PrepU Cardiac questions
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? "I should avoid taking a tub bath until my catheter site heals." "I should expect a low-grade fever and swelling at the site for the next week." "I should avoid prolonged sitting." "I should expect bruising at the catheter site for up to 3 weeks."
"I should expect a low-grade fever and swelling at the site for the next week." Explanation: Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement? "I sleep on three pillows each night." "My feet are bigger than normal." " My pants don't fit around my waist." "I don't have the same appetite I used to."
"I sleep on three pillows each night." Explanation: Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.
A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." "The older I get the higher my risk for peripheral arterial disease gets." "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease."
"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." Explanation: The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.
Which PR interval presents a first-degree heart block? 0.24 seconds 0.14 seconds 0.16 seconds 0.18 seconds
0.24 seconds Explanation: In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? 10 minutes 15 minutes 20 minutes 25 minutes
10 minutes Explanation: The survival rate decreases for every minute that defibrillation is delayed. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. The other options are too long of a time frame.
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 Explanation: Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).
A nurse is assessing a patient with congestive heart failure for jugular vein distension (JVD). Which of the following observations is important to report to the physician? No JVD is present. JVD is noted at the level of the sternal angle. JVD is noted 1 cm above the sternal angle. JVD is noted 3 cm above the sternal angle.
JVD is noted 3 cm above the sternal angle. Explanation: JVD is assessed with the patient sitting at a 45° angle. Jugular vein distention greater than 3 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure.
A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many mL per hour will the nurse infuse this solution? Enter the correct number ONLY.
24 Explanation: (1200 units/25,000 units) X 500 mL = 24 mL.
A client presents to the emergency room via EMS with a STEMI - per EMS EKG, which of the following interventions would the nurse perform? Notify the cardiac cath lab team Place on oxygen Start or maintain IV access Place on Cardiac monitor Administer aspirin
Notify the cardiac cath lab team Place on oxygen Start or maintain IV access Place on Cardiac monitor Administer aspirin
The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? A suction machine A defibrillator Cardioversion equipment An ECG machine
A defibrillator Explanation: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed.
Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. An hourly urine output of 50 to 70 mL A urine specific gravity reading of 1.021 A serum BUN of 70 mg/dL A serum creatinine of 1.0 mg/dL
A serum BUN of 70 mg/dL Explanation: These four laboratory results should always be assessed, post cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. The lab results in the other choices are all within normal range.
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Explanation: Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the physician before completing the initial assessment is premature.
Which of the following are risk factors for venous disorders of the lower extremities? Trauma Pacing wires Obesity Surgery
An incompetent venous valve. Explanation: Varicose veins are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.
To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: Inside of the ankle just above the heel. Exterior surface of the foot near the heel. Outside of the foot just below the heel. Anterior surface of the foot near the ankle joint.
Anterior surface of the foot near the ankle joint. Explanation: The dorsalis pedis pulse can be palpated on the dorsal surface of the foot distal to the major prominence of the navicular bone.
A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? IV bolus of atropine or temporary pacing Cardioversion or IV bolus of dopamine A maze procedure or IV bolus of furosemide Cardiac catheterization
IV bolus of atropine or temporary pacing Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists.
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? Assess the client's level of pain and administer prescribed analgesics. Assess the client's level of anxiety and provide emotional support. Prepare the client for pulmonary artery catheterization. Ensure that the client's family is kept informed of his status.
Assess the client's level of pain and administer prescribed analgesics. Explanation: The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? Atrial fibrillation Atrial flutter Ventricular tachycardia Ventricular fibrillation
Atrial flutter Explanation: Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011).
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticpate administering to treat his bradycardia? Atropine Dobutamine (Dobutrex) Amiodarone (Cordarone) Lidocaine (Xylocaine)
Atropine Explanation: I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation.
A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? Avoid caffeinated beverages. Request sublingual nitroglycerin. Apply supplemental oxygen. Lie down and elevate the feet.
Avoid caffeinated beverages. Explanation: If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.
The nurse is caring for a patient following the insertion of a permanent pacemaker. Which of the following discharge instructions are appropriate for the nurse to review with the patient? Select all that apply. Avoid handheld screening devices in airports. Refrain from walking through antitheft devices. Check pulse daily, reporting sudden slowing or increase. A void the usage of microwave ovens and electronic tools. Wear a medical alert noting the presence of a pacemaker.
Avoid handheld screening devices in airports. Check pulse daily, reporting sudden slowing or increase. Wear a medical alert noting the presence of a pacemaker. Explanation: Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the patient should be instructed initially to restrict activity on the side of implantation. Patients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Patients should walk through antitheft devices quickly and avoid standing in or near these devices. Patients can safely use microwave ovens and electronic tools.
The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? Report changes in the usual pattern of chest pain. Avoid situations that contribute to ischemic episodes. Avoid fatty foods and exercise. Take over-the-counter decongestants.
Avoid situations that contribute to ischemic episodes. Explanation: Teaching for clients with Raynaud's disease and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.
Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis? Balloon angioplasty Balloon valvuloplasty Cardiac catheterization Cardiac graft procedure
Balloon valvuloplasty Explanation: Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for aortic stenosis.
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? Jugular vein distention Right upper quadrant pain Bibasilar crackles Dependent edema
Bibasilar crackles Explanation: Bibasilar crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload and indicate left-sided heart failure. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.
The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms? Bradycardia Tachycardia Atrial fibrillation Atrial flutter
Bradycardia Explanation: If symptomatic, the treatment is the same as for bradycardia: the patient may be treated with pacing (temporary or permanent), IV atropine, or epinephrine.
Which of the following is a key diagnostic indicator of heart failure? Blood Urea Nitrogen (BUN) Creatinine Brain Natriuretic Peptide (BNP) Complete Blood Count(CBC)
Brain Natriuretic Peptide (BNP) Explanation: The Brain Natriuretic Peptid (BNP )is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of Heart Failure. A BUN, creatinine, and CBC are included in the initial workup.
Which complication of cardiac surgery occurs when there is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? Cardiac tamponade Fluid overload Hypertension Hypothermia
Cardiac tamponade Explanation: Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high PAWP, CVP, and pulmonary artery diastolic pressure as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? Coronary artery disease Raynaud's disease Cardiogenic shock Venous occlusive disease
Coronary artery disease Explanation: The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
Which of the following body system responses correlates with systolic heart failure (HF)? Decrease in renal perfusion Increased blood volume ejected from ventricle Vasodilation of skin Dehydration
Decrease in renal perfusion Explanation: A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure.
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Anxiety related to an actual threat to health status, invasive procedures, and pain Disabled family coping related to knowledge deficit and a temporary change in family dynamics Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time
Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
Clinical manifestation of right sided heart failure include : (Select all that apply) JVD Hepatomegaly Dependant edema ascites weight gain
JVD Hepatomegaly Dependant edema ascites weight gain
What is the primary underlying disorder of pulmonary edema? Decreased left ventricular pumping Decreased right ventricular elasticity Increased left atrial contractility Increased right atrial resistance
Decreased left ventricular pumping Explanation: Pulmonary edema is an acute event that results from heart failure. Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation. Pulmonary edema quickly develops.
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 Explanation: Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).
Cardioversion is used to terminate dysrhythmias. With cardioversion, the: 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. Explanation: 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.
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following? Variable heart rate, usually fewer than 90 bpm Irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden within the QRS complex
Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? A variable heart rate, usually fewer than 60 bpm An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex
Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).
Coronary artery bypass grafting is considered the treatment of choice in which population of patients Middle age adults with LAD and Circumflex disease Young adult with single vessel disease Middle age adult with 20-% left main stenosis Diabetic client with 3 vessel disease
Diabetic client with 3 vessel disease
Which of the following are characteristics of arterial insufficiency? Diminished or absent pulses Superficial ulcer Aching, cramping pain Pulses are present, may be difficult to palpate
Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.
A patient is prescribed digitalis medication. Which of the following conditions should the nurse closely monitor when caring for the patient? Vasculitis Electrolyte and water loss Flexion contractures Enlargement of joints
Electrolyte and water loss Explanation: The nurse should closely monitor a patient being administered diuretics for electrolyte and water loss. Digitalis medications (not diuretics) are potent and may cause various toxic effects. The nurse should monitor the patient for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. However, the effects do not include vasculitis, flexion contractures, or enlargement of joints.
A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? Elevate the legs periodically for at least an hour. Avoid foods with iodine. Elevate the legs periodically for at least 15 to 20 minutes. Refrain from sexual activity for a week.
Elevate the legs periodically for at least 15 to 20 minutes. Explanation: The nurse should advise the client to periodically elevate the legs for at least 15 to 20 minutes. Avoiding foods with iodine or refraining from sexual activity for a week does not relate to venous insufficiency.
Which of the following statements is accurate regarding Reynaud's disease? The disease generally affects the patient bilaterally. It affects more than two digits on each hand or foot. It is most common in men 16 to 40 years of age. Episodes may be triggered by unusual sensitivity to cold.
Episodes may be triggered by unusual sensitivity to cold. Explanation: Episodes of Reynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.
A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when The pericardial space is eliminated with scar tissue and thickened pericardium. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. Explanation: The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD), and distant (muffled) heart sounds. Increased pericardial pressure, reduced venous return to the heart, and decreased carbon dioxide result in cardiac tamponade (eg, compression of the heart).
An ST elevation MI is characterized by elevated cardiac enzymes without associated EKG changes True False
False
Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure? Fatigue Pedal edema Nocturia Irregular pulse
Fatigue Explanation: Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition.
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering Nausea Hypotension Fever
Fluttering Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? Romberg's Phalen's Rinne Homans'
Homans' Explanation: A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.
When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality? Hyperkalemia Hypercalcemia Hypomagnesemia Hyponatremia
Hyperkalemia Explanation: Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T-wave formation.
Which of the following is a potential cause of premature ventricular complexes (PVCs)? Hypokalemia Alkalosis Hypovolemia Bradycardia
Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.
Which of the following in an inconsistent manifestation of metabolic syndrome? Insulin resistance Hypotension Dyslipidemia Chronic inflammation
Hypotension Explanation: Metabolic syndrome consists of insulin resistance, dyslipidemia, hypertension, and chronic inflammation.
A patient admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which of the following medications will the nurse administer to relieve the patient's anxiety and decrease cardiac workload? IV morphine IV nitroglycerin Tenormin (atenolol Norvasc (amlodipine)
IV morphine Explanation: IV morphine is the analgesic of choice for treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of Tenormin and Norvasc are not indicated in this situation.
When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects: Inadequate fluid volume Normal glomerular filtration Overhydration Anuria
Inadequate fluid volume Explanation: Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mL or greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine.
A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? Hyperuricemia Increased liver enzymes Hyperglycemia Gastrointestinal distress
Increased liver enzymes Explanation: Myopathy and increased liver enzymes are significant side effects of the statins, HMG-CoA reductase inhibitors that are used to affect lipoprotein metabolism.
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 Explanation: 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. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.
Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? Intermittent claudication Acute limb ischemia Dizziness Vertigo
Intermittent claudication Explanation: The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.
A client in the hospital informs the nurse he "feels like his heart is racing and can't catch his breath." What does the nurse understand occurs as a result of a tachydysrhythmia? It causes a loss of elasticity in the myocardium. It reduces ventricular ejection volume. It increases afterload. It increases preload.
It reduces ventricular ejection volume. Explanation: Reducing ventricular ejection volume because diastole, during which the ventricle fills withblood (preload), is shortened as a result of a tachydsrhythmia. Causing a loss of elasticity in the muscle is a result of cardiomyopathy. Afterload is decreased not increased.
A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? Application of ace wraps from the toe to below the knees Use of antiembolytic stockings Elevation of the legs above the heart Keeping the legs in a neutral or dependent position
Keeping the legs in a neutral or dependent position Explanation: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? Cyanosis of the lips Bilateral crackles Productive cough Leg edema
Leg edema Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.
Which of the following is the hallmark of systolic heart failure? Low ejection fraction (EF) Pulmonary congestion Limitation of activities of daily living (ADLs) Basilar crackles
Low ejection fraction (EF) Explanation: A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the patient's symptoms.
As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. Total cholesterol Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Triglycerides
Low-density lipoproteins (LDL) Explanation: When there is an excess of LDL, these particles adhere to vulnerable points in the arterial endothelium. Here, macrophages ingest then, leading to the formation of foam cells and the beginning of plaque formation. A harmful effect is exerted on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining.
A client, who is resting in bed, presents with symptoms of poikilothermy, bilateral lower extremity edema, and pallor. Which is the best nursing measure to initiate? Elevate the legs. Apply cool compresses. Smoking cessation class. Lower the legs.
Lower the legs. Explanation: These are symptoms of peripheral artery disease. By lowering the legs, blood flow will be increased to the lower extremities. Elevation of the legs would be helpful in the management of impaired venous blood return. Smoking cessation is paramount but not the initial action to be taken, and cool compresses stimulate vasoconstriction and further impede blood flow.
Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Monitor blood pressure frequently Encourage patient to ambulate in room Titrate milrinone rate slowly before discontinuing Teach patient about safe home use of the medication
Monitor blood pressure frequently Explanation: Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to patients with severe HF, including patients who are waiting for a heart transplant. Because the drug causes vasodilation, the patient's blood pressure is monitored prior to administration since if the patient is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and following infusions of milrinone.
What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? Monitor blood pressure continuously. Monitor cardiac rhythm continuously. Provide supplemental oxygen. Palpate the client's pulse and observe the client's response.
Monitor cardiac rhythm continuously. Explanation: The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias.
Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? Cleanse the site with disinfectants and dress the wound appropriately Refrain from sexual activity for one month Monitor the site for bleeding or hematoma. Normal activities of daily living can be resumed the first day post op
Monitor the site for bleeding or hematoma. Explanation: The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or development of a hard mass indicative of hematoma. A nurse does not advise the patient to clean the site with disinfectants or refrain from sexual activity for one month.
Which of the following medications is a human brain natriuretic peptide (BNP) preparation? Natrecor Metoprolol Captopril Enalapril
Natrecor Explanation: Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing dieresis and vasodilation, reducing blood pressure, and improving cardiac output. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors.
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 Explanation: The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization.
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Date and time of insertion Location of the generator Model number Pacer rate
Pacer rate Explanation: After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? Cyanosis Gangrene Pallor Clubbing of the fingers
Pallor Explanation: Pallor is the initial symptom in Raynaud's followed by cyanosis and aching pain. Gangrene can occur with persistent attacks and interference of blood flow. Clubbing of the fingers is a symptom associated with chronic oxygen deprivation to the distal phalanges.
A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? Peripheral pulses every 15 minutes following surgery Ankle-arm indices every 12 hours Blood pressure every 2 hours Color of the leg every 4 hours
Peripheral pulses every 15 minutes following surgery Explanation: 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.
Which of the following describes the amount of blood presented to the ventricle just before systole? Afterload Preload Ejection fraction S troke volume
Preload Explanation: Preload is the amount of blood presented to the ventricle just before systole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction.
When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? Ventricular bigeminy Ventricular tachycardia Premature ventricular contraction Ventricular fibrillation
Premature ventricular contraction A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
The action of ACE inhibitors includes : (Select all that apply) Promotes vasodilation Decreases BP Increases afterload Decreases preload Promotes peripheral vasoconstriction
Promotes vasodilation Decreases BP Decreases preload
Which of the following medications is an antidote to heparin? Protamine sulfate Alteplase (t-PA) Clopidogrel (Plavix) Aspirin
Protamine sulfate Explanation: Protamine sulfate is known as the antagonist to heparin. Alteplase is a thrombolytic agent. Clopidogrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client? Pulmonary congestion Pedal edema Nausea Jugular venous distention
Pulmonary congestion Explanation: When the left ventricle cannot effectively pump blood out of the ventricle into the aorta, the blood backs up into the pulmonary system and causes congestion, dyspnea, and shortness of breath. All the other choices are symptoms of right-sided heart failure. They are all symptoms of systolic failure.
A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) Jugular vein distention Ascites Pulmonary crackles Dyspnea Cough
Pulmonary crackles Dyspnea Cough Explanation: The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.
The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? QT interval that is 0. 46 seconds long PR interval that is 0.18 seconds long QRS complex that is 0.10 seconds long ST segment that is isoelectric in appearance
QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Right side of sternum, fourth intercostal space Left side of sternum, fourth intercostal space Midway between V2 and V4 Mid-clavicular line, fifth intercostal space
Right side of sternum, fourth intercostal space Explanation: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space.
The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? ST elevations Isolated premature ventricular contractions (PVCs) Sinus tachycardia Frequent premature atrial contractions (PACs)
ST elevations Explanation: The first signs of an acute MI are usually seen in the T wave and ST segment. The T wave becomes inverted; the ST segment elevates (usually flat). An elevation in ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e. ST elevation myocardial infarction, STEMI). This patient requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.
Priority discharge education for a patient who just had a coronary stent placement is: Teach the importance of taking antiplatelet medication Teach the patient progressive exercise for cardiac rehab Teach the patient how to read labels when grocery shopping teach the patient stress management techniques
Teach the importance of taking antiplatelet medication
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? The registered nurse stating to administer Lanoxin (digoxin) The registered nurse administering atropine sulfate intravenously The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute The registered nurse stating to administer all medications except those which are cardiotonics
The registered nurse administering atropine sulfate intravenously Explanation: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.
A transesophogeal echocardiogram is completed prior to a cardioversion for stable atrial fib for : To check that the heart is strong enough to undergo cardioversion To verify that the client is in atrial fibrillation and needs cardioversion To assess for intracardiac thrombus prior to cardioversion To evaluate the oxygenation of blood flow through the heart
To assess for intracardiac thrombus prior to cardioversion
A nurse notices an irregular heart rhythm when auscultating heart sounds; the telemetry monitor reveals PACs. the most appropiate nursing action is? To call a code blue To place the patient on oxygen To assess the patient To Administer adenosine
To assess the Patient
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes: Treating the underlying cause Electrical cardioversion Administration of amiodarone Immediate defibrillation
Treating the underlying cause Explanation: Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected.
Which of the following is also termed preinfarction angina? Stable angina Unstable angina Variant angina Silent ischemia
Unstable angina Explanation: Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs on exertion and it relieved by rest. Variant angina is exhibited by pain at rest with reversible ST-segment elevation. In silent angina, there is evidence of ischemia, but the patient reports no symptoms.
A patient, who is resting quietly in a step-down cardiac care unit, reports chest pain. The cardiac monitor indicates the presence of reversible ST-segment elevation. The nurse understands that the patient may be experiencing coronary artery vasospasm. This is a type of angina known as: Silent Stable Intractable Variant
Variant
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? Measuring and recording fluid intake and output Weighing the client daily at the same time each day Assessing the client's vital signs every 4 hours Checking the client's lungs for crackles during every shift
Weighing the client daily at the same time each day Explanation: Increased fluid volume leads to rapid weight gain — 2.2 lb (1 kg) for each liter of fluid retained. Weighing the client daily at the same time and in similar clothing provides more objective data than measuring fluid intake and output, which may be inaccurate because of omitted measurements such as insensible losses. Changes in vital signs are less reliable than daily weight because these changes usually are subtle during early stages of fluid retention. Weight gain is an earlier sign of excess fluid volume than crackles, which represent pulmonary edema. The nurse should plan to detect fluid accumulation before pulmonary edema occurs.
Which of the following nursing interventions should a nurse perform when a patient with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta blockers? Observe for symptoms of pulmonary edema. Continue the drug and document in the patient's chart. Withhold the drug and inform the primary health care provider. Check for signs of toxicity.
Withhold the drug and inform the primary health care provider. Explanation: Before administering beta blockers, the nurse should monitor the patient's apical pulse. If the heart rate is less than 60 bpm, the nurse should withhold the drug and inform the primary health care provider.
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as: a first heart sound (S1). a third heart sound (S3). a fourth heart sound (S4). a murmur.
a third heart sound (S3). Explanation: An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.
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 Explanation: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium-channel blocker.
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? chest pain that occurs at rest and usually in the middle of the night radiating chest pain that lasts 15 minutes or less prolonged chest pain that accompanies exercise chest pain of increased frequency, severity, and duration
chest pain that occurs at rest and usually in the middle of the night Explanation: A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.
Frequently, what is the earliest symptom of left-sided heart failure? dyspnea on exertion anxiety confusion chest pain
dyspnea on exertion Explanation: Dyspnea on exertion is often the earliest symptom of left-sided heart failure.
A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? echocardiogram electrocardiogram cardiac catheterization cardiac ultrasound
echocardiogram Explanation: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan, not an electrocardiogram or cardiac ultrasound. Cardiac catheterization is not the diagnostic tool for this measurement.
The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: decrease anxiety. enhance myocardial oxygenation. administer sublingual nitroglycerin. educate the client about his symptoms.
enhance myocardial oxygenation. Explanation: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are import in care delivery, neither is a priority when a client is compromised.
A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: encouraging ambulation to prevent pooling of blood. providing warmth to the extremity. elevating the extremity to prevent pooling of blood. forcing blood into the deep venous system.
forcing blood into the deep venous system. Explanation: Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: administer oxygen. have the client take deep breaths and cough. place the client in high Fowler's position. perform chest physiotherapy.
place the client in high Fowler's position. Explanation: The high Fowler's position will initially promote oxygenation in the client and relieve shortness of breath. Additional measures include administering oxygen to increase oxygen content in the blood. Deep breathing and coughing will improve oxygenation postoperatively but may not immediately relieve shortness of breath. Chest physiotherapy results in expectoration of secretions, which isn't the primary problem in pulmonary edema.
Prevention of DVT during hospitilzation is best accomplished, when possible, by : Full dose anticoagulation Dietary management regular and early ambulation supplemental oxygen
regular and early ambulation
A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: creatine kinase. lactate dehydrogenase. myoglobin. troponin.
troponin. Explanation: This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase and myoglobin tests can show evidence of muscle injury, but they're less specific indicators of myocardial damage than troponin.