Nurs 4 - Heart Failure, Cardiomyopathies, and Valvular Issues

The nurse conducts a health history interview of a patient who is diagnosed with infective endocarditis. Which questions are appropriate for the nurse to include when assessing the patient's cognitive-perceptual pattern? Select all that apply. 1 "Do you have a headache?" 2 "Do you experience chills?" 3 "Do you have night sweats?" 4 "Do you experience chest pain?" 5 "Do you experience abdominal pain?"

1 - "Do you have a headache?" 4 - "Do you experience chest pain?" 5 - "Do you experience abdominal pain?" While assessing the effect of infective endocarditis on a patient's cognitive-perceptual pattern, the appropriate questions to ask are related to the patient's history of headache, chest pain, abdominal pain, and muscle tenderness. Asking the patient about the occurrence of chills helps to assess nutritional-metabolic pattern. Asking the patient about night sweats will help to assess sleep-rest pattern in the patient.

The nurse obtains subjective data while assessing a patient that presents with suspected cardiac failure. What questions should the nurse ask related to the patient's sleep-rest pattern? Select all that apply. 1 "Do you need to sleep upright in a chair?" 2 "How long does it take you to fall asleep?" 3 "Do you fall asleep with the television on?" 4 "How many pillows do you need to sleep at night?" 5 "Do you exercise within two hours of going to bed?"

1 - "Do you need to sleep upright in a chair?" 4 - "How many pillows do you need to sleep at night?" Many patient with heart failure need to sleep with several pillows or upright in a chair. The nurse should note the number of pillows needed to sleep or the need to sleep upright (orthopnea) and whether this has changed recently. Indications of insomnia and sleeping habits (e.g., how long it takes to fall asleep, exercising before going to bed, falling asleep with the television on) are not part of the assessment for cardiovascular problems.

The nurse is performing a health history on a patient with cardiovascular disease. Which questions reflect the Health Perception-Health Management functional health pattern? Select all that apply. 1 "Do you use recreational drugs?" 2 "How long have you been married?" 3 "Have you lost or gained any weight recently?" 4 "Do you drink alcoholic beverages? How often?" 5 "Do you use extra pillows when you sleep? How many?" 6 "How many years have you smoked, and how many packs a day?"

1 - "Do you use recreational drugs?" 4 - "Do you drink alcoholic beverages? How often?" 6 - "How many years have you smoked, and how many packs a day?" Questions about smoking history, alcohol use, and any use of habit-forming drugs, including recreational drugs, reflect the Health Perception-Health Management functional health pattern. Questions about marriage reflect the Role-Relationships functional health pattern. Questions about weight gain or loss reflect the Nutritional-Metabolic health pattern. The use of extra pillows for sleep may be indicative of heart failure and reflects the Sleep-Rest health pattern.

The nurse educates a patient with heart failure (HF) about lifestyle changes to avoid complications. Which statement made by the patient indicates that further teaching is needed? 1 "I can add salt to my food and eat what I want." 2 "I can eat hard candy or ice pops to avoid thirst." 3 "I shouldn't exercise or do anything to strain my heart." 4 "I will take all of my medications at the prescribed times."

1 - "I can add salt to my food and eat what I want." Not following a low-sodium diet may lead to complications such as hypertension, edema, and other conditions. Fluid restriction is not usually prescribed for the patient with mild to moderate HF. However, in chronic HF, fluids are limited to 2 L/day. Use of ice pops and hard candy helps avoid thirst, which is a side effect of the HF medications. Lack of exercise does not increase a patient's sodium level. Taking medication at the prescribed times is correct and does not need further teaching.

A nurse provides education to a patient with hypertension related to lifestyle modifications to reduce overall cardiovascular risk. Which statement made by the patient indicates effective learning? Select all that apply. 1 "I should exercise for at least 30 minutes daily." 2 "I should achieve and maintain a healthy weight." 3 "I should limit my alcohol intake to five drinks per day." 4 "I should restrict my salt intake to less than or equal to 1500 mg/day." 5 "I can continue to smoke because nicotine does not affect blood pressure."

1 - "I should exercise for at least 30 minutes daily." 2 - "I should achieve and maintain a healthy weight." 4 - "I should restrict my salt intake to less than or equal to 1500 mg/day." Lifestyle modifications play a vital role in reducing blood pressure and cardiovascular risk. Overweight people are at higher risk of cardiovascular disease. A weight loss of 22 lb may decrease systolic blood pressure by approximately 5 to 20 mm Hg. Being physically active is essential to maintain good health. It decreases the cardiovascular risk of hypertension. Sodium reduction helps to control blood pressure. A hypertensive patient should lower salt intake to 1500 mg/day. The nicotine in tobacco causes vasoconstriction and increases blood pressure. Therefore smokers who are hypertensive should stop smoking. Excessive alcohol consumption increases the risk of hypertension. Consuming three or more drinks per day increases the risk of cardiovascular disease and stroke.

A patient has undergone surgery for a valve replacement. Which statements indicate that the patient understands the instructions from the nurse? Select all that apply. 1 "I should wear a Medic Alert device." 2 "I will start a vigorous aerobic exercise program." 3 "Valve surgery has completely cured my disease." 4 "I will need to take antibiotics when I have my teeth extracted." 5 "I should contact my health care provider if I have a respiratory infection."

1 - "I should wear a Medic Alert device." 4 - "I will need to take antibiotics when I have my teeth extracted." 5 - "I should contact my health care provider if I have a respiratory infection." It is advisable for this patient to wear a Medic Alert device to provide information in case of an emergency. Antibiotic prophylaxis prior to invasive dental procedures (such as extraction) is necessary to prevent endocarditis. Respiratory infections should be treated with antibiotics because some microorganisms may damage the valves of the heart. Also, valve surgery only relieves the symptoms and does not cure the disease; therefore, regular follow-up is important to monitor the disease progression. Strenuous physical exercise should be avoided because the valve may be unable to accommodate the associated increase in cardiac output. The extent of physical exercise should be prescribed by the health care provider.

A patient seeks information about the advantages of minimally invasive valvuloplasty surgery. What should the nurse say to explain the procedure to the patient? Select all that apply. 1 "It is associated with less pain." 2 "It can lead to postoperative atrial fibrillation." 3 "It involves a shorter length of stay in the hospital." 4 "It is associated with a higher risk of sternal infection." 5 "It is more likely that a postoperative blood transfusion will be needed."

1 - "It is associated with less pain." 2 - "It can lead to postoperative atrial fibrillation." 3 - "It involves a shorter length of stay in the hospital." Minimally invasive valvuloplasty surgery involves a mini-sternotomy. Hence, there is a shorter hospital stay because a small surgical wound takes less time to heal. Postoperative atrial fibrillation is reported in this procedure due to the surgery on the valves but is less common than with open surgical valvuloplasty. Because the procedure is minimally invasive, there is less postoperative pain. The procedure carries a lesser risk of sternal infection due to the small incision. Also, fewer blood transfusions are needed compared to open valvuloplasty because the blood loss is typically minimal.

Which instruction should the nurse give to a patient that is scheduled for Holter monitoring? 1 "Keep a diary of all activities and symptoms." 2 "Remove the monitor only to shower or bathe." 3 "Refrain from exercising while wearing this monitor." 4 "Connect the monitor whenever you feel symptoms."

1 - "Keep a diary of all activities and symptoms." A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. Normal patient activity is encouraged to stimulate conditions that produce symptoms. Event monitoring involves the starting of a recording as soon as symptoms begin or as soon thereafter as possible.

Which instructions should the nurse provide to a patient who is scheduled for a transesophageal echocardiogram (TEE)? Select all that apply. 1 "Remove dentures prior to the test." 2 "Refrain from tobacco use 24 hours before the test." 3 "It is permissible to eat light meals between the scans." 4 "Withhold all caffeine products for 12 hours before the test." 5 "It is important to consume nothing by mouth for six hours before the test."

1 - "Remove dentures prior to the test." 5 - "It is important to consume nothing by mouth for six hours before the test." Transesophageal echocardiogram (TEE) is a diagnostic test for cardiovascular assessment in which a probe with a transducer at the tip is swallowed and the primary health care provider controls the angle and depth. The patient should be on NPO status for six hours before the test to minimize the risk of vomiting and aspiration. The patient should remove dentures prior to the test to prevent partial airway obstruction by dislodgement of dentures. Light meals can be taken between scans during exercise nuclear imaging, not during TEE. Patients should refrain from tobacco use for 24 hours before undergoing positron emission tomography (PET), not before TEE. Caffeine products should be withheld for 12 hours before pharmacologic nuclear imaging, not before TEE.

The parent of a child who is at risk for infective endocarditis (IE) asks the nurse how to prevent infection in the child. What instruction does the nurse provide to the parent? 1 "Take prophylactic antibiotics prior to dental work." 2 "Increase daily fluid intake to prevent dehydration." 3 "Read food labels to limit sodium intake in your diet." 4 "Take frequent rest periods and limit physical activity."

1 - "Take prophylactic antibiotics prior to dental work." The nurse instructs the parent to contact the dentist prior to dental appointments to obtain prophylactic antibiotics. This is because microorganisms may enter the bloodstream due to dental decay, which can cause IE. Increasing the fluid intake does not prevent any kind of infection, which is a priority in this case. Sodium is restricted in patients with heart failure, not as a preventative measure for IE. The amount of physical activity that a child engages in does not ensure that the infection will be prevented.

What information does the nurse provide to parents of a child with a chest tube when they ask about chest tube removal? Select all that apply. 1 "The child will be given analgesics before the procedure." 2 "A chest radiograph will be taken after chest tube removal." 3 "The chest tubes will be removed five days after the surgery." 4 "The child will need to rest 24 hours after chest tube removal." 5 "The child will feel momentary pain during chest tube removal."

1 - "The child will be given analgesics before the procedure." 2 - "A chest radiograph will be taken after chest tube removal." 5 - "The child will feel momentary pain during chest tube removal." The child feels a momentary sharp pain during chest tube removal, as the tube is quickly pulled out. The child is given analgesics before the procedure because this is a painful procedure. A chest radiograph is taken after the chest tube removal to assess for complications such as pneumothorax or pleural effusion. The chest tube is removed between the first to third postoperative days as drainage is usually decreased. The child is taught light physical exercise immediately after the chest tube removal to encourage lung expansion.

While palpating the patient's pedal pulses, the nurse determines that the pulses are absent. What factor could contribute to this result? 1 Atherosclerosis 2 Hyperthyroidism 3 Arteriovenous fistula 4 Cardiac dysrhythmias

1 - Atherosclerosis Atherosclerosis can cause an absent peripheral pulse. The feet would be cool also and may be discolored. Hyperthyroidism causes a bounding pulse. An arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.

A patient is admitted to a hospital with chest pain and is scheduled for a stress test. What instructions should the nurse give to the patient regarding the test? Select all that apply. 1 "Wear comfortable clothes and shoes for the test." 2 "Refrain from smoking for three hours before the test." 3 "Do not engage in strenuous exercise for three hours before the test." 4 "Do not consume caffeinated food or drinks for an hour before the test." 5 "Report any uncomfortable symptoms that you experience during the test."

1 - "Wear comfortable clothes and shoes for the test." 2 - "Refrain from smoking for three hours before the test." 3 - "Do not engage in strenuous exercise for three hours before the test." 5 - "Report any uncomfortable symptoms that you experience during the test." The patient scheduled for a stress test should not smoke for three hours before the test. Smoking may alter the oxygen-carrying capacity of the blood and result in an increased workload of the heart. This can interfere with accurate test results. Engaging in strenuous exercise also increases the activity of the heart and interferes with the stress test. The patient should wear comfortable clothes and shoes for walking and running during the test. The patient should immediately report any discomfort experienced during the test, which can indicate undue stress on the heart. In such a case, the test would need to be discontinued. Caffeine-containing foods and fluids should be avoided for 24 hours before the test, because they can interfere with the test results.

A patient with a history of angina is being treated with nitrates and beta blockers. What important information should the nurse give to the patient regarding sexuality? 1 "You cannot take medicines like sildenafil." 2 "Stop taking nitrates when planning to have sexual intercourse." 3 "Stop taking beta blockers, because they can cause impotence." 4 "You cannot have sexual intercourse while taking these medicines."

1 - "You cannot take medicines like sildenafil." The nurse should advise the patient to avoid taking erectile dysfunction (ED) drugs such as sildenafil. This is because the combination of ED drugs and nitrates can cause significant hypotension. The patient should not be asked to avoid sex. Beta blockers may cause erectile dysfunction; however, the drug should not be stopped without consulting the primary healthcare provider. Discontinuing nitrates can worsen the angina.

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because it is what? 1 A diuretic 2 A β-blocker 3 An ACE inhibitor 4 A form of digitalis

1 - A diuretic Furosemide (Lasix) is a diuretic used to eliminate excess water and salt to prevent reaccumulation of the fluid. It is not a β-blocker, ACE inhibitor, or form of digitalis.

The nurse receives information about the assigned patients during shift report. Which patient should the nurse assess first? 1 A patient that reports a severe headache and that is vomiting 2 A patient that reports dizziness and whose blood pressure (BP) is 150/92 3 A patient with a hip fracture that reports a pain level of "2" on a 1 to 10 scale 4 A patient that received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously reports fatigue

1 - A patient that reports a severe headache and that is vomiting Severe headache and vomiting are signs of hypertensive crisis that is an emergency situation; therefore, the nurse must assess this patient first. Dizziness is one of the symptoms of hypertension, and the patient has an elevated blood pressure, but it is not an emergency situation. A pain level of 2 on a scale of 1 to 10 is mild pain and, therefore, this patient is not a priority. Fatigue is one of the symptoms of hypertension, but the patient just received an antihypertensive medication.

While obtaining objective data during the assessment of the cardiovascular system of a patient, the nurse identifies that which findings will require further evaluation? Select all that apply. 1 A thready pulse is present. 2 Hands and feet are cold to touch. 3 Edema is absent in the extremities. 4 Veins in the neck are not distended. 5 Capillary refill takes longer than two seconds.

1 - A thready pulse is present. 2 - Hands and feet are cold to touch. 5 - Capillary refill takes longer than two seconds. Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. Capillary refill taking longer than two seconds indicates the possibility of reduced arterial capillary perfusion or anemia. Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern.

The nurse obtains a health history from a patient with primary hypertension and recognizes which nonmodifiable risk factors? Select all that apply. 1 Age 65 years 2 Excessive dietary sodium 3 African American ethnicity 4 Excessive alcohol consumption 5 A family history of hypertension

1 - Age 65 years 3 - African American ethnicity 5 - A family history of hypertension Nonmodifiable risk factors for hypertension include increasing age, African American ethnicity, and a family history of hypertension. Consumption of excessive dietary sodium and excessive alcohol consumption are considered modifiable risk factors.

Which is a secondary cause of restrictive cardiomyopathy? 1 Amyloidosis 2 Aortic stenosis 3 Muscular dystrophy 4 Coronary artery disease

1 - Amyloidosis Amyloidosis is the deposition of a protein, amyloid, that can lead to restrictive cardiomyopathy as a result of the buildup of amyloid deposits in the heart affecting its shape and function. Aortic stenosis causes hypertrophic cardiomyopathy. Muscular dystrophy and coronary heart disease cause dilated cardiomyopathy.

The nurse reviews the medical records of several patients and identifies that which ones are at high risk of developing hypertension? Select all that apply. 1 An elderly man who smokes 2 A 35-year-old man with obesity 3 A 65-year-old African American woman 4 A female teenager with a fracture of the humerus 5 A 50-year-old man whose parent had hypertension

1 - An elderly man who smokes 2 - A 35-year-old man with obesity 3 - A 65-year-old African American woman 5 - A 50-year-old man whose parent had hypertension An elderly man is at risk of hypertension due to his age. In addition, smoking increases the risk of developing hypertension. African Americans have an increased risk of developing hypertension compared to their white counterparts. In addition, the woman is 65 years old; in females the risk of hypertension increases after 50 years of age. Obesity increases the risk of hypertension. The risk is even greater with abdominal obesity. A person who has a family history of hypertension is at increased risk of developing hypertension. A female teenager with a fracture is not at risk, due to her young age and female gender.

A patient is diagnosed with heart failure, which was caused by thyrotoxicosis. The nurse identifies what other precipitating causes of heart failure? Select all that apply. 1 Anemia 2 Myocarditis 3 Paget's disease 4 Pulmonary embolism 5 Coronary artery disease

1 - Anemia 3 - Paget's disease 4 - Pulmonary embolism The precipitating causes of heart failure include anemia, in which the oxygen-carrying capacity of the blood is reduced. Hypoxemia leads to an increase in cardiac output, which then increases the workload on the heart. In Paget's disease, there is an increase in the vascular bed in the skeletal muscles, which causes an increase in the cardiac workload. In pulmonary embolism, an increase in pulmonary pressure decreases cardiac output. Myocarditis and coronary artery disease are the primary causes of heart failure but are unlikely in this patient.

A patient is admitted to the hospital with a diagnosis of aortic valve stenosis. Which manifestation does the nurse expect when taking the health history? 1 Angina 2 Fatigue 3 Orthopnea 4 Weakness

1 - Angina Angina is one of the classic triad of manifestations that occurs on exertion in aortic valve stenosis. Angina occurs when the myocardial oxygen demand of the hypertrophied left ventricle exceeds oxygen supply. Fatigue and orthopnea are associated with chronic aortic valve regurgitation. Weakness is not a clinical manifestation of aortic valve stenosis.

What is the nursing priority for a patient with rheumatic fever? 1 Antibiotic therapy 2 Anticoagulation therapy 3 Optimizing joint mobility 4 Application of ice packs to painful joints

1 - Antibiotic therapy Patients with a history of rheumatic fever frequently require ongoing antibiotic therapy. Heat should be applied to painful joints. Anticoagulation is not indicated in this patient population. A priority nursing goal is relief of joint pain, not optimization of joint mobility.

A patient has blood regurgitating into the ventricles of the heart at the end of each ventricular contraction. The nurse reviews the patient's two-dimensional echo report and recognizes that damage to which cardiac structures support this finding? Select all that apply. 1 Aortic valve 2 Pulmonic valve 3 Papillary muscle 4 Pulmonary aorta 5 Chordae tendineae

1 - Aortic valve 2 - Pulmonic valve The semilunar valves (aortic valve and pulmonic valve) are one-way valves that separate the ventricles from major arteries. The aortic valve separates the left ventricle from the aorta, while the pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles contract, ventricular pressure exceeds arterial pressure, the semilunar valves open and blood is pumped into the major arteries. Therefore damage to the semilunar valves can result in regurgitation of blood into the ventricles. The papillary muscle does not prevent the regurgitation of blood into the ventricles. The pulmonary aorta does not prevent the regurgitation of blood into the ventricles. The chordae tendineae do not prevent the regurgitation of blood into the ventricles.

A patient asks the nurse, "How can I use my smartphone to help control my hypertension?" The nurse should inform the patient that a smartphone can perform what functions that will help manage the patient's blood pressure? Select all that apply. 1 Appointment tracking 2 Maintaining a drug history 3 Generating a report to the patient's healthcare provider 4 Contacting emergency services if a blood pressure reading is critical 5 The patient can enter variables including time of day and arm or wrist used

1 - Appointment tracking 2 - Maintaining a drug history 3 - Generating a report to the patient's healthcare provider 5 - The patient can enter variables including time of day and arm or wrist used A smartphone can be used to help a patient with hypertension manage his or her care by tracking clinical appointments, generating reports, maintaining a drug history, and allowing the patient to enter variables. A smartphone does not correlate critical blood pressure readings to the need to contact emergency services.

A patient with pericarditis is admitted to the hospital. The nurse recognizes that what is the best method of auscultation in this patient? 1 Ask the patient to sit and lean forward. 2 Place the patient in a standing position. 3 Maintain the patient in a supine position. 4 Place the patient in 3 positions: supine, sitting, and standing.

1 - Ask the patient to sit and lean forward. In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions such as supine or standing.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE) and should perform which interventions? Select all that apply. 1 Assess for return of gag reflex. 2 Assess groin for hematoma or bleeding. 3 Monitor vital signs and oxygen saturation. 4 Position patient supine with head of bed flat. 5 Assess lower extremities for circulatory compromise.

1 - Assess for return of gag reflex. 3 - Monitor vital signs and oxygen saturation. The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation also are important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels; therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

A male patient that takes nifedipine to treat hypertension continues to have blood pressure readings over 140/90 mm Hg. What action should the nurse take first? 1 Assess the patient's adherence to therapy 2 Request a prescription for a thiazide diuretic 3 Assist the patient in creating an exercise plan 4 Instruct the patient to use the Dietary Approaches to Stop Hypertension (DASH) diet

1 - Assess the patient's adherence to therapy A long-acting calcium channel blocker, such as nifedipine, causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance (SVR) and arterial blood pressure (BP) and related side effects. A major problem in the long-term management of the patient with hypertension is poor adherence with the treatment plan. The nurse needs to assess the patient's adherence to therapy. The patient's blood pressure is still elevated and must be addressed. Asking the patient to make an exercise plan or use the DASH diet is not addressing the blood pressure. It is not necessary to request another medication without assessing if the patient actually is taking the medication prescribed.

A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention? 1 Auscultate the lung sounds. 2 Observe for bloody sputum. 3 Assess for water-hammer pulse. 4 Palpate lower extremities for edema.

1 - Auscultate the lung sounds. Auscultation of the lung sounds is the priority nursing intervention in acute mitral valve regurgitation. In acute mitral valve regurgitation there is a rapid increase in left atrial pressure and volume, which leads to pulmonary congestion, resulting in pulmonary edema and possible cardiogenic shock. Hemoptysis can occur with mitral valve stenosis, not acute mitral valve regurgitation. Lower extremity edema is a manifestation of tricuspid stenosis. Water-hammer pulse is a manifestation of chronic, severe aortic valve regurgitation.

The nurse is planning discharge teaching for a patient with cardiomyopathy. What instructions should be included in the plan? Select all that apply. 1 Avoid alcohol. 2 Balance activity and rest periods. 3 Drink 2 to 4 glasses of water a day. 4 Avoid vigorous isometric exercises. 5 Consume food products with high sodium content.

1 - Avoid alcohol. 2 - Balance activity and rest periods. 4 - Avoid vigorous isometric exercises. A patient with cardiomyopathy should avoid alcohol because it may increase blood pressure and can have adverse effects on the heart. Balance between activities and rest is essential to decrease systemic valvular resistance. Dehydration can increase systemic valvular resistance, which may result in obstruction to the forward flow of blood. Therefore it is important to drink six to eight glasses of water every day to avoid dehydration. Patients should avoid heavy lifting or vigorous isometric exercises. It is important to follow a low-sodium diet because it helps prevent water retention in the body.

The nurse should include which instructions when teaching a patient with mitral valve prolapse about self-care? Select all that apply. 1 Avoid caffeine. 2 Avoid all exercise. 3 Avoid heavy lifting or isometric exercises. 4 Avoid ephedrine in over-the-counter medications. 5 Use antibiotics prophylactically prior to a procedure. 6 Immediately report shortness of breath, fatigue, and palpitations.

1 - Avoid caffeine. 4 - Avoid ephedrine in over-the-counter medications. 6 - Immediately report shortness of breath, fatigue, and palpitations. The nurse will teach a patient with mitral valve prolapse to immediately report shortness of breath, fatigue, palpitations, or other symptoms such as anxiety to the healthcare provider, or if necessary, activate the emergency response system. Avoiding caffeine and ephedrine will prevent heart palpitations. The patient is encouraged to begin or maintain an exercise program to maintain optimal health. The use of antibiotics prior to a procedure is not necessary with mitral valve prolapse. Instructing a patient to avoid heavy lifting or isometric exercises is reserved for patients with a symptomatic or a pathologic cardiac condition such as cardiomyopathy.

The nurse is planning discharge teaching for a patient with valvular heart disease. What instructions should the nurse include in the plan? Select all that apply. 1 Avoid cigarettes. 2 Take planned rest periods. 3 Limit activities that cause fatigue. 4 Undergo regular cardiac assessments. 5 Continue with 30-40 minutes/day of strenuous exercise to build stamina.

1 - Avoid cigarettes. 2 - Take planned rest periods. 3 - Limit activities that cause fatigue. 4 - Undergo regular cardiac assessments. Consumption of tobacco should be strictly avoided because it stimulates the heart. Rest periods should be planned to avoid exertion. Activities that cause fatigue or dyspnea should be limited. Regular cardiac assessment helps to monitor the disease progress and effectiveness of the treatment provided. The patient should be advised to avoid strenuous physical activities because damaged valves may not be able to properly cope with the increased cardiac output demand.

A nurse is caring for a patient with hypertrophic cardiomyopathy. What measures should be included in planning the care for this patient? Select all that apply. 1 Avoid dehydration. 2 Avoid strenuous activity. 3 Encourage elevation of the feet. 4 Administer nitroglycerin for chest pain. 5 Ask the patient to do vigorous leg exercises.

1 - Avoid dehydration. 2 - Avoid strenuous activity. 3 - Encourage elevation of the feet. The nurse should instruct the patient to avoid strenuous activity and dehydration, because these may increase systemic valvular resistance, which may lead to obstruction to the forward flow of the heart. Elevation of the feet while resting helps to improve the volume of blood returning to the heart. The use of vasodilators such as nitroglycerin to relieve chest pain can actually worsen the patient's condition by decreasing venous return. It can further increase obstruction of blood flow from the heart. Vigorous leg exercises should be avoided because they can lead to an increase in systemic vascular resistance.

The nurse identifies a group of patients who have a high risk of developing infective endocarditis. What instructions should be included when teaching the patients about the prevention of infective endocarditis? Select all that apply. 1 Avoid overexertion. 2 Visit a dentist regularly. 3 Undergo immunotherapy. 4 Remain on complete bed rest. 5 Avoid people with cold and flu symptoms.

1 - Avoid overexertion. 2 - Visit a dentist regularly. 5 - Avoid people with cold and flu symptoms. Patients who have a high risk of developing infective endocarditis should not overexert themselves because this can increase cardiac workload. Such patients should plan rest periods before and after activities to avoid excessive fatigue. Contact with people having cold or flulike symptoms should be avoided to prevent infection. Dental hygiene is very important in preventing infective endocarditis. Regular visits to the dentist would help in maintaining good oral hygiene, thus preventing infection. Bed rest is not recommended unless the patient has fever or heart damage. Modulating the immune response contributes little to the development of endocarditis. Therefore immunotherapy is not the treatment of choice.

The nurse reviews laboratory test results for a patient with acute infective endocarditis. Which test result is significant for determining the plan of treatment? 1 Blood cultures 2 C- reactive protein 3 White blood cell count 4 Erythrocyte sedimentation rate

1 - Blood cultures A significant laboratory test for making the diagnosis of acute infective endocarditis is blood cultures. The collection of two blood cultures will be positive in more than 90 percent of patients. The C-reactive protein, white blood cell count, and erythrocyte sedimentation rate laboratory tests are more significant in monitoring the patient's response to antibiotic treatment.

Which type of murmur is observed in patients with chronic aortic valve regurgitation? 1 Diastolic murmur 2 Austin Flint murmur 3 Holosystolic murmur 4 Loud midsystolic murmur

2 - Austin Flint murmur An Austin Flint murmur occurs in patients with chronic aortic valve regurgitation. Mitral valve stenosis involves diastolic murmur. Holosystolic murmur occurs in patients with mitral valve prolapse. Loud midsystolic murmur occurs in patients with tricuspid and pulmonic stenosis.

During a physical examination of a patient, the nurse performs a capillary refill test. What test finding should the nurse consider as normal? 1 Capillary refill time of one second 2 Capillary refill time of four seconds 3 Capillary refill time of six seconds 4 Capillary refill time of eight seconds

1 - Capillary refill time of one second The capillary refill test assesses arterial flow to the extremities. The fingernail is pressed and the time required for refilling of blood is noted. This refill is appreciated by the change in the color of the nail bed. This should occur in less than 2 seconds with normal tissue perfusion and cardiac output. Capillary refill times of four seconds, six seconds, and eight seconds indicate an underlying defect in circulation.

The nurse is reviewing the function of the vascular system. What portion of the vascular system exchanges cellular nutrients and metabolic end products? 1 Capillary vessels 2 Smooth muscle of the arteriole 3 Endothelial layer of the arteries 4 Elastic middle layer of the veins

1 - Capillary vessels The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.

The nurse is caring for a patient with acute pericarditis. Which assessment findings reflect a serious complication of this condition? Select all that apply. 1 Chest pain 2 Bradycardia 3 Peripheral edema 4 Pulsus paradoxus 5 Narrowed pulse pressure 6 Jugular venous distention

1 - Chest pain 4 - Pulsus paradoxus 5 - Narrowed pulse pressure 6 - Jugular venous distention Cardiac tamponade develops as the pericardial effusion increases in volume. This results in compression of the heart. The speed of fluid accumulation affects the severity of clinical manifestations. The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. As the compression of the heart increases, there is decreased cardiac output (CO), muffled heart sounds, and narrowed pulse pressure. The patient develops tachypnea and tachycardia. Neck veins usually are distended markedly because of increased jugular venous pressure, and pulsus paradoxus is present. Pulsus paradoxus is a decrease in systolic blood pressure (BP) during inspiration that is exaggerated in cardiac tamponade. Bradycardia and peripheral edema are not assessment findings associated with cardiac tamponade.

A patient is prescribed lisinopril for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1 Cough 2 Edema 3 Impotence 4 Hypotension 5 Muscle stiffness

1 - Cough 4 - Hypotension Cough and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor.

The nurse is caring for an infant with a cardiac defect. What signs in the infant will indicate heart failure? Select all that apply. 1 Cyanosis 2 Dyspnea 3 Orthopnea 4 Weight loss 5 Flaring nares

1 - Cyanosis 2 - Dyspnea 3 - Orthopnea 5 - Flaring nares Cyanosis, dyspnea, and orthopnea are due to a lack of oxygen that may lead to heart failure in newborns. Flaring nares indicate respiratory distress. Weight gain caused by fluid retention instead of weight loss is an indicator of heart failure.

What signs of worsening heart failure does the nurse teach the parents to be alert for in a child with heart failure? Select all that apply. 1 Decreased output 2 Inadequate feeding 3 Decrease in weight 4 Increased sweating 5 Frequent headaches

1 - Decreased output 2 - Inadequate feeding 4 - Increased sweating The nurse should teach the parents how to manage the disease process, including signs of worsening heart failure that need to be reported to the primary health care provider. Poor feeding, decreased output, and increased sweating are signs that should be immediately reported. If the heart failure is worsening, the child will actually gain weight that is predominantly excess fluid volume. Frequent headaches are seen in children with hypertension.

While reviewing the diagnostic reports of a patient with hypertrophic cardiomyopathy, the nurse notes an abnormal, irregular, and rapid heartbeat and left ventricular outflow obstruction. Which medications may be beneficial to the patient? Select all that apply. 1 Digitalis 2 Verapamil 3 Metoprolol 4 Amiodarone 5 Nitroglycerin

1 - Digitalis 2 - Verapamil 3 - Metoprolol Abnormal, irregular, and rapid heartbeat indicates atrial fibrillation. Digitalis decreases automaticity at the atrioventricular (AV) node, which prolongs the effective refractory period of the AV node tissue resulting in slowing the conduction velocity through the node. Verapamil is a calcium channel blocker that is used in the reduction of ventricular filling in patients with asymmetric septal hypertrophy (ASH). Metoprolol is a beta-adrenergic blocker that reduces ventricular filling. Amiodarone is used in the treatment of dysrhythmias. Nitroglycerin is a nitrate that is used to reduce preload in patients with heart failure.

The nurse anticipates that what will be included in the treatment plan of a patient with myocarditis who has hypotension and a low ejection fraction? Select all that apply. 1 Digoxin 2 Anticoagulation therapy 3 Intravenous (IV) milrinone 4 Immunosuppressive agents 5 Intravenous (IV) nitroprusside

1 - Digoxin 2 - Anticoagulation therapy 4 - Immunosuppressive agents A patient with myocarditis and hypotension will have a low ejection fraction, which may result in a thrombus formation. Anticoagulation therapy reduces the risk of thrombus formation from blood stasis. Digoxin improves myocardial contractility and reduces the heart rate. Myocarditis is considered an autoimmune disorder; therefore, immunosuppressive agents should be administered to reduce myocardial inflammation. IV milrinone and IV nitroprusside reduce afterload and should not be given if hypotension is present.

The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply. 1 Edema 2 Ascites 3 Crackles 4 Anasarca 5 Wheezes

1 - Edema 2 - Ascites 4 - Anasarca Edema, ascites, and anasarca are manifestations of right-sided heart failure caused by fluid retention. Crackles and wheezes are manifestations of left-sided heart failure because fluid moves from the pulmonary capillary bed into the pulmonary interstitium and alveoli.

While performing cardiac assessment, the nurse finds that a patient's right atrial pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select all that apply. 1 Distended neck veins 2 Enlarged cardiac muscle 3 Engorged or enlarged liver 4 Decreased afterload in the ventricle 5 Decreased resistance to blood ejection

1 - Distended neck veins 2 - Enlarged cardiac muscle 3 - Engorged or enlarged liver The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of 12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and right atrial pressure. Therefore distention of neck veins is indicative of elevated right atrial pressure. Elevated arterial blood pressure gives the ventricles increased resistance to eject blood and thus increases the work demand, resulting in ventricular hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac output. Elevated right atrial pressure increases resistance to blood flow and can result in liver engorgement. Elevated right atrial pressure can increase afterload and resistance to blood ejection.

A patient is diagnosed with pulmonary edema. The nurse anticipates a prescription for which type of medication? 1 Diuretic 2 Vasodilator 3 β-adrenergic blocker 4 Angiotensin-converting enzyme (ACE) inhibitor

1 - Diuretic Diuretics are used to treat pulmonary edema because they act on the ascending loop of Henle to promote sodium, chloride, and water excretion. Vasodilators cause dilation of the blood vessel wall. β-adrenergic blockers help counteract the negative effect of the sympathetic nervous system. Angiotensin-converting enzyme inhibitors block the enzyme that can cause angiotensin I to form angiotensin II, which is a potent vasoconstrictor.

A patient is admitted with myocarditis with accompanying heart failure. The nurse will expect to initiate which pharmacologic treatments? Select all that apply. 1 Diuretics 2 Beta blockers 3 Anticoagulants 4 Angiotensin-converting enzyme (ACE) inhibitors 5 Nonsteroidal antiinflammatory drugs (NSAIDs)

1 - Diuretics 2 - Beta blockers 3 - Anticoagulants 4 - Angiotensin-converting enzyme (ACE) inhibitors The treatment for myocarditis consists of managing associated heart symptoms. ACE inhibitors and beta blockers are used if the heart is enlarged or to treat heart failure. Diuretics reduce fluid volume and decrease preload. If hypotension is not present, intravenous (IV) medications such as nitroprusside and milrinone reduce afterload and improve cardiac output (CO) by decreasing systemic vascular resistance. Anticoagulation therapy reduces the risk of clot formation from blood stasis in patients with a low ejection fraction (EF). NSAIDs are not used in the treatment of myocarditis.

A patient being treated for peripheral vascular disease reports erectile dysfunction (ED). The nurse reviews the patient's medication history and identifies which medication classifications that may be contributing to the condition? Select all that apply. 1 Diuretics 2 Phosphodiesterase (PDE) inhibitors 3 β-blockers 4 Corticosteroids 5 Antidepressants

1 - Diuretics 3 - β-blockers β-blockers, which are used to treat cardiovascular disorders, have erectile dysfunction as a major side effect. Taking diuretics along with medications for peripheral vascular disease increases problems in sexual function, such as decreased libido and difficulty ejaculating. PDEs such as sildenafil (Viagra) are often first-line therapy for ED, not the cause of it. Oral antidepressants do not directly cause ED in patients with peripheral vascular disease, although they may contribute to decreased libido. Corticosteroids help reduce breathing difficulty but do not impair sexual activity.

A patient whose blood pressure is 200/120 mm Hg receives a prescription for clonidine. The nurse instructs the patient to avoid hazardous activities due to what medication side effect? 1 Drowsiness 2 Orthostatic hypotension 3 Rapid decrease in BP 4 Rebound hypertension

1 - Drowsiness Clonidine is an adrenergic inhibitor that reduces sympathetic outflow from the central nervous system. It lowers BP by reducing peripheral sympathetic tone, dilating the blood vessels, and decreasing the systemic vascular resistance. Drowsiness is a side effect of the drug, and the patient is advised to avoid engaging in hazardous activities, because this can increase the risk of injury. The drug also causes orthostatic hypotension, so the patient is advised to change position slowly. The drug does not cause a rapid decrease in BP. The drug can cause rebound hypertension if discontinued abruptly.

A patient with suspected hypertrophic cardiomyopathy (CMP) reports exertional dyspnea, fatigue, angina, and syncope. The nurse recognizes that which assessment finding is the most common symptom associated with hypertrophic CMP? 1 Dyspnea 2 Fatigue 3 Angina 4 Syncope

1 - Dyspnea The most common symptom is dyspnea, caused by an elevated left ventricular diastolic pressure. Fatigue occurs because of the resistant decrease in cardiac output (CO) and in exercise-induced flow obstruction. Angina can occur and is most often caused by the increased left ventricular mass or compression of the small coronary arteries by the hypertrophic ventricular myocardium. Syncope most often is caused by an increase in obstruction to aortic outflow during increased activity.

A patient is suspected of having hypertrophic cardiomyopathy (CMP). The nurse anticipates a prescription for what primary diagnostic study? 1 Echocardiogram 2 Heart catheterization 3 Nuclear stress testing 4 Electrocardiogram (ECG)

1 - Echocardiogram The echocardiogram is the primary diagnostic tool used to confirm hypertrophic cardiomyopathy. The electrocardiogram will reveal some dysrhythmias associated with the ventricle. Heart catheterization and nuclear stress testing may also be helpful in diagnosing and treating hypertrophic cardiomyopathy, but the echocardiogram will be the first choice of test.

A patient is admitted to a hospital with a possible diagnosis of hypertrophic cardiomyopathy. The nurse anticipates that which diagnostic tests will be performed? Select all that apply. 1 Echocardiogram 2 Complete blood count 3 Cardiac catheterization 4 Doppler color-flow imaging 5 Transesophageal echocardiography

1 - Echocardiogram 3 - Cardiac catheterization Cardiac catheterization helps to clarify how well the heart chambers are pumping and will show any leakage in the valves. It is also used in diagnosing as well as guiding the treatment of hypertrophic cardiomyopathy. The echocardiogram is the primary tool used in confirming hypertrophic cardiomyopathy because it demonstrates wall motion abnormalities and diastolic dysfunction. Transesophageal echocardiography and Doppler color-flow imaging are usually not required to confirm the diagnosis. These tests are appropriate for diagnosing valvular heart diseases. A complete blood count will not help in diagnosis.

The nurse reviews the laboratory reports of a patient with acute pericarditis. The electrocardiogram report shows an elevated ST segment. What laboratory abnormalities would the nurse expect to find in this patient? Select all that apply. 1 Elevated troponin levels 2 Decreased hemoglobin count 3 Elevated white blood cell count 4 Elevated C-reactive protein (CRP) 5 Decreased erythrocyte sedimentation rate (ESR)

1 - Elevated troponin levels 3 - Elevated white blood cell count 4 - Elevated C-reactive protein (CRP) Elevated CRP is a common laboratory finding in acute pericarditis. It is caused by the inflammation of the pericardial sac. Troponin levels are increased with the elevation of the ST segment, which indicates concurrent myocardial damage. Leukocytosis commonly occurs because of inflammation. The ESR is elevated due to inflammation of the pericardial sac. A decreased hemoglobin count is not associated with acute pericarditis.

The nurse reviews the laboratory reports of a patient with myocarditis. Which laboratory findings are likely to be in the reports? Select all that apply. 1 Elevated viral titers 2 Decreased level of troponin 3 Moderate leukocytosis 4 Decreased erythrocyte sedimentation ratio (ESR) 5 Elevated C-reactive protein (CRP) levels

1 - Elevated viral titers 3 - Moderate leukocytosis 5 - Elevated C-reactive protein (CRP) levels Myocarditis refers to the focal or diffuse inflammation of the myocardium. Viral titers are elevated because of the presence of virus in the myocardial tissue causing cellular damage and necrosis of the myocardial tissue. Mild to moderate leukocytosis may be present due to the inflammation. CRP levels may be elevated because of the inflammation. Troponin is a myocardial marker; hence, the level of troponin will be elevated. The ESR is also elevated, because it is an inflammatory marker.

The nurse assesses a 70-year-old patient during a follow-up visit. The patient has progressive valvular disease caused by rheumatic fever. Which interventions are appropriate for the nurse to perform? Select all that apply. 1 Encourage planned rest periods. 2 Ensure ongoing prophylactic therapy. 3 Encourage persistent physical exercise. 4 Evaluate the effectiveness of medication. 5 Discuss the recommendation for a mechanical valve replacement.

1 - Encourage planned rest periods. 2 - Ensure ongoing prophylactic therapy. 4 - Evaluate the effectiveness of medication. When assessing a patient with progressive valvular disease caused by rheumatic fever, the nurse should ensure ongoing prophylaxis to prevent recurrence. The nurse should encourage the patient to plan rest periods and should evaluate the effectiveness of medication. The patient should avoid persistent physical exercise to prevent fatigue and dyspnea; instead, the patient should have an appropriate exercise plan to increase cardiac tolerance. It is preferable for patients over 65 years of age to undergo biologic valve replacement rather than mechanical valve replacement because the latter involves higher risk of bleeding from anticoagulants.

The nurse is caring for a patient admitted to a health care facility with acute pericarditis. Which interventions should the nurse perform? Select all that apply. 1 Ensure that the patient is kept on bed rest. 2 Ensure that the patient is supine at all times. 3 Elevate the head of the bed at meal time only. 4 Keep the head of the bed raised to 45 degrees. 5 Administer antiinflammatory drugs with milk or food.

1 - Ensure that the patient is kept on bed rest. 4 - Keep the head of the bed raised to 45 degrees. 5 - Administer antiinflammatory drugs with milk or food. The nurse should administer antiinflammatory drugs with milk or food. The nurse should ensure complete bed rest for the patient. The nurse should keep the head of the bed raised to 45 degrees and provide an overbed table to assist with pain relief. Patients with acute pericarditis experience severe pain when lying supine; hence, the head of the bed should be elevated to 45 degrees, and the patient should be provided an overbed table for support when leaning forward.

The nurse is caring for an infant with heart failure. What does the nurse include in the infant's plan of care? Select all that apply. 1 Ensures uninterrupted periods of sleep 2 Asks the parent to stay with the infant 3 Changes bed linens often for sanitation 4 Feeds the child at first signs of hunger 5 Provides small feedings every 3 hours

1 - Ensures uninterrupted periods of sleep 2 - Asks the parent to stay with the infant 4 - Feeds the child at first signs of hunger 5 - Provides small feedings every 3 hours The nurse ensures that the infant has uninterrupted periods of sleep so that the infant feeds properly after waking up. The nurse asks the parent to stay with the infant and asks to hold, rock, and cuddle the infant so that the infant sleeps more soundly. The nurse feeds the child at the first signs of hunger so that the infant does not exhaust energy in crying. The nurse provides small feedings every 3 hours to ensure adequate nutrition. Bed linens are changed only if necessary as it may disturb the infant.

The nurse provides education to a patient with hypertension about symptoms of uncontrolled hypertension. What should the nurse include in the education? Select all that apply. 1 Fatigue 2 Dizziness 3 Palpitations 4 Cluster headaches 5 Shortness of breath

1 - Fatigue 2 - Dizziness 3 - Palpitations Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. Cluster headaches and shortness of breath do not occur with uncontrolled hypertension.

The Heart Failure Society of America (HFSA) has developed the acronym FACES that a nurse can use to teach patients about the symptoms of heart failure. What are the symptoms that are included in FACES? Select all that apply. 1 Fatigue 2 Edema 3 Asphyxia 4 Chest congestion 5 Shortness of breath 6 Limitation of activities

1 - Fatigue 2 - Edema 4 - Chest congestion 5 - Shortness of breath 6 - Limitation of activities The acronym FACES includes the symptoms fatigue, limitation of activities, chest congestion/cough, edema, and shortness of breath. In heart failure, inadequate oxygenation of the blood causes fatigue even while performing routine activities. Edema is due to change in cardiac output, which leads to accumulation of fluid in the interstitial spaces. This causes shortness of breath and chest congestion. All these factors lead to limitation of activities in the patient. Asphyxia is not associated with HF.

A patient is diagnosed with left-sided heart failure. The nurse expects what assessment finding? 1 Orthopnea 2 Low blood pressure 3 Pulsating neck veins 4 Edema in the lower extremities

1 - Orthopnea Orthopnea, difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure.

The nurse assesses an 80-year-old patient. The nurse determines that the patient is at risk of dependent edema related to what effects of aging on the cardiovascular system? Select all that apply. 1 Heart valves become thicker. 2 Arterial blood vessels become thin and fragile. 3 The resting supine heart rate is markedly reduced. 4 The number of pacemaker cells in the SA node decrease. 5 There is a decreased response to physical and emotional stress.

1 - Heart valves become thicker. 4 - The number of pacemaker cells in the SA node decrease. 5 - There is a decreased response to physical and emotional stress. Heart valves become thinker and stiffer from lipid accumulation, degeneration of collagen, and fibrosis. The number of pacemaker cells in the SA node decreases with age. By age 75, a person may have only 10% of the normal pacemaker cells. The autonomic nervous system control of the cardiovascular system changes with aging. The number and function of beta-adrenergic receptors in the heart decrease with age; thus the older adult has a decreased response to physical and emotional stress. Arterial and venous blood vessels thicken and become less elastic with age. The resting supine HR is not markedly affected by aging.

The nurse provides information to a patient that is scheduled for a transesophageal echocardiography (TEE) related to potential complications. What should the nurse include in the education? Select all that apply. 1 Hemorrhage 2 Dysrhythmias 3 Renal impairment 4 Transient hypoxemia 5 Increased levels of lactate dehydrogenase levels

1 - Hemorrhage 2 - Dysrhythmias 4 - Transient hypoxemia Transesophageal echocardiography (TEE) evaluates mitral valve disease and endocarditis vegetation in the patient. Complications of this procedure include tearing of the esophagus, hemorrhage, dysrhythmias, and transient hypoxemia. Some contrast media cause nephrotoxicity in patients; however, transesophageal echocardiography does not involve the injection of contrast medium into the patient's heart. Increased levels of lactate dehydrogenase is not a complication of the procedure.

The nurse obtains laboratory results for a patient that presents to an emergency department with angina. Which parameters in the laboratory report indicate myocardial infarction? Select all that apply. 1 High troponin level 2 High cholesterol level 3 Elevated homocysteine (Hcy) level 4 Increased C-reactive protein (CRP) level 5 Increased creatinine kinase (CK-MB) level

1 - High troponin level 5 - Increased creatinine kinase (CK-MB) level Many chemical parameters may indicate and confirm the presence of a myocardial infarction. Cardiac-specific troponin levels are specific to heart muscles. Their levels are usually very low, and any increase indicates myocardial injury. Creatinine kinase (CK) is a protein found skeletal muscle, brain and nervous tissue, and the heart. CK-MB is heart specific and high levels of this protein are indicative of myocardial infarction. A high cholesterol level indicates an increased risk of cardiovascular diseases but is not suggestive of myocardial infarction. C-reactive protein is elevated during inflammation. Homocysteine levels may be elevated in people having a high risk of coronary artery disease.

The nurse is teaching the parent of an infant how to treat a hypercyanotic spell in the child after a crying episode. What does the nurse teach the mother? 1 Hold the infant in the knee-chest position 2 Place the infant in a semi-Fowler position 3 Administer oral fluids to prevent dehydration 4 Breastfeed the infant after he or she is calm

1 - Hold the infant in the knee-chest position Flexing the hips and knees decreases venous return to the heart from the legs. When venous return to the heart is decreased, the cardiac workload is decreased. The child may not be able to feed orally, so the nurse does not advise the mother to breastfeed the child. If the child is placed in a semi-Fowler position, it will not help to decrease the cardiac overload. Oral fluids are not administered to the child; instead the child is gavage fed.

The nurse assesses a patient with a family history of heart failure. Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. 1 Hypertension 2 Hyperthyroidism 3 Cardiomyopathy 4 Rheumatic heart disease 5 Coronary artery disease (CAD)

1 - Hypertension 3 - Cardiomyopathy 5 - Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include coronary artery disease, cardiomyopathy, and hypertension. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutation. Some of the precipitating causes of heart failure include anemia, hypothyroidism, and infection.

A patient's pulmonary artery is blocked and damaged. The nurse recalls that the first consequence of this condition will be what type of impaired blood flow? 1 Impaired flow of deoxygenated blood to the lungs 2 Impaired flow of oxygenated blood away from the lungs 3 Impaired flow of oxygenated blood from the aorta to all body parts 4 Impaired flow of deoxygenated blood from the right atrium to the right ventricle

1 - Impaired flow of deoxygenated blood to the lungs The pulmonary artery carries deoxygenated blood from the right ventricle of the heart to the lungs. Therefore damage to the pulmonary artery leads to impaired flow of deoxygenated blood from the right side of the heart initially (on its way to the lungs). Subsequently, it impairs the flow of oxygenated blood away from the lungs, and from the systemic aorta to all other body parts. The pulmonary artery does not carry deoxygenated blood from the right atrium to the right ventricle. Therefore damage to pulmonary artery does not affect blood flow between the right atrium and the ventricle.

How does the endothelium respond if a rupture occurs on the endothelial surface of an artery? 1 Initiates coagulation cascade 2 Promotes blood flow in the artery 3 Decreases viscosity of the blood in the artery 4 Decreases platelet aggregation at the ruptured site

1 - Initiates coagulation cascade The endothelium is the innermost layer of the arteries in the body. After damage to any part of the artery, it initiates cascade formation and aids in the formation of a fibrin clot to reduce the risk of bleeding. The endothelium promotes blood flow in the artery during normal conditions, but not after a rupture. The endothelium does not decrease the viscosity of the blood in the artery in either normal or damaged conditions. The endothelium increases platelet aggregation at the ruptured site to repair the ruptured part of the epithelial surface.

The nurse assessing a patient with mitral valve stenosis will likely find symptoms primarily associated with what cardiac change? 1 Reduced lung compliance 2 Inadequate filling of the right ventricle 3 Increased pressure in the left ventricle 4 Decreased pulmonary vascular pressure

1 - Reduced lung compliance The primary symptom of mitral stenosis is exertional dyspnea caused by a reduced lung compliance. Increased pulmonary vascular pressure results due to increased left atrial pressure and volume increase. Increased left ventricular pressure may be seen with aortic stenosis. Inadequate filling of the right ventricle may be due to atrial fibrillation or atrial flutter.

A patient with aortic valve stenosis is receiving nitroglycerin. What should the nurse include in the medication teaching? Select all that apply. 1 It can worsen chest pain. 2 It is given to treat angina. 3 It can cause hypotension. 4 It is given to control heart palpitations. 5 It is a drug of choice in mitral valve prolapse.

1 - It can worsen chest pain. 2 - It is given to treat angina. 3 - It can cause hypotension. Nitroglycerin is used with caution in patients with aortic valve stenosis to treat angina. This is because it can significantly reduce blood pressure and worsen chest pain due to a decrease in preload and a drop in blood pressure. The drug causes hypotension through dilation of blood vessels. It is not recommended in mitral valve prolapse because the chest pain in mitral valve prolapse does not respond to antianginal treatment. Also, nitroglycerin is not administered for controlling palpitations.

A patient is scheduled for a percutaneous transluminal balloon valvuloplasty. What information should the nurse provide to the patient before the procedure? Select all that apply. 1 It has few complications. 2 It requires a surgical incision. 3 It is performed in an operating room. 4 The procedure is difficult but has good results. 5 Long-term results are similar to surgical commissurotomy.

1 - It has few complications. 5 - Long-term results are similar to surgical commissurotomy. Percutaneous transluminal balloon valvuloplasty is an alternative treatment for patients with valvular disease. It is an easy procedure with few complications, because the approach for the procedure is transcutaneous; therefore, it is a minimally invasive procedure. The long-term results are similar to those of surgical commissurotomy with regard to the function of the repaired valve. The surgery is performed in a cardiac catheterization laboratory and not in an operating room. The procedure is not difficult and does not require a surgical incision.

Which statement is true regarding hypertrophic cardiomyopathy? 1 It involves impaired diastole. 2 Its only symptoms are dyspnea and fatigue. 3 It is associated with a thin and fragile ventricular wall. 4 It is characterized by moderate to severe cardiomegaly.

1 - It involves impaired diastole. Hypertrophic cardiomyopathy is asymmetric left ventricular hypertrophy without ventricular dilation. Impaired filling (diastole) is a main characteristic. It is associated with a thickened intraventricular septum and ventricular wall. Hypertrophic cardiomyopathy is characterized by exertional dyspnea, fatigue, angina, syncope, and palpitations; dyspnea and fatigue only occur in restrictive cardiomyopathy. Cardiomegaly is mild to moderate in hypertrophic cardiomyopathy.

The nurse provides information to a group of nursing students about cardiac output. What information should be included in the teaching? 1 It is calculated by multiplying the patient's stroke volume by the heart rate. 2 It is the average amount of blood ejected during one complete cardiac cycle. 3 It is determined by measuring the electrical activity of the heart and the patient's heart rate. 4 It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

1 - It is calculated by multiplying the patient's stroke volume by the heart rate. Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a one-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

The nurse is caring for a patient with Takotsubo cardiomyopathy. What information should the nurse provide to the patient about this disease? Select all that apply. 1 It is more common in menopausal women. 2 It causes permanent impairment of cardiac function. 3 The clinical findings are similar to acute coronary syndrome. 4 It does not reflect any changes in the electrocardiogram (ECG). 5 Cardiac angiography shows no significant coronary artery disease.

1 - It is more common in menopausal women. 3 - The clinical findings are similar to acute coronary syndrome. 5 - Cardiac angiography shows no significant coronary artery disease. Takotsubo cardiomyopathy is an acute stress-related syndrome. The clinical findings are the same as in acute coronary syndrome. It is commonly observed in menopausal women. Cardiac angiography shows no significant coronary artery disease. It is often accompanied by chest pain; the ST segment in the ECG is elevated, along with an increase in the cardiac enzyme levels. Normal cardiac function returns after days or weeks after supportive therapy.

The nurse provides information about side effects of digoxin to a nursing student. What should the nurse include? Select all that apply. 1 It may cause toxicity. 2 It increases the heart rate. 3 It may result in dysrhythmias. 4 It decreases myocardial contractility. 5 It increases the risk of thrombus formation.

1 - It may cause toxicity. 3 - It may result in dysrhythmias. In the case of a patient with myocarditis, the heart has increased sensitivity to dysrhythmias. Therefore digoxin should be used with caution. Myocarditis also predisposes the patient to digoxin toxicity. Digoxin reduces the heart rate and improves myocardial contractility. It is not associated with thrombus formation.

What techniques should the nurse use while assessing the heart sounds of a patient? Select all that apply. 1 Listen for friction rubs with the patient upright and leaning forward. 2 Use the diaphragm of the stethoscope to listen to S1 and S2 sounds. 3 Listen to S3 and S4 sounds (if present) with the bell of the stethoscope. 4 Ask the patient to lean forward to enhance the sounds at the mitral area. 5 Place the patient in a left side-lying position to detect sounds from the second intercostal space.

1 - Listen for friction rubs with the patient upright and leaning forward. 2 - Use the diaphragm of the stethoscope to listen to S1 and S2 sounds. 3 - Listen to S3 and S4 sounds (if present) with the bell of the stethoscope. The nurse listens to the S1 and S2 sounds with the diaphragm of the stethoscope because they are high pitched. S3 and S4 are extra heart sounds. If these sounds are present, then they can be detected with the bell of the stethoscope. The nurse instructs the patient to lean forward while sitting. This helps her to listen to the enhanced sounds from the second intercostal space. The nurse listens to friction rubs when the patient sits in an upright position and leans forward following expiration. The patient is positioned in a left side-lying position to enhance the sounds at the mitral area.

The nurse assesses a patient with cardiac problems. The nurse measures the circumference of the calves and finds that they are asymmetrical. What might this finding imply? Select all that apply. 1 Lymphedema 2 Hypertension 3 Varicose veins 4 Angina pectoris 5 Venous thromboembolism

1 - Lymphedema 3 - Varicose veins 5 - Venous thromboembolism There may be asymmetries in the circumference of two limbs in disorders like lymphedema, varicose veins, and thromboembolism. In these disorders, the affected limb is generally increased in circumference. Hypertension doesn't cause swelling of the limbs. Similarly, angina pectoris refers to pain in the chest and doesn't cause changes in the circumference of lower extremities.

The nurse is assessing a child before beginning the cardiac catheterization. What does the nurse include in the assessment? Select all that apply. 1 Marks the dorsalis pedis pulse 2 Evaluates the blood count result 3 Asks about any allergic reactions 4 Assesses for presence of any rashes 5 Assesses height and weight of the child

1 - Marks the dorsalis pedis pulse 3 - Asks about any allergic reactions 4 - Assesses for presence of any rashes 5 - Assesses height and weight of the child The nurse assesses the height and weight of the patient so that the correct catheter can be selected. The nurse asks about the history of allergic reactions to ensure that the child is not allergic to the iodine-based contrast agents used in the procedure. The nurse marks the dorsalis pedis pulse before the procedure for ease of assessing the pedal pulses after the procedure. The nurse also notes if there are any severe diaper rashes on the infant in case the femoral site is used. In that case the procedure is cancelled as it may raise the risk of catheterization procedure. The blood count result does not affect the cardiac catheterization procedure.

A patient is diagnosed with acute ischemic stroke. The patient is receiving IV antihypertensive drugs. Which interventions should the nurse perform for this patient? Select all that apply. 1 Measure hourly urine output. 2 Perform frequent neurologic checks. 3 Ambulate the patient with a 1-person assist. 4 Assess blood pressure (BP) and heart rate (HR) every 30 minutes. 5 Titrate drug according to mean arterial pressure (MAP) or BP as prescribed.

1 - Measure hourly urine output. 2 - Perform frequent neurologic checks. 5 - Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. Drugs should be titrated according to MAP or BP as prescribed. The nurse should measure hourly urine output to assess renal perfusion and should perform frequent neurologic checks. Antihypertensive IV drugs have a rapid onset of action; hence, BP and pulse should be assessed every two to three minutes using a noninvasive BP machine. The patient should be restricted to bed; severe cerebral ischemia or fainting may result if the patient tries to get up.

The nurse finds diastolic murmurs in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." What condition does the nurse suspect? 1 Mitral valve stenosis 2 Aortic valve stenosis 3 Mitral valve prolapse 4 Aortic valve regurgitation

1 - Mitral valve stenosis Coughing up of blood from the bronchi, larynx, or lungs is known as hemoptysis, and difficulty breathing is dyspnea. Hemoptysis, dyspnea, and diastolic murmurs indicate mitral valve stenosis. Aortic valve stenosis is characterized by angina, dyspnea, syncope, and left ventricular failure. Mitral valve prolapse is an abnormality of the mitral valve leaflets and the papillary muscles that involves dysrhythmias, ventricular tachycardia, palpitations, light-headedness, and dizziness. Aortic valve regurgitation is associated with abrupt dyspnea, chest pain, left ventricular failure, and cardiogenic shock.

The nurse teaches a caregiver about the plan of care for an elderly patient with orthostatic hypotension. Which action by the caregiver will be most beneficial to the patient? 1 Monitoring for the risk of falls 2 Encouraging laughter therapy 3 Encouraging treadmill exercises 4 Taking the patient out for recreation

1 - Monitoring for the risk of falls Orthostatic hypotension, or postural hypotension, is low blood pressure that occurs in patients when they stand up from sitting or lying down. Patients with orthostatic hypotension are at an increased risk of falls. Therefore the caregiver should monitor for falls in the patient. The caregiver can encourage laughter therapy and treadmill exercises, but these measures are not as beneficial as monitoring the patient for falls. The caregiver can take the patient out for recreation, but it is not as beneficial as monitoring the patient's risk of falls.

A patient's assessment findings include peripheral edema, distended neck veins, and lung crackles. What diagnosis does the nurse anticipate? 1 Myocarditis 2 Polyarthritis 3 Aortic valve stenosis 4 Rheumatic heart disease

1 - Myocarditis Peripheral edema (swollen limbs), jugular vein distention (distended neck veins), and crackling heart sounds indicate myocarditis. Polyarthritis is a manifestation of rheumatic fever, characterized by swelling, redness, tenderness of knees, ankles, elbows, and wrists. Aortic valve stenosis is characterized by angina, syncope, dyspnea, heart failure, and absence of S2. Rheumatic heart disease is a chronic condition that results from rheumatic fever; it is associated with scarring and deformity of the heart valves.

What is a noninfectious cause of pericarditis? 1 Myxedema 2 Lyme disease 3 Rheumatic fever 4 Ankylosing spondylitis

1 - Myxedema Myxedema is swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands; it is a noninfectious cause of pericarditis. Lyme disease is an infectious cause of pericarditis. Rheumatic fever and ankylosing spondylitis are hypersensitive or autoimmune causes of pericarditis.

The nurse suspects that a child has cardiac disease. What does the nurse include in the assessment? Select all that apply. 1 Nutritional status 2 Chest deformities 3 Clubbing of fingers 4 Blood glucose levels 5 Heart rate and rhythm

1 - Nutritional status 2 - Chest deformities 3 - Clubbing of fingers 5 - Heart rate and rhythm The nurse needs to assess for chest deformities because an enlarged heart can cause chest disfiguration. The nurse assesses the child's nutritional status, as weight loss is associated with heart disease. The nurse listens to the rate and rhythm of the heart that may indicate any deformity. The nurse should listen for fast (tachycardia) or slow (bradycardia) heart rates. The nurse should also listen for any irregularities in the rhythm of the heartbeat. The nurse assesses if there is clubbing of fingers, which may indicate cyanosis. Blood glucose levels are evaluated in patients with diabetes mellitus.

The nurse is providing postoperative care to a child after cardiac surgery. What does the nurse include in the child's plan of care? Select all that apply. 1 Obtain vital signs frequently 2 Monitor the heart rate and rhythm 3 Auscultate lung sounds once a day 4 Report decreased body temperature 5 Assess fluid and electrolyte balance

1 - Obtain vital signs frequently 2 - Monitor the heart rate and rhythm 5 - Assess fluid and electrolyte balance The nurse records vital signs frequently until they are stable. The nurse records the heart rate and rhythm to assess for any irregularities. The nurse monitors fluid and electrolyte status to prevent dehydration or fluid volume overload. The nurse auscultates lung sounds every hour and is alert for any diminished or absent sounds. This may indicate an area of atelectasis, a pleural effusion, or a pneumothorax. The nurse does not need to report about hypothermia as it is expected to happen immediately after the surgery. Instead, the nurse keeps the child warm to prevent additional heat loss.

A patient is diagnosed with left ventricular hypertrophy that resulted from untreated hypertension. The nurse should monitor the patient for symptoms of what condition? 1 Poor contractility 2 Less O2 requirement 3 Decreased ventricular irritability 4 Rich coronary arterial circulation

1 - Poor contractility Poor contractility is a complication seen in patients who have hypertrophy of the cardiac walls. The heart muscle, which undergoes hypertrophy, increases in muscle mass and cardiac wall thickness, due to overwork and strain. As a result, the hypertrophic heart muscle exhibits poor contractility over time. Hypertrophic heart muscle is more irritable and, thus, prone to dysrhythmias. A hypertrophic heart requires more oxygen (O2) to perform work. Because the tissue in a hypertrophic heart becomes ischemic more easily, there is poor coronary artery circulation.

The nurse is caring for a patient who has been diagnosed with rheumatic fever. Which criteria aid in confirming the diagnosis? Select all that apply. 1 Positive throat culture for group A streptococci 2 Presence of albuminuria 3 Presence of polyarthralgia 4 Decreased hemoglobin count 5 Presence of subcutaneous nodules

1 - Positive throat culture for group A streptococci 3 - Presence of polyarthralgia 5 - Presence of subcutaneous nodules Positive throat culture indicates evidence of group A streptococcal infection. Polyarthritis is also a common finding in rheumatic fever. Subcutaneous nodules are associated with severe carditis and are observed in patients with rheumatic fever. Albuminuria is a clinical sign of renal dysfunction and is not associated with rheumatic fever. Hemoglobin count may be unaffected in rheumatic fever.

Which factors affect the stroke volume of the blood? Select all that apply. 1 Preload 2 Afterload 3 Contractility 4 Cardiac index 5 Cardiac output

1 - Preload 2 - Afterload 3 - Contractility Increased or decreased preload, afterload, and contractility alter the stroke volume of the blood. Cardiac index and cardiac output are affected by stroke volume but do not affect the stroke volume of the blood.

A patient has been admitted with acute pericarditis. How should the nurse care for this patient? Select all that apply. 1 Provide an overbed table. 2 Tell the patient to avoid alcohol. 3 Administer antiinflammatory medications. 4 Discontinue use of proton pump inhibitors. 5 Keep the patient in a Trendelenberg position.

1 - Provide an overbed table. 2 - Tell the patient to avoid alcohol. 3 - Administer antiinflammatory medications. A sitting position with an overbed table helps in reducing the pain associated with acute pericarditis. The patient should be instructed to avoid alcohol to prevent gastrointestinal bleeding. Antiinflammatory medicines should be administered for pain relief. The patient should not be placed in a Trendelenberg position; instead, the head of the bed should be elevated to 45 degrees. A proton pump inhibitor may be given to reduce stomach acid.

The nurse is providing care to a child with Kawasaki disease. What does the nurse include in the child's plan of care? Select all that apply. 1 Provide frequent mouth care 2 Monitor fluid intake and output 3 Offer clear liquids and soft food 4 Provide stimulating musical toys 5 Monitor the child's cardiac status

1 - Provide frequent mouth care 2 - Monitor fluid intake and output 3 - Offer clear liquids and soft food 5 - Monitor the child's cardiac status The nurse monitors the child's fluid intake and output to prevent dehydration. Administering large volumes of intravenous immunoglobulin (IVIG) to the child may cause diminished left ventricular function. Therefore the nurse also monitors the cardiac status. The child may have oral mucosal inflammation; so the nurse offers clear liquids and soft food to prevent discomfort while eating. The nurse provides mouth care to treat mucosal inflammation by applying lubricating ointment to the child's lips. The nurse does not use musical toys or toys that make a lot of noise as the child is very irritable and needs a quiet environment.

A child with severe heart failure is being treated with furosemide (Lasix). What interventions does the nurse implement in the child's plan of care? Select all that apply. 1 Provide potassium-rich foods 2 Increase the child's fluid intake 3 Assess for signs of dehydration 4 Record output after administration 5 Administer cool humidified oxygen

1 - Provide potassium-rich foods 3 - Assess for signs of dehydration 4 - Record output after administration The nurse should record the urine output after giving the medication to prevent dehydration. The nurse should assess for signs of dehydration to determine the effectiveness of the medication. The nurse provides potassium-rich foods because furosemide (Lasix) is a loop diuretic and a major side effect is hypokalemia. The nurse does not increase the child's fluid intake as the medication is given to eliminate fluid. The nurse administers cool humidified oxygen to the child when the oxygen saturation result is decreased.

Which blood vessel carries oxygenated blood toward the heart from the lungs? 1 Pulmonary vein 2 Pulmonary artery 3 Inferior vena cava 4 Superior vena cava

1 - Pulmonary vein The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol. The nurse should withhold the dose and consult the prescribing health care provider for which vital sign taken just before administration? 1 Pulse 48 2 Respirations 24 3 Blood pressure 118/74 4 Oxygen saturation 93%

1 - Pulse 48 Because esmolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse-rate limits. Respirations, blood pressure, and oxygen saturation are not a source of concern in this case.

While assessing a patient with pericarditis, the nurse expects to observe what manifestation of the disorder? 1 Pulsus paradoxus 2 Clubbing of the fingers 3 Prolonged PR intervals 4 Widened pulse pressure

1 - Pulsus paradoxus Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every four hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree atrioventricular (AV) block. Widened pulse pressure occurs with valvular heart disease. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

The nurse assesses a patient with infective endocarditis and expects what clinical manifestations? Select all that apply. 1 Roth's spots 2 Osler's nodes 3 Aschoff's bodies 4 Janeway's lesions 5 Sydenham's chorea

1 - Roth's spots 2 - Osler's nodes 4 - Janeway's lesions Osler's nodes are painful, tender, red or purple, pea-sized lesions found on the fingertips or toes in patients with infective endocarditis. Janeway's lesions are flat, painless, small, red spots that may be seen on the palms and soles of patients with infective endocarditis. Roth's spots are also seen in patients with infective endocarditis during fundoscopic examination of retinal lesions. Aschoff's bodies are nodules that are formed in patients with rheumatic heart disease. Sydenham's chorea is a central nervous system manifestation of rheumatic fever.

The nurse is preparing a school-age child with a cardiac defect for heart surgery. What does the nurse include in the preoperative teaching? Select all that apply. 1 Show the child play areas in the facility 2 Describe new equipment that will be used 3 Teach how to manage pain after the surgery 4 Stay away from the intensive care unit (ICU) 5 Inform about what the child will see and feel

1 - Show the child play areas in the facility 2 - Describe new equipment that will be used 5 - Inform about what the child will see and feel The nurse informs the child about the play areas in the facility to alleviate the child's anxiety and focus on the pleasurable parts of the hospital stay. The nurse also describes the new equipment that is used for the procedure so that the child is not intimidated. The nurse also informs the child what the child will see and feel to diminish the child's fears. The nurse does not focus on the pain after the procedure, but distracts the child with imagery or storytelling. The nurse shows the ICU to the child before the procedure so that the child is not worried or anxious when transferred to that room.

A patient is admitted to the hospital for chest pain. The nurse expects that which diagnostic studies will be prescribed? Select all that apply. 1 Stress test 2 Chest x-ray 3 Funduscopy 4 Electrocardiogram 5 Electroencephalogram

1 - Stress test 2 - Chest x-ray 4 - Electrocardiogram A patient with chest pain undergoes tests to assess the cardiovascular status. A stress test shows the function of the heart under stress or exercise. A chest x-ray helps one to understand the status of structures in the chest and can assist in understanding any abnormality. An electrocardiogram helps one to understand electrical activity of the heart and is extremely important while assessing a patient with cardiac troubles. A funduscopy is done to examine the eyes and is not related to the cardiovascular system. An electroencephalogram is done to examine the brain and neurologic system.

The nurse is preparing a presentation related to complications of hypertension. Which information should the nurse include? Select all that apply. 1 Stroke as a result of atherosclerosis 2 Heart failure as a result of increased heart contractility 3 Blurring of vision or loss of vision secondary to retinal damage 4 Right ventricular hypertrophy as a result of increased workload 5 Coronary artery disease caused by an increase in the elasticity of arterial walls

1 - Stroke as a result of atherosclerosis 3 - Blurring of vision or loss of vision secondary to retinal damage Embolic stroke may be a result of cerebral blood flow obstruction by a portion of atherosclerotic plaque or a blood clot formed in the carotid arteries. Hypertension leads to retinal damage that is manifested by blurred vision or loss of vision and retinal hemorrhage. Heart failure is a result of decreased heart contractility along with decreased stroke volume and cardiac output. Hypertension leads to increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of arterial walls and narrowing of the lumen.

A patient is diagnosed with heart failure. The nurse identifies that which factors may influence the patient's cardiac output? Select all that apply. 1 Stroke volume 2 Portal pressure 3 Respiratory rate 4 Myocardial contractility 5 Decreased filling of the ventricles

1 - Stroke volume 4 - Myocardial contractility 5 - Decreased filling of the ventricles Cardiac output depends on various factors such as stroke volume, decreased filling of the ventricles, and myocardial contractility. Stroke volume x heart rate = cardiac output (CO). Decreased filling of the ventricles decreases cardiac output. Impaired myocardial contractility decreases cardiac output. Respiratory rate and portal pressure do not alter cardiac output.

Which nursing interventions does the nurse include while suctioning a child after endotracheal extubation? Select all that apply. 1 Suctioning is limited to 5 seconds at a time. 2 Administer oxygen before and after suctioning. 3 Monitor the heart rate before and after suctioning. 4 The child should face the nurse during suctioning. 5 Ensure suctioning is completed every three hours.

1 - Suctioning is limited to 5 seconds at a time. 2 - Administer oxygen before and after suctioning. 3 - Monitor the heart rate before and after suctioning. 4 - The child should face the nurse during suctioning. The nurse suctions the child for no longer than 5 seconds to prevent depleting the oxygen supply. The nurse administers oxygen before and after suctioning to prevent hypoxia. The nurse faces the child while suctioning to assess the child's color and tolerance of the procedure. The nurse monitors the heart rate before and after suctioning to detect changes in the heart rhythm or rate. The nurse performs suctioning only when needed, to prevent vagal stimulation.

A patient undergoes routine blood pressure (BP) monitoring. What actions should the nurse take when obtaining the BP measurement? Select all that apply. 1 Support the patient's arm at heart level. 2 Deflate the cuff at a rate of 5-10 mm Hg/sec. 3 Average two or more readings, taken at intervals of at least 1 minute. 4 Ensure the patient has not exercised within 30 minutes before measurement. 5 Take the measurement immediately after placing the patient in the seated position.

1 - Support the patient's arm at heart level. 3 - Average two or more readings, taken at intervals of at least 1 minute. 4 - Ensure the patient has not exercised within 30 minutes before measurement. The nurse should ensure that the patient has not exercised, smoked, or ingested caffeine within 30 minutes before measurement. The patient's arm should be supported at heart level. The nurse should average two or more readings (taken at intervals of at least 1 minute). The nurse should obtain additional readings if the first two readings differ by more than 5 mm Hg. The radial pulse is palpated for auscultatory measurement. The nurse should begin measurement only after the patient has rested patiently for 5 minutes after sitting. The cuff should be deflated at a rate of 2 to 3 mm Hg/sec.

Diagnostic results of a patient reveal an ejection fraction (EF) of 32%. The nurse recognizes that the finding may be indicative of what conditions? Select all that apply. 1 Systolic failure 2 Diastolic failure 3 Myocardial infarction 4 Coronary heart disease 5 Mixed systolic and diastolic failure

1 - Systolic failure 5 - Mixed systolic and diastolic failure Ejection factor (EF) is defined as the amount of blood ejected from the left ventricle after each contraction. Normal EF is 55-60%. The hallmark of systolic failure is a decrease in EF (less than 45%). Patients with mixed systolic and diastolic failure have extremely low EF (less than 35%). The EF in diastolic failure is normal. Myocardial infarction is the damage to the heart muscle due to decreased blood flow and oxygen supply, which may or may not result in low EF. Coronary heart disease, if not severe, may not affect the EF.

Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults? Select all that apply. 1 Systolic murmur 2 Diminished pedal pulses 3 Decreased cardiac reserve 4 Increased maximal heart rate 5 Increased recovery time from activity

1 - Systolic murmur 2 - Diminished pedal pulses 3 - Decreased cardiac reserve 5 - Increased recovery time from activity Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease with age related to cellular aging and fibrosis of the conduction system. The aging patient experiences decreased cardiac reserve as a result of myocardial hypertrophy, increased collagen and scarring, and decreased elastin.

When assessing the cardiovascular system of an 83-year-old patient, what symptoms should the nurse expect to find? Select all that apply. 1 Systolic murmur 2 Diminished pedal pulses 3 A narrowed pulse pressure 4 Increased systolic blood pressure 5 Difficulty in isolating the apical pulse

1 - Systolic murmur 2 - Diminished pedal pulses 4 - Increased systolic blood pressure 5 - Difficulty in isolating the apical pulse Gerontologic differences in the assessment of the cardiovascular system include the presence of a systolic murmur, diminished pedal pulses, increased systolic blood pressure, and difficulty in isolating the apical pulse. The pulse pressure may be widened, not narrowed.

A patient presents to the emergency department with acute decompensated heart failure (ADHF) and indications of alveolar edema. The nurse expects what assessment findings? Select all that apply. 1 Tachypnea 2 Lower PaO2 3 Increased glucose levels 4 Changes in metabolic status 5 Increased partial pressure of CO2 in arterial blood (PaCO2)

1 - Tachypnea 2 - Lower PaO2 5 - Increased partial pressure of CO2 in arterial blood (PaCO2) When the pulmonary venous pressure increases, the alveoli lining cells are disrupted and a fluid containing red blood cells moves into the alveoli (alveolar edema). As the disruption becomes worse from further increases in the pulmonary venous pressure, the alveoli and airways are flooded with fluid. This is accompanied by a worsening of the arterial blood gases (i.e., lower PaO2 and possible increased partial pressure of CO2 in arterial blood and progressive respiratory alkalosis). Abnormalities in the glucose levels and metabolic status of the patient do not indicate alveolar edema.

A patient arrives at a medical clinic for a routine physical exam. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits, and there is no previous history of elevated blood pressure. The nurse suspects that the falsely high blood pressure was caused by what? 1 The blood pressure cuff was too small. 2 There is atherosclerosis present in the subclavian artery. 3 The patient smoked the day before the BP measurement. 4 The patient engaged in strenuous exercises the day before the BP measurement.

1 - The blood pressure cuff was too small. BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small, as it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement, because they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings.

During a physical examination of a patient with cardiovascular disease, the nurse auscultates murmurs. How should the nurse interpret the finding? 1 The cardiac valves are affected. 2 The patient has high blood pressure. 3 The patient has pericardial friction rub. 4 There is a decreased compliance of ventricles during filling.

1 - The cardiac valves are affected. Murmurs are heard when the blood flow is turbulent due to dysfunctional valves. The valves may get affected due to accumulation of lipids, degeneration of collagen, and fibrosis. A decreased compliance of ventricles during filling would result in the S4 heart sound. A pericardial friction rub is usually heard as a high-pitched, scratchy sound. High blood pressure does not cause murmurs.

The health care provider has prescribed echocardiography for a child to detect cardiac dysfunction. What does the nurse teach about the procedure to the parents? Select all that apply. 1 The child needs to be still during the test. 2 The procedure is noninvasive and painless. 3 The procedure may have some side effects. 4 The procedure may be stressful for the child. 5 Sound waves are used to produce an image of the heart.

1 - The child needs to be still during the test. 2 - The procedure is noninvasive and painless. 4 - The procedure may be stressful for the child. 5 - Sound waves are used to produce an image of the heart. The nurse informs the parents how the procedure is performed. The nurse explains that ultra-high-frequency sound waves are used in the procedure to produce the image of the heart. The nurse informs that the procedure is noninvasive and painless and so the child will be comfortable. The nurse informs that the child will be required to be still during the test to prevent diagnostic errors. The procedure is stressful for the child as the child needs to be still and cannot move. The procedure does not have any side effects.

A multiple gated acquisition (MUGA) scan has been prescribed to a patient with cardiac problems to determine what? 1 The patient's ejection fraction (EF) 2 The presence of conduction disturbances 3 The effectiveness of dilated cardiomyopathy 4 The presence of infectious organisms in the heart tissue

1 - The patient's ejection fraction (EF) A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20 percent is associated with a 50 percent mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy.

A patient with suspected infective endocarditis (IE) is scheduled for cardiac catheterization. The nurse recognizes that the purpose of the test for this patient is what? 1 To evaluate valve function 2 To detect the presence of murmurs 3 To check for the presence of infection 4 To check for the presence of vegetations

1 - To evaluate valve function Valve dysfunction is a common pathologic feature associated with infective endocarditis. Cardiac catheterization is an investigation required to evaluate the functioning of the heart valves. Echocardiography is an investigation used to detect the presence of vegetations. Blood cultures are done to determine the presence of an infection that can cause endocarditis. The presence of murmurs can be detected through auscultation.

The nurse is preparing to give digoxin to a 9-month-old infant. The nurse checks the dose and draws up 4 mL of the drug. What is the most appropriate nursing action? 1 To not give the dose; suspect dosage error 2 To mix the dose with juice to disguise its taste 3 To check heart rate; administer the dose by placing it to the back and side of the mouth 4 To check heart rate; administer the dose by letting the infant suck it through a nipple

1 - To not give the dose; suspect dosage error Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Some institutions require that digoxin dosages be confirmed by another professional before administration. The nurse has drawn up too much medication. Checking heart rate, administering the dose by placing it to the back and side of the mouth, or by letting the infant suck it through a nipple are correct procedures, but too much medication has been prepared.

A patient is diagnosed with primary hypertension. The nurse reviews the patient's history and identifies which factors that contributed to the development of the hypertension? Select all that apply. 1 Tobacco use 2 Thyroid disease 3 Diabetes mellitus 4 Increased sodium intake 5 Greater-than-ideal body weight 6 Underproduction of sodium-retaining hormones

1 - Tobacco use 3 - Diabetes mellitus 4 - Increased sodium intake 5 - Greater-than-ideal body weight Contributing factors to primary hypertension include increased sympathetic nervous system (SNS) activity, overproduction (not underproduction) of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater-than-ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption. Thyroid disease is related to secondary hypertension.

A patient that has been taking clonidine for ten years tells the nurse, "I decided to quit taking the medication a few days ago." The nurse should monitor the patient for which indication of withdrawal syndrome? 1 Tremors 2 Lethargy 3 Dysphasia 4 Bradycardia

1 - Tremors Sudden discontinuation may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, and sweating, Bradycardia, lethargy, and dysphasia are not indicators of withdrawal syndrome.

Which type of valvular heart disease occurs almost exclusively in patients that abuse drugs intravenously? 1 Tricuspid stenosis 2 Pulmonic stenosis 3 Aortic valve stenosis 4 Mitral valve stenosis

1 - Tricuspid stenosis Tricuspid stenosis is the disease of the tricuspid valve that occurs in patients who abuse drugs intravenously or who have had rheumatic fever. Pulmonic stenosis is congenital. Aortic valve stenosis occurs due to rheumatic fever. Mitral valve stenosis occurs due to rheumatic heart disease.

A patient presents to the emergency department reporting chest pain. The nurse recalls that what component of the patient's blood work is most clearly indicative of an acute myocardial infarction (MI)? 1 Troponin 2 Myoglobin 3 Creatine kinase (CK) 4 C-reactive protein (CRP)

1 - Troponin Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.

The nurse is caring for the patient with cardiac disease. The nurse expects that which blood studies will be prescribed? Select all that apply. 1 Troponin 2 Homocysteine 3 C-reactive protein 4 Blood urea nitrogen 5 Thyroid stimulating hormone

1 - Troponin 2 - Homocysteine 3 - C-reactive protein Troponin, homocysteine, and C-reactive protein are laboratory tests that may help provide clues to cardiovascular health and possible indicators for cardiac disease. Thyroid stimulating hormone evaluates the thyroid, and blood urea nitrogen evaluates the kidney function; these may not be pertinent initially to a focused cardiovascular assessment.

The nurse is assessing a child with hypertension. Which tests will the nurse evaluate for the effects of hypertension? Select all that apply. 1 Urinalysis 2 Thyroid tests 3 Echocardiogram 4 Complete blood count 5 Renal ultrasonography

1 - Urinalysis 3 - Echocardiogram 4 - Complete blood count 5 - Renal ultrasonography A urinalysis is done to assess the kidney function and also to check for the presence of diabetes in a child with hypertension. A complete blood count helps to assess the level of the red blood cells, white blood cells, and platelets. Renal ultrasonography is evaluated to assess the kidney size and its function. An echocardiogram is done to evaluate the presence of end-organ involvement such as left ventricular hypertrophy. Thyroid tests are done when cholesterol levels in the blood are elevated.

The nurse is caring for an infant with the diagnosis of heart failure. What should the nurse include in the infant's plan of care to ensure adequate nutrition? Select all that apply. 1 Uses a soft preemie nipple for feeding 2 Feeds the infant soon after awakening 3 Positions the infant in an upright position 4 Ensures the infant is well rested before feeding 5 Strokes jaws and cheeks to encourage sucking

1 - Uses a soft preemie nipple for feeding 2 - Feeds the infant soon after awakening 4 - Ensures the infant is well rested before feeding 5 - Strokes jaws and cheeks to encourage sucking The infant is fed soon after awakening so that the infant does not expend energy by crying. The nurse ensures that the infant is well rested before feeding, which enables the infant to increase their volume of feeding. The soft preemie nipple is used to enable the infant to suck easily. The infant's jaws and cheeks are stroked so that the infant continues sucking and completes the feeding. The infant is placed in a semi-upright position for comfortable feeding.

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO)? Select all that apply. 1 Ventricular dilation 2 Ventricular hypertrophy 3 Production of endothelin 4 Release of renin by the kidneys 5 Activation of the sympathetic nervous system (SNS)

1 - Ventricular dilation 2 - Ventricular hypertrophy 5 - Activation of the sympathetic nervous system (SNS) Increased contraction due to dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart's muscle fibers due to hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in HR and myocardial contractility. Initially, this compensatory mechanism is beneficial with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of HF. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already overloaded state

While assessing an elderly patient with arterial stiffening, the nurse finds the presence of inflamed, painful, cordlike varicosities. Which other finding is the nurse likely to observe? 1 Widened pulse pressure 2 Decreased venous tortuosity 3 Decreased systolic blood pressure 4 Thinning of the intima of the arteries

1 - Widened pulse pressure Arterial stiffening in the elderly patient results in loss of arterial compliance and increases pulse wave velocity, resulting in widened pulse pressure. Arterial stiffening is due to loss of elastin in arterial walls and subsequent thickening of the intima of the arteries. The presence of inflamed, painful, or cordlike varicosities indicates increased venous tortuosity. Arterial stiffening can result in increased systolic blood pressure.

The nurse is assessing a patient for pericardial friction rub related to myocarditis. The nurse should perform the steps of the assessment in what order? 1. Place the stethoscope at the lower left sternal border of the chest. 2. Assist the patient to lean forward. 3. Repeat several times. 4. Ask the patient to hold his or her breath.

1. - Assist the patient to lean forward. 2. - Place the stethoscope at the lower left sternal border of the chest. 3. - Ask the patient to hold his or her breath. 4. - Repeat several times. The nurse helps the patient to lean forward, and the stethoscope is placed at the lower left sternal border of the chest. The patient should be asked to hold his or her breath to distinguish a pericardial friction rub from a pleural friction rub. The process may be repeated several times to identify pericardial friction rub because pericardial friction rubs are often intermittent and short lived.

The nurse reviews compensatory mechanisms associated with heart failure (HF). The nurse recalls that the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur in what order? 1. Renin is released. 2. Cardiac output falls. 3. Vasoconstriction occurs. 4. Angiotensinogen is activated. 5. Angiotensin I is converted to angiotensin II.

1. - Cardiac output falls. 2. - Renin is released. 3. - Angiotensinogen is activated. 4. - Angiotensin I is converted to angiotensin II. 5. - Vasoconstriction occurs. In the RAAS, decreased cardiac output leads to release of renin from the kidneys. Renin causes activation of angiotensinogen, which is the enzyme that changes angiotensin I into angiotensin II, which is a potent vasoconstrictor.

A patient is hospitalized with heart failure and severe anemia. The nurse suspects that the anemia led to heart failure and recalls that the associated anemic events occur in what order? 1. Increase in cardiac output 2. Increase in size of left ventricle 3. Decrease in oxygen-carrying capacity of blood 4. Increase in cardiac workload

1. - Decrease in oxygen-carrying capacity of blood 2. - Increase in cardiac output 3. - Increase in cardiac workload 4. - Increase in size of left ventricle When a patient has severe, chronic anemia, a decrease in the oxygen carrying capacity of the blood stimulates an increase in cardiac output. This increase in cardiac output causes an increase in cardiac workload, resulting in hypertrophy of the left ventricle.

What is the order of the events in which the blood flows through the heart? 1. To the left atrium through the pulmonary veins 2. Through the mitral valve and into the left ventricle 3. Through the tricuspid valve into the right ventricle 4. Through the pulmonic valve into the pulmonary artery and to the lungs 5. Through the aortic valve into the aorta and then into the systemic circulation 6. From the inferior and superior venae cavae and the coronary sinus into the right atrium

1. - From the inferior and superior venae cavae and the coronary sinus into the right atrium 2. - Through the tricuspid valve into the right ventricle 3. - Through the pulmonic valve into the pulmonary artery and to the lungs 4. - To the left atrium through the pulmonary veins 5. - Through the mitral valve and into the left ventricle 6. - Through the aortic valve into the aorta and then into the systemic circulation First, the deoxygenated blood from the inferior and superior venae cavae and the coronary sinus enters the right atrium. Then the blood flows through the tricuspid valve and enters the right ventricle. From the right ventricle, blood flows through the pulmonic valve into the pulmonary artery and to the lungs. Then the oxygenated blood enters into the left atrium through the pulmonary veins. After flowing through the mitral value of the left atrium, the blood enters the left ventricle. From the left ventricle, the blood is ejected through the aortic valve into the aorta and then into the systemic circulation.

The nurse reviews the compensatory mechanisms an overloaded heart uses to try to maintain adequate cardiac output (CO). What is the order of events that occur when the sympathetic nervous system is activated? 1. Increase in cardiac output 2. Inadequate cardiac output 3. Release of catecholamines 4. Increase in peripheral vasoconstriction

1. - Inadequate cardiac output 2. - Release of catecholamines 3. - Increase in peripheral vasoconstriction 4. - Increase in cardiac output The compensatory mechanism is activated when the CO is inadequate, which results in the increased release of catecholamines. Increased catecholamines cause constriction of the blood vessels, which causes preload of the heart to increase. Eventually, the cardiac output is increased.

A patient is diagnosed with early left ventricular heart failure (HF). The nurse recalls that the changes involved in the development of dyspnea associated with the failure occur in what order? 1. Inadequate alveolar gas exchange 2. Ineffective ventricular contractility 3. Elevated pressure in the left atrium 4. Fluid leaking into interstitial spaces

1. - Ineffective ventricular contractility 2. - Elevated pressure in the left atrium 4. - Fluid leaking into interstitial spaces 3. - Inadequate alveolar gas exchange In left ventricular HF, ineffective ventricular contractions impair the normal forward flow of blood to the body. As a result, fluid returning to the heart from the lungs backs up in the heart and increases the pressure in the left atrium. If contractility continues to falter, the blood continues to back up into the pulmonary vasculature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs. This abnormal fluid in the parenchyma and alveoli impairs gas exchange, which causes dyspnea.

An elderly patient often experiences sudden dizziness when standing. The nurse should perform the steps of an assessment for orthostatic hypotension in what order? 1. Assist the patient to a sitting position with legs dangling. 2. Assist the patient to stand and measure blood pressure (BP) and heart rate (HR) within one to two minutes. 3. Measure blood pressure (BP) and heart rate (HR) in supine position after two to three minutes of rest. 4. Measure blood pressure (BP) and heart rate (HR) again within one to two minutes after sitting. 5. Evaluate the findings.

1. - Measure blood pressure (BP) and heart rate (HR) in supine position after two to three minutes of rest. 2. - Assist the patient to a sitting position with legs dangling. 3. - Measure blood pressure (BP) and heart rate (HR) again within one to two minutes after sitting. 4. - Assist the patient to stand and measure blood pressure (BP) and heart rate (HR) within one to two minutes. 5. - Evaluate the findings. When assessing a patient for orthostatic or postural changes in BP and pulse, the nurse initially measures BP in supine position after two to three minutes of rest. BP and pulse are then measured one to two minutes after assisting the patient to a sitting position with legs dangling. Next, BP and pulse are assessed in the standing position after standing for one to two minutes. Finally, the findings should be evaluated to determine if orthostatic hypotension exists.

A patient is scheduled for cardiac catheterization. What does the nurse provide to the patient as the primary rationale for the procedure? 1 Bypassing obstructed vessels 2 Assessing the presence of arterial blockages 3 Opening and dilating blocked coronary arteries 4 Assessing the need for antianginal medications

2 - Assessing the presence of arterial blockages Cardiac catheterization is performed to assess the extent and severity of coronary artery blockage. The results of a cardiac catheterization will facilitate decisions regarding the need for medical management, angioplasty, or coronary artery bypass surgery.

A patient's stroke volume is 0.074 L, and the heart rate is 74 beats/minute. The systemic vascular resistance is 19 mm Hg/min/L. What value of blood pressure (BP) should the nurse enter in the patient's medical record? Record the answer using a whole number. ___________ mm Hg

104 The blood pressure (BP) is manually calculated by multiplying the cardiac output with systemic vascular resistance. Cardiac output is obtained by multiplying the stroke volume with the heart rate. Therefore the patient's cardiac output is 0.074 × 74 = 5.476, and blood pressure is 5.476 × 19 = 104 mm Hg.

While assessing a patient for orthopnea, what is an appropriate question for the nurse to ask? 1 "How many times do you get up at night to urinate?" 2 "How many pillows do you use for sleeping at night?" 3 "Do you get awakened by shortness of breath at night?" 4 "Are you comfortable while walking as well as talking at the same time?"

2 - "How many pillows do you use for sleeping at night?" Patients with heart failure often experience orthopnea. This refers to a condition in which patients may feel the need to sleep with their head elevated and use several pillows to sleep upright. When assessing a patient for nocturia, the nurse asks how frequently the patient gets up at night to urinate. When assessing the patient for paroxysmal nocturnal dyspnea, the nurse asks if the patient wakes up at night due to shortness of breath at night. When checking for shortness of breath during daily activities, the nurse asks the patient whether the patient is comfortable while walking and talking at the same time.

The nurse provides discharge teaching for a patient with a diagnosis of subacute infective endocarditis. Which statement made by the patient indicates the need for further teaching? 1 "I will make sure to plan rest periods during any of my activities." 2 "I will receive a prescription for antibiotics that I will take by mouth." 3 "Fatigue, malaise, or chills might indicate a recurrence of the infection." 4 "Before I schedule a dentist appointment, I will tell my health care provider."

2 - "I will receive a prescription for antibiotics that I will take by mouth." Intravenous, not oral, antibiotic therapy is the prescribed treatment for subacute infective endocarditis. Rest periods during activities will decrease the cardiac workload. Fatigue, malaise, or chills are signs and symptoms that may indicate recurrent infection. Prophylactic antibiotic therapy is needed before dental procedures to reduce the risk of recurrent infective endocarditis.

The nurse detects a heart murmur in a patient and suspects what condition? 1 Stiffened arteries 2 A damaged mitral valve 3 Varicosities in the large veins 4 Dependent edema in the veins

2 - A damaged mitral valve The turbulent flow of blood across the mitral and aortic valves affected by lipid accumulation can result in a heart murmur. A heart murmur does not indicate stiffened arteries; instead, thickened intima of the arteries indicates arterial stiffening. A heart murmur does not indicate varicosities in the veins; instead, increased venous tortuosity and dependent edema indicates the presence of varicose veins.

The nurse is teaching the parent of a child with hypercholesterolemia how to reduce serum cholesterol. What does the nurse include in the teaching? Select all that apply. 1 "Incorporate the child's favorite food in the diet once in a while." 2 "Include an hour of aerobic exercise in the child's daily routine." 3 "You need to cook the child's food in either olive oil or canola oil." 4 "Increase intake of whole grains, fruits, and vegetables in the diet." 5 "Make sure nobody smokes in the house when the child is around."

2 - "Include an hour of aerobic exercise in the child's daily routine." 3 - "You need to cook the child's food in either olive oil or canola oil." 4 - "Increase intake of whole grains, fruits, and vegetables in the diet." 5 - "Make sure nobody smokes in the house when the child is around." The nurse advises the parent to increase whole grains, fruits, and vegetables in the diet as they are low in saturated fats. Olive oil and canola oil are monounsaturated fats that have beneficial effects on high-density lipoprotein (HDL) cholesterol values. The nurse advises aerobic exercise 60 minutes a day 5 days a week as it helps to lower cholesterol levels. Toxins from cigarettes contribute to heart disease, so the nurse advises the parent to not smoke when the child is around. The child needs to follow a strict diet; any excess fat in the preferred food can increase the cholesterol levels.

A patient with a myocardial infarction is preparing for discharge, following successful treatment. What is important for the nurse to include in the discharge teaching related to elimination? 1 "A goal is to have a bowel movement only once a day." 2 "It is important to avoid straining during bowel movements." 3 "A goal is to not have bowel movements immediately after eating." 4 "It will be necessary to take a medication daily to regulate the bowels."

2 - "It is important to avoid straining during bowel movements." It is extremely important that the patient doesn't strain during bowel movement. Straining during bowel movement puts pressure on the heart for circulation of blood. This can aggravate heart troubles. Passing stools after food and passing stools more than once a day are absolutely fine and do not affect the patient. Advising the patient to take unsupervised over-the-counter (OTC) drugs is not advisable, because they can be detrimental to the patient's health.

The patient reports being confused about how there can be a blockage in the left anterior descending artery (LAD) although there is damage to the right ventricle. What explanation should the nurse give? 1 "The one vessel curves around from the left side to the right ventricle." 2 "The LAD supplies blood to the left side of the heart and part of the right ventricle." 3 "The right ventricle is supplied during systole primarily by the right coronary artery." 4 "It is actually on your right side of the heart but we call it the left anterior descending vessel."

2 - "The LAD supplies blood to the left side of the heart and part of the right ventricle." The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.

The nurse is assessing an infant for possible heart disease. What questions does the nurse include in the assessment while speaking to the mother? Select all that apply. 1 "How often do you breastfeed your child?" 2 "What chronic health conditions do you have?" 3 "What was the infant's weight at the time of birth?" 4 "Does anybody in the family have heart disease?" 5 "How often did you consume alcohol when pregnant?"

2 - "What chronic health conditions do you have?" 3 - "What was the infant's weight at the time of birth?" 4 - "Does anybody in the family have heart disease?" 5 - "How often did you consume alcohol when pregnant?" Mothers with chronic health conditions such as diabetes are likely to have infants with heart disease, so the nurse asks the mother about it. The nurse also asks about maternal alcohol and illicit drug use during pregnancy as it increases the risk of heart disease in infants. Infants with very high birth weight or low birth weight are also likely to have heart disease. Incidence of heart disease is high in infants who have a sibling or another family member with the same disease. Breastfeeding is not related to heart disease.

A patient with cardiovascular disease is scheduled for a triglyceride test. What is appropriate for the nurse to include in the preprocedural instructions? Select all that apply. 1 "Avoid tobacco use for 24 hours before the test." 2 "You are permitted to drink water before the test." 3 "Avoid consuming alcohol for 24 hours before the test." 4 "You are permitted to eat a light breakfast before the test." 5 "Retain as much urine in your bladder as possible before the test."

2 - "You are permitted to drink water before the test." 3 - "Avoid consuming alcohol for 24 hours before the test." A triglyceride test should be performed in a fasting state, but the patient can drink water. Alcohol consumption will raise the triglyceride blood levels by producing more fatty acids from the liver. Therefore the nurse should instruct the patient to drink water and to withhold alcohol for 24 hours before the test. Voiding will not affect the triglyceride levels in the blood. Tobacco should be withheld for 24 hours before positron emission tomography (PET). The test should be performed on the patient in a fasting state for 12 hours, and the patient should avoid milk or food except water.

While palpating the arteries of a patient with cardiovascular disease, the nurse rates the force of the pulse as weak. How should the nurse document the assessment finding? 1 0 2 1+ 3 2+ 4 3+

2 - 1+ A weak pulse in a patient with cardiovascular disease is indicated by 1+. Absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse.

A patient with hypertension receives a prescription for metoprolol 37.5 mg. The pharmacy provides 25-mg tablets. How many tablets should the nurse administer? 1 1 tablet 2 1.5 tablets 3 2 tablets 4 2.5 tablets

2 - 1.5 tablets Using ratio and proportion, multiply 25 by x and multiply 37.5 × 1 to yield 25x = 37. Divide 37.5 by 25 to yield 1.5 tablets.

The nurse reviews a list of potential candidates for valve replacement surgery. When considering the two types of prosthetic valves available, the nurse identifies that which patients are more likely to receive a biologic valve? Select all that apply. 1 A 20-year-old man 2 A 67-year-old man 3 A 35-year-old man 4 A 12-year-old boy 5 A 32-year-old woman

2 - A 67-year-old man 5 - A 32-year-old woman The 32-year-old woman is of childbearing age and cannot take anticoagulant therapy, which is required after mechanical valve replacement. Taking long-term anticoagulant therapy may increase the risk of bleeding during future pregnancies; therefore, she would be considered for a biologic valve. Biologic valves are less durable than mechanical valves. In a 67-year-old man, durability is less important than the side effects of anticoagulant therapy, such as the risk of bleeding from anticoagulants. Hence, a biologic valve is preferred. A 20-year-old boy, 35-year-old man, and 12-year-old boy are all younger patients; hence, a mechanical valve is best for them because of its durability.

When taking care of a patient with a probable diagnosis of acute coronary syndrome (ACS), the nurse expects what finding when assessing objective data? 1 Acute heart palpitations 2 A rise in troponin levels 3 Shortness of breath, especially at rest 4 Decreased levels of C-reactive protein (CRP)

2 - A rise in troponin levels Biomarkers are useful in the diagnosis of acute coronary syndrome (ACS), and troponin is the biomarker of choice. Acute heart palpitations and shortness of breath are subjective data used in the assessment of probable diagnosis of ACS. C-reactive protein (CRP) has been linked with the presence of atherosclerosis and prediction of future heart event risks in patients with myocardial infarction (MI).

The nurse assesses a patient with valvular heart disease. The nurse recalls that the absence of what heart sound is indicative of aortic valve stenosis? 1 Absence of S1 2 Absence of S2 3 Absence of S3 4 Absence of S4

2 - Absence of S2 Aortic stenosis occurs as the result of rheumatic fever and is characterized by a diminished or absent S2. A diminished or absent S1, S3, or S4 is associated with aortic valve regurgitation.

A patient reports severe chest pain radiating to the neck and arms. Assessment findings include a scratching, grating, and high-pitched sound at the lower sternal border of the chest. The nurse recognizes the presence of the hallmark finding of what condition? 1 Subacute nodules 2 Acute pericarditis 3 Rheumatic endocarditis 4 Chronic rheumatic carditis

2 - Acute pericarditis Severe chest pain radiating to the neck, arms, and shoulders indicates acute pericarditis. Pericardial friction rub is scratching, grating, and high-pitched sound heard at the lower sternal border of the chest; this condition is associated with patients who have acute endocarditis. Subacute nodules are small, firm, painless, and hard swellings over the knees, elbows, and wrists associated with rheumatic fever. Rheumatic endocarditis and chronic rheumatic carditis are complications associated with rheumatic fever.

Which intervention can the nurse implement in order to increase calories for an infant with heart failure? 1 Feed the infant an hour after rest 2 Add corn oil to the infant's formula 3 Provide a feeding every two hours 4 Have the mother breastfeed the child

2 - Add corn oil to the infant's formula The nurse boosts the infant's nutrition by increasing the caloric content of the formula. This can be done by adding corn oil to the formula. This ensures that the child gets more calories from a smaller volume of intake. The nurse feeds the infant immediately after rest to prevent expending the infant's energy on crying. The nurse asks the mother to alternate breastfeeding with high-calorie formulas to increase the child's nutrition. Feeding the infant every two hours does not provide adequate rest in between feedings for the infant and, in turn, decreases the child's food intake.

A wheelchair-bound patient is scheduled for a multigated acquisition (MUGA) scan to aid in the diagnosis of coronary artery disease (CAD). The nurse most expects which revisions in the test procedure will be made? 1 Vital signs will be monitored more frequently. 2 Adenosine will be administered intravenously (IV). 3 The degree of incline on the treadmill will be lower. 4 A 12-lead electrocardiogram (ECG) will be performed.

2 - Adenosine will be administered intravenously (IV). A multigated acquisition (MUGA) scan is a common nuclear imaging test for heart wall motion during systole and diastole. Because the patient is unable to exercise, IV adenosine (Adenocard) will be given to dilate the coronary arteries and simulate the effect of exercise. The nurse will monitor vital signs, but this is not the priority action at this time. A 12-lead ECG will not be performed at this time. The patient will not be prepared for the treadmill, because he or she is unable to exercise.

A patient with pericardial effusion has acute cardiac tamponade. The nurse is preparing the patient for a scheduled pericardiocentesis. What is appropriate to be included in the patient's plan of care? Select all that apply. 1 Maintain NPO status. 2 Administer dopamine. 3 Administer volume expanders. 4 Discontinue all anticoagulant drugs. 5 Explain that the procedure is noninvasive.

2 - Administer dopamine. 3 - Administer volume expanders. 4 - Discontinue all anticoagulant drugs. It is important to administer volume expanders and ionotropic agents, like dopamine, to provide hemodynamic support. Anticoagulant drugs should be discontinued because these may increase the risk of bleeding. Keeping the patient NPO is not necessary. During a pericardiocentesis, a needle is inserted into the pericardial space to remove fluid for analysis, meaning that this is an invasive procedure.

What does the nurse include in the teaching for a family of a child with a heart defect? Select all that apply. 1 Ask the parents to discuss any problems with parent groups 2 Advise the parents to read about the disease on the Internet 3 Show a simple drawing of the heart to teach about the defect 4 Explain the nature of the disease in easy to understand words 5 Provide written instructions for the family about the child's care

2 - Advise the parents to read about the disease on the Internet 3 - Show a simple drawing of the heart to teach about the defect 4 - Explain the nature of the disease in easy to understand words 5 - Provide written instructions for the family about the child's care The nurse explains the nature of the disease to the parents in simple language so that the parents can understand it. The nurse also shows a simple drawing or model of the heart to explain in detail about the disease. The nurse provides written instructions for the family about the child's condition and care in case the parents do not remember the verbal instructions. The nurse advises the parents to read about the disease on the Internet or any other source to obtain general information. Other parents may not have the correct information, so the nurse asks the parents to discuss any problems with the health care provider or other medical staff to obtain accurate information.

A patient that has been taking an antihypertensive medication for four years reports blurred vision. The nurse notes that the patient's diagnostic reports indicate the blurred vision is due to retinal damage caused by hypertension. What are other manifestations of target organ disease? Select all that apply. 1 Anemia 2 Aneurysm 3 Proteinuria 4 Pneumonia 5 Transient ischemic attack

2 - Aneurysm 3 - Proteinuria 5 - Transient ischemic attack Hypertension affects the kidneys; a manifestation of renal disease is proteinuria (>1+). Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Pneumonia and anemia are not manifestations of target organ disease.

A patient with a transplanted heart has developed heart valve disease. What should the nurse include in the patient teaching? Select all that apply. 1 Avoid pregnancy. 2 Avoid strenuous physical exercise. 3 Notify the health care provider for planned dental work. 4 If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. 5 If on anticoagulation therapy, the international normalized ratio (INR) will need to be checked annually.

2 - Avoid strenuous physical exercise. 3 - Notify the health care provider for planned dental work. 4 - If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. Patients should avoid strenuous physical exercise because damaged valve may not handle the increased cardiac output (CO) demand. Any planned invasive or dental work requires the patient to notify the health care provider. If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. Pregnancy is not contraindicated; however, prophylactic antibiotic therapy may be administered to prevent endocarditis. If on anticoagulation therapy, the international normalized ratio (INR) will need to be checked regularly (more frequently than just annually).

The nurse is caring for an older patient that is diagnosed with pulmonic stenosis. The nurse anticipates that which type of conservative therapy may be prescribed? 1 Annuloplasty 2 Balloon valvuloplasty 3 Mitral commissurotomy 4 Sapien Transcatheter Heart Valve (THV)

2 - Balloon valvuloplasty Balloon valvuloplasty or percutaneous transluminal balloon valvuloplasty (PTBV) is generally indicated for older adults and for those who are poor surgery candidates. PTBV is used for mitral, tricuspid, and pulmonic stenosis. Annuloplasty is the reconstruction of annulus that is beneficial in patients with mitral or tricuspid regurgitation. Mitral commissurotomy or valvulotomy is used in patients with pure mitral stenosis. Sapien Transcatheter Heart Valve (THV) is beneficial in patients with atrial stenosis.

The nurse reviews the medical record of a patient with heart failure (HF). The nurse should question which assessment finding, recognizing that it does not correlate with the patient's diagnosis? 1 Fatigue 2 Bradycardia 3 Clammy and cold skin 4 Paroxysmal nocturnal dyspnea

2 - Bradycardia Bradycardia is not related to ADHF or chronic heart failure. Fatigue is an indication associated with chronic heart failure. Clammy and cold skin is a result of vasoconstriction during ADHF. Paroxysmal nocturnal dyspnea is also associated with chronic heart failure.

An African American patient is hospitalized for treatment of hypertension. When comparing medications used to treat high blood pressure, the nurse recalls that which type of medication provides better control for this population? 1 Beta adrenergic blockers 2 Calcium-channel blockers 3 Peripheral adrenergic inhibitors 4 Angiotensin-converting enzyme inhibitors

2 - Calcium-channel blockers In African Americans, calcium-channel blockers provide better control than other classes of antihypertensives, including beta adrenergic blockers and peripheral adrenergic inhibitors. African Americans have a higher risk of angioedema with angiotensin-converting enzyme inhibitors than whites.

Which medication does the nurse expect the primary health care provider to prescribe to reduce afterload in a child with heart failure? 1 Digoxin (Lanoxin) 2 Captopril (Capoten) 3 Furosemide (Lasix) 4 Chlorothiazide (Diuril)

2 - Captopril (Capoten) Captopril (Capoten) causes vasodilation, which results in decreased blood pressure and a reduction in afterload. Chlorothiazide (Diuril) and furosemide (Lasix) are diuretics used for removing accumulated fluid and sodium from the body. Digoxin (Lanoxin) is administered to patients with heart failure to improve contractility and increase cardiac output.

The nurse is reviewing the mechanism of blood pressure (BP). What are the main factors that influence blood pressure? Select all that apply. 1 Capillary refill 2 Cardiac output 3 Oxygen saturation 4 Pulmonary pressure 5 Systemic vascular resistance

2 - Cardiac output 5 - Systemic vascular resistance The two main factors influencing BP are cardiac output and systemic vascular resistance. Capillary refill, oxygen saturation, and pulmonary pressure do not influence blood pressure.

A patient that is receiving treatment for acute pericarditis reports a new onset of chest pain. The nurse assesses the patient and notes confusion, anxiety, and restlessness. The nurse suspects what complication? 1 Monoarthritis 2 Cardiac tamponade 3 Sydenham's chorea 4 Chronic rheumatic carditis

2 - Cardiac tamponade A major complication that may result from acute pericarditis is cardiac tamponade. It develops as the pericardial effusion increases in volume. This results in compression of the heart. The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. Monoarthritis is a manifestation of rheumatic fever and involves joint swelling, heat, redness, tenderness, and limitation of motion. Chronic rheumatic carditis results from changes in valvular structure that may occur months to years after an episode of rheumatic fever. Sydenham's chorea is a manifestation of rheumatic fever, characterized by involuntary movements of the face and limbs.

A patient with infective endocarditis is being discharged from the health care facility. What should the nurse teach the patient and caregiver about nursing care at home? Select all that apply. 1 Avoid exercise. 2 Continue follow-up care. 3 Ensure complete bed rest. 4 Take antibiotics as scheduled. 5 Avoid people with an upper respiratory tract infection.

2 - Continue follow-up care. 4 - Take antibiotics as scheduled. 5 - Avoid people with an upper respiratory tract infection. The nurse should teach the patient to avoid people with infection, especially upper respiratory tract infection. The patient should continue to receive antibiotics as scheduled, and the caregiver should observe the patient for any adverse drug reaction. The nurse should explain to the patient the importance of good follow-up care, good nutrition, and early treatment of infections. The patient should take periods of rest between activities. The patient may ambulate and perform moderate activity without exertion. The patient should be assisted in performing range-of-motion (ROM) exercises to prevent problems with reduced mobility.

The nurse assesses a patient and suspects acute mitral valve regurgitation (MR). Which symptoms support the nurse's suspicion? Select all that apply. 1 Palpitations 2 Cool extremities 3 Peripheral edema 4 Thready, peripheral pulses 5 Audible third heart sound (S3)

2 - Cool extremities 4 - Thready, peripheral pulses Mitral regurgitation is a valvular heart disease that causes backward flow of blood from the left ventricle to the left atrium due to incomplete valve closure during systole. Acute mitral regurgitation is characterized by thready peripheral pulses and cool extremities. Palpitations, peripheral edema, and an audible third heart sound (S3) are symptoms of chronic mitral regurgitation.

A patient that is suspected to have heart failure reports fatigue. The nurse recalls that what condition related to newly diagnosed heart failure causes fatigue? 1 Impaired renal perfusion 2 Decreased oxygenation of the tissues 3 Reabsorption of fluid from dependent body areas 4 An increased pulmonary pressure secondary to interstitial and alveolar edema

2 - Decreased oxygenation of the tissues Fatigue is caused by decreased oxygenation of the tissues. Impaired renal perfusion resulting in decreased urine output during the day is a cause of nocturia, not fatigue. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluids from the dependent body areas when the patient is lying flat. Dyspnea, not fatigue, is caused by an increased pulmonary pressure secondary to interstitial and alveolar edema.

A patient is diagnosed with dilated cardiomyopathy. The nurse identifies that interventions should focus on controlling heart failure (HF) by enhancing what cardiac activities? Select all that apply. 1 Improving diastolic filling 2 Decreasing preload and afterload 3 Improving myocardial contractility 4 Relieving left ventricular outflow obstruction 5 Improving ventricular filling by reducing ventricular contractility

2 - Decreasing preload and afterload 3 - Improving myocardial contractility The patient is experiencing dilated cardiomyopathy. Interventions should be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility are the goals for hypertrophic cardiomyopathy. Interventions aimed at improving diastolic filling are associated with restrictive cardiomyopathy.

A nurse provides education to a patient that is scheduled for exercise testing to evaluate the patient's cardiovascular function. What should the nurse include in the instructions? 1 Stop smoking 1 hour before the test. 2 Do not take β-blockers 24 hours before the test. 3 Avoid strenuous exercise 6 hours before the test. 4 Avoid all caffeine-containing foods 3 hours before the test.

2 - Do not take β-blockers 24 hours before the test. β-blockers may be held 24 hours before the test because they blunt the HR and limit the patient's ability to achieve maximal HR. . The nurse informs the patient not to consume caffeine-containing foods (and caffeine-containing fluids) for 24 hours before the test. The nurse also instructs the patient to avoid strenuous exercise and smoking for three hours before the test.

A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For what diagnostic test does the nurse prepare the patient? 1 Chest x-ray 2 Echocardiogram 3 Cardiac catheterization 4 Electrocardiogram (ECG)

2 - Echocardiogram An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine ejection fraction (EF) and blockages.

The nurse should instruct a child to remain completely still during which procedure in which high frequency sound waves are translated into images by a transducer? 1 Electrophysiology 2 Echocardiography 3 Electrocardiography 4 Cardiac catheterization

2 - Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system.

A patient is admitted to the emergency department with pain, dyspnea, and lower extremity edema. The patient is diagnosed with diastolic heart failure. The nurse recognizes that which clinical finding aids in the diagnosis of diastolic heart failure? 1 Low filling pressures 2 Ejection fraction of 55% 3 Impaired contractile function 4 Ejection fraction less than 45%

2 - Ejection fraction of 55% Diastolic failure is also known as heart failure with preserved EF (HFpEF), thus eluding to the finding of a normal ejection fraction (EF). A normal ejection fraction is 55-60%. In systolic heart failure, the ejection fraction is generally less than 45%. Diastolic failure is characterized by high filling pressures because of stiff ventricles. Systolic failure results from an inability of the heart to pump blood effectively, caused by impaired contractile function.

A patient is admitted with suspected myocarditis. Which test is considered most diagnostic for this illness? 1 Echocardiogram 2 Endomyocardial biopsy 3 Electrocardiogram (ECG) 4 Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels

2 - Endomyocardial biopsy Histologic confirmation of myocarditis is through an endomyocardial biopsy. A biopsy done during the first six weeks of acute illness is most diagnostic. This is the period in which lymphocytic infiltration and myocyte damage are present. The ECG changes for a patient with myocarditis are often nonspecific but may reflect associated pericardial involvement (e.g., diffuse ST segment changes). Dysrhythmias and conduction disturbances may be present. Laboratory findings are often inconclusive. They may include mild to moderate leukocytosis and atypical lymphocytes, increased ESR and CRP levels, elevated levels of myocardial markers such as troponin, and elevated viral titers. The virus is generally present in tissue and pericardial fluid samples only during the initial 8 to 10 days of illness. Nuclear scans, echocardiography, and magnetic resonance imaging (MRI) are used to assess cardiac function.

The registered nurse observes another health care provider caring for a patient that is undergoing transesophageal echocardiograph studies. The nurse recognizes that which action by the care provider needs correction? 1 Places a bite block in the patient's mouth 2 Ensures that the patient's dentures fit snugly 3 Administers anesthetic in the patient's throat 4 Instructs the patient not to eat food for six hours before the study

2 - Ensures that the patient's dentures fit snugly Dentures should be removed, because they may be dislodged during the study and cause airway obstruction. The procedure involves placing a bite block after inserting the probe to displace the tongue. The gag reflex prevents the passage of food from the throat. Therefore the care provider should instruct the patient to avoid eating for six hours before the test in order to prevent vomiting and aspiration. The care provider should administer anesthetic in the patient's throat to produce a localized effect and reduce pain.

The nurse is assessing a patient with mitral valve stenosis. Which findings are likely during the nursing examination? Select all that apply. 1 Syncope 2 Exertional dyspnea 3 Nausea and vomiting 4 Fatigue and palpitations 5 Low-pitched diastolic murmur at the apex

2 - Exertional dyspnea 4 - Fatigue and palpitations 5 - Low-pitched diastolic murmur at the apex Exertional dyspnea is caused by reduced lung compliance in mitral stenosis. Fatigue and palpitations are present because of atrial fibrillation. A low-pitched diastolic murmur is heard in mitral stenosis; however, it is best heard at the apex using the stethoscope. Syncope, nausea, and vomiting are not seen in patients with mitral stenosis.

A nurse provides discharge education to a patient about care and management of hypertension. What should the teaching plan include? Select all that apply. 1 Supplement the diet with foods high in sodium. 2 Explain the meaning of the blood pressure (BP) values. 3 Explain the potential dangers of uncontrolled hypertension. 4 Assure the patient that short-term therapy will cure hypertension. 5 Exercise after taking the medication prescribed for hypertension. 6 Do not alter medication dosage without first consulting the health care provider.

2 - Explain the meaning of the blood pressure (BP) values. 3 - Explain the potential dangers of uncontrolled hypertension. 6 - Do not alter medication dosage without first consulting the health care provider. The nurse should explain the meaning of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. The nurse should also explain the potential dangers of uncontrolled hypertension and dangers of altering the dosage without consulting the health care provider. The nurse should inform the patient that long-term therapy and follow-up care are essential to treat hypertension, and that therapy will not cure but should control hypertension. The patient should avoid foods high in sodium; instead, supplement diet with foods high in potassium. The patient should avoid strenuous exercise, hot baths, and excessive amounts of alcohol within three hours of medication.

While assessing a patient with acute decompensated heart failure (ADHF), the nurse auscultates fine crackles bilaterally. The nurse recognizes that crackles are an indicator of what? 1 Atelectasis 2 Fluid in the alveoli 3 Mucus in the alveoli 4 Bronchoconstriction

2 - Fluid in the alveoli Fluid in the alveoli is the correct answer because crackles are made by the sound of air moving through fluid-filled alveoli. Atelectasis is the collapsing of alveoli and would not produce sound. Mucus in the airways sounds like rhonchi or would cause diminished lung sounds if there were consolidation. Bronchoconstriction results in wheezing.

A nurse is caring for a patient with pericardial effusion. Which clinical sign is associated with phrenic nerve compression due to pericardial effusion? 1 Cough 2 Hiccups 3 Dyspnea 4 Hoarseness of voice

2 - Hiccups Pericardial effusion can cause compression of nearby structures. Phrenic nerve compression causes hiccups. In pericardial effusion, cough and dyspnea occur due to compression of the pulmonary tissue. Hoarseness of the voice is due to compression of the laryngeal nerve.

The nurse reviews a patient's medical history and identifies what risk factors for heart failure (HF)? Select all that apply. 1 Cirrhosis 2 Hypertension 3 Multiple sclerosis 4 Marfan's syndrome 5 Metabolic syndrome

2 - Hypertension 5 - Metabolic syndrome Hypertension and coronary artery disease (CAD are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, also contribute to the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.

While reviewing a patient's electrocardiogram reports, the nurse finds that the U wave is present. The nurse suspects that the patient has what condition? 1 Hypothermia 2 Hypokalemia 3 Hypocalcemia 4 Hypothyroidism

2 - Hypokalemia The U wave appears and exceeds the T-wave amplitude in the electrocardiogram if the serum potassium level in the blood is less than 3 mEq/L. Because the normal potassium levels in the blood are in the range of 3.5 to 5.0, the presence of a U wave indicates hypokalemia. The presence of a U wave does not indicate altered body temperature or hypothermia. A U wave may be seen during hypercalcemia but not during hypocalcemia. A U wave does not indicate decreased thyroxine levels or hypothyroidism.

The nurse recalls that which are the main characteristics of hypertrophic cardiomyopathy (CMP)? Select all that apply. 1 Impaired systole 2 Impaired diastole 3 Atrial hypertrophy 4 Massive ventricular hypertrophy 5 Rapid, forceful contraction of the left ventricle

2 - Impaired diastole 4 - Massive ventricular hypertrophy 5 - Rapid, forceful contraction of the left ventricle The main characteristics of hypertrophic cardiomyopathy include massive ventricular hypertrophy, impaired diastole, and rapid, forceful contractions of the left ventricle. Atrial hypertrophy and impaired systole are not characteristic of hypertrophic cardiomyopathy; this disease process involves the left ventricle.

The nurse identifies a U wave on a patient's electrocardiogram. Which dietary instruction will be beneficial to the patient? 1 Use virgin coconut oil for cooking. 2 Increase consumption of bananas. 3 Increase consumption of milk products. 4 Increase consumption of foods with omega-3 oils.

2 - Increase consumption of bananas. The presence of a U wave in the patient's electrocardiogram may indicate hypokalemia or repolarization of the Purkinje fibers. Hypokalemia can be caused by excessive sweating, diarrhea, or excessive laxative use. Bananas are a rich source of potassium. Therefore increasing the consumption of bananas will be beneficial for the patient. Coconut oil increases digestion and bowel function. Raw and virgin coconut oil have a laxative effect and should not be recommended. Milk and milk products like cheese are rich in sodium but not in potassium. Omega-3 oils help flush toxins out of the body. Therefore increasing the consumption of omega-3 oils would produce a laxative effect in the patient and potentiate hypokalemia.

What events occur as a result of ventricular remodeling? Select all that apply. 1 Increased contractility 2 Increased wall tension 3 More effective pumping 4 Increased ventricular mass 5 Increased O2 consumption

2 - Increased wall tension 4 - Increased ventricular mass 5 - Increased O2 consumption Remodeling involves hypertrophy of the ventricular myocytes. This results in large, abnormally shaped contractile cells. This altered shape of the ventricles eventually leads to increased ventricular mass, increased wall tension, increased O2 consumption, and impaired contractility. Although the ventricles become larger, they become less effective pumps.

The nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply. 1 It causes vasodilation. 2 It reduces plasma volume. 3 It promotes sodium and water excretion. 4 It reduces the vascular response to catecholamines. 5 It prevents extracellular calcium from moving into the cells.

2 - It reduces plasma volume. 3 - It promotes sodium and water excretion. 4 - It reduces the vascular response to catecholamines. Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers.

The nurse recalls that a patient with a mitral valve disorder will have impaired blood flow between what two structures of the heart? 1 Vena cava and right atrium 2 Left atrium and left ventricle 3 Right atrium and right ventricle 4 Right ventricle and pulmonary artery

2 - Left atrium and left ventricle The mitral valve is located between the left atrium and the left ventricle. Blood flow would not be impaired between the vena cava and right atrium, right ventricle and pulmonary artery, or right atrium and right ventricle in a patient with mitral valve disorder.

The nurse reviews an elderly patient's electrocardiogram and recognizes that what finding indicates cellular aging and fibrosis of the conduction system? 1 Regular cardiac rhythm 2 Lengthened QT intervals 3 Increased amplitude of QRS complex 4 Shortened PR interval and shortened QRS complex

2 - Lengthened QT intervals Lengthened QT intervals in an elderly patient's electrocardiogram indicate cellular aging and fibrosis of the conduction system. The patient with cellular aging and fibrosis of the conduction system is characterized by irregular cardiac rhythms, lengthened PR, QRS complex, and a decreased amplitude of QRS complex.

An older patient presents to the emergency department with recent weight gain, pitting edema to the bilateral lower extremities, and distended neck veins. The nurse expects what other assessment findings? Select all that apply. 1 Irregular heart rate 2 Lower extremity cyanosis 3 Third heart sound (S3) upon auscultation 4 Displaced point of maximal impulse (PMI) 5 High-pitched scratching sound during S1 or between normal heart sounds

2 - Lower extremity cyanosis 3 - Third heart sound (S3) upon auscultation 4 - Displaced point of maximal impulse (PMI) Pitting bilateral lower extremity edema, weight gain, and jugular venous distention (JVD) are all hallmarks of heart failure. Lower extremity cyanosis, a third heart sound, and displaced PMI are all symptoms that are often found in the patient with heart failure. Irregular heart rate is a hallmark of atrial fibrillation. A high-pitched scratching sound during or between normal heart sounds is indicative of a pericardial friction rub and more commonly indicates pericarditis, not heart failure.

The nurse performs an international normalized ratio (INR) blood study for a patient two months after the patient underwent mitral valve replacement surgery. The patient has been receiving warfarin therapy since the surgery. The INR value is 3.1. The nurse should take what action? 1 Prepare to administer a vitamin K injection. 2 Maintain the patient at the same warfarin dose. 3 Request a prescription for a higher dose of warfarin. 4 Instruct the patient to stop taking the warfarin until the INR level decreases.

2 - Maintain the patient at the same warfarin dose. International normalized ratio (INR) values of 2.5 to 3.5 are therapeutic for patients with mechanical valves, so it is not necessary to change the dose. The patient should not stop taking the warfarin or take a higher dose. Vitamin K is the antidote for warfarin, and it is not necessary to take because the INR is in a therapeutic range.

The nurse determines that a patient is at an increased risk for an infection of the endocardial layer of the heart based on the patient's history of what? 1 Myxedema 2 Marfan's syndrome 3 Hodgkin's lymphoma 4 Postpericardiotomy syndrome

2 - Marfan's syndrome Infection of the endocardial layer of the heart indicates infective endocarditis. Marfan's syndrome is a genetic disorder that affects the connective tissue and is a risk factor for infective endocarditis. Myxedema and Hodgkin's lymphoma are noninfectious causes of pericarditis. Postpericardiotomy syndrome is a hypersensitive or autoimmune cause of pericarditis.

A patient's apical heart rate is 45 beats/minute. The nurse should withhold which scheduled medication? 1 Morphine 2 Metoprolol 3 Furosemide 4 Rosuvastatin

2 - Metoprolol Metoprolol, which is a β-adrenergic blocker, inhibits the sympathetic nervous system, causing a decrease in heart rate; therefore, this drug should be withheld and the primary health care provider notified. Diuretics, such as furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases preload and afterload; it may be given if the patient is in pain and has a heart rate of 45. Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in the patient; a heart rate of 45 does not indicate that it should be withheld.

The nurse assesses a patient's heart sounds and auscultates the left midclavicular line at the fifth intercostal space (ICS). This is the best location for hearing sounds from which heart valve? 1 Aortic 2 Mitral 3 Tricuspid 4 Pulmonic

2 - Mitral The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS). The aortic area is best heard at the right second intercostal space. Tricuspid area is assessed best at the midleft sternal border. Pulmonic is heard best at the left second intercostal space.

A patient with heart failure (HF) often experiences dyspnea and reports feeling very anxious during the dyspneic episodes. The nurse anticipates a prescription for what medication? 1 Digoxin 2 Morphine 3 Dopamine 4 Metolazone

2 - Morphine Morphine is an opioid analgesic used to both reduce anxiety and treat heart failure. Digoxin is a cardiac glycoside, which is used to increase cardiac contractility. Dopamine is a positive inotrope that is used to treat heart failure. Metolazone is a thiazide-like diuretic that is used to treat heart failure.

A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. The nurse suspects what diagnosis? 1 Stroke 2 Myocardial infarction (MI) 3 Coronary artery disease (CAD) 4 Peripheral vascular disease (PVD)

2 - Myocardial infarction (MI) Creatine kinase (CK-BB) enzymes are present in the cardiac muscle and are released into the blood due to cell injury. An increase in creatine kinase (CK-MB) enzymes indicates the onset of symptoms of myocardial infarction (MI). Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, coronary artery disease (CAD), and peripheral vascular disease (PVD).

The nurse is providing care for a cyanotic child. What does the nurse assess for while caring for the child? Select all that apply. 1 Cardiac tamponade 2 Onset of dehydration 3 Respiratory infections 4 Decreased hematocrit 5 Clubbing of the fingers

2 - Onset of dehydration 3 - Respiratory infections 4 - Decreased hematocrit 5 - Clubbing of the fingers For children with underlying heart failure, respiratory tract infections can worsen hypoxemia in the child. Clubbing of the fingers in a cyanotic child indicates severe heart disease. Dehydration in the child can lead to a cerebrovascular accident because of poor oxygenation to the brain. A decreased hematocrit is indicative of anemia. This too affects oxygenation. Tamponade, or the accumulation of blood or fluid in the pericardial space, is a complication from either cancer treatment or cardiac surgery.

The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-sized lesions on the fingertips and toes. How should the nurse document this finding? 1 Roth's spots 2 Osler's nodes 3 Janeway's lesions 4 Splinter hemorrhages

2 - Osler's nodes The nurse should document this finding as Osler's nodes. Osler's nodes are red or purple, tender, pea-size lesions on the fingertips and toes that are vascular manifestations of infective endocarditis. Other vascular manifestations include splinter hemorrhages, Janeway's lesions, and Roth's spots. Splinter hemorrhages are black longitudinal streaks in the nail beds. Janeway's lesions are flat, painless, small, red spots on the palms and soles. Roth's spots are hemorrhagic retinal lesions that are revealed by funduscopic examination.

The nurse does not have information about a patient's typical systolic blood pressure. The nurse is preparing to take the patient's blood pressure using a sphygmomanometer and a stethoscope. What action should the nurse take? 1 Replace the cuff on the patient's arm with slightly larger-sized cuff 2 Palpate the brachial pulse and inflate the cuff until the pulse ceases 3 Apply extra pressure on the cuff manually to measure blood pressure 4 Discontinue blood pressure measurement and try to obtain the information within the next hour

2 - Palpate the brachial pulse and inflate the cuff until the pulse ceases While measuring blood pressure with the sphygmomanometer and a stethoscope, if systolic blood pressure is not known, then the nurse should palpate the brachial pulse and inflate the cuff until the pulse ceases. Using a larger-sized cuff cannot give accurate results for blood pressure. Applying extra pressure can increase the pressure on the brachial artery, which can give inaccurate test results. When a blood pressure measurement is scheduled, the nurse should be timely and take the patient's blood pressure, using the appropriate technique.

The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. What is the priority nursing action? 1 Perform ultrafiltration 2 Provide supplemental oxygen 3 Provide mechanical ventilation 4 Obtain arterial blood gases (ABGs)

2 - Provide supplemental oxygen Supplemental oxygen helps increase the percentage of oxygen in inspired air. Ultrafiltration is a process used to remove excess salt and water from the blood in case of volume overload. Mechanical ventilation is used in cases of pulmonary edema, to help decrease the preload. An ABG test will provide information about the amount of oxygen and carbon dioxide is in the blood, but it is not a priority.

What supportive measures should the nurse implement when providing care to a patient with myocarditis? Select all that apply. 1 Allowing for frequent visitors 2 Providing a quiet environment 3 Spacing activity and rest periods 4 Placing the patient in semi-Fowler's position 5 Keep the patient and caregiver informed about the therapeutic plan

2 - Providing a quiet environment 3 - Spacing activity and rest periods 4 - Placing the patient in semi-Fowler's position 5 - Keep the patient and caregiver informed about the therapeutic plan Keeping the patient and caregiver informed about the therapeutic plan will decrease anxiety. The nurse should implement measures to decrease cardiac workload. These include placing the patient in a semi-Fowler's position, spacing activity and rest periods, and providing a quiet environment. To provide for a restful environment, visitors should be restricted. This also helps to minimize the risk of infection.

A patient with mitral valve stenosis presents with hemoptysis. The nurse suspects that the symptom is caused by what? 1 Atrial fibrillation 2 Pulmonary hypertension 3 Decreased cardiac output 4 Atrial enlargement pressing on the laryngeal nerve

2 - Pulmonary hypertension Pulmonary hypertension causes hemoptysis or bleeding in the lungs and the coughing up of blood due to increased pressure in the pulmonary circulation. Atrial fibrillation in patients with mitral valve prolapse results in fatigue and palpitations. Decreased cardiac output results in chest pain in patients with mitral valve prolapse. Hoarseness occurs due to atrial enlargement pressing on the laryngeal nerve in patients with mitral valve prolapse.

A nurse is performing a cardiac assessment. How should the nurse assess for jugular venous distention in the patient? 1 Place the patient in a supine position. 2 Raise the patient to approximately 45 degrees. 3 Place the patient in a sitting, leaning forward position. 4 Observe the vein in three positions-supine, sitting, and standing.

2 - Raise the patient to approximately 45 degrees. Jugular venous distention can be seen in right-sided heart failure. In this condition the large veins in the neck are distended due to the back-pressure exerted by the blood. It is best appreciated when the patient is raised to approximately 45 degrees or slightly less. This exerts pressure and helps in visualization of jugular veins. Placing the patient in other positions like supine, sitting, leaning, or standing does not help in clear visualization of jugular venous distention.

What is a priority nursing intervention when administering loop diuretics to a child with heart failure? 1 Ensure that the child gets adequate rest 2 Record the child's fluid intake and output 3 Change the child's position every 2 hours 4 Restrict salt and potassium in the child's diet

2 - Record the child's fluid intake and output Loop diuretics are designed to eliminate excess extracellular fluid. Therefore the nurse should record the child's fluid intake and output because of the risk of dehydration due to fluid loss. Salt is restricted by the health care provider because it promotes water retention. However, potassium is not restricted. A side effect of loop diuretics is hypokalemia, or potassium loss. The child will be asked to include high potassium foods in the diet and may even need potassium supplements. Ensuring that the child gets adequate rest will not help to prevent dehydration. The nurse changes the child's position every two hours to prevent skin breakdown and not to prevent dehydration.

After a patient returns from cardiac catheterization, the nurse assesses that the pulse distal to the catheter insertion site is weaker. What should the nurse do? 1 Elevate the affected extremity 2 Record the data on the nurse's notes 3 Notify the physician of the observation 4 Apply warm compresses to the insertion site

2 - Record the data on the nurse's notes Because a weaker pulse is an expected finding, the nurse should document this and continue to monitor. The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. Elevation is not necessary; the extremity is kept straight. It should gradually increase in strength. The insertion site is kept dry. There is no need to notify the physician.

A nurse is preparing a patient for a transesophageal echocardiogram (TEE). What intervention does the nurse perform for this patient? 1 Inform the patient that skin irritation is likely. 2 Remove dentures and place a bite block in the mouth. 3 Provide lead shielding to areas that are exposed to radiation. 4 Provide information about risks associated with general anesthesia.

2 - Remove dentures and place a bite block in the mouth. While preparing a patient for a TEE, the nurse asks the patient to remove the dentures and places a bite block in the mouth. This is done because an ultrasound transducer will need to be swallowed and passed through the esophagus. When preparing the patient for a chest x-ray, the nurse provides lead shielding to areas that are exposed to radiation. If the patient is undergoing ambulatory ECG, then the nurse asks him to carefully observe possible symptoms of skin irritation. The patient will receive IV sedation; general anesthesia is not used for the procedure.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is important for the nurse to provide? 1 Restrict all caffeine 2 Restrict sodium intake 3 Increase protein intake 4 Use calcium supplements

2 - Restrict sodium intake The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower blood pressure.

Which type of cardiomyopathy impairs diastolic filling and stretch? 1 Dilated cardiomyopathy 2 Restrictive cardiomyopathy 3 Takotsubo cardiomyopathy 4 Hypertrophic cardiomyopathy

2 - Restrictive cardiomyopathy Restrictive cardiomyopathy, the least common type of cardiomyopathy, impairs diastolic filling and stretch. Dilated cardiomyopathy involves diffuse inflammation and rapid degeneration of myocardial fibers. Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome. Hypertrophic cardiomyopathy involves asymmetric hypertrophy without ventricular dilation.

The nurse conducts a complete physical assessment on a patient admitted with suspected infective endocarditis (IE). Which diagnostic finding is indicative of the disorder? 1 Heart rate of 50 2 Retinal hemorrhages 3 Respiratory rate of 10 4 Feeling of impending doom

2 - Retinal hemorrhages Retinal hemorrhages are associated with IE. A feeling of impending doom is not a clinical manifestation. Tachycardia and tachypnea are also clinical manifestations.

The nurse recalls that which heart disease involves the inflammation of all layers of the heart? 1 Pericarditis 2 Rheumatic fever 3 Infective endocarditis 4 Rheumatic heart disease

2 - Rheumatic fever Rheumatic fever is an acute inflammatory that involves the inflammation of the endocardium, pericardium, and myocardium. Pericarditis is the inflammation of the pericardial sac. Infective endocarditis is the infection of the endocardium. Caused by rheumatic fever, rheumatic heart disease involves scarring and deformity of the heart valves.

The nurse recalls that, in the majority of people, the atrioventricular (AV) node and the bundle of His receive blood supply from which artery? 1 Circumflex artery 2 Right coronary artery 3 Left main coronary artery 4 Left anterior descending artery

2 - Right coronary artery The right coronary artery supplies blood to the bundle of His and the atrioventricular (AV) node in the heart, and a blockage of this artery can affect blood supply to the bundle of His. The circumflex artery, left main coronary artery, and left anterior descending artery do not supply blood to the bundle of His.

A patient with valvular heart disease has not experienced any symptom of heart failure. How should the nurse classify this patient according to the American College of Cardiology/American Heart Association (ACC/AHA) stages of heart failure (HF)? 1 Stage A 2 Stage B 3 Stage C 4 Stage D

2 - Stage B According to ACC/AHA the nurse should classify this patient as stage B. Stage B patients have structural heart disease without any sign or symptom. Stage A patients are at high risk for HF, but without structural heart disease or symptoms of HF. Stage C patients have prior or current symptoms of HF associated with a known structural heart disease. Stage D patients have refractory HF requiring specialized interventions.

The nurse is assessing a patient with rheumatic fever in the outpatient unit of a health care facility. For which condition should the nurse assess the patient? 1 Black longitudinal streaks in the nail beds 2 Subcutaneous nodules over all bony surfaces 3 Petechiae in the conjunctivae, lips, buccal mucosa, and palate 4 Painful, tender, red or purple, pea-size lesions on the fingertips or toes

2 - Subcutaneous nodules over all bony surfaces When assessing the patient with rheumatic fever, the nurse should inspect the patient's skin for subcutaneous nodules by palpating over all bony surfaces and along extensor tendons of the hands and feet. Patients with infective endocarditis are assessed for petechiae in the conjunctivae, lips, buccal mucosa, and palate; Osler's nodes are painful, red or purple, pea-size lesions found on the fingertips or toes; and splinter hemorrhages are black longitudinal streaks that may occur in the nail beds.

A patient receives instructions about monitoring the blood pressure (BP) levels at home. What should the nurse teach the patient about measuring the BP in a supine position? 1 Take the reading immediately after lying down. 2 Support the arm with a pillow during measurement. 3 Take at least two consecutive readings one after another. 4 Use the arm with the lower BP for all future measurements.

2 - Support the arm with a pillow during measurement. When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements.

Which clinical symptoms in a child with heart failure indicate impaired myocardial function? Select all that apply. 1 Weight gain 2 Tachycardia 3 Exercise intolerance 4 Weak peripheral pulses 5 Decreased urinary output

2 - Tachycardia 4 - Weak peripheral pulses 5 - Decreased urinary output Decreased urinary output, weak peripheral pulses, and tachycardia are some of the clinical manifestations of impaired myocardial function in a child with heart failure. Weight gain caused by fluid retention indicates systemic venous congestion. Exercise intolerance or dyspnea indicates pulmonary congestion.

The nurse provides information to a group pf nursing students about primary causes of heart failure (HF). The nurse should include what interventions that are associated with the primary causes and that are aimed at reducing the risk of patients developing HF?? Select all that apply. 1 Blood transfusions for anemia 2 Taking blood pressure medication as prescribed 3 Decreasing dysrhythmias by reducing caffeine intake 4 Initiating lifestyle changes to avoid coronary artery disease (CAD) 5 Taking aspirin every day to reduce the incidence of pulmonary embolism

2 - Taking blood pressure medication as prescribed 4 - Initiating lifestyle changes to avoid coronary artery disease (CAD) Hypertension and coronary artery disease (CAD) are considered primary causes of heart failure (HF). Anemia, dysrhythmias, and pulmonary embolism are precipitating causes of heart failure.

The nurse provides education to a patient that is scheduled for a serum test for triglycerides and lipoproteins. What should the nurse include in the teaching? 1 Avoid alcohol for 12 hours before the test. 2 The blood can be obtained in a nonfasting state, but some protocols continue to recommend obtaining results in a fasting state. 3 A triglyceride level of greater than 100 mg/dL is considered to be high risk, and recommendations for treatment will be made. 4 The lipoproteins test will be used for diagnosis and treatment.

2 - The blood can be obtained in a nonfasting state, but some protocols continue to recommend obtaining results in a fasting state. The nurse instructs the patient that both tests may be obtained in a nonfasting state; however some protocols continue to recommend obtaining results in a fasting state. Consumption of alcohol should be restricted for at least 24 hours before the test. The reference interval for triglycerides is < 150 mg/dL. Because there are marked day-to-day fluctuations in the serum lipoprotein levels, more than one test is required for accurate diagnosis and treatment.

As treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. The nurse recognizes that it is important to assess the patient's thiocyanate levels for what reason? 1 The medication has a long half-life. 2 The medication is metabolized to cyanide, then thiocyanate. 3 An increased level indicates interactions with other drugs the patient is taking. 4 An increased level indicates adverse effects on target organs caused by the medication.

2 - The medication is metabolized to cyanide, then thiocyanate. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the blood pressure. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4mcg/kg/min. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications. The cause of concern and the need to assess the thiocyanate level do not relate to the medication's half-life.

s treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. The nurse recognizes that it is important to assess the patient's thiocyanate levels for what reason? 1 The medication has a long half-life. 2 The medication is metabolized to cyanide, then thiocyanate. 3 An increased level indicates interactions with other drugs the patient is taking. 4 An increased level indicates adverse effects on target organs caused by the medication.

2 - The medication is metabolized to cyanide, then thiocyanate. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the blood pressure. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4mcg/kg/min. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications. The cause of concern and the need to assess the thiocyanate level do not relate to the medication's half-life.

The nurse is learning about circulatory disorders within the heart resulting from congenital heart defects. Which disorders cause cyanosis? Select all that apply. 1 There is an increase in the pulmonary blood flow within the heart. 2 There is a severe obstruction located on the right side of the heart. 3 Oxygenated and deoxygenated blood mixes in the heart chambers. 4 The blood is shunted from the right side to the left side of the heart. 5 The pressure on the right side of the heart is lower than the left side.

2 - There is a severe obstruction located on the right side of the heart. 3 - Oxygenated and deoxygenated blood mixes in the heart chambers. 4 - The blood is shunted from the right side to the left side of the heart. With many congenital heart defects, the blood is shunted from the right side of the heart to the left side of the heart due to increased pulmonary vascular resistance, or obstruction to blood flow through the pulmonic valve and artery. This results in cyanosis. Cyanosis also occurs if the oxygenated and deoxygenated blood mixes within the heart chambers. Cyanosis is also caused by severe obstruction on the right side of the heart. If the pressure on the right side of the heart is lower than that of the left side, it indicates a normal heart. An increased pulmonary blood flow within the heart indicates heart failure.

A patient that has undergone valve replacement takes warfarin. The patient asks the nurse why regular international normalized ratio (INR) tests are prescribed. What explanation should the nurse give to emphasize the importance of this test? Select all that apply. 1 To prevent endocarditis 2 To determine proper dosage 3 To prolong durability of valves 4 To determine patency of valves 5 To determine adequacy of therapy

2 - To determine proper dosage 5 - To determine adequacy of therapy The INR must be checked regularly if the patient is on anticoagulation therapy to determine the proper dosage. A high or low INR may require the dose to be adjusted. INR is also tested to determine the adequacy of anticoagulation. If the anticoagulant is not adequate, blood clots may form. If anticoagulation is more than adequate, there is an increased risk of bleeding. The test cannot indicate endocarditis or patency or durability of valves.

A patient with pharyngitis is suspected to have rheumatic fever. The nurse anticipates that what interventions will be included in the patient's plan of care? Select all that apply. 1 Cold fomentation for painful joints 2 Treatment for streptococcal pharyngitis 3 Relief of joint pain as a priority nursing goal 4 Discontinuation of antibiotics if there is symptomatic relief 5 Administering nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain

2 - Treatment for streptococcal pharyngitis 3 - Relief of joint pain as a priority nursing goal 5 - Administering nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain Adequate treatment of streptococcal pharyngitis prevents the initial attack of rheumatic fever. NSAIDs can be given to relieve pain in the joints. A priority nursing goal is relief of joint pain. Completing the full course of antibiotics is important for successful treatment. Heat needs to be applied to painful joints because cold fomentation may lead to stiffness.

After reviewing a patient's laboratory reports, the nurse concludes that the patient is at a high risk for myocardial injury. Which finding in the patient's lab reports supports the nurse's conclusion? 1 CK-MB value of 2% 2 Troponin I value of 3.5 ng/mL 3 Cholesterol value of 250 mg/dL 4 B-type natriuretic peptide (BNP) value of 140 pg/mL

2 - Troponin I value of 3.5 ng/mL Troponin is a contractile protein released after a myocardial infarction. If the value of troponin I is greater than 2.3 ng/mL, it indicates that the patient is at high risk for myocardial injury. A CK-MB value greater than 4% to 6% indicates myocardial infarction. A cholesterol value of 250 mg/dL indicates cardiovascular heart disease. A b-type natriuretic peptide (BNP) value of 140 pg/mL indicates heart failure.

Auscultation of a patient's heart reveals the presence of a murmur. The nurse recalls that the finding is the result of what abnormality? 1 Increased viscosity of the patient's blood 2 Turbulent blood flow across a heart valve 3 Friction between the heart and the myocardium 4 A deficit in heart conductivity that impairs normal contractility

2 - Turbulent blood flow across a heart valve Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

The nurse reviews the assessment findings of a patient with acute decompensated heart failure (ADHF) and notes a pulmonary artery wedge pressure (PAWP) of 28 mm Hg, an intake of 1000 mL more than the output in 24 hours, and resistance to diuretics. The nurse anticipates a prescription for which clinical intervention? 1 Oxygen therapy 2 Ultrafiltration (UF) 3 Biventricular pacing 4 Cardiac transplantation

2 - Ultrafiltration (UF) In a patient with acute decompensated heart failure, the pulmonary artery wedge pressure (PAWP) can be as high as 30 mm Hg. A normal PAWP is generally between 18 and 12mm Hg. The ideal patients for ulrafiltration (UF) are those with major pulmonary or systemic overload who have shown resistance to diuretics and are hemodynamically stable. UF helps decrease the fluid overload in the lungs and, therefore, decreases the pulmonary artery wedge pressure. Oxygen therapy may improve perfusion, but it does not cause a decrease in pulmonary artery wedge pressure (PAWP). Biventricular pacing and cardiac transplantation are preferred in cases of chronic heart failure but are not the best options in cases of ADHF.

It is determined that a patient with advanced dilated cardiomyopathy (CMP) is not a candidate for heart transplantation. The nurse anticipates a prescription for what treatment? 1 Atrioventricular pacemaker 2 Ventricular assist device (VAD) 3 Ventriculomyotomy and myectomy surgery 4 Percutaneous transluminal septal myocardial ablation

2 - Ventricular assist device (VAD) Patients with dilated cardiomyopathy may benefit from nondrug therapies. A VAD allows the heart to rest and recover from acute heart failure. It also may serve as a bridge to heart transplantation. Additionally, cardiac resynchronization therapy and an implantable cardioverter-defibrillator are used in appropriate patients. Atrioventricular pacemaker, ventriculomyotomy and myectomy surgery, and percutaneous transluminal septal myocardial ablation are appropriate for hypertrophy cardiomyopathy.

The nurse is assessing a patient with chronic aortic regurgitation in the emergency unit of a health care facility. The nurse expects to find which heart sound? 1 S3 gallop 2 Water-hammer pulse 3 Loud accentuated S1 4 Low-pitched diastolic murmur

2 - Water-hammer pulse The nurse assessing a patient with chronic aortic regurgitation would find a strong, quick beat that collapses immediately, known as water-hammer pulse. Heart sounds may include a soft or absent S1, S3, or S4 and a soft, high-pitched diastolic murmur. Low-pitched diastolic murmur and loud accentuated S1 are observed in mitral valve stenosis. An S3 gallop is found in patients with chronic mitral valve regurgitation.

The nurse is providing discharge education to a patient with dilated cardiomyopathy (CMP). Which patient statement indicates the need for further teaching? 1 "I may need to start taking a diuretic." 2 "I may be given a prescription for nitroglycerin." 3 "Most patients with this diagnosis respond well to treatment." 4 "I should alternate periods of rest with required activities of daily living."

3 - "Most patients with this diagnosis respond well to treatment." Dilated CMP does not respond well to therapy, and patients experience multiple episodes of heart failure (HF). Nitrates and diuretics decrease preload and may be prescribed. Alternating periods of rest with activity is needed to reduce the workload of the heart.

A patient with hypertension asks the nurse, "What can I do to decrease my blood pressure?" How should the nurse respond? 1 "Reduce sodium intake to less than 3000 mg per day." 2 "Restrict alcohol consumption to no more than three drinks daily." 3 "Perform moderate-intensity aerobic physical activity for at least 30 minutes daily." 4 "Reduce weight by 10 pounds, which can decrease systolic blood pressure by 20 to 30 mm Hg."

3 - "Perform moderate-intensity aerobic physical activity for at least 30 minutes daily." Moderate physical activity, such as walking for at least 30 minutes, is recommended at least five days per week to reduce BP. For those with hypertension, sodium should be restricted to less than or equal to 1500 mg per day. Weight reduction by 20 lbs leads to a reduction in SBP of 5 to 20 mm Hg. Alcohol consumption should be restricted to no more than one drink per day for women and no more than two drinks per day for men.

The nurse is instructing the mother about feeding habits for an infant with heart failure. Which precaution related to breastfeeding should the nurse include in the teaching? 1 "Breastfeed the child every 2 hours." 2 "Increase volume of feeding if fed every 4 hours." 3 "Alternate breast milk with high-calorie formulas." 4 "Withhold breastfeeding and provide gavage feeding."

3 - "Alternate breast milk with high-calorie formulas." The caloric needs of the infants with heart failure are greater than the average infant. So the nurse advises the mother to alternate breast milk with high-calorie formulas. The nurse advises the mother to provide small feedings every 3 hours for adequate nutrition. A 4 hour schedule will not ensure adequate nutrition as the infant may not increase the volume of feeding. The nurse asks to withhold breastfeeding and provide gavage feeding only in case of respiratory distress. Breastfeeding every 2 hours does not provide adequate rest to the infant.

A patient with chronic hypertension is admitted to the emergency department with a sudden rise in blood pressure (BP). What is the priority question for the nurse to ask the patient? 1 "Are you pregnant?" 2 "Do you need to urinate?" 3 "Do you have a headache or confusion?" 4 "Are you taking antiseizure medications as prescribed?"

3 - "Do you have a headache or confusion?" The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy, from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not indicate a hypertensive emergency.

The nurse provides teaching to a patient with acute rheumatic fever (RF). Which statement made by the patient indicates a need for further education? 1 "I will receive ibuprofen for my joint pain." 2 "I will need to take antibiotics to stop the infection." 3 "Exercise is important to help me regain my strength." 4 "I can have a heating pad placed on my painful knees if needed."

3 - "Exercise is important to help me regain my strength." Promoting optimal rest (not promoting exercise) is essential to reduce cardiac workload and the body's metabolic needs. The primary goals of managing a patient with RF are to (1) control and remove the infecting organism; (2) prevent cardiac complications; and (3) relieve joint pain, fever, and other symptoms. Administer salicylates, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids as prescribed, and monitor fluid intake as appropriate. Administer antibiotics as prescribed to treat the streptococcal infection. Teach the patient that completing the full course of antibiotics is vital to successful treatment. Another priority nursing goal is relief of joint pain. Position painful joints for comfort and in proper alignment. Heat may be applied and salicylates or NSAIDs administered for joint pain.

Which statement made by the nurse to a patient with cardiomyopathy regarding home care instructions needs correction? 1 "Avoid diet pills." 2 "Eat a low-sodium diet." 3 "Increase your caffeine consumption." 4 "Report increased fatigue to your primary health care provider."

3 - "Increase your caffeine consumption." Caffeine contains stimulants that stimulate the heart, which results in irregular heart rhythms. Therefore patients with cardiomyopathy should avoid caffeine. The patient should avoid diet pills because they may contain stimulants. The patient should consume a low-sodium diet. The patient should report increased fatigue to the primary health care provider.

A patient receives a new prescription for doxazosin. What should the nurse include in the patient's medication education? 1 "Weigh yourself daily and report any weight loss to your prescriber." 2 "Increase your potassium intake by eating more bananas and apricots." 3 "Take this drug at bedtime because of the risk of orthostatic hypotension." 4 "The impaired taste associated with this medication usually goes away in two to three weeks."

3 - "Take this drug at bedtime because of the risk of orthostatic hypotension." A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. Taking the drug at bedtime reduces risks associated with orthostatic hypotension. The patient does not need to increase potassium intake. Doxazosin does not cause impaired taste. It does not cause weight loss, because it is not a diuretic.

A patient with group A streptococcal pharyngitis states, "I do not want to take the antibiotics that have been prescribed." How should the nurse respond? 1 "You will not feel well if you do not take the medicine and get over this infection." 2 "You may not want to take the antibiotics for this infection, but you will be sorry if you do not." 3 "Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease." 4 "If you don't take the medication, you may have complications of the infection, such as loss of balance."

3 - "Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease." RF is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. The complications do not include loss of balance. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say.

The nurse auscultates a pericardial friction rub when assessing a patient's heart sounds. What would cause an increase in friction between the heart layers during contraction? 1 An atrial myocardium thinner than the ventricle 2 Different thicknesses in the walls of each chamber 3 5 mL of fluid in the space between the pericardial layers 4 12 mL of fluid in the space between the pericardial layers

3 - 5 mL of fluid in the space between the pericardial layers Pericardial fluid between the pericardial layers prevents friction between the layers as the heart contracts. Approximately 10 to 15 mL of pericardial fluid is sufficient to reduce the friction. Therefore 5 mL of pericardial fluid indicates that the patient experiences greater friction between the pericardial layers. The wall of each chamber of a normal heart is a different thickness; it does not cause greater friction. If the atrial myocardium is thinner than the ventricle, it also indicates normal heart anatomy. Pericardial fluid of 12 mL is a normal finding and does not indicate friction between the pericardial layers.

A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure? 1 40 mm Hg 2 60 mm Hg 3 80 mm Hg 4 100 mm Hg

3 - 80 mm Hg Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120 + 2 x 60)/3 which is equal to (120 + 120)/3 = 80 mm Hg.

A patient dies of irreversible brain injury. The nurse recognizes that which assessments must be performed to determine the suitability of harvesting the heart for cardiac transplantation? Select all that apply. 1 Gram stain 2 Bronchoscopy 3 ABO blood type 4 Body size and heart size 5 Human leukocyte antigen typing 6 Panel of reactive antibody (PRA) level

3 - ABO blood type 4 - Body size and heart size 5 - Human leukocyte antigen typing 6 - Panel of reactive antibody (PRA) level In order to avoid complications after cardiac transplantation, a careful selection of the donor's heart must be performed. The donor's organ must fulfill certain matching criteria with the recipient. These assessments include: ABO blood type, body size, heart size, human leukocyte antigen, and panel antibody reactive level. Gram stain and bronchoscopy findings are the matching criteria to be fulfilled for lung transplantation.

The nurse observes another health care provider taking the blood pressure (BP) of an older patient. The cuff is inflated to 180 mm Hg. The care provider records the systolic blood pressure (SBP) as 180 mm Hg. The nurse recognizes that the reading is inaccurate based on what understanding of BP measurements in older adults? 1 An older patient's SBP is typically at or below 140 mm Hg. That's high. 2 The older patient is more prone to anxiety, which can alter the SBP reading. 3 An auscultatory gap may be present. The older patient's SBP was underestimated. 4 The wrong size cuff was used. A cuff that fit the older patient's arms more snugly should have been obtained.

3 - An auscultatory gap may be present. The older patient's SBP was underestimated. Careful technique is important in assessing blood pressure in older adults. Some older people have a wide gap between the first Korotkoff sound and subsequent beats. This is called the auscultatory gap. Failure to inflate the cuff high enough may result in underestimating systolic blood pressure (SBP). There is no information provided that the wrong size cuff was used or that the patient was anxious. Gerentologic changes in the older population often place the patient at risk for hypertension.

The nurse assesses a thready pulse in a patient with cardiovascular disease and recognizes that the finding may indicate the presence of what conditions? Select all that apply. 1 Hyperthyroidism 2 Hyperkinetic states 3 Aortic valve disease 4 Cardiac dysrhythmias 5 Peripheral arterial disease

3 - Aortic valve disease 5 - Peripheral arterial disease A thready pulse is a weak, slowly rising pulse observed in patients with aortic valve disease and peripheral arterial disease. Hyperthyroidism and hyperkinetic states are associated with a bounding pulse. An irregular pulse is observed in patients with cardiac dysrhythmias.

While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect? 1 Aortic valve stenosis 2 Mitral valve stenosis 3 Aortic valve regurgitation 4 Mitral valve regurgitation

3 - Aortic valve regurgitation A quick, strong beat that collapses immediately is known as water-hammer pulse. Water-hammer pulse, dyspnea, and chest pain due to trauma indicate aortic regurgitation (AR). Aortic stenosis (AS) is characterized by angina, exertional dyspnea, syncope, and left ventricular failure. Mitral valve stenosis involves exertional dyspnea, hoarseness, hemoptysis, chest pain, and seizures. Mitral valve regurgitation is associated with weakness, fatigue, palpitations, and dyspnea.

A patient with cardiovascular disease is diagnosed with venous thromboembolism. What assessment finding does the nurse expect? 1 Abnormal capillary refill 2 Unusually warm extremities 3 Asymmetry in limb circumference 4 Pitting edema of lower extremities

3 - Asymmetry in limb circumference Venous thrombosis is the formation of clots and most commonly occurs in the pelvis or lower extremity—that is, in the deep veins of the legs. This condition results in asymmetry in limb circumference. Possible reduced arterial capillary perfusion and anemia cause abnormal capillary refill. Thyrotoxicosis results in unusually warm extremities. Interruption of venous return to the heart and right-sided heart failure are associated with pitting edema of the lower extremities.

A patient is scheduled for a dose of metoprolol. The nurse should withhold the medication and consult the health care provider after noting which assessment finding? 1 Migraine headache 2 Pitting edema of +1 3 Blood sugar 217 mg/dL 4 Pulse 112 beats/minute

3 - Blood sugar 217 mg/dL Metoprolol is a β-adrenergic-blocking agent that reduces blood pressure. It should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia and may adversely affect glucose metabolism. Metoprolol will not worsen migraine, will decrease the elevated pulse rate, and may help with decreasing edema.

The nurse assesses the vital signs of a patient and should use which artery to check the blood pressure? 1 Radial 2 Carotid 3 Brachial 4 Femoral

3 - Brachial Blood pressure is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking blood pressure is the brachial artery. This artery is on the arm near the elbow. The radial artery is on the wrist. The carotid artery is in the neck region, and the femoral artery is around the groin. Any other site other than the brachial artery is not suitable for checking blood pressure with a sphygmomanometer.

The nurse recognizes that which blood component is a marker of inflammation in a patient with cardiovascular disease? 1 Myoglobin 2 NT-Pro-BNP 3 C-reactive protein (CRP) 4 B-type natriuretic peptide (BNP)

3 - C-reactive protein (CRP) C-reactive protein (CRP) is a marker of inflammation that can predict the risk of cardiac events and cardiac diseases. Myoglobin is a low-molecular-weight protein that is sensitive to myocardial injury. NT-Pro-BNP helps in assessing the severity of heart failure. B-type natriuretic peptide (BNP) is a peptide that causes natriuresis and its elevation distinguishes a cardiac versus respiratory cause of dyspnea.

The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication? 1 Nitrate 2 Positive inotrope 3 Calcium channel blocker 4 Angiotensin-converting enzyme (ACE) inhibitor

3 - Calcium channel blocker Atrial dysrhythmia is an irregular heartbeat that occurs in the atrium. Calcium channel blockers dilate arteries by reducing calcium flux into the cells, which increases myocardial oxygen supply and prevents atrial dysrhythmias. Nitrates and ACE inhibitors are vasodilators that are used in the treatment of heart failure. Positive inotropes are used to treat heart failure in patients with valvular heart disease.

The nurse is caring for a patient with ventricular hypertrophy and expects what assessment finding? 1 Hypotension 2 Increased cardiac output 3 Cardiac output of 4 L/min/m2 4 Increased size of the heart chambers

3 - Cardiac output of 4 L/min/m2 The patient with ventricular hypertrophy has an enlargement of the heart muscle without an increase in cardiac output (CO) or the size of the chambers. If the arterial blood pressure (BP) is elevated, the ventricles meet increased resistance to ejection of blood, thus increasing the work demand of the heart, causing the muscles of the heart to enlarge. The enlargement occurs without increase in the size of the chambers. The patient experiences elevated blood pressure. The normal CO is 2.8 to 4.2 L/min/m2.

A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). The nurse recognizes that this type of medication benefits patients with HF because it blocks what action? 1 Secretion of aldosterone 2 Conversion of pro-renin to renin 3 Conversion of angiotensin I to angiotensin II 4 Conversion of angiotensinogen to angiotensin I

3 - Conversion of angiotensin I to angiotensin II When renal blood flow is reduced, the juxtaglomerular cells secrete renin into circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the angiotensin-converting enzyme found in the lungs. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases blood pressure.

A patient with an inflammation of the pericardial sac secondary to systemic lupus erythematosus (SLE). The nurse anticipates that which therapy will be prescribed? 1 Salicylate therapy 2 Antibiotic therapy 3 Corticosteroid therapy 4 Nonsteroidal antiinflammatory drug (NSAIDs) therapy

3 - Corticosteroid therapy Inflammation of the pericardial sac indicates pericarditis; corticosteroid therapy is reserved for patients with pericarditis secondary to systemic lupus erythematosus (SLE). Salicylate therapy is beneficial to patients with rheumatic fever. Antibiotic therapy is used in the treatment of bacterial pericarditis. Nonsteroidal antiinflammatory drug (NSAIDs) therapy is used to control pain and inflammation in patients with pericarditis.

When reviewing the electrocardiogram (ECG) of a patient, the nurse recalls that the QRS complex recorded on the ECG represents which part of the heart's beat? 1 Depolarization of the atria 2 Repolarization of the ventricles 3 Depolarization from the atrioventricular (AV) node throughout the ventricles 4 The length of time it takes for the impulse to travel from the atria to the ventricles

3 - Depolarization from the atrioventricular (AV) node throughout the ventricles The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.

What does the QRS complex represent in an electrocardiogram? 1 Depolarization of the atria 2 Repolarization of the ventricles 3 Depolarization of both ventricles 4 Repolarization of the Purkinje fibers

3 - Depolarization of both ventricles An electrocardiogram is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. Time taken for depolarization of both the ventricles is represented by the QRS interval. Depolarization of the atria is represented by the P wave. The T wave in the electrocardiogram should be upright, and it represents time for ventricular repolarization. If present, the U wave indicates the repolarization of the Purkinje fibers.

A patient with valvular heart disease is hospitalized. The nurse anticipates a prescription for which diagnostic tests that monitor heart disease progression? Select all that apply. 1 Chest x-ray 2 Electrocardiogram (ECG) 3 Doppler color-flow imaging 4 Real-time 3-D echocardiography 5 Transesophageal echocardiography

3 - Doppler color-flow imaging 5 - Transesophageal echocardiography Transesophageal echocardiography and Doppler color-flow imaging help to diagnose and monitor progression of valvular disease. A chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Real-time 3-D echocardiography helps to assess mitral valve and congenital heart diseases. An ECG identifies heart rate, rhythm, and any ischemia or ventricular hypertrophy.

The nurse reviews a patient's medication profile and recognizes that which medication is a potential cause of the patient's cardiomyopathy? 1 Ibuprofen 2 Prednisone 3 Doxorubicin 4 Chlorpromazine

3 - Doxorubicin Doxorubicin is an anticancer medication that results in cardiomyopathy. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that results in hypertension, myocardial infarction, and stroke. Prednisone is a corticosteroid that causes hypotension, edema, and potassium depletion. Chlorpromazine is an antipsychotic medication that results in dysrhythmias and orthostatic hypotension.

The nurse reviews the medical record of a patient with dilated cardiomyopathy. What findings are expected in the diagnostic reports? Select all that apply. 1 Normal chest x-ray 2 Decreased serum levels of b-type natriuretic peptide (BNP) 3 Electrocardiogram (ECG) that reveals conduction disturbances 4 Multiple gated acquisition (MUGA) nuclear scan that reveals a decreased ejection fraction (EF) 5 Elevated serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels

3 - Electrocardiogram (ECG) that reveals conduction disturbances 4 - Multiple gated acquisition (MUGA) nuclear scan that reveals a decreased ejection fraction (EF) A MUGA scan determines EF. Dilated CMP results in ventricular dilation, impaired systolic function, atrial enlargement, and stasis of blood in the left ventricle. The result is decreased EF. ECG of patients with dilated cardiomyopathy will show tachycardia, bradycardia, and dysrhythmias with conduction disturbances. Chest x-ray shows cardiomegaly with signs of pulmonary venous hypertension and pleural effusion. The serum level of BNP is elevated in case of dilated cardiomyopathy. SGOT and SGPT are liver enzymes and are not associated with dilated cardiac myopathy.

An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse caring for the patient understands that this condition has occurred as a result of a chronic condition. What could be the cause of the cardiac dilation? 1 Increased heart rate 2 Increased muscle thickness 3 Elevated pressure in the ventricles 4 Increased release of catecholamine

3 - Elevated pressure in the ventricles Cardiac dilation is an enlargement of the heart chambers, usually the ventricles; it occurs when pressure in the heart chambers is elevated over time. Hypertrophy is an increase in the muscle mass and thickness of the cardiac wall in response to overwork and strain. When the sympathetic nervous system activation is increased, there is an increased release of catecholamines, which results in an increased heart rate.

While assessing a patient with cardiovascular disease who is sitting at a 45-degree angle, the nurse observes distended neck veins. What reason does the nurse suspect behind this finding? 1 Vasoconstriction 2 Poor venous return 3 Elevated right atrial pressure 4 Incompetent valves in the veins

3 - Elevated right atrial pressure Bulging of the external jugular vein is known as jugular vein distention. When the arterial pressure in the right atrium increases, the pressure in the jugular vein increases; this results in distention of the veins. Vasoconstriction causes peripheral cyanosis. Poor venous return causes ulcers. Incompetent valves in veins lead to varicose veins.

A patient with a history of cardiovascular disease reports symptoms of erectile dysfunction (ED). The patient tells the nurse, "I am really frustrated and embarrassed." How should the nurse respond? Select all that apply. 1 Educate the patient on medications to treat ED. 2 Ask the patient about his normal sexual habits and routine. 3 Explain that ED may be a symptom of peripheral vascular disease. 4 Validate the patient's feelings, and ask a male colleague to complete the assessment. 5 Review the patient's medications and explain that ED can be a side effect of a cardiac drug.

3 - Explain that ED may be a symptom of peripheral vascular disease. 5 - Review the patient's medications and explain that ED can be a side effect of a cardiac drug. ED may be a symptom of peripheral vascular disease, or it can be a side effect of a cardiac medication, such as a beta-blocker or a diuretic. A full cardiovascular assessment should be performed prior to making assumptions about medication therapy, particularly when medications for ED are contraindicated if the patient is also taking a nitrate. A history of the patient's sexual routine is important to cardiac assessment, as there are many symptoms of cardiac conditions that could impede sexual activity, such as shortness of breath or chest pain. However, taking this history should wait until the nurse has explained the connection between ED and vascular disease. Validating the patient's frustrations may help diffuse the situation after the link has been explained. It is not necessary to have a male colleague complete the assessment.

An elderly patient presents to a clinic for a routine physical examination. The nurse reviews the patient's medical record and notes a progressive increase in systolic blood pressure (SBP). What action should the nurse take? 1 Alert the healthcare provider immediately. 2 Ask the patient about any recent symptoms of dizziness. 3 Explain to the patient that this is a normal age-related change. 4 Inform the patient that an antihypertensive medication will be prescribed.

3 - Explain to the patient that this is a normal age-related change. As adults age, arterial stiffening from loss of elastin in arterial walls can cause thickening of arteries and progressive fibrosis which may have the downstream effect of causing increased systolic BP and a decrease or no change in diastolic BP. Thus an increase in pulse pressure is found. The nurse may explain to the patient that this is a normal age-related change. There is no need to alert the healthcare provider immediately, as this is not a life-threatening emergency. It may be prudent to assess for dizziness during cardiac evaluation, as orthostatic hypotension is common in the older adult. There is insufficient data to determine if an antihypertensive medication is needed.

What assessment findings does the nurse expect when caring for a patient with mitral valve stenosis? Select all that apply. 1 Syncope 2 Orthopnea 3 Palpitations 4 Atrial fibrillation 5 Exertional dyspnea

3 - Palpitations 4 - Atrial fibrillation 5 - Exertional dyspnea The overloaded left atrium places the patient at risk for atrial fibrillation. Dyspnea on exertion and palpitations may also occur. Orthopnea occurs with aortic valve regurgitation. Syncope occurs with mitral valve prolapse.

A patient with a high triglyceride level takes an over-the-counter fish oil tablet every day. What risk factor should the nurse inform the patient about with the use of fish oil? 1 Fish oil may increase prostate-specific antigen (PSA) levels. 2 Fish oil may decrease blood pressure. 3 Fish oil may increase the risk of bleeding. 4 Fish oil may decrease blood sugar levels.

3 - Fish oil may increase the risk of bleeding. Fish oil is used for hypertriglyceridemia and hypertension. However, patients should be informed that the use of fish oil may increase the risk of bleeding, and the patient should be observant for related signs and symptoms. Fish oil may increase blood sugar levels. It does not have any effect on prostate cancer or blood pressure levels.

Which medication is prescribed to decrease preload in patients with dilated cardiomyopathy? 1 Captopril 2 Metoprolol 3 Furosemide 4 Spironolactone

3 - Furosemide Furosemide is a diuretic that decreases preload in patients with dilated cardiomyopathy. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that reduces afterload. Metoprolol is an adrenergic blocker that controls neurohormonal stimulation in patients with heart failure. Spironolactone is a diuretic that controls neurohormonal stimulation in patients with heart failure.

The nurse recognizes that interventions for a patient with dilated cardiomyopathy focus on controlling heart failure (HF). Which medications are prescribed decrease preload, to assist with this goal? Select all that apply. 1 Captopril 2 Metoprolol 3 Furosemide 4 Nitroglycerin 5 Spironolactone

3 - Furosemide 4 - Nitroglycerin Nitroglycerin and furosemide decrease preload. Captopril reduces afterload. Metoprolol and spironolactone control the neurohormonal stimulation that occurs with HF.

While reviewing the medical record of a patient with cardiovascular disease, the nurse notes the presence of thrombi. The nurse suspects which blood component to be the cause of the condition? 1 Myoglobin 2 Cholesterol 3 Homocysteine 4 Lipoprotein(a)

3 - Homocysteine Homocysteine is an amino acid produced during protein catabolism. Homocysteine may cause damage to the endothelium and lead to the formation of thrombi. Myoglobin is a low-molecular-weight protein associated with myocardial injury. Cholesterol is a serum lipid component, which is a risk factor for cardiovascular disease. Increased levels of lipoprotein(a), which is a serum lipid component, result in stroke and premature coronary artery disease.

Which defect is present with tetralogy of Fallot? 1 Coarctation of the aorta 2 Patent ductus arteriosus 3 Hypertrophy of the right ventricle 4 Transportation of the great arteries

3 - Hypertrophy of the right ventricle Tetralogy of Fallot has four characteristics: ventricular septal defect, positioning of the aorta over the defect, pulmonary stenosis, and hypertrophy of the right ventricle. Patent ductus arteriosus is a result of the failure of the ductus arteriosus to close after birth. Blood flow is impeded, though this constricted area of the aorta is not a characteristic of tetralogy of Fallot. In transportation of the great arteries, the positions of the aorta and pulmonary artery are reversed.

A patient that is diagnosed with heart failure experiences fatigue. The nurse suspects that the fatigue is caused by what? 1 Increased cardiac output 2 Increased hemoglobin levels 3 Impaired perfusion to vital organs 4 Increased oxygenation of the tissues

3 - Impaired perfusion to vital organs Fatigue is one of the early signs of heart failure. Due to heart failure, there is inadequate blood circulation, leading to decreased perfusion to the vital organs. An impaired functioning of the vital organs may lead to fatigue. Cardiac output decreases in heart failure, depriving the body tissues of oxygen and nutrients, leading to fatigue. Inadequate blood supply results in inadequate oxygenation of the tissue and causes fatigue when the oxygen demands are not met. Hemoglobin levels are low in heart failure, leading to anemia. A decreased oxygen-carrying capacity of the blood also results in fatigue.

The nurse is educating a patient about diastolic failure and should include what characteristic feature? 1 High pulmonary pressures 2 Decrease in ejection fraction (EF) 3 Inability of the ventricles to relax and fill 4 Inability of the ventricles to pump blood effectively

3 - Inability of the ventricles to relax and fill Diastolic failure is the inability to relax and fill the ventricles during diastole. Systolic failure is the inability of the heart to pump blood effectively. Patients with mixed systolic and diastolic failure experience high pulmonary pressures. The EF is normal with diastolic failure.

A patient with hypertension receives a prescription for lisinopril. The nurse recognizes that it is appropriate for the patient because the medication has what mechanism of action? 1 Blocks α-adrenergic effects 2 Relaxes arterial and venous smooth muscle 3 Inhibits conversion of angiotensin I to angiotensin II 4 Reduces sympathetic outflow from the central nervous system (CNS)

3 - Inhibits conversion of angiotensin I to angiotensin II Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and blood pressure (BP).

The nurse is caring for a patient with worsening heart failure (HF) that is hemodynamically unstable. What is likely to be included in the patient's treatment plan to increase coronary blood flow to the heart muscle? 1 Vasodilators 2 Ultrafiltration 3 Intraaortic balloon pump (IABP) 4 Ventricular assist device (VAD)

3 - Intraaortic balloon pump (IABP) The IABP is a device that increases coronary blood flow to the heart muscle and decreases the heart's workload through a process called counterpulsation. Vasodilators improve the coronary artery circulation by dilating the coronary arteries. Ultrafiltration is the process of removing excess salt and water from the patient's blood. Ventricular assist devices (VADs) are used to maintain the pumping action of the blood, because the contracting ability of the heart decreases, thereby affecting its ability to function.

The nurse expects what assessment finding in a patient diagnosed with acute pericarditis? 1 Pulsus paradoxus 2 Muffled heart sounds 3 Pericardial friction rub 4 Narrowed pulse pressure

3 - Pericardial friction rub The hallmark finding in acute pericarditis is a pericardial friction rub. Muffled heart sounds, pulsus paradoxus, and a narrowed pulse pressure are findings associated with cardiac tamponade, not acute pericarditis.

After assessing a patient with rheumatic fever, the nurse documents Sydenham's chorea in the patient's medical record. Which assessment finding led the nurse to document this condition? 1 Inflammation of the joints 2 Red or purple pea-sized lesions on the toes 3 Involuntary movements of the face and limbs 4 Bright pink, nonpruritic, maplike macular lesions on the trunk

3 - Involuntary movements of the face and limbs Sydenham's chorea is a major manifestation of rheumatic fever; it is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Inflammation of the joints indicates monoarthritis or polyarthritis. Osler's nodes are red or purple pea-sized lesions on the toes observed in patients with infective endocarditis. Bright pink, nonpruritic, maplike macular lesions on the trunk indicate subacute nodules in patients with rheumatic fever.

While assessing a patient with cardiovascular disorder, the nurse observes flat, small, painless, red spots on the soles of the feet and palms of the hands. The nurse recognizes that the findings meet the definition of what condition? 1 Roth's spots 2 Osler's nodes 3 Janeway's lesions 4 Splinter hemorrhages

3 - Janeway's lesions Flat, small, painless, red spots on the soles and palms indicate Janeway's lesions, which are observed in patients with infective endocarditis. Roth's spots are hemorrhagic lesions on the retina. Osler's nodes are painful, tender, purple or red pea-size lesions observed on the toes and fingertips of patients with infective endocarditis. Splinter hemorrhages are black longitudinal streaks that occur in the nail beds of patients with infective endocarditis.

A patient presents to the emergency department with a sudden rise in blood pressure (BP) and a severe headache. The patient receives a prescription for IV labetalol. The nurse recognizes that what precaution should be taken while administering the medication? 1 Maintaining seizure precautions 2 Monitoring for severe tachycardia 3 Keeping the patient supine during the administration 4 Taking the patient's blood pressure every 5 minutes

3 - Keeping the patient supine during the administration The patient is experiencing hypertensive crisis. Labetalol is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. Patients must be kept supine during IV administration due to severe orthostatic hypotension that occurs with the medication. The BP should be assessed every 2 to 3 minutes during the initial administration of the drug. Seizure activity is not an adverse effect of the medication. The medication will decrease the heart rate.

A nurse is caring for a patient with pleural effusion who is not responding to conventional medical treatment. Assessment findings include S3 and S4 heart sounds, crackles, and an increased heart rate. Which condition is most likely affecting the patient? 1 Cor pulmonale 2 Pulmonary edema 3 Left-sided heart failure 4 Right-sided heart failure

3 - Left-sided heart failure Manifestations of left-sided heart failure include pleural effusion, S 3 and S 4 heart sounds, crackles, and increased heart rate. These symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided heart failure causes edema, murmurs, and jugular vein distention. Pulmonary edema manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin.

A patient with infective endocarditis is admitted to the health care facility. The nurse is aware that primary lesions of infective endocarditis can cause emboli. Which organ may be affected by the process of embolization due to right-sided heart lesions? 1 Brain 2 Spleen 3 Lungs 4 Liver

3 - Lungs Right-sided heart lesions move to the lungs, resulting in pulmonary emboli. Systemic embolization occurs from left-sided heart lesions moving to the brain, spleen, liver, and kidneys.

The nurse is preparing a discharge teaching plan for a patient admitted with restrictive cardiomyopathy. Which instruction should the nurse include in the plan? 1 Follow a normal sodium diet. 2 Drink three to four glasses of water daily. 3 Maintain a reasonable weight and avoid large meals. 4 Report signs of heart failure to the health care provider, which include weight loss.

3 - Maintain a reasonable weight and avoid large meals. The patient should maintain a reasonable weight and avoid large meals. The patient should follow a low-sodium diet and read all product labels for sodium content. The patient should drink six to eight glasses of water a day unless fluids are restricted. Weight gain is a sign of heart failure.

A child with heart failure is prescribed digoxin (Lanoxin) to improve myocardial function. What precaution does the nurse take after administering the drug? 1 Takes apical pulse rate 2 Ensures complete bed rest 3 Observes for signs of toxicity 4 Provides sodium-restricted diet

3 - Observes for signs of toxicity Digoxin has narrow therapeutic range and so the patient who is administered digoxin is at risk for toxicity. The nurse takes apical pulse rate before administering the drug. Ensuring bed rest is a precaution taken for the general health promotion of the patient and not to counter digoxin toxicity. Sodium-restricted diet is provided to control heart failure.

What does nursing care of the infant or child with congestive heart failure include? 1 Forcing fluids appropriate to age 2 Monitoring respirations during active periods 3 Organizing activities to allow for uninterrupted sleep 4 Giving larger feedings less often to conserve energy

3 - Organizing activities to allow for uninterrupted sleep The nurse must organize care to facilitate a decrease in the child's energy expenditure. The child who has congestive heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The child often cannot tolerate larger feedings.

While assessing the cardiovascular status of a patient, what technique should the nurse use to assess for the presence of a pulse deficit? 1 Position the patient supine 2 Ask the patient to hold his or her breath 3 Palpate the radial pulse while auscultating the apical pulse 4 Use the bell of the stethoscope when auscultating S1 and S2

3 - Palpate the radial pulse while auscultating the apical pulse To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.

The nurse is providing care to a school-age child with heart failure. What does the nurse include in the child's plan of care? Select all that apply. 1 Teach the child how to take medications 2 Allow the child to go to the play area often 3 Provide the child with frequent rest periods 4 Prepare the child for prescribed procedures 5 Explain the disease process in simple terms

3 - Provide the child with frequent rest periods 4 - Prepare the child for prescribed procedures 5 - Explain the disease process in simple terms The nurse explains the disease to the child in simple terms so that the child understands the condition. The nurse prepares the child for prescribed procedures to relieve the child's anxiety about the treatment or procedures. The nurse ensures that the child takes adequate rest so that the child is not stressed out or fatigued. The nurse does not take the child to the play area but engages the child in quiet activities to prevent fatigue. The nurse does not teach the child to take medications, to prevent the risk of medication error.

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. The nurse identifies that what intervention will increase the percentage of O2 in inspired air and is effective in decreasing preload? 1 Providing O2 at 2-4 liters/NC 2 Placing the patient in Trendelenburg position 3 Providing bilevel positive airway pressure (BiPAP) 4 Advising the patient to take physical and emotional rest

3 - Providing bilevel positive airway pressure (BiPAP) In severe pulmonary edema, the patient may need noninvasive positive pressure ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective in decreasing preload. When a patient has dyspnea, the patient should be placed in high Fowler's position. Oxygen therapy delivered at 2-4 liters/minute via nasal cannula will not be adequate for a patient experiencing severe pulmonary edema. Taking physical and emotional rest helps in conserving energy; it does not increase the percentage of inspired O2, and it does not decrease preload.

The nurse is caring for a patient with left-sided heart failure and expects what assessment finding? 1 Hepatomegaly 2 Splenomegaly 3 Pulmonary congestion 4 Vascular congestion of gastrointestinal tract

3 - Pulmonary congestion Left-sided heart failure results from left ventricular dysfunction; this is manifested as pulmonary congestion and edema. Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema.

A nurse reviews the medical record of a patient with pulmonary embolism and notes the presence of cor pulmonale. The nurse recalls that this refers to a disorder of the heart that is caused by what? 1 Liver disease 2 Renal disease 3 Pulmonary disease 4 Preexisting heart disease

3 - Pulmonary disease Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart diseases.

Which diagnostic study is used to assess congenital heart disease in a patient? 1 Chest x-ray 2 Doppler color-flow imaging 3 Real time 3-D echocardiography 4 Computerized tomography scan

3 - Real time 3-D echocardiography Real-time 3-D echocardiography is used to assess mitral valve defects and congenital heart disease. Chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Doppler color-flow imaging and transesophageal echocardiography help diagnose and monitor valvular heart disease progression. Computerized tomography scan with contrast gold helps diagnose aortic disorders.

Which diagnostic study is used to diagnose mitral valve prolapse? 1 Electrocardiogram 2 Cardiac catheterization 3 Real-time 3-D echocardiography 4 CT scan of the chest with contrast

3 - Real-time 3-D echocardiography Echocardiogram is the diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. Echocardiogram is used to monitor progression of valvular heart disease. A CT scan of the chest with contrast is the gold standard for evaluating aortic disorders. An electrocardiogram is used to identify heart rate, rhythm, ischemia, or ventricular hypertrophy. Cardiac catheterization is used to detect pressure changes in the cardiac chambers.

The nurse providing dietary instruction to a patient with hypertension should advise the patient to reduce the intake of which foods? Select all that apply. 1 Nuts 2 Poultry 3 Red meat 4 Canned soup 5 Frozen dinners

3 - Red meat 4 - Canned soup 5 - Frozen dinners Foods high in fat and sodium, including canned soup, red meat, and frozen dinners, should be avoided by the patient with hypertension. Nuts and poultry are included in the Dietary Approaches to Stop Hypertension (DASH) eating plan.

The nurse observes blanching of a patient's nail beds for two seconds after release of pressure. Which does the nurse recognize as the potential cause of the assessment finding? 1 Thyrotoxicosis 2 Intermittent claudication 3 Reduced arterial capillary perfusion 4 Interruption of venous return to heart

3 - Reduced arterial capillary perfusion Reduced arterial capillary perfusion results in a decreased amount of oxygen supply to body parts, which results in blanching of nail beds for two seconds after release of pressure. Hands and feet that are warmer than normal indicate thyrotoxicosis. When the hands and feet are cold to the touch, it indicates intermittent claudication. Visible finger pitting on application of firm pressure indicates interruption of venous return to the heart.

The nurse is reviewing basic electrocardiogram (ECG) interpretation. The T wave represents which action? 1 Hypokalemia 2 Depolarization of the atria 3 Repolarization of the ventricles 4 Repolarization of the Purkinje fibers

3 - Repolarization of the ventricles On an ECG, the T wave represents repolarization of the ventricles. Depolarization of the atria is represented by the P wave. The U wave, if present, can represent either repolarization of the Purkinje fibers or hypokalemia.

A patient in heart failure experiences a neurohormonal response of the renin-angiotensin-aldosterone system (RAAS). What does this response trigger? 1 Vasodilation 2 Decreased cardiac output 3 Retention of sodium and water 4 Decreased release of the antidiuretic hormone (ADH)

3 - Retention of sodium and water When activated repeatedly, the RAAS triggers retention of fluid and sodium. It causes vasoconstriction to increase blood pressure, not vasodilation. Cardiac output is increased, not decreased, and ADH release is increased, not decreased.

The nurse is assessing a patient diagnosed with pericarditis. Which characteristics of chest pain might be noted in this patient? Select all that apply. 1 Pain is reduced by lying down. 2 Pain worsens with deep exhalation. 3 Severe, sharp pain is felt in the chest. 4 Pain may radiate to the neck, arms, or left shoulder. 5 Rapid, shallow breathing helps to avoid the chest pain.

3 - Severe, sharp pain is felt in the chest. 4 - Pain may radiate to the neck, arms, or left shoulder. 5 - Rapid, shallow breathing helps to avoid the chest pain. Pain related to pericarditis can be described as a severe, sharp pain in the chest that may radiate to the neck, arms, or left shoulder. Patients with pericarditis usually have a rapid, shallow breathing pattern because this helps them to avoid chest pain. The chest pain is aggravated by lying down and is relieved with an erect posture. Chest pain worsens with deep inspiration.

What initiates the action potential in the heart? 1 Bundle of His 2 Purkinje fibers 3 Sinoatrial node 4 Left bundle branch

3 - Sinoatrial node The sinoatrial node is called the pacemaker of the heart, and it initiates the electrical impulse, or action potential, in the heart. By way of the Purkinje fibers, the action potential moves through the walls of ventricles, but it is not initiated at this point. The action potential moves from the atrioventricular node through the bundle of His and the right and left bundle branches, but it is not initiated at these points.

A patient that is hospitalized with acute pericarditis reports severe, sharp chest pain. To increase patient comfort, the nurse should encourage the patient to assume which position? 1 Flat on back 2 Semi-Fowler's 3 Sit up and lean forward 4 Lie down and bend knees

3 - Sit up and lean forward Chest pain associated with acute pericarditis often is relieved when the patient sits up and leans forward. Lying supine makes the pain worse. The semi-Fowler's position and lying down with the knees bent do not relieve chest pain associated with acute pericarditis.

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. What is the position automatically assumed by the child? 1 Prone 2 Supine 3 Squatting 4 Low-Fowler's

3 - Squatting The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate. Low-Fowler's would assist with respiratory issues but would not assist with the need for cardiac compensation. A prone or supine position does not offer any advantage to the child.

The nurse assesses a patient with anxiety and expects which type of pulse? 1 Thready 2 Irregular 3 Tachycardia 4 Pulsus alternans

3 - Tachycardia Tachycardia is associated with anxiety due to increased adrenaline. A thready pulse is associated with peripheral arterial disease, aortic valve disease, and decreased cardiac output. The pulse is irregular in patients with cardiac dysrhythmias. Pulsus alternans is observed in patients with heart failure and cardiac tamponade.

The nurse cares for a patient with infective endocarditis (IE) and expects what assessment findings? Select all that apply. 1 Bradycardia 2 Bradypnea 3 Tachycardia 4 Peripheral edema 5 Retinal hemorrhages

3 - Tachycardia 4 - Peripheral edema 5 - Retinal hemorrhages Assessment findings in a patient with infective endocarditis may include peripheral edema, retinal hemorrhage, and tachycardia. Bradycardia is not a symptom of IE, and the patient will experience tachypnea, not bradypnea.

The ECG (electrocardiogram) of a postmenopausal woman reporting chest pain reveals an elevated ST segment, and the laboratory test reports indicate elevated cardiac biomarkers. Which condition does the nurse suspect? 1 Dilated cardiomyopathy 2 Restrictive cardiomyopathy 3 Takotsubo cardiomyopathy 4 Hypertrophic cardiomyopathy

3 - Takotsubo cardiomyopathy Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome and is commonly observed in postmenopausal women. Dilated cardiomyopathy is characterized by reduced capacity to exercise, dyspnea at rest, and orthopnea. Restrictive cardiomyopathy involves orthopnea, angina, palpitations, and syncope. Hypertrophic is characterized by fatigue, exertional dyspnea, syncope, and angina.

The nurse observes a bluish tinge around the ears of a patient with cardiovascular disease. What does the nurse suspect is the likely reason behind the assessment finding? 1 Diabetes 2 Endocarditis 3 Vasoconstriction 4 Venous thromboembolism

3 - Vasoconstriction A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels due to the contraction of muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of nail beds. Venous thromboembolism results in asymmetry in limb circumference.

The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which type of medication does the nurse expect will be prescribed? 1 Statin 2 Nitrate 3 β-blocker 4 Anti-ischemic

3 - β-blocker Palpitations are fast, hard, and irregular heartbeats. Propranolol is an example of a β-blocker that slows the heart rate by acting on the β-adrenergic receptors located on the heart cells. A statin, such as atorvastatin, is used primarily to treat elevated blood cholesterol levels and reduce the risk of cardiovascular disease. An anti-ischemic medication, such as trimetazidine, improves glucose control and improves cardiac function in dilated cardiomyopathy. A nitrate, such as isosorbide dinitrate, is used to prevent angina attacks by dilating blood vessels.

The blood pressure of a patient is 90/60 mm Hg. What should the nurse document as the patient's pulse pressure? Record the answer using a whole number. ________ mm Hg

30 The difference between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) is the pulse pressure. The patient's systolic blood pressure is 90, and the diastolic blood pressure is 60; therefore the pulse pressure is 90 - 60 = 30 mm Hg.

The nurse is measuring a patient's pulsus paradoxus. The first Korotkoff sound during expiration is noted at 115 mm Hg, and the reading at which sounds are heard throughout the respiratory cycle is noted at 84 mm Hg. What is the amount of paradoxus? Record the answer using a whole number.

31 The difference between the pressure at which the first Korotkoff sound during expiration is noted and the pressure at which sound throughout the respiratory cycle is noted is the amount of paradoxus (115 mm Hg - 84 mm Hg = 31 mm Hg).

A parent of a child with a heart defect tells the nurse, "I learned on a medical website that my child's heart condition will never improve." What is the nurse's best response? 1 "This information does not apply to your child." 2 "Discuss this information in your parent groups." 3 "You shouldn't read too much about the disease." 4 "As the validity of a website cannot be assumed, it would be better to clarify this information with your primary health care provider."

4 - "As the validity of a website cannot be assumed, it would be better to clarify this information with your primary health care provider." The nurse should be aware that all information obtained on a medical website may not be valid or reliable, therefore this information should be conveyed to the parents and then a further clarification discussion can be arranged with their primary health care provider. The nurse does not discourage the parent from learning about the child's disease from any sources. Saying that the information does not apply to the child is not adequate. The parent needs to be told in detail why it does not apply to the child. The nurse does not advise the parent to discuss it in the parent groups, but requests to discuss it with qualified personnel like the primary health care provider so that the parent receives accurate information. With regard to NCLEX, the test framework is based on the RN being able to handle clinical situations unless there is a medical emergency. This option negates the importance of that nursing role to be able to handle a situation by referring to the health care provider.

The nurse provides education to a patient with infective endocarditis related to home care management. Which statement made by the patient indicates the need for further teaching? 1 "I should wear elastic compression stockings." 2 "I should cough and deep breathe every two hours." 3 "I should perform range-of-motion exercises daily." 4 "I should be aware that fever and fatigue are normal."

4 - "I should be aware that fever and fatigue are normal." A patient with infective endocarditis should not consider fever and fatigue as normal and should notify the primary health care provider if these symptoms persist. The patient should cough every two hours and wear elastic compression stockings to prevent the complications of immobility. Patients with infective endocarditis should perform range-of-motion exercises to reduce problems related to reduced mobility.

The nurse provides education to a patient that is scheduled for a transesophageal echocardiogram (TEE). Which statement made by the patient indicates the need for more instruction? 1 "I will need to remove my dentures before the test." 2 "My spouse will drive me home after the test is completed." 3 "I can't eat or drink anything for six hours before this test." 4 "I will be able to have lunch as soon as the test is finished"

4 - "I will be able to have lunch as soon as the test is finished" Patient instructions for a transesophageal echocardiogram (TEE) include remaining nothing by mouth (NPO) for at least six hours before the test, removing dentures, and having a designated driver if the patient has the test as an outpatient. The patient may not eat or drink until the gag reflex has returned.

During a physical examination of a patient, where should a nurse auscultate for the aortic area? 1 5th intercostal space to the left of the sternum 2 2nd intercostal space to the left of the sternum 3 5th intercostal space to the right of the sternum 4 2nd intercostal space to the right of the sternum

4 - 2nd intercostal space to the right of the sternum The surface anatomy for the aortic area is in the second intercostal space to the right of the sternum. The pulmonic area is in the second aortic area to the left of the sternum. The tricuspid area is in the fifth left intercostal space. No auscultation is performed in the fifth right intercostal space.

The nurse is caring for a patient developing pulmonary edema. What respiratory rate does the nurse anticipate when assessing this patient? 1 10 to 14 breaths/minute 2 16 to 20 breaths/minute 3 22 to 28 breaths/minute 4 32 to 36 breaths/minute

4 - 32 to 36 breaths/minute A respiratory rate higher than 30 breaths/minute is often found in patients with pulmonary edema. A patient experiences dyspnea and orthopnea due to the accumulation of edematous fluid in the lung tissues, which affects the patient's respiratory rate. The respiratory rates in the ranges of 12 to 16, 16 to 20, and 20 to 24 breaths/minute indicate normal respiration.

A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S3 gallop. The nurse recognizes those symptoms as being caused by what? 1 Pneumonia 2 An asthma attack 3 A myocardial infarction 4 Acute pulmonary edema

4 - Acute pulmonary edema Extreme shortness of breath and a persistent cough with pink, frothy sputum are symptoms of pulmonary edema. Pneumonia, an asthma attack, and a myocardial infarction are not correct because pink frothy sputum and an S3 gallop are not symptoms of any of these.

Which category of medication helps reduce afterload in patients with heart failure? 1 Morphine 2 Antidysrhythmia drugs 3 β-adrenergic blockers 4 Angiotensin-converting enzyme (ACE) inhibitors

4 - Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors block angiotensin II and dilate both arteries and veins. ACE inhibitors reduce arterial pressure and afterload in patients with heart failure by causing vasodilation. As a vasodilator, morphine decreases cardiac workload by lowering myocardial O2 consumption, reducing contractility, and decreasing BP and HR. Antidysrhythmic drugs are used to suppress abnormal rhythms such as atrial fibrillation and atrial flutter. β-adrenergic blockers suppress the neurohormonal stimulation that occurs in patients with heart failure.

A patient with a history of rheumatic fever is diagnosed with mitral valve stenosis. The patient is scheduled for prosthetic valve replacement surgery. The nurse should inform the patient that what protective mechanism will be implemented after the surgery? 1 Exercise plan to increase cardiac tolerance 2 β-adrenergic blockers to control palpitations 3 Immunosuppressive therapy to prevent rejection 4 Antibiotic prophylaxis for dental manipulation involving the gums of the teeth

4 - Antibiotic prophylaxis for dental manipulation involving the gums of the teeth The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Immunosuppressive therapy is not necessary. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

A patient is administered amitriptyline to treat depression. To evaluate the patient for a complication related to the medication, the nurse should perform what assessment? 1 Assess potassium levels. 2 Assess for symptoms of thromboembolism. 3 Assess peripheral extremities for indications of edema. 4 Assess blood pressure after patient moves from a sitting to a standing position.

4 - Assess blood pressure after patient moves from a sitting to a standing position. Amitriptyline is used to treat depression. It causes orthostatic hypotension. Therefore monitoring the patient's blood pressure when the patient is in a standing position will help provide effective care. Amitriptyline does not increase the patient's risk of edema. Therefore the nurse will not check the patient for the symptoms of edema. Unlike corticosteroids, amitriptyline does not increase elimination of potassium and does not cause hypokalemia. Amitriptyline does not impair clotting and does not obstruct blood flow in the vessels. Therefore the nurse will not check for the symptoms of thromboembolism.

A patient has been diagnosed with mitral valve prolapse. What should be included in the treatment plan of the patient? Select all that apply. 1 Fluid restriction 2 Maintain bed rest 3 Nitrates for chest pain 4 Avoiding caffeine or ephedrine 5 β-adrenergic blockers to control palpitations

4 - Avoiding caffeine or ephedrine 5 - β-adrenergic blockers to control palpitations A patient with mitral valve prolapse should avoid caffeine or ephedrine because these can exacerbate the symptoms. The patient should also be kept hydrated to maintain hemodynamic stability. β-adrenergic blockers should be prescribed for palpitations and chest pain. Inactivity may cause stasis of blood; hence, bed rest is not recommended. The patient with mitral valve prolapse does not respond to antianginal treatment such as nitrates when administered for chest pain.

A patient is diagnosed with paroxysmal nocturnal dyspnea. The nurse expects the patient to report what clinical manifestation? 1 Decreased attention span 2 Breathlessness on exertion 3 Shortness of breath when lying down 4 Awakening from sleep with feelings of suffocation

4 - Awakening from sleep with feelings of suffocation Paroxysmal nocturnal dyspnea occurs when the patient is asleep. The patient awakes in a state of panic with a feeling of suffocation and has a strong desire to sit or stand up. Breathlessness on exertion is called dyspnea. Shortness of breath when lying down, that is, orthopnea, often accompanies dyspnea. A decreased attention span is a behavioral change that may be due to poor gas exchange or worsening heart failure.

A patient with atrial fibrillation has been scheduled to undergo biologic valve replacement surgery. What should the nurse tell the patient about the benefits of a biologic valve versus a mechanical valve? Select all that apply. 1 Biologic valves do not leak. 2 Biologic valves are more durable. 3 Biologic valves do not cause endocarditis. 4 Biologic valves lower the risk of tissue rejection. 5 Biologic valves do not require anticoagulation therapy.

4 - Biologic valves lower the risk of tissue rejection. 5 - Biologic valves do not require anticoagulation therapy. Biologic valves are made from bovine, porcine, or human tissues. Therefore they have a low risk of eliciting an immune response and tissue rejection. Because they have low thrombogenicity, they do not require anticoagulation therapy, unlike mechanical valves. However, biologic valves may tend to leak or cause endocarditis, similarly to mechanical valves. Biologic valves are also less durable than mechanical valves.

A patient with infective endocarditis is scheduled for a transesophageal echocardiogram (TEE). The nurse recalls that the test is performed to detect what? 1 Cardiomegaly 2 Cardiac dysrhythmias 3 Atrioventricular block 4 Vegetations on the heart valves

4 - Vegetations on the heart valves A transesophageal echocardiogram (TEE) is used to detect vegetations on the heart valves. A chest x-ray is used to detect cardiomegaly. An electrocardiograph is used to detect cardiac dysrhythmias in patients with pericarditis. An electrocardiogram (ECG) detects first- or second-degree atrioventricular (AV) block.

The nurse is caring for a patient with chronic heart failure. What is appropriate to be included on the patient's plan of care? 1 Ultrafiltration (UF) 2 Hemodynamic monitoring 3 Intraaortic balloon pump (IABP) 4 Cardiac resynchronization therapy (CRT)

4 - Cardiac resynchronization therapy (CRT) In chronic HF, neurohormonal effects and cardiac remodeling can result in dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra lead is placed, which allows for normal electrical conduction between the RV and LV, which increases left ventricular function and CO. Hemodynamic monitoring, UF, and IABP are included in the plan of care for patients with acute decompensated heart failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The patient may have hemodynamic monitoring, including arterial BP and pulmonary artery pressure. The ideal patients for UF are those with major pulmonary or systemic volume overload. The IABP is helpful in hemodynamically unstable patients.

While auscultating a patient's heart, the nurse hears turbulent sounds between normal heart sounds. Which complication does the nurse suspect? 1 Aneurysm 2 Cardiac dysrhythmias 3 Left ventricular failure 4 Cardiac valve disorder

4 - Cardiac valve disorder Turbulent sounds heard between normal heart sounds are known as murmurs. Murmurs are found in patients with cardiac valve disorder. An aneurysm is associated with a turbulent flow sound in the peripheral artery. Cardiac dysrhythmias are characterized by an apical heart rate exceeding the peripheral pulse rate. Left ventricular failure is associated with an extra, low-pitched heart sound in early diastole.

The nurse presents information to a group of nursing students about heart transplantation. When listing major causes of death after the first year posttransplantation, what should the nurse include? 1 Infection 2 Acute rejection 3 Immunosuppression 4 Cardiac vasculopathy

4 - Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease [CAD]) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increase the patient's risk of an infection.

A patient reports anorexia, weight loss, edema, and dyspnea on exertion. Upon physical examination, the nurse finds jugular venous distention. What type of cardiovascular inflammation does the nurse suspect the patient is experiencing? 1 Myocarditis 2 Infective endocarditis 3 Rheumatic endocarditis 4 Chronic constrictive pericarditis

4 - Chronic constrictive pericarditis Anorexia, weight loss, edema, dyspnea, and distention of neck veins indicate chronic constrictive pericarditis, which results from scarring due to loss of elasticity of the pericardium. Myocarditis is the inflammation of the myocardium, characterized by fever, fatigue, myalgia, dyspnea, and lymphadenopathy. Infective endocarditis is characterized by fever, malaise, anorexia, abdominal discomfort, and clubbing of the fingers. Rheumatic endocarditis is characterized by inflammation in the joints, resulting in painful deformity and immobility.

While reviewing a patient's medical record, the nurse notices loss of elasticity of the pericardial sac. Which condition does the nurse suspect in this patient? 1 Pericarditis 2 Pericardiectomy 3 Pericardiocentesis 4 Chronic constrictive pericarditis

4 - Chronic constrictive pericarditis Chronic constrictive pericarditis results from scarring, with fibrin deposition and loss of elasticity of the pericardial sac. Inflammation of the pericardial sac is termed pericarditis. A pericardiectomy is a procedure that involves complete resection of the pericardium through median sternotomy with the use of cardiopulmonary bypass. Pericardiocentesis is a procedure usually performed for pericardial effusion with acute cardiac tamponade, purulent pericarditis, and suspected neoplasm.

The nurse assesses a patient with infective endocarditis and expects that if petechiae are observed, they will be found in what location of the body? 1 Toes 2 Nail beds 3 Fingertips 4 Conjunctivae

4 - Conjunctivae Petechiae are manifestations of infective endocarditis, which result from fragmentation and microembolization of vegetative lesions. Petechiae occur on the conjunctivae, buccal mucosa, palate, and lips. Janeway's lesions occur on toes and fingertips. Splinter hemorrhages occur in nail beds.

A 75-year-old patient is experiencing a sinus dysrhythmia. The nurse identifies that the patient is at risk for dysrhythmias due to what physiologic change that occurs with aging? 1 Decrease in pulse pressure 2 Decreased resting supine heart rate (HR) 3 Progressive decrease in systolic blood pressure (SBP) 4 Decrease in the number of pacemaker cells in the SA node

4 - Decrease in the number of pacemaker cells in the SA node The number of pacemaker cells in the SA node decreases with age. By age 75, a person may have only 10% of the normal number of pacemaker cells. The resting supine HR is not markedly affected by age. Arterial and venous blood vessels thicken and become less elastic with age. Arteries increase their sensitivity to vasopressin (antidiuretic hormone). With aging, both of these changes contribute to a progressive increase in SBP and a decrease or no change in diastolic blood pressure (DBP). Thus an increase in the pulse pressure is found.

The nurse recalls that the decreased filling of the ventricles that is associated with diastolic failure results in what primary manifestation? 1 Decreased afterload 2 Decreased left ventricular ejection fraction 3 Decreased left ventricular end-diastolic pressure 4 Decreased stroke volume and cardiac output (CO)

4 - Decreased stroke volume and cardiac output (CO) Diastolic failure often is referred to as heart failure with normal ejection fraction. Decreased filling of the ventricles results in decreased stroke volume and CO. Diastolic failure is characterized by high filling pressures because of stiff ventricles. This results in venous engorgement in both the pulmonary and systemic vascular systems.

The health care provider has prescribed cardiac catheterization for a school-aged child. What action does the nurse take to prepare the child and the family for the procedure? 1 Tell the parents that the procedure may be risky 2 Say that the procedure will not have any side effects 3 Say that only fluids are allowed before the procedure 4 Describe the procedure to the child and the family step-by-step

4 - Describe the procedure to the child and the family step-by-step The nurse describes the procedure to the child step-by-step so that the child understands what will be done. It lessens the anxiety about the procedure. Telling the parents that the procedure is risky will make the parents anxious. The nurse does not give any misleading information about side effects and instead tells the parents that the child needs to be monitored for any side effects. The patient is allowed nothing by mouth for 4 to 6 hours before the procedure.

A patient with chronic heart failure (HF) reports disturbed sleep due to the urge to urinate frequently. The nurse suspects that what condition that is associated with HF is most likely causing the patient's nocturia? 1 Diabetes 2 An enlarged prostate 3 Increased caffeine intake during the day, resulting in diuresis at night 4 Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys

4 - Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys In a patient with chronic heart failure, there is decreased renal perfusion and urine production during the day, because most fluid gets accumulated in the peripheral tissues. However, while lying down at night in a recumbent position, the fluid from the peripheral interstitial tissues enters the central circulation. This leads to an increase in renal function, causing nocturia. Diabetes, an enlarged prostate, and caffeine intake before going to bed also cause nocturia but are less likely in this case.

What assessment finding potentially leading to a cerebrovascular accident (CVA) would be of concern to a nurse who is taking care of a child with hypoxemia? 1 Body temperature 2 Acid-base balance 3 Bilateral lung sounds 4 Fluid intake and output

4 - Fluid intake and output The nurse monitors fluid status in a child with hypoxemia as the child is at risk for dehydration and CVA. The nurse monitors temperature in a child who is at risk for hypothermia or hyperthermia. The nurse should assess the child's lung sounds as part of a head to toe assessment, but it will not prevent a CVA. The nurse monitors chloride and acid-base balance in a child who takes diuretics, as the child loses excessive fluids.

While reviewing the laboratory reports of a patient, the nurse notes that the homocysteine level is 17 μmol/L. The nurse anticipates that which treatment will be prescribed? 1 Nesiritide infusion 2 Estrogen + progestin infusion 3 Vitamin C and vitamin K supplements 4 Folic acid and vitamin B12 supplements

4 - Folic acid and vitamin B12 supplements When a patient's homocysteine levels are greater than 10.4 μmol/L, it indicates that the patient has hyperhomocysteinemia. Hyperhomocysteinemia is caused by a deficiency in folic acid, vitamin B12, and vitamin B6; therefore administering folic acid and vitamin B12 supplements will be beneficial for the patient. Nesiritide helps to increase b-Type natriuretic peptide (BNP), but it does not treat deficiencies of folic acid, vitamin B12, and vitamin B6. Estrogen + progestin helps to increase estrogen levels in the blood, but does not reduce homocysteine levels. Homocysteine levels increase because of folic acid and vitamin B deficiencies, but are unrelated to vitamins C and K.

The patient with hypertension receives a prescription for atenolol 100 mg by mouth (PO) daily. The pharmacy provides 25-mg tablets. How many tablets should the nurse administer? 1 One tablet 2 Two tablets 3 Three tablets 4 Four tablets

4 - Four tablets Using ratio and proportion, multiply 25 by x and multiply 100 × 1 to yield 25x = 100. Divide 100 by 25 to yield four tablets.

The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The nurse should monitor the patient for which characteristic symptom that occurs exclusively with this disorder? 1 Fatigue 2 Anxiety 3 Anorexia 4 Frothy, pink-tinged sputum

4 - Frothy, pink-tinged sputum Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF. Fatigue and anxiety are present as a common symptom both in right-sided and left-sided HF. Anorexia is exclusively a symptom of right-sided HF.

The nurse is assessing a child with cyanosis. The nurse observes that there is clubbing of the fingers in the child. Which condition does the nurse suspect in the child? 1 Pneumonia 2 Dehydration 3 Renal failure 4 Heart disease

4 - Heart disease Clubbing of fingers is the thickening and flattening of the tips of the fingers and toes. It occurs due to chronic tissue hypoxemia and indicates heart disease. Pneumonia is an acute infection in the lungs. It can lower the oxygen saturation, but does not cause clubbing. Renal failure is a disease of the kidneys and does not cause cyanosis. Dehydration is indicated by decreased urinary output and decreased fluid intake.

The nurse recalls that paroxysmal nocturnal dyspnea is a condition indicative of what more serious problem? 1 COPD 2 Asthma 3 Bronchitis 4 Heart failure

4 - Heart failure A classic symptom of left-sided heart failure is paroxysmal nocturnal dyspnea, which awakens the patient after several hours of sleep. Although a patient with chronic obstructive pulmonary disease, asthma, or bronchitis may experience shortness of breath, these symptoms do not usually manifest while the patient is sleeping.

A patient's baseline heart rate is 85 beats/minute. The nurse recognizes that the sympathetic nervous system is stimulated in the patient when what heart rate is assessed? 1 Heart rate of 50 beats/minute 2 Heart rate of 70 beats/minute 3 Heart rate of 80 beats/minute 4 Heart rate of 110 beats/minute

4 - Heart rate of 110 beats/minute Stimulation of the sympathetic nervous system increases heart rate. The normal heart rate is in the range of 60 to 100 beats/minute. Therefore the patient with heart rate of 110 beats/minute has a stimulated sympathetic nervous system. Stimulation of the sympathetic nervous system does not decrease the patient's heart rate. Therefore the heart rate of 50 beats/minute does not indicate stimulation of the patient's sympathetic nervous system. The heart rates of 70 and 80 beats/minute are normal findings and do not indicate stimulation of the patients' sympathetic nervous systems.

A patient with heart failure (HF) receives a prescription for digoxin. The nurse recognizes that this medication benefits patients with HF because of what positive inotropic effect? 1 Increased heart rate 2 Increased stroke volume 3 Increased cardiac output 4 Increased myocardial contractility

4 - Increased myocardial contractility Increase in myocardial contractility is called positive inotropic effect. Increase in heart rate is called positive chronotropic effect. Positive inotropic effect results in an increase in stroke volume and cardiac output.

A patient's assessment findings include an ejection fraction of 34%, high pulmonary pressures, and biventricular failure. The nurse suspects that the patient is experiencing what condition? 1 Systolic failure 2 Diastolic failure 3 Myocardial ischemia 4 Mixed systolic and diastolic failure

4 - Mixed systolic and diastolic failure Mixed systolic and diastolic failure results in low ejection fraction, high pulmonary pressures, and biventricular failure. Systolic failure results only in low ejection fraction. Diastolic failure is characterized by high filling pressures due to a stiff ventricle. Myocardial ischemia is a condition of insufficient blood flow to the heart muscle.

After administering digoxin (Lanoxin) to a child with heart failure, the nurse monitors for serum potassium levels in the child. What is the rationale for this action? 1 Decreased serum potassium levels can lead to dehydration. 2 Increased serum potassium levels can result in hypertension. 3 Decreased serum potassium levels can potentiate heart failure. 4 Increased serum potassium levels makes digoxin less effective.

4 - Increased serum potassium levels makes digoxin less effective. Increased serum potassium levels diminish the effect of digoxin and will not improve myocardial function in the child. Therefore it is important to monitor serum potassium levels. Low serum potassium levels result in hypertension. A decrease in serum potassium levels causes changes to the heart rhythm, but will not worsen heart failure. Dehydration may be caused by fluid restrictions instituted in the acute stages of heart failure.

The nurse assesses a patient at risk for cardiovascular disease and notes the presence of splinter hemorrhages. The finding may be indicative of what condition? 1 Varicose veins 2 Arteriosclerosis 3 Vasoconstriction 4 Infective endocarditis

4 - Infective endocarditis Splinter hemorrhages are small, red-to-black streaks under the fingernails that indicate the presence of infective endocarditis. Ulcers in a patient with a risk for cardiovascular disease indicate varicose veins and arteriosclerosis. Peripheral cyanosis indicates vasoconstriction.

The nurse provides post-procedural care to a patient that was admitted to an inpatient unit after cardiac catheterization. Which assessment is the highest priority? 1 Determining the level of pain 2 Verifying the patency of the IV site 3 Obtaining a blood pressure reading 4 Inspecting the site of the catheterization

4 - Inspecting the site of the catheterization The highest priority for a patient who has undergone cardiac catheterization, upon arrival to the nursing unit, is to first assess the catheterization site for signs of hemorrhage. Assessments of pain, blood pressure, and the IV site are all important assessments, but they are of lower priority than checking the cardiac catheterization site.

The registered nurse observes another healthcare provider performing a cardiac assessment on a patient. Which activity should the nurse question? 1 Documents a normal peripheral pulse as 2+ 2 Identifies that a capillary refill of 3 seconds is abnormal 3 Uses the diaphragm of the stethoscope to auscultate for S1 and S2 heart sounds 4 Inspects the large veins in the neck while swiftly moving the patient from a supine position to a 40-degree position

4 - Inspects the large veins in the neck while swiftly moving the patient from a supine position to a 40-degree position To assess for jugular vein distention, the healthcare provider should inspect the large veins in the neck while the patient is gradually moved from a supine position to an upright (30- to 45-degree position). The patient should not be repositioned too quickly. When a normal peripheral pulse is a normal force, it should be documented as 2+. A capillary refill should occur in less than 2 seconds with normal tissue perfusion and cardiac output (CO). S1 and S2 are heard best with the diaphragm of the stethoscope because they are high pitched.

Congenital heart defects traditionally have been divided into acyanotic or cyanotic defects. What should the nurse recognize about the system in clinical practice? 1 It is helpful because it explains the hemodynamics involved. 2 It is problematic because cyanosis is rarely present in children. 3 It is helpful because children with cyanotic defects are easily identified. 4 It is problematic because children with acyanotic heart defects may develop cyanosis.

4 - It is problematic because children with acyanotic heart defects may develop cyanosis. This classification is problematic. Children with traditionally named acyanotic defects may be cyanotic, and children with traditionally classified cyanotic defects may appear pink. The classification does not reflect the path of blood flow within the heart. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects in which oxygenated blood and unoxygenated blood are mixed.

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. The nurse identifies that what age-related change contributes to this finding? 1 Stenosis of the heart valves 2 Decreased adrenergic sensitivity 3 Increased parasympathetic activity 4 Loss of elasticity in arterial vessels

4 - Loss of elasticity in arterial vessels An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. Valvular rigidity of aging causes murmurs and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

The nurse presents information to a group of nursing students about cultural and ethnic health disparities related to hypertension. What should the nurse include in the education about Mexican Americans, when comparing them to the white and African American populations? 1 Mexican Americans have higher rates of blood pressure control. 2 Mexican Americans are more likely to receive treatment for hypertension. 3 Mexican Americans have the highest prevalence of hypertension in the world. 4 Mexican Americans have lower levels of awareness of hypertension and its treatment.

4 - Mexican Americans have lower levels of awareness of hypertension and its treatment. Mexican Americans have lower levels of awareness of hypertension and its treatment than do whites and African Americans. Mexican Americans are less likely to receive treatment for hypertension, and they have lower rates of blood pressure control. African Americans have the highest prevalence of hypertension in the world.

A patient has been diagnosed with dilated cardiomyopathy (DCM). The nurse identifies that the patient is at risk for what condition? 1 Systolic failure 2 Diastolic failure 3 Left ventricular hypertrophy 4 Mixed systolic and diastolic failure

4 - Mixed systolic and diastolic failure Dilated cardiomyopathy is a condition in which already compromised systolic function is further compromised by dilated left ventricular walls, which are unable to relax. With this condition, patients usually have very low ejection factor, as well as biventricular failure, which is a characteristic of mixed systolic and diastolic failure. Systolic failure is characterized by a decrease in left ventricular ejection factor because of the heart's inability to pump blood effectively. Diastolic failure is referred to as a heart failure with normal ejection factor. Left ventricular hypertrophy is the thickening of the left ventricle muscle, which may result in heart failure, but left ventricular hypertrophy is not a type of heart failure itself.

The nurse is asked to administer captopril (Capoten) for afterload reduction in a child with heart failure. Which action does the nurse take before administering the drug? 1 Monitors temperature 2 Obtains blood glucose 3 Takes apical pulse rate 4 Monitors blood pressure

4 - Monitors blood pressure Captopril (Capoten) is an angiotensin-converting-enzyme (ACE) inhibitor that lowers the blood pressure. The nurse monitors blood pressure before administering captopril (Capoten) to assess for hypotension. The nurse takes the apical pulse rate before administering digoxin (Lanoxin) to assess for bradycardia as this is a side effect of the medication. The nurse would obtain a blood glucose reading for a child with diabetes mellitus. The nurse monitors temperature in a child who may be at risk for an infection.

The patient with pericarditis reports chest pain. The nurse recognizes that which intervention will help provide pain relief? 1 Corticosteroids 2 Morphine sulfate 3 Proton pump inhibitor 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

4 - Nonsteroidal antiinflammatory drugs (NSAIDs) NSAIDs will control pain and inflammation. Corticosteroids are reserved for patients already taking them for autoimmune conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.

A nurse is counseling a patient about dietary supplements normally used for the prevention and treatment of cardiovascular disease. Which supplement has strong scientific evidence for its use? 1 Melatonin 2 Green tea 3 Glucosamine 4 Omega-3 fatty acids

4 - Omega-3 fatty acids There is strong scientific evidence for the use of omega-3 fatty acids in the treatment and prevention of hypertension, hypertriglyceridemia, and cardiovascular disease. Melatonin, green tea, and glucosamine are not indicated for prevention and treatment of cardiovascular disease. There is unclear scientific evidence for the use of green tea in the treatment of high cholesterol.

The nurse is caring for a patient with a psychosis who is prescribed amitriptyline therapy. The nurse should monitor the patient for which complication? 1 Hypokalemia 2 Thromboembolism 3 Myocardial infarction 4 Orthostatic hypotension

4 - Orthostatic hypotension Amitriptyline is a tricyclic antidepressant that alleviates the symptoms of depression by decreasing the levels of serotonin and epinephrine in the brain. Due to the decrease in epinephrine, the patient may have low blood pressure, resulting in orthostatic hypotension. Therefore the nurse monitors for orthostatic hypotension in the patient. Hypokalemia occurs in patients receiving corticosteroids, not tricyclic antidepressants. Thromboembolism may occur in patients receiving hormone therapy, but this is not a risk for patients on amitriptyline. Patients taking hormone therapy and nonsteroidal antiinflammatory medications are at risk for developing myocardial infarctions, but amitriptyline does not increase the risk for myocardial infarctions.

A 78-year-old patient experiences cardiac sinus dysrhythmias. The nurse recalls that a reduction in which type of cells leads to this condition? 1 Conduction cells in the bundle of His 2 Conduction cells in the internodal tracts 3 Conduction cells in the bundle branches 4 Pacemaker cells in the sinoatrial (SA) node

4 - Pacemaker cells in the sinoatrial (SA) node A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks.

The patient is admitted to the hospital with reports of awakening during the night with sudden shortness of breath. How should the nurse document this assessment finding? 1 Orthopnea 2 Atrial fibrillation 3 Intermittent claudication 4 Paroxysmal nocturnal dyspnea

4 - Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea is defined as "attacks of shortness of breath, especially at night," which awaken the patient. Orthopnea is the need to sleep in an upright position. Atrial fibrillation is a conduction abnormality of the heart. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle.

An 80-year-old patient who is a poor surgery candidate is diagnosed with aortic stenosis. The nurse anticipates that what procedure will likely be recommended? 1 Annuloplasty 2 Aortic valve replacement 3 Open commissurotomy (valvulotomy) procedure 4 Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

4 - Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The PTBV procedure is generally indicated for an older patient who is a poor surgery candidate. Annuloplasty is an option for patients with mitral or tricuspid regurgitation. An open commissurotomy procedure is used for mitral stenosis. Valve replacement may be required for mitral, aortic, tricuspid, and occasionally pulmonic valve disease.

The nurse reviews the medical record of a patient newly diagnosed with infective endocarditis (IE). The nurse identifies that it is essential to notify the primary health care provider about which finding? 1 Patient reports of fatigue 2 Recent dental procedure 3 Results of the echocardiogram 4 Positive results of a blood culture

4 - Positive results of a blood culture Positive results of a blood culture of a patient diagnosed with IE indicate that the causative organism is not susceptible to the ordered antibiotic. This needs to be communicated immediately so the proper antibiotic can be administered. Fatigue is an expected symptom of IE. The information regarding the recent dental procedure is obtained with the history of the patient and is not a priority to report to the health care provider. An echocardiogram is a diagnostic tool.

The nurse notices that a patient with pulmonary edema experiences shortness of breath while lying down. What is the most likely reason for the development of orthopnea in this patient? 1 Heart failure 2 Hypertension 3 Pulmonary failure 4 Pulmonary congestion

4 - Pulmonary congestion In pulmonary edema, there is congestion in the lungs, which causes inadequate oxygenation. In a recumbent position, the congestion is further increased, causing further hypoxemia, which causes orthopnea, or shortness of breath while lying down. Orthopnea does not indicate heart failure but is an early sign of heart failure. Hypertension and pulmonary failure are found in later stages of heart failure.

A patient is diagnosed with left-sided heart failure. The nurse should carefully monitor the patient for what complication? 1 Hepatomegaly 2 Splenomegaly 3 Vascular congestion 4 Pulmonary congestion

4 - Pulmonary congestion The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure occurs when the right ventricle fails to contract effectively.

A patient with a history of acute decompensated heart failure (ADHF) reports blood-tinged sputum, productive frothy cough, and rapid heart rate. The nurse suspects that which condition induced these clinical manifestations? 1 Cerebral edema 2 Peripheral edema 3 Lymphatic edema 4 Pulmonary edema

4 - Pulmonary edema Acute decompensated heart failure (ADHF) can manifest as pulmonary edema, which is an acute life-threatening condition. In this condition, the alveoli become filled with serosanguinous fluid, and the clinical manifestations include cough, blood-stained sputum, and rapid heart rate. Cerebral edema presents in the form of seizures, headache, and other neurologic symptoms. Peripheral edema presents as a swelling in the lower extremities. Lymphatic edema presents as hyperplasia and hyperkeratosis.

What is a major central nervous system (CNS) manifestation of rheumatic fever (RF)? 1 Aschoff's bodies 2 Pulsus paradoxus 3 Dressler syndrome 4 Sydenham's chorea

4 - Sydenham's chorea Sydenham's chorea is a major central nervous system (CNS) manifestation of rheumatic fever. It is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Aschoff's bodies are nodules formed by a reaction to inflammation upon swelling and destruction of collagen fibers; these are not CNS manifestations. Pulsus paradoxus is an abnormally large decrease in systolic blood pressure during inspiration and is observed in patients with pericarditis. Dressler syndrome is late pericarditis that occurs four to six weeks after a myocardial infarction.

The nurse reviews the pathophysiology of heart failure. Which compensatory mechanism results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction? 1 Ventricular dilation 2 Ventricular hypertrophy 3 Neurohormonal response 4 Sympathetic nervous system (SNS) activation

4 - Sympathetic nervous system (SNS) activation SNS activation is often the first mechanism triggered in low-cardiac output states. In response to an inadequate stroke volume and cardiac output, SNS activation increases, resulting in the increased release of catecholamines (epinephrine and norepinephrine). This results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac output. However, over time these factors are harmful because they increase the already failing heart's workload and need for oxygen. Ventricular dilation, ventricular hypertrophy, and neurohormonal response do not cause increased heart rate, increased myocardial contractility, and peripheral vasoconstriction.

Which complication occurs due to obstruction to aortic outflow during increased activity? 1 Angina 2 Fatigue 3 Dyspnea 4 Syncope

4 - Syncope Syncope occurs when blood flow is obstructed and is insufficient to meet the demands associated with activity. Increased left ventricular muscle mass by the hypertrophic ventricular myocardium will result in angina. A decrease in cardiac output and in exercise-induced flow obstruction leads to fatigue. Dyspnea occurs due to increased left ventricular diastolic pressure.

The nurse recalls that symptoms of right-sided heart failure are caused by what condition? 1 Decreased preload 2 Increased cardiac output 3 Fluid congestion in the lungs 4 Systemic venous congestion

4 - Systemic venous congestion The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Fluid congestion in the lungs is a symptom of left-sided heart failure. Decreased preload is not correct; preload in right-sided heart failure is increased. Increased cardiac output is not correct; cardiac output is decreased in right-sided heart failure.

What is cardiac reserve? 1 The amount of blood pumped by each ventricle in one minute 2 The peripheral resistance against which the left ventricle must pump 3 The amount of blood in the ventricles at the end of diastole, before the next contraction 4 The cardiovascular system's ability to respond to health and illness demands by altering cardiac output

4 - The cardiovascular system's ability to respond to health and illness demands by altering cardiac output The ability of the cardiovascular system to alter cardiac output in response to numerous situations in health and illness, such as stress, hypervolemia, and exercise, is known as cardiac reserve. The amount of blood pumped by each ventricle in one minute is called cardiac output. Afterload is the peripheral resistance against which the left ventricle must pump. Preload is the amount of blood in the ventricles at the end of diastole, before the next contraction.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress what? 1 The need to be extremely concerned about cyanotic spells 2 The importance of relaxing discipline and limit-setting to prevent crying 3 The importance of reducing caloric intake to decrease cardiac demands 4 The desirability of promoting normalcy within the limits of the child's condition

4 - The desirability of promoting normalcy within the limits of the child's condition Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake. The child needs discipline and appropriate limits. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs to have social interactions, discipline, and appropriate limit-setting.

Which diagnostic study detects the presence of vegetation on heart valves in a client with infectious endocarditis? 1 Chest x-ray 2 Electrocardiogram 3 Cardiac catheterization 4 Transesophageal echocardiogram

4 - Transesophageal echocardiogram Transesophageal echocardiogram and two- or three-dimensional transthoracic echocardiograms help detect vegetation on the heart valves of a client with infectious endocarditis. The presence of vegetation on heart valves cannot be detected by chest x-ray, cardiac catheterization, or electrocardiography; however, a chest x-ray can help to identify gross cardiac changes, blood vessels can be examined by cardiac catheterization, and an electrocardiogram can identify cardiac rhythm changes.

A nurse is reviewing a patient's laboratory results: blood cholesterol level of 350 mg/dL; homocysteine level of 14 µmol/L; b-Type natriuretic peptide (BNP) of 90 pg/mL; Troponin I (cTnI) level of 0.3 ng/mL; myoglobin level of 16 mcg/L, and C-reactive protein of 4 mg/L. What should the nurse interpret from the lab reports? 1 The patient has heart failure. 2 The patient has pulmonary complications. 3 The patient has had a myocardial infarction (MI). 4 The patient has a high risk of cardiovascular disease.

4 - The patient has a high risk of cardiovascular disease. The patient has a high risk of developing cardiovascular disease as evident by the high cholesterol levels, the homocysteine levels, and the C-reactive protein level. High cholesterol levels directly impact the heart and the blood vessels. A high homocysteine level indicates amino acid production during protein catabolism. It can harm the endothelium. C-reactive protein is a marker of inflammation, and a level of >3 mg/L indicates high risk of cardiac disease. The patient has normal levels of troponin and myoglobin, which are indicators of myocardial injury; therefore the patient has not had a myocardial infarction. The b-Type natriuretic peptide (BNP) level is normal, thus ruling out heart failure. A normal level of BNP also rules out pulmonary complications.

A patient is admitted to the hospital with heart failure. Following an assessment, the primary health care provider classifies the patient as NYHA II. The nurse recognizes that what is the most likely reason for this classification? 1 The patient is unable to perform daily chores, like dressing oneself. 2 The patient experiences dyspnea even at rest, and discomfort increases with activities. 3 The patient experiences no dyspnea when resting or when performing daily routine activity. 4 The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue.

4 - The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue. According to the NYHA functional classification of heart disease, the patient belongs to Class II, in which there are no symptoms at rest. The patient can perform daily routine activities but tires easily and experiences palpitations and dyspnea. In Class I, ordinary physical activity does not cause fatigue or dyspnea, and there is no limitation of physical activity. In Class III, there is inability to perform daily chores like dressing oneself. The patient may be comfortable at rest. In Class IV, the patient has symptoms even at rest and is unable to carry out any activity without discomfort.

The nurse helps a patient move from a supine position to a standing position. The patient suddenly reports feeling dizzy. What is the probable reason for the dizziness? 1 The peripheral arteries constricted. 2 The venous return to the heart increased. 3 The force of contraction of the heart increased. 4 The sympathetic nervous system (SNS) did not respond.

4 - The sympathetic nervous system (SNS) did not respond. During any change in position, the vasomotor center is activated and stimulates the sympathetic nervous system (SNS) response. The SNS response ensures that cerebral blood flow is maintained by causing peripheral vasoconstriction and by increasing venous return. If the patient feels dizzy when changing positions, it means that the SNS response did not occur. If the peripheral arteries constrict and the venous return to the heart is increased, the blood flow to the heart is maintained, preventing dizziness in the patient. If the force of contraction is increased, the patient would not experience dizziness; the blood flow to the brain would be maintained.

The nurse provides information about the anatomic characteristics of the heart to a group of nursing students. What should the nurse include in the education? 1 The right and the left atria are similar in size. 2 The atrial myocardium is thicker than that of the ventricles. 3 The right ventricular wall is three times thicker than the left ventricular wall. 4 The thickness of the left ventricle is necessary to pump the blood into the systemic circulation.

4 - The thickness of the left ventricle is necessary to pump the blood into the systemic circulation. The left ventricle is thicker because it needs to pump the blood into circulation. The right and left atria are different sizes and have different wall thicknesses. The atrial myocardium is thinner than that of the ventricles. The left ventricular wall is two or three times thicker than the right ventricular wall.

The nurse encourages the patient diagnosed with chronic heart failure to obtain physical and emotional rest. What is the rationale that is offered by the nurse to the patient? 1 To relieve dyspnea and fatigue 2 To increase oxygen saturation of blood 3 To involve the patient in cardiac rehabilitation 4 To decrease the need for additional oxygen

4 - To decrease the need for additional oxygen Physical and emotional activities may cause additional utilization of oxygen. Therefore the patient is advised to take rest to conserve energy and prevent additional use of oxygen. Administration of oxygen relieves dyspnea and fatigue. Taking physical and emotional rest do not affect oxygen saturation of the blood. Asking the patient to take rest may help conserve energy but would not motivate the patient to participate in cardiac rehabilitation.

While performing right-sided heart catheterization on a patient with dilated cardiomyopathy, the primary health care provider performs an endomyocardial biopsy. What does the nurse recall as the rationale for the biopsy? 1 To rule out cardiomegaly 2 To determine eosinophilic fasciitis 3 To confirm coronary artery disease 4 To identify infectious organisms in heart tissue

4 - To identify infectious organisms in heart tissue Endomyocardial biopsy along with right-sided heart catheterization is used to identify infectious organisms in heart tissue in patients with cardiomyopathy. Chest x-ray is used to rule out cardiomegaly. A multiple gated acquisition (MUGA) nuclear scan is used to determine eosinophilic fasciitis. Cardiac catheterization is used to confirm coronary artery disease.

What is the therapeutic role of digoxin in treating myocarditis? 1 To decrease preload 2 To treat an enlarged heart 3 To improve cardiac output 4 To improve myocardial contractility

4 - To improve myocardial contractility Myocarditis is the diffuse inflammation of myocardium. Digoxin improves myocardial contractility and reduces the heart rate. Diuretics reduce the fluid volume and decrease the preload. ACE inhibitors reduce afterload and treat enlarged heart associated with myocarditis. Intravenous medications like nitroprusside reduce afterload and improve cardiac output by decreasing systemic vascular resistance.

Which is considered a mixed cardiac defect? 1 Pulmonic stenosis 2 Atrial septal defect 3 Patent ductus arteriosus 4 Transposition of the great arteries

4 - Transposition of the great arteries Transposition of the great arteries allows the mixing of blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

A nurse is caring for a patient who is a smoker with a two-year history of using oral contraceptives. Based on the findings, the patient should be assessed for which condition? 1 Hypotension 2 Cardiomyopathy 3 Dependent edema 4 Venous thromboembolism

4 - Venous thromboembolism Long-term use of oral contraceptives can lead to serious side effects. In addition, smoking enhances the risk of developing complications such as venous thromboembolism. Hypotension is not an effect of oral contraceptives. Similarly, contraceptives do not affect the muscles of the heart and do not cause cardiomyopathy. Dependent edema is not a common side effect of oral contraceptives.

Which condition leads to an increase in the pulmonary blood flow? 1 Aortic stenosis 2 Pulmonic stenosis 3 Coarctation of the aorta 4 Ventricular septal defect

4 - Ventricular septal defect A ventricular septal defect causes an increase in pulmonary blood flow. It is a congenital heart defect that is an abnormal opening between the right and left ventricles. It occurs because the blood flows from the higher-pressure left side of the heart to the lower-pressure right side. Coarctation of the aorta and aortic stenosis obstructs blood flow coming out of the heart. Pulmonic stenosis is a narrowing of the pulmonic artery and leads to right ventricular hypertrophy.

What should the nurse include when teaching a patient with rheumatic fever about how to prevent acquired rheumatic valve disease? Select all that apply. 1 Avoid exercise. 2 Drink more coffee. 3 Wear a Medic Alert bracelet. 4 Watch for symptoms of heart valve disease. 5 Prophylactic antibiotic therapy will be prescribed.

4 - Watch for symptoms of heart valve disease. 5 - Prophylactic antibiotic therapy will be prescribed. The patient with rheumatic fever should be taught about the symptoms of valvular heart disease. This is done to provide early medical treatment to the patient and alert him. It is necessary to take prophylactic antibiotic therapy to prevent endocarditis. The patient should be taught to practice hygiene measures to prevent contracting any infection. Avoiding exercise and drinking more coffee will not prevent rheumatic valve disease. Coffee contains caffeine, which can have adverse effects on the heart. Wearing a Medic Alert bracelet is recommended after valve surgery but is not required to prevent it.

The nurse is providing care to a patient with a blood pressure of 120/80 mm Hg. What is the patient's pulse pressure? Fill in the blank using a whole number. __ mm Hg

40 Pulse pressure is calculated as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). It is normally about one third of the SBP. If the patient's blood pressure is 120/80, the pulse pressure would be 120 - (minus) 80, which is equal to 40 mm Hg.

The nurse is auscultating the heart sounds of a patient with valvular heart disease. Which assessment findings may indicate mitral valve regurgitation? Select all that apply. 1 An Austin Flint murmur 2 A soft S1 heart sound 3 A prominent S4 heart sound 4 A diminished S2 heart sound 5 Audible third heart sound (S3) 6 A loud holosystolic murmur at the apex radiating to the left axilla.

5 - Audible third heart sound (S3) 6 - A loud holosystolic murmur at the apex radiating to the left axilla. Auscultation of heart sounds in the presence of mitral valve regurgitation reveals an audible third heart sound (S3), even with normal left ventricular function, because of increased left ventricular volume. The murmur is a loud holosystolic murmur at the apex radiating to the left axilla. A systolic murmur, a soft S1 heart sound, a prominent S4heart sound, and a diminished S2 heart sound are found upon assessment of aortic valve stenosis. An Austin Flint murmur is due to aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium.

Studies show that 0.070 L of blood is ejected from the ventricle with every heartbeat. A patient's heart rate is 72 beats/min. What cardiac output value should the nurse document in the patient's medical record? Record the answer using a whole number. ___________ L/min

5.0 The amount of blood ejected from the ventricle with each heartbeat is known as the stroke volume. Therefore, this patient's stroke volume is 0.070 L. Cardiac output (CO) is calculated by multiplying the stroke volume (SV) by the heart rate (HR), or CO = SV × HR. Therefore, CO = 0.070 × 72 = 5.0 L/min.

Immediately after completing an exercise class, a patient's blood pressure is 140/85 mm Hg. The nurse calculates the pulse pressure and should document what number? Fill in the blank using a whole number. ____

55 Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140 - 85 = 55.

Immediately after completing an exercise class, a patient's blood pressure is 140/85 mm Hg. The nurse calculates the pulse pressure and should document what number? Fill in the blank using a whole number. ____

55 Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140 - 85 = 55.

The patient's blood pressure (BP) is 90/50. The nurse calculates the mean arterial pressure (MAP) to see if the BP is high enough to adequately perfuse and sustain the vital organs. What is the MAP? Record the answer by rounding to the nearest whole number. ____

63 The MAP is 63. (90 + 2(50))/3 = 63. So, the BP is high enough to perfuse and sustain vital organs, as a MAP greater than 60 is needed.

A patient's systolic blood pressure (SBP) is 100 mm Hg and diastolic blood pressure (DBP) is 70 mm Hg. What should the nurse document as the patient's mean arterial pressure? Record the answer using a whole number. ________ mm Hg

80 The mean arterial pressure (MAP) is calculated by using the formula MAP = (SBP + 2DBP)/3. Therefore MAP = (100 + 2(70))/3 = (100 + 140)/3 = 240/3 = 80 mm Hg.