of cardiomyopathy? 1. Congestive 2. Dilated 3. Hypertrophic 4. Restrictive

3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.

Which of the following symptoms might a pt with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia

3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.

Myocardial oxygen consumption increases as which of the following parameters increase? 1. Preload, afterload, & cerebral blood flow 2. Preload, afterload, & renal blood flow 3. Preload, afterload, contractility, & heart rate. 4. Preload, afterload, cerebral blood flow, & heart rate.

3. Myocardial oxygen consumption increases as preload, afterload, renal contractility, & heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption.

Medical treatment of coronary artery disease includes which of the following procedures? 1. Cardiac catherization 2. Coronary artery bypass surgery 3. Oral med therapy 4. Percutaneous transluminal coronary angioplasty

3. Oral med administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery & percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

A pt with angina complains that the angina pain is prolonged & severe & occurs at the same time each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as: 1. Stable angina 2. Unstable angina 3. Variant angina 4. Nonanginal pain

3. Stable angina is induced by exercise & is relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower & lower levels of activity & rest, is less predictable, & is often a precursor of myocardial infarction. Variant angina, or Prinzmetal's angina, is prolonged & severe & occurs at the same time each day, most often in the morning.

Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle

3. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases & fluid accumulates in the interstitial & alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium & right ventricle were damaged, right-sided heart failure would result.

If medical treatments fail, which of the following invasive procedures is necessary for treating cariomyopathy? 1. Cardiac catherization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump (IABP)

3. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible.

A pt with pulmonary edema has been on diuretic therapy. The pt has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the pt also will be started on Digoxin (Lanoxin), a nurse checks the pt's most recent: 1. Digoxin level 2. Sodium level 3. Potassium level 4. Creatinine level

3. The serum potassium level is measured in the pt receiving digoxin & furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the pt w/ hypokalemia. Hypokalemia also predisposes the pt to ventricular dysrhythmias.

Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK)

3. Troponin I levels rise rapidly & are detectable w/in 1 hour of myocardial injury. Troponin I levels aren't detectable in people w/out cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues & not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, & a complete chemistry is obtained to review electrolytes. Because CK levels may rise w/ skeletal muscle injury, CK isoenzymes are required to detect cardiac injury

6) A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? Seating the client with arm bared, supported, and at heart level. Measuring the blood pressure after the client has been seated quietly for 5 minutes. Using a cuff with a rubber bladder that encircles at least 80% of the limb. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

4. BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.

14) 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? Cancer Hypertension Liver disease Myocardial infarction

4. Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is normal).

7) IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? Vitamin K Aminocaporic acid Potassium chloride Protamine sulfate

4. The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.

1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? Intake and output Baseline peripheral pulse rates Height and weight Allergy to iodine or shellfish

4. This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.

Which of the following cardiac conditions does a fourth heart sound (S4) indicate? 1. Dilated aorta 2. Normally functioning heart 3. Decreased myocardial contractility 4. Failure of the ventricle to eject all of the blood during systole

4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart.

Which of the following is an expected outcome for a pt on the second day of hospitalization after an MI? 1. Has severe chest pain 2. Can identify risks factors for MI 3. Agrees to participate in a cardiac rehabilitation walking program 4. Can perform personal self-care activities without pain

4. By day 2 of hospitalization after an MI, pts are expected to be able to perform personal care w/out chest pain. Day 2 hospitalization may be too soon for pts to be able to identify risk factors for MI or begin a walking program; however, the pt may be sitting up in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present.

Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia

4. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention occurs & hypercapnia results.

Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased afterload 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium

4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

Which of the following classes of meds maximizes cardiac performance in pts with heart failure by increasing ventricular contractibility? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents

4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility & ultimately increasing cardiac output.

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

4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain & anxiety while causing sedation, but it isn't primarily given for those reasons.

A nurse caring for a pt in one room is told by another nurse that a second pt has developed severe pulmonary edema. On entering the 2nd pt's room, the nurse would expect the pt to be: 1. Slightly anxious 2. Mildly anxious 3. Moderately anxious 4. Extremely anxious

4. Pulmonary edema causes the pt to be extremely agitated & anxious. The pt may complain of a sense of drowning, suffocation, or smothering.

Which of the following symptoms is the most likely origin of pain the pt described as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary

4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases w/ movement. Cardiac & GI pains don't change w/ respiration.

Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac catherization 4. 12-lead electrocardiogram (ECG)

4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, w/ variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.

Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP & diuresis 4. Increased BP & fluid retention

4. The body compensates for a decrease in cardiac output w/ a rise in BP, due to the stimulation of the sympathetic NS & an increase in blood volume as the kidneys retain sodium & water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

In which of the following disorders would the nurse expect to assess sacral edema in a bedridden pt? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure

4. The most accurate area on the body to assess dependent edema in a bed-ridden pt is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.

The nurse coming on duty receives the report from the nurse going off duty. Which of the following pts should the on-duty nurse assess first? 1. The 58-year-old pt who was admitted 2 days ago with heart failure, BP of 126/76, & a RR 21 bpm 2. The 88-year-old pt with end-stage right-sided heart failure, BP of 78/50, & a DNR order. 3. The 62-year-old pt who was admitted one day ago with thrombophlebitis & receiving IV heparin. 4. A 76-year-old pt who was admitted 1 hour ago with new-onset atrial fibrillation & is receiving IV diltiazem (Cardizem).

4. The pt w/ A-fib has the greatest potential to become unstable & is on IV med that requires close monitoring. After assessing this pt, the nurse should assess the pt w/ thrombophlebitis who is receiving a heparin infusion, & then go to the 58-year-old pt admitted 2-days ago w/ heart failure (her s/s are resolving & don't require immediate attention). The lowest priority is the 89-year-old w/ end stage right-sided heart failure, who requires time consuming supportive measures.

A pt who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The pt received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL & the serum creatinine is 2.2 mg/dL. A nurse interprets the pt is at risk for: 1. Hypovolemia 2. UTI 3. Glomerulonephritis 4. Acute renal failure

4. The pt who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor med therapy. Renal insult is signaled by decreased urine output, & increased BUN & creatinine levels. The pt may need meds such as dopamine (Intropin) to increase renal perfusion & possibly could need peritoneal dialysis or hemodialysis.

Dyspnea, cough, expectoration, weakness, & edema are classic signs & symptoms of which of the following conditions? 1. Pericarditis 2. Hypertension 3. MI 4. Heart failure

4. These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest & auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, & a flushed face. MI causes heart failure but isn't related to these symptoms.

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

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

A pt has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: 1. It is uncomfortable for the pt, giving a sense of impending doom. 2. It produces a high cardiac output that quickly leads to cerebral & myocardial ischemia. 3. It is almost impossible to convert to a normal sinus rhythm. 4. It can develop into ventricular fibrillation at any time.

4. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral & myocardial ischemia. Pt's frequently experience a feeling of impending death. Ventricular tachycardia is treated w/ antidysrhythmic meds or magnesium sulfate, cardioversion (pt awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure

4. Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.

An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? Observe electrocardiogram readings and report deviations to the nurse. Assist the client with ambulation three times during the shift. Monitor vital signs every 15 minutes and report each reading to the nurse. Accurately weigh the patient, and report and record the readings.

Accurately weigh the patient, and report and record the readings. Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care.

Modification of lifestyle behaviors to help manage hypertension does not include which of the following? (Select all that apply.) Weight loss of even 10 pounds The DASH diet Fruits, vegetables, and whole grains Alcohol intake with meals

Alcohol intake with meals \ Rationale: Weight loss of even 10 pounds; fruits, vegetables, and whole grains; the DASH diet; and a daily exercise regimen will help reduce high blood pressure. Alcohol intake with meals should be reduced to help manage high blood pressure.

Which of the following are direct causes of chronic ischemic pain? (Select all that apply.) Aortic stenosis Acid reflux Pulmonary embolus Herpes zoster (shingles)

Aortic stenosis Acid reflux Pulmonary embolus Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain. Integrated Process: Nursing Process; Evaluation Cognitive Level: Evaluation NCLEX-RN Test Plan: Physiological Integrity; Physiological Adaptation Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain.

A patient receiving the drug simvastatin (Zocor) should be taught this medication helps to prevent coronary heart disease by: Increasing lower-density lipoprotein. Controlling lower-density lipoprotein. Increasing triglycerides. Increasing very low-density lipoprotein.

Controlling lower-density lipoprotein. Rationale: The Heart Protective Study has also shown that controlling low-density lipoprotein (LDL) with simvastatin (Zocor) assists in the prevention of coronary heart disease by raising HDL. Responses 1, 3, and 4 are incorrect.

Which of the following diagnostic tests is preferred for evaluating heart valve function? Chest x-ray Duplex Doppler Echocardiogram Electrocardiogram

Echocardiogram Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it allows the visualization of the valves as they open and close. A chest x-ray will determine the size of the heart, the duplex measures blood flow through major arteries, and an electrocardiogram identifies electrical activity.

It is important that the nurse be knowledgeable about cardiac output in order to: Evaluate blood flow to peripheral tissues. Determine the electrical activity of the myocardium. Provide information on the immediate need for oxygen. Implement nutritional changes.

Evaluate blood flow to peripheral tissues. Rationale: Blood flow to the tissues is measured clinically as the cardiac output, and assists to predict tissue perfusion. Electrical activity is evaluated more effectively by EKG. While the cardiac output is important for perfusion and oxygenation of tissues, the oxygen saturation would provide more valuable information. Nutritional changes would be targeted to sodium and would depend on symptoms of disease. Integrated Process: Nursing Process; Planning Cognitive Level: Evaluation NCLEX-RN Test Plan: Health Promotion and Maintenance

Nurses can best help older clients prevent hypertension by teaching: Low-fat, low-cholesterol diets. The importance of exercise. How to handle stressful situations. How to maintain a normal blood pressure.

How to maintain a normal blood pressure. Rationale: Hypertension is a major risk factor for other cardiovascular conditions. In persons older than 50, systolic blood pressure greater than 140 mm Hg is a much more important cardiovascular disease risk factor than is diastolic blood pressure. The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg. Answers 1, 2, and 3 are important elements to include in education of a patient with blood pressure elevation, and are included in the correct answer.

Which of the following assessments would be an important finding for a patient with arterial disease? Intermittent claudication with exercise Brownish discoloration around the ankles Non-pitting edema on the lower extremities Altered sensation to touch

Intermittent claudication with exercise Rationale: Intermittent claudication is a common finding in persons with arterial disease, usually due to progression of atherosclerosis and alteration of tissue perfusion to the extremities. In venous disease, valves of the veins in the extremities become incompetent, resulting in higher pressures than normal in the veins. The pressure is transmitted to the capillaries of the lower extremities, resulting in thickening and non-pitting edema of tissues around the ankles. Prolonged thickening results in the red blood cells' being pressed outside the capillaries. The cells eventually break down, resulting in collection of hemosiderin deposits being collected in the area. Altered sensation to touch would be due to neuropathic changes commonly found with diabetes mellitus.

Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.) Mental status changes Agitation Frequent falls Sudden changes in GI function

Mental status changes Agitation Frequent falls Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.

A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation? Left atrium Right atrium Right ventricle Left ventricle

Right atrium Rationale: The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.

Which of the following drug classifications should the nurse question if prescribed for a person with congested heart failure (CHF)? Angiotensin-converting enzyme (ACE) inhibitor Beta-adrenergic blocker Alpha adrenergic antagonist Rosiglitazone (Avandia)

Rosiglitazone (Avandia) Correct answer: Thiazolidinediones, like rosiglitazone (Avandia), are glucose-reducing drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker, has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and beta2 receptors in various organs, resulting in reduction of heart rate and the force of contraction, and suppresses impulse conduction through the AV node, all of which slows the progression of the disease process. Carvedilol (Coreg) is another beta-adrenergic blocker used to treat heart failure.

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication? Sublingual nitroglycerin Cardiac glycosides HMG-CoA reductase inhibitors Morphine sulfate

Sublingual nitroglycerin Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.

A client with post-myocardial infarction develops acute bacterial pericarditis. Which of the following medications would the physician most likely prescribe as the primary drug? Ticarcillin disodium (Ticar) Acetaminophen (Tylenol) Ibuprofen (Motrin) Trioxsalen (Trisoralen)

Ticarcillin disodium (Ticar) Rationale: Acute bacterial pericarditis is a complication that can occur post-myocardial infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.

Which of the following diagnostic studies most likely would confirm a myocardial infarction? Serum myoglobin level Creatinine kinase (CK) White blood cell count (WBC) Troponin T levels

Troponin T levels Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8 hours after the infarct (tissue necrosis) but also can occur with other types of tissue damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an inflammatory response. Troponin levels are more elevated than are the other cardiac enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue necrosis).

A common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered? Aspirin (acetylsalicylic acid) Warfarin sodium (Coumadin) Simvastatin (Zocor) Vinorelbine tartrate (Navelbine)

Warfarin sodium (Coumadin) Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic.