perfusion 25, 27, 30, 42, 48,

After explaining an electrocardiogram to a patient, which statement indicates that the patient understands this test? "It will show the chambers of my heart in different views." "It will measure the amount of blood being pumped." "It will show how impulses are moving through my heart." "It will help to identify how my heart is working mechanically."

"It will show how impulses are moving through my heart." An electrocardiogram is a recording of the patterns of electrical impulses as they move through the heart. It is a measure of electrical activity and provides no information about the mechanical function of the heart.

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which teaching point best captures a component of cardiac function? "Efficient heart function requires that the ventricles not retain any blood at the end of the cardiac cycle." Recall that the heart sounds that we listen to as part of our assessments are the sounds of myocardium contracting." "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." "Aortic pressure will exceed ventricular pressure during systole."

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood." Diastole is associated with ventricular filling and relaxation. Cardiac output is not 100% or near to it with each cardiac cycle, and heart sounds are associated with valve closing. Ventricular pressure exceeds that of the aorta during systole.

The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what? A)Arterial vasoconstriction B)Venous vasoconstriction C)Arterial vasodilation D)Venous vasodilation

A Feedback:Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.

A patient with a complex cardiac history is scheduled for transthoracic echocardiography. What should the nurse teach the patient in anticipation of this diagnostic procedure? A)The test is noninvasive, and nothing will be inserted into the patients body. B)The patients pain will be managed aggressively during the procedure. C)The test will provide a detailed profile of the hearts electrical activity. D)The patient will remain on bed rest for 1 to 2 hours after the test.

A Feedback:Before transthoracic echocardiography, the nurse informs the patient about the test, explaining that it is painless. The test does not evaluate electrophysiology and bed rest is unnecessary after the procedure.

The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response? A)Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are. B)Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts. C)Cardiac catheterization is usually done to evaluate cardiovascular response to stress. D)Cardiac catheterization is most commonly done to evaluate cardiac electrical activity

A Feedback:Cardiac catheterization is usually used to assess coronary artery patency to determine if revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.

The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what? A)Increased LDL and decreased HDL increase my risk of coronary artery disease. B)Increased LDL has the potential to decrease my risk of heart disease. C)The decreased HDL level will increase the amount of cholesterol moved away from the artery walls. D)The increased LDL will decrease the amount of cholesterol deposited on the artery walls.

A Feedback:Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate? A)Possible hypovolemia B)Possible myocardial infarction (MI) C)Left-sided heart failure D)Aortic valve regurgitation

A Feedback:Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart failure are less likely causes of decreased CVP.

The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems? A)To assess the patients response to fluid and drug administration B)To obtain specimens for arterial blood gas measurements C)To dislodge pulmonary emboli D)To diagnose the etiology of chronic obstructive pulmonary disease A

A Feedback:Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.

The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure? A)46 mm Hg B)99 mm Hg C)198 mm Hg D)76 mm Hg

A Feedback:Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

CH 25 A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what? A)Systole B)Diastole C)Repolarization D)Ejection fraction

A Feedback:Systole is the action of the chambers of the heart becoming smaller and ejecting blood. This action of the heart is not diastole (relaxations), ejection fraction (the amount of blood expelled), or repolarization (electrical charging).

The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located? A)SA node B)AV node C)Bundle of His D)Purkinje cells

A Feedback:The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).

A patients declining cardiac status has been attributed to decreased cardiac action potential. Interventions will be aimed at restoring what aspect of cardiac physiology? A)The cycle of depolarization and repolarization B)The time it takes from the firing of the SA node to the contraction of the ventricles C)The time between the contraction of the atria and the contraction of the ventricles D)The cycle of the firing of the AV node and the contraction of the myocardium

A Feedback:This exchange of ions creates a positively charged intracellular space and a negatively charged extracellular space that characterizes the period known as depolarization. Once depolarization is complete, the exchange of ions reverts to its resting state; this period is known as repolarization. The repeated cycle of depolarization and repolarization is called the cardiac action potential.

When describing circulation, which would a nurse include? Low to high pressure system One course of blood flow A closed system Primarily a resistance system

A closed system Circulation is a closed, high- to low-pressure system that can follow two courses (systemic and pulmonary) and involves a resistance system (arterial) and a capacitance (venous) system.

In which situation would blood be most likely to be rapidly relocated from central circulation to the lower extremities? A client undergoes a stress test on a treadmill A client does isotonic exercises in a wheelchair A client is helped out of bed and stands up A client reclines from a sitting to supine position

A client is helped out of bed and stands up During a change in body position, blood is rapidly relocated from the central circulation (when the patient is recumbent) to the lower extremities (when the patient stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? (Mark all that apply.) A)Need for careful monitoring for cardiac symptoms B)Need for carefully regulated exercise C)Need for dietary modifications D)Need for early resumption of prediagnosis activity E)Need for increased fluid intake

A, B, C Feedback:Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing three major cardiovascular risk factors: hyperlipidemia, hypertension, and diabetes. There is no need to increase fluid intake and activity should be slowly and deliberately increased.

When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply. A)A transducer B)A flush system C)A leveler D)A pressure bag E)An oscillator

A, B, D Feedback:To perform hemodynamic monitoring, a CVP, pulmonary artery, or arterial catheter is introduced into the appropriate blood vessel or heart chamber. It is connected to a pressure monitoring system that has several components. Included among these are a transducer, a flush system, and a pressure bag. A pressure monitoring system does not have a leveler or an oscillator.

A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply. A)Pneumothorax B)Infection C)Atelectasis D)Bronchospasm E)Air embolism

A, B, E Feedback:Complications from use of hemodynamic monitoring systems are uncommon, but can include pneumothorax, infection, and air embolism. Complications of hemodynamic monitoring systems do not include atelectasis or bronchospasm.

The patient has a homocysteine level ordered. What aspects of this test should inform the nurses care? Select all that apply. A)A 12-hour fast is necessary before drawing the blood sample. B)Recent inactivity can depress homocysteine levels. C)Genetic factors can elevate homocysteine levels. D)A diet low in folic acid elevates homocysteine levels. E)An ECG should be performed immediately before drawing a sample

A, C, D Feedback:Genetic factors and a diet low in folic acid, vitamin B6, and vitamin B12 are associated with elevated homocysteine levels. A 12-hour fast is necessary before drawing a blood sample for an accurate serum measurement. An ECG is unnecessary and recent inactivity does not influence the results of the test.

After teaching a group of students about the events that occur when blood flow to the kidneys is reduced, the students demonstrate understanding when they identify that what occurs last? Aldosterone release Renin release Production of angiotensin I Conversion to angiotensin II

Aldosterone release When blood flow to the kidneys is reduced, the cells in the kidney release renin, which then converts angiotensinogen to angiotensin I. This is converted by angiotensin converting enzyme (ACE) to angiotensin II, which reacts with specific receptor sites on blood vessels to cause vasoconstriction. Angiotensin II also causes the release of aldosterone.

A nurse is explaining to a client the physiology of the heart with reference to the cardiac valves. Which statement by the client about the function of the cardiac valves demonstrates the correct understanding of the nurse's explanation? Contract with sufficient force to pump blood Act as receiving centers for blood Divide the heart into right and left sides Allow blood to flow in one direction only

Allow blood to flow in one direction only The cardiac valves are one-way flaps of tissue that open and close in response to pressure changes within the chambers. These unidirectional valves allow blood to flow in one direction only, preventing backflow. The cardiac valves do not contract with sufficient force to pump blood; that is the function of the left ventricle. The atria heart chambers are receiving centers for blood. A complete muscular wall called the septum divides the heart into right and left sides.

In preparation for cardiac surgery, a patient was taught about measures to prevent venous thromboembolism. What statement indicates that the patient clearly understood this education? A)"I'll try to stay in bed for the first few days to allow myself to heal." B)"I'll make sure that I don't cross my legs when I'm resting in bed." C)"I'll keep pillows under my knees to help my blood circulate better." D)"I'll put on those compression stockings if I get pain in my calves."

Ans: "I'll make sure that I don't cross my legs when I'm resting in bed." Feedback:To prevent venous thromboembolism, patients should avoid crossing the legs. Activity is generally begun as soon as possible and pillows should not be placed under the popliteal space. Compression stockings are often used to prevent venous thromboembolism, but they would not be applied when symptoms emerge.

The nurse admits a 32-year-old woman who takes oral contraceptives; she is expected to need aminocaproic acid postoperatively. The nurse recognizes this patient is at risk for what? A) Hypercoagulation B) Bleeding C) Pregnancy D) Infertility

Ans: A Feedback: Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with oral contraceptives or estrogens. Oral contraceptives do not increase the risk of pregnancy, bleeding, or infertility.

The patient receives a new diagnosis of peripheral artery disease and the nurse anticipates an order for what drug? A) Clopidogrel B) Persantine C) Aspirin D) Warfarin

Ans: A Feedback: Clopidogrel (Plavix) is indicated for the treatment of patients who are at risk for ischemic events; patients with a history of myocardial infarction, peripheral artery disease, or ischemic stroke; and patients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this patient.

The nurse administers agents that control bleeding to patients with hemophilia and what othercondition? A) Liver disease B) Lymes disease C) Disseminated intravascular coagulation (DIC) D) Pheochromocytoma

Ans: A Feedback: Drugs to control bleeding are also given to patients with liver disease because liver disease prohibits clotting factors and proteins needed for clotting from being produced in adequate quantities. Lymes disease, DIC, and pheochromocytoma are not indications for administration of agents to control bleeding.

The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatricuse? A) Heparin B) Dabigatran C) Rivaroxaban D) Low-molecular-weight heparins

Ans: A Feedback: Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated based on weight and age. It should be verified by another person before the drug is administered. Dabigatran and rivaroxaban are not approved for use in children. The safety of low-molecular-weight heparins has not been established in children.

The 86-year-old patient, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox).The nurse evaluates that he understands why enoxaparin is being used if he states that it will do what? A) Inhibit the formation of additional clots B) Stimulate production of certain clotting factors C) Prevent the blood from clotting D) Dissolve the clot

Ans: A Feedback: Low-molecular-weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects.

An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? A)Brachial artery B)Brachial vein C)Femoral artery D)Greater saphenous vein

Ans: Greater saphenous vein Feedback:The greater saphenous vein is the most commonly used graft site for CABG. The right and left internal mammary arteries, radial arteries, and gastroepiploic artery are other graft sites used, though not as frequently. The femoral artery, brachial artery, and brachial vein are never harvested.

What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin? A) Avoiding intramuscular injections B) Assessing for symptoms of respiratory depression C) Measuring hourly urinary outputs D) Monitoring BP hourly

Ans: A Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the patient is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because of heparin administration.

The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A) Heparin B) Urokinase C) Aspirin D) Warfarin

Ans: A Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors. None of the other medications listed in this question are indicated for treatment of DIC and may, in fact, make the condition worse.

The nurse admits a patient in acute respiratory distress secondary to pulmonary emboli. What drug willthe nurse administer to lyse the clots? A) Urokinase B) Tenecteplase C) Rivaroxaban D) Fondaparinux

Ans: A Feedback: Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Reteplase is used to treat coronary artery thrombosis associated with an acute myocardial infarction. Rivaroxaban is used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat and prevent venous thromboembolic events.

When the nurse administers warfarin it is expected that the drug will have what effect on the body? A) Decrease in production of vitamin K dependentt clotting factors B) Increase in prothrombin C) Increase in vitamin K dependent factors in the liver D) Increase in procoagulation factors

Ans: A Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production ovitamin Kdependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin Kdependent factors in the liver, or procoagulation factors.

A nurse is working with a patient who has been scheduled for a percutaneous coronary intervention (PCI) later in the week. What anticipatory guidance should the nurse provide to the patient? A)He will remain on bed rest for 48 to 72 hours after the procedure. B)He will be given vitamin K infusions to prevent bleeding following PCI. C)A sheath will be placed over the insertion site after the procedure is finished. D)The procedure will likely be repeated in 6 to 8 weeks to ensure success.

Ans: A sheath will be placed over the insertion site after the procedure is finished. Feedback:A sheath is placed over the PCI access site and kept in place until adequate coagulation is achieved. Patients resume activity a few hours after PCI and repeated treatments may or may not be necessary. Anticoagulants, not vitamin K, are administered during PCI.

The nurse is caring for a pediatric patient with hemophilia who receives antihemophilic factor several times a year. What should this patient be regularly screened for? (Select all that apply.) A) HIV B) Hepatitis C) Anemia D) Infection E) Cardiomyopathy

Ans: A, B, C Feedback: The most common adverse effects associated with antihemophilic agents involve risks associated with the use of blood products (e.g., in a patient with hepatitis or AIDS). Patients with hemophilia should also be monitored for anemia secondary to blood loss. There is no associated risk for infection or cardiomyopathy.

The nurse is sending a patient home who will remain on anticoagulant therapy. What teaching point does the nurse make when teaching the patient about the drug? (Select all that apply.) A) Brush teeth gently with soft bristle brush. B) Wear or carry a MedicAlert notification. C) Warning signs of bleeding include fatigue, pallor, and increased heart rate. D) Treat minor side effects with over-the-counter (OTC) medications. E) Obtain follow-up lab work regularly as ordered.

Ans: A, B, C, E Feedback: Patients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The patient should have a MedicAlert to notify other health care providers of anticoagulant therapy.

The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this morning. What actions will the nurse take? (Select all that apply.) A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). C) Expect to administer protamine sulfate. D) Expect to administer vitamin K. E) Assess partial thromboplastin time (PTT).

Ans: A, B, D Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin.

What drug would the nurse administer for its antiplatelet effects? (Select all that apply.) A) Ticlid B) Iprivask C) Arixtra D) ReoPro E) Activase

Ans: A, D Feedback: Antiplatelet agents available for use include abciximab (ReoPro), anagrelide (Agrylin), aspirin, cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), eptifibatide (Integrilin), ticlopidine (Ticlid), ticagrelor (Brilinta), and tirofiban (Aggrastat). Iprivask and Arixtra are anticoagulants, and Actuvase is a thrombolytic agent.

A cardiovascular clinical nurse specialist describes the dysfunctional endothelium in relation to cardiovascular disease. What is the major factor in the development of the dysfunctional endothelium? Inflammation Septicemia Tumor Atherosclerosis

Atherosclerosis Dysfunctional endothelium is considered a major factor in atherosclerosis, acute coronary syndromes, hypertension, and thromboembolic disorders. Dysfunctional endothelium is not related to inflammation, septicemia, or tumor.

The nurse providing care for a patient post PTCA knows to monitor the patient closely. For what complications should the nurse monitor the patient? Select all that apply. A)Abrupt closure of the coronary artery B)Venous insufficiency C)Bleeding at the insertion site D)Retroperitoneal bleeding E)Arterial occlusion

Ans: Abrupt closure of the coronary artery, Bleeding at the insertion site, Retroperitoneal bleeding, Arterial occlusion Feedback:Complications after the procedure may include abrupt closure of the coronary artery and vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion, as well as acute renal failure. Venous insufficiency is not a postprocedure complication of a PTCA.

The nurse is creating a plan of care for a patient with acute coronary syndrome. What nursing action should be included in the patient's care plan? A)Facilitate daily arterial blood gas (ABG) sampling. B)Administer supplementary oxygen, as needed. C)Have patient maintain supine positioning when in bed. D)Perform chest physiotherapy, as indicated.

Ans: Administer supplementary oxygen, as needed. Feedback:Oxygen should be administered along with medication therapy to assist with symptom relief. Administration of oxygen raises the circulating level of oxygen to reduce pain associated with low levels of myocardial oxygen. Physical rest in bed with the head of the bed elevated or in a supportive chair helps decrease chest discomfort and dyspnea. ABGs are diagnostic, not therapeutic, and they are rarely needed on a daily basis. Chest physiotherapy is not used in the treatment of ACS.

You are writing a care plan for a patient who has been diagnosed with angina pectoris. The patient describes herself as being "distressed" and "shocked" by her new diagnosis. What nursing diagnosis is most clearly suggested by the woman's statement? A)Spiritual distress related to change in health status B)Acute confusion related to prognosis for recovery C)Anxiety related to cardiac symptoms D)Deficient knowledge related to treatment of angina pectoris

Ans: Anxiety related to cardiac symptoms Feedback:Although further assessment is warranted, it is not unlikely that the patient is experiencing anxiety. In patients with CAD, this often relates to the threat of sudden death. There is no evidence of confusion (i.e., delirium or dementia) and there may or may not be a spiritual element to her concerns. Similarly, it is not clear that a lack of knowledge or information is the root of her anxiety.

The nurse administers clopidogrel (Plavix) appropriately to the patient with what condition? A) Maintaining the patency of grafts B) Treating peripheral artery disease C) Preventing emboli from valve replacements D) Dissolving a pulmonary embolus and improving oxygenation

Ans: B Feedback: Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or injured blood vessels like those found in peripheral artery disease. Maintaining the patency of grafts or preventing emboli from valve replacements would be accomplished using an anticoagulant. Dissolving emboli would be accomplished using streptokinase or a similar enzyme to stimulate the conversion of plasminogen to plasmin.

When the nurse administers heparin it is anticipated the drug will have what action on the patient's body? A) Binds to factor X B) Blocks the formation of thrombin C) Binds to factor Xa D) Promotes the inactivation of factor VIII

Ans: B Feedback: Heparin blocks the formation of thrombin from prothrombin. Heparin does not bind to factors X and Xa. Heparin does not inactivate factor VIII.

A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing thepatient's knowledge of the drug, what would indicate that the patient needs further instruction concerning drug therapy? A) I love to eat homegrown tomatoes in the summer. B) I take aspirin for my arthritis. C) I walk 2 miles a day. D) I drink a glass of wine about once a week

Ans: B Feedback: Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the patient to stop taking aspirin. Walking, eating tomatoes, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.

Prior to beginning anticoagulant therapy, the nurse will question the female patient about what? A) Last menstrual period B) Peptic ulcers C) Urinary tract infection D) Weight

Ans: B Feedback: The nurse should screen for conditions that could be exacerbated by increased bleeding tendencies, including hemorrhagic disorders, recent trauma, spinal puncture, gastrointestinal (GI) ulcers, recent surgery, intrauterine device placement, tuberculosis, presence of indwelling catheters, and threatened abortion. Beginning anticoagulant therapy with active peptic ulcers could result in severe bleeding. Last menstrual period, urinary tract infection, and weight should not impact anticoagulant therapy.

A young man has been diagnosed with hemophilia and the nurse is planning his discharge teaching and includes what teaching point? A) Using nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain B) Preventing trauma to the body C) Receiving IV factor VIII therapy at home D) Understanding the condition is an X-linked recessive disorder

Ans: B Feedback: The nurse's thorough patient teaching must include the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation. Hemophilia A is an X-linked recessive disorder that primarily affects males. Approximately 90% of persons with hemophilia produce insufficient quantities of the factor VIII. The prevention of trauma is important in people with hemophilia. The other options are incorrect.

The nurse reviews the patient's lab values and determines warfarin therapy is at therapeutic levels withwhat lab result? A) Partial thromboplastin time (PTT) 1.5 to 2.5 times the control B) Prothrombin time (PT) 1.3 to 1.5 times the control C) International normalized ratio (INR) of 3 to 4 D) Activated partial thromboplastin time (aPTT) 3 to 4 times the control

Ans: B Feedback: Warfarin is at therapeutic level when the INR is 2 to 3.5 and the PT is 1.3 to 1.5 times control. PTT and aPTT should be 1.5 to 2.5 to indicate heparin dosage is at therapeutic level.

The nurse evaluates teaching about warfarin (Coumadin) is successful when the patient makes what statement? A) If I miss a dose, I will take two pills the next day. B) I will check with the pharmacist before taking any herbal supplements. C) I will increase the dark-green leafy vegetables in my diet. D) I will take a multivitamin daily.

Ans: B Feedback: Warfarin is involved in many drugdrug and drugherb interactions so the patients statement about checking with the doctor before starting any new drugs or supplements would be correct. The other statements made by the patient indicate the need for further teaching because he or she should not take two pills after missing a dose, there is no need to increase green leafy vegetables containing vitamin K, and multivitamin use is contraindicated.

Teach patients to recognize the signs of blood loss and stress the importance of follow-up lab work. Patients should be taught to avoid adding any new medication, prescription or OTC, without first talking to the health care provider or pharmacist to ensure safety. Indications for the nurse to administer heparin include what? (Select all that apply.) A) Treatment of hemophilia B) Prevention and treatment of pulmonary emboli C) Treatment of atrial fibrillation with embolization D) Prevention and treatment of venous thrombosis E) Diagnosis and treatment of disseminated intravascular coagulation (DIC)

Ans: B, C, D, E Feedback: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to patients with hemophilia because the drug would worsen bleeding.

The nurse is participating in the care conference for a patient with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? A)Maximizing cardiac output while minimizing heart rate B)Decreasing energy expenditure of the myocardium C)Balancing myocardial oxygen supply with demand D)Increasing the size of the myocardial muscle

Ans: Balancing myocardial oxygen supply with demand Feedback:Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with ACS. Treatment is not aimed directly at minimizing heart rate because some patients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardium's energy expenditure is often beneficial, but this must be balanced with productivity.

A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? A)Begin ECG monitoring. B)Obtain information about family history of heart disease. C)Auscultate lung fields. D)Determine if the patient smokes.

Ans: Begin ECG monitoring. Feedback:The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the patient smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.

A patient with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the patient? A)Hyperlipidemia B)Bleeding at insertion site C)Left ventricular hypertrophy D)Congestive heart failure

Ans: Bleeding at insertion site Feedback:Complications of PTCA may include bleeding at the insertion site, abrupt closure of the artery, arterial thrombosis, and perforation of the artery. Complications do not include hyperlipidemia, left ventricular hypertrophy, or congestive heart failure; each of these problems takes an extended time to develop and none is emergent.

By what route will the nurse administer the antihemophilic agent to the patient with hemophilia following a car accident? A) Oral B) Topical C) IV D) Sublingual

Ans: C Feedback: All antihemophilic agents are administered IV and are not available for administration by any other route.

The nurse discovers a patient receiving warfarin is bleeding. What drug would the nurse prepare to counteract this drug? A) Vitamin E B) Vitamin K C) Protamine sulfate D) Calcium gluconate

Ans: C Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this patient.

A patient is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid what? A) St. John's wort B) Tarragon C) Ginkgo D) Saw palmetto

Ans: C Feedback: Many of the herbal remedies are known to alter blood coagulation and should be avoided when taking anticoagulants. Patients taking these drugs should be cautioned to avoid angelica, cat's claw, chamomile, chondroitin, feverfew, garlic, Ginkgo, goldenseal, grape seed extract, green leaf tea, horse chestnut seed, psyllium, and turmeric. If a patient who is taking an anticoagulant presents with increased bleeding and no other interaction or cause is found, question the patient about the possibility of use of herbal therapies. St. John's wort, tarragon, and saw palmetto are not implicated as having an interaction with anticoagulants.

The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the patient require to evaluate therapeutic effects of the drug? A) Activated partial thromboplastin time (APTT) only B) International normalized ratio (INR) only C) Prothrombin time (PT) and INRD ) PT and APTT

Ans: C Feedback: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value and the ratio of PT to INR is 2 to 3.5.

The nurse is caring for a patient who received protamine sulfate in error. The patient is not receiving,and has never received, heparin. What effect does the nurse assess for in this patient? A) Coagulation effects B) No effect C) Anticoagulant effects D) Antiplatelet effects

Ans: C Feedback: Paradoxically, if protamine is given to a patient who has not received heparin, it has anticoagulant effects. Protamine is normally used as an antidote to heparin overdose but if heparin was not administered, it does not have coagulation or antiplatelet effects. Since it has anticoagulant effects it cannot be said to have no effect.

The nurse is caring for a patient with a fever and severe diarrhea in addition to thrombophlebitis. How will this patient's condition impact the clotting process? A) Depleted production of Hageman factor B) Increased production of thrombin C) Activation of plasminogen D) Reduced production of fibrinolysin

Ans: C Feedback: Plasminogen is the basis for the clot-dissolving system. It is converted to plasmin (fibrinolysin) by several factors including Hageman's factor, which is factor XII found in circulating blood. Activated thrombin breaks down fibrinogen to form fibrin threads, which form a clot inside the blood vessel. Patients with diarrhea or fever could alter the normal clotting process by, respectively, loss of vitamin K from the intestine or activation of plasminogen.

A patient is admitted to the hospital with deep vein thrombosis. A 10,000-unit dose of heparin isadministered subcutaneously. What drug does the nurse keep on hand to reverse the effects of heparin if the patient begins to bleed? A) Antithrombin (Thrombate III) B) Desirudin (Iprivask) C) Protamine sulfate D) Vitamin K

Ans: C Feedback: The antidote for heparin is protamine sulfate. This drug forms stable salts as soon as it comes in contact with heparin. The reaction immediately reverses heparin's anticoagulation effects. Vitamin K reverses the effect of warfarin. Antithrombin and desirudin are anticoagulants that would not be administered with heparin.

The nurse evaluates the effects of warfarin (Coumadin) by monitoring what laboratory test? A) Red blood cell count (RBC) B) Activated thromboplastin time (APT) C) Prothrombin time (PT) and international normalized ratio (INR) D) Platelet count

Ans: C Feedback: The warfarin dose is regulated according to the INR. INR is based upon the PT. The other options are incorrect.

A patient in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in her femoral region. What is the nurse's most appropriate action? A)Call for assistance and initiate cardiopulmonary resuscitation. B)Reposition the patient's leg in a nondependent position. C)Promptly remove the femoral sheath. D)Call for help and apply pressure to the access site.

Ans: Call for help and apply pressure to the access site. Feedback:The femoral sheath produces pressure on the access site. Pressure will temporarily reduce bleeding and allow for subsequent interventions. Removing the sheath would exacerbate bleeding and repositioning would not halt it. CPR is not indicated unless there is evidence of respiratory or cardiac arrest.

The OR nurse is explaining to a patient that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe? A)Coronary artery bypass graft (CABG) B)Percutaneous transluminal coronary angioplasty (PTCA) C)Atherectomy D)Cardiopulmonary bypass

Ans: Cardiopulmonary bypass Feedback:Cardiopulmonary bypass is often used to circulate and oxygenate blood mechanically while bypassing the heart and lungs. PTCA, atherectomy, and CABG are all surgical procedures, none of which achieves the two goals listed.

A nurse has taken on the care of a patient who had a coronary artery stent placed yesterday. When reviewing the patient's daily medication administration record, the nurse should anticipate administering what drug? A)Ibuprofen B)Clopidogrel C)Dipyridamole D)Acetaminophen

Ans: Clopidogrel Feedback:Because of the risk of thrombus formation within the stent, the patient receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.

A patient who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action? A)Document the patient's low urine output and monitor closely for the next several hours. B)Contact the dietitian and suggest the need for increased oral fluid intake. C)Contact the patient's physician and suggest assessment of fluid balance and renal function. D)Increase the infusion rate of the patient's IV fluid to prompt an increase in renal function.

Ans: Contact the patient's physician and suggest assessment of fluid balance and renal function. Feedback:Nursing management includes accurate measurement of urine output. An output of less than 1 mL/kg/h may indicate hypovolemia or renal insufficiency. Prompt referral is necessary. IV fluid replacement may be indicated, but is beyond the independent scope of the dietitian or nurse.

A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause? A)Decreased cardiac output B)Decreased cardiac contractility C)Infarction of the myocardium D)Coronary arteriosclerosis

Ans: Coronary arteriosclerosis Feedback:In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease.

The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurseinstruct the patient to do prior to starting heparin to treat venous thrombosis? A) Wait an hour after taking the anticoagulant before feeding the infant. B) Push fluids to clear the drug from her system before feeding the infant. C) Find another method of feeding the infant while taking this drug. D) Continue breast-feeding because heparin does not enter breast milk.

Ans: D Feedback: Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, push fluids, or find another method of feeding the baby.

The nurse receives a patient having an acute myocardial infarction (MI) to the emergency department.What drug will the nurse administer before transferring the patient to a larger facility? A) Anagrelide (Agrylin) B) Clopidogrel (Plavix) C) Ticlopidine (Ticlid) D) Tenecteplase (TNKase)

Ans: D Feedback: Arrange to administer tenecteplase to reduce mortality associated with acute MI as soon as possible after the onset of symptoms because the timing for the administration of tenecteplase is critical to resolve the clot before permanent damage occurs to the myocardial cells. Anagrelide is used to treat essential thrombocytopenia. Clopidogrel is used to treat patients who are at risk for ischemic events; ticlopidine is used to reduce the risk of thrombotic stroke.

The nurse teaches the patient taking warfarin (Coumadin) to minimize foods high in vitamin K including what type of food? A) Eggs B) Dairy products C) Citrus fruits D) Green leafy vegetables

Ans: D Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Vitamin K is responsible for promoting the liver synthesis of several clotting factors. When these pathways have been inhibited by warfarin, clotting time is increased. If an increased level of vitamin K is provided, more of these factors are produced, and the clotting time can be brought back within a normal range. Green leafy vegetables are high in vitamin K and should be avoided or minimized in the diet to prevent reversal of warfarin effects. The other food options are not high in vitamin K.

The nurse is caring for a patient following repeat coronary artery bypass grafting who has excessive bleeding. What systemic hemostatic drug will the nurse expect to administer? A) Thrombin recombinant B) Microfibrillar collagen C) Human fibrin sealant D) Aminocaproic acid (Amicar)

Ans: D Feedback: The hemostatic drug that is used systemically is aminocaproic acid (Amicar). Topical hemostatic agents include absorbable gelatin (Gelfoam), human fibrin sealant (Artiss, Evicel), microfibrillar collagen (Avitene), thrombin (Thrombinar, Thrombostat), and thrombin recombinant (Recothrom).

The nurse evaluates that additional patient teaching is needed regarding anticoagulants when the patient states that he will do what? A) Carry a Medic Alert card with him. B) Report to the lab once a month. C) Use acetaminophen for arthritis pain. D) Use a disposable safety razor to shave.

Ans: D Feedback: The patient should use an electric razor to shave rather than a disposable razor that could nick his skin and increase risk of bleeding. Carrying a MedicAlert card, getting regular follow-up lab work, and use of acetaminophen would all be appropriate actions that would not indicate the need for further teaching.

A 76-year-old patient is receiving IV heparin 5,000 units every 8 hours. An activated thromboplastintime (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action? A) Give a larger dose to increase the aPTT. B) Give the dose as ordered and chart the results. C) Check the patient's vital signs prior to administering the dose. D) Hold the dose and call the result to the physician.

Ans: D Feedback: The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The patient's value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the physician.

The public health nurse is participating in a health fair and interviews a patient with a history of hypertension, who is currently smoking one pack of cigarettes per day. She denies any of the most common manifestations of CAD. Based on these data, the nurse would expect the focuses of CAD treatment most likely to be which of the following? A)Drug therapy and smoking cessation B)Diet and drug therapy C)Diet therapy only D)Diet therapy and smoking cessation

Ans: Diet therapy and smoking cessation Feedback:Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostics findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.

The nurse working on the coronary care unit is caring for a patient with ACS. How can the nurse best meet the patient's psychosocial needs? A)Reinforce the fact that treatment will be successful. B)Facilitate a referral to a chaplain or spiritual leader. C)Increase the patient's participation in rehabilitation activities. D)Directly address the patient's anxieties and fears.

Ans: Directly address the patient's anxieties and fears. Feedback:Alleviating anxiety and decreasing fear are important nursing functions that reduce the sympathetic stress response. Referrals to spiritual care may or may not be appropriate, and this does not relieve the nurse of responsibility for addressing the patient's psychosocial needs. Treatment is not always successful, and false hope should never be fostered. Participation in rehabilitation may alleviate anxiety for some patients, but it may exacerbate it for others.

The nurse is assessing a patient with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? Select all that apply. A)Dyspnea B)Unusual fatigue C)Hypotension D)Syncope E)Peripheral cyanosis

Ans: Dyspnea, Unusual fatigue, Syncope Feedback:Systematic assessment includes a careful history, particularly as it relates to symptoms: chest pain or discomfort, difficulty breathing (dyspnea), palpitations, unusual fatigue, faintness (syncope), or sweating (diaphoresis). Each symptom must be evaluated with regard to time, duration, and the factors that precipitate the symptom and relieve it, and in comparison with previous symptoms. Hypotension and peripheral cyanosis are not typically associated with ACS.

When discussing angina pectoris secondary to atherosclerotic disease with a patient, the patient asks why he tends to experience chest pain when he exerts himself. The nurse should describe which of the following phenomena? A)Exercise increases the heart's oxygen demands. B)Exercise causes vasoconstriction of the coronary arteries. C)Exercise shunts blood flow from the heart to the mesenteric area. D)Exercise increases the metabolism of cardiac medications.

Ans: Exercise increases the heart's oxygen demands. Feedback:Physical exertion increases the myocardial oxygen demand. If the patient has arteriosclerosis of the coronary arteries, then blood supply is diminished to the myocardium. Exercise does not cause vasoconstriction or interfere with drug metabolism. Exercise does not shunt blood flow away from the heart.

The nurse has just admitted a 66-year-old patient for cardiac surgery. The patient tearfully admits to the nurse that she is afraid of dying while undergoing the surgery. What is the nurse's best response? A)Explore the factors underlying the patient's anxiety. B)Teach the patient guided imagery techniques. C)Obtain an order for a PRN benzodiazepine. D)Describe the procedure in greater detail.

Ans: Explore the factors underlying the patient's anxiety. Feedback:An assessment of anxiety levels is required in the patient to assist the patient in identifying fears and developing coping mechanisms for those fears. The nurse must further assess and explore the patient's anxiety before providing interventions such as education or medications.

The nurse is caring for a patient who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure? A)Increase in the size of the artery's lumen B)Decrease in arterial blood flow in relation to venous flow C)Increase in the patient's resting heart rate D)Increase in the patient's level of consciousness (LOC)

Ans: Increase in the size of the artery's lumen Feedback:PTCA is used to open blocked coronary vessels and resolve ischemia. The procedure may result in beneficial changes to the patient's LOC or heart rate, but these are not the overarching goals of PTCA. Increased arterial flow is the focus of the procedures.

The nurse is caring for an adult patient who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina? A)Ineffective breathing pattern related to decreased cardiac output B)Anxiety related to fear of death C)Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) D)Impaired skin integrity related to CAD

Ans: Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) Feedback:Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.

The nurse is assessing a patient who was admitted to the critical care unit 3 hours ago following cardiac surgery. The nurse's most recent assessment reveals that the patient's left pedal pulses are not palpable and that the right pedal pulses are rated at +2. What is the nurse's best response? A)Document this expected assessment finding during the initial postoperative period. B)Reposition the patient with his left leg in a dependent position. C)Inform the patient's physician of this assessment finding. D)Administer an ordered dose of subcutaneous heparin.

Ans: Inform the patient's physician of this assessment finding. Feedback:If a pulse is absent in any extremity, the cause may be prior catheterization of that extremity, chronic peripheral vascular disease, or a thromboembolic obstruction. The nurse immediately reports newly identified absence of any pulse.

Preoperative education is an important part of the nursing care of patients having coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse would be sure to include education about which subject? A)Symptoms of hypovolemia B)Symptoms of low blood pressure C)Complications requiring graft removal D)Intubation and mechanical ventilation

Ans: Intubation and mechanical ventilation Feedback:Most patients remain intubated and on mechanical ventilation for several hours after surgery. It is important that patients realize that this will prevent them from talking, and the nurse should reassure them that the staff will be able to assist them with other means of communication. Teaching would generally not include symptoms of low blood pressure or hypovolemia, as these are not applicable to most patients. Teaching would also generally not include rare complications that would require graft removal.

The triage nurse in the ED assesses a 66-year-old male patient who presents to the ED with complaints of midsternal chest pain that has lasted for the last 5 hours. If the patient's symptoms are due to an MI, what will have happened to the myocardium? A)It may have developed an increased area of infarction during the time without treatment. B)It will probably not have more damage than if he came in immediately. C)It may be responsive to restoration of the area of dead cells with proper treatment. D)It has been irreparably damaged, so immediate treatment is no longer necessary.

Ans: It may have developed an increased area of infarction during the time without treatment. Feedback:When the patient experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated, the more likely the treatment will prevent or minimize myocardial tissue necrosis. Delays in treatment equate with increased myocardial damage. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage. Dead cells cannot be restored by any means.

The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? A)Lipids and fibrous tissue B)White blood cells C)Lipoproteins D)High-density cholesterol

Ans: Lipids and fibrous tissue Feedback:As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of white cells, lipoproteins, or high-density cholesterol.

The nurse is providing care for a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? A)High HDL values and high triglyceride values B)Absence of detectable total cholesterol levels C)Elevated blood lipids, fasting glucose less than 100 D)Low LDL values and high HDL values

Ans: Low LDL values and high HDL values Feedback:The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.

The ED nurse is caring for a patient with a suspected MI. What drug should the nurse anticipate administering to this patient? A)Oxycodone B)Warfarin C)Morphine D)Acetaminophen

Ans: Morphine Feedback:The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta- blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.

The nurse is working with a patient who had an MI and is now active in rehabilitation. The nurse should teach this patient to cease activity if which of the following occurs? A)The patient experiences chest pain, palpitations, or dyspnea. B)The patient experiences a noticeable increase in heart rate during activity. C)The patient's oxygen saturation level drops below 96%. D)The patient's respiratory rate exceeds 30 breaths/min.

Ans: The patient experiences chest pain, palpitations, or dyspnea. Feedback:Any activity or exercise that causes dyspnea and chest pain should be stopped in the patient with CAD. Heart rate must not exceed the target rate, but an increase above resting rate is expected and is therapeutic. In most patients, a respiratory rate that exceeds 30 breaths/min is not problematic. Similarly, oxygen saturation slightly below 96% does not necessitate cessation of activity.

An adult patient is admitted to the ED with chest pain. The patient states that he had developed unrelieved chest pain that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? A)Thrombolytics, oxygen administration, and nonsteroidal anti-inflammatories B)Morphine sulphate, oxygen, and bed rest C)Oxygen and beta-adrenergic blockers D)Bed rest, albuterol nebulizer treatments, and oxygen

Ans: Morphine sulphate, oxygen, and bed rest Feedback:The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.

An ED nurse is assessing an adult woman for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female patients? Select all that apply. A)Shortness of breath B)Chest pain C)Anxiety D)Numbness E)Weakness

Ans: Numbness, Weakness Feedback:Although these symptoms are not wholly absent in men, many women have been found to have atypical symptoms of MI, including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among patients of all ages and genders.

The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors would the nurse list that can be controlled or modified? A)Gender, obesity, family history, and smoking B)Inactivity, stress, gender, and smoking C)Obesity, inactivity, diet, and smoking D)Stress, family history, and obesity

Ans: Obesity, inactivity, diet, and smoking Feedback:The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.

A patient is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? A)Administration of bronchodilators by nebulizer B)Administration of inhaled corticosteroids by metered dose inhaler (MDI) C)Patient's consistent performance of deep breathing and coughing exercises D)Patient's active participation in the cardiac rehabilitation program

Ans: Patient's consistent performance of deep breathing and coughing exercises Feedback:Clearance of pulmonary secretions is accomplished by frequent repositioning of the patient, suctioning, and chest physical therapy, as well as educating and encouraging the patient to breathe deeply and cough. Medications are not normally used to achieve this goal. Rehabilitation is important, but will not necessarily aid the mobilization of respiratory secretions.

The nurse is caring for patient who tells the nurse that he has an angina attack beginning. What is the nurse's most appropriate initial action? A)Have the patient sit down and put his head between his knees. B)Have the patient perform pursed-lip breathing. C)Have the patient stand still and bend over at the waist. D)Place the patient on bed rest in a semi-Fowler's position.

Ans: Place the patient on bed rest in a semi-Fowler's position. Feedback:When a patient experiences angina, the patient is directed to stop all activities and sit or rest in bed in a semi-Fowler's position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. No need to have the patient put his head between his legs because cerebral perfusion is not lacking.

A patient presents to the ED in distress and complaining of "crushing" chest pain. What is the nurse's priority for assessment? A)Prompt initiation of an ECG B)Auscultation of the patient's point of maximal impulse (PMI) C)Rapid assessment of the patient's peripheral pulses D)Palpation of the patient's cardiac apex

Ans: Prompt initiation of an ECG Feedback:The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. Each of the other listed assessments is valid, but ECG monitoring is the most time dependent priority.

A patient with cardiovascular disease is being treated with amlodipine (Norvasc), a calcium channel blocking agent. The therapeutic effects of calcium channel blockers include which of the following? A)Reducing the heart's workload by decreasing heart rate and myocardial contraction B)Preventing platelet aggregation and subsequent thrombosis C)Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart D)Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain

Ans: Reducing the heart's workload by decreasing heart rate and myocardialcontraction Feedback:Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis, which impedes blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and, in higher doses, the arteries.

The nurse is caring for a patient who is believed to have just experienced an MI. The nurse notes changes in the ECG of the patient. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? A)P wave inversion B)T wave inversion C)Q wave changes with no change in ST or T wave D)P wave enlargement

Ans: T wave inversion Feedback:T-wave inversion is an indicator of ischemic damage to myocardium. Typically, few changes to P waves occur during or after an MI, whereas Q-wave changes with no change in the ST or T wave indicate an old MI.

When assessing a patient diagnosed with angina pectoris it is most important for the nurse to gather what information? A)The patient's activities limitations and level of consciousness after the attacks B)The patient's symptoms and the activities that precipitate attacks C)The patient's understanding of the pathology of angina D)The patient's coping strategies surrounding the attacks

Ans: The patient's symptoms and the activities that precipitate attacks Feedback:The nurse must gather information about the patient's symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. The patient's coping, understanding of the disease, and status following attacks are all important to know, but causative factors are a primary focus of the assessment interview.

Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? A)The symptoms indicate angina and should be treated as such. B)The symptoms indicate a pulmonary etiology rather than a cardiac etiology. C)The symptoms indicate an acute coronary episode and should be treated as such. D)Treatment should be determined pending the results of an exercise stress test.

Ans: The symptoms indicate an acute coronary episode and should be treated as such. Feedback:Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patient's symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.

A patient with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the patient about what potential adverse effects? A)Nervousness or paresthesia B)Throbbing headache or dizziness C)Drowsiness or blurred vision D)Tinnitus or diplopia

Ans: Throbbing headache or dizziness Feedback:Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy.

The nurse is caring for a patient who is scheduled for cardiac surgery. What should the nurse include in preoperative care? A)With the patient, clarify the surgical procedure that will be performed. B)Withhold the patient's scheduled medications for at least 12 hours preoperatively. C)Inform the patient that health teaching will begin as soon as possible after surgery. D)Avoid discussing the patient's fears as not to exacerbate them.

Ans: With the patient, clarify the surgical procedure that will be performed. Feedback:Preoperatively, it is necessary to evaluate the patient's understanding of the surgical procedure, informed consent, and adherence to treatment protocols. Teaching would begin on admission or even prior to admission. The physician would write orders to alter the patient's medication regimen if necessary; this will vary from patient to patient. Fears should be addressed directly and empathically.

When assessing venous disease in a patient's lower extremities, the nurse knows that what test will most likely be ordered? A)Duplex ultrasonography B)Echocardiography C)Positron emission tomography (PET) D)Radiography

Ans:A Feedback:Duplex ultrasound may be used to determine the level and extent of venous disease as well as its chronicity. Radiographs (x-rays), PET scanning, and echocardiography are never used for this purpose as they do not allow visualization of blood flow.

A patient with advanced venous insufficiency is confined following orthopedic surgery. How can the nurse best prevent skin breakdown in the patient's lower extremities? A)Ensure that the patient's heels are protected and supported. B)Closely monitor the patient's serum albumin and prealbumin levels. C)Perform gentle massage of the patient's lower legs, as tolerated. D)Perform passive range-of-motion exercises once per shift.

Ans:A Feedback:If the patient is on bed rest, it is important to relieve pressure on the heels to prevent pressure ulcerations, since the heels are among the most vulnerable body regions. Monitoring blood work does not directly prevent skin breakdown, even though albumin is related to wound healing. Massage is not normally indicated and may exacerbate skin breakdown. Passive range- of-motion exercises do not directly reduce the risk of skin breakdown.

The nurse is caring for a patient who returned from the tropics a few weeks ago and who sought care with signs and symptoms of lymphedema. The nurse's plan of care should prioritize what nursing diagnosis? A)Risk for infection related to lymphedema B)Disturbed body image related to lymphedema C)Ineffective health maintenance related to lymphedema D)Risk for deficient fluid volume related to lymphedema

Ans:A Feedback:Lymphedema, which is caused by accumulation of lymph in the tissues, constitutes a significant risk for infection. The patient's body image is likely to be disturbed, and the nurse should address this, but infection is a more significant threat to the patient's physiological well-being. Lymphedema is unrelated to ineffective health maintenance and deficient fluid volume is not a significant risk.

A nurse is creating an education plan for a patient with venous insufficiency. What measure should the nurse include in the plan? A)Avoiding tight-fitting socks. B)Limit activity whenever possible. C)Sleep with legs in a dependent position. D)Avoid the use of pressure stockings.

Ans:A Feedback:Measures taken to prevent complications include avoiding tight-fitting socks and panty girdles; maintaining activities, such as walking, sleeping with legs elevated, and using pressure stockings. Not included in the teaching plan for venous insufficiency would be reducing activity, sleeping with legs dependent, and avoiding pressure stockings. Each of these actions exacerbates venous insufficiency.

The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the patient takes oral contraceptives. Consequently, the nurse's postoperative plan of care should include what intervention? A)Early ambulation and leg exercises B)Cessation of the oral contraceptives until 3 weeks postoperative C)Doppler ultrasound of peripheral circulation twice daily D)Dependent positioning of the patient's extremities when at rest

Ans:A Feedback:Oral contraceptive use increases blood coagulability; with bed rest, the patient may be at increased risk of developing deep vein thrombosis. Leg exercises and early ambulation are among the interventions that address this risk. Assessment of peripheral circulation is important, but Doppler ultrasound may not be necessary to obtain these data. Dependent positioning increases the risk of venous thromboembolism (VTE). Contraceptives are not normally discontinued to address the risk of VTE in the short term.

The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks several blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what instruction about long-term care to the client? A)"Be sure to practice meticulous foot care." B)"Consider cutting down on your smoking." C)"Reduce your activity level to accommodate your limitations." D)"Try to make sure you eat enough protein."

Ans:A Feedback:The patient with peripheral vascular disease or diabetes should receive education or reinforcement about skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot care is essential. The patient should stop smoking—not just cut down—because nicotine is a vasoconstrictor. Daily walking benefits the patient with intermittent claudication. Increased protein intake will not alleviate the patient's symptoms.

A patient who has undergone a femoral to popliteal bypass graft surgery returns to the surgical unit. Which assessments should the nurse perform during the first postoperative day? A)Assess pulse of affected extremity every 15 minutes at first. B)Palpate the affected leg for pain during every assessment. C)Assess the patient for signs and symptoms of compartment syndrome every 2 hours. D)Perform Doppler evaluation once daily.

Ans:A Feedback:The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable. Doppler evaluations should be performed every 2 hours. Pain is regularly assessed, but palpation is not the preferred method of performing this assessment. Compartment syndrome results from the placement of a cast, not from vascular surgery.

The nurse is caring for a patient with a large venous leg ulcer. What intervention should the nurse implement to promote healing and prevent infection? A)Provide a high-calorie, high-protein diet. B)Apply a clean occlusive dressing once daily and whenever soiled. C)Irrigate the wound with hydrogen peroxide once daily. D)Apply an antibiotic ointment on the surrounding skin with each dressing change.

Ans:A Feedback:Wound healing is highly dependent on adequate nutrition. The diet should be sufficiently high in calories and protein. Antibiotic ointments are not normally used on the skin surrounding a leg ulcer and occlusive dressings can exacerbate impaired blood flow. Hydrogen peroxide is not normally used because it can damage granulation tissue.

The nurse is evaluating a patient's diagnosis of arterial insufficiency with reference to the adequacy of the patient's blood flow. On what physiological variables does adequate blood flow depend? Select all that apply. A)Efficiency of heart as a pump B)Adequacy of circulating blood volume C)Ratio of platelets to red blood cells D)Size of red blood cells E)Patency and responsiveness of the blood vessels

Ans:A, B, E Feedback:Adequate blood flow depends on the efficiency of the heart as a pump, the patency and responsiveness of the blood vessels, and the adequacy of circulating blood volume. Adequacy of blood flow does not primarily depend on the size of red cells or their ratio to the number of platelets.

The nurse has performed a thorough nursing assessment of the care of a patient with chronic leg ulcers. The nurse's assessment should include which of the following components? Select all that apply. A)Location and type of pain B)Apical heart rate C)Bilateral comparison of peripheral pulses D)Comparison of temperature in the patient's legs E)Identification of mobility limitations

Ans:A, C, D, E Feedback:A careful nursing history and assessment are important. The extent and type of pain are carefully assessed, as are the appearance and temperature of the skin of both legs. The quality of all peripheral pulses is assessed, and the pulses in both legs are compared. Any limitation of mobility and activity that results from vascular insufficiency is identified. Not likely is there any direct indication for assessment of apical heart rate, although peripheral pulses must be assessed.

An occupational health nurse is providing an educational event and has been asked by an administrative worker about the risk of varicose veins. What should the nurse suggest as a proactive preventative measure for varicose veins? A)Sit with crossed legs for a few minutes each hour to promote relaxation. B)Walk for several minutes every hour to promote circulation. C)Elevate the legs when tired. D)Wear snug-fitting ankle socks to decrease edema.

Ans:B Feedback:A proactive approach to preventing varicose veins would be to walk for several minutes every hour to promote circulation. Sitting with crossed legs may promote relaxation, but it is contraindicated for patients with, or at risk for, varicose veins. Elevating the legs only helps blood passively return to the heart and does not help maintain the competency of the valves in the veins. Wearing tight ankle socks is contraindicated for patients with, or at risk for, varicose veins; socks that are below the muscles of the calf do not promote venous return, the socks simply capture the blood and promote venous stasis.

While assessing a patient the nurse notes that the patient's ankle-brachial index (ABI) of the right leg is 0.40. How should the nurse best respond to this assessment finding? A)Assess the patient's use of over-the-counter dietary supplements. B)Implement interventions relevant to arterial narrowing. C)Encourage the patient to increase intake of foods high in vitamin K. D)Adjust the patient's activity level to accommodate decreased coronary output.

Ans:B Feedback:ABI is used to assess the degree of stenosis of peripheral arteries. An ABI of less than 1.0 indicates possible claudication of the peripheral arteries. It does not indicate inadequate coronary output. There is no direct indication for changes in vitamin K intake and OTC medications are not likely causative.

An older adult patient has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? A)Use of supplementary oxygen to aid tissue oxygenation B)Daily use of normal saline compresses on the lower limbs C)Daily administration of prophylactic antibiotics D)A high-protein diet that is rich in vitamins

Ans:D Feedback:A diet that is high in protein, vitamins C and A, iron, and zinc is encouraged to promote healing and prevent future ulcers. Prophylactic antibiotics and saline compresses are not used to prevent ulcers. Oxygen supplementation does not prevent ulcer formation.

A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of HF and peripheral arterial disease (PAD). At present the patient is unable to stand or ambulate. The nurse should implement measures to prevent what complication? A)Aoritis B)Deep vein thrombosis C)Thoracic aortic aneurysm D)Raynaud's disease

Ans:B Feedback:Although the exact cause of venous thrombosis remains unclear, three factors, known as Virchow's triad, are believed to play a significant role in its development: stasis of blood (venous stasis), vessel wall injury, and altered blood coagulation. In this woman's case, she has venous stasis from immobility, vessel wall injury from PAD, and altered blood coagulation from HF. The cause of aoritis is unknown, but it has no direct connection to HF, PAD, or mobility issues. The greatest risk factors for thoracic aortic aneurysm are atherosclerosis and hypertension; there is no direct connection to HF, PAD, or mobility issues. Raynaud's disease is a disorder that involves spasms of blood vessels and, again, no direct connection to HF, PAD, or mobility issues.

The nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following heart surgery. The patient has been walking on a regular basis for about a week and walks for 15 minutes 3 times a day. The patient states that he is having a cramp-like pain in the legs every time he walks and that the pain gets "better when I rest." The patient's care plan should address what problem? A)Decreased mobility related to VTE B)Acute pain related to intermittent claudication C)Decreased mobility related to venous insufficiency D)Acute pain related to vasculitis

Ans:B Feedback:Intermittent claudication presents as a muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest. Patients with peripheral arterial insufficiency often complain of intermittent claudication due to a lack of oxygen to muscle tissue. Venous insufficiency presents as a disorder of venous blood reflux and does not present with cramp-type pain with exercise. Vasculitis is an inflammation of the blood vessels and presents with weakness, fever, and fatigue, but does not present with cramp-type pain with exercise. The pain associated with VTE does not have this clinical presentation.

The nurse is providing care for a patient who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? A)Numbness and tingling in the distal extremities B)Unequal peripheral pulses between extremities C)Visible clubbing of the fingers and toes D)Reddened extremities with muscle atrophy

Ans:B Feedback:PAD assessment may manifest as unequal pulses between extremities, with the affected leg cooler and paler than the unaffected leg. Intermittent claudication is far more common than sensations of numbness and tingling. Clubbing and muscle atrophy are not associated with PAD.

You are caring for a patient who is diagnosed with Raynaud's phenomenon. The nurse should plan interventions to address what nursing diagnosis? A)Chronic pain B)Ineffective tissue perfusion C)Impaired skin integrity D)Risk for injury

Ans:B Feedback:Raynaud's phenomenon is a form of intermittent arteriolar vasoconstriction resulting in inadequate tissue perfusion. This results in coldness, pain, and pallor of the fingertips or toes. Pain is typically intermittent and acute, not chronic, and skin integrity is rarely at risk. In most cases, the patient is not at a high risk for injury.

A nurse has written a plan of care for a man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? A)Elevate his legs and arms above his heart when resting. B)Encourage the patient to engage in a moderate amount of exercise. C)Encourage extended periods of sitting or standing. D)Discourage walking in order to limit pain.

Ans:B Feedback:The nursing diagnosis of altered peripheral tissue perfusion related to compromised circulation requires interventions that focus on improving circulation. Encouraging the patient to engage in a moderate amount of exercise serves to improve circulation. Elevating his legs and arms above his heart when resting would be passive and fails to promote circulation. Encouraging long periods of sitting or standing would further compromise circulation. The nurse should encourage, not discourage, walking to increase circulation and decrease pain.

A postsurgical patient has illuminated her call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the patient's left leg is visibly swollen and reddened. What is the nurse's most appropriate action? A)Administer a PRN dose of subcutaneous heparin. B)Inform the physician that the patient has signs and symptoms of VTE. C)Mobilize the patient promptly to dislodge any thrombi in the patient's lower leg. D)Massage the patient's lower leg to temporarily restore venous return.

Ans:B Feedback:VTE requires prompt medical follow-up. Heparin will not dissolve an established clot. Massaging the patient's leg and mobilizing the patient would be contraindicated because they would dislodge the clot, possibly resulting in a pulmonary embolism.

The nurse is caring for a patient who is admitted to the medical unit for the treatment of a venous ulcer in the area of her lateral malleolus that has been unresponsive to treatment. What is the nurse most likely to find during an assessment of this patient's wound? A)Hemorrhage B)Heavy exudate C)Deep wound bed D)Pale-colored wound bed

Ans:B Feedback:Venous ulcerations in the area of the medial or lateral malleolus (gaiter area) are typically large, superficial, and highly exudative. Venous hypertension causes extravasation of blood, which discolors the area of the wound bed. Bleeding is not normally present.

The prevention of VTE is an important part of the nursing care of high-risk patients. When providing patient teaching for these high-risk patients, the nurse should advise lifestyle changes, including which of the following? Select all that apply. A)High-protein diet B)Weight loss C)Regular exercise D)Smoking cessation E)Calcium and vitamin D supplementation

Ans:B, C, D Feedback:Patients at risk for VTE should be advised to make lifestyle changes, as appropriate, which may include weight loss, smoking cessation, and regular exercise. Increased protein intake and supplementation with vitamin D and calcium do not address the main risk factors for VTE.

A 79-year-old man is admitted to the medical unit with digital gangrene. The man states that his problems first began when he stubbed his toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the patient has a history of what health problem? A)Raynaud's phenomenon B)CAD C)Arterial insufficiency D)Varicose veins

Ans:C Feedback:Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually is caused by trauma. The toe is stubbed and then turns black. Raynaud's, CAD and varicose veins are not the usual causes of digital gangrene in the elderly.

The triage nurse in the ED is assessing a patient who has presented with complaint of pain and swelling in her right lower leg. The patient's pain became much worse last night and appeared along with fever, chills, and sweating. The patient states, "I hit my leg on the car door 4 or 5 days ago and it has been sore ever since." The patient has a history of chronic venous insufficiency. What intervention should the nurse anticipate for this patient? A)Platelet transfusion to treat thrombocytopenia B)Warfarin to treat arterial insufficiency C)Antibiotics to treat cellulitis D)Heparin IV to treat VTE

Ans:C Feedback:Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include acute onset of swelling, localized redness, and pain; it is frequently associated with systemic signs of fever, chills, and sweating. The patient may be able to identify a trauma that accounts for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a patient's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency would present with ongoing pain related to activity. This patient does not have signs and symptoms of VTE.

The nurse is caring for an acutely ill patient who is on anticoagulant therapy. The patient has a comorbidity of renal insufficiency. How will this patient's renal status affect heparin therapy? A)Heparin is contraindicated in the treatment of this patient. B)Heparin may be administered subcutaneously, but not IV. C)Lower doses of heparin are required for this patient. D)Coumadin will be substituted for heparin.

Ans:C Feedback:If renal insufficiency exists, lower doses of heparin are required. Coumadin cannot be safely and effectively used as a substitute and there is no contraindication for IV administration.

A nurse on a medical unit is caring for a patient who has been diagnosed with lymphangitis. When reviewing this patient's medication administration record, the nurse should anticipate which of the following? A)Coumadin (warfarin) B)Lasix (furosemide) C)An antibiotic D)An antiplatelet aggregator

Ans:C Feedback:Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process. Antibiotics are always a component of treatment. Diuretics are of nominal use. Anticoagulants and antiplatelet aggregators are not indicated in this form of infection.

A medical nurse has admitted four patients over the course of a 12-hour shift. For which patient would assessment of ankle-brachial index (ABI) be most clearly warranted? A)A patient who has peripheral edema secondary to chronic heart failure B)An older adult patient who has a diagnosis of unstable angina C)A patient with poorly controlled type 1 diabetes who is a smoker D)A patient who has community-acquired pneumonia and a history of COPD

Ans:C Feedback:Nurses should perform a baseline ABI on any patient with decreased pulses or any patient 50 years of age or older with a history of diabetes or smoking. The other answers do not apply.

How should the nurse best position a patient who has leg ulcers that are venous in origin? A)Keep the patient's legs flat and straight. B)Keep the patient's knees bent to 45-degree angle and supported with pillows. C)Elevate the patient's lower extremities. D)Dangle the patient's legs over the side of the bed.

Ans:C Feedback:Positioning of the legs depends on whether the ulcer is of arterial or venous origin. With venous insufficiency, dependent edema can be avoided by elevating the lower extremities. Dangling the patient's legs and applying pillows may further compromise venous return.

A nurse is closely monitoring a patient who has recently been diagnosed with an abdominal aortic aneurysm. What assessment finding would signal an impending rupture of the patient's aneurysm? A)Sudden increase in blood pressure and a decrease in heart rate B)Cessation of pulsating in an aneurysm that has previously been pulsating visibly C)Sudden onset of severe back or abdominal pain D)New onset of hemoptysis

Ans:C Feedback:Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Impending rupture is not typically signaled by increased blood pressure, bradycardia, cessation of pulsing, or hemoptysis.

The nurse is preparing to administer warfarin (Coumadin) to a client with deep vein thrombophlebitis (DVT). Which laboratory value would most clearly indicate that the patient's warfarin is at therapeutic levels? A)Partial thromboplastin time (PTT) within normal reference range B)Prothrombin time (PT) eight to ten times the control C)International normalized ratio (INR) between 2 and 3 D)Hematocrit of 32%

Ans:C Feedback:The INR is most often used to determine if warfarin is at a therapeutic level; an INR of 2 to 3 is considered therapeutic. Warfarin is also considered to be at therapeutic levels when the client's PT is 1.5 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, whereas lower values indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. Hematocrit does not provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage.

A patient presents to the clinic complaining of the inability to grasp objects with her right hand. The patient's right arm is cool and has a difference in blood pressure of more than 20 mm Hg compared with her left arm. The nurse should expect that the primary care provider may diagnose the woman with what health problem? A)Lymphedema B)Raynaud's phenomenon C)Upper extremity arterial occlusive disease D)Upper extremity VTE

Ans:C Feedback:The patient with upper extremity arterial occlusive disease typically complains of arm fatigue and pain with exercise (forearm claudication) and inability to hold or grasp objects (e.g., combing hair, placing objects on shelves above the head) and, occasionally, difficulty driving. Assessment findings include coolness and pallor of the affected extremity, decreased capillary refill, and a difference in arm blood pressures of more than 20 mm Hg. These symptoms are not closely associated with Raynaud's or lymphedema. The upper extremities are rare sites for VTE.

A nurse is admitting a 45-year-old man to the medical unit who has a history of PAD. While providing his health history, the patient reveals that he smokes about two packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority health education for this patient? A)The lack of exercise, which is the main cause of PAD. B)The likelihood that heavy alcohol intake is a significant risk factor for PAD. C)Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD. D)Alcohol suppresses the immune system, creates high glucose levels, and may cause PAD.

Ans:C Feedback:Tobacco is powerful vasoconstrictor; its use with PAD is highly detrimental, and patients are strongly advised to stop using tobacco. Sedentary lifestyle is also a risk factor, but smoking is likely a more significant risk factor that the nurse should address. Alcohol use is less likely to cause PAD, although it carries numerous health risks.

Graduated compression stockings have been prescribed to treat a patient's venous insufficiency. What education should the nurse prioritize when introducing this intervention to the patient? A)The need to take anticoagulants concurrent with using compression stockings B)The need to wear the stockings on a "one day on, one day off" schedule C)The importance of wearing the stockings around the clock to ensure maximum benefit D)The importance of ensuring the stockings are applied evenly with no pressure points

Ans:D Feedback:Any type of stocking can inadvertently become a tourniquet if applied incorrectly (i.e., rolled tightly at the top). In such instances, the stockings produce rather than prevent stasis. For ambulatory patients, graduated compression stockings are removed at night and reapplied before the legs are lowered from the bed to the floor in the morning. They are used daily, not on alternating days. Anticoagulants are not always indicated in patients who are using compression stockings.

A nurse working in a long-term care facility is performing the admission assessment of a newly admitted, 85-year-old resident. During inspection of the resident's feet, the nurse notes that she appears to have early evidence of gangrene on one of her great toes. The nurse knows that gangrene in the elderly is often the first sign of what? A)Chronic venous insufficiency B)Raynaud's phenomenon C)VTE D)PAD

Ans:D Feedback:In elderly people, symptoms of PAD may be more pronounced than in younger people. In elderly patients who are inactive, gangrene may be the first sign of disease. Venous insufficiency does not normally manifest with gangrene. Similarly, VTE and Raynaud's phenomenon do not cause the ischemia that underlies gangrene.

A patient comes to the walk-in clinic with complaints of pain in his foot following stepping on a roofing nail 4 days ago. The patient has a visible red streak running up his foot and ankle. What health problem should the nurse suspect? A)Cellulitis B)Local inflammation C)Elephantiasis D)Lymphangitis

Ans:D Feedback:Lymphangitis is an acute inflammation of the lymphatic channels. It arises most commonly from a focus of infection in an extremity. Usually, the infectious organism is hemolytic streptococcus. The characteristic red streaks that extend up the arm or the leg from an infected wound outline the course of the lymphatic vessels as they drain. Cellulitis is caused by bacteria, which cause a generalized edema in the subcutaneous tissues surrounding the affected area. Local inflammation would not present with red streaks in the lymphatic channels. Elephantiasis is transmitted by mosquitoes that carry parasitic worm larvae; the parasites obstruct the lymphatic channels and results in gross enlargement of the limbs.

The nurse caring for a patient with a leg ulcer has finished assessing the patient and is developing a problem list prior to writing a plan of care. What major nursing diagnosis might the care plan include? A)Risk for disuse syndrome B)Ineffective health maintenance C)Sedentary lifestyle D)Imbalanced nutrition: less than body requirements

Ans:D Feedback:Major nursing diagnoses for the patient with leg ulcers may include imbalanced nutrition: less than body requirements, related to increased need for nutrients that promote wound healing. Risk for disuse syndrome is a state in which an individual is at risk for deterioration of body systems owing to prescribed or unavoidable musculoskeletal inactivity. A leg ulcer will affect activity, but rarely to this degree. Leg ulcers are not necessarily a consequence of ineffective health maintenance or sedentary lifestyle.

The nurse is assessing a woman who is pregnant at 27 weeks' gestation. The patient is concerned about the recent emergence of varicose veins on the backs of her calves. What is the nurse's best response? A)Facilitate a referral to a vascular surgeon. B)Assess the patient's ankle-brachial index (ABI) and perform Doppler ultrasound testing. C)Encourage the patient to increase her activity level. D)Teach the patient that circulatory changes during pregnancy frequently cause varicose veins.

Ans:D Feedback:Pregnancy may cause varicosities because of hormonal effects related to decreased venous outflow, increased pressure by the gravid uterus, and increased blood volume. In most cases, no intervention or referral is necessary. This finding is not an indication for ABI assessment and increased activity will not likely resolve the problem.

A nurse is reviewing the physiological factors that affect a patient's cardiovascular health and tissue oxygenation. What is the systemic arteriovenous oxygen difference? A)The average amount of oxygen removed by each organ in the body B)The amount of oxygen removed from the blood by the heart C)The amount of oxygen returning to the lungs via the pulmonary artery D)The amount of oxygen in aortic blood minus the amount of oxygen in the vena caval blood

Ans:D Feedback:The average amount of oxygen removed collectively by all of the body tissues is about 25%. This means that the blood in the vena cava contains about 25% less oxygen than aortic blood. This is known as the systemic arteriovenous oxygen difference. The other answers do not apply.

A nurse in the rehabilitation unit is caring for an older adult patient who is in cardiac rehabilitation following an MI. The nurse's plan of care calls for the patient to walk for 10 minutes 3 times a day. The patient questions the relationship between walking and heart function. How should the nurse best reply? A)"The arteries in your legs constrict when you walk and allow the blood to move faster and with more pressure on the tissue." B)Walking increases your heart rate and blood pressure. Therefore your heart is under less stress." C)"Walking helps your heart adjust to your new arteries and helps build your self-esteem." D)"When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart."

Ans:D Feedback:Veins, unlike arteries, are equipped with valves that allow blood to move against the force of gravity. The legs have one-way bicuspid valves that prevent blood from seeping backward as it moves forward by the muscles in our legs pressing on the veins as we walk and increasing venous return. Leg arteries do constrict when walking, which allows the blood to move faster and with more pressure on the tissue, but the greater concern is increasing the flow of venous blood to the heart. Walking increases, not decreases, the heart' pumping ability, which increases heart rate and blood pressure and the hearts ability to manage stress. Walking does help the heart adjust to new arteries and may enhance self-esteem, but the patient had an MI—there are no "new arteries."

A nurse is assessing a new patient who is diagnosed with PAD. The nurse cannot feel the pulse in the patient's left foot. How should the nurse proceed with assessment? A)Have the primary care provider order a CT. B)Apply a tourniquet for 3 to 5 minutes and then reassess. C)Elevate the extremity and attempt to palpate the pulses. D)Use Doppler ultrasound to identify the pulses.

Ans:D Feedback:When pulses cannot be reliably palpated, a hand-held continuous wave (CW) Doppler ultrasound device may be used to hear (insonate) the blood flow in vessels. CT is not normally warranted and the application of a tourniquet poses health risks and will not aid assessment. Elevating the extremity would make palpation more difficult.

The nurse is taking a health history of a new patient. The patient reports experiencing pain in his left lower leg and foot when walking. This pain is relieved with rest. The nurse notes that the left lower leg is slightly edematous and is hairless. When planning this patient's subsequent care, the nurse should most likely address what health problem? A)Coronary artery disease (CAD) B)Intermittent claudication C)Arterial embolus D)Raynaud's disease

B Feedback:A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise. The nurse would not suspect the patient has CAD, arterial embolus, or Raynaud's disease; none of these health problems produce this cluster of signs and symptoms.

A patient has been scheduled for cardiovascular computed tomography (CT) with contrast. To prepare the patient for this test, what action should the nurse perform? A)Keep the patient NPO for at least 6 hours prior to the test. B)Establish peripheral IV access. C)Limit the patients activity for 2 hours before the test. D)Teach the patient to perform incentive spirometry.

B Feedback:An IV is necessary if contrast is to be used to enhance the images of the CT. The patient does not need to fast or limit his or her activity. Incentive spirometry is not relevant to this diagnostic test.

The nurse is doing discharge teaching with a patient who has coronary artery disease. The patient asks why he has to take an aspirin every day if he doesnt have any pain. What would be the nurses best response? A)Taking an aspirin every day is an easy way to help restore the normal function of your heart. B)An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks. C)Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely. D)An aspirin a day eventually helps your blood carry more oxygen that it would otherwise.

B Feedback:An aspirin a day is a common nonprescription medication that improves outcomes in patients with CAD due to its antiplatelet action. It does not affect oxygen carrying capacity or perfusion. Aspirin does not restore cardiac function

The critical care nurse is caring for a patient with a central venous pressure (CVP) monitoring system. The nurse notes that the patients CVP is increasing. Of what may this indicate? A)Psychosocial stress B)Hypervolemia C)Dislodgment of the catheter D)Hypomagnesemia

B Feedback:CVP is a useful hemodynamic parameter to observe when managing an unstable patients fluid volume status. An increasing pressure may be caused by hypervolemia or by a condition, such as heart failure, that results in decreased myocardial contractility. Stress, dislodgement of the catheter, and low magnesium levels would not typically result in increased CVP.

The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A)A change in position from standing to sitting B)A heart rate of 54 bpm C)A pulse oximetry reading of 94% D)An increase in preload related to ambulation

B Feedback:Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.

A resident of a long-term care facility has complained to the nurse of chest pain. What aspect of the residents pain would be most suggestive of angina as the cause? A)The pain is worse when the resident inhales deeply. B)The pain occurs immediately following physical exertion. C)The pain is worse when the resident coughs. D)The pain is most severe when the resident moves his upper body.

B Feedback:Chest pain associated with angina is often precipitated by physical exertion. The other listed aspects of chest pain are more closely associated with noncardiac etiologies.

The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place? A)Apply antibiotic ointment to the insertion site twice daily. B)Change the site dressing whenever it becomes visibly soiled. C)Perform passive range-of-motion exercises to prevent venous stasis. D)Aspirate blood from the device once daily to test pH.

B Feedback:Gauze dressings should be changed every 2 days or transparent dressings at least every 7 days and whenever dressings become damp, loosened, or visibly soiled. Passive ROM exercise is not indicated and it is unnecessary and inappropriate to aspirate blood to test it for pH. Antibiotic ointments are contraindicated.

The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis? A)Immunosuppression B)Inflammation C)Infection D)Hemostasis

B Feedback:High-sensitivity CRP is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis.

The nurses assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the patients plan of care? A)Risk for ineffective breathing pattern related to hypotension B)Risk for falls related to orthostatic hypotension C)Risk for ineffective role performance related to hypotension D)Risk for imbalanced fluid balance related to hemodynamic variability

B Feedback:Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompanies it. It does not normally affect breathing or fluid balance. The patients ability to perform normal roles may be affected, but the risk for falls is the most significant threat to safety.

The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function? A)Central venous pressure (CVP) monitoring B)Pulmonary artery pressure monitoring (PAPM) C)Systemic arterial pressure monitoring (SAPM) D)Arterial blood gases (ABG)

B Feedback:PAPM is used to assess left ventricular function. CVP is used to assess right ventricular function; SAPM is used for continual assessment of BP. ABG are used to assess for acidic and alkalotic levels in the blood.

While auscultating a patients heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient? A)An older adult B)A 20-year-old patient C)A patient who has undergone valve replacement D)A patient who takes a beta-adrenergic blocker

B Feedback:S3 represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is called a physiologic S3. It is an abnormal finding in a patient with an artificial valve, an older adult, or a patient who takes a beta blocker.

During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI? A)Left midclavicular line of the chest at the level of the nipple B)Left midclavicular line of the chest at the fifth intercostal space C)Midline between the xiphoid process and the left nipple D)Two to three centimeters to the left of the sternum

B Feedback:The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.

A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis? A)Pleurisy B)Heart failure C)Valve dysfunction D)Cardiomyopathy

B Feedback:The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.

The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what? A)Development of an atrial-septal defect B)Myocardial ischemia C)Formation of a pulmonary embolism D)Release of potassium ions from cardiac cells

B Feedback:Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Patients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.

The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply. A)Loop connectivity B)Excitability C)Automaticity D)Conductivity E)Independence

B, C, D Feedback:Three physiologic characteristics of two types of specialized electrical cells, the nodal cells and the Purkinje cells, provide this synchronization: automaticity, or the ability to initiate an electrical impulse; excitability, or the ability to respond to an electrical impulse; and conductivity, the ability to transmit an electrical impulse from one cell to another. Loop connectivity is a distracter for this question. Independence of the cells has nothing to do with the synchronization described in the scenario.

Which heart valve controls the flow of blood between the left atria and the left ventricle? Tricuspid valve Pulmonic valve Bicuspid valve Aortic valve

Bicuspid valve The bicuspid valve controls the flow of blood between the left atria and left ventricle. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery, while the aortic valve controls flow between the left ventricle and aorta.

A lipid profile has been ordered for a patient who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results? A)As close to the end of the day as possible B)After a meal high in fat C)After a 12-hour fastD)Thirty minutes after a normal meal

C Feedback:Although cholesterol levels remain relatively constant over 24 hours, the blood specimen for the lipid profile should be obtained after a 12-hour fast.

The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment? A)Whether the patient and involved family members understand the role of genetics in the etiology of the disease B)Whether the patient and involved family members understand dietary changes and the role of nutrition C)Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately D)Whether the patient and involved family members understand the importance of social support and community agencies

C Feedback:During the health history, the nurse needs to determine if the patient and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.

A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform? A)Instruct the patient to drink 1 liter of water before the test. B)Administer IV benzodiazepines and opioids. C)Inform the patient that she will remain on bed rest following the procedure. D)Inform the patient that an access line will be initiated in her femoral artery.

C Feedback:During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.

A patient has had a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. You are aware that the damage occurred where? A)Endocardium B)Pericardium C)Myocardium D)Visceral pericardium

C Feedback:The myocardium is the layer of the heart responsible for the pumping action.

The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurses most recent assessment reveals that CVP is 7 mm Hg. What is the nurses most appropriate action? A)Arrange for continuous cardiac monitoring and reposition the patient. B)Remove the CVP catheter and apply an occlusive dressing. C)Assess the patient for fluid overload and inform the physician. D)Raise the head of the patients bed and have the patient perform deep breathing exercise, if possible.

C Feedback:The normal CVP is 2 to 6 mm Hg. Many problems can cause an elevated CVP, but the most common is due to hypervolemia. Assessing the patient and informing the physician are the most prudent actions. Repositioning the patient is ineffective and removing the device is inappropriate.

The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding? A)This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B)Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C)This is an accurate indicator of myocardial injury. D)This result indicates muscle injury, but does not specify the source.

C Feedback:Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.

Which property is related to the ability of the heart cells to transmit an action potential of electrical impulse? Contractility Automaticity Afterload Conductivity

Conductivity Conductivity is the property of heart cells to rapidly conduct an action potential of electrical impulse.

The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult? A)Decreased left ventricular ejection time B)Decreased connective tissue in the SA and AV nodes and bundle branches C)Thinning and flaccidity of the cardiac values D)Widening of the aorta

D Feedback:Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).

A critical care nurse is caring for a patient with a pulmonary artery catheter in place. What does this catheter measure that is particularly important in critically ill patients? A)Pulmonary artery systolic pressure B)Right ventricular afterload C)Pulmonary artery pressure D)Left ventricular preload

D Feedback:Monitoring of the pulmonary artery diastolic and pulmonary artery wedge pressures is particularly important in critically ill patients because it is used to evaluate left ventricular filling pressures (i.e., left ventricular preload). This device does not directly measure the other listed aspects of cardiac function.

The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurses most appropriate response? A)Administer sublingual nitroglycerin to allow the patient to finish the test. B)Initiate cardiopulmonary resuscitation. C)Administer analgesia and slow the test. D)Stop the test and monitor the patient closely.

D Feedback:Signs of myocardial ischemia would necessitate stopping the test. CPR would only be necessary if signs of cardiac or respiratory arrest were evident.

The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence? A)SA node to bundle of His to AV node to Purkinje fibers B)SA node to AV node to Purkinje fibers to bundle of His C)SA node to bundle of His to Purkinje fibers to AV node D)SA node to AV node to bundle of His to Purkinje fibers

D Feedback:The normal electrophysiological conduction route is SA node to AV node to bundle of HIS to Purkinje fibers.

A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care? A)Fluctuations in core body temperature B)Signs and symptoms of esophageal varices C)Signs and symptoms of compartment syndrome D)Perfusion distal to the insertion site

D Feedback:The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.

A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate? A)Left-sided heart catheterization B)Cardiac telemetry C)Transesophageal echocardiography D)Hardwire continuous ECG monitoring

D Feedback:Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? Decreased vascular perfusion due to parasympathetic stimulation Decreased heart rate, contractility and after load Decreased heart rate as a result of parasympathetic innervation of the heart Decreased heart rate as a result of impaired acetylcholine reuptake

Decreased heart rate as a result of parasympathetic innervation of the heart Vagal stimulation results in lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced.

The nurse assists and educates clients about blood pressure regulation. Based on this information, the nurse asks the client what the number 80 in the blood pressure 120/80 represents. Which response by the client demonstrates correct understanding of the basic concepts of blood pressure? Cardiac output Pulse pressure Systolic pressure Diastolic pressure

Diastolic pressure Cardiac output is the amount of blood the ventricles pump out in 1 minute; normally, 4 to 6 L/minute. Blood pressure is the force exerted by the blood against the walls of the blood vessels. Systolic blood pressure, in this example 120, is the force during ventricular contraction. Diastolic blood pressure, in this example is 80, is the force during ventricular relaxation. The difference between systolic and diastolic pressure is called pulse pressure.

The nurse assists and educates clients about blood pressure regulation. Which information is important to include in the review with clients about blood pressure? Force exerted by the blood against the walls of the blood vessels Diastolic blood pressure is the force of blood pressure during ventricular contraction Systolic blood pressure is the force during ventricular relaxation Amount of blood the ventricles pumps out in 1 minute

Force exerted by the blood against the walls of the blood vessels Blood pressure is the force exerted by the blood against the walls of the blood vessels. Cardiac output is the amount of blood the ventricles pump out in 1 minute, normally, 4 to 6 L/minute. Systolic blood pressure is the force during ventricular contraction. Diastolic blood pressure is the force during ventricular relaxation.

Fluid moves into the arterial end of a capillary due to: Hydrostatic pressure Fluid needs of the cells Oncotic pressure Loose endothelial cells

Hydrostatic pressure Hydrostatic pressure regulates the movement of fluids at the arterial end of the capillary; entotic pressure regulates this movement at the venous end of the capillary. It is the pressure that directs flow through the loosely connected endothelial cells of the capillary.

With an understanding of how hydrostatic forces effect the capillaries, which would increase the capillary hydrostatic pressure? Decrease in the arteriole pressure Decrease in gravity when standing increase in small artery pressure Increase in venous pressure

Increase in venous pressure Changes in venous pressure have a greater effect on the capillary hydrostatic pressure than does the same change in arterial pressure. An increase in small artery and arterial pressure elevates capillary hydrostatic pressure.

Which is true regarding the pulmonary circulation? The system functions with an increased arterial pressure to circulate through the distal body parts It is a low pressure system that allows for improved gas exchange It is the larger of the two circulatory systems It consists of the left side of the heart, the aorta and its branches

It is a low pressure system that allows for improved gas exchange The pulmonary circulation consists of the right heart, and the pulmonary artery, capillaries and veins. It is the smaller of the systems at functions at a lower pressure to assist with gas exchange.

Proper function of the cardiovascular system relies on blood following the correct pathway through the heart. Valves within the heart separate the organ's chambers and prevent blood from flowing in the wrong direction. What valve separates the left atrium and left ventricle? Mitral Pulmonic Aortic Tricuspid

Mitral The mitral valve separates the left atrium and left ventricle.

A backflow of blood is noted in the left ventricle from the left atrium. The patient is suffering from a defect in which valve? Mitral valve Tricuspid valve Pulmonic valve Aortic valve

Mitral valve The mitral valve separates the left atrium and left ventricle. This malfunction allows the backflow of blood due to a defect in the mitral valve. The tricuspid valve separates the right atrium and right ventricle. The pulmonic valve separates the right ventricle and pulmonary artery. The aortic valve separates the left ventricle and aorta.

During which phase of the action potential does calcium slowly enter the cell and potassium begin to leave? Phase 2 Phase 0 Phase 1 Phase 3

Phase 2 During phase 2, the cell membrane becomes less permeable to sodium and calcium slowly enters the cell and potassium begins to leave (repolarization).During phase 0, the cell reaches a point of stimulation with sodium rushing into the cell (depolarization).During phase 1, sodium ion concentrations are equal inside and outside the cell.During phase 3, rapid repolarization occurs, as the gates close and potassium rapidly moves out of the cell.

Of the following factors, which increases the heart's output, and is dependent on the actions of the heart and the vasculature before contraction? Preload Afterload Cardiac contractility Heart rate

Preload Preload represents the amount of blood that the heart must pump with each beat and is determined by the venous return to the heart and the accompanying stretch of the cardiac muscle fibers.

A nurse is measuring the BP of a client. The client asks what the BP measures. What is the best response by the nurse about the measurement of BP? Pressure of blood within the veins Pressure of blood within the arteries Pressure of blood within the heart Pressure of blood within the lungs

Pressure of blood within the arteries When measuring BP, the systolic (contraction) pressure and the diastolic (relaxation) pressure of the blood within the arteries are recorded. The pressure of blood within the veins, within the heart, or within the lungs is not recorded for measuring BP.

Which is responsible for transmitting the nerve impulse to the ventricular cells? AV node Bundle of His Bundle branches Purkinje fibers

Purkinje fibers The Purkinje fibers deliver the impulse to the ventricular cells. The AV node receives the impulse from the atrial bundles and moves it to the bundle of His and then into the bundle branches.

Which enzyme is produced in the kidney? Lipase Renin Creatinine kinase Gastrin

Renin Cells in the kidney release renin, which is transported to the liver to convert angiotensinogen to angiotensin I.

Which is released initially when blood flow to the kidneys is decreased? Renin Angiotensin I Angiotensin II Aldosterone

Renin When blood flow to the kidneys is reduced, the cells in the kidney release renin, which then converts angiotensinogen to angiotensin I. This is converted by angiotensin-converting enzyme to angiotensin II, which reacts with specific receptor sites on blood vessels to cause vasoconstriction. Angiotensin II also causes the release of aldosterone.

The pathway for blood flow through the heart is: Right atria to left ventricle to pulmonary veins through lungs to pulmonary artery to left atria and then to left ventricle. Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. Left atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. Right atria to right ventricle to pulmonary veins through lungs to pulmonary artery to left atria and then to left ventricle.

Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle. The heart has four chambers: two atria and two ventricles. The right atrium receives deoxygenated blood from the body by way of the vena cava; the right ventricle sends deoxygenated blood through the pulmonary circulation. The left atrium receives oxygenated blood from the lungs through the pulmonary veins. The left ventricle pumps oxygenated blood through the systemic circuit.

Which area of the heart is supplied by the right coronary artery? Left ventricle Right side of the heart Cardiac septum Conduction system

Right side of the heart The right coronary artery supplies most of the right side of the heart, including the SA node. The left circumflex artery supplies most of the left ventricle. The left anterior descending artery feeds the septum and anterior areas, including much of the conduction system.

After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse? SA node AV node Bundle of His Purkinje fibers

SA node The SA node acts as the pacemaker of the heart, initiating the impulse. The AV node, bundle of His, and Purkinje fibers are part of the conduction system.

The nurse is reviewing a patient's ECG and notes that the ECG is normal, but the rate is 110 beats/minute. The nurse would identify this as: Sinus tachycardia Atrial flutter Atrial fibrillation Paroxysmal atrial tachycardia

Sinus tachycardia Sinus tachycardia would be characterized by a normal appearing ECG, but a rate usually less than 100 beats per minute. Atrial flutter is characterized by sawtoothed shaped P waves, often with 2 or 3 P waves occurring for every QRS complex. Atrial fibrillation would be characterized by many irregular P waves, depicting bombardment of the AV node in an unpredictable number causing the ventricles to beat in a fast, irregular, and often inefficient heart manner. Paroxysmal atrial tachycardia would be characterized by sporadically occurring runs of rapid heart rate.

These are activities involved in the action potential of cardiac muscle. Place them in the proper sequence beginning with activities in phase 0 through phase 4. 1Sodium rushes into the cell. 2Sodium ion concentration equalizes. 3Calcium slowly enters and potassium begins to leave the cell. 4Potassium rapidly moves out of the cell. 5Sodium is outside the cell and potassium is inside the cell

Sodium rushes into the cell. Sodium ion concentration equalizes. Calcium slowly enters and potassium begins to leave the cell. Potassium rapidly moves out of the cell. Sodium is outside the cell and potassium is inside the cell. The action potential of the cardiac muscle cell consists of five phases: Phase 0 occurs when the cell reaches a point of stimulation. The sodium gates open along the cell membrane, and sodium rushes into the cell, resulting in a positive flow of electrons into the cell, or an electrical potential. This is called depolarization. The membrane no longer has a positive side or pole and a negative side; it is depolarized, or electrically the same on both sides. Phase 1 is the very short period when the sodium ion concentrations are equal inside and outside the cell. Phase 2, or the plateau stage, occurs as the cell membrane becomes less permeable to sodium. Calcium slowly enters the cell, and potassium begins to leave the cell. The cell membrane is trying to return to its resting state, a process called repolarization, the return of the polarity on either side of the membrane. Phase 3 is a period of rapid repolarization as the gates are closed and potassium rapidly moves out of the cell. Phase 4 occurs when the cell comes to rest as the sodium-potassium pump returns the membrane to its previous state, with more sodium outside and more potassium inside the cell. Spontaneous depolarization begins again.

A client who has been diagnosed with blood pressure problems is eager to know more about the condition. What should the nurse explain is one of the internal processes that attempt to maintain blood pressure within normal limits? Special sensory receptors in blood vessel walls called baroreceptors are stimulated. The arteries that supply the heart muscle with blood will increase in size. The right and left coronary arteries divide into smaller branches over the surface. Blood moves on through the heart valve during contraction to enter lungs.

Special sensory receptors in blood vessel walls called baroreceptors are stimulated. Special sensory receptors in blood vessel walls, called baroreceptors, are stimulated by a change in blood pressure (BP). They send signals, which cause various body reactions to help maintain normal BP. The left anterior descending (LAD) artery descends along the anterior intraventricular groove to provide blood to most of the ventricular septum and the anterior portion of the left ventricle. The right and left coronary arteries extend over the heart's surface and divide into smaller branches to supply heart tissue with oxygen and nourishment. Blood moves on through the pulmonic valve during ventricular contraction to enter the pulmonary artery and lungs to receive oxygen.

An instructor is describing an action of the heart, likening it to that of stretching a rubber band. The instructor is describing: Starling's law of the heart Automaticity Capacitance system Conductivity

Starling's law of the heart Starling's law of the heart is often compared to the stretching of a rubber band, such that the heart returns to its normal size after it is stretched and the further it is stretched, the stronger the spring back to normal. Automaticity refers to the heart cells being able to generate an action potential without an external stimulus. Capacitance system refers to the venous system that is distensible and flexible. Conductivity refers to the heart cells being able to rapidly conduct an action potential of electrical impulse.

A nurse is educating a group of nursing students about the heart's chambers and the muscular septum wall. What information by a nursing student demonstrates a correct understanding about the four chambers into which the heart is divided? (Select all that apply.) The interior of the heart is divided into two chambers. The thin-walled, low-pressure chambers are the receiving centers for blood. Ventricles are high-pressure chambers because they pump blood out of the heart. The left ventricle is the thickest chamber and it pumps blood to the rest of the body.

The thin-walled, low-pressure chambers are the receiving centers for blood. Ventricles are high-pressure chambers because they pump blood out of the heart. The left ventricle is the thickest chamber and it pumps blood to the rest of the body.

The nurse is reviewing with the client the three major layers of the heart wall and how they relate to the pericardium. What is the best description by the nurse to the client about the myocardium layer of the heart? Thick, strong muscles making up the middle layer Thin outer layer of the cardiac wall A membrane lining the heart's interior wall Outermost layer anchoring the heart

Thick, strong muscles making up the middle layer Thick, strong muscles making up the middle layer is known as the myocardium. The thin outer layer of the cardiac wall is known as the epicardium. The endocardium is a membrane lining the heart's interior wall. The pericardium is the outermost layer anchoring the heart.

A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries. What should the nurse include in the client education about the function of arteries? To serve as a capacitance vessels for blood To exchange oxygen and nutrients with body cells To take the blood back into the heart's chambers To carry oxygenated blood to the body cells

To carry oxygenated blood to the body cells Arteries are elastic and smooth muscular tubes that, with the exception of the pulmonary artery, carry oxygenated blood to body cells. To exchange oxygen and nutrients with cells is the function of the capillaries. Veins flow the blood back into the heart. Systemic veins and venules serve as capacitance vessels.

Which substance is responsible for keeping the proteins in the cardiac muscle apart? Troponin Actin Myosin Calcium

Troponin Troponin keeps the proteins, actin and myosin, apart. Actin is one of the proteins in the cardiac muscle cell. Myosin is one of the proteins of the cardiac muscle cell. Calcium is involved in the action potential and allows actomyosin bridges to form.

After teaching a group of students about circulation, the instructor determines that the teaching was successful when the students identify it as: a high to low pressure system. a semi-open system. single resistance system. a solitary course of blood flow.

a high to low pressure system. Circulation is a high to low pressure system. Circulation is a closed system. Circulation involves a resistance and capacitance system. Circulation follows two courses, a systemic and a pulmonary courses.

When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery supplies the: left ventricle. right side of the heart. conduction system. cardiac septum.

left ventricle. Left circumflex artery supplies most of the left ventricle. The right coronary artery supplies most of the right side of the heart. The left anterior descending artery feeds the septum and anterior areas including much of the conduction system. The left anterior descending artery feeds the septum and anterior areas, including much of the conduction system.

A group of nursing students is preparing a poster presentation describing the anatomy and function of the heart. In their diagram of the organ, they label the structure that separates the left and right sides of the heart as the: auricle. bundle of His. mitral valve. septum.

septum. The septum is a muscular wall that separates the right and left sides of the heart.

When describing Starling's law of the heart, the instructor compares this to: moving up and down on a staircase stretching of a rubber band pushing and pulling of a rope flowing of water through a pipe

stretching of a rubber band Starling's law of the heart is often compared with the stretching of a rubber band, such that the heart returns to its normal size after it is stretched—the further it is stretched, the stronger is the spring back to normal.