PrepU - Ch.25 Assessment of Cardiovascular Function

Test 4 1. A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its Cardioprotective benefits. What is the best response by the nurse? A. "You need to research hormone replacement therapy and determine what you want to do" B. "Thats a great idea. You don't want to have a heart attack" C. "Current research determines that estrogen replacement protects heart health for most women after menopause" D. "Current evidence indicates that estrogen replacement is not effective at preventing cardiovascular disease and carries some risks"

"Current evidence indicates that estrogen replacement is not effective at preventing cardiovascular disease and carries some risks" In the past, hormone therapy was routinely prescribed for postmenopausal women with the belief that it would deter the onset and progression of coronary artery disease (CAD). However, based on results from the multisite, prospective, longitudinal Women's Health Initiative study, the American Heart Association (AHA) no longer recommends the use of hormone therapy to prevent cardiovascular disease. However, hormone replacement therapy has not been shown to be harmful for all women, and it may be a good choice for some women seeking to reduce symptoms of menopause.

Test 2 8. The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include? A. "You can take a tub bath or a shower when you get home" B. "Contact your primary care provider if you develop a temperature above 102 F" C. "Do not bend at the waist, strain, or lift heavy objects for the next 24 hours" D. "If any discharge occurs at the puncture site, call 911 immediately"

"Do not bend at the waist, strain, or lift heavy objects for the next 24 hours" The nurse should instruct the client to follow these guidelines: For the next 24 hours, do not bend at the waist, strain, or lift heavy objects if the artery of the groin was used; contact the primary provider if swelling, new bruising or pain from the procedure puncture site, or a temperature of 101°F or more occur. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The client should not drive to the hospital. "You should be able to return to work in 2 to 3 days if you do not do heavy work. Do not take a bath or swim for the first week. You may take showers, but make sure the area where the catheter was inserted does not get wet for the first 24 to 48 hours."

Test 3 7. You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment? A. "Have you had any episodes of dizziness or fainting?" B. "Have you had any episodes when you are to nauseas?" C. "Have you had any episodes of mottling in your hands D. "Have you had any episodes of pain radiating into your lower extremities?"

A "Have you had any episodes of dizziness or fainting?" Ask if the client has episodes of dyspnea, dizziness, or fainting. Options B, C, and D are incorrect. Being nauseous, mottling of the hands, and pain radiating into the lower extremities are not indications of cardiac problems.

Test 6 12. The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? A. Baroreceptors B. Sympathetic Nerve Fibers C. Vagus Nerve D. Chemoreceptors

A Baroreceptors Baroreceptor sense pressure in nerve endings in the walls of the atria and major blood vessels. The baroreceptors respond accordingly to raise or lower the pressure. Chemoreceptors are sensitive to pH, CO2, and O2 in the blood. Sympathetic nerve fibers increase the heart rate. The vagus nerve slows the heart rate

Test 2 17. The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? A. Count the heart rate at the apex B. Calculate the pauses between pulsations C. Count the Radial Pulse for 20 to 25 seconds D. Calculate the palpated volume

A Count the heart rate at the apex The nurse determines the pulse deficit by counting the heart rate through auscultation at the apex while a second nurse simultaneously palpates and counts the radial pulse for a full minute. The difference, if any, is the pulse deficit. The pulse quality refers to its palpated volume. Pulse rhythm is the pattern of the pulsations and the pauses between them Pulse Deficit = Apical - Radial Pulse - done by 2 nurses at same time for 1 minute

Test 5 2. The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmia. Which of the following assessment considerations is essential when caring for this client? A. Digoxin level B. Dyspnea C. Cardiac output D. Activity level

A Digoxin level The action of Digoxin slows and strengthens the heart rate. Assessment of the pulse rate is essential prior to administration in all clients. Due to decreased perfusion common in geriatric clients, toxicity may occur more often. The nurse must monitor Digoxin levels in the body. Monitoring symptoms reflecting cardiac output, activity level, and dyspnea are also important assessment considerations for all clients.

Test 3 3. Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? A. Endocardium B. Pericardium C. Epicardium D. Myocardium

A Endocardium The inner layer, the Endocardium, is composed of a thin, smooth layer of endothelial cells. Folds of endocardium form the heart valves. The middle layer, the Myocardium, consists of muscle tissue and is the force behind the heart's pumping action. The Pericardium is a saclike structure that surrounds and supports the heart. The outer layer, the Epicardium, is composed of fibrous and loose connective tissue. (OUTER) Pericardium --> Epicardium --> Myocardium --> Endocardium (INNER)

Test 4 17. A client is admitted to the hospital with weakness. What nursing assessment indicates Postural Hypotension? A. Heart Rate increased from 85 to 110 bpm B. Systolic pressure did not change with the change in position C. Heart Rate decreased from 85 to 75 bpm at the same time that the Systolic Pressure increased from 120 to 135 mm Hg D. Diastolic pressure went from 80 to 110 mm Hg

A Heart Rate increased from 85 to 110 bpm A sign of Postural Hypotension is the increase in the Heart Rate from 5 to 20 bpm with the change in position from lying, sitting and standing. Therefore, an increase of 25 bpm is indicative of Hypotension. With Postural Hypotension, the Systolic and Diastolic blood pressure will decrease with standing and heart rate will increase

Test 4 5. The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? A. Heart failure B. Pulmonary Embolism C. Pericarditis D. Myocardial Infarction

A Heart failure An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.

Test 3 16. The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's Prothrombin Time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate? A. International Normalized Ratio (INR) B. Complete Blood Count (CBC) C. Sodium D. Partial Thromboplastic Time (PTT)

A International Normalized Ratio (INR) The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.

Test 2 14. he nurse correctly identifies which data as an example of blood pressure and heart rate measurements in a client with postural hypotension? A. supine: BP 120/70 mm Hg, HR 70 bpm; sitting: BP 100/55 mm Hg, HR 90 bpm; standing: BP 98/52 mm Hg, HR 94 bpm B. supine: BP 140/78 mm Hg, HR 72 bpm; sitting: BP 145/78 mm Hg, HR 74 bpm; standing: BP 144/78 mm Hg, HR 74 bpm C. supine: BP 130/70 mm Hg, HR 80 bpm; sitting: BP 128/70 mm Hg, HR 80 bpm; standing: BP 130/68 mm Hg, HR 82 bpm D. supine: BP 114/82 mm Hg, HR 90 bpm; sitting: BP 110/76 mm Hg, HR 95 bpm; standing: BP 108/74 mm Hg, HR 98 bpm

A supine: BP 120/70 mm Hg, HR 70 bpm; sitting: BP 100/55 mm Hg, HR 90 bpm; standing: BP 98/52 mm Hg, HR 94 bpm Postural (orthostatic) hypotension is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting position to a standing position. The following is an example of BP and HR measurements in a client with postural hypotension: supine: BP 120/70 mm Hg, HR 70 bpm; sitting: BP 100/55 mm Hg, HR 90 bpm; standing: BP 98/52 mm Hg, HR 94 bpm. Normal postural responses that occur when a person moves from a lying to a standing position include (1) a HR increase of 5 to 20 bpm above the resting rate; (2) an unchanged systolic pressure, or a slight decrease of up to 10 mm Hg; and (3) a slight increase of 5 mm Hg in diastolic pressure.

Test 2 11. A client has undergone cardiac catheterization and will be discharged today. What information should the nurse emphasize during discharge teaching? A. Bend only at the waist B. Avoid heavy lifting for the next 24 hours C. New bruising at the puncture site is normal D. Take a tub bath, rather than a shower

Avoid heavy lifting for the next 24 hours For the next 24 hours, the patient should not bend at the waist, strain, or lift heavy objects. The patient should avoid tub baths, but can shower as desired. The patient should call the healthcare provider if she has any bleeding, swelling, new bruising, or pain from her procedure puncture site, or a temperature of 101.5 degrees Fahrenheit (38.6 degrees C) or higher.

Test 6 17. The nurse admits an adult female client with a medical diagnosis of "rule out MI." The client is very frightened and expresses surprise that a woman would have heart problems. What response by the nurse will be most appropriate? A. "The stroke volume from a woman's heart is lower than from a man's heart." B. "A woman's heart is smaller and has smaller arteries that become occluded more easily." C. "A woman's resting heart rate is lower than a man's" D. "It takes longer for an electrical impulse to travel from the Sinoatrial Node to the Atrioventricular Node in a woman"

B "A woman's heart is smaller and has smaller arteries that become occluded more easily." Because the coronary arteries of a woman are smaller, they become occluded from atherosclerosis more easily. The resting rate, stroke volume, and ejection fraction of a woman's heart are higher than those of a man. The electrical impulses from the Sinoatrial Node to the Atrioventricular Node are not different in the genders.

Test 2 1. The nurse assesses a client with increasing shortness of breath and peripheral edema. The healthcare provider inserts a triple lumen catheter and orders a transduced Central Venous Pressure (CVP). What CVP reading does the nurse suspect will correlate with the client's symptoms? A. 6 mmHg B. 8 mmHg C. 2 mmHg D. 0 mmHg

B 8 mmHg The normal CVP reading is 2-6 mmHg. A reading of 0 mmHg indicates hypovolemia. A reading of 8 mmHg, which is high, correlates with Hypervolemia and the client's symptoms of fluid overload with increasing shortness of breath and edema.

Test 5 19. The nurse cares for a client with an intra-arterial blood pressure monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which condition? A. Pneumothorax B. Catheter-Related Bloodstream Infections C. Air Embolism D. Hemorrhage

B Catheter-Related Bloodstream Infections Catheter-related bloodstream infections (CRBSIs) are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air

Test 5 10. A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). The client's blood pressure is 104/68 mm Hg. The client's pulse rate is 76 beats/minute. The nurse detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take? A. Encourage the client to perform isometric leg exercise to improve circulation in the legs B. Contact the health care provider and report the findings C. Slow the I.V. fluid to prevent any more swelling at the puncture site D. Documenting findings and check the client again in 1 hour

B Contact the health care provider and report the findings The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the health care provider immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time

Test 3 6. What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse? A. Repolarization B. Contractility C. Diastole D. Depolarization

B Contractility - Contractility - is the ability of the cardiac muscle to shorten in response to an electrical impulse. - Depolarization - is the electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell. - Repolarization - is the return of the cell to the resting state, caused by reentry of potassium into the cell while sodium exits the cell. - Diastole - is the period of ventricular relaxation resulting in ventricular filling.

Test 4 12. Which area of the heart is located at the 3rd intercostal (IC) space to the left of the sternum? A. Aortic Area B. Erb Point C. Epigastric Area D. Pulmonic Area

B Erb Point Erb point is located at the third ICS to the left of the sternum. The aortic area is located at the second ICS to the right of the sternum. The pulmonic area is at the second ICS to the left of the sternum. The epigastric area is located below the Xiphoid Process

Test 4 20. The nurse cares for a client in the emergency department who has a B-type Natriuretic Peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? A. Pulmonary Edema B. Heart Failure C. Ventricular Hypertrophy D. Myocardial Infarction

B Heart Failure A BNP level greater than 100 pg/mL is suggestive of heart failure. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of heart failure in settings such as the emergency department. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the healthcare provider correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of heart failure

Test 1 3. Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body? A. Right Atrium B. Left Ventricle C. Right Ventricle D.Left Atrium

B Left Ventricle The left ventricle pumps blood to all the cells and tissues of the body. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs to be oxygenated. The right atrium receives deoxygenated blood from the venous system.

Test 2 20. The nurse is educating a patient at risk for atherosclerosis. What non-modifiable risk factor does the nurse identify for the patient? A. Stress B. Positive family history C. Obesity D. Hyperlipidemia

B Positive family history The health history provides an opportunity for the nurse to assess patients' understanding of their personal risk factors for coronary artery, peripheral vascular, and cerebrovascular diseases and any measures that they are taking to modify these risks. Risk factors are classified by the extent to which they can be modified by changing one's lifestyle or modifying personal behaviors. Stress, obesity, and hyperlipidemia are all risk factors that can be modified by personal behaviors. Family history is a non-modifiable risk factor, because it cannot be changed.

Test 2 4. The Electrical Conduction System of the heart has several components, all of which are instrumental in maintaining Polarization, Depolarization, and Repolarization of cardiac tissue. Which of the conductive structures is known as the pacemaker of the heart? A. Bundle of His B. Sinoatrial Node C. Bundle Branches D. Atrioventricular Node

B Sinoatrial Node The SA node is an area of nerve tissue located in the posterior wall of the right atrium. The SA node is called the pacemaker of the heart because it initiates the electrical impulses that cause the atria and ventricles to contract. When the impulse from the SA node reaches the AV node, it is delayed a few hundredths of a second. While the ventricles fill with blood, the impulse travels from the AV node to the bundle of His, to the right and left bundle branches, and eventually to the Purkinje fibers. Then, both ventricles contract. While the ventricles fill with blood, the impulse travels from the AV node to the bundle of His, to the right and left bundle branches, and eventually to the Purkinje fibers. Then, both ventricles contract.

Test 2 3. The patient has a heart rate of 72 bpm with a regular rhythm. Where does the nurse determine the impulse arises from? A. The Ventricles B. The Sinoatrial Node C. The Purkinje Fibers D. The AV Node

B The Sinoatrial Node The sinoatrial node, the primary pacemaker of the heart, in a normal resting adult heart has an inherent firing rate of 60 to 100 impulses per minute; however, the rate changes in response to the metabolic demands of the body (Weber & Kelley, 2010).

Test 5 13. You are evaluating the expected outcomes on a client who is recovering from a cardiac catheterization. What is an expected outcome that you would evaluate? A. The client and family understands the need to restrict activity for 72 hours B. The client and family understands the need for medication C. The client and family understands the discharge instructions D. The client and family understands the client's CV diagnosis

B The client and family understands the discharge instructions The client is relaxed and feels secure. The test is performed uneventfully or the client is stabilized when complications are managed successfully. The client and family have an accurate understanding of the diagnostic testing process and discharge instructions. The scenario does not indicate that the client has a CV diagnosis, a need for medication, or a need to restrict their activity for 72 hours

Test 3 2. The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A. Positron Emission Tomography Scan B. Cardiac Catheterization C. Magnetic Resonance Imaging (MRI) D. Echocardiogram

B, C, D Echocardiogram Cardiac catheterization Magnetic resonance imaging Echocardiogram, cardiac catheterization, and magnetic resonance imaging can provide ejection fraction estimates. The positron emission tomography scan reveals areas of decreased blood flow in the heart. Troponin levels are cardiac markers and do not measure ejection fractions. EF= Stroke Volme (SV) / End Diastolic Volume (EDV) = %

Test 1 4. You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of Myocardial Infarction. Which test would you expect to show elevated levels? A. WBC B. Platelets C. Enzymes D. RBC

C Enzymes When tissues and cells break down, are damaged, or die, great quantities of certain enzymes are released into the bloodstream. Enzymes can be elevated in response to cardiac or other organ damage. After an MI, RBCs and platelets should not be elevated. WBCs would only be elevated if there was a bacterial infection present.

Test 3 9. The nurse prepares to auscultate heart sounds. What nursing intervention will be most effective to assist with this procedure? A. Ask the client to sit on the edge of the bed and hold breath while the nurse listens. B. Insist that the family members leave the room if they must speak to each other while the nurse is auscultating heart sounds. C. Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard. D. Ask the client to take deep breaths thru the mouth while the nurse auscultates heart sounds

C Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard. During auscultation, the client remains supine and the room should be as quiet as possible while the nurse listens to heart sounds. The client should breathe normally during the examination. Sitting on the edge of the bed is not the preferred client position. The room should be quiet so asking the families to remain quiet is acceptable. The client does not need to take deep breaths during heart auscultation.

Test 1 5. A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following a therapeutic regimen? A. Total Cholesterol level increases from 250 mg/dl to 275 mg/dl B. Low Density Lipoproteins (LDL) increase from 180 mg/dl to 190 mg/dl C. High Density Lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl D. Triglycerides increase from 225 mg/dl to 250 mg/dl

C High Density Lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl The goal of treating hyperlipidemia is to decrease total cholesterol and LDL levels while increasing HDL levels. HDL levels should be greater than 35 mg/dl. This client's increased HDL levels indicate that a therapeutic regimen has been followed. Recommended total cholesterol levels are below 200 mg/dl. LDL levels should be less than 160 mg/dl, or, in clients with known coronary artery disease (CAD) or diabetes mellitus, less than 70 mg/dl. Triglyceride levels should be between 100 and 200 mg/d.

Test 3 1. The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which finding is a priority to report to the healthcare provider? A. Na+ 140 mEq/L B. Ca++ 9 mg/dL C. K+ 3.1 mEq/L D. Mg++ mEq/L

C K+ 3.1 mEq/L All laboratory levels are within normal limits except for the K+, which is low. A low K+ level can cause ventricular tachycardia or fibrillation.

Test 2 10. The nurse is caring for a client who is scheduled for a Transesophageal Echocardiogram. What nursing intervention is a priority after the procedure? A. Keep the client turned to the right side and watch for bleeding from the site B. Monitor the puncture site and assess the affected extremity C. Keep the head of the bed elevated 45 degrees and keep NPO until return of the gag reflex D. Observe for bloody urine and stools

C Keep the head of the bed elevated 45 degrees and keep NPO until return of the gag reflex During the recovery period, the client must have the head of the bed elevated 45 degrees to avoid aspiration. The nurse should restrict food and fluids until the return of the gag reflex and the client is fully awake and alert. There will be no puncture site after an Transesophageal Echocardiogram. There is no need to turn the client on the right side or watching for bleeding from the esophagus. There are no anticoagulants given during this procedure, so bloody stools or urine should not occur

Test 5 16. Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs? A. Right Atrium B. Left Ventricle C. Left Atrium D. Right Ventricle

C Left Atrium The left atrium receives oxygenated blood from the lungs. The left ventricle pumps that blood to all the cells and tissues of the body. The right atrium receives deoxygenated blood from the venous system. The right ventricle pumps that blood to the lungs to be oxygenated

Test 3 10. While the nurse is preparing a client for a cardiac catheterization, the client states that they have allergies to seafood. Which of the following medications may the nurse give prior to the procedure? A. Phenytoin B. Lorazepam C. Methylprednisolone D. Furosemide

C Methylprednisolone Prior to Cardiac Catheterization, the patient is assessed for previous reactions to contrast agents or allergies to iodine-containing substances, as some contrast agents contain iodine. If allergic reactions are of concern, antihistamines or methylprednisolone (Solu-Medrol) may be administered to the patient before angiography is performed. Furosemide, Lorazepam, and Phenytoin do not counteract allergic reactions.

Test 4 15. The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? A. Propafenone B. Amiodarone C. Metoprolol D. Diltiazem

C Metoprolol Patients may receive beta-blockers prior to the scan to control heart rate and rhythm.

Test 3 17. A client in the ICU has a Central Venous Pressure (CVP) line placed. The CVP reading is 10 mm Hg. To what condition does the nurse correlate the CVP reading? A. Hypovolemia B. Reduction in Preload C. Right-sided Heart Failure D. Left-sided Heart Failure

C Right-sided Heart Failure Normal CVP is 2 to 8 mm Hg. A CVP greater that 8 mm Hg indicates Hypervolemia or Right-Sided Heart Failure. A CVP less than 2 mm Hg indicates a reduction in preload or Hypovolemia.

Test 5 9. The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing? A. Heart rate changes; 78 bpm to 112 bpm B. BP changes 148/80 mm Hg to 166/90 mm Hg C. ST-segment changes on the ECG D. Dizziness and leg cramping

C ST-segment changes on the ECG During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; blood pressure; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the client experiences signs of myocardial ischemia. Further diagnostic testing, such as a cardiac catheterization, may be warranted if the client develops chest pain, extreme fatigue, a decrease in blood pressure or pulse rate, serious dysrhythmias or ST-segment changes on the ECG during the stress test. The other findings would not warrant stopping the test

Test 5 17. A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by: A. An excess level of Thyroid Hormone B. An increased level of Catecholamines C. Stimulation of the Vagus Nerve D. Sympathetic NS stimulation

C Stimulation of the Vagus Nerve Parasympathetic impulses, which travel to the heart through the vagus nerve, can slow the cardiac rate. The other choices cause an increase in heart rate

Test 3 11. The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition? A. Increased risk of Heart block B. Enhanced sensitivity to Digitalis C. Impaired myocardial contractility D. Inclination to Ventricular Fibrillation

C Impaired myocardial contractility Normal Serum Calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.

Test 3 13. What does decreased pulse pressure reflect? A. Reduced distensibility of the Arteries B. Tachycardia C. Reduced Stroke Volume D. Elevated Stroke Volume

C Reduced Stroke Volume Decreased Pulse Pressure reflects Reduced Stroke Volume and Ejection Velocity or obstruction to blood flow during systole. Increased Pulse Pressure would indicate reduced distensibility of the arteries, along with Bradycardia. PP = Stroke Volume (SV) / Arterial Compliance (C)

Test 2 7. The nurse is administering a stool softener to a client who experienced a myocardial infarction. The client says, "I had a heart attack; I don't have a problem with constipation." What explanation will the nurse use to answer the client's question? A. "The prescribed stool softener will decrease stress with a bowel movement and protect your heart from further injury" B. "The heart attack sets you up for limited activity, so constipation is often a problem for clients after a heart attack" C. "Please talk this over with your healthcare provider for further information" D. "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous."

D "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." When straining during defecation, the client bears down, which momentarily may cause the heart to slow and cause fainting or syncope in the client. The stool softener will allow easier pass of stool by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass. The client will not have prescribed limited activity after a myocardial infarction. The nurse needs to explain the medication and not refer the client back to the healthcare provider. Stool softeners do not decrease stress. Vaso Vagal stimulation = drop in BP and HR

Test 3 12. The nurse is caring for a client on a monitored telemetry unit. During morning assessment, the nurse notes abnormal ECG waves on the telemetry monitor. Which action would the nurse do first? A. Assess for mechanical dysfunction B. Call the physician with a report C. Reposition the client D. Assess the client

D Assess the client When a nurse notes an abnormal rhythm on a telemetry monitor, the first action is to assess the client. After client assessment, the nurse is able to make an informed decision on the next nursing action.

Test 3 4. The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current? A. Once electrodes are applied, change them every 72 hrs B. Clean the client's chest with alcohol prior to application of electrodes C. Apply baby powder to the client's chest prior to placing the electrodes D. Clip the client's chest hair prior to applying the electrodes

D Clip the client's chest hair prior to applying the electrodes The nurse should complete the following actions when applying cardiac electrodes: (1) Clip (do not shave) hair from around the electrode site, if needed; (2) if the client is diaphoretic (sweaty), apply a small amount of benzoin to the skin, avoiding the area under the center of the electrode; (3) debride the skin surface of dead cells with soap and water and dry well (or as recommended by the manufacturer); (4) change the electrodes every 24 to 48 hours (or as recommended by the manufacturer); (5) examine the skin for irritation and apply the electrodes to different locations.

Test 4 16. The nurse is performing a skin assessment for a client and observes a blue tinge in the buccal mucosa and tongue. What condition does the nurse correlate this finding with? A. Peripheral Vasoconstriction B. Blood leaking outside the blood vessel C. Intermittent Arteriolar Vasoconstriction D. Congenital heart disease

D Congenital heart disease Cyanosis is due to serious cardiac disorders. A bluish tinge in the tongue and buccal mucosa are signs of central cyanosis caused by venous blood passing through the pulmonary circulation without being oxygenated. In the absence of pulmonary edema and Cardiogenic Shock, this sign is indicative of congenital heart disease. Refer to Table 25-3 in the text.

Test 1 1. The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? A. Coarseness B. Whistling C. Rhonchi D. Crackles

D Crackles When the left side of the heart is pumping inefficiently, blood backs up into the pulmonary veins and lung tissue. Auscultation reveals a crackling sound. Wheezes and gurgles may also be heard.

Test 2 6. For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain? A. Blood Pressure in the Left Arm B. Sound of the Apical Pulses C. Pulse Rate in upper extremities D. Description of the pain

D Description of the pain If the client is experiencing chest pain, a history of its location, frequency, and duration is necessary. A description of the pain is also needed, including if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the client and measures vital signs. The nurse may measure blood pressure in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities. OLD CART?

Test 1 2. After a physical examination, the provider diagnosed a patient with a Grade 4 heart murmur. During assessment, the nurse expects to hear a murmur that is: A. Very loud can be heard with the stethoscope half way off the chest B. Loud and may be associated with a thrill sound similar to (a purring cat) C. Easily heard with no palpable thrill D. Loud and may be associated with a thrill sound similar to (a purring cat)

D Loud and may be associated with a thrill sound similar to (a purring cat) Heart murmurs are characterized by location, timing, and intensity. A Grading System is used to describe the Intensity or loudness of a murmur. Grade 1: Very faint and difficult for the inexperienced clinician to hear Grade 2: Quiet but readily perceived by the experienced clinician Grade 3: Moderately loud Grade 4: Loud and may be associated with a thrill Grade 5: Very loud; heard when stethoscope is partially off the chest; associated with a thrill Grade 6: Extremely loud; detected with the stethoscope off the chest; associated with a thrill

Test 6 18. A nurse is assessing a client with heart failure. When assessing Hepatojugular Reflux, what is the appropriate action for the nurse to take? A. Press the right upper abdomen B. Elevate the client's C. Lay the client flat in bed D. Press the right upper abdomen

D Press the right upper abdomen As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a client has positive Hepatojugular Reflux. Hepatojugular reflux, a sign of right-sided heart failure, is assessed with the head of the bed at a 45-degree, not 90-degree, angle

Test 5 6. The nurse is assessing a patient's blood pressure. What does the nurse document as the difference between the systolic and the diastolic pressure? A. Korotkoff sounds B. Auscultatory Gap C. Pulse Deficit D. Pulse Pressure

D Pulse Pressure The difference between the systolic and the diastolic pressures is called the pulse pressure.

Test 3 19. The clinic nurse is assessing a client's pulse before outpatient diagnostic testing. What should the nurse document when assessing the client's pulse? A. Rate, Rhythm, and Volume B. Pressure, Rate, and Rhythm C. Quality, Volume, and Rate D. Rate, Quality, and Rhythm

D Rate, Quality, and Rhythm Assess apical and radial pulses, noting rate, quality, and rhythm. Pulse pressure and volume are not assessed in this instance.

Test 3 18. It is important for a nurse to understand Cardiac Hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: A. Right Ventricular Pressure must decrease with Systole B. The Pulmonic Valve must be closed C. The Atrioventricular Valves must be open D. Right Ventricular Pressure must be higher than Pulmonary Arterial Pressure

D Right Ventricular pressure must be higher than Pulmonary Arterial Pressure For the right ventricle to pump blood in need of oxygenation into the lungs via the pulmonary artery, right ventricular pressure must be higher than pulmonary arterial pressure.

Test 4 14. The nurse is assessing heart sounds in a patient with heart failure. An abnormal heart sound is detected early in diastole. How would the nurse document this? A. S2 B. S4 C. S1 D. S3

D S3 An S3 ("DUB") is heard early in diastole during the period of rapid ventricular filling as blood flows from the atrium into a noncompliant ventricle. It is heard immediately after S2. "Lub-dub-DUB" is used to imitate the abnormal sound of a beating heart when an S3 is present

Test 2 2. The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a Blood Urea Nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. What priority reason will the nurse notify the healthcare provider? A. These values show a risk for dysrhythmias B. The client is overhydrated, which puts him ta risk for Heart Failure during the procedure C. The client is at risk for bleeding D. The client is at risk for renal failure due to the contrast agent that will be given during the procedure

D The client is at risk for renal failure due to the contrast agent that will be given during the procedure The contrast medium must be excreted by the kidneys. If there is already a degree of renal impairment, indicated by the increased BUN and creatinine, the risk for contrast agent-induced nephropathy and renal failure is high. Renal impairment is not usually associated with dysrhythmias. The increased BUN and creatinine do not indicate overhydration, but decreased kidney function. The BUN and creatinine levels do not interfere with coagulability or bleeding

Test 2 9. The nurse is performing an assessment for an older adult client with reports of chest pain. What assessment finding correlates with a potential age-related change? A. A heart rate of 92 beats/minute B. A progressive decrease in Systolic Blood Pressure C. A shortened Pulse Pressure D. The presence of an S4 sound

D The presence of an S4 sound With age, the heart rate will decrease, and heart block can occur with changes in the conduction system. Auscultation may reveal the presence of an S4 sound. Pulse pressure will widen, and the systolic pressure will increase because of stiffening of the blood vessels. The heart rate should decrease. S4 heart sound is often a sign of diastolic HF, and it is rarely a normal finding. Like S3, the S4 sound is low pitched and best heard at the apex with the patient in the left lateral decubitus position. S4 or "atrial gallop," occurs just before S1 when the atria contract to force blood into the left ventricle. If the left ventricle is noncompliant, and atrial contraction forces blood through the atrioventricular valves, a S4 is produced by the blood striking the

Test 4 3. The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located? A. The inner lining of the heart and valves B. The heart's muscle fibers C. The exterior layers of the heart D. The thin fibrous sac encasing the heart

D The thin fibrous sac encasing the heart The heart is encased in a thin, fibrous sac called the pericardium, which is composed of two layers. Inflammation of this sac is known as pericarditis.

Test 5 5. The nurse is admitting an older adult client with heart failure. Which education will the nurse prepare for this client prior to discharge? A. Continue to increase the amount of exercise, because Cardiac Output increases with age B. Exercise tolerance should remain the same as in younger years C. Any kind of stress is acceptable, because the aging heart has an increase ability to respond D. Try to avoid emotional stress and take part in mild physical stress only

D Try to avoid emotional stress and take part in mild physical stress only Stressful physical and emotional conditions may have adverse effects on the aged person's heart. Stress is not tolerated by older adults with heart failure. Exercise regimes need to be tailored to the older adult's ability. Cardiac output does not increase with age.

Test 3 15. During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? A. High-pitched sounds B. Laborious breathing C. Stridor D. Wheezes with wet lung sounds

D Wheezes with wet lung sounds If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.

Test 2 13. The nurse is performing an assessment of the patient's heart. Where would the nurse locate the apical pulse if the heart is in a normal position? A. Right 3rd intercostal space at the Midclavicular Line (MCL) B. Left 2nd intercostal space at the Midclavicular Line (MCL) C. Left 5th intercostal space at the Midclavicular Line (MCL) D. Right 2nd intercostal space at the Midclavicular Line (MCL)

Left 5th intercostal space at the Midclavicular Line (MCL) As a result of this close proximity to the chest wall, the pulsation created during normal ventricular contraction, called the apical impulse (also called the point of maximal impulse [PMI]), is easily detected. In the normal heart, the PMI is located at the intersection of the Midclavicular Line of the left chest wall and the fifth intercostal space (Bickley, 2009; Woods et al., 2009).

Test 2 16. When the balloon on the distal tip of a pulmonary artery catheter is inflated and the pressure is measured, the measurement obtained is referred to as the A. Cardiac Output B. Pulmonary Artery Pressure C. Pulmonary Artery Wedge Pressure D. Central Venous Pressure

Pulmonary Artery Wedge Pressure When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary artery until it can no longer be passed. The pressure is recorded, reflecting left-atrial pressure and left-ventricular end-diastolic pressure. Central venous pressure is measured in the right atrium. Pulmonary artery pressure is measured when the balloon tip is not inflated. Cardiac output is determined through thermodilution, which involves injection of fluid into the pulmonary artery catheter

Test 2 18. Before a Transesophageal Echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes no active gag reflex. What nursing action is a priority? A. Position the client on his side B. Withhold food and fluids C. Introduce a Nasogastric (NG) tube D. Insert an oral airway

Withhold food and fluids Following a Transesophageal Echocardiogram in which the client's throat has been anesthetized, the nurse should withhold food and fluid until the client's gag reflex returns. There's no indication that oral airway placement would be appropriate. The client should be in the upright position, and the nurse needn't insert an NG tube.