Ati Cardiac
right sided heart failure
fluid retention + Hepatomegaly
A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? A."You might no longer be able to feel chest pain." B."Your level of activity intolerance will not change." C."After 6 months, you will no longer need to restrict your sodium intake." D."You will be able to stop taking immunosuppressants after 12 months."
A Rationales: -Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart. -activity tolerance should gradually improve as the healing process progresses -life-long restriction of sodium & fat + immunosuppressants
A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following findings should the nurse report? A.Mediastinal drainage 100 mL/hr B.Blood pressure 160/80 mm Hg C.Temperature 37.1° C (98.8° F) D.Potassium 4.0 mEq/L
B Rationales: -Mediastinal drainage of up to 150 mL/hr is expected during this time. -The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.
A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching? A.Apply the new patch to the same site as the previous patch. B.Place the patch on an area of skin away from skin folds and joints. C.Keep the patch on 24 hr per day. D.Replace the patch at the onset of angina.
B Rationales: -have a patch-free interval of 10 to 12 hr each day to prevent tolerance to the medication -nitroglycerin patches offer ongoing prevention of angina attacks. The nurse should instruct the client that patches do not treat angina attacks because they do not take effect immediately.
A nurse is preparing a client for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure? A.Hemoglobin 14.4 g/dL B.History of peripheral arterial disease C.Urine output 200 mL/4 hr D.Previous allergic reaction to shellsh
D Rationales: -This procedure involves access through large arteries or veins into the heart and is not affected by peripheral arterial disease. -The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure.
A nurse is providing discharge teaching to a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A.Weight gain of 0.9 kg (2 lb) in 24 hr B.Increase of 10 mm Hg in systolic blood pressure C.Dyspnea with exertion D.Dizziness when rising quickly
A Rationales: -This weight gain is an indication of fluid retention resulting from worsening heart failure *S/S: -Dyspnea + fatigue from exertion -dependent edema(fluid retention) -pulmonary edema → productive cough -cyanosis -JVD
A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A.Initiate chest compressions B.Vagal stimulation C.Administration of atropine IV D. Debrillatio
B Rationales: -vagal stimulation temporarily slows the heart rate ("bear down to slow down") I .e.Valsalva maneuver & squatting. Have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole. -chest compressions: pulseless ventricular tachycardia until a defibrillator is available -atropine: treat bradydysrhythmia -Cardioversion=supraventricular tachycardia. -Defibrillation = ventricular fibrillation /pulseless ventricular tachycardia.
___________ is an adverse effect of fluoroquinolone antibiotics, like ciprofloxacin (Cipro) for UTI.
Tendonitis
A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? A.A client who has hypothyroidism B.A client who has diabetes mellitus C.A client whose daily caloric intake consists of 25% fat D.A client who consumes two 12-oz (0.35-L) bottles of beer a day
B Rationales: -Risk factors: HTN,high sugar & lipid -S/S: 1.pain in the legs during exercise (intermittent claudication) 2.Numbness or burning pain primarily in the feet when in bed 3.Pain relieve w/ dependent position
LDL
bad cholesterol
exercise electrocardiography (stress test) __________ prior to this test can change the outcome (assesses cardiovascular response to an increased workload) and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.The provider might withhold cardiovascular medications prior to this procedure to effectively monitor cardiovascular response to stress.
Smoking
Bradydysrhythmia can cause decreased systemic perfusion and lower cardiac output because of the decreased heart rate, which can lead to ____________. Therefore, the nurse should monitor the clients ______________.
confusion; mental status
A ____________ is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication; Frequent urination is an expected outcome of this medication; _________ is an adverse effect of ACE inhibitors. However, the client does not need to discontinue use or report this to the provider.
persistent cough; Constipation
Left sided heart failure
pulmonary edema +coughing
①What is heart doing during depolarization? ②What is heart doing during repolarization?
①contraction(systolic);Na+ in & K+ out ②relaxation(diastolic);Na+ out&K+ in
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately? A.Slurred speech B.Irregular pulse C.Dependent edema D.Persistent fatigue
A Rationales: -The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech = inadequate circulation to the brain r/t embolus -P(×) QRS(narrow) T(√) -asymptomatic: irregular rhythm + fast HR -Tx: Warfarin/ Coumadin (blood thinner) to prevent clots in atria + Digoxin to slow heart
A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? A. Dyspnea on exertion B. Tracheal deviation C. Pericardial rub D. Weight loss
A Rationales: -The manifestation of dilated cardiomyopathy: dyspnea on exertion, fatigue, SOB, edema(weight gain), & exercise intolerance(ventricular compromise,fluid retention & ↓ cardiac output.) -tracheal deviation = tension pneumothorax -pericardial rub=pericarditis
A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer? A.Explore the client's family history of peripheral vascular disease. B.Note the presence or absence of pain at the ulcer site. C.Inquire about the presence or absence of claudication. D.Ask if the client has had a recent infection.
C Rationales:Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.
A nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following ndings can indicate shock and should be reported to the provider? A.Serosanguineous drainage on dressing B.Severe pain with coughing C.Urine output of 20 mL/hr D.Increase in temperature from 36.8° C (98.2° F) to 37.5° C (99.5° F
C Rationales: -Coughing is painful after an aortic aneurysm repair -Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.
P wave represents _____________; QRS complex represents _______________; T wave represents ______________.
atrial depolarization (contraction); ventricular depolarization (contraction); ventricular repolarization (relaxation)
A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? A.Increased abdominal girth B.Weak peripheral pulses C.Jugular venous neck distention D.Dependent edema
B Rationales: -Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure. -Increased abdominal girth, Jugular venous neck distention & Dependent edema r/t systemic congestion resulting from right-sided heart failure
The point of maximal impulse is _________ and located at the left fifth intercostal space in the midclavicular line
apex
A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? A."I can't get rid of these hiccups." B."I feel dizzy when I stand." C."My incision site stings." D."I have a headache."
A Rationales: -Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation. -Dizziness is expected initially as the client adjusts to the pacemaker. -the client should monitor the pacemaker insertion site for manifestations of infection, not pain & stinging
A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? A.Ventricular depolarization B.Guillain-Barré syndrome C.Myelodysplastic syndrome D.Valvular disease
D Rationales: -Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium. -Guillain-Barré syndrome: acute, inflammatory disease of the nerves characterized by the loss of myelin from the nerves -myelodysplastic syndrome: a group of bone marrow disorders that are characterized by the insufficient production of one or more types of blood cells due to dysfunction of the bone marrow
A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated? A.Administering IV morphine sulfate B.Administering oxygen at 2 L/min via nasal cannula C.Helping the client to the bedside commode D.Assisting with thrombolytic therapy
D Rationales: The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy(drugs to dissolve clots are injected into the bloodstream of patients with coronary thrombosis). -Using a bedside commode is less stressful than using a bedpan, and most clients are allowed to use a commode following myocardial infarction. - IV morphine relieves pain & myocardial oxygen demand.
A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? A. Obtain the client's current weight. B. Review serum electrolyte values. C. Determine the time of the last digoxin dose. D. Check the client's urine output.
B Rationales: -Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level because the client is at risk for dysrhythmias from hypokalemia. -determine the time of the last digoxin dose in order to evaluate when the next dose is due.
A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)? A.Myoglobin B.C-reactive protein C.Creatine kinase-MB D.Homocysteine
C Rationales: -Myoglobin=↑ w/ MI & skeletal muscle injury.(not specific to cardiac muscle) -C-reactive protein =↑@ beginning of the inflammatory process(e.g. rheumatoid arthritis) -Creatine kinase-MB is the isoenzyme specific to the myocardium. ↑ creatine kinase-MB =myocardial muscle injury -Homocysteine is always present in the blood.