Acute Cardiac
A nurse is monitoring a client admitted with a diagnosis of myocardial infarction (MI) for dysrhythmias. Which reason for increased incidence of dysrhythmias in this client should the nurse monitor? 1. Metabolic acidosis 2. myocardial hypoxia 3. Decreased catecholamine secretion 4. Increased parasympathetic nervous system stimulation
Answer: 2, Dysrhythmias are common and result from decreased oxygen to the cells of the myocardium.
What age-related cardiovascular changes should the nurse assess for when providing care to an older adult patient? (Select all that apply.) a. systolic murmur b. diminished pedal pulses c. increased maximal heart rate d. decreased maximal heart rate e. increased recovery time from activity
Answer: a, b, d, e Rationale: Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.
A female patient with type 1 diabetes has chronic stable angina controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use in planning care to prevent cardiovascular disease progression? a. Exercise almost every day. b. Avoid saturated fat intake. c. Limit calories to daily limit. d. Keep Hgb A1C less than 7%.
d Rationale: If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past 3 months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.
A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions should the nurse anticipate? SELECT ALL THAT APPLY 1.Stop the infusion 2.Raise the head of the bed 3.Administer protamine sulfate 4.Administer diphenhydramine 5.Call for the Rapid Response Team
Answer 1,4,5 Strategy: Notice strategic word priority. Recall that an allergic reaction and possible anaphylaxis are risks associated with alteplase therapy. Also, focusing on the signs and symptoms in the question will assist in answering correctly. When a severe allergic reaction occurs, the offending substance should be stopped, and lifesaving treatments should begin.
The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. 1. U waves 2. Absent P waves 3. Inverted T waves 4. Depressed ST segment 5. Widened QRS complex
Answer: 1, 3, 4 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level lower than 3.5 mEq/L (3.5 mmol/L) indicates hypokalemia. Potassium deficit is an electrolyte imbalance that can be potentially life-threatening. Electrocardiographic changes include shallow, flat, or inverted T waves; ST segment depression; and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation, junctional rhythms, or ventricular rhythms. A widened QRS complex may be noted in hyperkalemia and in hypermagnesemia.
1. The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles. The nurse immediately asks another nurse to contact the primary health care provider and prepares to implement which priority interventions? Select all that apply. 1. Administering oxygen 2. Inserting a Foley catheter 3. Administering furosemide 4. Administering morphine sulfate intravenously 5. Transporting the client to the coronary care unit 6. Placing the client in a low-Fowler's side-lying position
Answer: 1,2,3,4- Extreme dyspnea, tachycardia, and lung crackles in a client with heart failure indicate pulmonary edema, a life-threatening event. In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high-Fowler's position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention (Saunders NCLEX, pg. 732). Strategies- note the word priority
1. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: 1. Jugular venous distention 2. Persistent cough 3. Weight gain 4. Crackles 5. Nocturia 6. Orthopnea
Answer: 2,4,6- Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure (Registered Nurse RN). Strategies: the word NOT - not typical
A client returns from a cardiac catheterization procedure and is to remain in the supine position for 4 hours with the affected leg straight. What are these measures intended to prevent? 1. Orthostatic hypotension 2. Headache with disorientation 3. Bleeding at the arterial puncture site 4. infiltration of the radiopaque dye in the tissue
Answer: 3 Bedrest and elevation encourages coagulation, and healing of the arterial puncture site.
A client with a long history of cardiovascular problems, including angina and hypertension, is scheduled to have a cardiac catheterization. During preprocedural teaching, what does the nurse explain to the client is the major purpose for catheterization? 1) To obtain the pressures in the heart chambers 2) To determine the existence of congenital heart disease 3) To visualize the disease process in the coronary arteries 4) To measure oxygen content in various heart chambers
Answer: 3, Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization.
An older client who has had multiple hospital admissions for recurring heart failure is returned to the hospital by an adult child. The client is admitted for observation to the coronary care unit and calmly states, "I know I'm sick, but I can really take care of myself at home." What should the nurse conclude that the client most likely is attempting to do? 1. Suppress fears 2. Deny illness 3. Maintain independence 4. Reassure the adult child
Answer: 3, Maintain independence. The client's statement is really saying, "I can manage this myself. I am capable." None of the information given leads to the conclusion that the client is suppressing fears. Nothing in the statement can be interpreted as denial; the client has stated, "I know I'm sick." Telling the adult child that self-care is possible will not be reassuring to a family member who brought the client to the hospital and who probably is more reassured by having the client hospitalized.
A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. 1. Age 2. Height 3. Weight 4. Smoking 5. Family history
Answer: 3,4. Weight and Smoking are modifiable risk factors of CAD. The other options are non-modifiable factors.
1. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? * 1. Echocardiogram shows an ejection fraction of 38%. 2. Heart catheterization shows an ejection fraction of 65%. 3. Patient has frequent episodes of nocturnal paroxysmal dyspnea. 4. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.
Answer: 4- Option 2 is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart (Registered Nurse RN). Strategies- Left side, expected finding?
These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? 1. Beta Blockers 2. Vasodilators 3. Angiotensin II receptor blockers 4. Angiotensin-converting-enzyme inhibitor
Answer: 4- This is a description of ACE inhibitors (Registered Nurse RN Strategies- first line treatment
What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. 1. Left ventricular systolic dysfunction 2. Left ventricular right-sided dysfunction 3. Right ventricular diastolic function 4. Left ventricular diastolic dysfunction
Answer: 4- This statement describes left ventricular DIASTOLIC dysfunction. Strategies- blood is backing up into the lungs, and it is heart failure
What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply. A. The RR intervals are relatively consistent B. One P wave precedes each QRS complex C. Four to eight complexes occur in a 6 second strip D. The ST segment is higher than the PR interval E. The QRS complex ranges from 0.12 to 0.20 second
Answer: A, B · The consistency of the RR interval indicates regular rhythm. A normal P wave before each complex indicates the impulse originated in the SA node. The number of complexes in a 6 second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100. Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm. The QRS duration should be less than 0.12 second; the PR interval should be 0.12 to 0.20 second.
A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact? A. Frequent movement of the client B. Tightly secured cable connections C. Leads applied over hairy areas D. Leads applied to the limbs
Answer: B Motion artifact, or "noise," can be caused by frequent client movement, electrode placement on limbs, and insufficient adhesion to the skin, such as placing electrodes over hairy areas of the skin. Electrode placement over bony prominences also should be avoided. Signal interference can also occur with electrode removal and cable disconnection.
A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: A. Sinus tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Ventricular fibrillation
Answer: B · Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled).
A 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 or definable QRS complexes. Instead, there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be: A. Ventricular tachycardia B. Ventricular fibrillation C. Atrial fibrillation D. Asystole
Answer: B · 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.
A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? a. Women are less likely to delay seeking treatment than men. b. Women are more likely to have noncardiac symptoms of heart disease. c. Women are often less ill when presenting for treatment of heart disease. d. Women have more symptoms of heart disease at a younger age than men.
Answer: Women are more likely to have noncardiac symptoms of heart disease. Rationale: Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.
The nurse determines that a patient's pedal pulses are absent. What factor could contribute to this finding? a. Atherosclerosisb. b. Hyperthyroidism c. Atrial dysrhythmias d. Arteriovenous fistula
Answer: a Rationale: Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is most important for the nurse to assess and document before this procedure? a. iron b. iodine c. aspirin d. penicillin
Answer: b Rationale: The provider will usually use an iodine-based contrast to perform this procedure. Therefore, it is imperative to know whether the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.
A patient presents to the emergency department reporting chest pain for 3 hours. What component of the blood work is most clearly indicative of a myocardial infarction (MI). a. CK-MB b. Troponin c. Myoglobin d. c-reactive protein
Answer: b Rationale: Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.
The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? 1.Report of frequent insomnia 2.Development of expiratory wheezes 3.A baseline blood pressure of 150/80 Hg followed by a blood pressure of 138/72 Hg after 2 doses of the medication 4. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication
Answer:2 Strategy: Focus on the subject, a potential adverse complication. Eliminate options indicating a decrease in blood pressure and a decrease in heart rate first, because these are expected effects from the medication. Next, focusing on the subject will direct you to the correct option.
IV heparin therapy is prescribed for a client with A-Fib. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1.Vitamin 2.Protamine sulfate 3.Potassium chloride 4.Aminocaproic acid
Answer:2 Strategy: Focus on the subject, the antidote for heparin. Knowledge regarding the various antidotes is needed to answer this question. Remember that the antidote to heparin is protamine sulfate.
A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? 1.Monitor for kidney failure. 2.Monitor psychosocial status. 3.Monitor for signs of bleeding. 4, Have heparin sodium available.
Answer:3 Strategy: Note the strategic word priority. Remember that bleeding is a priority for thrombolytic medications.
The nurse provides discharge instructions to a client with A-Fib who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a Medic Alert bracelet." 4. "I will take coated aspirin for my headaches because it will coat my stomach."
Answer:4 Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recalling that warfarin is an anticoagulant and that coated aspirin is an aspirin-containing product will direct you to the correct option.
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? a. "I will replace my nitroglycerin supply every 6 months." b. "I can take up to 5 tablets every 3 minutes for relief of my chest pain." c. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin. d. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."
b Rationale: Dyslipidemia is one of the four major modifiable risk factors for CAD. The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.
The Nurse prepares a discharge teaching plan for a patient who has recently been diagnosed with coronary artery disease (CAD). Which priority risk factor should the nurse plan to focus on during the teaching session? a. Type A personality. b. Elevated serum lipids. c. Family cardiac history. d. High homocysteine levels.
b Rationale: Dyslipidemia is one of the four major modifiable risk factors for CAD. The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.
Which person would the nurse identify as having the highest risk for coronary artery disease (CAD)? a. A 60-yr-old man with low homocysteine levels b. A 45-yr-old man with a high-stress job who is depressed c. A 54-yr-old woman vegetarian with increased high-density lipoprotein (HDL) levels A 62-yr-old woman who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2
b Rationale: The 45-yr-old depressed man with a high-stress job is at the highest risk for CAD. Depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.
In caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient? a. "What precipitated the pain?" b. "Has the pain changed this time?" c. "In what areas did you feel this pain?" d. "What is your pain level on a scale from 0-10?"
c Rationale: Using PQRST, the assessment data not volunteered by the patient is the radiation of pain, the area the patient felt the pain, and if it radiated. The precipitating event was going to the bathroom and having a bowel movement. The quality of the pain was "like before I was admitted," although a more specific description may be helpful. Severity of the pain was the "worst chest pain ever," although an actual number may be needed. Timing is supplied by the patient describing when the pain occurred and that he had previously had this pain.
