Saunders NCLEX questions Cardio

A client with angina has a 12-lead electrocardiogram taken during an episode of chest pain. The nurse should examine the tracing for which electrocardiographic (ECG) change caused by myocardial ischemia? 1. Tall, peaked T waves 2. Prolonged PR interval 3. Widened QRS complex 4. ST segment elevation or depression

4 An electrocardiogram taken during a chest pain episode captures ischemic changes, which include ST segment elevation or depression. Tall, peaked T waves may indicate hyperkalemia. A prolonged PR interval indicates first-degree heart block. A widened QRS complex indicates delay in intraventricular conduction, such as a bundle branch block.

A man who has developed atrial fibrillation and has been placed on warfarin (Coumadin). The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he stated he would choose which foods while taking this medication? 1. Cherries 2. Potatoes 3. Broccoli 4. Spaghetti

3 Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

4 An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia.

A nurse is caring for a client who has lost a significant amount of blood as a result of complications of a surgical procedure. The nurse understands that which client assessment will provide the earliest indication of new decreases in fluid volume? 1. Pulse rate 2. Blood pressure (BP) 3. Assessment for edema 4. Lung auscultation for crackles

1 The cardiac output is determined by the volume of the circulating blood, the pumping action of the heart, and the tone of the vascular bed. Early decreases in fluid volume are compensated for by an increase in the pulse rate. Options 3 and 4 indicate an increase in fluid volume. Although the BP will decrease, it is not the earliest indicator.

A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as the most likely indicator that the client is experiencing complications of this therapy? 1. Tarry stools 2. Nausea and vomiting 3. Orange-colored urine 4. Decreased urine output

1 Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.

The client who has experienced a myocardial infarction (MI) is recovering from cardiogenic shock. The nurse knows that which observation of the client's clinical condition is most favorable? 1. Urine output of 40 mL/hr 2. Heart rate of 110 beats/min 3. Frequent premature ventricular contractions 4. Central venous pressure (CVP) of 15 mm Hg

1 Urine output of greater than 30 mL/hr indicates adequate perfusion to the kidneys, so the other organs are most likely equally perfused. Classic cardiovascular signs of cardiogenic shock include low blood pressure and tachycardia. Dysrhythmias commonly occur as a result of decreased oxygenation to the myocardium and are not a favorable sign. The CVP rises as the effects of the backward blood flow caused by the left ventricular failure became apparent.

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? 1. Sinus dysrhythmia 2. Sinus tachycardia 3. Sinus bradycardia 4. Normal sinus rhythm

2 Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.

A nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion? 1. The cardiac output is above the normal range. 2. The cardiac output is below the normal range. 3. The cardiac output is in the low-normal range. 4. The cardiac output is in the high-normal range.

2 The normal cardiac output for the adult can range from 4 to 7 L/min. Therefore a cardiac output of 3.2 L/min is below normal range.

A nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin (Lanoxin) notes that the heart rate is 52 beats/min. The nurse should make which interpretation about this information? 1. Normal, because of the client's age 2. Abnormal, requiring further assessment 3. Normal, as a result of the effects of digoxin 4. Normal, because this is the reason the client is receiving digoxin

2 The normal heart rate is 60 to 100 beats/min in an adult. On auscultating a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the health care provider. Digoxin increases the strength and contraction of the heart; it is not used to treat low heart rates. If a low heart rate is noted in a client taking digoxin, the medication is withheld and the health care provider is notified. Options 1, 3, and 4 are incorrect interpretations because the heart rate of 52 beats/min is not normal.

The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm? 1. Bradycardia 2. Tachycardia 3. Atrial fibrillation 4. Normal sinus rhythm (NSR)

3 In atrial fibrillation, the P waves may be absent. There is no PR interval, and the QRS duration usually is normal and constant. Bradycardia is a slowed heart rate, and tachycardia is a fast heart rate. In NSR a P wave precedes each QRS complex, the rhythm is essentially regular, the PR interval is 0.12 to 0.20 seconds in duration, and the QRS interval is 0.06 to 0.10 seconds in duration.

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was unsuccessful? 1. Rising blood pressure 2. Clearly audible heart sounds 3. Client expressions of relief 4. Rising central venous pressure

4 Following pericardiocentesis, a rise in blood pressure and a fall in central venous pressure are expected. The client usually expresses immediate relief. Heart sounds are no longer muffled or distant.

A nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications? 1. Bleeding and infection 2. Thrombosis and infection 3. Bleeding and wound dehiscence 4. Wound dehiscence and evisceration

1 After inferior vena cava filter insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Heparin therapy also predisposes the client to bleeding. Thrombosis is unlikely because the client is on heparin therapy. Wound dehiscence and evisceration are not concerns because no abdominal incision is made.

A nurse overhears a health care provider (HCP) stating that a client who is in hypovolemic shock requires plasma expansion. Which blood product should the nurse anticipate that the HCP will write a prescription for? 1. Albumin 2. Platelets 3. Cryoprecipitate 4. Packed red blood cells

1 Albumin may be used as a plasma expander in hypovolemia with or without shock. Platelets are used when the client's platelet count is low, typically below 20,000/mm3. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander.

A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse's response incorporates the information that bearing down or straining would trigger which physical response? 1. Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility 2. Vagus nerve stimulation, causing an increase in heart rate and cardiac contractility 3. Sympathetic nerve stimulation, causing an increase in heart rate and cardiac contractility 4. Sympathetic nerve stimulation, causing a decrease in heart rate and cardiac contractility

1 Bearing down as if straining to have a bowel movement can stimulate a vagal reflex. Stimulation of the vagus nerve causes a decrease in heart rate and cardiac contractility. Stimulation of the sympathetic nervous system has the opposite effect. These two branches of the autonomic nervous system oppose each other to maintain homeostasis.

Which should the nurse do when setting up an arterial line? 1. Tighten all tubing connections. 2. Use macrodrop intravenous tubing. 3. Level the transducer to the ventricle. 4. Raise the height of the normal saline infusion to prevent backup.

1 Because the arterial vasculature is a high-pressure system, all tubing connections must be tight to avoid blood loss from loose connections. High-pressure tubing with a transducer is used (not macrodrip tubing). The transducer should be level to the atrium not the ventricle. Raising the height of the infusion is not sufficient to prevent backflow.

The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1. 50 to 100 joules 2. 150 to 300 joules 3. 300 to 350 joules 4. 350 to 400 joules

1 For cardioversion procedures, the defibrillator is charged to the energy level prescribed by the HCP. Countershock usually is started at 50 to 100 joules. Options 2, 3, and 4 are incorrect.

A client experiencing cocaine toxicity is brought to the emergency department. The nurse should prepare to take which initial action? 1. Ensure a patent airway. 2. Administer naloxone (Narcan). 3. Establish an intravenous access. 4. Obtain a 12-lead electrocardiogram (ECG).

1 Initial management when caring for a client with cocaine toxicity is to ensure a patent airway. Although options 2, 3, and 4 are components of care, airway is the priority.

Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin (Coumadin). The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication? 1. A decreased dosage of warfarin 2. An increased dosage of warfarin 3. A decreased dosage of levothyroxine 4. An increased dosage of levothyroxine

1 Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin (Coumadin) are enhanced. Therefore if thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

What should the nurse teach a client about an expected outcome of nesiritide (Natrecor) administration? 1. The client will have an increase in urine output. 2. The client will have an absence of dysrhythmias. 3. The client will have an increase in blood pressure. 4. The client will have an increase in pulmonary capillary wedge pressure.

1 Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output. The remaining options are incorrect about the intended effect of this medication.

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which medication available for immediate use? 1. Procainamide 2. Digoxin (Lanoxin) 3. Verapamil (Calan SR) 4. Metoprolol (Lopressor)

1 Procainamide is an antidysrhythmic that may be used to treat ventricular dysrhythmias in clients who are allergic to lidocaine. Digoxin is a cardiac glycoside; verapamil is a calcium-channel blocking agent; metoprolol is a β-adrenergic blocking agent.

The nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse should make which interpretation about this finding? 1. A normal finding 2. Indicative of atrial flutter 3. Indicative of atrial fibrillation 4. Indicative of impending reinfarction

1 The PR interval represents the time it takes for the cardiac impulse to spread from the atria to the ventricles. The normal range for the PR interval is 0.12 to 0.20 second. Options 2, 3, and 4 are incorrect.

A client has experienced a myocardial infarction. The nurse plans care for the client, knowing that the person's chest pain is caused by tissue hypoxia in which layer of the heart? 1. Myocardium 2. Endocardium 3. Parietal pericardium 4. Visceral pericardium

1 The myocardial layer of the heart is damaged when a client experiences a myocardial infarction. This is the middle layer that contains the striated muscle fibers responsible for the contractile force of the heart. The endocardium is the thin inner layer of cardiac tissue. The parietal pericardium and visceral pericardium are outer layers that protect the heart from injury and infection.

A client in cardiogenic shock had an intra-aortic balloon pump inserted 24 hours earlier via the left femoral approach. The nurse notes that the client's left foot is cool and mottled and the left pedal pulse is weak. Which action should the nurse take? 1. Call the health care provider immediately. 2. Re-evaluate the neurovascular status in 1 hour. 3. Increase the rate of intravenous nitroglycerin that is infusing. 4. Document these findings, which are expected because of the catheter size.

1 The nursing interventions for the client with an intra-aortic balloon pump are the same as for any client who has had cardiovascular surgery. The peripheral circulation to the affected limb is monitored for signs of occlusion, such as coolness, mottling, pain, tingling, and decreased or absent distal pulse. Adverse changes are reported immediately. Options 2, 3, and 4 are incorrect.

A new nursing graduate is caring for a client who is attached to a cardiac monitor. While assisting the client with bathing, the nurse observes the sudden development of ventricular tachycardia (VT), but the client remains alert and oriented and has a pulse. Which interventions would the nurse take? Select all that apply. 1. Administer oxygen. 2. Defibrillate the client. 3. Obtain an electrocardiogram (ECG). 4. Contact the health care provider (HCP). 5. Assess circulation, airway, and breathing. 6. Initiate cardiopulmonary resuscitation (CPR).

1, 3, 4, 5 With VT in a stable client, the nurse assesses circulation, airway, and breathing; administers oxygen; and confirms the rhythm via a 12-lead ECG. The HCP is contacted, and antidysrhythmics may be prescribed. With pulseless VT, the HCP or a specially trained nurse must immediately defibrillate the client or initiate CPR followed by defibrillation as soon as possible.

The nurse is evaluating a client's response to cardioversion. Which observation would be of highest priority to the nurse? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level of consciousness

2 Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection.

A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value came back elevated? 1. Myoglobin 2. Cardiac troponin 3. C-reactive protein 4. Creatine kinase (CK)

2 Cardiac troponin elevations indicate myocardial injury or infarction. Although the remaining options may also rise, they are not definitive enough to draw a conclusive diagnosis.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

2 Common laboratory ranges for activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

A nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is most likely unrelated to the aneurysm? 1. Pulsatile abdominal mass 2. Hyperactive bowel sounds in the area 3. Systolic bruit over the area of the mass 4. Subjective sensation of "heart beating" in the abdomen

2 Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Not all clients with abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.

A client in shock is receiving dopamine hydrochloride by intravenous (IV) infusion. The nurse should have which medication available for local injection if IV infiltration and medication extravasation occur? 1. Vitamin K 2. Phentolamine 3. Atropine sulfate 4. Protamine sulfate

2 Phentolamine is an α-adrenergic blocking agent that prevents dermal necrosis and sloughing after infiltration of norepinephrine or dopamine. Vitamin K is the antidote for warfarin (Coumadin). Atropine sulfate is the antidote for cholinergic crisis. Protamine sulfate is the antidote for heparin.

A nurse is assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. The nurse plans care with the understanding that the heart normally sends out how many liters of blood per minute to the body? 1. 2 L/min 2. 5 L/min 3. 10 L/min 4. 15 L/min

2 The cardiac cycle consists of contraction and relaxation of the heart muscle. The heart normally sends out about 5 L of blood every minute to the body. Therefore, options 1, 3, and 4 are incorrect.

The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client? 1. Fluid overload 2. Peripheral vasoconstriction 3. Inability to perform self-care 4. Inability to discriminate hot or cold sensations

2 The client who is receiving dopamine therapy should be assessed for peripheral vasoconstriction related to the action of the medication. Options 1, 3, and 4 are not related directly to this medication therapy.

The nurse is assessing a client hospitalized with acute pericarditis. The nurse monitors the client for cardiac tamponade, knowing that which signs are associated with this complication of pericarditis? Select all that apply. 1. Bradycardia 2. Pulsus paradoxus 3. Distant heart sounds 4. Falling blood pressure 5. Distended jugular veins

2, 3, 4, 5 Assessment findings with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention, and a falling blood pressure (BP), accompanied by pulsus paradoxus (a drop in inspiratory BP by greater than 10 mm Hg).

The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? 1. "I'll need to become a strict vegetarian." 2. "I should use polyunsaturated oils in my diet." 3. "I need to substitute eggs and whole milk for meat." 4. "I should eliminate all cholesterol and fat from my diet."

2 The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian.

Which locations is the correct position for the V1 lead when performing a 12-lead electrocardiogram? 1. Fourth intercostal space left sternal border 2. Fourth intercostal space right sternal border 3. Fifth intercostal space left midaxillary line 4. Fifth intercostal space left midclavicular line

2 The correct location for the V1 electrode is the fourth intercostal space right sternal border. Therefore, options 1, 3, and 4 are incorrect.

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures? 1. Left ventricle to aorta 2. Left atrium to left ventricle 3. Right atrium to right ventricle 4. Right ventricle to pulmonary artery

2 The mitral valve separates the left atrium from the left ventricle. Options 1, 3, and 4 describe the aortic, tricuspid, and pulmonic valves, respectively.

A nurse is performing cardiopulmonary resuscitation on a client who has had a cardiac arrest. An automatic external defibrillator is available to treat the client. Which activity will allow the nurse to assess the client's cardiac rhythm? 1. Hold the defibrillator paddles firmly against the chest. 2. Apply adhesive patch electrodes to the chest and move away from the client. 3. Connect standard electrocardiographic electrodes to a transtelephonic monitoring device. 4. Apply standard electrocardiographic monitoring leads to the client, and observe the rhythm.

2 The nurse or rescuer puts two large adhesive patch electrodes on the client's chest in the usual defibrillator positions. The nurse stops cardiopulmonary resuscitation and requests that anyone near the client to move away and not touch the client. The defibrillator then analyzes the rhythm, which may take up to 30 seconds. The machine then indicates whether defibrillation is necessary.

A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium (Coumadin) 7.5 mg at 5:00 pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

2 When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

The nurse is caring for a client who is pulseless and experiencing ventricular tachycardia dysrhythmia. Which interventions should the nurse anticipate implementing in collaboration with the health care provider (HCP)? Select all that apply. 1. Prepare for cardioversion. 2. Prepare to administer epinephrine. 3. Prepare to administer digoxin (Lanoxin). 4. Provide cardiopulmonary resuscitation (CPR). 5. Prepare to administer amiodarone (Cordarone).

2, 4, 5 Pulseless ventricular tachycardia is treated the same way as ventricular fibrillation with measures that include defibrillation, CPR and medication therapy, with agents such as vasopressin, epinephrine, amiodarone, lidocaine, and magnesium sulfate.

The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1. Flat neck veins 2. A pulse rate of 60 beats/min 3. Muffled or distant heart sounds 4. Wheezing on auscultation of the lungs

3 Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention with clear lung sounds, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg). Bradycardia is not a sign of cardiac tamponade.

A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem) for several months. The client schedules an appointment with the health care provider because of episodes of chest pain, and Prinzmetal's angina is diagnosed. The nurse understands that this medication will provide which therapeutic effect for this new diagnosis? 1. Increases oxygen demands within the myocardium 2. Increases the force of contraction of ventricular tissues 3. Prevents influx of calcium ions in vascular smooth muscle 4. Leads to an increase in calcium absorption in the vascular smooth muscle

3 Diltiazem is a calcium channel blocker that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. These medications decrease myocardial oxygen demands and block calcium channels, thereby decreasing the force of contraction of the ventricular tissue.

The nurse has given a client the prescribed dose of intravenous hydralazine (Apresoline). The nurse evaluates the effectiveness of the medication by monitoring which client parameter? 1. Pulse rate 2. Urine output 3. Blood pressure 4. Potassium level

3 Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. It is a vasodilator medication that decreases afterload. The blood pressure needs to be monitored. Options 1, 2, and 4 are unrelated to the use of this medication.

A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle

3 Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. Options 1, 2, and 4 are not the chambers that are primarily responsible for this disease process although these chambers may become affected as the disease becomes more

A client with cardiac disease has begun taking propranolol (Inderal LA), and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop? 1. Insomnia and headache 2. Nausea and constipation 3. Night cough and dyspnea 4. Drowsiness and nightmares

3 Propranolol is a β-adrenergic blocker that is used as an antihypertensive, antianginal, antidysrhythmic, and antimigraine medication. It may precipitate heart failure or myocardial infarction in clients with cardiac disease. Signs of heart failure include dyspnea (particularly on exertion or lying down), night cough, peripheral edema, and distended neck veins. If signs of heart failure occur, the HCP should be notified. Options 1, 2, and 4 identify side effects of this medication that do not warrant HCP notification if they occur.

The nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris. The client is receiving sotalol (Betapace) orally daily. Which assessment finding indicates to the nurse that the client is experiencing a side/adverse effect related to the medication? 1. Dry mouth 2. Diaphoresis 3. Palpitations 4. Difficulty swallowing

3 Sotalol is a β-adrenergic blocking agent. Side/adverse effects include bradycardia, palpitations, difficulty breathing, irregular heartbeat, signs of heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness also can occur.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? 1. Call a code. 2. Call the health care provider. 3. Check the client's status and lead placement. 4. Press the recorder button on the electrocardiogram console.

3 Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? 1. Flat neck veins 2. Nausea and vomiting 3. Hypotension and dizziness 4. Clubbed fingertips and headache

3 The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A nurse is auscultating a 56 year old adult client's apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 48 beats/minute. Which action should the nurse take? 1. Withhold the digoxin, and reevaluate the heart rate in 4 hours. 2. Administer half the prescribed dose to avoid a further decrease in heart rate. 3. Withhold the digoxin; assess for signs of decreased cardiac output and digoxin toxicity. 4. Administer the digoxin. The heart rate would be considered normal because of the client's age.

3 The normal heart rate is 60 to 100 beats/min in an adult. If the nurse notes a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would further evaluate the client for signs and symptoms of digoxin toxicity. When clients are bradycardic, they may have symptoms of decreased cardiac output so this would also be assessed.

The nurse is caring for a client with hypertension receiving torsemide (Demadex) orally daily. Which laboratory test result would indicate to the nurse that the client may be experiencing an adverse effect related to the medication? 1. A chloride level of 98 mEq/L 2. A sodium level of 135 mEq/L 3. A potassium level of 3.1 mEq/L 4. A blood urea nitrogen (BUN) of 15 mg/dL

3 Torsemide is a loop diuretic. The medication can produce acute and profound water loss, volume and electrolyte depletion, dehydration, decreased blood volume, and circulatory collapse. The correct option is the only one that indicates an electrolyte depletion, because the normal potassium level is 3.5 to 5.0 mEq/L. The normal chloride level is 98 to 107 mEq/L. The normal sodium level is 135 to 145 mEq/L. The normal blood BUN is 8 to 25 mg/dL.

The home health nurse is visiting an older client whose family has gone out for the day. During the visit, the client experiences chest pain that is unrelieved by sublingual nitroglycerin tablets given by the nurse. Which action by the nurse would be appropriate at this time? 1. Notify a family member who is the next of kin. 2. Drive the client to the health care provider's (HCP) office. 3. Inform the home care agency supervisor that the visit may be prolonged. 4. Call for an ambulance to transport the client to the hospital emergency department.

4 Chest pain that is unrelieved by rest and nitroglycerin might not be typical anginal pain but may signal myocardial infarction (MI). Because the risk of sudden cardiac death is greatest in the first 24 hours after MI, it is imperative that the client receive emergency cardiac care. Communication with the family or home care agency delays client treatment, which is needed immediately. An HCP's office is not equipped to treat MI.

The nurse has a prescription to give a client a scheduled dose of digoxin (Lanoxin). Prior to administering the medication, the nurse should assess for which manifestations that could indicate digoxin toxicity? 1. Dyspnea, edema, and palpitations 2. Chest pain, hypotension, and paresthesias 3. Constipation, dry mouth, and sleep disorder 4. Double vision, loss of appetite, and nausea

4 Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Other signs of digoxin toxicity include bradycardia, visual alterations (such as green and yellow vision, or seeing spots or halos), confusion, vomiting, diarrhea, decreased libido, and impotence. The other options are incorrect because they do not identify manifestations of digoxin toxicity.

A male client is on enalapril (Vasotec) for the treatment of hypertension. The nurse teaches the client that he should seek emergent care if he experiences which adverse effect? 1. Nausea 2. Insomnia 3. Dry cough 4. Swelling of the tongue

4 Enalapril is an angiotensin-converting enzyme inhibitor. Angioedema is an adverse effect. Swelling of the tongue and lips can result in airway occlusion. Nausea, insomnia, and a cough can occur as side, not adverse effects of the medication.

A client has frequent runs of ventricular tachycardia. The health care provider has prescribed an antidysrhythmic, flecainide (Tambocor). What is the best nursing action related to the effects of this medication? 1. Monitor the client's urinary output. 2. Assess the client for neurological changes. 3. Keep the call bell within the client's reach. 4. Monitor the client's vital signs and cardiac rhythm frequently.

4 Flecainide is an antidysrhythmic medication that slows conduction and decreases excitability, conduction velocity, and automaticity. The nurse needs to monitor the client's vital signs for changes and cardiac rhythm for the development of a new or a worsening dysrhythmia. Options 1, 2, and 3 are components of standard care.

Hydrochlorothiazide (HydroDIURIL) has been prescribed for a client. The nurse contacts the health care provider to verify the prescription if which condition is noted in the assessment data? 1. Hypertension 2. Allergy to eggs 3. Nephrotic syndrome 4. Allergy to sulfonamides

4 Hydrochlorothiazide is a diuretic and antihypertensive medication that is used to treat mild to moderate hypertension, edema associated with heart failure, and nephrotic syndrome. The medication is a sulfonamide derivative. A contraindication to the use of this medication is a history of hypersensitivity to sulfonamides. The conditions noted in options 1, 2, and 3 are not contraindications for the use of this medication.

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? 1. Before each P wave 2. Just after each P wave 3. Just after each T wave 4. Before each QRS complex

4 If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted. A demand pacemaker fires only when needed and should therefore discharge only when no electrical activity is occurring in the client's own heart.

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most anticipate in this client if PVCs are occurring? 1. A P wave preceding every QRS complex 2. QRS complexes that are short and narrow 3. Inverted P waves before the QRS complexes 4. Premature beats followed by a compensatory pause

4 PVCs are abnormal ectopic beats originating in the ventricles. They are characterized by an absence of P waves, presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy.

Daily administration of dipyridamole (Persantine) been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates an understanding of the instructions? 1. "This medication will prevent a stroke." 2. "This medication will prevent a heart attack." 3. "This medication will help keep my blood pressure down." 4. "If I take this medicine with my Coumadin, it will protect my artificial heart valve."

4 Persantine combined with warfarin sodium (Coumadin) is prescribed to protect the client's artificial heart valves. Persantine does not prevent strokes, heart attacks, or hypertension.

A health care provider (HCP) prescribes quinidine gluconate for a client. The nurse decides to withhold the medication and contact the HCP if which assessment finding is documented in the client's medical record? 1. Muscle weakness 2. History of asthma 3. Presence of infection 4. Complete atrioventricular (AV) block

4 Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. It is contraindicated in complete AV block, intraventricular conduction defects, and abnormal impulses and rhythms caused by escape mechanisms, and with myasthenia gravis. It is used with caution in clients with preexisting muscle weakness, asthma, infection with fever, and hepatic or renal insufficiency.

A nurse is caring for a client with unstable ventricular tachycardia. The nurse should instruct the client to take which action, if prescribed, during an episode of ventricular tachycardia? 1. Lie down flat in bed. 2. Remove any metal jewelry. 3. Breathe deeply, regularly, and easily. 4. Inhale deeply and cough forcefully every 1 to 3 seconds.

4 Restorative coughing techniques are sometimes used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough cardiopulmonary resuscitation (CPR), if prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented. The other options will not assist in terminating the dysrhythmia.

A client is brought into the emergency department in ventricular fibrillation (VF). The advanced cardiac life support (ACLS) nurse prepares to defibrillate by placing conductive gel pads on which part of the chest? 1. The upper and lower halves of the sternum 2. Parallel between the umbilicus and the right nipple 3. The right shoulder and the back of the left shoulder 4. The right of the sternum just below the clavicle and to the left of the precordium

4 The ACLS nurse would place one gel pad to the right of the sternum just below the clavicle and the other gel pad to the left of the precordium. The nurse would then place the electrode paddles over the pads. Options 1, 2, and 3 identify incorrect positions.

A client is seen in the clinic complaining of anorexia and nausea. The health care provider suspects that the client may be experiencing digoxin toxicity. While waiting for test results to become available, the nurse should assess the client for which sign or symptom that would support a diagnosis of digoxin toxicity? 1. Edema 2. Chest pain 3. Constipation 4. Photophobia

4 The most common early manifestations of digoxin toxicity are gastrointestinal disturbances such as anorexia, nausea, and vomiting and neurological disturbances such as fatigue, headache, weakness, drowsiness, confusion, and nightmares. Visual disturbances such as photophobia, light flashes, halos around bright objects, and yellow or green color perception also may occur.

A client in cardiogenic shock has a pulmonary artery catheter (Swan-Ganz type) placed. The nurse would interpret which cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) readings as indicating that the client is most unstable? 1. CO 5 L/min, PCWP low 2. CO 3 L/min, PCWP low 3. CO 4 L/min, PCWP high 4. CO 3 L/min, PCWP high

4 The normal cardiac output is 4 to 7 L/min. With cardiogenic shock, the CO falls below normal because of failure of the heart as a pump. The PCWP, however, rises because it is a reflection of the left ventricular end-diastolic pressure, which rises with pump failure.

A client develops atrial fibrillation with a ventricular rate of 140 beats/min and signs of decreased cardiac output. Which medication should the nurse anticipate administering first? 1. Atropine sulfate 2. Warfarin (Coumadin) 3. Lidocaine (Xylocaine) 4. Metoprolol (Lopressor)

4 β-Blockers such as metoprolol (Lopressor) slow conduction of impulses through the AV node and decrease the heart rate. In rapid atrial fibrillation, the goal first is to slow the ventricular rate and improve the cardiac output and then attempt to restore normal sinus rhythm. Atropine sulfate will further increase the heart rate and will further decrease the cardiac output. Although warfarin is administered to clients with atrial fibrillation to prevent clots from forming in the atria, it will have no effect in decreasing the ventricular rate or restoring normal sinus rhythm. Lidocaine is only useful in suppressing ventricular dysrhythmias.

The home care nurse has given instructions to a client who is beginning therapy with digoxin (Lanoxin). The nurse determines a need for further teaching of the instructions if the client makes which statement? 1. "If I miss a dose, I should just take two the next day." 2. "I shouldn't change brands without asking the health care provider first." 3. "I should call the health care provider if my daily pulse rate is under 60 or over 100." 4. "The pills should be kept in their original container so they don't get mixed up with my other medicines."

1 Client teaching should include taking the dose exactly as prescribed each day. If the client misses a dose and more than 12 hours goes by, that dose should be omitted, and only the next scheduled dose should be taken; the client should not double-dose. The HCP should be consulted before changing brands because the bioavailability of another preparation of the medication may be different. A daily pulse check is necessary, and the client should know the parameters for which the health care provider (HCP) should be called. Clients are advised not to mix digoxin in pill boxes with other medications.

The nurse has provided self-care activity instructions to a client after insertion of an automatic internal cardioverter-defibrillator (AICD). The nurse determines that further instruction is needed if the client makes which statement? 1. "I can perform activities such as swimming, driving, or operating heavy equipment as I need to." 2. "I need to avoid doing anything that could involve rough contact with the AICD insertion site." 3. "I should try to avoid doing strenuous things that would make my heart rate go up to or above the rate cutoff on the AICD." 4. "I should keep away from electromagnetic sources such as transformers, large electrical generators, metal detectors, and I shouldn't lean over running motors."

1 Post discharge instructions typically include avoiding tight clothing or belts over AICD insertion sites; rough contact with the AICD insertion site; and electromagnetic fields such as with electrical transformers, radio/TV/radar transmitters, metal detectors, and running motors of cars or boats. Clients also must alert health care providers (HCP) or dentists to the presence of the device because certain procedures such as diathermy, electrocautery, and magnetic resonance imaging may need to be avoided to prevent device malfunction. Clients should follow the specific advice of a HCP regarding activities that are potentially hazardous to self or others, such as swimming, driving, or operating heavy equipment.

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? 1. Chest pain 2. Urge to cough 3. Warm, flushed feeling 4. Pressure at the insertion site

1 The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.

The nurse determines that a client requires further teaching after permanent pacemaker insertion if which statement is made? 1. "My pulse rate should be less than what my pacemaker is set at." 2. "I'll need to call my health care provider if I feel tired or dizzy." 3. "I'll have to avoid carrying the grocery bags into the house for the next 6 weeks." 4. "It's safe to use my microwave as long it is properly grounded and well shielded."

1 The client should call the health care provider if the pulse rate is less than what the pacemaker is set at because this could be a sign of pacemaker or battery failure. Option 1 indicates the client needs further teaching, whereas options 2, 3, and 4 are correct statements.

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding? 1. Hypotension 2. Flat neck veins 3. Complaints of nausea 4. Complaints of headache

1 The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

1 Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Clients frequently experience a feeling of impending doom. Ventricular tachycardia is treated with antidysrhythmic medications, cardioversion (if client is awake), or defibrillation (loss of consciousness). Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.

A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse should include which priority safety instruction regarding this medication? 1. Avoid brushing the teeth. 2. Avoid taking acetylsalicylic acid (aspirin). 3. Avoid walking long distances and climbing stairs. 4. Avoid all activities because bruising injuries can occur.

2 Aspirin can interact with the anticoagulant medication to increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided.

The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication

2 Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. b-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

The nurse is administering lidocaine hydrochloride by the intravenous route. Which finding would indicate to the nurse that the client is experiencing toxicity? 1. Urine output of 275 mL over the past 8 hours 2. Client complaints of blurred vision and nausea 3. Heart rate of 70 beats/min, blood pressure of 130/72 mm Hg 4. Client complaints of a headache and a temperature of 100° F orally

2 Blurred vision and nausea are common indicators of lidocaine toxicity. Urine output is greater than the minimum amount of 30 mL/hr and therefore is adequate. The heart rate and blood pressure noted in option 3 are normal. A headache and elevated temperature are important to note but are not related to the lidocaine.

A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse interpret this rhythm? 1. Sinus tachycardia 2. Sinus dysrhythmia 3. Sinus bradycardia 4. Normal sinus rhythm

2 Sinus dysrhythmia has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected.

A client admitted with hypertensive crisis has an intravenous (IV) infusion of 1000 mL of normal saline with 20 mEq of potassium chloride added. A prescription is written to administer sodium nitroprusside by continuous IV infusion. The nurse should plan to do which to administer this medication? 1. Monitor the blood pressure every 15 minutes during administration. 2. Protect the sodium nitroprusside from light with an opaque material. 3. Check the solution for a faint brown coloration and discard it if this is noticed. 4. Piggyback the sodium nitroprusside into the IV line containing the potassium chloride.

2 Sodium nitroprusside can be degraded by light and should be protected with an opaque material. It is dispensed in powdered form and must be dissolved and diluted for the IV solution. A fresh solution may have a faint brown coloration, but solutions that are deeply colored, such as blue-green or dark red, should be discarded. No other medication should be mixed with the infusion solution. During the infusion, the blood pressure should be monitored continuously either through an arterial line or with an electronic monitoring device.

A hospitalized client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned and takes action, knowing that this level could ultimately lead to which complication? 1. Stroke 2. Cardiac arrest 3. High blood pressure 4. Urinary stone formation

2 The normal calcium level is 8.6 to 10 mg/dL. A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization and move back during repolarization. Depolarization is responsible for cardiac contraction. Options 1 and 3 are unrelated to calcium levels. Elevated calcium levels can lead to urinary stone formation. The nurse would take action and contact the health care provider when a calcium level is abnormal.

A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain? 1. Stable angina 2. Variant angina 3. Unstable angina 4. Nonanginal pain

2 Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.

A client's electrocardiogram shows that the atrial and ventricular rhythms are irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? 1. Atrial flutter 2. Atrial fibrillation 3. Third-degree AV block 4. First-degree atrioventricular (AV) block

2 With atrial fibrillation, the atrial and ventricular rhythms are irregular and there are usually no discernible P waves. In atrial flutter, the QRS complexes may be either regular or irregular, and the P waves occur as flutter waves. A client in third-degree AV block (also known as complete heart block) has regular atrial and ventricular rhythms, but there is no connection between the P waves and the QRS complexes. In other words, the PR interval is variable and the QRS complexes are normal or widened, with no relationship with the P waves. With first-degree AV block the PR interval is longer than normal, and there is a connection between the occurrence of P waves and that of QRS complexes.

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the client was in the intensive care unit. The nurse determines that this test was performed to assist in diagnosing which condition? 1. Heart failure 2. Atrial fibrillation 3. Myocardial infarction 4. Ventricular tachycardia

3 Cardiac troponin T or cardiac troponin I has been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction. The test is not used to diagnose heart failure, ventricular tachycardia, or atrial fibrillation.

The nurse is reviewing the medical record of a client transferred to the medical unit from the critical care unit. The nurse notes that the client received intra-aortic balloon pump (IABP) therapy while in the critical care unit. The nurse suspects that the client received this therapy for which condition? 1. Heart failure 2. Pulmonary edema 3. Cardiogenic shock 4. Aortic insufficiency

3 IABP therapy most often is used in the treatment of cardiogenic shock and is most effective if instituted early in the course of treatment. Use of the IABP is contraindicated in clients with aortic insufficiency and thoracic and abdominal aneurysms. This therapy is not used in the treatment of congestive heart failure or pulmonary edema.

The nurse is caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The nurse administers morphine sulfate to the client as prescribed by the health care provider. After administration of the morphine sulfate, the nurse plans to monitor which item(s) most closely? 1. Mental status 2. Urinary output 3. Respirations and blood pressure 4. Temperature and blood pressure

3 Morphine sulfate is an opioid analgesic that may be administered to relieve pain in a client with MI. The nurse would monitor the client's respirations and blood pressure. Signs of morphine toxicity include respiratory depression and hypotension. Although monitoring mental status is a component of the nurse's assessment, it is not the priority after administration of morphine sulfate. Urinary output is unrelated to the administration of this medication. Monitoring the temperature also is not associated with the use of this medication.

A client is admitted to the hospital with a diagnosis of myocardial infarction (MI) and is going to have an intravenous nitroglycerin infusion started. Noting that the client does not have an intra-arterial monitoring line in place, what piece of equipment should the nurse obtain for use at the bedside? 1. Defibrillator 2. Pulse oximeter 3. Noninvasive blood pressure monitor 4. Central venous pressure (CVP) insertion tray

3 Nitroglycerin dilates both arteries and veins, causing peripheral blood pooling, thereby reducing preload, afterload, and myocardial work. This also accounts for the primary side effect of nitroglycerin, which is hypotension. In the absence of continuous direct arterial pressure (intra-arterial) monitoring, the nurse should use an automatic noninvasive blood pressure monitor. Options 1, 2, and 4 are not specifically associated with the administration of intravenous nitroglycerin.

Which readings obtained from a client's pulmonary artery catheter suggest that the client is in left-sided heart failure? 1. Cardiac output of 5 L/min 2. Right atrial pressure of 9 mm Hg 3. Pulmonary capillary wedge pressure (PCWP) 20 mm Hg 4. Pulmonary artery systolic/diastolic pressures of 24/10 mm Hg

3 Normal PCWP ranges from 8 to 15 mm Hg. A PCWP of 20 mm Hg is elevated and corresponds to volume overload of the left ventricle, such as occurs in heart failure. Options 1, 2, and 4 are normal values.

The nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The P waves and QRS complexes are regular. The PR interval is 0.14 second, and the QRS complexes measure 0.08 second. The overall heart rate is 82 beats/min. The nurse interprets the cardiac rhythm to be which rhythm? 1. Sinus bradycardia 2. Sick sinus syndrome 3. Normal sinus rhythm 4. First-degree heart block

3 Normal sinus rhythm is defined as a regular rhythm with an overall rate of 60 to 100 beats/min. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? 1. Sinus bradycardia 2. Sick sinus syndrome 3. Normal sinus rhythm 4. First-degree heart block

3 Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.

A client returning to the nursing unit after a cardiac catheterization procedure has a stat prescription to receive a dose of procainamide. Which piece of equipment would be most appropriate for the nurse to use in determining the client's response to this medication? 1. Glucometer 2. Pulse oximeter 3. Cardiac monitor 4. Noninvasive blood pressure cuff

3 Procainamide is an antiarrhythmic medication often used to treat ventricular arrhythmias that do not adequately respond to lidocaine. The effectiveness of this medication is best determined by evaluating the client's cardiac rhythm. Therefore a cardiac monitor would be the most appropriate device for determining the client's response, although the blood pressure cuff and the pulse oximeter would provide general information about the client's cardiovascular status. A glucometer is not needed for this client with the information presented.

The home health nurse is visiting a client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery? 1. "I need to count my pulse every day." 2. "I have to do deep breathing exercises every 2 hours." 3. "I threw away my straight razor and bought an electric razor." 4. "I have to go to the bathroom frequently because of my medication."

3 Prosthetic valves require long-term anticoagulation to prevent clots from forming on the "foreign" tissue implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding, such as the use of straight razors. Counting pulse, deep breathing exercises, and going to the bathroom frequently are not specifically related to postoperative care after prosthetic valve replacement.

A client is to be discharged from the hospital on quinidine gluconate to control ventricular ectopy. The nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction? 1. "The best time to schedule this medication is with meals." 2. "I need to avoid alcohol, caffeine, and cigarettes while I am on this medication." 3. "I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs." 4. "I need to take this medication regularly, even if the heartbeat feels strong and regular."

3 Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. Diarrhea, nausea, vomiting, loss of appetite, and dizziness all are common side effects of quinidine gluconate. If any of these occur, the health care provider (HCP) or the nurse should be notified; however, the medication should never be discontinued abruptly. Rapid decrease in medication levels of antidysrhythmics could precipitate dysrhythmia. The other options indicate correct information.

A client has developed atrial fibrillation, with a ventricular rate of 150 beats/minute. The nurse should assess the client for which associated signs/symptoms? 1. Flat neck veins 2. Nausea and vomiting 3. Hypotension and dizziness 4. Hypertension and headache

3 The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. In formulating a response, the nurse understands that this effect occurs because of the client's primary need for which increased cardiac response? 1. Pulse rate 2. Cardiac index 3. Cardiac output 4. Stroke volume

3 The client's symptoms are the direct result of the body's attempt to meet the metabolic demands generated during exercise. An adequate cardiac output is needed to maintain perfusion to the vital organs of the body. With exercise, these demands increase, and the heart must beat faster (increased heart rate) and harder (increased stroke volume) to meet them. Cardiac index is an artificial number used to determine the adequacy of the cardiac output for a given individual. It is calculated by adjusting the cardiac output for body surface area.

A hospitalized client is experiencing a decrease in blood pressure. The nurse plans care for the client, knowing that this change will have which primary effect on his or her heart? 1. Decreased heart rate 2. Increased contractility 3. Decreased myocardial blood flow 4. Increased resistance to electrical stimulation

3 The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time.

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1. Check the blood pressure. 2. Call the health care provider. 3. Check the client and the chest leads. 4. Initiate cardiopulmonary resuscitation (CPR).

3 This type of pattern on the cardiac monitor indicates either ventricular fibrillation or lead displacement. The first action of the nurse is always to check the client and the chest leads. If the client is nonresponsive and the leads are not the problem, then option 4 would be the next choice, along with contacting the health care provider.

A client with a history of hypertension has been prescribed triamterene (Dyrenium). The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit? 1. Apples 2. Pears 3. Bananas 4. Cranberries

3 Triamterene is a potassium-retaining diuretic, so the client should avoid foods high in potassium. Fruits that are naturally higher in potassium include avocados, bananas, fresh oranges, mangos, nectarines, papayas, and prunes.

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm? 1. Asystole 2. Atrial fibrillation 3. Ventricular fibrillation 4. Ventricular tachycardia

3 Ventricular fibrillation is characterized by irregular chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats/minute. The nurse determines that the client is experiencing which dysrhythmia? 1. Sinus tachycardia 2. Ventricular fibrillation 3. Ventricular tachycardia 4. Premature ventricular contractions

3 Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (longer than 0.12 second), and typically a rate between 140 and 180 impulses/minute. The rhythm is regular.

The nurse is evaluating a client's cardiac rhythm strip to determine if there is proper function of the VVI mode pacemaker. Which denotes proper functioning? 1. Spikes precede all P waves and QRS complexes. 2. There are consistent spikes before each P wave. 3. Spikes occur before QRS complexes when intrinsic ventricular beats do not occur. 4. Spikes occur before all QRS complexes regardless of intrinsic ventricular activity.

3 When a pacemaker is operating in the VVI mode, pacemaker spikes will be observed before the QRS complex if the client does not have their own intrinsic beat; therefore options 1, 2, and 4 are incorrect.

The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? 1. "I need to be sure not to go barefoot around the house." 2. "If I cut my toenails, I need to be sure that I cut them straight across." 3. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." 4. "I need to be sure that I elevate my leg above my heart level for at least an hour every day."

4 Foot care instructions for the client with peripheral arterial disease are the same as those for a client with diabetes mellitus. The client with arterial disease, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if venous stasis is also present. The client statements in options 1, 2, and 3 are correct statements.

A client hospitalized with a diagnosis of myocardial infarction calls for the unit nurse because the client is experiencing chest pain. The nurse administers a sublingual nitroglycerin tablet as prescribed. The client, who is receiving oxygen by nasal cannula, reports that her chest pain is unrelieved by the nitroglycerin. Which is the next nursing action for this client? 1. Call the client's family. 2. Increase the flow rate of oxygen. 3. Contact the health care provider (HCP). 4. Administer another nitroglycerin tablet.

4 For the hospitalized client, nitroglycerin tablets are administered one tablet every 5 minutes, for a total of three tablets per episode of chest pain, so long as the client maintains a systolic blood pressure of 100 mm Hg or higher. Increasing the flow rate of oxygen may be prescribed by the HCP but would not be the next nursing action. If three nitroglycerin tablets do not relieve the client's chest pain, the HCP needs to be notified. It is premature to call the client's family

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1. Assessing pain 2. Administering vasodilators 3. Avoiding over-the-counter medications 4. Moving slowly from a sitting to a standing position

4 Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls. Vasodilators normally are not prescribed for the client with cardiomyopathy. Options 1 and 3, although important, are not directly related to the issue of safety.

A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action should be included in the client's plan of care? 1. Limiting oral and intravenous fluids 2. Measuring the client's pulse each shift 3. Providing the client with short, frequent walks 4. Eliminating sources of caffeine from meal trays

4 Sinus tachycardia often is caused by fever, physical and emotional stress, heart failure, hypovolemia, certain medications, nicotine, caffeine, and exercise. Fluid restriction and exercise will not alleviate tachycardia. Option 2 will not decrease the heart rate. Additionally, the pulse should be taken more frequently than each shift.

A nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the HCP is referring to which arteries? 1. Circumflex coronary artery 2. Right coronary artery (RCA) 3. Posterior descending coronary artery (PDA) 4. Left anterior descending coronary artery (LAD)

4 The LAD bifurcates from the left main coronary artery to supply the anterior wall of the left ventricle and a few other structures. The circumflex coronary artery bifurcates from the left coronary artery and supplies the left atrium and the lateral wall of the left ventricle. The RCA supplies the right side of the heart, including the right atrium and right ventricle. The PDA supplies the posterior wall of the heart.

The home health nurse visits a client recovering from cardiogenic shock secondary to an anterior myocardial infarction and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? 1. "I exercise every day after breakfast." 2. "I've gained 8 pounds since discharge." 3. "I take an antacid when I experience epigastric pain." 4. "I have planned periods of rest at 10:00 am and 3:00 pm daily."

4 The client recovering from cardiogenic shock secondary to a myocardial infarction will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated myocardial infarction. The complication of cardiogenic shock increases the recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing. It is best to allow the meal to settle prior to activity in order to improve circulation to the heart during exercise. Epigastric pain or a weight gain of 8 pounds is significant and should be reported to the health care provider, at which point follow-up should occur.

A nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1. Serum sodium level of 145 mEq/L 2. Serum chloride level of 98 mEq/L 3. Serum calcium level of 10 mg/dL 4. Serum potassium level of 2.8 mEq/L

4 The nurse should check the client's serum laboratory study results for hypokalemia. The client may experience PVCs in the presence of hypokalemia, because this electrolyte imbalance increases the electrical instability of the heart. The values noted in the remaining options are normal.

The nurse would evaluate that defibrillation of a client was most successful if which observation was made? 1. Arousable, sinus rhythm, BP 116/72 mm Hg 2. Nonarousable, sinus rhythm, BP 88/60 mm Hg 3. Arousable, marked bradycardia, BP 86/54 mm Hg 4. Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg

1 After defibrillation, the client requires continuous monitoring of electrocardiographic rhythm, hemodynamic status, and neurological status. Respiratory and metabolic acidosis develop during ventricular fibrillation because of lack of respiration and cardiac output. These can cause cerebral and cardiopulmonary complications. Arousable status, adequate blood pressure, and a sinus rhythm indicate successful response to defibrillation.

A nurse assesses the sternotomy incision of a client on the third day after cardiac surgery. The incision shows some slight puffiness along the edges and is non-reddened, with no apparent drainage. The client's temperature is 99° F orally. The white blood cell count is 7500 cells/mm3. How should the nurse interpret these findings? 1. Incision is slightly edematous but shows no active signs of infection. 2. Incision shows early signs of infection, although the temperature is nearly normal. 3. Incision shows no sign of infection, although the white blood cell count is elevated. 4. Incision shows early signs of infection, supported by an elevated white blood cell count.

1 Sternotomy incision sites are assessed for signs and symptoms of infection, such as redness, swelling, induration, and drainage. An elevated temperature and white blood cell count 3 to 4 days postoperatively usually indicate infection. Therefore, option 1 is correct.

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's prescriptions? Select all that apply. 1. Elevation of the right leg 2. Ambulation in the hall every 4 hours 3. Application of moist heat to the right leg 4. Administration of acetaminophen (Tylenol) 5. Monitoring for signs of pulmonary embolism

1, 3, 4, 5 Standard management of the client with deep vein thrombosis includes possible bed rest for 5 to 7 days or as prescribed; limb elevation; relief of discomfort with warm, moist heat and analgesics as needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. Ambulation is contraindicated because it increases the likelihood of dislodgement of the tail of the thrombus, which could travel to the lungs as a pulmonary embolism.

The nurse has a prescription to give amiodarone (Cordarone) intravenously to a client. During administration of this medication, the nurse should monitor which option as the priority? 1. Blood pressure 2. Cardiac rhythm 3. Skin color and dryness 4. Oxygen saturation level

2 Amiodarone is an antidysrhythmic used to treat life-threatening ventricular dysrhythmias. The client requires continuous cardiac monitoring, with infusion of the medication by an intravenous pump. Although the other assessments are not incorrect, monitoring of cardiac rhythm is the priority nursing action.

A client with rapid-rate atrial fibrillation has a new prescription for diltiazem hydrochloride by intravenous bolus followed by a continuous intravenous infusion of the same medication. What should the nurse know when administering this medication safely? 1. A bolus needs to be pushed very rapidly over 2 to 3 seconds. 2. A continuous infusion should not infuse for more than 24 hours. 3. This medication is one of the most effective beta-blockers in treating dysrhythmias. 4. This medication increases myocardial contractility and thus decreases oxygen demand.

2 Diltiazem hydrochloride is a calcium channel blocker used in the treatment of atrial flutter and fibrillation. It decreases myocardial contractility and workload, thereby decreasing the need for oxygen. A bolus of 0.25 mg/kg is given slowly over 2 minutes, and a continuous infusion of 5 to 10 mg/hour may be continued for up to 24 hours.

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm? 1. Sinus tachycardia 2. Ventricular fibrillation 3. Ventricular tachycardia 4. Premature ventricular contractions (PVCs)

2 Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Sinus tachycardia has a recognizable P wave and QRS. Ventricular tachycardia is a regular pattern of wide QRS complexes. PVCs appear as irregular beats within a rhythm. Each of the incorrect options has a recognizable complex that appears on the monitoring screen.

The nurse has a new prescription to administer verapamil (Calan) by the intravenous (IV) route. In administering this medication, the most important nursing action should be to use what item to monitor the client's response to the medication? 1. A pulse oximeter 2. A cardiac monitor 3. Supplemental oxygen 4. A noninvasive blood pressure monitor

2 Verapamil is a calcium channel-blocking agent that may be used to treat rapid-rate supraventricular tachydysrhythmias such as atrial flutter or atrial fibrillation. A cardiac monitor is used to determine the client's response to the medication. A pulse oximeter and oxygen are related to respiratory care and may be other useful adjuncts to care, but they are not directly related to the use of this medication. A noninvasive blood pressure monitor also is helpful but is not as essential or critical as the cardiac monitor.

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1. Soak the feet in hot water daily. 2. Be careful not to injure the legs or feet. 3. Use a heating pad on the legs to aid vasodilation. 4. Walk each day to increase circulation to the legs. 5. Cut down on the amount of fats consumed in the diet.

2, 4, 5 Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity is contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further.

A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block? 1. Presence of Q waves 2. Tall, peaked T waves 3. Prolonged PR interval 4. Widened QRS complex

3 A prolonged PR interval indicates first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An ECG taken during a pain episode is intended to capture ischemic changes, which also include ST-segment elevation or depression.

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? 1. Chloride level of 98 mEq/L 2. Sodium level of 135 mEq/L 3. Potassium level of 6.8 mEq/L 4. Magnesium level of 1.6 mEq/L

3 Hyperkalemia can cause tall, peaked or tented T waves on the ECG. Levels of potassium 5.0 mEq/L or greater indicate hyperkalemia. Options 1, 2, and 4 are normal levels.

A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? 1. Bundle of His 2. Purkinje fibers 3. Sinoatrial (SA) node 4. Atrioventricular (AV) node

3 The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity.

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? 1. Dietitian 2. Medical social worker 3. Pain management clinic 4. Smoking-cessation program

4 Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking-cessation program may be helpful for many clients. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops. A dietitian, a medical social worker, and a pain management clinic are not specifically associated with the lifestyle changes required in this disorder although they may be needed if secondary problems arise.

A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding? 1. Occur in pairs 2. Appear to be multifocal 3. Fall on the second half of the T wave 4. Decrease to a frequency of less than 6 per minute

4 PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias.

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1. Sensation of palpitations 2. Causative factors, such as caffeine 3. Precipitating factors, such as infection 4. Blood pressure and oxygen saturation

4 Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.

A client in ventricular fibrillation is about to be defibrillated. A nurse knows that to convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? 1. 50 J 2. 120 J 3. 200 J 4. 360 J

4 The energy level used for all defibrillation attempts with a monophasic defibrillator is 360 joules.

A nurse reading the operative record for a client who has undergone cardiac surgery notes that the client's cardiac output immediately after surgery was 3.6 L/min. The nurse determines that this measurement indicates which finding? 1. Above the normal range 2. In the high-normal range 3. In the low-normal range 4. Below the normal range

4 The normal cardiac output for the adult can range from 4 to 8 L/min and varies greatly with body size. The heart normally pumps 5 L of blood every minute.

The nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse correctly interpret the client's heart rhythm? 1. Atrial fibrillation 2. Sinus tachycardia 3. Ventricular fibrillation 4. Ventricular tachycardia

1 Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombus formation.

A nursing student who is researching a medication at the nursing station asks the registered nurse (RN) what an α1-adrenergic receptor is. The RN responds by telling the student that these receptors are found primarily in which peripheral vascular structures and produce which actions? 1. The peripheral arteries and veins, and when stimulated cause vasoconstriction 2. Arterial and bronchial walls, and when stimulated cause vasodilation and bronchodilation 3. The heart, and when stimulated cause an increase in heart rate, atrioventricular (AV) node conduction, and contractility 4. Several tissues, and when stimulated cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation

1 Found in the peripheral arteries and veins, α1-adrenergic receptors cause a powerful vasoconstriction when stimulated. Options 2, 3, and 4 describe β1-, β2-, and α2-adrenergic receptors, respectively.

A left atrial catheter is inserted into a client during cardiac surgery. The nurse is monitoring the left atrial pressure (LAP) and documents the following pressure. Which readings are within normal limits (WNL) for the client? Select all that apply. 1. 6 mm Hg 2. 8 mm Hg 3. 15 mm Hg 4. 25 mm Hg 5. 32 mm Hg

1, 2 The normal LAP is 1 to 10 mm Hg; therefore, options 1 and 2 are correct. Because the left atrium does not generate significant pressure during atrial contraction, the atrial pressure is recorded as an average (mean) pressure, rather than as a systolic or diastolic pressure. Options 3, 4, and 5 are incorrect and elevated pressures.

The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous infusion at a rate of 150 mL/hour, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL most recent). The client's blood urea nitrogen level is 35 mg/dL and the serum creatinine level is 1.8 mg/dL, measured this morning. Which nursing action is the priority? 1. Check the urine specific gravity. 2. Call the health care provider (HCP). 3. Check to see if the client had a sample for a serum albumin level drawn. 4. Put the intravenous (IV) line on a pump so that the infusion rate is sure to stay stable.

2 Following abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery. Options 1 and 3 are not associated with the data in the question. The IV should have already been on a pump. Urine output lower than 30 mL/hour is reported to the HCP.

A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further research on the anatomy and physiology of the heart? 1. "The coronary arteries branch from the aorta." 2. "The coronary arteries supply the heart muscle with blood." 3. "The left coronary artery provides blood for the left atrium and the left ventricle." 4. "The left coronary artery supplies the right atrium and right ventricle with blood."

4 The left coronary artery divides into the anterior descending artery and the circumflex artery, providing blood for the left atrium and left ventricle. The right coronary artery supplies the right atrium and right ventricle. Options 1, 2, and 3 are correct

A client being admitted to the coronary care unit from the emergency department has a stat prescription to receive a dose of procainamide. The nurse interprets that the client has which condition if this medication is needed? 1. Dyspnea 2. Bradycardia 3. Hypertension 4. Ventricular ectopy

4 Procainamide is an antidysrhythmic medication used to treat ventricular dysrhythmias unresponsive to lidocaine. The other options are not indications for giving this medication.

A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure? 1. The client is wearing a nasal cannula delivering oxygen at 2 L/min. 2. The client's digoxin (Lanoxin) has been withheld for the last 48 hours. 3. The defibrillator has the synchronizer turned on and is set at 50 joules (J). 4. The client has received an intravenous dose of a conscious sedation medication.

1 During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular fibrillation. Energy level typically is set at 50 to 100 J. The client typically receives a dose of an intravenous sedative or antianxiety agent.

A client with heart failure has been started on intravenous medication therapy with inamrinone. The nurse determines which finding, if noted in the client, is an adverse effect of the medication? 1. Hypotension 2. Decreased weight 3. Absence of lung crackles 4. Reduced peripheral edema

1 Inamrinone is an inotropic agent used to relieve the manifestations of heart failure. Therapeutic effects include a decrease in weight (fluid), lung crackles, dyspnea, and edema. Blood pressure should remain stable or increase (if the client is hypotensive). Hypotension is an adverse effect of the medication.

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider will most likely prescribe which option? 1. Maintain bed rest. 2. Maintain the affected leg in a dependent position. 3. Administer an opioid analgesic every 4 hours around the clock. 4. Apply cool packs to the affected leg for 20 minutes every 4 hours.

1 Standard management for the client with DVT includes bed rest; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Ambulation is contraindicated because such activity can cause the thrombus to dislodge and travel to the lungs. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen (Tylenol).

A client whose cardiac rhythm was normal sinus rhythm suddenly exhibits atrial fibrillation on the monitor. The nurse should take which action? 1. Continue to watch the monitor. 2. Contact the health care provider. 3. Check to see if cardiac medications are due. 4. Call respiratory therapy to do a respiratory treatment.

2 Atrial fibrillation is characterized by multiple rapid impulses from many atrial foci in a totally disorganized manner at a rate of 350 to 600 times per minute. The atria quiver in fibrillation. As a result, thrombi can form within the right atrium and move through the right ventricle to the lungs. This can be a life-threatening situation requiring pharmacological therapy. Therefore, the health care provider needs to be contacted. Options 1 and 3 delay necessary and required interventions. Option 4 is not useful for this client.

The nurse is told by a health care provider that a client in hypovolemic shock will require plasma expansion. The nurse anticipates receiving a prescription to transfuse which product? 1. Albumin 2. Platelets 3. Cryoprecipitate 4. Packed red blood cells

1 Albumin may be used as a plasma expander. Platelets are used when the client's platelet count is low. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander.

A client is admitted to the hospital for an acute episode of angina pectoris. Which parameter is the priority for the nurse to monitor? 1. Pulse and blood pressure 2. Temperature and chest pain 3. Food tolerance and urinary output 4. Right upper quadrant pain and fatigue

1 Angina pectoris is transient chest pain or discomfort that is caused by an imbalance between myocardial oxygen supply and demand. The discomfort typically occurs in the retrosternal area; may or may not radiate; and is described as a tight, heavy, squeezing, burning, or choking sensation. The two major types of angina pectoris are stable (classic exertional) angina and unstable angina. Stable angina, the most common type, is usually precipitated by physical exertion or emotional stress, lasts 3 to 5 minutes, and is relieved by rest and nitroglycerin. Acute intervention for the client who has an anginal attack includes vital signs, oxygen, pain relief, and continuous electrocardiographic monitoring.

A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1. 0.5 to 2 ng/mL 2. 1.2 to 2.8 ng/mL 3. 3.0 to 5.0 ng/mL 4. 3.5 to 5.5 ng/mL

1 Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. The ranges in the remaining options are incorrect.

A client with heart disease is taking digoxin (Lanoxin) and complains of having no appetite, and experiencing diarrhea and blurry vision. The nurse notes that the client's serum potassium (K) level is 3.0 mEq/L. Based on analysis of the data, what might the nurse expect to note when reviewing the digoxin level results? 1. Digoxin level of 1.8 ng/mL 2. Digoxin level higher than 2 ng/mL 3. Digoxin level lower than 0.5 ng/mL 4. Digoxin level of 0 ng/mL because of diarrhea

2 When a client is taking digoxin, digoxin toxicity is a concern. The therapeutic digoxin level is 0.5 to 2 ng/mL. Anorexia, diarrhea, and visual disturbances are symptoms of digoxin toxicity. In addition, a low serum potassium level potentiates the risk for digoxin toxicity. This client's potassium level is low at 3.0 mEq/L. The client's complaints are indicative of digoxin toxicity. Therefore the only correct choice is option 2.

he nurse is providing care for a client with new onset of a atrial fibrillation dysrhythmia. The nurse anticipates which prescriptions from the health care provider? Select all that apply. 1. Oxygen therapy 2. An echocardiogram 3. An intravenous dose of metoprolol (Lopressor) 4. One dose of atropine to promote slowing of the rate 5. A bolus of intravenous heparin followed by a continuous infusion

1, 2, 3, 5 In atrial fibrillation the ventricles often beat with a rapid rate in response to the numerous atrial impulses. Heart dilation and blood pooling in the atria can lead to thrombus formation, which increases the risk for stroke or other embolic events; therefore heparin is indicated. The rapid and irregular ventricular rate decreases ventricular filling and reduces cardiac output, further impairing the heart's perfusion ability. Therefore, oxygen and metoprolol (to slow the ventricular response) are appropriate. An echocardiogram will help to assess heart valve function because mitral valve disease can lead to atrial fibrillation. Atropine will increase the heart rate further.

An adult client has been defibrillated three times unsuccessfully for ventricular fibrillation, and cardiopulmonary resuscitation (CPR) is resumed. The nurse confirms that CPR is being administered effectively by noting which action? 1. The ratio of compressions to ventilations is 30:2. 2. The carotid pulse is palpable with each compression. 3. Respirations are given at a rate of 10 breaths per minute. 4. The chest compressions are given at a depth of 1.5 to 2 inches.

2 With effective compressions, carotid pulsations should be present. At its best, CPR produces only 30% of the normal cardiac output, so correct technique is vital. Assessment of the carotid pulse during CPR is the most accurate way to assess the effectiveness of CPR. Correct procedure for CPR in an adult includes a compression-to-ventilation ratio of 30:2. With adults, compressions are performed at a depth of 1.5 to 2 inches. The 30:2 compression-ventilation ratio yields an effective rate of 8 to 10 breaths per minute.

The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2,4,5 Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL.

A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is the most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

3 Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected by this medication. The temperature also is not associated with administration of this medication.

An automatic external defibrillator (AED) interprets that the rhythm of a pulseless client is ventricular fibrillation. Which action should the nurse take next? 1. Administers rescue breathing during the defibrillation 2. Performs cardiopulmonary resuscitation (CPR) for 1 minute before defibrillating 3. Charges the machine and immediately pushes the discharge buttons on the console 4. Orders personnel away from the client, charges the machine, and depresses the discharge buttons

4 If the AED advises to defibrillate, the rescuer orders all personnel away from the client, charges the machine, and pushes both of the discharge buttons on the console at the same time. The charge is delivered through the patch electrodes, so this method is known as "hands off" defibrillation, which is safer for the rescuer. The sequence of charges is similar to that of conventional defibrillation.

A client with chronic atrial fibrillation is being started on quinidine sulfate (Quinidine) as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction? 1. "I will avoid chewing the tablets." 2. "I will take the dose at the same time each day." 3. "I will take the medication with food if my stomach becomes upset." 4. "I will stop taking the prescribed anticoagulant after starting this new medication."

4 Medication-specific teaching points for quinidine sulfate include to take the medication exactly as prescribed, not to chew the tablets, to take with food if stomach upset occurs, to wear a medical identification (e.g., Medic-Alert) bracelet or tag, and to have periodic checks of heart rhythm and blood counts. The client should not stop taking a prescribed medication unless specifically prescribed by the health care provider.

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? 1. Measure the heart rate on the rhythm strip. 2. Administer prescribed nitroglycerin tablets. 3. Obtain a 12-lead electrocardiogram immediately. 4. Auscultate the client's apical pulse and obtain a blood pressure.

4 Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure.

A client in ventricular fibrillation is brought into the emergency department. The advanced cardiac life support (ACLS) nurse prepares to defibrillate by placing conductive gel pads on which part of the client's chest? 1. The upper and lower halves of the sternum 2. Parallel between the umbilicus and the right nipple 3. The right shoulder and the back of the left shoulder 4. To the right of the sternum below the clavicle and to the left of the precordium

4 The ACLS nurse should place one gel pad to the right of the sternum just below the clavicle and the other gel pad to the left of the precordium. The nurse then places the electrode paddles over the pads. The remaining options describe incorrect positions.

The postmyocardial infarction client is scheduled for a technetium 99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure? 1. A Foley catheter 2. Signed informed consent 3. A central venous pressure (CVP) line 4. Notation of allergies to iodine or shellfish

2 MUGA is a radionuclide study used to detect myocardial infarction and decreased myocardial blood flow, and to determine left ventricular function. A radioisotope is injected intravenously; therefore a signed informed consent is necessary. A Foley catheter and CVP line are not required. The procedure does not use radiopaque dye; therefore allergies to iodine and shellfish are not a concern.

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? 1. The neurovascular status is normal because of increased blood flow through the leg. 2. The neurovascular status is moderately impaired, and the surgeon should be called. 3. The neurovascular status is slightly deteriorating and should be monitored for another hour. 4. The neurovascular status is adequate from an arterial approach, but venous complications are arising.

1 An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. The remaining options are incorrect interpretations.

A client with rapid-rate atrial fibrillation asks a nurse why the health care provider is going to perform carotid sinus massage. Which is a correct explanation? 1. The vagus nerve slows the heart rate. 2. The diaphragmatic nerve slows the heart rate. 3. The diaphragmatic nerve overdrives the rhythm. 4. The vagus nerve increases the heart rate, overdriving the rhythm.

1 Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. Others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm. The remaining options 2, 3, and 4 are incorrect descriptions of this procedure.

The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse? 1. Blood pressure 2. Status of airway 3. Oxygen flow rate 4. Level of consciousness

2 Nursing responsibilities after cardioversion include maintenance of a patent airway, oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. Airway, however, is always the highest priority.

A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse plans care for the client, knowing that the failure of the aortic valve to close completely allows blood to flow retrograde through which structures? 1. Aorta to left ventricle 2. Left ventricle to left atrium 3. Right ventricle to right atrium 4. Pulmonary artery to right ventricle

1 The aortic valve separates the aorta from the left ventricle. Options 2, 3, and 4 describe the mitral, tricuspid, and pulmonic valves, respectively.

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the paddles on the client's chest and before discharging them, which intervention should be done? 1. Ensure that the client has been intubated. 2. Set the defibrillator to the "synchronize" mode. 3. Administer an amiodarone bolus intravenously. 4. Confirm that the rhythm is actually ventricular fibrillation.

4 Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch, if present, is removed. The client does not have to be intubated to be defibrillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchronize. Amiodarone may be given subsequently but is not required before defibrillation.

The nurse is documenting information in a client's chart when the electrocardiogram telemetry alarm sounds, and the nurse notes that the client is in ventricular tachycardia (VT). The nurse rushes to the client's bedside and should perform which assessment first? 1. Cardiac rate 2. Blood pressure 3. Respiratory rate 4. Responsiveness of the client

4 VT is associated with a significant decrease in cardiac output. Assessing for unresponsiveness determines whether the client is affected by the decreased cardiac output. Although options 1, 2, and 3 may be a component of the assessment, the first action would be to determine responsiveness of the client.