Practice question MS2E1
What is not a symptom of myocardial infarction (MI)? A. Shortness of breath B. Heartburn C. Headache D. Nausea
C. Headache
What type of shock is albumin used as treatment? A. Cardiogenic B. Anaphylactic C. Hypovolemic D. Neurogenic
C. Hypovolemic
Which patient below is at MOST risk for developing cardiogenic shock? A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish. B. A 25-year-old female who has experienced an upper thoracic spinal cord injury. C. A 72-year-old male who is post-op from a liver transplant. D. A 49-year-old female who is experiencing an acute myocardial infarction.
D. A 49-year-old female who is experiencing an acute myocardial infarction.
The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? A. "Do you have a family history of endocarditis?" B. "Have you been to the dentist recently?" C. "Have you recently vacationed outside of the United States?" D. "Do you live with any domesticated animals in your home?"
B. "Have you been to the dentist recently?" Risk factors for endocarditis: IV drug abusers, poor dentation
A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of: SATA A. nitroglycerine (Tridil). B. dobutamine (Dobutrex). C. norepinephrine (Levophed). D. sodium nitroprusside (Nipride).
dobutamine (Dobutrex) and norepinephrine (Levophed) Both are vasopressors
When vasopressor medications are administered, the nurse must monitor vital signs at least how often? A. 15 minutes B. 30 minutes C. 45 minutes D. Hourly
A. 15 minutes
A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as A. 90 bpm. B. 80 bpm. C. 70 bpm. D. 100 bpm.
A. 90 bpm. Each RR interval (9) multiplied by 10= HR
The nurse recognizes which symptom as a classic sign of cardiogenic shock? A. Restlessness and confusion B. Hyperactive bowel sounds C. High blood pressure D. Increased urinary output
A. Restlessness and confusion Weak pulse, cool/clammy Causes: Pts w/ MI & cardiomyopathy
A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? A. 10 minutes B. 5 minutes C. 15 minutes D. 20 minutes
A. 10 minutes STEMI= treatment within 90 minutes (PCI) NSTEMI= treatment within 12/72 hours
A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response? A. "You are at risk of developing an infection in your heart." B. "Your teeth will not bleed as much if you have antibiotics." C. "This procedure may cause your valve to malfunction." D. "Antibiotics will prevent vegetative growth on your valves."
A. "You are at risk of developing an infection in your heart."
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? A. 12-lead ECG B. Monitor intake and output C. Troponin level D. Aspirin 325 mg orally
A. 12-lead ECG See if pt is having an MI
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? A. Atrial flutter B. Atrial fibrillation C. Ventricular fibrillation D. Ventricular tachycardia
A. Atrial flutter No P wave present High risk for clots- can lead to DVT, pulmonary embolism, stroke
The nurse is planning discharge teaching for a patient with cardiomyopathy. What instructions should be included in the plan? SATA A. Avoid alcohol B. Balance activity and rest periods C. Drink 2-4 glasses of water daily D. Avoid vigorous isometric exercises E. Consume food products with high sodium content
A. Avoid alcohol B. Balance activity and rest periods D. Avoid vigorous isometric exercises Isometric exercise examples: wall sits, planks, leg lifts, squat holds
The nurse is caring for a client diagnosed with pericarditis. What serious complication should this client be monitored for? A. Cardiac tamponade B. Decreased venous pressure C. Hypertension D. Left ventricular hypertrophy
A. Cardiac tamponade Other complication is pericardial effusion
What is the main cause of myocardial infarction (MI)? A. Coronary artery disease B. Vasospasm C. Cocaine ingestion D. Severe anemia
A. Coronary artery disease
The nurse is assessing a client with mitral regurgitation. The nurse expects to note what finding in this client? A. Dyspnea, fatigue, and weakness B. Dizziness, syncope, and palpitations C. Orthopnea, angina, and pulmonary edema D. Dry cough, wheezing, and hemoptysis
A. Dyspnea, fatigue, and weakness
A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms? A. Exertional dyspnea, orthopnea, pulmonary edema B. Nausea, vomiting, exertional fatigue C. Dizziness, nausea, diarrhea D. Syncope, fever, vomiting
A. Exertional dyspnea, orthopnea, pulmonary edema
A patient with a newly inserted pacemaker receives discharge instructions from the nurse. Which patient statement indicates that further teaching is required? A. I should avoid using microwave ovens B. I should avoid standing near antitheft devices C. I should avoid direct blows to the pacemaker site D. I should avoid close proximity to high-output electric generators
A. I should avoid using microwave ovens Do not raise arm higher than heart level, tell TSA about pacemaker, carry a card with you, cannot have MRI, use cell phone on opposite side of pacemaker, do not take pulse/bp/IV on side of pacemaker insertion, follow up appointments are very important, check the batteries of the pacemaker.
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator emphasizes that aortic regurgitation causes what? A. Left ventricular hypertrophy B. Cardiac tamponade C. Ventricular insufficiency D. Right-sided heart failure
A. Left ventricular hypertrophy
The nurse finds diastolic murmurs in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." What condition does the nurse suspect? A. Mitral valve stenosis B. Mitral valve prolapse C. Aortic valve stenosis D. Aortic valve regurgitation
A. Mitral valve stenosis S2 diastolic murmur w/ rumbling sound Stenosis= Forward flow of blood
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect what symptoms during the physical examination? A. Orthopnea and dyspnea B. Increased urine output C. Headache and vomiting D. Nausea and low urine output
A. Orthopnea and dyspnea S/S: palpitation, dyspnea, orthopnea, fatigue, angina, sinus tachycardia, pulmonary congestion, crackles, rhonci, pitting edema --> so much pressure can lead to pulmonary hypertension.
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition? A. Premature atrial contraction B. Atrial flutter C. Sinus tachycardia D. Ventricular fibrillation
A. Premature atrial contraction "Nursing school dysrhythmia"
A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? A. Rheumatic endocarditis B. Atrial fibrillation C. Myocardial infarction D. Congestive heart failure
A. Rheumatic endocarditis
The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock? A. Septic B. Anaphylactic C. Neurogenic D. Cardiogenic
A. Septic Septic shock will have increased temp except elderly (may be hypothermic due to decreased body fat)
The nurse is caring for a patient with aortic stenosis. What should the nurse assess the patient for? A. Systolic murmur B. Pericardial friction rub C. Diminished or absent S4 D. Low-pitched diastolic murmur
A. Systolic murmur S1 murmur high pitched Blowing sound
What does the T wave in an electrocardiogram (ECG) represent? A. Time for ventricular repolarization B. Time for depolarization of both ventricles C. Time for the passage of electrical impulse through the atrium D. Time between ventricular depolarization and repolarization
A. Time for ventricular repolarization P wave= atrial depolarization (contraction) QRS= ventricular depolarization (contraction) PR interval= time needed for impulse to travel from atria/SA node to the AV node to Purkinje fibers in ventricles
A patient tells the nurse, "I had severe chest pain six days ago." The nurse identifies that which cardiac biomarker will be most helpful in determining whether the patient had a myocardial infarction at the time the patient experienced chest pain? A. Troponin B. Myoglobin C, Homocysteine D. Creatine kinase
A. Troponin This lab takes 3-4 hours to come back. EKG is taken first to determine if MI occurred.
Which type of angina increases in frequency, duration, and severity as the time progresses? A. Unstable B. Prinzmetal's C. Chronic stable D. Microvascular
A. Unstable Pain will last longer than 30 minutes and is constant
When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of A. valvular heart disease B. pulmonary hypertension C. superior vena cava syndrome D. hypertrophy of the right ventricle
A. valvular heart disease Mitral stenosis= rheumatic carditis Mitral regurgitation= rheumatic fever
A patient is diagnosed with hypovolemic shock. What does the nurse anticipate being included in the plan of care? A. Administration of broad-spectrum antibiotics B. Administration of blood products and intravenous fluids C. Administration of vitamin K D. Administration of protamine sulfate
B. Administration of blood products and intravenous fluids Hypovolemic=massive bleeding, third spacing (fluid moves from outside the vessels into tissues- fluid is outside the vascular space), loss of volume
A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? A. Assessing the patient's capillary refill time and peripheral pulses B. Assessing the patient for signs and symptoms of hemorrhage C. Assessing the patient for signs and symptoms of acute renal failure D. Assessing the patient for signs and symptoms of infection
B. Assessing the patient for signs and symptoms of hemorrhage Highest risk is bleeding!
The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which of the following findings are significant? A. Respiratory rate of 18 and heart rate of 90 B. Regurgitant murmur at Erb's point C. Heart rate of 94 and capillary refill time of 2 seconds D. Point of maximal impulse palpable in fourth intercostal space
B. B. Regurgitant murmur at Erb's point NOTE: A bruit would be a common finding at the mitral valve
The nurse provides information to a patient about preventing coronary artery disease (CAD) by maintaining healthy serum low-density lipoproteins (LDL) and high-density lipoprotein (HDL) levels. The nurse should include what goals? A. Decreased LDLs; decreased HDLs B. Decreased LDLs; increased HDLs C. Increased LDLs; decreased HDLs D. Increased LDLs; increased HDLs
B. Decreased LDLs; increased HDLs Help to determine if statins (fat breakers) are working. Need to give statins at night.
The nurse is monitoring the client in shock. The client begins bleeding from previous venipuncture sites, in the indwelling catheter, and rectum, and the nurse observes multiple areas of ecchymosis. What does the nurse suspect has developed in this client? A. Stress ulcer B. Disseminated intravascular coagulation (DIC) C. Septicemia D. Stevens-Johnson syndrome from the administration of antibiotics
B. Disseminated intravascular coagulation (DIC) Client is not clotting- risk for bleeding is HIGH Is not a disease- is a process Check fibrinogen levels (low is bad)
A patient is diagnosed with cardiogenic shock. Which medication will the RN expect to be prescribed? A. Dopamine B. Dobutamine C. Desmopressin D. Diazepam
B. Dobutamine Vasopressor
The nurse provides medication teaching to a patient who has been prescribed sublingual nitroglycerin tablets. Which statement made by the patient indicates the need for further education? A. When I put the tablet under my tongue, I should feel a tingling sensation B. I can take as many tablets as needed until the pain goes away, each five minutes apart C. I will need to be careful when I stand up because nitroglycerin can cause dizziness D. If chest pain occurs, I will stop what I'm doing and put a tablet under my tongue
B. I can take as many tablets as needed until the pain goes away, each five minutes apart Take up to 3 tablets 5 minutes apart. If the pain does not go away by the second tab, will need to call MD
When caring for a patient in acute septic shock, the nurse would anticipate A. Administering osmotic and/or loop diuretics. B. Infusing large amounts of intravenous fluids. C. Administering intravenous diphenhydramine (Benadryl). D. Assisting with insertion of a ventricular assist device (VAD).
B. Infusing large amounts of intravenous fluids. All shock gets fluids but septic gets A LOT more
A patient in the coronary care unit develops Vfib. The first action the nurse should take is to A. Perform defibrillation B. Initiate CPR C. Prepare for synchronized cardioversion D. Administer IV antidysrhythmic drugs per protocol
B. Initiate CPR Vfib is a lethal rhythm. There is no cardiac output.
The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-sized lesions on the fingertips and toes. How should the nurse document this finding? A. Roth's spots B. Osler's nodes C. Janeway's lesions D. Splinter hemorrhages
B. Osler's nodes Is a sign of endocarditis
The nurse assesses a patient and notes a temperature of 101.6° F. Which type of dysrhythmia is associated with a fever? A. Fibrillation B. Sinus tachycardia C. Sinus bradycardia D. Junctional tachycardia
B. Sinus tachycardia
Drugs that the nurse would expect to be prescribed for patients with a mechanical valve replacement include A. oral nitrates B. anticoagulants C. atrial antidysrhythmics D. beta adrenergic blocking agents
B. anticoagulants Pts with valve replacements will be on anticoagulants for life
Following several months of increasing dyspnea on exertion, a 71-year-old woman has been diagnosed with mitral stenosis (MS). The woman is relieved to receive a diagnosis that explains her symptoms but does not completely understand the root of her problem. How can the nurse best explain the woman's health problem? A. "The left side of your heart is having trouble overcoming the resistance in your blood vessels because a valve is not sealing." B. "When your heart beats, some of the blood that should go to your body is backing up into your heart because the valve leaks." C. "The valve in the left side of your heart has become stiff and narrowed, so your heart can't fill with all the blood that your body needs." D. "The valve between your lungs and your heart has become inelastic, so your heart can't fill up with enough blood."
C. "The valve in the left side of your heart has become stiff and narrowed, so your heart can't fill with all the blood that your body needs."
A nurse practitioner visits a client in a cardiac care unit. They assess the client for shock, knowing that the primary cause of cardiogenic shock is: A. Valvular damage. B. Cardiomyopathies. C. A myocardial infarction. D. Arrhythmias.
C. A myocardial infarction.
A patient has a diagnosis of acute MI, and his cardiac rhythm is sinus bradycardia with 6-8 PVCs per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is: A. An irregular rhythm B. An inverted T wave C. A wide, distorted QRS complex D. An increasingly long PR interval
C. A wide, distorted QRS complex Wide QRS is PVC and narrow QRS is PAC
While assessing a client with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? A. Notify the health care provider. B. Document that the pericarditis has resolved. C. Ask the client to lean forward and listen again. D. Prepare to insert a unilateral chest tube.
C. Ask the client to lean forward and listen again.
The nurse that is monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate 250 beats/minute. How should the nurse document this pattern? A. Sinus tachycardia B. Sinus bradycardia C. Atrial flutter D. A fib
C. Atrial flutter Atrial rate between 220-350 Regular QRS w/ no P wave Can lead to DVT, pulmonary embolism, stroke
A patient with neurogenic shock is experiencing a heart rate of 30 bpm. What medication does the nurse anticipate will be ordered by the physician STAT?A. Adenosine B. Warfarin C. Atropine D. Norepinephrine
C. Atropine S/S of neurogenic shock is bradycardia, atropine is used to treat bradycardia
A patient with chronic stable angina has received a prescription for sublingual (SL) nitroglycerin. The nurse tells the patient that orthostatic hypotension is a side effect of the drug. What should the nurse include in the patient's teaching about preventing complications associated with the side effect? A. Take your BP daily and record the measurement B. Take the medication with each meal while you are seated C. Avoid sudden changes in position after taking nitroglycerin to prevent falls D. If the medication causes a tingling sensation, this indicates that hypotension will be more severe
C. Avoid sudden changes in position after taking nitroglycerin to prevent falls Major side effect of nitro is orthostatic hypotension
The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication? A. Nitrate B. Positive inotrope C. Calcium channel blocker D. ACE inhibitor
C. Calcium channel blocker (end in pine or dilitaziem/cardizem or verapmil)
Following a motor vehicle collision, a client is admitted to the emergency department with a blood pressure of 88/46, pulse of 54 beats/min with a regular rhythm, and respirations of 20 breaths/min with clear lung sounds. The client's skin is dry and warm. The nurse assesses the client to be in which type of shock? A. Septic B. Anaphylactic C. Neurogenic D. Cardiogenic
C. Neurogenic Motor vehicle collision= possible spinal cord injury Bradycardia/Hypotension
The nurse is assessing a client with aortic stenosis. The nurse expects to note what finding in this client? A. Dyspnea, fatigue, and weakness B. Dizziness, syncope, and palpitations C. Orthopnea, angina, and pulmonary edema D. Dry cough, wheezing, and hemoptysis
C. Orthopnea, angina, and pulmonary edema
Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? A. Unmeasurable rate and rhythm B. Rate 200 bpm; inverted P wave C. Rate 150 bpm; P wave not visible D. Rate 125 bpm; normal QRS complex
C. Rate 200 bpm; P wave not visible Vtach is lethal w/ HR between 150-250 and has 3 PVCS in a row.
A patient that is hospitalized with acute pericarditis reports severe, sharp chest pain. To increase patient comfort, the nurse should encourage the patient to assume which position? A. Flat on back B. Semi-Fowlers C. Sit up and lean forward D. Lie down and bend knees
C. Sit up and lean forward Tripod positioning. With pericarditis you will hear a pleural friction rub and chest pain will be bad when lying flat on back.
A young parent brings a 4-year-old child to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The parent states the child has been healthy until about 3 weeks ago, when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis? A. Epstein-Barr virus B. Streptococcus viridians C. Streptococcus aureus D. Group A beta-hemolytic strepu
C. Streptococcus aureus Main cause of rheumatic heart disease Will be on antibiotics 5 years or more
A patient with group A streptococcal pharyngitis states, "I do not want to take the antibiotics that have been prescribed." How should the nurse respond? A. You will not feel well if you don't take this medicine and get over this infection B. You may not want to take the antibiotics for this infection, but you'll be sorry if you don't C. Without treatment, you can get rheumatic fever, which can lead to rheumatic heart disease D. If you don't take this medication, you may have complications of the infection, such as loss of balance
C. Without treatment, you can get rheumatic fever, which can lead to rheumatic heart disease
The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? A. dyspnea B. fatigue lasting more than 1 month C. reports of constant chest pain D. elevated ESR and CRP
C. reports of constant chest pain Pain increases with inspiration or lying flat
A patient has a diagnosis of dilated cardiomyopathy (DCM) and was admitted 24 hours ago for treatment. Which of the following principles should the nurse integrate into the planning of this patient's care? A. The patient will benefit from early ambulation. B. Normal levels of activity should be resumed as soon as possible to reduce the risk of complications. C. The patient will need to avoid a heart rate of 75 beats per minute or more for several months. D. The patient will benefit from bed rest in the short term, and activity should be introduced slowly.
D. The patient will benefit from bed rest in the short term, and activity should be introduced slowly.
An emergency department nurse is admitting four patients. Which patient is a candidate for immediate percutaneous coronary intervention (PCI)? A. A patient with a NSTEMI who needs a heparin infusion. B. A patient with coronary artery disease who is anxious. C. A patient with chest pain who ran out of nitroglycerin at home. D. A patient with a STEMI who reports severe left arm pain.
D. A patient with a STEMI who reports severe left arm pain.
Which category of medication helps reduce afterload in patients with heart failure? A. Morphine B. Antidysrhythmia drugs C. Beta blockers D. ACE inhibitors
D. ACE inhibitors End in pril Biggest side effect= dry/nonproductive cough
A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm? A. Atrial flutter B. Supraventricular tachycardia C. Normal sinus rhythm D. Atrial fibrillation
D. Atrial fibrillation
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? A. Stay at least 5 feet away from microwave ovens. B. Never engage in activities that require vigorous arm and shoulder movement. C. Avoid going through airport metal detectors. D. Avoid undergoing magnetic resonance imaging (MRI).
D. Avoid undergoing magnetic resonance imaging (MRI). Notify airport security, avoid arm movement for (6 weeks?), do not take BP/IV on the affected arm, avoid direct blows, do not get pacemaker wet, avoid using cell phone on affected side.
Which are anticipated vital signs for a patient with neurogenic shock? A. Blood pressure 84/67 mm Hg and heart rate 112 bpm B. Blood pressure 120/80 mm Hg and heart rate 80 bpm C. Blood pressure 188/101 mm Hg and heart rate 125 bpm D. Blood pressure 74/42 mm Hg and heart rate 48 bpm
D. Blood pressure 74/42 mm Hg and heart rate 48 bpm They will have bradycardia/hypotension
A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client 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
D. Coronary arteriosclerosis
The nurse is assessing a client with mitral stenosis. The nurse expects to note what finding in this client? A. Dyspnea, fatigue, and weakness B. Dizziness, syncope, and palpitations C. Orthopnea, angina, and pulmonary edema D. Dry cough, wheezing, and hemoptysis
D. Dry cough, wheezing, and hemoptysis
A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the client about for termination of the dysrhythmia? A. Defibrillation B. Mace procedure C. Pacemaker implantation D. Elective cardioversion
D. Elective cardioversion Use moderate sedation- they will be awake Sign consent and make sure they are NPO before procedure
A 19 yo patient with rheumatic heart disease is admitted to the hospital with a recurrence of rheumatic fever. In planning care for the patient, which nursing diagnosis should the nurse include? A. Ineffective coping r/t refusal to carry out health promotion activities B. Risk for infection r/t recent exposure to group A beta-hemolytic streptococci C. Impaired adjustment r/t unsuccessful lifestyle modifications, goal setting, and problem solving D. Ineffective health management r/t lack of knowledge about long-term prophylactic antibiotic therapy
D. Ineffective health management r/t lack of knowledge about long-term prophylactic antibiotic therapy Will be on antibiotic therapy for 5 years or greater.
A patient's cardiac rhythm is sinus bradycardia with a HR of 34 bpm. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit A. Palpitations B. HTN C. Warm, flushed skin D. SOB
D. SOB First intervention= administer oxygen
T/F: You should monitor for hypothermia if a patient is in neurogenic shock
True Provide warm blankets
T/F: Diabetics and women are less likely to notice the effects of an MI
True Women= higher pain tolerance Diabetics= cardiac neuropathy
