amy 47 cardiac questions REVIEW again-most were on last exam

Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload

1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates

1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this procedure may stimulate the: 1. Vagus nerve to slow the heart rate 2. Vagus nerve to increase the heart rate; overdriving the rhythm. 3. Diaphragmic nerve to slow the heart rate 4. Diaphragmic nerve to overdrive the rhythm

1. Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. The others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy often is needed as an adjunct to keep the rate down or maintain the normal rhythm.

Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension

1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right- and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

An 18-year-old client who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? 1. Erythema marginatum, subcutaneous nodules, and fever 2. Tachycardia, finger clubbing, and a load S3 3. Dyspnea, cough, and palpitations 4. Dyspnea, fatigue, and syncope

1. Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham's chorea, subcutaneous nodules, and erythema maginatum (transient, nonprurtic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, and a prolonged PR-interval on ECG.

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the medication 2. Monitoring BP q4h 3. Monitoring urine output hourly 4. Obtaining serum potassium levels daily

1. IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sinus tachycardia 4. Sinus dysrhythmia

1. Normal Sinus Rhythm

Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec)

1. One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other medications aren't associated with such an effect.

Which of the following actions is the appropriate initial response to a client coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the client

1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the client is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow.

Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress and anxiety 4. Reduction of associated risk factors

1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed.

A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client's medical history included DM, HTN, and heart failure. Which of the following disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus

1. SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum are late signs of pulmonary edema.

Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? 1. Sit the client down 2. Get the client back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin

1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECGm sublingual nitro would be administered. When the client's condition is stabilized, he can be returned to bed.

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction

1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right sided heart failure.

Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations

1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

A nurse is assessing 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 per minute. The nurse assesses the cardiac rhythm as: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sick sinus syndrome 4. First-degree heart block.

1. measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively

What is the first intervention for a client experiencing MI? 1. Administer morphine 2. Administer oxygen 3. Administer sublingual nitroglycerin 4. Obtain an ECG

2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

Atherosclerosis impedes coronary blood flow by which of the following mechanisms? 1. Plaques obstruct the vein 2. Plaques obstruct the artery 3. Blood clots form outside the vessel wall 4. Hardened vessels dilate to allow blood to flow through

2. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can't dilate properly and, therefore, constrict blood flow.

Aspirin is administered to the client experiencing an MI because of its: 1. Antipyrectic action 2. Antithrombotic action 3. Antiplatelet action 4. Analgesic action

2. Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

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: 1. Sinus tachycardia 2. Atrial fibrillation 3. Ventricular tachycardia 4. Ventricular fibrillation

2. 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).

Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following a 2-gram sodium diet? 1. Apples 2. Tomato juice 3. Whole wheat bread 4. Beef tenderloin

2. Canned foods and juices, such as tomato juice, are typically high in sodium and should be avoided in a sodium-restricted diet.

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

2. Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough 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.

A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following medications readily available for use? 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin) 3. Propranolol (Inderal) 4. Metoprolol (Lopressor)

2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure. Diltiazem (calcium channel blocker) and propranolol and metoprolol (beta blockers) have a negative inotropic effect and would worsen the failing heart.

Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? 1. Decrease anxiety 2. Enhance myocardial oxygenation 3. Administer sublingual nitroglycerin 4. Educate the client about his symptoms

2. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.

A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management

2. MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, and ineffective therapeutic regimen management are appropriate but don't take priority.

While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse's first course of action should be to: 1. Increase the IV infusion rate 2. Notify the physician promptly 3. Increase the oxygen concentration 4. Administer a prescribed analgesic

2. PVCs are often a precursor of life-threatening dysrhythmias, including ventricular tachycardia and ventricular fibrillation. An occasional PVC is not considered dangerous, but if PVCs occur at a rate greater than 5 or 6 per minute in the post MI client, the physician should be notified immediately. More than 6 PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine. Increasing the IV infusion rate would not decrease the number of PVCs. Increasing the oxygen concentration should not be the nurse's first course of action; rather, the nurse should notify the physician promptly. Administering a prescribed analgesic would not decrease ventricular irritability.

A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for: 1. Thrombocytopenia and weight gain 2. Anorexia, nausea, and visual disturbances 3. Diarrhea and hypotension 4. Fatigue and muscle twitching

2. The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias.

Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina

2. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress.

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: 1. Ventricular tachycardia 2. Ventricular fibrillation 3. Atrial fibrillation 4. Asystole

2. 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 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 over 100. The nurse determines that the client is experiencing: 1. Premature ventricular contractions 2. Ventricular tachycardia 3. Ventricular fibrillation 4. Sinus tachycardia

2. Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.

Which of the following positions would best aid breathing for a client with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying with knees flexed 3. In high Fowler's position with legs dangling 4. In semi-Fowler's position with knees flexed

3. A high Fowler's position with legs dangling promotes ventilation and facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen the breathing and increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as the Fowler's position will.

Captopril may be administered to a client with HF because it acts as a: 1. Vasopressor 2. Volume expander 3. Vasodilator 4. Potassium-sparing diuretic

3. ACE inhibitors have become the vasodilators of choice in the client with mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure.

Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema? 1. Risk for infection related to stasis of alveolar secretions 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility

3. Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the client with HF and pulmonary edema, nor is constipation related to immobility.

What is the most common complication of an MI? 1. Cardiogenic shock 2. Heart failure 3. arrhythmias 4. Pericarditis

3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.

Which of the following conditions is most commonly responsible for myocardial infarction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 4. Renal failure

3. Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually a result from an MI.

A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? 1. Immediately defibrillate 2. Prepare for pacemaker insertion 3. Administer amiodarone (Cordarone) intravenously 4. Administer epinephrine (Adrenaline) intravenously

3. First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate and already excitable ventricle and is contraindicated.

Which of the following symptoms might a client with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia

3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.

A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin), a nurse checks the client's most recent: 1. Digoxin level 2. Sodium level 3. Potassium level 4. Creatinine level

3. The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK)

3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia

4. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention occurs and hypercapnia results.

Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased after load 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium

4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

What is the primary reason for administering morphine to a client with an MI? 1. To sedate the client 2. To decrease the client's pain 3. To decrease the client's anxiety 4. To decrease oxygen demand on the client's heart

4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons.

Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac cauterization 4. 12-lead electrocardiogram (ECG)

4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.

Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP and diuresis 4. Increased BP and fluid retention

4. The body compensates for a decrease in cardiac output with a rise in BP, due to the stimulation of the sympathetic NS and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

The nurse coming on duty receives the report from the nurse going off duty. Which of the following clients should the on-duty nurse assess first? 1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of 21 breaths a minute. 2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order. 3. The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin. 4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem).

4. The client with A-fib has the greatest potential to become unstable and is on IV medication that requires close monitoring. After assessing this client, the nurse should assess the client with thrombophlebitis who is receiving a heparin infusion, and then go to the 58-year-old client admitted 2-days ago with heart failure (her s/s are resolving and don't require immediate attention). The lowest priority is the 89-year-old with end stage right-sided heart failure, who requires time consuming supportive measures.

In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure

4. The most accurate area on the body to assess dependent edema in a bed-ridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.

Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? 1. Pericarditis 2. Hypertension 3. MI 4. Heart failure

4. These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. MI causes heart failure but isn't related to these symptoms.

Which of the following types of angina is most closely related with an impending MI? 1. Angina decubitus 2. Chronic stable angina 3. Noctural angina 4. Unstable angina

4. Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.

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

4. 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. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure

4. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output.