PN 150 Week 3 Online Questions
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's bestresponse? "Cardioversion is done on a beating heart; defibrillation is not." "The difference is the timing of the delivery of the electric current." "Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not." "Cardioversion is always attempted before defibrillation because it has fewer risks."
"The difference is the timing of the delivery of the electric current." (One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the client's electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized.)
A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" "To detect and treat bradycardia, which is an excessively slow heart rate" "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" "To shock your heart if you have a heart attack at home"
"To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia"
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." "The two look very much alike; it is difficult to tell the difference." "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal."
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."
The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? "As soon as you feel pain, we will go back and elevate your legs." "If you feel pain during the walk, keep walking until the end of the hallway is reached." "Walk to the point of pain, rest until the pain subsides, then resume ambulation." "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."
"Walk to the point of pain, rest until the pain subsides, then resume ambulation." (so that endurance can be increased as collateral circulation develops.)
A 56-year-old woman with severe varicose veins has opted for venous ablation, and the nurse is providing patient education before the scheduled procedure. What instructions should the nurse provide to this patient? "Try to limit your activity for the first 10 days to 2 weeks to prevent reoccurrence of your varicose veins." "You might experience some pain after the procedure, but this will be managed with ice packs rather than medications." "If you notice any bruising in the area, make sure to let someone know because that could be a sign of a serious complication." "We'll help you get walking as soon as you sedation has worn off, and you'll continue to gradually increase your activity level."
"We'll help you get walking as soon as you sedation has worn off, and you'll continue to gradually increase your activity level."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds.
0.12 and 0.2 seconds.
A client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for the client's CAD. The client's lipid profile reveals LDL greater than HDL. At what point should hyperlipidemia treatment begin? LDL between 100 mg/dL and 130 mg/dL LDL between 125 mg/dL and 150 mg/dL HDL between 100 mg/dL and 130 mg/dL HDL between 125 mg/dL and 150 mg/dL
100-130
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? 160-190 mg/dL 210-240 mg/dL 250-275 mg/dL 280-300 mg/dL
160-190 mg/dL (Normal total cholesterol is less than 200 mg/dL.)
The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be? 2.0-3.0 4.0-5.0 5.0-6.0 7.0-8.0
2.0-3.0
To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? 30 minutes 60 minutes 9 days 6 to 12 months
60 minutes
A client 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? Assess pulse of affected extremity every 15 minutes at first. Palpate the affected leg for pain during every assessment. Assess the client for signs and symptoms of compartment syndrome every 2 hours. Perform Doppler evaluation once daily.
Assess pulse of affected extremity every 15 minutes at first. (The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair)
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? Atropine Dobutamine Amiodarone Lidocaine
Atropine
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep the arm on the side of the pacemaker higher than the head Delay activities such as swimming and bowling for at least 3 weeks Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference
Avoid sources of electrical interference
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? Urine output of 15 ml/hour and 2+ hematuria Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute Urine output of 150 ml/hour and heart rate of 45 beats/minute Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute
Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute (Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses.)
Which is a diagnostic marker for inflammation of vascular endothelium? C-reactive protein (CRP) Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Triglyceride
C-reactive protein (CRP)
The nurse is caring for a client who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment? Cardiac monitoring Monitoring the implanted device signal Pain assessment Monitoring the client's level of consciousness (LOC)
Cardiac monitoring
A client 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 mostappropriate action? Document the client's low urine output and monitor closely for the next several hours. Contact the dietitian and suggest the need for increased oral fluid intake. Contact the client's health care provider and continue to assess fluid balance and renal function. Increase the infusion rate of the client's IV fluid to prompt an increase in renal function.
Contact the client's health care provider and continue to assess fluid balance and renal function. (An output of <0.5 mL/kg/h may indicate hypovolemia or renal insufficiency. Prompt referral is necessary.)
The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? Decreases the sinoatrial node automaticity Increases the atrioventricular node conduction Increases the heart rate Creates a positive inotropic effect
Decreases the sinoatrial node automaticity
The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
Defibrillator should be set to deliver a shock during the QRS complex. (Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.)
When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? Keep the patient's legs flat without the knees raised. Keep the patient's knees at a 45-degree angle. Elevate the patient's lower extremities. Hang the patient's legs over the side of the bed
Elevate the patient's lower extremities
A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? Prolonged PR interval Absent Q wave Elevated ST segment Widened QRS complex
Elevated ST segment (Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave)
A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? Nausea, vomiting, depression, fatigue, and impotence. Sedation, nausea, vomiting, constipation, and respiratory depression. Headache, hypotension, dizziness, and flushing. Flushing, dizziness, headache, and pedal edema.
Headache, hypotension, dizziness, and flushing.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level. low LDL level. normal LDL level. fasting LDL level.
High LDL level (should be below 100)
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? Impaired gas exchange related to increased blood flow Excess fluid volume related to peripheral vascular disease Risk for injury related to edema Ineffective peripheral tissue perfusion related to venous congestion
Ineffective peripheral tissue perfusion related to venous congestion (Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT.)
The nurse is taking a health history of a new client who reports pain in his left lower leg and foot when walking. This pain is relieved with rest and the nurse observes that the left lower leg is slightly edematous and is hairless. When planning this client's care, the nurse should most likely address what health problem? Coronary artery disease (CAD) Intermittent claudication Arterial embolus Raynaud disease
Intermittent claudication (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.)
A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? Moderate to severe arterial insufficiency No arterial insufficiency Very mild arterial insufficiency Tissue loss to that foot
Moderate to severe arterial insufficiency (Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.)
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experieincing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? Nitroglycerin SL Chest x-ray Serum electrolytes Ativan 1 mg orally
Nitroglycerin SL (should be replaced every 6 months)
A client with an ICD calls his cardiologist's office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the client to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what? Infection Failure to capture Premature battery depletion Oversensing of dysrhythmias
Oversensing of dysrhythmias
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave PR interval QRS complex T wave
P wave (The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria.)
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? Protamine sulfate Alteplase Clopidogrel Aspirin
Protamine sulfate
The nursing educator is presenting a case study of an adult client who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? P wave T wave QRS complex U wave
QRS Complex (The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.)
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? P wave QRS complex PR interval QT interval
QRS complex
The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding? Recognize that the procedure was unsuccessful. Recognize this as a therapeutic goal of the procedure. Liaise with the care team in preparation for repeating the maze procedure. Prepare the client for pacemaker implantation.
Recognize this as a therapeutic goal of the procedure.
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? Sinus bradycardia Ventricular tachycardia Normal sinus rhythm Sinus tachycardia
Sinus tachycardia (occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response, stimulants, and illicit drugs)
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? Decreasing blood pressure and increasing mobility Increasing blood pressure and reducing mobility Stabilizing heart rate and blood pressure and easing anxiety Increasing blood pressure and monitoring fluid intake and output
Stabilizing heart rate and blood pressure and easing anxiety
The nurse is caring for a client 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? P wave inversion T wave inversion Q wave changes with no change in ST or T wave P wave enlargement
T wave inversion (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.)
A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? The aneurysm has become obstructed. The aneurysm may be preparing to rupture. The client is experiencing inflammation of the aneurysm. The client is experiencing normal sensations associated with this condition.
The aneurysm may be preparing to rupture. (Indications of a rupturing AAA include constant, intense back pain; falling blood pressure; and decreasing hematocrit.)
Family members bring a client 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? The symptoms indicate angina and should be treated as such. The symptoms indicate a pulmonary etiology rather than a cardiac etiology. The symptoms indicate an acute coronary episode and should be treated as such. Treatment should be determined pending the results of an exercise stress test.
The symptoms indicate an acute coronary episode and should be treated as such.
The nurse is assessing a hospital client who has low albumin levels due to liver disease. What assessment finding should the nurse attribute to the client's low albumin levels? There is severe edema to the client's legs and abdomen. The client has had two episodes of epistaxis (nosebleeds) in the past 24 hours. The client reports uncharacteristic levels of fatigue. The client is short of breath on exertion, with an expiratory wheeze.
There is severe edema to the client's legs and abdomen (Albumin helps to keep fluids within the vascular space. Deficiencies, as a result, cause the release of fluid into interstitial spaces, causing edema.)
What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? Loose and wrinkled skin Ulcers and infection in the edematous area Evident scarring Cyanosis
Ulcers and infection in the edematous area (In a client with lymphedema, the tissue nutrition is impaired because of the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area.)
A nurse is assessing a new client who is diagnosed with PAD. The nurse cannot feel the pulse in the client's left foot. How should the nurse proceed with assessment? Have the primary care provider prescribe a CT. Apply a tourniquet for 3 to 5 minutes and then reassess. Elevate the extremity and attempt to palpate the pulses. Use Doppler ultrasound to identify the pulses.
Use Doppler ultrasound to identify the pulses.
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation
Ventricular fibrillation
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? assessing blood pressure and heart rate frequently identifying a code-level status maintaining intravenous fluids alerting the healthcare provider of the third-degree heart block
alerting the healthcare provider of the third-degree heart block
The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. morphine atorvastatin enalapril aspirin sildenafil
atorvastatin enalapril aspirin
Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node
bundle of His
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? calcium-channel blocker beta-adrenergic blocker nitrate diuretic
calcium-channel blocker
A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality? Hyperkalemia Hypercalcemia Hypomagnesemia Hyponatremia
hyperkalemia (Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves))
On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? Taking daily walks Engaging in anaerobic exercise Reducing daily fat intake to less than 45% of total calories Abstaining from foods that increase levels of high-density lipoproteins (HDLs)
taking daily walks
