NU372 Week 5 EAQ Evolve Elsevier: Perfusion (Custom Quiz)

Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The nurse advises the client to anticipate pain relief will begin within which period of time? o 1 to 3 minutes o 4 to 5 seconds o 30 to 45 seconds o 10 to 15 minutes

o 1 to 3 minutes · The onset of action of sublingual nitroglycerin tablets is rapid (1-3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustained-release nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.

When the nurse is caring for a client who has just arrived in the intensive care unit after coronary artery bypass graft surgery, which finding would be of most concern? o Blood pressure 152/92 mm Hg o Blood glucose 120 mg/dL (6.68 mmol/L) o Atrial fibrillation, rate 112 beats/minute o 100 mL of blood in the chest drainage system

o Atrial fibrillation, rate 112 beats/minute · Atrial fibrillation is common after cardiac surgery and can adversely affect cardiac output and blood pressure. The nurse would discuss the dysrhythmia with the health care provider and anticipate a prescription for an antidysrhythmic medication. An elevated blood pressure immediately after surgery is common because of the stress response; the nurse would continue to monitor the blood pressure but no other immediate action is needed. Mild elevations in blood glucose are expected with stress and would not adversely affect wound healing or other client outcomes. The nurse would continue to monitor the glucose, but no other immediate action is needed. Moderate bleeding in the immediate postoperative period after cardiac surgery is common. The nurse would continue to monitor the chest drainage system and expect that bleeding would decrease, but no other immediate action is needed.

A beta blocker is prescribed for the client with persistent ventricular tachycardia. Which response indicates that the beta blocker is working effectively? o Decreased anxiety o Reduced chest pain o Decreased heart rate o Increased blood pressure

o Decreased heart rate · A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta blocker is not an anxiolytic and does not reduce anxiety. A beta blocker is not an analgesic and does not reduce chest pain. Beta blockers reduce blood pressure.

When the nurse is obtaining a health history for a client scheduled for cardiac catheterization, which client information is most important to communicate to the health care provider? o Drinks 2 cups of coffee daily o Reports allergy to most shellfish o Recently had dobutamine stress test o Takes daily low-dose aspirin tablet

o Reports allergy to most shellfish · Because cardiac catheterization uses iodine-based contrast for imaging, shellfish and iodine allergies must be identified so that pretreatment with antihistamines and steroids can be used if indicated. Moderate coffee consumption does not require any change in the cardiac catheterization protocol. Many clients scheduled for cardiac catheterization have had noninvasive cardiac stress testing, and a dobutamine stress test is not a contraindication to the planned procedure. Aspirin therapy is recommended for clients with possible coronary artery disease and is not a contraindication to the procedure.

When a client is diagnosed with microvascular angina, which topics would the nurse include in client teaching? Select all that apply. o Use of daily aspirin o Tobacco cessation techniques o Benefits of coronary artery bypass graft surgery o Management of usual daily activities to avoid symptoms o Use of nitroglycerin to prevent and treat anginal symptoms

o Use of daily aspirin o Tobacco cessation techniques o Management of usual daily activities to avoid symptoms o Use of nitroglycerin to prevent and treat anginal symptoms · Microvascular angina is caused by atherosclerosis or spasm in very distal microvascular branches of the coronary artery system. Daily aspirin use, tobacco cessation, and use of nitroglycerin would be included in client teaching. Microvascular angina tends to cause symptoms during usual daily activities and the nurse would teach symptom management through activity modification or the use of nitroglycerin. Because the coronary artery disease is in small and distal vessels, coronary artery bypass surgery is not an option for treatment.

Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective? o "I should take the medicine three times a day." o "I will be sure to take my pulse after I have exercised." o "It will be important to avoid activities that can cause angina." o "I should take one tablet before attempting activity that has caused angina."

o "I should take one tablet before attempting activity that has caused angina." · The response about taking one tablet before activity that has caused angina indicates that the client understands the nurse's teaching. Taking a nitroglycerin tablet before such an activity probably will prevent an episode of angina, which is an example of prophylactic use of a medication. Taking the medicine three times a day is an example of scheduled administration of a nitrate medication for prophylaxis, but the client is being prescribed sublingual nitrate. The statement to avoid activities that can cause angina indicates avoidance of activity rather than taking medication to prevent angina during the activity. Blood pressure, not pulse, is the parameter most affected by nitroglycerin.

Which statement by a client indicates that the nurse's preprocedure teaching about cardiac catheterization has been effective? o "I will be asleep during most of the procedure. " o "I will be in the catheterization laboratory for about 15 minutes." o "I will need to be in bed for several hours after the procedure." o "I will need to deep breathe and cough frequently after the procedure."

o "I will need to be in bed for several hours after the procedure." · Clients need to be on bed rest for several hours after cardiac catheterization to decrease the risk of bleeding from the catheter insertion site and because they require frequent monitoring of blood pressure and heart rate. Clients are given a mild sedative, but they are awake during the procedure. Cardiac catheterization requires about an hour because of the time needed to prepare the client and insert arterial catheters before injection of contrast dye. Because the client is awake during the procedure and general anesthesia is not used, deep breathing and coughing is not needed after the procedure.

Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin? o International normalized ratio (INR) is between 2 and 3 o Prothrombin time (PT) is 2.5 times the control value o Activated partial thromboplastin time (APTT) is 70 seconds o Activated clotting time (ACT) is in the range of 70 to 120 seconds

o Activated partial thromboplastin time (APTT) is 70 seconds · When a client is receiving intravenous heparin, the APTT should be 1.5 to 2 times the normal APTT of 40 seconds, or 60 to 80 seconds. INR and PT are used to evaluate therapeutic levels of warfarin. The ACT is not commonly used for monitoring of heparin, but ACT increases to a range of 150 to 200 seconds when heparin reaches therapeutic levels.

The cardiac monitor reveals several runs of ventricular tachycardia. Which medication is used to treat this dysrhythmia? o Atropine o Epinephrine o Amiodarone o Sodium bicarbonate

o Amiodarone · Amiodarone suppresses ventricular activity; therefore it is used for treatment of premature ventricular complexes (PVCs). It works directly on the heart tissue and slows the nerve impulses in the heart. Atropine blocks vagal stimulation; it increases the heart rate and is used for bradycardia, not PVCs. Epinephrine increases myocardial contractility and heart rate; therefore it is contraindicated in the treatment of PVCs. Sodium bicarbonate increases the serum pH level; it combats metabolic acidosis.

When a client exhibits severe bradycardia, which type of medication will the nurse be prepared to administer? o Nitrate o Anticholinergic o Antihypertensive o Cardiac glycoside

o Anticholinergic · An anticholinergic medication will block parasympathetic effects, causing an increased heart rate. Nitrates will decrease preload, not increase the heart rate. Antihypertensive medications will lower the blood pressure and may decrease the heart rate. Cardiac glycoside will improve cardiac contractility but will decrease the heart rate.

When a client has sinus tachycardia, which potential causes of the dysrhythmia would the nurse consider when assessing the client? Select all that apply. o Anxiety o Caffeine o Exercise o Anemia o Hypothermia

o Anxiety o Caffeine o Exercise o Anemia · Causes of sinus tachycardia include hypovolemia, heart failure, anemia, exercise, use of stimulants (such as caffeine), fever, and sympathetic response to fear or pain (for example, anxiety). Hypothermia will cause sinus bradycardia.

When admitting a client with acute coronary syndrome (ACS) to the telemetry unit after cardiac catheterization and percutaneous intervention (PCI), which action would the nurse take first? o Attach the cardiac monitor. o Auscultate the heart sounds o Check the intravenous fluid rate. o Assess alertness and orientation.

o Attach the cardiac monitor. · Because fatal dysrhythmias may occur in the first hours after myocardial infarction, cardiac monitoring is a priority. The nurse will also do auscultation of the heart, but changes in heart sounds are not expected with ACS and PCI. Checking the intravenous line for patency and correct infusion rate is also important, but would be done after establishing cardiac monitoring. Neurological status would be assessed, but changes in neurological status are not expected after PCI, which does not require general anesthesia.

After a client has had a ventricular pacemaker inserted, which point on the rhythm strip shows a pacemaker spike? o A o B o C o D

o B · Pacemaker impulses are represented by a spike (letter B), which should be followed by a QRS complex. Letters A, C, and D do not indicate the pacemaker spike.

Which assessment finding indicates that disseminated intravascular coagulation (DIC) is occurring in a postpartum client who has experienced an abruptio placentae? o Boggy uterus o Hypovolemic shock o Multiple vaginal clots o Bleeding at the venipuncture site

o Bleeding at the venipuncture site · Bleeding at the venipuncture site indicates afibrinogenemia; massive clotting in the area of the separation has resulted in a decrease in the circulating fibrinogen level. A boggy uterus indicates uterine atony. Although hypovolemic shock may occur with DIC, there are other causes of hypovolemic shock, not just DIC. Blood clots indicate an adequate fibrinogen level; however, vaginal clots may indicate a failure of the uterus to contract and should be explored further.

When a client who has had a myocardial infarction suddenly develops a heart rate of 120 beats/minute, which action would the nurse take first? o Offer reassurance. o Check blood pressure. o Call for an electrocardiogram (ECG). o Activate the hospital rapid response team.

o Check blood pressure. · With a sudden change in heart rate, the nurse's first action would be to determine whether the client was perfusing adequately by checking blood pressure. Reassurance may be needed if the client's high rate is due to anxiety, but more information about the client is needed before meaningful reassurance is offered. An ECG is needed for a sudden change in heart rate, because the client may be re-infarcting, but the nurse would initially check vital signs. The hospital rapid response team may need to be activated, but more information about the client is needed first.

Two hours after a cardiac catheterization that was accessed through the right femoral route, a client reports numbness and pain in the right foot. Which action will the nurse take first? o Call the primary health care provider. o Check the client's pedal pulses bilaterally. o Take the client's blood pressure and pulse. o Teach about postcatheterization embolus.

o Check the client's pedal pulses bilaterally. · These symptoms are associated with compromised arterial perfusion. An embolus of plaque and damage to the femoral artery wall are possible complications of a femoral arterial cardiac catheterization and must be suspected in the absence of a pedal pulse in the extremity below the entry site. A circulatory assessment would be conducted before notifying the primary health care provider, who will need to know whether pedal pulses are present. Taking the client's blood pressure and pulse is unnecessary, because the symptoms indicate a local peripheral problem, not a systemic or cardiac problem. The nurse may need to teach the client about what is causing the symptoms after the diagnosis is made.

Which information about a client who is being discharged 3 days after having an ST segment elevation myocardial infarction (STEMI) and coronary artery stent placement indicates that a home health referral may be needed at discharge? o ST segments have not yet returned to baseline. o Troponin T and Troponin I levels are still elevated. o Client reports frequently forgetting to take medications. o Pulse increases from 65 beats/minute to 75 beats/minute with exercise.

o Client reports frequently forgetting to take medications. · Because clients are discharged on multiple medications after experiencing STEMI and stenting, the statement about forgetting to take medications indicates a need for home health assessment and interventions to ensure medication adherence. ST segments may not return to baseline for a few days after STEMI. Troponin levels remain elevated for 10 to 14 days post-STEMI. A pulse rate increase of 10 beats/minute is a normal response to exercise.

Which client would be at an increased risk for coronary artery disease (CAD)? Select all that apply. o Client with total cholesterol 175 mg/dL and LDL cholesterol 80 mg/dL o Client with total cholesterol 190 mg/dL and HDL cholesterol 40 mg/dL o Client with total cholesterol 200 mg/dL and HDL cholesterol 45 mg/dL o Client with total cholesterol 250 mg/dL and LDL cholesterol 120 mg/dL o Client with total cholesterol 160 mg/dL and LDL cholesterol 125 mg/dL

o Client with total cholesterol 250 mg/dL and LDL cholesterol 120 mg/dL · Major risk factors for CAD include elevated serum lipid levels. A total cholesterol greater than 200 mg/dL, LDL cholesterol greater than 130 mg/dL, and HDL cholesterol less than 40 mg/dL increase a client's risk for CAD. Therefore, the client with a total cholesterol of 250 mg/dL is at an increased risk for CAD. Laboratory values of total cholesterol 175 mg/dL and LDL cholesterol 80 mg/dL; total cholesterol 190 mg/dL and HDL cholesterol 40 mg/dL; total cholesterol 200 mg/dL and HDL cholesterol 45 mg/dL; and total cholesterol 160 mg/dL and LDL cholesterol 125 mg/dL are all within normal limits and do not indicate that the client is at increased risk for CAD.

When the nurse in the coronary care unit (CCU) identifies ventricular fibrillation on a client's cardiac monitor, which intervention is the priority? o Defibrillate the client. o Notify the Rapid Response Team. o Administer intravenous epinephrine. o Initiate cardiopulmonary resuscitation.

o Defibrillate the client. · When ventricular fibrillation is verified, the first intervention is defibrillation; it is the only measure that will terminate this lethal dysrhythmia. Research indicates that early defibrillation is the strongest indicator for successful resuscitation. The Code 99 or Rapid Response Team will be notified, but the nurse will not wait to notify the team before attempting defibrillation. Epinephrine may be administered if defibrillation is initially unsuccessful, but is not the first action. Cardiopulmonary resuscitation will be started if a defibrillator is unavailable or if initial defibrillation is unsuccessful at ending the ventricular fibrillation.

When caring for a client with symptomatic bradycardia caused by heart block, the nurse will anticipate the need to teach the client about which treatment option? o Overdrive pacing o Demand pacemakers o Cardiac resynchronization therapy o Implantable cardioverter-defibrillators

o Demand pacemakers · Treatment for symptomatic bradycardia typically includes placement of a temporary or permanent demand pacemaker to prevent heart rate from dropping below a preset rate. Overdrive pacing is used to treat atrial tachycardias such as atrial flutter. Cardiac resynchronization therapy is used to improve ventricular function and cardiac output in clients with severe heart failure. Implantable cardioverter-defibrillators are used for clients at risk for sudden cardiac death caused by ventricular tachycardia or ventricular fibrillation.

A child being treated with cardiac medications developed vomiting, bradycardia, anorexia, and dysrhythmias. The nurse understands which medication toxicity is responsible for these symptoms? o Digoxin o Nesiritide o Dobutamine o Spironolactone

o Digoxin · Digoxin helps improve pumping efficacy of the heart, but an overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. The side effects of nesiritide may include effects such as headache, insomnia, and hypotension. Dobutamine does not cause nausea or vomiting but may cause hypertension and hypotension. Spironolactone may cause edema.

When a client is admitted to the emergency department with disseminated intravascular coagulation caused by sepsis, which prescribed action will the nurse take first? o Apply antiembolism stockings. o Draw blood for culture and sensitivity. o Administer vancomycin 1 gram intravenously. o Transfer the client to the intensive care unit.

o Draw blood for culture and sensitivity. · Treatment of disseminated intravascular coagulation focuses on treatment of the cause of the abnormal coagulation, so rapid initiation of antibiotic therapy is essential. However, blood cultures are drawn before antibiotic administration to ensure that appropriate antibiotics can be prescribed. Antiembolism stockings are needed to help prevent venous thrombosis, but are not the priority action. The client needs to be transferred to the intensive care unit, but the nurse would not wait for the transfer to obtain cultures and administer antibiotics.

Which finding on an electrocardiogram for a client complaining of chest pain indicates possible acute myocardial infarction? o Flattened T waves o Absence of P waves o Elevated ST segments o Disappearance of Q waves

o Elevated ST segments · Elevated ST segments are an early typical finding after a myocardial infarction because of the altered repolarization of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation. Q waves do not disappear with myocardial infarction, but large Q waves are seen late in the process of infarction.

When a client has a newly implanted demand pacemaker and the nurse observes spikes on the cardiac monitor at a regular rate but no QRS following the spikes, how will the finding be documented? o Failure to sense o Failure to capture o Loss of battery power o Pacer wire displacement

o Failure to capture · If pacemaker spikes are present, the pacemaker is firing appropriately, but the lack of resulting QRS complexes indicates that it is not stimulating or "capturing" the heart. Failure to sense would occur if pacemaker spikes continue to be seen even though the client's rate is above the preset pacemaker level. With loss of battery power, the nurse would observe that no spikes occurred even when the client's rate dropped. If pacer wires were displaced, no pacemaker spikes would be observed even if the client rate dropped below the preset pacemaker rate.

Which postpartum client is at the highest risk for disseminated intravascular coagulation (DIC)? o Gravida III with twins o Gravida V with endometriosis o Gravida II who had a 9-lb baby o Gravida I who has had an intrauterine fetal death

o Gravida I who has had an intrauterine fetal death · Intrauterine fetal death is one of the risk factors for DIC; other risk factors include abruptio placentae, amniotic fluid embolism, sepsis, and liver disease. Multiple pregnancy, endometriosis, and increased birthweight are not risk factors for DIC.

The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication? o Headache o Tachycardia o Constipation o Hypotension

o Hypotension · Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure. This medication does not cause headaches; this medication may be used to relieve vascular headaches. This medication may cause bradycardia, not tachycardia. This medication may cause diarrhea, not constipation.

A client with a diagnosis of myocardial infarction asks the nurse, "What is causing the pain I am having?" Which explanation would the nurse give? o Compression of the heart muscle o Release of myocardial isoenzymes o Rapid vasodilation of the coronary arteries o Inadequate oxygenation of the myocardium

o Inadequate oxygenation of the myocardium · Cessation of the blood flow that normally carries oxygen to the myocardium results in pain because of ischemia of myocardial tissue. Myocardial infarction does not involve compression of the heart. The release of myocardial isoenzymes is an indication of myocardial damage; this does not cause myocardial pain. Vasodilation will increase perfusion and contribute to pain relief, not cause myocardial pain.

Which action would the nurse perform when a client is in ventricular fibrillation? Select all that apply. o Initiating CPR o Assessing the EKG o Using a defibrillator o Obtaining electrolytes o Administering epinephrine

o Initiating CPR o Assessing the EKG o Using a defibrillator o Obtaining electrolytes o Administering epinephrine · Ventricular fibrillation is an abnormal heart rhythm that can be fatal. Key nursing interventions include initiating CPR, continuing to assess the heart rhythm through an EKG while performing interventions, and using a defibrillator to try to convert the client back to a normal sinus rhythm. An electrolyte panel can be used to determine if hyperkalemia led to the dysrhythmia as this imbalance would need to be corrected. Epinephrine and/or amiodarone may be administered when attempting to change the abnormal rhythm.

Which instruction will the nurse give a client with dysrhythmias who is scheduled to wear a Holter monitor for 24 hours? o Keep a diary of activities during the day. o Avoid taking any nitroglycerin tablets that day. o Stay away from high-output electrical generators. o Take both blood pressure and pulse every 2 hours.

o Keep a diary of activities during the day. · The purpose of a Holter monitor is to correlate dysrhythmias with the client's reported activity. The client should take nitroglycerin as needed and note it in the activities diary. Electrical activity produced by high output generators will not affect the Holter monitor. It is unnecessary to know the client's blood pressure and pulse rate every 2 hours during the test to correctly interpret results from a Holter monitor.

Which is the priority nursing intervention immediately after a client has a ventricular demand pacemaker inserted? o Encourage fluids. o Assess the implant site. o Monitor the heart rate and rhythm. o Encourage turning and deep breathing.

o Monitor the heart rate and rhythm. · Assessment of the heart's rate and rhythm determines how the newly implanted pacemaker is functioning. Encouraging fluids is appropriate, but not essential, immediately after pacemaker insertion, because the client will have had intravenous fluids during the procedure. Assessing the implant site is appropriate, but ensuring that the pacemaker is functioning well is a higher priority. The nurse will encourage the client to turn and deep breathe, but this is not as important as monitoring heart rate and rhythm.

Which is involved in the postprocedure nursing care of a child after left-side cardiac catheterization? o Encouraging early ambulation o Monitoring the insertion site for bleeding o Comparing blood pressures in the two extremities o Restricting fluids until the blood pressure has stabilized

o Monitoring the insertion site for bleeding · Postprocedure hemorrhage, a life-threatening complication after cardiac catheterization, is possible because arterial blood is under pressure and the catheter has entered an artery. Rest will be encouraged; flexion of the insertion site should be avoided to prevent disturbance of the clot. Comparing blood pressures in the two extremities is unnecessary; the pulse distal to the catheterization insertion site is monitored. The blood pressure will not be unstable unless a problem develops; fluid intake should be encouraged.

Digoxin and verapamil are prescribed to manage a client's cardiac dysrhythmia. The nurse will monitor the client for signs and symptoms of which adverse effect? o Physical agitation o Reflex stimulation o Myocardial depression o Respiratory depression

o Myocardial depression · Both digoxin and verapamil decrease cardiac impulse conduction, with resultant depression of the myocardium; verapamil decreases conduction at the sinoatrial (SA) and atrioventricular (AV) nodes, which may cause bradycardia, AV block, and cardiac arrest. Digoxin and verapamil together do not cause agitation. Side effects of verapamil include fatigue and depression, not agitation. Digoxin and verapamil do not influence the reflexes of the body. Digoxin and verapamil do not influence respirations.

Which priority assessment findings would the nurse expect to see when caring for a client with sinus tachycardia? Select all that apply. o Anxiety o Orthopnea o Restlessness o Shortness of breath o Decreased blood pressure

o Orthopnea o Shortness of breath o Decreased blood pressure · The priority assessment findings for clients with sinus tachycardia are orthopnea, shortness of breath, and decreased blood pressure because these assessments can help in identifying the condition of the client to start treatment. Anxiety and restlessness are observed in the client with sinus tachycardia, but they are not priorities.

When caring for a client who is hospitalized for an acute myocardial infarction, which prescription by the health care provider would the nurse question? o Long-acting beta blocker o Daily low-dose aspirin tablet o H1 blocker to reduce gastric acid secretions o Rectal suppository as needed for constipation

o Rectal suppository as needed for constipation · Rectal stimulation can stimulate the vagus nerve and cause bradycardia and is avoided in clients who have had myocardial infarction. Long-acting beta blockers are commonly prescribed after myocardial infarction to prevent cardiac remodeling and heart failure. Low-dose aspirin is typically prescribed to clients with coronary artery disease or myocardial infarction to prevent new coronary artery thrombus from forming. H1 blockers are frequently prescribed to hospitalized clients to prevent formation of stress-related gastric ulcers.

Which action would the nurse take first when using an automated external defibrillator (AED) for a pulseless and unresponsive client? o Attach the AED pads. o Push the "analyze" button. o Remove any medication patches. o Tell bystanders to "stand clear."

o Remove any medication patches. · Medication patches that interfere with electrode placement must be removed before application of AED pads because the patches may conduct electricity and interfere with defibrillation or cause burns on the chest. The AED pads would be attached after removing the medication patches. The analyze button would be pushed once the patches were attached. Bystanders would be instructed to "stand clear" after the rhythm had been analyzed and before pushing the "shock" button.

Which finding for a client who has just returned to the nursing unit after an emergency cardiac catheterization would be most important to report to the primary health care provider? o Anxiety about the results of the procedure o ST-segment elevation on the electrocardiogram o Pain at the femoral artery catheter insertion site o Premature atrial contractions on the cardiac monitor

o ST-segment elevation on the electrocardiogram · Embolization of plaque or injury to the coronary artery during catheterization may cause acute myocardial infarction. ST-segment elevation is a sign of acute myocardial injury and would be reported immediately because actions such as emergency coronary artery stent placement may be needed. Anxiety about test results is a common concern, but does not require immediate action by the health care provider. Pain at the arterial puncture site is attributable to entry and cannulation of the artery and is a common complaint after a cardiac catheterization. Premature atrial contractions usually do not require treatment, although the nurse will continue to monitor for dysrhythmias.

Which object would the nurse teach the client with a newly implanted pacemaker to avoid? o Strong magnet o Microwave oven o Mobile telephone o Remote control device

o Strong magnet · The client with a newly implanted pacemaker is taught to avoid strong magnets because they can change the settings and function of the pacemaker. Microwave oven use is not a concern for a client with a pacemaker. Remote control devices are not contraindicated for the client with a pacemaker. Mobile phones should be used in the ear opposite the pacemaker.

When a client has supraventricular tachycardia that has persisted despite treatment with vagal maneuvers and medications, which collaborative intervention will the nurse anticipate to treat the dysrhythmia? o Defibrillation o Pacemaker placement o Synchronized cardioversion o Cardiac resynchronization therapy

o Synchronized cardioversion · Synchronized cardioversion is application of a shock that is timed to land on the R wave to depolarize the myocardium and allow the normal cardiac pacemaker in the sinoatrial node to take over normal cardiac stimulation. Defibrillation is not synchronized and might cause fatal dysrhythmias such as ventricular fibrillation if used on a client with supraventricular tachycardia. A pacemaker would be used for slow heart rates such as might occur with atrioventricular blocks. Cardiac resynchronization therapy is used for clients with severe left ventricular failure to synchronize the contraction of the right and left ventricles and improve cardiac output.

When a client with angina is scheduled to have a cardiac catheterization, which explanation would the nurse give about the purpose of the procedure? o To obtain the pressures in the heart chambers o To determine the existence of congenital heart disease o To visualize the disease process in the coronary arteries o To measure the oxygen content of various heart chambers

o To visualize the disease process in the coronary arteries · Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization. Although pressures can be obtained, they are not the priority for this client; this assessment is appropriate for those with valvular disease. Determining the existence of congenital heart disease is appropriate for infants and young adults with cardiac birth defects. Measuring the oxygen content of various heart chambers is appropriate for infants and young children with suspected septal defects.

The nurse is preparing to apply nitroglycerin ointment. Before applying the ointment, which action will the nurse take? o Assess the client's pulse rate. o Prepare the site with an alcohol swab. o Shave the client's chest in the area for application. o Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount.

o Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount. · The nurse would use the dose measuring application paper supplied with the ointment and spread in a thin layer to the prescribed amount and place side down on the desired skin. The nurse would assess blood pressure reading, not pulse rate. There is no need to clean the site with alcohol before administration. Shaving is not recommended; a hairless site on the chest, back, abdomen, or anterior thigh should be selected.

The nurse observes the following dysrhythmia on a client's cardiac monitor. Which rhythm would the nurse identify? o Atrial flutter o Atrial fibrillation o Ventricular fibrillation o Ventricular tachycardia

o Ventricular fibrillation · Ventricular fibrillation reflects a rapid, feeble twitching/quivering of the ventricles; it has an irregular sawtooth configuration with unidentifiable PR intervals and QRS complexes. Atrial flutter is characterized by an atrial rate of 200 to 350 beats per minute and a ventricular rate of approximately 150 beats per minute; flutter to ventricular responses usually are 2:1, 3:1, or 4:1. Atrial fibrillation is characterized by an atrial rate of 350 to 600 beats per minute and a variable ventricular rate; the ventricular rhythm is grossly irregular. Ventricular tachycardia has a rate of 140 to 200 or even 250 beats per minute; the rhythm is usually regular but may vary. P waves are unidentifiable. PR intervals are unmeasurable. QRS complexes are wide and bizarre.

Which activities might cause chest pain in a client with stable angina? Select all that apply. o Deep breathing during meditation o Walking outside on a cold day o Sexual activity o Taking an afternoon nap o Smoking a cigarette o Use of an oral decongestant

o Walking outside on a cold day o Sexual activity o Smoking a cigarette o Use of an oral decongestant · Clients with stable angina experience chest pain (or other angina equivalents) in response to activities that increase cardiac workload or decrease blood flow and oxygen availability to the heart. Cold temperatures cause vasoconstriction, increasing the cardiac workload during systole. Sexual activity increases heart rate and force of contraction, leading to increased cardiac workload. Tobacco use stimulates catecholamine release, increasing heart rate and causing vasoconstriction, and resulting in increased cardiac workload. In addition, tobacco use transiently increases carbon monoxide levels, resulting in a decrease in available oxygen for cardiac tissues. Oral decongestants are sympathetic nervous system stimulants, which increase heart rate and force of contraction and cause vasoconstriction, leading to increased cardiac workload. Deep breathing will increase oxygen availability and tends to lead to relaxation, resulting in reduced heart rate and force of contraction. Taking an afternoon nap will reduce cardiac workload.