bstrandable NCLEX Cardiovascular/Hematologic 1 of 2
What suffix indicates a drug is a beta blocker?
"-olol"
A patient with PAD has a new prescription for clopidogrel (Plavix). Which information should the nurse include when teaching the patient about this medication?
"Call if you notice that your stools are black or have blood in them."
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis. Which question by the nurse is most appropriate?
"Have you been to the dentist lately?"
Heparin is prescribed for a patient who has dilated cardiomyopathy has been admitted to the hospital with fatigue and orthopnea. Which statement is appropriate for the nurse to use in patient teaching about anticoagulation therapy?
"Heparin will help prevent blood clots from forming in your heart chambers."
A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis?
"I can't get my shoes on at the end of the day."
The nurse establishes the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge concerning long-term management of rheumatic fever when a patient recovering from rheumatic fever says, _______________
"I will be immune to further episodes of rheumatic fever after this infection."
A hospitalized patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about captopril, which statement by the patient indicates that teaching has been effective?
"I will call for help when I need to get up to the bathroom."
When evaluating the outcomes of preoperative teaching with a patient scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says, ________________
"I will have incisions in my leg where they will remove the vein."
After the nurse teaches a patient with chronic stable angina about how to use the prescribed nitrates, which statement by the patient indicates that the teaching has been effective?
"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
Which statement by a patient who is being discharged 5 days after an abdominal aortic aneurysm repair and graft indicates that the discharge teaching has been effective?
"I will tell my dentist about this surgery the next time I have an appointment."
A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, _______________
"I won't lift the arm on the pacemaker side up very high until I see the doctor."
After having an AMI, a 62-year-old patient tells the nurse, "I guess having sex again will be too hard on my heart." The nurse's best response is ______________
"Sexual activity can be gradually resumed like other activity. A good comparison of energy expenditure is climbing two flights of stairs."
A patient with a DVT is started on IV heparin and oral warfarin (Coumadin). The patient asks the nurse why two medications are necessary. The nurse's best response to the patient is, __________
"The heparin will work immediately, but the Coumadin takes several days to have an effect on coagulation."
Why don't you want to give Beta Blockers to asthmatics and diabetics
(asthmatics) Some Beta Blockers also constrict the smooth muscle of the bronchioles. (diabetics) Block the sympathetic responses seen in hypoglycemia
Cooley's Anemia
(homozygous), the name that is sometimes used to refer to any type of thalassemia that requires treatment with regular blood transfusions, RBC destroyed prematurely. Can not live without blood transfusion.
Troponin
- High affinity for myocardial injury - Normal Troponin I = <0.6 - Normal Troponin T = 0-0.2
LDH
- ^ occur 24 hrs after MI - Normal = 140-280
Stable Angina
- c activities - Relieved c rest - Stable pattern of onset, duration, severity, relieving
Cardiac Cath pre-procedure nursing interventions
-Ask if they are allergic to shellfish or iodine (dye used in procedure) -Check kidney function because you excrete the dye through the kidneys -warn the patient that they will have a hot shot and flushed when dye goes through -palpitations are normal
Client Education/Teaching for Chronic Stable Angina
-Avoid Isometric exercise -avoid overeating -rest frequently -avoid excess caffeine or any other drugs that increase HR -wait 2 hours after eating to exercise -Dress warmly in cold weather (any temp extreme can precipitate an attack) -take nitroglycerin prophylactically -smoking cessation -lose weight -Do everything you can to decrease the workload on the heart
The nurse should assess the lungs sounds and take vital signs at what times?
-Before the transfusion -After the first 15 minutes of transfusion -Every hour until the transfusion is completed
Noninvasive temporary pacing
-Called transcutaneuos pacing -don't go in the body -2 large electrode pads are applied to the client and turned to the PACING mode. -This is an emergency procedure -The shock will hurt and the patient will need analgesics
When can sex be resumed and what is the safest time of day?
-Can resume sex when you can go up a flight of stairs or walk around the block without discomfort -morning is the safest time because you are well rested.
Pacemaker (general notes)
-Cardiac output can decrease if the SA node fires less than 60 BPM -Pacemakers are used to increase the heart rate with symptomatic bradycardia -They depolarize the heart muscle and a contraction will occur (electricity going through the muscle) -Repolarization (ventricles are resting and filling with blood)
Beta Blockers
-Decrease BP, HR, and myocardial contractility -Decreases the workload of the heart -Beta Blockers block the beta cells...these are the receptor sites for catecholamines (epi and norepi). So we just decreased the contractility. CO is decreased and we have decreased the workload of the heart. This is a good thing to a certain point because we decreased the workload of the heart, but we could decrease the patient's cardiac output too much with these drugs if we are not careful.
Patho of Acute Coronary Syndrome
-Decreased blood flow to the myocardium causing ischemia and necrosis -Goal of care is to limit the size -pain can come on at any time (not just exercise) -Rest or Nitro will not relieve the pain
PCI (percutaneous Coronary Intervention)
-Includes all interventions such as PTCA (angioplasty) and stents -Major complication of the angioplasty is a MI -If any problems occur, go to surgery -Anti-platelet medications are given after to keep the stented artery open. IV antiplatelets are given to high-risk patients
Post-procedure Cardiac Cath Nursing Care
-Monitor VS -Watch puncture site (for bleeding and hematoma) -Assess extremity distal to puncture site (5Ps) -bed rest, flat, leg straight for 4-6 hours -report pain ASAP
Post-Pace maker Procedure Care
-Monitor the incision -most common complication in early hours is electrode displacement (wires pulled out)...muscles need to grow around the heart -Immobilize the arm -PROM to prevent frozen shoulder -Keep the patient from raising their arm too high
Treatment for Chronic Stable Angina: Nitroglycerin
-Nitroglycerin (Nitrostat): Sublingual (tablet or spray) -causes venous and arterial dilation -result will decrease preload and afterload -Also causes dilation of coronary arteries which will increase blood flow to the actual heart muscle
Signs and Symptoms of Pacemaker Malfunction: Loss of Capture
-No mechanical event or contraction followed the stimuli -This is caused by: the pacemaker not being programmed correctly, electrodes can dislodge, or the battery may be depleted. Malfunctions can be caught with any signs of decreased CO or decreased HR
Signs/Symptoms of Acute Coronary Syndrome
-Pain: crushing, elephant sitting on chest, jaw -cold/clamy -BP drops -Cardiac output going down -increased WBCs -Increased temp (low grade) -ECG changes- heart is irritated -Vomiting because vagus nerve is stimulated
Taking and storing Nitro
-Take q 5 minutes up to 3 doses -Do not swallow -Keep in a dark, glass bottle and store in a dry, cool place -Might burn or fizz when you take it -Renew 3-5 months and the spray needs to be renewed 2 years -The BP may go down and there may be a headache
What is fresh-frozen plasma used for?
-To provide clotting factors -To provide volume expansion FRESH FROZEN PLASMA CONTAINS NO PLATELETS
Complications of a blood transfusion include:
-Transfusion reactions -Circulatory overload -Septicemia -Iron overload -Disease transmission -Hypocalcemia -Hyperkalemia -Citrate toxicity
Permanent Pacemakers
-Used when heart condition is chronic -Electrodes are anchored to the endocardium and attached to a battery source implanted into a subcutaneous pocket (need a little pocket of fat) -a demand pacemaker kicks in only when the client needs it to -a fixed rate fires at a fixed rate constantly -It is ok for the heart rate to increase, but it should never drop below set rate
Signs of transfusion reaction in an unconscious patient:
-Weak pulse -Fever -Tachycardia or bradycardia -Hypotension -Visible hemoglobinuria -Oliguria or anuria
Bleeding Precautions
-draw blood when starting IV -Decrease the number of puncture sites -watch for bleeding gums, hematuria, and black stools -use an electric razor, a soft toothbrush, and no IMs -no ABGs (only puncture veins)
Women's Heart Attack Triad of Symptoms
-fullness in abdomen -chronic fatigue -inability to catch breath
Invasive Temporary Pacemaker
-has pacing wires that are placed into the heart muscle (transvenous pacing) -wires are connected to a power source outside of the body -Epicardial pacing is when the wires are attached to the epicardium during surgery
The client is experiencing multifocal premature ventricular contractions. Which antidysrhythmic medication would the nurse expect the health-care provider to order for this client? 1. Lidocaine. 2. Atropine. 3. Digoxin. 4. Adenosine.
...
The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure? 1. An elevated B-type natriuretic peptide (BNP). 2. An elevated creatine kinase (CK-MB). 3. A positive D-dimer. 4. A positive ventilation/perfusion (V/Q) scan.
...
What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Nursing considerations: Platelets, what is the companion solution?
0.9% NS
What is the companion IV solution for packed red blood cells?
0.9% NaCl
What are the 5 types of blood transfusion reactions?
1. Allergic reaction/ Hypersensitivity 2.Acute Hemolytic reaction 3. Febrile reaction 4. Bacterial infection 5. Circulatory overload
3 Lab markers that are checked for MIs
1. CPK-MB 2. Troponin 3. Myoglobin
Blood transfusion reactions: SS of Circulatory overload
1. Crackles* 2. Dyspnea* 3. Increased resp rate* 4. tachycardia
A nurse is providing teaching to a client who has a new prescription for digoxin (Lanoxin) Which of the following may indicate dig toxicity & should be reported to the provider? 1. Fatigue 2. constipation 3. Anorexia 4. Rash 5. Diplopia
1. Fatigue Not constipation but -- nausea, vomiting & diarrhea 3. Anorexia b/c GI disturbances 5. Diplopia -- visual changes , halo, yellow-tinged vision.
Blood transfusion reactions: SS of Acute Hemolytic reaction
1. N/V 2. Pain in lower back* 3. Hypotension 4. Increase in pulse rate* 5. Decrease in urinary output* 6. Hematuria*
What are the benefits for autologous transfusions?
1. Prevention of viral infection from donated blood. 2. Used for pts w/ hx of transfusion reactions. 3. Rare blood type.
729. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit?
1. Protamine sulfate
What to do if circulatory overload occurs?
1. Slow or d/c the transfusion
What to do if hypersensitivity or allergic reactions occurs?
1. Stop the blood 2. Restart the 0.9% NS 3. Notify the MD. 4. Supportive care= Benadryl, Oxygen, Corticosteroids
What to do if Acute Hemolytic reaction occurs?
1. Stop the blood. 2. Supportive care= Oxygen, benadryl, airway MGMT
What to do if bacterial infection occurs?
1. Stop the blood. 2.Obtain blood cultures 3.May be given Antibiotics, IV fluids, vasopressors, steroids
Blood transfusion reactions: SS of Bacterial infection
1. Tachycardia 2. Hypotension 3.Fever* 4.Chills 5.Shock*
What does a RN do before giving blood or blood products?
1. Type and cross match blood to ensure the donor's blood and recipient's blood are compatible. 2. Check blood for bubbles, dark color, or cloudiness. 3.Ask pt about allergies or previous blood reactions. 4. Check by 2 RNs: MD order,pt identity, hospital ID band name and number, blood component tag name and number. 5.Blood type and Rh. 6. Check baseline vitals, including temp.
What equipment do you need to admin blood or blood products?
1.Blood or blood products 2. Tubing with filter 3. 19 gauge needle for venous access
What is the infusion time for fresh frozen plasma?
15 to 30 minutes
Platelet Range
150,000- 400,000
what guage catheter would you use to start an IV in hypovolemic shock
16 or larger
Albumin can be given as quickly as possible and at
1mL/min
HF pts should always report a weight gain of how many pounds
2-3 lbs. You should weigh them daily
Nursing considerations:Packed Red Cells, how long is it given over?
2-4 H
730. A client is receiving thrombolytic therapy with a continuous infusion of streptokinase (Streptase). The client suddenly becomes extremely anxious and complains of itching. A nurse hears stridor and on examination of the client notes generalized urticaria and hypotension. Which of the following should be the priority action of the nurse?
2. Stop the infusion and call the physician.
721. A nurse is monitoring a client who is taking propranolol (Inderal). Which assessment data would indicate a potential serious complication associated with propranolol?
2. The development of audible expiratory wheezes
How long after you receive blood products from the blood bank do you have to administer it before you have to return it to the blood bank?
20 to 30 minutes
in hypovolemic shock the output of urine will be less than
25-30CC PERHOUR
The nurse assessing a client who has a history of hypertension would assess the client for pulsations by palpating which cardiac landmark?
2nd intercostal space, right sternal border.
731. A client is admitted with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which of the following assessments to the physician before initiating this therapy?
3. Blood pressure of 198/110 mm Hg
When obtaining a cardiovascular health history the nurse should ask the client which questions? Select all that apply.
"Are you able to perform your ADL's?", "Have you had any weight changes?", Have you been treated for cardiovascular disease?", Do you know your cholesterol and triglyceride levels?
While obtaining an admission health history from a patient with possible rheumatic fever, which question will be most pertinent to ask?
"Have you had a recent sore throat?"
The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for DVT. The nurse determines that additional teaching is needed when the patient says, _________________ __
"I should change my diet to include more green, leafy vegetables."
Which of these statements made by a patient after the nurse has completed teaching about the TLC diet indicates that further teaching is needed?
"I will miss being able to eat peanut butter sandwiches."
The nurse identifies the nursing diagnosis of ineffective peripheral perfusion related to decreased arterial blood flow for a patient with chronic PAD. In evaluating the patient outcomes following patient teaching, the nurse determines a need for further instruction when the patient says, ______________
"I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."
After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?
"It is important not to suddenly stop taking the atenolol."
When developing a teaching plan for a patient newly diagnosed with PAD, which information should the nurse include?
"It is important to try to stop smoking."
While working in the outpatient clinic, the nurse notes that the chart states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information?
"My legs cramp whenever I walk more than a block."
The client is prescribed digoxin (Lanoxin) for treatment of HR. Which of the following statements by the client indicates the need for further teaching by the nurse? "I should not get short of breath anymore." "This drug will help my heart muscle pump less." "I may notice my heart rate decrease." "I may feel tired during early treatment."
"This drug will help my heart muscle pump less." Rationale: The ability to increase the strength of contractions is a characteristic of cardiac glycosides. It may result in a decrease in pulse. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.
A patient with ST-segment elevation in several ECG leads is admitted to the ED and diagnosed as having an AMI. Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy?
"What time did your chest pain begin?"
A patient who has been successfully resuscitated after developing ventricular fibrillation asks the nurse about what happened. The most appropriate response by the nurse is, _____________
"You had a serious abnormal heart rhythm, which treatment was able to reverse."
What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (THE PT. IS DYING) AND NOTIFY PHYSICIAN (2ND).
What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC, (2nd) if unconscious= begin CPR, and (3rd) Notify physician.
What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
727. A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril). A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?
3. Double vision, loss of appetite, and nausea
724. A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
3. Hypokalemia, hyperglycemia, sulfa allergy
How long before a transfusion should oral medications be given?
30 minutes
722. A nurse is caring for a client receiving a heparin intravenous (IV) infusion. The nurse anticipates that which laboratory study will be prescribed to monitor the therapeutic effect of heparin?
4. Activated partial thromboplastin time
WBC range
5,000 - 10,000
A patient has a severe blockage in his right coronary artery. Which cardiac structure is most likely to be affected by this? a. AV node b. Left ventricle c. Coronary Sinus d. Pulmonary valve
A
A patient in asystole is likely to receive which of the following drug treatments? A) a. Atropine and epinephrine B) b. Lidocaine and amiodarone C) c. Digoxin and procainamide D) d. β-Adrenergic blockers and dopamine
A
A patient with newly diagnosed hypertension has a BP of 158/98 mm Hg after 6 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. medication will be required because the BP is still not at goal b. continued BP monitoring for another 3 months is all that will be necessary at this time c. lifestyle modifications are no longer important since they were not effective and medications will be started d. more vigorous changes in the patient's lifestyle are needed for a longer period of time before starting medications
A
After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says, a. I would like to add weight lifting to my exercise program b. I can only keep my blood pressure with medication c. I can change my diet to decrease my intake of saturated fats d. I will change my lifestyle to reduce activities that increase my stress
A
The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which of the following ethnic groups would the nurse select as the highest priority for this intervention? A) a. White male B) b. Hispanic male C) c. African American male D) d. Native American female
A
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of atenolol (Tenormin). The nurse should withhold the dose and consult the prescribing physician for which of the following vital signs taken just before administration? A) a. Pulse 48 B) b. Respirations 24 C) c. Blood pressure 118/74 D) d. Oxygen saturation 93%
A
The nurse is providing care for a patient who has decreased cardiac output related to heart failure. The nurse recognizes that cardiac output is A) a. Calculated by multiplying the patient's stroke volume by the heart rate. B) b. The average amount of blood ejected during one complete cardiac cycle. C) c. Determined by measuring the electrical activity of the heart and the patient's heart rate. D) d. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.
A
When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmurs c. gallop rhythms d. pericardial friction rubs
A
Which of the following individuals would the nurse identify as having the highest risk for CAD? A) a. A 45-year-old depressed male with a high-stress job B) b. A 60-year-old male with below normal homocysteine levels C) c. A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels D) d. A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2
A
b. "These factors may put you at higher risk for myopathy."
A 70-year-old client who is taking several cardiac antidysrhythmic medications has been prescribed simvastatin (Zocor) 80 mg/day. What is essential information for the nurse to teach the client? a. "This dose may lower your cholesterol too much." b. "These factors may put you at higher risk for myopathy." c. "You should not take this drug with cardiac medications." d. "This combination will cause you to have nausea and vomiting."
What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
d. Subcutaneously
A client is prescribed dalteparin (Fragmin). LMWH is administered via which route? a. Intravenously b. Intramuscularly c. Intradermally d. Subcutaneously
c. "I will increase dark-green, leafy vegetables in my diet."
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse? a. "I will avoid contact sports." b. "I will take my medication in the early evening each day." c. "I will increase dark-green, leafy vegetables in my diet." d. "I will contact my health care provider if I develop excessive bruising."
a. Evaluate digoxin levels.
A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? a. Evaluate digoxin levels. b. Withhold the furosemide c. Administer potassium. d. Document the findings and reassess in 1 hour.
b. Hypokalemia
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia
b. Teach the client of potential drug interactions with anticoagulants.
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. b. Teach the client of potential drug interactions with anticoagulants. c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. d. Explain that the headache is an expected side effect and will subside shortly.
A client with HF has an order for lisnopril (Prinivil, Zestril) Which of the following conditions in the client's history would lead a nurse to confirm the order with the provider? 1. A history of HT previously treated with diuretics. 2. A history of seasonal allergies currently treated with antihistamines. 3. A history of angioedema after taking enalapril (Vasotec) 4. A history of alcoholism, currently abstaining.
A history of angioedema after taking enalapril (Vasotec)
b. 0.5 to 2.0 ng/mL
A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin? a. 0.1 to 1.5 ng/mL b. 0.5 to 2.0 ng/mL c. 1.0 to 2.5 ng/mL d. 2.0 to 4.0 ng/mL
What is epistaxis?
A nosebleed
c. Have the client increase fluids and fiber in his diet.
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do? a. Call the health care provider to change the medication. b. Tell the client to skip a dose of the medication. c. Have the client increase fluids and fiber in his diet. d. Administer an enema to the client.
d. Client stating that pain is 0 out of 10
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure 120/80 mm Hg b. Heart rate 70 beats per minute c. ECG without evidence of ST changes d. Client stating that pain is 0 out of 10
c. Administer the medication into subcutaneous tissue.
A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention? a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle. b. Utilize the Z-track method to inject the medication. c. Administer the medication into subcutaneous tissue. d. Rub the administration site after injecting.
A month or longer
A patient experiencing moderate depression is placed on sertraline (Zoloft). The nurse should counsel the patient to expect full effects from the drug in: a. 2-3 days b. 1 week c. A month or longer d. Within 24 hours after starting the drug
Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra), Cealis, or Levitra bc these drugs together can cause very low blood pressure and heart attack.
The nurse has received change-of-shift report about all of these patients on the telemetry unit. Which patient should the nurse see first?
A patient whose ICD fired three times today who is scheduled for a dose of amiodarone (Cordarone)
A patient is admitted to the hospital in hypertensive crisis (BP 243/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be appropriate for this patient? (select all that apply) a. measuring hourly urine output b. decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an intraarterial line d. maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status
A, C, E
A can donate blood to
A,AB
Which of the following nursing responsibilities are priorities when caring for a patient returning from a cardiac catherization (select all that apply)? a. monitoring vital signs and ECG b. checking the catheter insertion site and distal pulses c. assisting the patient to ambulate to the bathroom to void d. informing the patient that he will be sleeping from the general anesthesia e. instructing the patient about the risks of the radioactive isotope injection
A,B
Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults (select all that apply)? A) a. Arterial stiffening B) b. Increased blood pressure C) c. Increased maximal heart rate D) d. Decreased maximal heart rate E) e. Increased recovery time from activity
A,B,D,E
AB can donate blood to
AB
what blood type is the universal recipient
AB
The universal recipient is
AB+
What blood group is the universal receiver?
AB; AB can receive blood from O,A,B,AB.
Adverse reaction: Factor VIII (8)
ALLERGIC & FEBRILE reactions
conductivity
Ability of the heart muscle fibers to propagaqte electrical impulses along and across cell membranes
ACT
Activated Clotting Time
What is a good diagnosis for someone with right sided HF?
Activity intolerance
type of reaction: incompatibiltiy of blood
Acute Hemolytic reaction
What should be done immediately for someone with PE?
Administer 100% O2, left trendelenburg position, heparin administered, and oral warfarin started (give heparin and warfarin together for at least 5 days).
When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
What drug can you give to decrease aldosterone levels?
Aldactone (Spiro) potassium sparing
type of reaction: hypersensitivity to antibodies in donor's blood
Allergic reaction
suicidal ideation
Always ask pt about this before giving antidepressant. Children at greatest risk for this.
Tissue perfusion is dependent on what?
An adequate CO (changes according the body's needs)
What is pericarditis?
An inflammation of the pericardium. It may result in MI.
Symptoms: hypotension, dyspnea, decreased oxygen saturation, flushing
Anaphlaxsis
ACE
Angiotensin Converting Enzyme
ABI
Ankle Brachial Index
When auscultating the chest of a 75-year-old pt who recently experienced a myocardial infarction (MI), the nurse hears an S3 heart sound immediately following S2. Because of these findings, the nurse would assess for which other condition? 1. heart failure 2. extension of the MI 3. renal failure 4. liver failure
Answer: 1
When auscultating heart sounds, the pt is asked to lie on the left side, then sit up & lean forward. What is the rationale for this action? 1. The heart is closer to the chest wall. 2. It diminishes the effect of respiratory sounds during auscultation. 3. Use of the stethoscope diaphragm improves auscultation of high pitched murmurs. 4. Use of the bell side of the stethoscope allows low pitched sounds to be readily identified.
Answer: 1 Rationale 1: Asking the pt to lie on the left side, then sit & lean forward brings the heart closer to the chest wall & enhances auscultation. Rationale 2,3,4: The other options are not correct rationales for this action.
Upon auscultating the chest of a 75-year-old pt who recently experienced a myocardial infarction (MI) the nurse hears an S3 & lung crackles. Because of these findings, the nurse would assess for which other condition? 1. heart failure 2. extension of the MI 3. renal failure 4. liver failure
Answer: 1 Rationale 1: S3 & lung crackles are indications of heart failure. Rationale 2: Manifestations of MI extension include chest pain & a return of positive lab finding (CPK-MB & troponin). Rationale 3: Renal failure is a late complication of heart failure & is not manifested with an S3 & crackles. Rationale 4: Liver failure is not manifested with an S3 & crackles.
Place the following statement regarding cardiac catheterization in the correct order. Choice 1. Peripheral IV insertion. Choice 2. Catheter insertion in the leg. Choice 3. Thread catheter to heart chamber. Choice 4. Inject contrast. Choice 5. Heart activity is filmed
Answer: 1,2,3,4,5
Determine the ejection fraction (EF) of a pt whose stroke volume (SV) is 75 mL/beat & whose end-diastolic volume is 120 mL. Round to the nearest whole number & place the answer below. ____
Answer: 63 Rationale : The ejection fraction is the stroke volume divided by the end-diastolic volume & represents the fraction or percent of the diastolic volume that is ejected from the heart during systole. The normal ejection fraction ranges from 50% to 70%. Dividing 75 mL/beat by 120 mL equals 63%.
What are the S&S of pulmonary embolism?
Anxiousness, restlessness, tachycardia, tachypneic, 90% SP02, dyspnea, substernal pain, coughing, hemoptysis, and fever.
What landmarks should you be looking for on someone's chest?
Aortic valve, Pulmonic valve, right ventricle, tricuspid valve, and apex or mitral valve.
Buerger's Disease and Raynaud's Disease are both what types of disorders.
Arterial
What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90, Amplitude: 4+=strong and bounding, Edema: 0=none, Reflex 2+
What should you do when applying a femoral artery compression device?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg, wash hands and put on sterile gloves, gown, and mask, position device, check circulation and make sure good pedal pulse is present, IMMEDIATELY REPORT SEVERE PAIN THAT MAY INDICATE RETROPERITONEAL BLEEDING OR A PSEUDOANEURYSM, SUCH AS ABD/FLANK/OR BACK PAIN.
Which of these nursing actions in the care plan for a patient who had a repair of an abdominal aortic aneurysm 5 days previously is most appropriate for the nurse to delegate to an experienced nursing assistant?
Assist the patient in using a pillow to splint while coughing.
A few days after an acute MI, a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first?
Auscultate the heart sounds.
1 hr
Avoid antacids, coffee, tea, dairy products or whole grain breads for ___ after oral iron administration
The nurse is caring for a patient who is two days post-MI. The patient reports that she is experiencing chest pain. She states "it hurts when I take a deep breath." Which of the following actions would be a priority? a. Notify the physician STAT and obtain a 12-lead ECG b. obtain vital signs and auscultate for a pericardial friction rub c. Apply high-flow oxygen by face mask and auscultate breath sounds d. Medicate the patient with PRN analgesic and reevaluate in 30 minutes
B
The nurse is providing teaching to a patient recovering from an MI. Discussion regarding resumption of sexual activity should be A) a. Delegated to the primary care provider. B) b. Discussed along with other physical activities. C) c. Avoided because it is embarrassing to the patient. D) d. Accomplished by providing the patient with written material.
B
The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets that this rhythm is which of the following? A) a. Sinus tachycardia B) b. Atrial fibrillation C) c. Ventricular fibrillation D) d. Ventricular tachycardia
B
The portion of the vascular system responsible for hemostasis is the a. thin capillary vessels b. endothelial layer of the arteries c. elastic middle layer of the veins d. smooth muscle of the arterial wall
B
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which of the following ECG changes is most indicative of prolonged or complete coronary occlusion? A) a. Sinus tachycardia B) b. Pathologic Q wave C) c. Fibrillatory P waves D) d. Prolonged PR interval
B The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.
B can donate blood to
B,AB
B can recieve blood from
B,O
What factors place you at risk for HTN?
BIRTH CONTROL PILL (LEADING CAUSE OF HTN IN YOUNG WOMEN-45=STILL YOUNG), BLACK MALE (then white male, than black female, then white female), obesity, smoking, stress, high Na diet, lack of exercise, age, sex, race, or noncompliance.
What is secreted by the ventricular tissues in the heart when ventricular volumes and pressures in the heart are increased?
BNP- B-type natriuretic peptide (sensitive indicator for HF, can be positive for HF when the CXR does not indicate a problem)
postural (orthostatic) hypotension
BP decrease of more than 10 -15 mm Jg of the systolic pressure or a decrease of more the 10 mm Hg of the diastolic pressure and a 10% to 20% increase in HR. Occurs when BP is not maintained from a lying position to sitting or stand position.
What is labile hypertension?
BP is elevated or decreased depending on activity.
What equipment do you need for admin blood products?
Blood; tubing with filter; 19- gauge needle for venous access
A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate- 74 and regular; ventricular rate- 62 and irregular: p wave- normal shape; PR interval-lengthens progressively until a P wave is not conducted; QRS-normal shape. The priority nursing intervention would involve a. performing synchronized cardioversion b. administering epinephrine 1 mg IV push c. observing for symptoms of hypotension or angina d. preparing the patient for a transcutaneous pacemaker
C
A patient with a tricuspid valve disorder will have impaired blood flow between the: a. vena cave and right atrium b. left atrium and left ventricle c. right atrium and right ventricle d. right ventricle and pulmonary artery
C
The most common finding in individuals at risk for sudden cardiac death is a. aortic valve disease b. mitral valve disease c. left ventricular dysfunction d. atherosclerotic heart disease
C
The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says, a, "I should not eat any red meat such as beef, pork, or lamb." b. "I should have some type of fish at least 3 times a week." c. "Most of my fat intake should be from olive oil or the oils in nuts." d. "If I reduce the fat in my diet to about 5% of my calories, I will be much healthier."
C
The nurse is caring for a patient admitted with emphysema, angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which of the following adverse effects is this patient at risk for given the patient's health history? A) a. Hypocapnia B) b. Tachycardia C) c. Bronchospasm D) d. Nausea and vomiting
C
The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which of the following nursing interventions is most appropriate at this time? A) a. Reinforcing the pressure dressing as needed B) b. Encouraging range-of-motion exercises of the involved arm C) c. Assessing the incision for any redness, swelling, or discharge D) d. Applying wet-to-dry dressings every 4 hours to the insertion site
C
The nurse is monitoring the ECG of a patient admitted with ACS. Which of the following ECG characteristics would be most suggestive of ischemia? a. sinus rhythm with a pathologic Q wave b. sinus rhythm with an elevated ST segment c. Sinus rhythm with a depressed ST segment d. sinus rhythm with premature atrial contractions
C
When assessing the cardiovascular system of a 79-year-old patient, you might expect to find a. a narrowed pulse pressure b. diminished carotid artery pulses c. difficulty in isolating the apical pulse d. an increased heart rate in response to stress
C
Which of the following statements best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? A) a. The length of time it takes to depolarize the atrium B) b. The length of time it takes for the atria to depolarize and repolarize C) c. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers D) d. The length of time it takes for the electrical impulse to travel from the SA node to the AV node
C
When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be which of the following? A) a. 60 Beats/min B) b. 75 Beats/min C) c. 100 Beats/min D) d. 150 Beats/min
C Since each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).
In which patients do you hear crackles?
CHF, pulmonary edema
HF results from problems such as what
Cardiomyopathy, valvular heart disease, endocarditis, acute MI, HTN
CVP
Central Venous Pressure
What do you need to teach your client about pacemakers?
Check pulse daily, wear ID card, avoid electromagnetic fields, avoid MRI's, avoid contact sports, may set off airport alarms
What does the Allen test do and how performed
Checks for alternative circulation. pt makes fist, apply pressure to ulnar and radial at same time, hand should blanch. Then release only from ulnar and assess. Pink should return if positive.
CVI
Chronic Venous Insufficiency
What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
d. To suppress platelet aggregation
Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy? a. To dissolve the blood clot b. To decrease tissue necrosis c. To inhibit hepatic synthesis of vitamin K d. To suppress platelet aggregation
What should be done immediately if a pulmonary embolism is suspected?
Close the open catheter lumen with the clamp, and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts to become cyanotic you administer 100% oxygen and page a surgeon (O2 causes nitrogen in the air embolus to dissolve into the blood).
When arterial blood isn't getting to the tissues, what S/S?
Coldness, numbness, decreased peripheral pulses, atrophy, bruit, skin/nail changes, and ulcerations.
Circulatory Overload to blood transfusion S/S
Congestive HF, Hypertension, Bounding pulse, Distended neck veins- monitor I & O, infuse blood slowly, give diuretics.
What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A pt is scheduled for a cardiac ejection fraction (EF) study. Correct facts that guide pt teaching include which of the following? Select all that apply. 1. Stroke volume times heart rate equals cardiac output. 2. The effectiveness of the pumping action of the heart is evaluated. 3. The study measures the percentage of blood in the ventricle ejected during a heartbeat. 4. The normal ejection fraction is 95-100%. 5. The study identifies the ischemic areas of the heart.
Correct Answer: 1,2,3 Rationale 4: The normal ejection fraction is 50-75%. Rationale 5: An ischemic area of the heart is not identified during an EF study.
What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
What test is required for the administration of packed red blood cells?
Crossmatching
In reviewing medication instructions with a patient being discharged on antihypertensive medications, which of the following statements would be most appropriate for the nurse to make when discussing atenolol (Tenormin)? A) a. "A fast heart rate is a side effect to watch for while taking atenolol." B) b. "Stop the drug and notify your doctor if you experience any nausea or vomiting." C) c. "Because this drug may affect the lungs in large doses, it may also help your breathing." D) d. "Make position changes slowly, especially when going from a lying down to a standing position."
D
In teaching a patient with hypertension about controlling the condition, the nurse recognizes that a. all patients with elevated BP require medication b. it is not necessary to limit salt in the diet if taking a diuretic c. obese persons must achieve a normal weight in order to lower BP d. lifestyle modifications are indicated for all persons with elevated BP
D
The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that a. defibrillation requires a lower dose of electrical charge b. cardioversion is indicated to treat atrial bradydysrhythmias c. defibrillation is synchronized to deliver a shock during the QRS complex d. patients should be sedates if cardioversion is done on a non-emergency basis
D
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which of the following food choices? A) a. Baked flounder B) b. Angel food cake C) c. Baked potato with margarine D) d. Canned chicken noodle soup
D
Which of the following instructions given to a patient who is about to undergo Holter monitoring is most appropriate? A) a. "You may remove the monitor only to shower or bathe." B) b. "You should connect the monitor whenever you feel symptoms." C) c. "You should refrain from exercising while wearing this monitor." D) d. "You will need to keep a diary of all your activities and symptoms."
D A Holter monitor is worn for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.
What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
What do beta blockers do to the workload of the heart?
Decrease
What are washed red blood cells?
Depleted of: -Plasma -Platelets -Leukocytes
Pacemakers do what to the heart muscle causing a contraction to occur when electricity goes through the muscle?
Depolarize
What are the S&S of air embolism?
Difficulty breathing, pain in midchest and shoulder, pale, nausea, and light headedness.
What circulation should you assess for with A-line in place and how
Distal (5-P's: Pulselessness, Pallor, Pain, Paresthesia, Paralysis)
What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Give Ritalin in the morning. do not give Ritalin after 4pm.
Do not give Ritalin after ?
What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Don a protective gown, gloves, and goggles, call Dr, hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration, have another nurse firmly press on his nose just below bony part (apply pressure at least 10 mins), apply ice packs to lips, back of neck, and forehead to help stop bleeding.
Treatment for Acute Coronary Syndrome
Drugs for chest pain: -oxygen -aspirin (chewable works fastest) -nitro -morphine Head up position to decrease workload on heart and increase cardiac output
What would make someone more at risk for digoxin toxicity?
Elderly, hypothyroidism, renal dysfunction, dehydration, HYPOKALEMIA, hypomagnesemia, or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
The nurse performing a cardiovascular assessment observes splinter hemorrhages. The nurse should evaluate this client for which of the following?
Endocarditis
ET
Endothelin (vasoconstrictor)
EVAR
Endovascular Aneurism Repair
Seasonal Affective Disorder (SAD)
Enhanced release of melatonin due to lower light levels
What will a CXR likely show if a pt has HF?
Enlarged heart, pulmonary infiltrates/fluid/edema
Left-sided HF has these S/S?
Enlarged organs, edema, weight gain, distended neck veins, ascites
If the first shock doesn't work and the client remains in VFIB, what is the first vasopressor we give?
Epinephrine
If the first shock does not work, what do we give patient?
Epinephrine (or might give Lidocaine)
kidneys
Erythropoietin is produced in the _________
Hemosiderosis
Excess iron in body tissue
Hemochromatosis
Excess iron storage resulting in cell damage
What should you teach a patient regarding discharge after a DVT?
Exercise and use graduated compression devices as directed, don't stand for long period of time, to avoid dislodging blood clots don't rub or massage your legs.
What are the four types of pulmonary emboli?
Fat, Air, DVT, or Amniotic
What are the S&S associated with right sided heart failure?
Fatigue, JVD, Increased peripheral venous pressure, ascites, anorexia/complaints of GI distress, cyanosis, and dependent edema.
type of reaction: antibodies to donor platelets or leukocytes
Febrile reaction
Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
20, 3
For iron injections, use a _______ guage, ___ inch needle
Hemolytic reaction to blood transfusion S/S
Headache, Chest pain, Anxiety, Lower back pain, Hypotenstion, Tachycardia, Tachypnea, Hemoglobinemia, Bronchospasm, Vascular collapse,- Stop transfusion.
HR
Heart Rate
Cardiac Output
Heart Rate (HR) x Stroke Volume (SV) -tissue perfusion is dependent on an adequate cardiac output -CO changes according to the body's needs
Factors that affect cardiac output
Heart rate and certain arrhythmias Blood volume Decreased contractility (MI, medication, muscle disease)
Following an AMI, a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response, which of these assessment data would indicate that the exercise level should be decreased?
Heart rate increases from 66 to 90 beats/min.
What should you observe for in someone on bleeding precautions?
Hematuria (tea or coca cola colored), nosebleeds, gingival bleeding (no medicated mouth wash, flossing, or lemon glycerin swabs), and bruising (assess for abuse w/o caregiver).
HIT
Heparin Induce Thrombcytopenia
can you be on Heparin and Coumadin at same time and why
Heparin must be tapered slowly and you usually would go home on Coumadin
A patient with a non-ST segment elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin?
Heparin will prevent the development of clots in the coronary arteries.
Adverse reaction: Prothrombin
Hepatitis risk greater than WHOLE blood; ALLERGIC & FEBRILE reactions
For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs, aortic/mitral regurgitation murmurs). DIAPH(high)ragm
HRT
Hormone Replacement Therapy
pt w/ multiple myeloma becomes confused & lethargic, which indicates
Hypercalcemia
What signals an elevated venous pressure based on the internal jugular veins?
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
What causes essential/primary hypertension?
Idiopathic
When should you not use TED hose or SCDs
If a clot is KNOWN
When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
How long before a transfusion should IV medications be given?
Immediately before
Blood transfusion reactions: Likely Time of occurrence: Allergic reaction/Hypersensitivity
Immediatley or within 24 hours
What does unstable chronic angina lead to?
Impending MI
What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
The nurse developing a teaching plan for a client receiving thiazide diuretics should include the following. Teaching the client to take apical pulse. Decreasing potassium-rich foods in the diet. Including citrus fruits, melons, and vegetables in the diet. Teaching the client to check blood pressure t.i.d.
Including citrus fruits, melons, and vegetables in the diet. Rationale: Thiazide diuretics are potassium wasting, and levels should be closely monitored. Encouraging foods rich in potassium could help maintain potassium levels. Taking an apical pulse is indicated before administering cardiac glycosides and beta blockers. It would not be necessary to check blood pressure TID unless the client was experiencing hypotension.
Blood transfusion reactions: cause of Acute Hemolytic reaction
Incompatibility
Buerger's disease and treatment
Inflammation of arteries and veins; males mostly. Causes: Heavy smoking, cold, emotions (causes vasoconstriction of vessels; lower extremities/sometimes fingers) AVOID causes: Cold, shoes that don't fit, smoking, dehydration, shoes that don't fit, foot trauma
What things should you do to assess cardiovascular status?
Inspect pulses on chest, inspect the internal jugular veins, palpate the apical pulse, palpate the carotid arteries, and auscultate the heart sounds.
Postpartum Depression
Intense mood changes associated with hormonal changes
INR
International Normaliized Ratio
ICP
Intracranial pressure
IOP
Intraoccular pressure
Pernicious Anemia- Nursing Care
Intrinsic factor missing resulting in an inability to absorb vitamin B12- S/S: smooth, Beefy Red Tongue.- Tx: injection of Cyanocobalamin (vit. B12) weekly, than monthly to maintain.
Test ending in Gram=?
Iodine
What should you teach your patient about an electrocardiogram (ECG)?
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still, relax, and breathe normally and remain quiet. Talking or moving distorts the images
What are the proper steps to changing a central venous catheter dressing?
It is a sterile procedure so both nurse and patient should wear a mask, arrange sterile field, remove dressing, assess the catheter insertion site for infection, put on sterile gloves, clean the site moving outwardly in a circular motion, apply a skin prep or protectant, allow it to air dry then cover the site with a sterile dry occlusive dressing.
What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising, eating large meal, or feeling stress. Also very hot or cold weather).
What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
How should a pt store Nitroglycerin?
Keep in a dark, glass bottle; dry, cool
Blood transfusion reactions: cause of circulatory overload
Large volume over short time
hemolytic
Lead poisoning can cause _____________ anemia
LVH
Left Ventricle Hypertrophy
Where is the right ventricle landmark on the chest?
Left sternal border
What is intermittent claudication?
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
What activity should a patient with pericarditis, who is undergoing treatment, be allowed?
Maintain BED REST
The nurse has identified the collaborative problem of potential complication: pulmonary embolism for a patient with left-calf DVT. Which nursing action is appropriate to include in the plan of care?
Maintain bed rest as ordered.
Complications of Fibrinolytic therapy
Major complication is bleeding -Obtain a good bleeding hx (recent surgery, pregnant, stroke, bleeding ulcer?) -During and after administration we take bleeding precautions
False
Massage after injecting iron. t/f
MAP
Mean Arterial Pressure SBP + 2DBP = MAP
lithium (Eskalith)
Medication use for Mania symptoms of bipolar
What is the Tx for ACS: MI, UA?
Mona (morphine, O2, nitro and ASA), fibrinolytics, interventions like PCI or CABG, cardiac rehabilitation, pacemaker (temp or permanent)
What do you need to do after a cardiac catheterization?
Monitor VS, watch puncture site and distal extremity, bedrest, flat, leg straight for 4 to 6 hrs, report pain ASAP, watch for Hem.
TESTING STRATEGY RULE:
NEVER leave an UNSTABLE client.
Can you put medicine in an A-line?
Never. It can cause thrombosis.
Calcium Channel Blocker Examples
Nifedipine (Procardia XL) Verapamil (Calan) Amlodipine (Norvasc) Diltiazem (Cardizem)
NSTEMI
Non-Elevation ST Segment Myocardial Infarction These patients are usually less worrisome
NE
Norepinephrine
Myoglobin
Not as specific...can be other muscles not specific to just the heart -Increases within 1 hour and peaks in 12 hours -negative results are a good thing
The universal red blood cell donor is
O-
What blood group is the universal donor? Who can it act as a donor to?
O; O donates to O,A,B,AB.
Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
The Nurse is assessing a client who has a low-pitches murmur. What is the most appropriate way for the nurse to position the client to auscultate this murmur
On the left lateral side using the bell of the stethoscope.
What do calcium channel blockers do?
Open up blood vessels
What is a narrow pulse pressure?
PP<40 (but know baseline)
What are the S/S of ACS/MI/UA?
Pain, cold/clammy/BP drops, CO is going down, WBC's and temp increase, ECG changes, vomiting (due to pain)
What are the S&S of aortic dissection?
Pallor, diaphoresis, tachypnea, severe tearing chest pain radiating to back, PULSES IN ARMS ARE STRONG BUT LEG PULSES ARE WEAK, low SP02.
What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, BLOOD TINGED SPUTUM, cough, orthopnea, exertional dyspnea, cyanosis.
What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. THE LPN CAN DO THIS!
the amount of blood returning to the heart
Preload Look at "re" in pre and remember that is returning blood
What is characteristic of premature ventricular contractions?
Premature beats that are not preceded by a P-wave, QRS is wide and bizarre, and the T wave of the premature beat is generally large and in the opposite direction of the QRS.
Hypermagnesemia &hyperkalemia
Prolonged P-R interval
Beta Blocker Examples
Propranolol (Inderal) Metroprolol (Lopressor/Toprol XL) Atenolol (Tenormin) Carvedilol (Coreg)
What is the antidote for heparin?
Protamine Sulfate
PA
Pulmonary Artery
What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Adverse reaction: Packed red cells
Reactions less common than with WHOLE bloood
What test is required for the administration of plasma products?
Rh compatibility and ABO compatibility
Hypokalemia
S-T depression
heart's natural pacemaker
SA node. It sends out impulses that make the heart contract
venlafaxine, Effexor
SNRI. an atypical antidepressant; off labeled use for hot flashes associated with menopause.
What type of EKG change indicates MI?
ST segment elevation (STEMI)
Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Where is the aortic valve landmark on the chest?
Second right intercostal space
The nurse reviews lab studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include a Serum sodium level of 140 mEq/L. Serum digoxin level of 1.2 ng/dL. Serum potassium level of 3.0 mEq/L. Hemoglobin 14.4 g/dL.
Serum potassium level of 3.0 mEq/L. Rationale: Normal serum potassium level is 3.5-5.0 mEq/L. Hypokalemia may predispose the client to digitalis toxicity. The other lab values are WNL.
The nurse is performing a cardiovascular assessment. To evaluate the client for pulmonary edema the nurse would assess the client for which manifestation?
Shortness of Breath
The client is prescribed a beta-blocker as adjunct therapy to treatment of heart failure. The nurse recognizes that beta blockers act by Increasing contractility and cardiac output. Decreasing preload. Slowing the heart and decreasing afterload. Decreasing peripheral resistance
Slowing the heart and decreasing afterload. Rationale: Beta-blockers improve symptoms of HF by slowing heart rate and decreasing blood pressure. The decreased afterload causes decreased workload on the heart.
What is included in cardiac rehabilitation?
Smoking cessation, increase activity gradually, diet changes (low fat, low salt, low cholesterol), no iso exercises, no valsalva , no suppositories
What are common risk factors for an MI?
Smoking, elevated cholesterol, diabetes, hypertension, old age, and family hx of coronary artery disease.
When performing a dietary history on a client with a cardiovascular history, the nurse should obtain information related to which items?
Sodium intake
15
Stay with client for 1st ____ min of blood transfusion
What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
What are some fibrinolytics used to treat an MI?
Streptokinase (Streptase), Altepase (t-PA), Tenecteplase (TNKase) [one time push], Reteplase (Retavase)
Amount of blood pumped out of the ventricles with each beat?
Stroke volume
SVT
Superficial VeinThrombosis
SNS
Sympathetic Nervous System
SVR
Systemic Vascular Resistance
SBP
Systolic Blood Pressure
St. John's wort
Taking ____ with an MAOI could result in hypertensive crisis; patients should always consult with their health care provider before taking any medications or OTC drugs/herbal remedies.
Hypomagnesemia
Tall T waves
Hyperkalemia
Tall, peaked T waves
What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION, and if the client is symptomatic and showing S&S of decreased cardiac output, GIVE ATROPINE.
To detect the presence of an ascending aortic aneurysm, the nurse would palpate which area on the client's chest? Select the correct area
The A: Aortic valve
Preload
The amount of blood returning to the heart
a. Administer an additional dose of warfarin (Coumadin).
The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take? a. Administer an additional dose of warfarin (Coumadin). b. Hold the next dose of warfarin (Coumadin). c. Increase the heparin drip rate. d. Administer protamine sulfate.
a. Increase the serum digoxin sensitivity level
The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin? a. Increase the serum digoxin sensitivity level b. Decrease the serum digoxin sensitivity level c. Not have any effect on the serum digoxin sensitivity level d. Cause a low average serum digoxin sensitivity level
Where should you place your stethescope to find the ERB's Point?
(S1, S2) Third left intercostal space
afterload
The force the heart has to pump (peripheral resstance) to eject blood from the left ventricle.
d. "I should use a soft toothbrush for dental hygiene."
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? a. "I will double my dose if I forget to take it the day before." b. "I should keep taking ibuprofen for my arthritis." c. "I should decrease the dose if I start bruising easily." d. "I should use a soft toothbrush for dental hygiene."
a. Beta1 blocker
The nurse explains that which beta blocker category is preferred for treating hypertension? a. Beta1 blocker b. Beta2 blocker c. Beta1 and beta2 blockers d. Beta2 and beta3 blockers
c. Administer 2 mEq potassium chloride per kilogram per day IV.
The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention? a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. b. Administer Kayexalate. c. Administer 2 mEq potassium chloride per kilogram per day IV. d. Administer PhosLo, two tablets three times per day.
c. Beta blockers and ACE inhibitors
The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients? a. Diuretics b. Calcium channel blockers and vasodilators c. Beta blockers and ACE inhibitors d. Alpha blockers
d. Get up slowly from a sitting to a standing position.
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? a. Change the patch daily at the same time. b. Remove the patch before taking a shower or bath. c. Do not take other antihypertensive medications while on this patch. d. Get up slowly from a sitting to a standing position.
d. Chest pain
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? a. Blood pressure 110/90 mm Hg b. Flushing c. Headache d. Chest pain
b. Heart rate 58 beats per minute
The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate 110 beats per minute b. Heart rate 58 beats per minute c. Urinary output 40 mL/hr d. Blood pressure 90/50 mm Hg
d. spironolactone (Aldactone)
The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)
b. "Take this medication at the same time each day."
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include? a. "Take this medication on an empty stomach." b. "Take this medication at the same time each day." c. "Take this medication with breakfast." d. "Take this medication with an antacid."
c. Bleeding may increase when taken with aspirin.
The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.
a. 150 to 200 mg/dL
The nurse knows that the client's cholesterol level should be within which range? a. 150 to 200 mg/dL b. 200 to 225 mg/dL c. 225 to 250 mg/dL d. Greater than 250 mg/dL
b. hydrochlorothiazide
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? a. chlorthalidone b. hydrochlorothiazide c. bendroflumethiazide d. potassium-sparing diuretic
b. Administer aspirin 30 minutes before nicotinic acid.
The nurse plans which intervention to decrease the flushing reaction of niacin? a. Administer niacin with an antacid. b. Administer aspirin 30 minutes before nicotinic acid. c. Administer diphenhydramine hydrochloride (Benadryl) with niacin. d. Apply cold compresses to the head and neck.
b. To administer digoxin immune FAB (antidote)
The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? a. To administer atropine b. To administer digoxin immune FAB c. To administer epinephrine d. To administer Kayexalate
c. Client is on oral contraceptives.
The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? a. Client takes medications with grape juice. b. Client takes herbal therapy including kava kava. c. Client is on oral contraceptives. d. Client was started on penicillin for a respiratory infection.
Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?
The patient indicates that the pain is resolved after taking one sublingual nitroglycerin tablet.
What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC); which information obtained by the nurse is most relevant?
The patient's 29-year-old brother has had a sudden cardiac arrest.
diastole
The phase of the cardiac cycle in which the heart relaxes between contractions.
The maintenance dose of ASA is determined by who?
The physician (usually 81 mg-325 mg)
What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
What should you tell a patient who developed a hematoma in the hospital and is being discharged?
To report to her healthcare provider if she feels a large bump in her groin, if she has groin pain unrelieved by acetaminophen, or if she develops numbness, tingling, etc. in the affected leg.
What is characteristic of ventricular fibrillation?
Totally disorganized, chaotic pattern, and no discernible waves or complexes.
How do you position a pt with PE and why and how can you prevent PE in the future?
Upright position, legs down; Improves CO, promotes pooling of blood in lower extremities. To prevent in the future, check lung sounds, avoid FVE
Allergic reaction to blood transfusion S/S
Urticaria, Itching, Respiratory distress, Anaphylaxis - pretreat with antihistamine
What is the proper way to access and implanted venous access port (IVAP) (Mediport)?
Use sterile gloves and aseptic technique, clean skin over port with alcohol or iodine, insert a 21 or 22 gauge HUBER needle (noncoring-won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpable, aspirate for blood return to confirm placement then infuse drug, afterward flush port with saline solution and heparin and remove needle.
The client has a history of aortic stenosis and an S3 murmur. What action would the nurse take to auscultate this murmur?
Use the bell of the stethoscope.
What is the infusion time for 1 unit of packed red blood cells?
Usually between 2 and 4 hours
What is the infusion time for platelets?
Usually given rapidly, over 15 to 30 minutes
What untreated arrhythmias will put the client at risk for sudden death?
VFIB (you need to defib the VFIB)
What are some serious cardiac rhythms that make you pulseless?
VTACH, VFIB, Asystole
VTE
Venous Thromboembolism
What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
What are examples of calcium channel blockers?
Verapamil (calan), diltiazem (cardizem), nifedipine (procardia), amlodipine (norvasc).
S/S of HF
Weight gain, ankle edema, SOB, confusion
b. Apply the ointment to a nonhairy part of the upper torso.
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? a. Use the fingers to spread the ointment evenly over a 3-inch area. b. Apply the ointment to a nonhairy part of the upper torso. c. Massage the ointment into the skin. d. Cover the application paper with ointment before use.
allergic
What type blood transfusion reaction manifests in pruritus, respiratory distress,urticaria, and flushing
b. Headaches
When a client first takes a nitrate, the nurse expects which symptom that often occurs? a. Nausea and vomiting b. Headaches c. Stomach cramps d. Irregular pulse rate
What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
b. Elevated liver function tests
Which assessment finding in a client taking an HMG-CoA reductase inhibitor will the nurse act on immediately? a. Decreased hemoglobin b. Elevated liver function tests c. Elevated HDL d. Elevated LDL
b. Crackles in the lungs
Which assessment finding will alert the nurse to possible toxic effects of amiodarone? a. Heart rate 100 beats per minute b. Crackles in the lungs c. Elevated blood urea nitrogen d. Decreased hemoglobin
a. Loss of appetite with slight bradycardia
Which assessment finding will alert the nurse to suspect early digoxin toxicity? a. Loss of appetite with slight bradycardia b. Blood pressure 90/60 mm Hg c. Heart rate 110 beats per minute d. Confusion and diarrhea
c. A 47-year-old client with anuria
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)? a. A 67-year-old client with type 1 diabetes mellitus b. A 21-year-old client with a head injury c. A 47-year-old client with anuria d. A 55-year-old client receiving cisplatin to treat ovarian cancer
a. Alteration in cardiac output related to effects on the sympathetic nervous system
Which is a priority nursing diagnosis for a client taking an antihypertensive medication? a. Alteration in cardiac output related to effects on the sympathetic nervous system b. Knowledge deficit related to medication regimen c. Fatigue related to side effects of medication d. Alteration in comfort related to nonproductive cough
b. Fasting blood glucose level of 140 mg/dL
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L
c. Risk for injury
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy? a. Potential for fluid volume excess b. Potential for pain c. Risk for injury d. Potential for body image disturbance
Diarrhea and ataxia Hypotension and edema Slurred speech and muscle weakness
Which of the following symptoms would indicate to the nurse that a patient is experiencing lithium toxicity? (Select all that apply.) 1. Diarrhea and ataxia 2. Hypotension and edema 3. Hypertension and dehydration 4. Increased appetite, increased energy, and memory loss 5. Slurred speech and muscle weakness
Read labels of food and over-the-counter drugs.
Which of the following would be a priority component of the teaching plan for a patient prescribed * phenelzine (Nardil) for treatment of depression? a. Headache may occur. b. Hyperglycemia may occur. c. Read labels of food and over-the-counter drugs. d. Monitor blood pressure for hypotension.
a. "I will check my blood pressure daily and take my medication when it is over 140/90."
Which statement indicates that the client needs additional instruction about antihypertensive treatment? a. "I will check my blood pressure daily and take my medication when it is over 140/90." b. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." c. "I will change my position slowly to prevent feeling dizzy." d. "I will not mow my lawn until I see how this medication makes me feel."
b. "I will increase fiber in my diet."
Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)? a. "I will take Questran 1 hour before my other medications." b. "I will increase fiber in my diet." c. "I will weigh myself weekly." d. "I will have my blood pressure checked weekly."
5. The nurse explains that which beta blocker category is preferred for treating hypertension?
a. Beta1 blocker
2. The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?
a. Diuretic
7. When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what?
a. Inhibits absorption of dietary cholesterol in the intestines.
4. The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?
a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
The nurse finds a 76-year-old client's point of maximum impulse farther away from the fifth intercostal space, midclavicular line. What does this finding suggest to the nurse? a. The client has hypertension. b. The client had pneumonia. c. The client has benign prostatic hypertrophy. d. The client had a heart attack.
a. The client has hypertension.
The nurse notes a client's PR interval upon ECG is greater than 0.20 seconds. What can this information suggest to the nurse? a. The client's sinoatrial node is not pacing correctly. b. There is an elongated ventricular depolarization. c. It takes longer for the blood to leave the lungs and return to the heart. d. The client elongated ventricular is filling.
a. The client's sinoatrial node is not pacing correctly.
2. The nurse knows that the client's cholesterol level should be within which range?
a.150 to 200 mg/dL
3. A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life?
a.A longer half-life than heparin
1. When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)
a.Coronary thrombosis b.Acute myocardial infarction c.Deep vein thrombosis (DVT) d.Cerebrovascular accident (CVA) (stroke) e.Venous disorders
8. A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin? (Select all that apply.)
a.Have client lie down when taking a nitroglycerin sublingual tablet. b.Teach client to repeat taking a tablet in 5 minutes if chest pain persists. e.Warn client against ingesting alcohol while taking nitroglycerin.
5. The nurse acknowledges that which condition could occur when taking furosemide?
a.Hypokalemia
2. The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?
a.It is in the high (elevated) range
8. A client is diagnosed with peripheral arterial disease (PAD). He is prescribed isoxsuprine (Vasodilan). The nurse acknowledges that isoxsuprine does what? (Select all that apply.)
a.Relaxes the arterial walls within the skeletal muscles b.May cause hypotension, chest pain, and palpitations
2. A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?
a.protamine sulfate
Nadolol (Corgard) is prescribed for a patient with angina. In evaluating the effectiveness of the drug, the nurse will monitor for _________________
ability to do daily activities without chest discomfort.
Hemosiderosis
abnormal increase of iron in blood
Clomipramine (Anafranil)
are used to treat obsessive compulsive behavior. (OCD)
The nurse is listening to a client's heartbeat and is focusing on the second heart sound. Which heart valves produce this sound? a. Aortic and tricuspid b. Aortic and pulmonic c. Mitral and pulmonic d. Mitral and tricuspid
b. Aortic and pulmonic
The nurse feels pulsations on a client's right sternal border, second space. What does this finding suggest to the nurse? a. A prolapsed mitral valve b. Aortic stenosis c. Nothing. This is a normal finding. d. Tricuspid valve regurgitation
b. Aortic stenosis
A client has been diagnosed with pericarditis. Which layers of the heart are affected with this illness? a. Between the pericardium and the mediastinum b. Between the pericardium and the myocardium c. Between the myocardium and the mediastinum d. Between the myocardium and the endocardium
b. Between the pericardium and the myocardium
8. During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)
b. Dizziness c. Headache e. Ankle edema
7. The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
6. For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?
b. To increase the serum potassium level
4. The nurse realizes that which is the laboratory test ordered to determine the presence of the amino acid that can contribute to cardiovascular disease and stroke?
b. homocysteine
1. A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?
b.0.5 to 2.0 ng/mL
7. A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?
b.Blocking angiotensin II from AT1 receptors
5. When a client first takes a nitrate, the nurse expects which symptom that often occurs?
b.Headaches
7. The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?
b.Hyperkalemia
would sympathetic stimulators or sympathetic blockers help
blockers
A client has been diagnosed with a myocardial infarction that has damaged a part of the right atrium. Which of the following could happen as a result of this damage? a. Increase in collateral circulation b. Nothing c. A change in the rate and rhythm of the client's heartbeat d. Onset of aortic regurgitation
c. A change in the rate and rhythm of the client's heartbeat
4. The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?
c. Bleeding may increase when taken with aspirin.
A nurse, explaining the cardiac circulation to cardiac rehabilitation clients, wants to include the oxygenation of the heart muscle. Which of the following structures carries deoxygenated blood to the lungs? a. Right main coronary vein b. Pulmonary vein c. Pulmonary artery d. Great cardiac vein
c. Pulmonary artery
The nurse is instructing a client about his high cholesterol level and wants to include behavioral considerations. Which of the following should be included in this instruction? a. The need for annual flu inoculation b. The need for an annual cholesterol panel c. The need to stop smoking d. The need to reduce stress
c. The need to stop smoking
The nurse hears a heart sound right before S1 on a 72-year-old male client. What can this finding suggest to the nurse? a. Nothing. This is normal. b. This is an atrial kick and helps the heart beat better. c. This is an atrial gallop and can mean something is wrong. d. This is a ventricular gallop and is heard in healthy people.
c. This is an atrial gallop and can mean something is wrong. An S4 heard before S1 is termed an atrial gallop and may be associated with pathologic conditions such as myocardial infarction or heart failure.
10. A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?
c. Thrombolytic agent
6. The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
c.Decrease heart rate and decrease myocardial contractility
4. A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?
c.High-ceiling (loop) diuretic
2. What would cause the same client's electrolyte imbalance?
c.Hydrochlorothiazide
1. A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate?
c.Hyperlipidemia
1. A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?
c.Stage 1 hypertension
During the cardiac assessment, the nurse learns a client had rheumatic heart fever as a child. For which of the following cardiac conditions should this client be assessed? a. Pulmonic stenosis b. Aortic stenosis c. Mitral regurgitation d. Mitral stenosis
d. Mitral stenosis
3. A nurse is teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?
d. Serum glucose (sugar)
During the cardiac focused interview, the client tells the nurse he has smoked for 30 years. Which of the following would be appropriate for the nurse to respond to this client? a. High dose vitamin therapy reduces the risks of smoking. b. Exercise reduces the harmful effects of smoking. c. Do you also take recreational drugs? d. Smoking has been linked to high blood pressure and other heart problems.
d. Smoking has been linked to high blood pressure and other heart problems.
The nurse is calculating the cardiac output for a client with a heart rate of 88 beats per minute. What other measurements does the nurse need to complete this calculation? a. Cardiac index b. QT interval c. T wave d. Stroke volume
d. Stroke volume
During the examination of an eight-month-pregnant client, the nurse measures the blood pressure at 160/98 and notes bilateral edema of the ankles. What do these findings suggest to the nurse? a. This client is going into labor early. b. The client is in normal health. c. The client is hyperventilating. d. The client could be preeclamptic.
d. The client could be preeclamptic.
During the cardiac assessment, the nurse finds a client has jugular vein distention. What does this mean to the nurse? a. The client is fine. b. The client is dehydrated. c. The client has an infection. d. The client could have fluid overload.
d. The client could have fluid overload.
6. Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
d.Constant, irritating cough
5. A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?
d.Liver enzymes
3. The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
d.Pulse below 60 beats/min and irregular rate
5. A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?
d.Subcutaneously
8. Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?
d.To suppress platelet aggregation
In thrombocytopenia instruct pt to
dab nose instead of blowing
A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, the nurse will ask the patient about _________
difficulty swallowing.
three types of transfusion reactions that can occur
hemolytic febrile allergic
what do caffeine and smoking do to bp
increase it
in hypovolemic shock the LOC
is decreased
nursing management of sickle cell crisis
monitor CBC, blood transfusions if required & iron chelation (removes excess iron from body), pain management, oxygen therapy, rest as needed, DVT prophylaxis
Nursing interventions for severe anemia r/t petic ulcer disease
monitoring stools for guaiac & instructions for high iron diet
Nursing considerations: Platelets, what type of filter is used?
nonwettable filter
The health care provider writes the following admitting orders for a patient with suspected IE who has fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr, acetylsalicylic acid (ASA) for temperature above 102° F (38.9° C), and blood cultures ∗ 2, complete blood cell count (CBC), and electrocardiogram (ECG). When admitting the patient, the nurse gives the highest priority to ____________
obtaining the blood cultures.
what is the #1 side effect of anti htn
orthostatic hypotension
Three days after an MI, the patient develops chest pain that radiates to the back and left arm and is relieved by sitting in a forward position. On auscultation of the patient's chest, the nurse would expect to hear a ____________
pericardial friction rub.
How often should a pt renew their Nitroglycerin pills and spray?
pills: 3-5 months, spray: 2 years
When developing a plan to decrease preload in the patient with heart failure, the nurse will include actions such as ______________
positioning the patient in a high-Fowler's position with the feet horizontal in the bed.
PVC
premature ventricular contractions
What is the nursing consideration prevention before a allergic reaction or hypersensitivity occurs?
premedicate with antihistamines
While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of pain related to decreased coronary blood flow. An appropriate intervention by the nurse is to ___________
promote rest to decrease myocardial oxygen demand.
how often vs
q15
Elderly main symptom of MI
shortness of breath (could also have change in behavior)
Nursing considerations: Packed Red Cells, what type of filter is used?
standard blood filter
The nurse hears the cardiac monitor alarm and notes that the patient has a cardiac pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious with no pulse or respirations. After calling for assistance, the nurse should _______________
start basic cardiopulmonary resuscitation (CPR).
Priority nursing action for pt w/ new-onset temp (102.2ºF) & severe neutropenia
taking full set of VS & notifying MD immediately, drawing peripheral & central line blood cultures, admin prescribed antibiotics STAT, ongoing monitoring of VS for septic shock
htn is often fatal if untreated
true
when does the typing and cross matching need to be done?
whenever a client is to get a blood product. it is only good for 24 hours.
What are the 6 blood and blood products that can be given?
1.Packed red blood cells 2. Platelets 3. Plasma 4.Albumin 5.Prothrombin 6. Factor VIII (8)
If hemoglobin is less than ____ and hematocrit less than ___, autologous blood collection cannot happen
11 for hemoglobin; 33% for hematocrit
SSRIs
1st line of defense against depression
in reg pt, each unit is infused?
2 hours for each unit.
How does Morphine help PE?
2 mg IV push for vasodilation to decrease preload and afterload
To prevent septicemia, administration of packed red blood cells should not exceed
2 to 4 hours
Packed red blood cells can be given within
2-4 hours
A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving the therapeutic effect based on which of the following results?
2. Activated partial thromboplastin time of 60 seconds
A nurse is administering a dopamine infusion at a moderate dose to a client who has severe HF. Which of the following is an expected effect? 1. Lowered heart rate 2. Increased myocardial contractility 3. Decreased conduction through the AV node D. Vasoconstriction of the renal blood vessels
2. Increased myocardial contractility -- thus increasing CO
A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. concurrent use of which of the following medications places the client at risk for dig toxicity? 1. Phenytoin (Dilantin) 2. Verapamil (Calan) 3. Warfarin (Coumadin) 4. Aluminum hydroxide (Amphojel)
2. Verapamil (Calan) -- CCB, can increase digoxin levels. if used together dig dosage may need to be lowered.
black box warning
2004 FDA issued this. To be included at beginning of drug package inserts and drug information sheets. These warnings apply especially to children, who are at greater risk for suicidal ideation.
For an autologous donation, a donation can be made every how many days?
3 days, as long as the hemoglobin is within a safe range
Each unit of packed red blood cells increases the hemoglobin by
3% (The change in laboratory values takes 4-6 hours after the completion of the blood transfusion)
elderly blood transfusion should be over
3-4 hours
723. A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which of the following is a priority nursing intervention?
3. Monitor for signs of bleeding.
728. A client is being treated for acute congestive heart failure with intravenously administered bumetanide (Bumex). The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment?
3. Monitoring blood pressure
A nurse in a provider's office is monitoring serum electrolytes for 4 older adult clients who take digoxin(Lanoxin) & furosemide(Lasix). Which of the following electrolyte values puts a client at risk for dig toxicity? 1. Calcium 9.2 mg/dL 2. Calcium 10.3 mg/dL 3. Potassium 3.4 mEq/L 4. Potassium 4.8 mEq/L
3. Potassium 3.4 mEq/L
Erb's point
3rd intercostal space, left of sternum aortic and pulmonic murmurs
What class of New York HF is the worst (1-4)?
4 is the worst
Autologous blood transfusion can be collected pre-operativley how long before surgery
4-6 weeks
When are autologous transfusions collected?
4-6 weeks before surgery.
718. A nurse provides discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
725. A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
4. "I'll continue my nicotinic acid from the health food store."
726. A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions?
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
720. A client is being treated with procainamide (Procanbid) for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
4. Auscultate the client's apical pulse and obtain a blood pressure.
100/60 what is pulse pressure
40
what is normal pulse pressure
40 +/- 10
How is Lasix given to treat PE?
40 mg IV push over 1-2 mins to prevent hypotension and ototoxicity
A patient has a junctional escape rhythm on the monitor. The nurse would expect the patient to have a pulse rate of ____ beats/min.
40-60
Before assessing the client's carotid arteries for pulsations, the nurse would raise the client's head of bed to how many degrees elevation for proper position?
45 degrees
Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Autologous donations should begin within _______ of the transfusion date and end at least ______ before the date of transfusion
5 weeks 3 days
For each unit of platelets adminstered an increase of ______ is expected
5,000 to 10,000 cells/mm3
How soon should fibrinolytics be administered after the onset of myocardial pain?
6-8 hours (sooner the better)
How soon after the onset of myocardial pain should fibrinolytics be administered?
6-8 hrs
When analyzing an ECG rhythm strip of a patient with a regular cardiac rhythm, the nurse finds there are 25 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ______.
60
client is having a heart attack and the goal is to get them to cath lab when
<90min
The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which of the following mechanisms? A) a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. B) b. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. C) c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. D) d. Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.
A
Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are a. hypertension and cigarette smoking. b. obesity and smokeless tobacco use. c. elevated serum lipids and diabetes mellitus. d. physical inactivity and elevated homocysteine levels.
A
When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of a. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation b. chemoreceptors that inhibit the sympathethic nervous system causing vasodilation c. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation d. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate.
A
When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of A) a. Oxygen, nitroglycerin, aspirin, and morphine. B) b. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine. C) c. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen. D) d. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin).
A
A patient has sought care following a syncopal episode of unknown etiology. Which of the following nursing actions should the nurse prioritize in the patient's subsequent diagnostic workup? A) a. Preparing to assist with a head-up tilt-test B) b. Assessing the patient's knowledge of pacemakers C) c. Preparing an intravenous dose of a b-adrenergic blocker D) d. Teaching the patient about the role of antiplatelet aggregators
A A head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV b-blockers are not indicated and addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient education surrounding antiplatelet aggregators is not directly relevant to the patient's syncope.
For which of the following dysrhythmias is defibrillation primarily indicated? A) a. Ventricular fibrillation B) b. Third-degree AV block C) c. Uncontrolled atrial fibrillation D) d. Ventricular tachycardia with a pulse
A Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.
An increased susceptibility to infections
A 17-year-old male has started valproic acid (Depakene) for treatment of bipolar disorder. While he is taking this drug, he should be carefully monitored for: a. Unusual abdominal pain, especially in the upper quadrant areas b. An increased susceptibility to infections c. Lethargy or confusion d. Unusual bleeding or bruising
The nurse has just received change-of-shift report about these four patients. Which patient should the nurse assess first?
A 51-year-old who has just returned to the unit after a coronary arteriogram and PCI
c. Hypotension
A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication? a. Hypokalemia b. Dysrhythmias c. Hypotension d. Increased intracranial pressure
What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
b. Hepatic disease
A client diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor). The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history? a. Chronic pulmonary disease b. Hepatic disease c. Leukemia d. Renal disease
c. Hyperlipidemia
A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? a. Hypolipidemia b. Normolipidemia c. Hyperlipidemia d. Alipidemia
b. Administer protamine sulfate.
A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? a. Teach the client about the phenytoin. b. Administer protamine sulfate. c. Assess the INR before surgery. d. Administer vitamin K.
c. High-ceiling (loop) diuretic
A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug? a. Thiazide diuretic b. Osmotic diuretic c. High-ceiling (loop) diuretic d. Potassium-sparing diuretic
c. Thrombolytic agent
A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery? a. Anticoagulant agent b. Antiplatelet agent c. Thrombolytic agent d. Low-molecular-weight heparin (LMWH)
b. warfarin (Coumadin)
A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? a. enoxaparin sodium (Lovenox) b. warfarin (Coumadin) c. bivalirudin (Angiomax) d. lepirudin (Refludan)
b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record.
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor ECG continuously. f. Insert an arterial line for continuous blood pressure monitoring.
b. Respiratory assessment
A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client? a. Assessment of blood glucose levels b. Respiratory assessment c. Orthostatic blood pressure assessment d. Teaching about potential tachycardia
a. A longer half-life than heparin
A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life? a. A longer half-life than heparin b. A shorter half-life than heparin c. The same half-life as heparin d. A four-times shorter half-life than heparin
c. Muscle pain.
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse? a. Headache. b. Slight nausea. c. Muscle pain. d. Fatigue.
b. "You may experience headaches with this medication."
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client? a. "Take aspirin before the medication if you experience facial flushing." b. "You may experience headaches with this medication." c. "You will need to have weekly blood drawn to assess for hyperkalemia." d. "Cholesterol levels will need to be assessed daily for one week."
b. Blocking angiotensin II from AT1 receptors
A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what? a. Inhibiting angiotensin-converting enzyme b. Blocking angiotensin II from AT1 receptors c. Preventing the release of angiotensin I d. Promoting the release of aldosterone
b. Activated partial thromboplastin time (aPTT) of 120 seconds *normal therapeutic range is 45-75 secs
A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse? a. Platelet count of 150,000 b. Activated partial thromboplastin time (aPTT) of 120 seconds c. INR of 1.0 d. Blood urea nitrogen (BUN) level of 12 mg/dL
b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? a. "Your concern is valid. I will call the doctor to discontinue the heparin." b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
a. "I take aspirin daily for headaches."
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring? a. "I take aspirin daily for headaches." b. "I take ibuprofen (Motrin) at least once a week for joint pain." c. "Whenever I have a fever, I take acetaminophen (Tylenol)." d. "I take my medicine first thing in the morning."
d. Liver enzymes
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor? a. Blood urea nitrogen b. Complete blood count c. Cardiac enzymes d. Liver enzymes
b. Elevated INR range *therapeutic range is 2.0-3.0
A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what? a. Within normal range b. Elevated INR range c. Low INR range d. Low average INR range
a. "Apply the patch to a nonhairy area of the upper torso or arm."
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? a. "Apply the patch to a nonhairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."
b. Decrease the intravenous nitroglycerin by 10 mcg/min.
A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? a. Assess the client's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Stop the nitroglycerin infusion for 1 hour, and then restart. d. Recheck the client's vital signs in 15 minutes but continue the infusion.
c. Fish
A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? a. Apricots b. Bananas c. Fish d. Strawberries
a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.
A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.) a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. d. Call the health care provider after taking 5 tablets if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.
b. Administer vitamin K.
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? a. Administer vitamin E. b. Administer vitamin K. c. Administer protamine sulfate. d. Administer calcium gluconate.
a. protamine sulfate
A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin? a. protamine sulfate b. vitamin K c. aminocaproic acid d. vitamin C
c. Lungs clear.
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working? a. Potassium level decreased from 4.5 to 3.5 mEq/L. b. Crackles auscultated in the bases. c. Lungs clear. d. Output 30 mL/hr.
c. Decreased aldosterone
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? a. Decreased potassium level b. Decreased crackles in the lung bases c. Decreased aldosterone d. Decreased ankle edema
c. Stage 1 hypertension
A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage? a. Normal b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension
b. It is the desired level of HDL.
A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level? a. It is lower than the desired level of HDL. b. It is the desired level of HDL. c. It is higher than the desired level of HDL. d. It is a much lower HDL level than desired.
a. Administer ordered dose of digoxin.
A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? a. Administer ordered dose of digoxin. b. Hold future digoxin doses. c. Administer potassium. d. Call the health care provider.
What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
What is superior vena cava syndrome?
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.
What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
What is cardiac tamponade? Common causes?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumatic injury, cancer, kidney failure, acute myocardial infarction, or infections.
What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing, swelling around site, palpable 2 inch fullness, and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
What is an aortic dissection?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client? a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia. b. The fact that Lasix has been proven to decrease symptoms with pneumonia. c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency. d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.
a. Call the health care provider to switch the medication.
A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? a. Call the health care provider to switch the medication. b. Assess the client for other symptoms of upper respiratory infection. c. Instruct the client to take antitussive medication until the symptoms subside. d. Tell the client that the cough will subside in a few days.
c. gemfibrozil (Lopid)
A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer? a. cholestyramine (Questran) b. colestipol (Colestid) c. gemfibrozil (Lopid) d. simvastatin (Zocor)
d. Serum glucose (sugar)
A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels? a. Hemoglobin and hematocrit b. Blood urea nitrogen (BUN) c. Arterial blood gases d. Serum glucose (sugar)
Refractoriness
A property of excitable tissue, prevents uncontrolled rapid cardiac contractions and helps preserve the heart rhythm.
When providing nutritional counseling for patients at risk for CAD, which of the following foods would the nurse encourage patients to include in their diet (select all that apply)? A) a. Tofu B) b. Walnuts C) c. Tuna fish D) d. Whole milk E) e. Orange juice
A,B,C Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly
A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which of the following assessments are appropriate for this patient (select all that apply)? a. Assess for return of gag reflex. b. Assess groin for hematoma or bleeding. c. Monitor vital signs and oxygen saturation. d. Position patient supine with head of bed flat. e. Assess lower extremities for circulatory compromise.
A,C
A patient is admitted to the CCU with a diagnosis of unstable angina. Which of the following medications would the nurse expect the patient to receive? (select all that apply) a. antiplatelet therapy b. fibrinolytic therapy c. B-adrenergic blockers d. prophylactic antibiotics e. intravenous nitroglycerin
A,C,E
Which BP regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. release of norepinephrine b. secretion of prostaglandins c. stimulation of the sympathetic nervous system d. stimulation of the parasympathetic nervous system e. activation of the renin-angiotensin-aldosterone system
A,C,E
What anti-platelet medications can be given for a PCI?
ASA, Plavis, ReoPro IV, and Ingegrilin IV
AAA
Abdominal Aortic Aneurism
aPTT
Activated Partial Thromboplastin Time
Which of these nursing interventions included in the plan of care for a patient who had an AMI 3 days ago is most appropriate for the RN to delegate to an experienced LPN/LVN?
Administration of the ordered metoprolol (Lopressor) and aspirin
pressure in the aorta and peripheral arteries that the L ventricle has to pump against to get the blood out
Afterload-also called resistance, think RE is backwards here because the L ventricle has to push the blood out, resistance
What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
killer complications of using a Swan?
Air embolus, pulmonary infarction
What are the five areas for listening to the heart?
All People Enjoy Time Magazine= Aortic, Pulmonic, ERB's point, Tricuspid, and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
A 19-year-old student has a mandatory ECG before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate?
Allow the student to participate on the swim team.
A few days after experiencing an MI, the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which nursing intervention is appropriate to include in the nursing care plan?
Allow the use of denial as a coping mechanism until the patient begins asking questions about the MI.
What anti-arrhythmic is used when VFIB is resistant and also for fast arrhythmias?
Amiodarone
What drug is the first anti-arrhythmic drug of choice?
Amiodarone
What anti-arrhythmic drugs are given commonly to prevent a second episode of VFib?
Amiodarone and Lidocaine
What drugs are commonly given to prevent a second episode of VFIB?
Amiodarone and Lidocaine
What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
paradoxical blood pressure
An exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle. Normal value is 3 - 10 mm Hg
When the nurse assesses an apical heart rate & hears _____, it is called tachycardia. 1. greater than 100 beats per minute 2. less than 60 beats per minute 3. 60-90 beats per minute 4. 90 beats per minute
Answer: 1
When palpating a thrill on the precordium, the nurse recognizes this sign as being associated w/ which of the following cardiac conditions? 1. severe valve stenosis 2. an enlarged heart 3. stenosis of the carotid arteries 4. aortic aneurysm
Answer: 1 Rationale 1: A palpable thrill over the precordium is indicative of severe valve stenosis. Rationale 2: A thrill is not present merely when the heart is enlarged. Rationale 3: Stenosis of the carotid arteries would produce a thrill palpable on the neck over the carotid arteries, not the precordium. Rationale 4: Increased pulsations in the aortic area are indicative of an aortic aneurysm.
A nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important info for the nurse to include? 1. Stop smoking. 2. Eat in moderation. 3. Exercise when able. 4. Reduce saturated fats in the diet.
Answer: 1 Rationale 1: Cigarette smoking is the leading independent risk factor for coronary heart disease. Rationale 2,3,4: The remaining options are teaching points, but are not specific. The problems associated with the remaining options are not as significant as smoking.
During a follow-up appointment after a myocardial infarction, a pt states, "My friends tell me to add more garlic to my diet & start drinking red wine each evening." Which response by the nurse is best? 1. "Discuss your idea with the physician to see what would benefit you." 2. "That sounds fine. See how they work." 3. "I wouldn't do that if I were you." 4. "You should also add ginkgo biloba for cardiovascular health."
Answer: 1 Rationale 1: Complimentary therapies could be helpful. They should be added only after discussion with a healthcare provider who is familiar with the pt's history & current med/allergy list. Interactions between herbal preparations & prescribed meds are common. Rationale 2: They should be added only after discussion with a healthcare provider who is familiar with the pt's history & current medication/allergy list. Rationale 3: Since the pt has taken an interest in her health by discussing it with her friends, ignoring her comment or discouraging her would not be beneficial. Rationale 4: The nurse should not add or approve any other complimentary therapies unless directed so by the physician.
During an office visit, a 55-yr-old female pt asks why she has not been prescribed a daily dose of aspirin. Her 56-yr-old husband has been advised by the physician to take a daily aspirin. What can the nurse explain is the most likely reason for this? 1. The benefit of aspirin in women under age 65 is not clear. 2. Aspirin is not recommended for women. 3. This must have been an oversight. 4. She has other meds that could interfere
Answer: 1 Rationale 1: In women, the benefit of low-dose aspirin in reducing the risk for coronary heart disease is not clear prior to 65 years of age. Rationale 2: Aspirin is recommended for women over the age of 65. Rationale 3: This was not an oversight. Rationale 4: There is not enough info to determine if the pt has other meds that could interfere with aspirin.
The pt is having a treadmill test. Which of the following is an important teaching point? 1. Comfortable clothing & shoes should be worn for the test. 2. A pt gown & slippers should be worn for the test. 3. Smoking is permitted up until the time of the test. 4. There are no restrictions prior to the test in the foods eaten as long as small meals are planned the day of the test.
Answer: 1 Rationale 1: Pt teaching is based on understanding how the test will be conducted. Comfortable & safe clothing is essential. The pt may be more comfortable in exercise clothing instead of a pt gown. Rationale 2: Slippers may not be safe so secure shoes should be worn for walking since speed is increased during the test. Rationale 3: Smoking is discouraged prior to testing. Rationale 4: The diet may be restrictive regarding the amount & types of foods allowed in order to prevent nausea & oxygen deprivation to the cardiac muscle.
When completing the health history of a pt w/ a suspected cardiac disorder, which of the following childhood illnesses should the nurse ask about? 1. rheumatic fever & strep throat infections 2. rubella & chicken pox 3. asthma & bronchitis 4. otitis media & respiratory syncytial virus (RSV)
Answer: 1 Rationale 1: Rheumatic fever & streptococcal throat infections are caused by beta- hemolytic streptococci, which have a propensity to form growths & calcium deposits on the leaflets of heart valves. This sets the individual up for valvular stenosis. Rationale 2,3,4: The other childhood illnesses are not directly related to cardiac disorders.
Following a transmural myocardial infarction, which ECG change stays with the pt for life? 1. Q wave deepening 2. ST segment elevation 3. ST segment depression 4. P wave inversion
Answer: 1 Rationale 1: The development of an abnormal Q wave is a definitive diagnostic sign of myocardial necrosis. Since it is indicative of necrosis, it stays with the pt for life. Rationale 2: ST segment elevation represents myocardial ischemia, which is reversible by increasing the blood flow to the heart. Rationale 3: ST segment depression occurs when muscle ischemia involves only a portion of the heart wall. Rationale 4: P wave inversion represents a junctional pacemaker in the heart & is not related to changes that occur with a myocardial infarction.
A pt who is prescribed atorvastatin (Lipitor) should be monitored for which occurrence? 1. liver enzyme alteration 2. blood glucose & uric acid level alteration 3. renal function alteration 4. sudden back pain & constipation
Answer: 1 Rationale 1: The nurse should be observing lab work for the current cholesterol level & to ensure that liver enzymes remain normal. Rationale 2: Blood glucose & uric acid level are generally not associated with the use of this drug. Rationale 3: Renal function alteration is generally not associated with the use of this drug. Rationale 4: Constipation & sudden back pain are generally not associated with the use of this drug
The nurse, caring for a pt diagnosed with Prinzmetal's or variant angina, realizes this is a serious type of chest pain. Why is this so? 1. It indicates presence of coronary artery spasm. 2. It indicates there is associated renal disease. 3. It indicates there is associated pulmonary disease. 4. It indicates the presence of a myocardial infarction.
Answer: 1 Rationale 1: Variant, Prinzmetal's, or vasospastic angina is a serious type of angina. It occurs when single or multiple sites in major coronary arteries & their large branches have vasospasm, thereby cutting off the blood supply to an area of the myocardium. Rationale 2: Prinzmetal's angina does not occur due to renal disorders. Rationale 3: Prinzmetal's angina does not occur due to a pulmonary disorder. Rationale 4: Prinzmetal's angina is not specifically diagnostic for a myocardial infarction.
A 52-year-old obese male pt who is admitted with elevated triglycerides & a history of smoking two packs of cigarettes a day for 20 years asks about his risk for coronary artery disease. What info should the nurse provide? 1. He is at risk for coronary artery disease. 2. He is not at risk for coronary artery disease. 3. He possesses all nonmodifiable risk factors for coronary artery disease that cannot be overcome. 4. He possesses all modifiable risk factors for coronary artery disease that can be overcome.
Answer: 1 Rationale 1,2,3,4: Age is a nonmodifiable risk factor & obesity, elevated triglycerides & smoking are modifiable risk factors. Together the risk factors place the pt at higher risk to develop coronary artery disease.
A pt comes into the health clinic asking for advice on lowering the individual's risk of heart disease. The nurse's best response is to do which of the following? 1. Conduct a health history & physical exam to determine the pt's area of risks & then educate the pt based upon these findings. 2. Conduct a physical exam of the pt & discuss the findings. 3. Determine the pt's risks based upon a prior chart for the pt. 4. Discuss the pt's perceived area of health risks.
Answer: 1 Rationale 1: A thorough health history & physical exam should disclose a pt's risk factors. Rationale 2: Conducting a physical exam would discover some risk factors, but is not inclusive of the health history. Rationale 3: Using the pt's old chart may disclose some risk factors, but would not include any recent concerns. Rationale 4: Discussing the pt's perceived area of health risks will not be inclusive & may only capture those risks the pt is aware of. Modifiable risk factors can be evaluated & discussed w/ the pt.
A pt being evaluated for cardiac pathology asks the nurse why sodium, calcium, & potassium are so important in his diet. What is the nurse's best response? 1. "The action potentials of the heart muscle cells are dependent upon the diffusion of sodium, potassium & calcium across the cell membrane." 2. "Because you are on potassium supplements, it is important to monitor electrolytes." 3. "Heart rate is affected by the oxygen levels in your body, which involves the attachment of oxygen molecules to these electrolytes." 4. "It is the pacemaker of your heart that is responsible for the heart beat."
Answer: 1 Rationale 1: Action potentials of the cardiac muscle involve shifts in potassium, calcium, & sodium across the cell membrane. Rationale 2: There is not enough data to justify Option 2. Rationale 3: Oxygen molecules attach to the hemoglobin molecule, not electrolytes. Rationale 4: The pacemaker is responsible for the heartbeat but this response does not answer the pt's question.
The nurse is assessing a pt who is currently experiencing chest pain. The pt has a previous diagnosis of chest pain but now reports an increase in the frequency & duration. Appropriate nursing care for this type of chest pain includes which nursing intervention? 1. aspirin 325 mg PO per day per physician prescription 2. bed rest with bathroom privileges 3. aluminum hydroxide (Maalox) 5 mL PO PRN per physician prescription 4. atropine (Atropair) 0.4 mg IVP PRN per physician prescription
Answer: 1 Rationale 1: Aspirin is considered helpful due to its antiplatelet effects. Rationale 2: Bed rest with bathroom privileges would not necessarily be indicated in this situation. Rationale 3: Antacids are used to treat heartburn or upset stomach. Rationale 4: Atropine (Atropair) is used to dry secretions & stimulate cardiac function, not for chest pain.
What physical assessment data is necessary to calculate a pt's cardiac index (CI)? 1. weight & height 2. weight only 3. weight & waist measurement 4. waist measurement & height
Answer: 1 Rationale 1: Cardiac index (CI) is the cardiac output adjusted for the pt's body size or body surface area. Body surface area is calculated using height & weight measurements. Rationale 2,3,4: Body surface area is calculated using height & weight measurements.
The nurse is reviewing a new prescription for propranolol (Inderal) for a pt with coronary heart disease (CHD). The nurse would call the physician & question this prescription if the pt has which history? 1. has a history of asthma & chronic obstructive pulmonary disease (COPD) 2. is also taking antioxidants 3. is also taking simvastatin (Zocor) 4. has a history of bleeding disorders
Answer: 1 Rationale 1: Class II beta-blockers such as propranolol are used to reduce heart rate & myocardial contractility & in the treatment of supraventricular tachycardia. These drugs may cause bronchospasm & are contraindicated for pts with asthma, chronic obstructive pulmonary disease (COPD), or other restrictive or obstructive lung diseases. Rationale 2: Antioxidants may be taken concurrently. Rationale 3: Simvastatin may be taken concurrently. Rationale 4: Bleeding disorders are not associated with propranolol use.
A pt reports the following symptoms to the nurse: nausea, loss of appetite, blurred & double vision, green yellow halos, vomiting & "feeling uneasy."." What situation should the nurse suspect? 1. digoxin toxicity 2. lidocaine toxicity 3. amiodarone toxicity 4. procainamide toxicity
Answer: 1 Rationale 1: Classic symptoms of digoxin toxicity include anorexia, nausea, vomiting, blurred or double vision, yellow green halos, & new-onset dysrhythmias. Rationale 2: Lidocaine toxicity is manifested by changes in neurologic status. Rationale 3: Amiodarone toxicity is manifested by altered hepatic function, pulmonary fibrosis, & photosensitivity. Rationale 4: Procainamide toxicity is manifested by flu-like symptoms, skin rash, & signs of heart failure.
In the pt w/ hypovolemic shock, the nurse realizes that the heart sounds will change in the which of the following ways? 1. diminished S2 & accentuated S1 2. diminished S1 & S2 3. accentuated S2 & diminished S1 4. no change in S1 or S2
Answer: 1 Rationale 1: Diminished S2 occurs due to a fall in BP & accentuated S1 occurs because of the tachycardia. The 3 earliest signs of hypovolemic shock are tachycardia, delayed capillary refill, & restlessness. Rationale 2,3,4: Diminished S2 occurs due to a fall in BP & accentuated S1 occurs because of the tachycardia.
In the pt w/ hypovolemic shock, the nurse realizes that the heart sounds will change in which of the following ways? 1. diminished S2 & accentuated 2. accentuated S2 & diminished S1 3. S1diminished S1 & S2 4. no change in S1 or S2
Answer: 1 Rationale 1: Diminished S2 occurs due to a fall in blood pressure & accentuated S1 occurs because of the tachycardia. The three earliest signs of hypovolemic shock are tachycardia, delayed capillary refill, & restlessness.
A pt received an implantable cardioverter-defibrillator (ICD). The nurse would include which instruction during discharge teaching for this pt? 1. "If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation." 2. "You can activate the ICD whenever you feel a change in your heart rhythm." 3. "The batteries of the ICD won't need to be replaced if the ICD never shocks the heart." 4. "There should be no discomfort if the ICD discharges & you probably won't notice it."
Answer: 1 Rationale 1: Family members may receive a shock or tingling sensation when in direct contact with an individual when their ICD discharges. Rationale 2: The ICD is programmed to automatically activate when detecting a potentially lethal cardiac rhythm & cannot be activated by the pt. Rationale 3: Batteries must be surgically replaced every five years or following manufacturer's instructions. Rationale 4: Some pts experience significant discomfort with ICD discharge.
The nurse, caring for a pt admitted w/ chest pain, realizes that which factor places the pt at the highest risk for heart disease? 1. overweight & carries the weight around the waist 2. mother died at age 70 of an acute myocardial infarction 3. a single mother of four young children with a low income 4. has a desk job & works long hours
Answer: 1 Rationale 1: Fat accumulation in the upper body, giving the body an appearance of an "apple," has been linked to a greater risk of coronary artery disease (CAD) as opposed to a "pear" shape with body fat accumulation in the gluteofemoral region. Abdominal obesity is associated with elevated levels of cholesterol & greater risk for CAD. Rationale 2: If the pt's mother had died before age 55, that would be a risk factor. Rationale 3: Being a single mother is not a specific risk factor for the development of CAD. Rationale 4: Sedentary life style is a risk factor, but not as significant as fat accumulation in the upper body.
The pt is being evaluated for left atrium thrombus due to a dysrhythmia (altered heart rhythm). Which of the following cardiac tests will be ordered to assess for thrombus? 1. transesophageal echocardiography (TEE) 2. pericardiocentesis 3. cardiac catheterization 4. computed tomography (CT)
Answer: 1 Rationale 1: For this pt, the TEE test can assess for left atrial thrombi & is an expected test. Transesophageal echocardiography (TEE) allows visualization of adjacent cardiac & extracardiac structures, left atrium for thrombus, dissection of the aorta, endocarditis, left ventricle function, & repairs being made during cardiac surgery. Rationale 2: Pericardiocentesis is a procedure to remove fluid from the pericardial sac. Rationale 3: Cardiac catheterization is used to identify coronary artery disease (CAD) or valve disease, measure pulmonary artery or heart chamber pressures, obtain a biopsy, evaluate artificial valves or to angioplasty or stent an area in the coronary arteries. Rationale 4: A computed tomography (CT) scan can show calcium deposits in coronary arteries.
Nursing care of the pt after thrombolytic therapy focuses on the assessment of which finding that is the most common complication? 1. bleeding 2. reperfusion chest pain 3. lethargy 4. heart block
Answer: 1 Rationale 1: Hemorrhage or bleeding is the most common complication; it can be life-threatening. Rationale 2: Recurrent chest pain is not associated with thrombolytic therapy. Rationale 3: Lethargy is not associated with thrombolytic therapy. Rationale 4: Heart block is not associated with thrombolytic therapy.
Pericardiocentesis would be utilized in which of the following pt situations? 1. cardiac tamponade 2. slow heart rhythm 3. chest pain 4. suspected damage to a heart valve
Answer: 1 Rationale 1: In the case of cardiac tamponade, pericardiocentesis is considered an emergency procedure. It is done to remove fluid from the pericardial sac, which is preventing the heart from pumping blood effectively. Rationale 2: This procedure would not be recommended in pts w/ chest pain. Rationale 3: This procedure would not be recommended in pts w/ slow heart. Rationale 4: This procedure would not be recommended in pts suspected damage to a heart valve.
The nurse is teaching a pt about coronary artery bypass surgery. Which statement, included in this teaching, is essential for the pt to understand? 1. "You must still reduce or modify cardiac risk factors." 2. "This surgery prolongs life on an average of two years." 3. "You have only a minimal chance of functional improvement, even with this surgery." 4. "This surgery will cure your atherosclerosis."
Answer: 1 Rationale 1: It is essential that the pt understand that the goal of the surgery is to relieve the symptoms & improve the quality of life. The pt must still reduce or modify controllable risk factors to retard the underlying process. Rationale 2: Research indicates that life expectancy is prolonged by greater than 15 years following CABG. Less than 10% of pts who undergo CABG will need subsequent revascularization within five to seven years. Rationale 3: CABG provides more complete revascularization & show better long-term relief of symptoms than percutaneous coronary interventions. Rationale 4: The surgery is not done to cure atherosclerosis.
Which is the priority nursing intervention for a pt with a junctional escape rhythm? 1. Assess the pt for symptoms associated with this rhythm. 2. Contact the physician immediately for emergency orders. 3. Eliminate caffeine from the diet. 4. Prepare for a pacemaker insertion.
Answer: 1 Rationale 1: Junctional escape rhythms may be monitored if the pt is not symptomatic. It is most important to assess the pt to see how they are affected by the rhythm. Rationale 2: Then, calling the physician to report the rhythm may be appropriate. Rationale 3: Eliminating caffeine is not an appropriate action for this pt with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given. Rationale 4: Preparing for a pacemaker insertion is not an appropriate action for this pt with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given.
The pt asks the nurse about metabolic syndrome. Which is the most accurate answer for the nurse to provide? 1. "Metabolic syndrome is caused by obesity, physical inactivity, & genetic factors." 2. "This syndrome is not a concern for females unless they smoke." 3. "This problem affects only older adults over the age of 65." 4. "It can be avoided by taking vitamins daily & drinking 64 fluid ounces of water a day."
Answer: 1 Rationale 1: Metabolic syndrome is caused by obesity, physical inactivity, & genetic factors. Rationale 2: The syndrome is not directly related to smoking. Rationale 3: The syndrome is not directly related to age. Rationale 4: Daily vitamin & fluid consumption have not been found to alter the syndrome.
The nurse is reviewing an electrocardiogram (ECG) rhythm strip. The P waves & QRS complexes are regular. The PR interval is 0.16 second & QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which of the following would be a correct interpretation based on these characteristics? 1. normal sinus rhythm 2. sick sinus syndrome 3. sinus bradycardia 4. first-degree heart block
Answer: 1 Rationale 1: Normal sinus rhythm is defined as regular rhythm w/ a rate of 60-100 beats per minute. The PR & QRS measurements are normal, measuring 0.12 to 0.20 second & 0.06 to 0.10 second respectively.
Premature ventricular contractions (PVCs) are best characterized by which statement? 1. They are insignificant in people with no history of heart disease. 2. PVCs typically have no pattern. 3. The frequency of PVCs is not associated with specific events. 4. Their incidence & significance has no relevance to the pt having had a myocardial infarction.
Answer: 1 Rationale 1: PVCs often have no significance in people without history of heart disease. Rationale 2: PVCs may be isolated or occur in specific patterns. Rationale 3: They may be triggered by anxiety or stress; tobacco, alcohol or caffeine use; hypoxia, acidosis, & electrolyte imbalances; sympathomimetic drugs; & coronary heart disease. Rationale 4: They may be associated with an increased risk for lethal dysrhythmias & their incidence & significance is greatest after myocardial infarction.
Angina that is characterized as atypical, occurs unpredictably & often at night & is associated with coronary artery spasm would be labeled as which type of angina? 1. Prinzmetal's (variant) angina 2. stable angina 3. unstable angina 4. ischemic angina
Answer: 1 Rationale 1: Prinzmetal's (variant angina) is atypical angina that occurs unpredictably (unrelated to activity) & often at night. It is caused by coronary artery spasm. Rationale 2: Stable angina occurs with a predictable amount of activity or stress & occurs when the work of the heart is increased. Rationale 3: Unstable angina is characterized by considerable unpredictable pain, occurs with either increasing or decreasing levels of activity or stress & may occur with rest. Rationale 4: Ischemic angina may occur with either activity or mental stress & is considered asymptomatic.
The S1 heart sound corresponds to which of the following physiological events? 1. closure of the AV valves 2. closure of the semilunar valves 3. ejection of blood from the atria 4. the onset of relaxation
Answer: 1 Rationale 1: S1 corresponds to the closure of the AV valves. Rationale 2: Closure of the semilunar valves corresponds to S2. Rationale 3: These valves are not associated w/ ejection of blood from just the atria or relaxation of the muscle. Rationale 4: These valves are not associated w/ ejection of blood from just the atria or relaxation of the muscle.
At which location will S1 be heard the loudest? 1. left midclavicular line at the fifth intercostal space 2. left sternal border at the fifth intercostal space 3. right sternal border at the third intercostal space 4. right midclavicular line at the fifth intercostal space
Answer: 1 Rationale 1: S1 is the sound produced by the atrioventricular (AV) valves closing. The apex of the heart is located lower on the left chest wall than the base of the heart. The loudest sounds can be heard over the apex of the heart. Rationale 2: The sound is audible at the left sternal boarder, but would not be as loud. Rationale 3: This sound would not normally be audible on the right midclavicular line at the third or fifth intercostal space, or at the right sternal border. Rationale 4: This sound would not normally be audible on the right midclavicular line at the third or fifth intercostal space, or at the right sternal border.
At which location will S1 be heard the loudest? 1. left midclavicular line at the fifth intercostal space 2. left sternal border at the fifth intercostal space 3. right midclavicular line at the fifth intercostal space 4. right sternal border at the third intercostal space
Answer: 1 Rationale 1: S1 is the sound produced by the atrioventricular (AV) valves closing. The apex of the heart is located lower on the left chest wall than the base of the heart. The loudest sounds can be heard over the apex of the heart. Rationale 2: The sound is audible at the left sternal border, but would not be as loud. Rationale 3: This sound would not normally be audible on the right midclavicular line at the5th intercostal space. Rationale 4: This sound would not normally be audible at the sternal border.
At what location will S2 be heard the loudest? 1. right sternal border at the second intercostal space 2. left sternal border at the fifth intercostal space 3. right midclavicular line at the third intercostal space 4. left midclavicular line at the fifth intercostal space
Answer: 1 Rationale 1: S2 is the sound produced by the closure of the aortic & pulmonic valves, & is best heard at the base of the heart, which is at the second intercostal space at the right sternal border. Rationale 2: S1 is best heard at the left midclavicular line at the fifth intercostal space. Rationale 3: The right midclavicular line at the third intercostal space is not optimal for auscultating heart sounds. The base of the heart is actually located higher on the chest wall than the apex. Rationale 4: S1 is best heard at the left midclavicular line at the fifth intercostal space.
When listening to heart sounds, the nurse expects to hear S1 & S2. The presence of an additional sound immediately following S2 is called _______, which can result from ______. 1. S3, ventricular volume overload 2. S4, increased resistance to ventricular filling 3. S4, inflammation of the pericardial sac 4. S3, a stenotic mitral valve
Answer: 1 Rationale 1: S3 is an abnormal (pathologic) heart sound heard immediately following S2 in adults. It is often called a ventricular gallop & results from conditions having increased ventricular filling such as congestive heart failure (CHF), mitral valve regurgitation, or tricuspid valve regurgitation. Rationale 2: S4 immediately precedes S1 & can result from conditions such as anemia or a change in ventricular compliance. Rationale 3: S4 immediately precedes S1 & can result from conditions such as anemia or a change in ventricular compliance. Rationale 4: S3 is an abnormal (pathologic) heart sound heard immediately following S2 in adults. It is often called a ventricular gallop & results from conditions having increased ventricular filling such as congestive heart failure (CHF), mitral valve regurgitation, or tricuspid valve regurgitation.
When listening to heart sounds, the nurse expects to hear S1 & S2. The presence of an additional sound immediately following S2 is called _____, which can result from _____. 1. S3, ventricular volume overload 2. S4, increased resistance to ventricular filling 3. S4, inflammation of the pericardial sac 4. S3, a stenotic mitral valve
Answer: 1 Rationale 1: S3 is an abnormal (pathologic) heart sound heard immediately following S2 in adults. It is often called a ventricular gallop & results from conditions such as congestive heart failure (CHF), mitral, or tricuspid valve regurgitation. Rationale 2: S4 immediately precedes S1 & can result from conditions such as anemia or a change in ventricular compliance. Rationale 3: S4 immediately precedes S1 & can result from conditions such as anemia or a change in ventricular compliance. Rationale 4: S3 is an abnormal (pathologic) heart sound heard immediately following S2 in adults. It is often called a ventricular gallop & results from conditions such as congestive heart failure (CHF), mitral, or tricuspid valve regurgitation.
The family of a pt who experienced a stroke after CABG surgery asks the nurse what caused the stroke to occur. The nurse's best response would be which of the following? 1. "Stroke is usually caused by a blood clot that brakes loose & travels to the brain." 2. "Stroke is usually caused by ruptured plaque inside the coronary artery." 3. "Stroke is caused by heart failure." 4. "No one knows what causes strokes."
Answer: 1 Rationale 1: Stroke is usually caused by an embolus from the ascending aorta or aortic arch, which travels through the heart into the vessels leading to the brain. Rationale 2: Plaque inside a coronary artery would travel downstream & lodge in a smaller vessel in the heart. Rationale 3: Heart failure does not cause a stroke. Rationale 4: Stating that no one knows what causes strokes is not a true statement; blood clots & ruptured vessels cause strokes.
The nurse, caring for a pt recovering from an acute myocardial infarction, realizes that the final extent of cardiac damage is dependent upon which factor? 1. reperfusion of the ischemic zone 2. pt's ethnicity 3. pt's gender 4. development of heart block
Answer: 1 Rationale 1: Surrounding the area of infarction is the zone of injury & the zone of ischemia. These zones are made of potentially viable tissues. They can become necrotic & die, or be reperfused & remain functional. The goal of treatment for an AMI is to establish reperfusion as early as possible to prevent necrosis & salvage the myocardium. Rationale 2: The pt's ethnicity does not impact the final extent of cardiac damage. Rationale 3: The pt's gender does not impact the final extent of cardiac damage. Rationale 4: Developing a heart block does not impact cardiac damage.
The nurse, assessing a middle-aged pt experiencing chest pain, realizes that presence of which symptoms would be most characteristic of an acute myocardial infarction? 1. substernal pressure type pain, radiating down the left arm 2. colic-like epigastric pain 3. sharp, well-localized unilateral chest & left arm pain 4. sharp, burning chest pain moving from place to place
Answer: 1 Rationale 1: Terms such as burning, crushing, suffocating, & pressure are typical descriptors of chest pain from myocardial ischemia, often with pain radiating to other areas of the upper torso. Rationale 2: Cardiac chest pain is not usually described as colic-like, localized to a defined spot such as the epigastric area, or as a sharp pain. Rationale 3: Cardiac chest pain is not usually described as localized to a defined spot or as a sharp pain. Rationale 4: Cardiac chest pain is not usually described as a sharp pain.
The pt's ECG shows the following characteristics: PR interval .08, QRS .08, & isoelectric ST segment. The nurse realizes that these characteristics indicate which of the following? 1. faster than normal conduction from the SA node to the ventricles, normal conduction through the ventricles & normal ST segment 2. faster than normal conduction from the SA node to the ventricles, faster than normal conduction through the ventricles & normal ST segment 3. normal conduction from the SA node to the ventricles, normal conduction through the ventricles & normal ST segment 4. normal conduction from the SA node to the ventricles, normal conduction through the ventricles & abnormal ST segment
Answer: 1 Rationale 1: The PR interval is normally 0.12 second (up to 0.24 second is considered normal in pts over age 65). Rationale 2: The normal duration of a QRS complex is from 0.06 to 0.10 second. Rationale 3: The PR interval is normally 0.12 second (up to 0.24 second is considered normal in pts over age 65). Rationale 4: The ST segment, the period from the end of the ARS complex to the beginning of the T wave, should be isoelectric.
Which of the following would be an example of the term cardiac reserve? 1. getting on a treadmill & gradually increasing the pace of walking 2. breathing in through the nose & out the mouth while sitting quietly 3. sitting in a chair, to cool down, after having completed an exercise routine 4. at the end of systole, approximately 50 mL of blood remains in the ventricles
Answer: 1 Rationale 1: The heart's ability to respond to the body's changing need for cardiac output is called cardiac reserve. Increasing the pace of walking would place demand on the heart to increase blood flow. Rationale 2,3,4: The other options do not place demand on the heart.
A pt reports chest pain, nausea, & vomiting off & on for the last 4 days, which the pt interpreted as the flu. Which lab tests will provide info about acute cardiac damage for this pt? 1. Troponin I & T 2. Red blood cells 3. CPK-MB 4. Homocysteine & platelets
Answer: 1 Rationale 1: The levels of Troponin T begin to rise within 3-6 hours after myocardial injury & remain elevated 14-21 days. Levels of Troponin I begin to increase in about 3-5 hours after myocardial ischemia & peak at 14--18 hours & remain elevated for 5--7 days. Rationale 2: Red blood cells are unaffected by acute cardiac damage. Rationale 3: The CPK-MB rises within 3-6 hours after the MI, peaks within 12-24 hours & levels return to normal 2-3 days following the infarction. This pt would most likely have normal valves 4 days out from the onset of symptoms. Rationale 4: Homocysteine does not change with acute cardiac damage. Platelets are unaffected by acute cardiac damage.
When assessing the adult heart, the nurse expects to hear the following normal heart sounds: 1. S1 then S2 2. S2 then S3 3. S3 then S4 4. S2 then S1
Answer: 1 Rationale 1: The normal sequence of heart sounds is S1, then S2. Rationale 2: 2. S3 & S4 are considered abnormal heart sounds in adults. Rationale 3: 3. S3 & S4 are considered abnormal heart sounds in adults. Rationale 4: 4. The normal sequence of heart sounds is S1, then S2.
A nurse is performing cardiopulmonary resuscitation (CPR) on a pt who is in cardiac arrest. An automatic external defibrillator (AED) is available. Which activity will allow the nurse to assess the pt's cardiac rhythm? 1. Apply adhesive patch electrodes to the chest & move away from the pt. 2. Apply standard electrocardiographic monitoring leads to the pt & observe the rhythm. 3. Hold the defibrillator paddles directly against the pt's chest. 4. Connect electrocardiographic electrodes to a telephone monitoring device & wait until the rhythm is analyzed.
Answer: 1 Rationale 1: The nurse applies adhesive patch electrodes to the pt's chest in the usual defibrillator positions, stops CPR, & orders everyone near the pt to move away & not touch the pt. The defibrillator analyzes the rhythm, which may take up to 30 seconds. The machine then indicates if defibrillation is indicated. Rationale 2: Standard electrocardiographic monitoring leads are not used with an AED. Rationale 3: Defibrillator paddles are not used with an AED. Rationale 4: Telephone monitoring devices are not used with an AED.
Sinus bradycardia (rate 56 bpm) is identified in a sleeping pt on telemetry. Which is the priority nursing action? 1. Awaken the pt & see how the heart rate responds. 2. Call the physician & report this dysrhythmia. 3. Check the medication administration record & see if there is a PRN medication that will improve this rhythm. 4. Call for an immediate 12-lead electrocardiogram (ECG).
Answer: 1 Rationale 1: The priority is to awaken the pt to determine how the heart rate is affected with activity as it normally should increase. The pt should be evaluated to determine how the dysrhythmia is affecting heart function. Many pts who are asymptomatic while in sinus bradycardia can be observed & require no further intervention. Common reasons for sinus bradycardia for the nurse to consider include athletic conditioning, sleep, or a conduction disorder. Rationale 2: Notifying the physician without first assessing the pt's response would not be appropriate. Rationale 3: The priority is to awaken the pt to determine how the heart rate is affected with activity as it normally should increase. The pt should be evaluated to determine how the dysrhythmia is affecting heart function. Many pts who are asymptomatic while in sinus bradycardia can be observed & require no further intervention. Rationale 4: Ordering an ECG requires a physician's prescription.
What info does the nurse consider when administering medication to treat hyperlipidemia? 1. Such meds include the statins, which act by lowering LDL levels. 2. These meds act by increasing the LDL levels & decreasing the HDL levels. 3. These meds do not include angiotensin-converting enzyme (ACE) inhibitors. 4. Such meds include bile acid sequestrants as first-line drugs to lower cholesterol levels.
Answer: 1 Rationale 1: The statin drugs specifically lower LDL. Rationale 2: Hyperlipidemia drugs are meant to lower LDL & raise HDL, not the opposite. Rationale 3: Angiotensin-converting enzyme (ACE) inhibitors are appropriate to add to drug treatment for high-risk pts. Rationale 4: Bile acid sequestrant drugs are not first-line drugs but may be added to statins when combination treatment is needed.
The nurse completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching would be indicated by which pt statement? 1. "I can lower my trans fatty acids by switching to the soft margarines & vegetable spreads." 2. "I will watch my fiber intake so I don't get too much." 3. "Well, I'll just have to go buy some of that coconut oil to cook with." 4. "Drinking a couple of glasses of milk each day will give me better protein."
Answer: 1 Rationale 1: Trans fatty acids behave like saturated fats & are found in solid vegetable fats (margarine, shortening) & stick butter, therefore the use of soft margarines & vegetable spreads is recommended for managing CHD. Rationale 2: Other dietary recommendations include reduced intake of saturated fats & cholesterol & increased soluble & insoluble fiber in the diet. Rationale 3: High proportions of saturated fats are found in coconut oil & red meats. Rationale 4: High proportions of saturated fats are found in whole-milk products.
The nurse, caring for a pt with myocardial damage, would expect which change on the ECG tracing? 1. ST segment elevation 2. loss of P waves 3. bradycardia 4. bradycardia 5. widening of the QRS complex
Answer: 1 Rationale 1: Transmural damage is present with ST segment elevation. Rationale 2: Loss of P waves occurs with atrial flutter & fibrillation. Rationale 3: Bradycardia can be a normal or abnormal rhythm. It's not specifically associated w/ transmural damage. Rationale 4: Widening of the QRS complex occur with bundle branch block. It is not specifically associated with transmural damage.
The nurse is caring for an adult pt who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage? 1. troponin 2. CPK 3. CK-MB 4. cholesterol
Answer: 1 Rationale 1: Troponin is primarily located in cardiac muscle & can indicate myocardial infarction or unstable angina. Troponin elevates at two to four hours after myocardial infarction. Rationale 2,3: CPK & CK-MB will elevate with myocardial damage, but will take longer to rise & are not as specific as troponin. Rationale 4: Cholesterol level is not helpful in diagnosis of myocardial damage.
During pt teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease? 1. elevated homocysteine 2. elevated creatinine 3. elevated high density lipoprotein (HDL) 4. elevated INR
Answer: 1 Rationale 1: Elevated levels of homocysteine (Hyc > 15 µmol/L) are associated with an increased risk of coronary artery disease (CAD). Homocysteine is an amino acid that is a by-product of the enzyme reactions from meat, dairy products, vitamin, & mineral metabolism. Homocysteine causes endothelial ulceration & scarring, & increases procoagulant properties of blood, all leading to an increase in the risk of thrombus formation. Rationale 2: Elevated creatinine indicates kidney disease. Rationale 3: HDL is the good cholesterol & when elevated it will decrease the risk for the development of CAD. Rationale 4: INR is a laboratory test that measures blood clotting function, not CAD.
The nurse is caring for a pt admitted w/ a grade III heart murmur heard during midsystole. The nurse realizes that the following cardiac conditions could result in which assessment finding? Select all that apply. 1. aortic stenosis 2. cardiomyopathy 3. atrioventricular (AV) valve disease 4. mitral valve prolapse
Answer: 1,2 Rationale 1: Midsystolic murmurs are associated w/ semilunar valve disease & hypertrophic cardiomyopathies. A grade III murmur can be heard clearly & can be categorized as systolic (between S1 & S2), diastolic (between S2 & S1), pansystolic (all of systole) or continuous (heard throughout systole & all or part of diastole). Rationale 2: Midsystolic murmurs are associated w/ semilunar valve disease & hypertrophic cardiomyopathies. A grade III murmur can be heard clearly & can be categorized as systolic (between S1 & S2), diastolic (between S2 & S1), pansystolic (all of systole) or continuous (heard throughout systole & all or part of diastole). Rationale 3: Murmurs associated w/ atrioventricular (AV) valve disease or mitral valve prolapse would more often be heard during early or middiastole. Rationale 4: Murmurs associated w/ atrioventricular (AV) valve disease or mitral valve prolapse would more often be heard during early or middiastole.
A pt, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which of the following is the most appropriate response for the nurse to make? Select all that apply. 1. "The surgery only relieves the symptoms; it does not cure the disease." 2. "You must continue to modify your cardiac risk factors." 3. "You are correct; your heart is now normal." 4. "You should not ever exercise again." 5. "There no need to monitor your fat intake any longer."
Answer: 1,2 Rationale 1: Denial is a common coping mechanism with cardiac pts; therefore, it is essential that the nurse stress that CABG is not a cure for coronary artery disease (CAD). Rationale 2: Atherosclerosis is a progressive disease; therefore, the pt needs to continue to modify risk factors. Rationale 3: CABG only relives symptoms, it does not cure the disease. Rationale 4: The pt should begin a cardiac rehabilitation program with a progressive exercise program. Rationale 5: The pt must continue to modify risk factors such as fat intake.
Which of the following should the nurse do to assist a pt recovering from cardiovascular surgery who is demonstrating chest tube output of greater than 100 mL per hours? Select all that apply. 1. Report to the surgeon. 2. Check the hemoglobin & hematocrit. 3. Administer a blood transfusion. 4. Notify the family.
Answer: 1,2 Rationale 1: It's abnormal to have > 100 mL of drainage in 1hr. It may indicate bleeding & needs to be assessed by the surgeon. Rationale 2: Hemoglobin & hematocrit should be checked. Rationale 3: The pt needs to be assessed along with the lab data before it is determined if a blood transfusion is necessary. Rationale 4: There is no need to notify family until the pt has been assessed. It may not be of significance.
A pt enters the ER complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this pt includes which nursing actions? Select all that apply. 1. morphine intravenously & oxygen 2. aspirin 325 mg orally 3. open heart surgery 4. heparin drip at 100 units per hour 5. Foley catheter insertion
Answer: 1,2 Rationale 1: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of pts with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, & aspirin. While the mnemonic does not imply a correct sequencing of treatment, it does describe a protocol for treatment of pts with suspected myocardial infarction. Rationale 2: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of pts with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, & aspirin. While the mnemonic does not imply a correct sequencing of treatment, it does describe a protocol for treatment of pts with suspected myocardial infarction. Rationale 3: Open heart surgery may be indicated later, but not on admission to the ER. Rationale 4: Heparin is not part of the admission protocol. Rationale 5: A Foley catheter is not part of the admission protocol.
Coronary heart disease (CHD) is a major problem in the United States. Pts with which history may require closer evaluation for CHD? Select all that apply. 1. diabetes 2. hyperlipidemia 3. positive family history 4. a premenopausal woman 5. hypotension
Answer: 1,2,3 Rationale 1: Diabetes is a disease condition that contributes to coronary heart disease (CHD). Rationale 2: Hyperlipidemia is a disease condition that contributes to CHD. Rationale 3: Positive family history in some cases is considered a nonmodifiable risk factor for CHD. Rationale 4: Women experiencing premature menopause (not premenopausal women) is also a condition to be evaluated. Rationale 5: Hypotension is not associated with development of CHD.
A nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statement(s) should the nurse include in the presentation? Select all that apply. 1. Epigastric pain & nausea are often experienced with a heart attack but attributed to heartburn. 2. Common symptoms of myocardial infarction (MI) include shortness of breath & fatigue. 3. Women are more likely to have an unrecognized myocardial infarction. 4. Weakness of the legs & back often precede a heart attack. 5. The mortality rate of young women having an MI is 50 % lower than that of men.
Answer: 1,2,3 Rationale 1& 2: Common symptoms of MI in women include epigastric pain or nausea, which is blamed on heartburn, shortness of breath, fatigue, & weakness of the shoulders & upper arms. Rationale 3: "Silent" or unrecognized heart attack occurs more frequently in women than men. Rationale 4: Weakness of the legs & back does not precede a heart attack. Rationale 5: The mortality rate of young women having an MI is twice that of men.
The pt is admitted to the hospital for evaluation & diagnosis of cardiovascular pathology. The pt is scheduled for an ejection fraction study. Correct facts that will guide pt teaching include which of the following? Select all that apply. 1. An ejection fraction (EF) study will measure the % of total blood in the ventricle ejected from the heart w/ each beat. 2. An ejection fraction (EF) provides information about how effectively the heart is pumping. 3. Stroke volume times heart rate equals cardiac output. 4. 4. The normal ejection fraction is 95-100%. 5. Cardiac output is not an indicator of how well the heart is functioning
Answer: 1,2,3 Rationale 1: Correct facts that will guide teaching include an ejection fraction (EF) study will measure the percentage of total blood in the ventricle ejected from the heart w/ each beat. Rationale 2: Correct facts that will guide teaching include an EF provides info about how effectively the heart is pumping. Rationale 3: Correct facts that will guide teaching include SV x HR= CO Rationale 4: Normal ejection fraction is 50-70%. Rationale 5: Cardiac output is an indicator of how well the heart is pumping.
The nurse is caring for a pt admitted w/ a grade III heart murmur heard during midsystole. The nurse realizes that the following cardiac conditions could result in which assessment finding? Select all that apply. 1. aortic stenosis 2. pulmonary stenosis 3. cardiomyopathy 4. atrioventricular (AV) valve disease 5. mitral valve prolapse
Answer: 1,2,3 Rationale 1: Midsystolic murmurs are associated w/ semilunar valve & hypertrophic cardiomyopathies. A grade III murmur can be heard clearly & can be categorized as systolic (between S1 & S2), diastolic (between S2 & S1), pansystolic (all of systole), or continuous (heard throughout systole & all or part of diastole). Rationale 2: Midsystolic murmurs are associated w/ semilunar valve & hypertrophic cardiomyopathies. A grade III murmur can be heard clearly & can be categorized as systolic (between S1 & S2), diastolic (between S2 & S1), pansystolic (all of systole), or continuous (heard throughout systole & all or part of diastole). Rationale 3: Midsystolic murmurs are associated w/ semilunar valve & hypertrophic cardiomyopathies. A grade III murmur can be heard clearly & can be categorized as systolic (between S1 & S2), diastolic (between S2 & S1), pansystolic (all of systole), or continuous (heard throughout systole & all or part of diastole). Rationale 4: Murmurs associated w/ atrioventricular (AV) valve disease or mitral valve prolapse would more often be heard during early or mid-diastole. Rationale 5: Murmurs associated w/ atrioventricular (AV) valve disease or mitral valve prolapse would more often be heard during early or middiastole.
The nurse reviews an ECG tracing & determines that it is not a high quality tracing. Which of the following factors can negatively influence an ECG tracing? Select all that apply. 1. pt movement during recording 2. history of COPD 3. incorrect positioning of leads 4. morbid obesity 5. leads in firm contact w/ the skin
Answer: 1,2,3,4 Rationale 1: Factors that can negatively impact the quality of an ECG tracing include motion artifact, which occurs when a pt moves during the recording. Rationale 2: Factors that can negatively impact the quality of an ECG tracing: a history of COPD. Rationale 3: Factors that can negatively impact the quality of an ECG tracing: incorrect positioning of leads. Rationale 4: Factors that can negatively impact the quality of an ECG tracing : morbid obesity. Rationale 5: Leads that are properly positioned & in firm contact w/ the skin ensure accuracy of the test.
The nurse is caring for a pt who develops atrial fibrillation with a heart rate above 100 bpm. Place the following nursing actions in sequence from the highest priority to the lowest priority. Click & drag the options below to move them up or down. Choice 1. Assess the pt for comfort level & vital signs. Choice 2. Check the patency of an intermittent IV. Choice 3. Check the pt's chart for lab results from today's tests. Choice 4. Call the physician to report the dysrhythmia.
Answer: 1,2,3,4 Rationale 1: Assess the pt first. Rationale 2: Check the patency of the IV in case it is needed for anticipated medication administration. Rationale 3,4: Check for lab results prior to calling the physician in order to respond to the physician's questions before the physician gives prescriptions.
Place the following terms in the correct order (from outer to inner) to describe the coverings & layers of the heart. Choice 1. fibrous pericardium Choice 2. parietal layer of serous pericardium Choice 3. pericardial cavity Choice 4. epicardium Choice 5. myocardium Choice 6. endocardium
Answer: 1,2,3,4,5,6 Global Rationale: The heart is covered by the fibrous pericardium & a parietal layer of serous pericardium. A serous lubricating fluid fills the pericardial cavity & cushions the heart. The outermost layer of the heart wall is the epicardium; the middle layer is the myocardium; & the innermost layer is the endocardium.
A pt is having elective synchronized cardioversion. Place the following steps of the procedure in the correct order. Click & drag the options below to move them up or down. Choice 1. Verify patency of IV access. Choice 2. Administer sedative per physician prescription. Choice 3. Set cardioverter to "synchronize" mode. Choice 4. Place conductive pads on the pt's chest. Choice 5. Charge the cardioverter to the selected energy level. Remove oxygen. Choice 6. Personnel step away from the bed prior to delivery of the electrical shock.
Answer: 1,2,3,4,5,6 Rationale 1: IV access is necessary for emergency drug administration & should be verified before the procedure is begun. Rationale 2: Pt comfort is maintained through administration of the prescribed sedation prior to the cardioversion. Rationale 3: The correct function of the cardioverter is set to synchronize mode. Rationale 4: Conductive pads are applied. Rationale 5: The cardioverter is charged to the selected energy level. Oxygen is removed since an electrical shock could cause oxygen combustion. Rationale 6: Personnel should not be touching the bed prior to & during delivery of the shock.
Determine the cardiac output (CO) of a pt whose stroke volume (SV) is 80 mL/beat & whose heart rate (HR) is 75 beats/minute. Round to the nearest whole number & place the answer below. _______
Answer: 6000 Rationale : Cardiac output is the amount of blood pumped by the ventricles into the pulmonary & systemic circulations in one minute. It is determined by multiplying the stroke volume by the heart rate (SV × HR = CO). Multiplying 80 mL/beat by 75 beats/minute equals 6000 mL.
Amiodarone (Cordarone)
Anti-arrhythmic used when VFib is resistant to treatment, and also for fast arrhythmias
Xa
Anti-factor
Blood transfusion reactions: cause of febrile reaction
Antibodies to donor platelets or leukocytes
Psychomotor symptoms
Anticholinergic effects are common adverse effects of antidepressants such as imipramine (Tofranil). These effects may include: a. Psychomotor symptoms b. Tachycardia, hypertension, and increase in respiratory rate c. Tardive dyskinesias d. Blurred vision, dry mouth, and constipation
How is DVT treated
Anticoagulant drugs to prevent clot from growing, limit foods with Vitamin K, surgery, bedrest, elevate extremity, TED hose, warm moist heat, prevention
SSRIs
Antidepressant drugs such as the ____ may not have full effects for a month or longer but some improvement in mood and depression should be noticeable after beginning therapy. DRUG OF CHOICE for depression.
paroxetine, Paxil
Antidepressant. Weight gain. pack it on ____
In the client with mitral regurgitation the nurse would confirm the presence of a murmur at which location on the anterior chest?
Apex
What do you need to do before a cardiac catheterization?
Ask if allergic to iodine or shellfish, check kidney fX (have to excrete dye)
How is the Allen's test done?
Ask patient to make a tight fist, using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand, ask pt to relax hand (hand and palm should appear blanched bc flow stopped), release pressure on ulnar artery and continue applying pressure to radial if the hand flushes within 5 sec the ulnar artery is patent and the Allen's test is positive for the ulnar artery, repeat the test releasing pressure on radial and maintaining pressure on ulnar.
To assist the patient with CAD to make the appropriate dietary changes, which of these nursing interventions will be most effective?
Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible.
When does PE usually occur and what are S/S
At night when client goes to bed because laying down increases venous return. S/S are severe hypoxia, sudden onset, breathless, restless/anxious, productive cough (pink frothy sputum)
While admitting a patient with an AMI, which action should the nurse carry out first?
Attach the cardiac monitor.
When palpating the carotid arteries it is essential that the nurse do which of the following?
Avoid palpating the carotids simultaneously.
What is the treatment for a pt. with ventricular tachycardia?
Awake and alert: IV lidocaine bolus and drip Unconscious, hypotensive, or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
A P wave on an ECG represents an impulse a. arising at the SA node and repolarizing the atria b. arising at the SA node and depolarizing the atria c. arising at the AV node and depolarizing the atria d. arising at the AV node and spreading to the bundle of HIS
B
A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia a. will always progress to myocardial infarction b. will be relieved by rest, nitroglycerin, or both c. indicates that irreversible myocardial damage is occurring d. is frequently associated with vomiting and extreme fatigue
B
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient states, A) a. "I will replace my nitroglycerin supply every 6 months." B) b. "I can take up to five tablets every 3 minutes for relief of my chest pain." C) c. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." D) d. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."
B
Auscultation of a patient's heart reveals the presence of a murmur. This assessment finding is a result of A) a. Increased viscosity of the patient's blood. B) b. Turbulent blood flow across a heart valve. C) c. Friction between the heart and the myocardium. D) d. A deficit in heart conductivity that impairs normal contractility.
B
The auscultatory area in the left midclavicular line at the level of the fifth ICS is the a. aortic area b. mitral area c. tricuspid area d. pulmonic area
B
The most significant factor in long-term survival of a patient with sudden cardiac death is a. absence of underlying heart disease. b. rapid institution of emergency services and procedures. c. performance of perfect technique in resuscitation procedures. d. maintenance of 50% of normal cardiac output during resuscitation efforts.
B
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. Which of the following allergies is most important for the nurse to assess before this procedure? A) a. Iron B) b. Iodine C) c. Aspirin D) d. Penicillin
B
When teaching a patient about dietary management of stage 1 hypertension, which of the following instructions is most appropriate? A) a. Restrict all caffeine. B) b. Restrict sodium intake. C) c. Increase protein intake. D) d. Use calcium supplements.
B
While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. a low-calcium diet b. excessive alcohol consumption c. a family history of hypertension d. consumption of a high-protein diet
B
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) daily for the past 10 years. Which of the following parameters would indicate the optimal intended effect of this drug therapy? A) a. Weight loss of 2 lb B) b. Blood pressure 128/86 C) c. Absence of ankle edema D) d. Output of 600 ml per shift
B Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.
When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which of the following meats? A) a. Broiled fish B) b. Roasted duck C) c. Roasted turkey D) d. Baked chicken breast
B Roasted duck is high in fat, which should be avoided by the patient with hypertension. The other meats are lower in fat and are therefore acceptable in the diet.
The nurse obtains a 6-second rhythm strip and charts the following analysis: atrial rate 70, regular; ventricular rate 40, regular; QRS 0.04 sec; no relationship between P waves and QRS complexes; atria and ventricles beating independently of each other. Which of the following would be a correct interpretation of this rhythm strip? A) a. Sinus dysrhythmias B) b. Third-degree heart block C) c. Wenckebach phenomenon D) d. Premature ventricular contractions
B Third-degree heart block represents a loss of communication between the atrium and ventricles. This is depicted on the rhythm strip as no relationship between the P waves, representing atrial contraction, and QRS complexes, representing ventricular contraction. The atrium are beating totally on their own at 70 beats/min, whereas the ventricles are pacing themselves at 40 beats/min.
A 59-year-old man has presented to the emergency department with chest pain. Which of the following components of his subsequent blood work is most clearly indicative of a myocardial infarction (MI)? A) a. CK-MB B) b. Troponin C) c. Myoglobin D) d. C-reactive protein
B 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.
In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include which of the following (select all that apply)? a. diffuse involvement of plaque formation in coronary veins b. abnormal levels of cholesterol, particularly low-density lipoproteins c. accumulation of lipid and fibrous tissue within the coronary arteries d. development of angina due to decreased blood supply to the heart muscle e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
B,C,D
When collecting subjective data related to the cardiovascular system, which of the following should be obtained from the patient (select all that apply)? a. annual income b. smoking history c. religious preference d. number of pillows used to sleep e. blood for basic laboratory data
B,C,D
Which of the following patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver? (select all that apply) a. avoid or limit air travel b. take and record a daily pulse rate c. obtain and wear a medic alert ID or bracelet at all times d. avoid lifting arm on the side of the pacemaker above the shoulder e. avoid microwave ovens because they interfere with pacemaker function
B,C,D
The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? A) a. Flushing B) b. Ashen skin C) c. Diaphoresis D) d. Nausea and vomiting E) e. S3 or S4 heart sounds
B,C,D,E During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing an increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.
An elderly patient with a 40-pack-year history of smoking and a recent myocardial infarction is admitted to the medical unit with acute shortness of breath; the nurse need to rule out pneumonia versus heart failure. The diagnostic test that the nurse will monitor to help in determining whether the patient has heart failure is ______________
B-type natriuretic peptide (BNP).
major complication post cath
Bleeding
How do Beta Adrenergic Blockers work and used in what cases?
Block adverse effects from sympathetic nervous stimulation to block receptor sites for epi and norepi so they will decrease the contractility and lower BP and HR. Used in angina, chest pain, HTN, V dysrhythmias and thyroid storm
How do ACEs work and what do they always end in
Block conversion of Angi I to Angi II to promote vasodilation and diuresis, which decreases the secretions of Aldosterone-end in Pril
TCAs
Block or inhibit the reuptake of NE and serotonin (or 5-HT) Are less dangerous than MAOI's. Sedation is a reported complaint at beginning of therapy.
How do ARBs work
Blocks effects of angiotensin II (vasoconstrictor) from binding with receptors in the vascular smooth muscle. Reduces resistance by vasodilating. (Used as an alternative to ACEIs)
BP
Blood pressure
Which med given for PE can be given IV push or as a continuous IV to rapidly remove FVE?
Bumex given 1-2 mg IV push over 1-2 mins
A patient is recovering from an uncomplicated MI. Which of the following rehabilitation guidelines is a priority to include in the teaching plan? a. refrain from sexual activity for a minimum of 3 weeks b. plan a diet program that aims for a 1-to2- pound weight loss per week c. begin an exercise program that aims for at least five 30-minute sessions per week d. consider the use of erectile agents and prophylactic NTG before engaging in sexual activity
C
If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the a. atria b. AV node c. ventricles d. bundle of HIS
C
Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double catheter use c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences.
C
While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which of the following practices should the nurse implement into the assessment during auscultation? A) a. Position the patient supine. B) b. Ask the patient to hold his or her breath. C) c. Palpate the radial pulse while auscultating the apical pulse. D) d. Use the bell of the stethoscope when auscultating S1 and S2.
C In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which of the following common complications? A) a. Dehydration B) b. Paralytic ileus C) c. Atrial dysrhythmias D) d. Acute respiratory distress syndrome
C Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications.
In caring for a patient admitted with poorly controlled hypertension, the nurse would understand that which of the following laboratory test results would indicate the presence of target organ damage secondary to the primary diagnosis? A) a. BUN of 15 mg/dl B) b. Serum uric acid of 3.8 mg/dl C) c. Serum creatinine of 2.6 mg/dl D) d. Serum potassium of 3.5 mEq/L
C The normal serum creatinine level is 0.6-1.3 mg/dl. This elevated level indicates target organ damage to the kidneys.
Which of the following ECG characteristics is consistent with a diagnosis of ventricular tachycardia (VT)? A) a. Unmeasurable rate and rhythm B) b. Rate 150 beats/min; inverted P wave C) c. Rate 200 beats/min; P wave not visible D) d. Rate 125 beats/min; normal QRS complex
C VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. P wave inversion and a normal QRS complex are not associated with VT. Rate and rhythm are not measurable in ventricular fibrillation.
A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which of the following orders is most important for the nurse to question? a. Oxygen at 4 L/min per nasal cannula b. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved c. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours d. IV nitroglycerin at 5 mcg/min; increase by 5 mcg/min every 3 to 5 minutes
C Rationale: Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.
Adverse reaction: Albumin
CIRCULATORY OVERLOAD
Adverse reaction: Plasma
CIRCULATORY OVERLOAD
CO = __ x __.
CO = HR x SV
How do you know Digoxin is working and what is normal level and S/S of toxicity
CO goes UP. Normal level is 0.5-2 ng/ml. S/S of Dig toxicity are anorexia, NV and then Late: arrhythmias and vision changes
Which cardiac specific isoenzyme is increased with damage to cardiac cells, elevates in 3-12 hours and peaks in 24 hours?
CPK-MB
what diagnostic lab work would you look at for a pt with a suspected ACS: MI, UA?
CPK-MB Troponin Myoglobin
What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
What are the hallmark S/S of cardiac tamponade?
CVP will be increased bc the heart is being squeezed, increasing the pressure; BP will be dropping
CCB
Calcium channel blocker
d. Constant, irritating cough
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects? a. Nausea and vomiting b. Dizziness and headaches c. Upset stomach d. Constant, irritating cough
CO
Cardiac Output
Troponin
Cardiac biomarker with high specificity to myocardial damage -Trop I and Trop T -Elevates within 3-4 hours and remains elevated up to 3 weeks Trop T <0.02 Trop I < 0.03
If a large volume of refrigerated blood is infused rapidly through a central venous catheter (into the ventricle of the heart) what can happen?
Cardiac dysrhythmias
What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
CPK-MB
Cardiac-specific iso-enzymes Increases when there is damage to cardiac cells Elevates in 3-12 hours and peaks in 24 hours
CVD
Cardiovascular Disease
During a cardiovascular assessment the nurse finds a bluish tinge on the clients lips, fingers, and toes. what is the appropriate documentation for this finding?
Central and peripheral cyanosis
A 36-year-old patient who has a history of thromboangiitis obliterans (Buerger's disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?
Cessation of smoking
True
Change needles between drawing up iron and injecting to prevent staining. t/f
How is angina treated?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT IN DIET (don't avoid all fat), lose weight, exercise, limit salt intake, nitro, Angioplasty (stent insertion) or CABG.
What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure, especially before patient gets out of bed, and always use tubing with twist lock connections.
What are the steps for adult/child 1 rescuer CPR?
Check for response, activate ERS and AED, open airway with head tilt chin lift, checking breathing (5-10 sec), give 2 breaths (1 sec each), check carotid pulse (5-10 sec), locate CPR hand position, deliver first cycle of compressions (30 compression <23 sec, 1 1/2-2" DEEP), give 2 breaths (1 sec each), deliver second cycle of compressions, give 2 breaths.
What are the steps for infant 1&2 rescuer CPR?
Check for response, activate ERS, open airway head tilt chin lift, check breathing (5-10 sec), give 2 breaths (1 sec) with visible chest rise, checks brachial pulse (5-10 sec), locates CPR finger position, deliver 1st cycle of compressions (30 compression <23 sec, 1/3-1/2" DEEP), 2 breaths, (2nd rescuer arrives) 1st rescuer deliver 2nd cycle of compression, 2nd rescuer gives 2 breaths, (after 2 cycles they switch positions).
A client with congestive heart failure, CHF, is prescribed digoxin (Lanoxin) and furosemide (Lasix). Nursing interventions will include: (Select all that apply.) Encourage intake of water and fruit juices. Restrict intake of green, leafy vegetables. Checking apical pulse before administering medication. Monitor hemoglobin and hematocrit levels. Monitor serum electrolytes.
Checking apical pulse before administering medication. Monitor serum electrolytes. Rationale: Digoxin is a cardiac glycoside. which can slow heart rate, and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF, which promotes not only water loss, but also loss of electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. H and H level do not need to be checked, and green, leafy vegetables would not need to be restricted.
When caring for a patient with ACS who has returned to the coronary care unit after having a PCI, the nurse obtains these assessment data. Which data indicate the need for immediate intervention by the nurse?
Chest pain level 8 on a 10-point scale
What is angina? Stable vs. unstable?
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer, hurts more, etc.)
Febrile reaction to blood Transfusion S/S
Chills, Tachycardia, Fever, Hypotension.
What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Clip hair if necessary, abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes-improves tracings), dry skin if necessary, and attach the lead wires to the electrodes before you apply them to the patient.
What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
CAD
Coronary Artery Disease
The nurse is performing a cardiovascular assessment and notes creases in he client's earlobes. Based on this find the nurse would conclude that the client may be experiencing which condition?
Coronary artery disease.
Aspirin has been prescribed for a pt following a myocardial infarction. What should the nurse include in teaching about this drug? 1. Check with your healthcare provider before taking any herbal remedies. 2. Report any itching that develops after seven days of taking the drug. 3. Take at a different time of day than warfarin (Coumadin). 4. Do not skip any scheduled appointments to have blood drawn for labs.
Correct Answer: 1 Rationale 1: Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin. Rationale 2: Itching is not a common side effect of aspirin therapy. Rationale 3: Aspirin & Coumadin are not to be taken concurrently. Rationale 4: No lab appointments will be made just for aspirin therapy.
Which diagnostic test would the nurse anticipate as priority for a pt admitted with chest pain to determine coronary heart disease status? 1. coronary angiography 2. stress electrocardiography 3. echocardiography 4. radionuclide testing
Correct Answer: 1 Rationale 1: The gold standard for evaluating coronary arteries is coronary angiography. Visualization of the arteries is allowed with this method. Rationale 2,3,4: The other tests may be used, but are not the primary exam. The remaining exams will probably not be done until the angiography is completed & analyzed.
The nurse is assessing a pt who is six hours postoperative from coronary artery bypass graft (CABG) surgery. The pt's heart rate is 120, bp is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, & peripheral pulses are diminished. What action should be taken by the nurse first? 1. Notify the physician immediately. 2. Recheck vital signs in 15 minutes. 3. Reposition the pt. 4. Increase the intravenous fluids.
Correct Answer: 1 Rationale 1: The pt is exhibiting signs of cardiac tamponade. This is an emergency, & the Dr. must be notified immediately. Rationale 2: Delaying the response by waiting 15 minutes will be ineffective. Rationale 3: Repositioning the pt will be ineffective. Rationale 4: No change in intravenous fluids should be made until a physician order is given to do so.
The primary factor regulating blood flow through the coronary arteries is which of the following? 1. blood pressure in the aorta 2. blood vessel dilation 3. the low pressure systemic circulation 4. the draining of blood into the coronary sinus by the coronary veins
Correct Answer: 1 Rationale 1: Blood flow through the coronary arteries is primarily regulated by the aortic BP. Rationale 2: Other factors include the blood vessel tone (constriction), HR, & metabolic activity of the heart. Rationale 3: Other factors include the blood vessel tone (constriction), HR, & metabolic activity of the heart. Rationale 4: Other factors include the blood vessel tone (constriction), heart rate, & metabolic activity of the heart.
Fifteen hours after admission, a pt's CPK-MB level is markedly increased. What does this indicate to the treatment team? 1. Cellular necrosis of myocardial tissue has occurred. 2. Lactic acid is present. 3. Thrombolytic therapy is indicated. 4. Cardiac function has returned to normal.
Correct Answer: 1 Rationale 1: CPK-MB is the intracellular enzyme that is released when cell damage & death occur. CPK-MB becomes elevated when myocardial cell death has occurred. Rationale 2: The pH is the indicator of lactic acid buildup. Rationale 3: Thrombolytic therapy is indicated within the first 12 hours after symptoms develop, thus, it is too late for this intervention. Rationale 4: Cardiac function has not returned to normal.
The pt has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes that this means that this which type of pacemaker? 1. asynchronous pacing 2. demand pacing 3. dual-chamber pacing 4. atrial single-chamber pacing
Correct Answer: 1 Rationale 1: Considerations when determining the type of pacemaker include the pacing spike frequency noted on the ECG, the location within each complex, & whether it is fixed or intermittent. An asynchronous pacemaker produces the description provided. Rationale 2: A demand pacemaker spike varies with the heart rate. Rationale 3: A dual-chamber pacer normally produces two pacing spikes, one before the P wave & one before the QRS. Rationale 4: An atrial pacer would produce a spike, normally with a P wave that follows it prior to the QRS.
The pt is being interviewed by the nurse. Which functional health pattern is related to asking the pt if she has had tests to check the function of her heart? 1. health perception-health management 2. cognitive-perceptual 3. nutritional-metabolic 4. activity-exercise
Correct Answer: 1 Rationale 1: The category of health perception-health management assists the nurse to gather info about past heart problems, tx for problems, previous diagnoses, previous tests & findings, & meds the pt has been prescribed. Rationale 2: The cognitive-perceptual pattern refers to the pt's ability to understand & process information. Rationale 3: The nutritional-metabolic pattern assesses intake patterns. Rationale 4: The activity-exercise pattern refers to the pt's level of physical activity.
The nurse is caring for a pt who has just undergone cardiac catheterization. The catheter insertion site is free from bleeding or signs of hematoma. Vital signs & distal pulses remain w/in normal range. IV fluids were discontinued. The pt denies hunger or thirst & refuses food or fluids, asking to be left alone. Which of the following is the best response by the nurse? 1. "It is important that you drink fluids after the procedure to protect kidney function. I will bring you some fresh water." 2. "It is important that you ambulate, so I will return in 30 minutes to walk w/ you." 3. "You are recovering well from the procedure & rest is a good idea." 4. "You need to do the leg exercises that you practiced before the procedure to maintain good circulation to your legs. After your exercises, you can rest."
Correct Answer: 1 Rationale 1: The dye used in angiography is nephrotoxic & a pt should have adequate fluids after the procedure to eliminate the dye. Rationale 2: The pt should lie w/ the affected leg extended for 6 to 12 hours (or as ordered). Rationale 3: Option 3 is giving false reassurance to a pt who could be at risk if fluids are not ingested. Rationale 4: Leg exercises are not recommended as this could dislodge the clot at the insertion site.
An important nutritional-metabolic interview question to ask pts who are being evaluated for heart conditions is which of the following? 1. "Have you had a recent weight gain or loss?" 2. "Is there any change in your usual bowel elimination?" 3. "Has there been a change in your usual daily activities?" 4. "Have you experienced chest pain in the last week?"
Correct Answer: 1 Rationale 1: Weight gain can be linked to abnormal retention of fluids, which can affect heart function. Weight loss can be linked to level of nutrition or dehydration. The nutritional-metabolic functional health pattern guides questions that are related to weight gain or loss. Rationale 2:?'s regarding elimination are important but are categorized under other functional health patterns. Rationale 3: ?'s regarding daily activity are important but are categorized under other functional health patterns. Rationale 4: ?'s regarding chest pain are important but are categorized under other functional health patterns.
The nurse is instructing a pt on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse's instructions? Select all that apply. 1. "Take a second dose if the angina is not relieved within five minutes." 2. "The drug should remain in this brown bottle since it is sensitive to light." 3. "Store this medication in your bathroom medicine cabinet so it is readily available to you." 4. "Eating or drinking will not interfere when taking the medication." 5. "Call your doctor immediately if you develop a headache when taking this drug."
Correct Answer: 1,2 Rationale 1: A second dose of nitrates is recommended within five minutes if the first dose does not relieve the angina. Rationale 2: Sublingual nitrates should not be removed from their original amber bottle since it protects the medication from light. Rationale 3: They should be stored in a dry location & not placed in the bathroom medicine cabinet since moisture affects nitrates. Rationale 4: This medication is taken sublingually, therefore eating & drinking will interfere with absorption. Rationale 5: A transient headache may occur when taking this medication & will diminish over time.
The nurse, discussing coronary heart disease risk factors with a group of factory employees, would include which option(s) as modifiable risk factors? Select all that apply. 1. hypertension 2. diabetes mellitus 3. obesity 4. age 5. heredity
Correct Answer: 1,2,3 Rationale 1: A person can make a choice to modify HTN by controlling it through meds, weight control, diet, & exercise. Rationale 2: A person can make a choice to modify DM by controlling it through meds, weight control, diet, & exercise. Rationale 3: A person can make a choice to obesity by controlling it through meds, weight control, diet, & exercise. Rationale 4: Hereditary effects on coronary heart disease cannot be changed. Rationale 5: Aging effects on coronary heart disease cannot be changed.
The term pacemaker noncapture requires which nursing action(s)? Select all that apply. 1. Contact the physician & describe what is noted on the ECG strip. 2. Assess the pt to determine response to the pacemaker noncapture. 3. Document the event by printing the ECG strip & placing it on the pt's record. 4. Ask the pt to ambulate to increase cardiac output. 5. Administer nitroglycerin sublingual one dose stat according to physician prescription.
Correct Answer: 1,2,3 Rationale 1: Actions the nurse should take when noncapture occurs include contacting the physician & describing the ECG strip. Rationale 2: Actions the nurse should take when noncapture occurs include assessing the pt to determine the response to the noncapture event. Rationale 3: Actions the nurse should take when noncapture occurs include documenting the event by printing an ECG strip & placing it on the pt's record. Rationale 4: Having the pt ambulate would not be indicated for pacemaker malfunction. Rationale 5: Administering nitroglycerin would not be indicated for pacemaker malfunction. Nitrogycerin is administered for chest pain.
A pt returns to the unit following a cardiac catheterization. Which are appropriate nursing interventions for this pt? Select all that apply. 1. Assess cardiac rhythm & rate. 2. Assess pt for complaints of shortness of breath. 3. Maintain bed rest as ordered. 4. Assess pulses proximal to the insertion site. 5. Maintain fluid restriction.
Correct Answer: 1,2,3 Rationale 1: Nursing interventions after the cardiac catheterization procedure include monitoring vital signs every 15 minutes for the first hour & then every 30 minutes until stable. Assess cardiac rhythm & rate for alterations. Rationale 2: Assess pt for complaints of chest heaviness, shortness of breath, & abdominal or groin pain. Rationale 3: Instruct pt to remain on bed rest as ordered. Rationale 4: Assess pulses distal to the insertion site. Assessing pulses proximal to the insertion site is not appropriate. Rationale 5: Encourage oral fluids unless contraindicated. Maintaining fluid restrictions is not appropriate.
The nurse realizes that the pt in the critical care area with ventricular tachycardia will require which action? Select all that apply. 1. immediate assessment & probable emergency intervention by the nurse 2. cardioversion, if sustained & symptomatic 3. probable administration of a potassium channel blocker 4. close observation for one hour prior to calling the physician 5. defibrillation to convert the rhythm in the awake pt
Correct Answer: 1,2,3 Rationale 1: The nurse should immediately assess the pt to see how the potentially life-threatening rhythm is being tolerated. Rationale 2: The nurse should be prepared to cardiovert the pt in ventricular tachycardia with a pulse according to standing prescriptions. The nurse in critical care needs to be aware of standing prescriptions for each pt prior to an emergent event & needs to have the necessary emergency equipment & meds ready. Rationale 3: Class III antidysrhythmic meds (potassium channel blockers) are typically administered. Rationale 4: Observation prior to calling a physician is not an appropriate action when a potentially life-threatening rhythm is identified. Rationale 5: Defibrillation is only conducted in ventricular tachycardia when the pt is pulseless; otherwise, time is taken to synchronize for cardioversion.
A pt is in sinus tachycardia. Which nursing interventions are appropriate? Select all that apply. 1. Observe the pt for effects on cardiac function. 2. Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present. 3. Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause. 4. Give pain meds as prescribed if pain is present. 5. Give atropine per physician prescription to slow the heart rate.
Correct Answer: 1,2,3,4 Rationale 1: Appropriate nursing interventions for the pt in sinus tachycardia are to observe the pt for effects on cardiac function; treat fever, hypovolemia, & pain if present. The focus is on determining the pt response to the elevated heart rate & treating the underlying causes, which are often fever, pain, & hypovolemia. Rationale 2: Appropriate nursing intervention for the pt in sinus tachycardia is to treat fever Rationale 3: Appropriate nursing intervention for the pt in sinus tachycardia is to treat hypovolemia. Rationale 4: Appropriate nursing intervention for the pt in sinus tachycardia is to treat pain if present. Rationale 5: Atropine acts to increase heart rate & may be a cause of sinus tachycardia.
The nurse is notified by the cardiac monitoring technician that a pt on continuous cardiac monitoring is having frequent alarms. When the nurse enters the pt's room, the pt is in no apparent distress, is sitting in the chair & eating. Which are appropriate nursing interventions? Select all that apply. 1. Confirm that lead wires are properly connected. 2. Assess placement of electrodes. 3. Remove & reapply new electrodes if nonadherent. 4. Assess skin sites & move an electrode if the skin appears irritated. 5. Call for assistance.
Correct Answer: 1,2,3,4 Rationale 1: Nursing actions include assessing lead wire connections. Rationale 2: Nursing actions include assessing placement of electrodes. Rationale 3: Nursing actions include changing electrodes every 24 to 48 hours or removing & reapplying electrodes that are dislodged or nonadherent. Rationale 4: Nursing actions include assessing & documenting skin condition under the pads & moving pads to alternate sites to avoid skin irritation. Rationale 5: Since the pt is in no apparent distress, assistance is not required.
The nurse is analyzing an ECG. Identify the correct order of the steps in this analyzing. Choice 1. Determine heart rate. Choice 2. Determine regularity of the rhythm. Choice 3. Assess P wave. Choice 4. Assess P to QRS relationship. Choice 5. Determine interval durations. Choice 6. Identify abnormalities.
Correct Answer: 1,2,3,4,5,6 Rationale 1: Begin by determining the heart rate. Rationale 2: Then determine regularity of the rhythm. Rationale 3: Assess the P wave. Rationale 4: Assessment of the P to QRS relationship. Rationale 5: Determine the interval durations. Rationale 6: Identify abnormalities
Place the following steps in the correct order for interpreting an electrocardiogram (ECG) rhythm strip. Choice 1. Determine rate. Choice 2. Determine regularity. Choice 3. Assess P wave. Choice 4. Assess P to QRS relationship. Choice 5. Determine interval durations. Choice 6. Identify abnormalities.
Correct Answer: 1,2,3,4,5,6 Rationale 1: It is necessary to use a consistent method for ECG analysis. The 1st step is to determine rate. Rationale 2: The 2nd step is to determine regularity. Rationale 3: The 3rd step is to assess P wave. Rationale 4: The 4th step is to assess P to QRS relationship. Rationale 5: The 5th step is to determine interval durations. Rationale 6: The sixth step is to identify abnormalities.
What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck, shoulders, or jaw, diaphoresis, nausea, and SOB.
The ECG monitor of a patient in the cardiac care unti following an MI indicates ventricular bigeminy with a rate of 50 beats/minute. The nurse would anticipate. a. performing defibrillation b. treatment with IV lidocaine c. insertion of a temporary transvenous pacemaker d. assessing the patient's response to the dysrhythmia
D
The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. Which of the following is an age-related change that contributes to this finding? A) a. Stenosis of the heart valves B) b. Decreased adrenergic sensitivity C) c. Increased parasympathetic activity D) d. Loss of elasticity in arterial vessels
D
For which of the following antilipemic medications would the nurse question an order in a patient with cirrhosis of the liver? A) a. Niacin (Nicobid) B) b. Ezetimibe (Zetia) C) c. Gemfibrozil (Lopid) D) d. Atorvastatin (Lipitor)
D Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently and the medication stopped if these enzymes increase. Thus liver disease is a contraindication for atorvastatin.
For which of the following is percutaneous coronary intervention (PCI) most clearly indicated? A) a. Chronic stable angina B) b. Left-sided heart failure C) c. Coronary artery disease D) d. Acute myocardial infarction
D PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure.
A patient was admitted to the emergency department 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). Which of the following complications of MI should the nurse anticipate? A) a. Unstable angina B) b. Cardiac tamponade C) c. Sudden cardiac death D) d. Cardiac dysrhythmias
D The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes; cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.
Complication of MI: Major Arrhythmias: What major arrhythmia will put the patient at risk for sudden death?
D-Fib the V-Fib (worst one!)
What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
What is the treatments for hypertension?
Decrease in weight, diuretics (watch K loss), aldactone (k sparing but check renal fx), inderal (do NOT give to asthma patients or diabetic patients), more exercise, no smoking, and decreased Na intake.
How do diuretics work to treat HF and when should they be given?
Decrease preload, block reabsorption of sodium, chloride and water so can be excreted by kidneys. Give them in the morning
Calcium Channel Blocker Action
Decrease the BP -They also dilate coronary arteries
What are the other S/S of cardiac tamponade?
Decreased CO, heart sounds muffled or distant, neck veins distended, pressures in all 4 chambers are the same, shock paradoxical pulse (pulsus paradoxus) and narrowed pulse pressure (from the baseline)
What heart problem has these characteristics?
Decreased blood flow to the myocardium=ischemia TEMPORARY pain/pressure in the chest usually caused by CAD brought on by LOW OXYGEN usually d/t EXERTION and pain is relieved by REST and/or NITROGLYCERIN=Chronic STABLE angina
What is a nursing diagnosis for arterial occlusion? Tx:
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
How does Lidocaine work to prevent a second episode of VFIB?
Decreases irritability of the heart, causes it to stop throwing PVC's
What do beta blockers do to BP, P, and myocardial contractility?
Decreases them
DVT
Deep Vein Thrombosis
Where do the internal jugular veins lie?
Deep in the sternomastoid muscle, so look for pulsations in the soft tissue surrounding that area.
What are the 2 types of pacemakers?
Demand: Works PRN (when HR goes below predetermined rate) or Fixed: beats constantly at predetermined rate so no matter what heart does still beats at same rate.
Hypomagnesemia
Depressed S-T segment
The nurse caring for a client experiencing chest discomfort should obtain which assessment data from the client?
Description of the pain and location.
ventricles can't relax and fill, what type of HF
Diastolic
DBP
Diastolic Blood Pressure
What is pulse pressure?
Difference between SBP and the DBP
What medications are used to tx HF?
Digitalis (Lanoxin), Diuretics, ACE inhibitor/ARBs and/or a BB
What drug is used with AF and HF and is both a positive inotrope (contraction increases) and negative chronotrope (HR decreases)
Digitalis (Lanoxin). check apical pulse before giving-5th ICS, mid-clavicular line
The client's serum digoxin level is 2.2 ng/dL and the heart rate is 120 and irregular. The nurse expects to administer which of the following drugs? Digoxin immune Fab (Digibind) Furosemide (Lasix) 60 mg I.V. Digoxin 0.5 mg bolus I.V. Potassium 40 mEq added to I.V. fluids
Digoxin immune Fab (Digibind) Rationale: Digibind binds and removes digoxin from the body and prevents toxic effects of digoxin overdose. A serum level of 2.2 is elevated, and the client is exhibiting signs of digoxin toxicity. The question does not indicate that the potassium level is low. Giving additional digoxin would exacerbate the toxicity. Giving Lasix may reduce potassium levels and contribute to increased toxicity.
iron
Dilute liquid ________ preparations in juice or water and administer with a plastic straw to avoid staining teeth
What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti-arrhythmic drugs (lidocaine, Procainamide, and Bretylium).
If a victim is choking but can cough, speak, or breath what should you do?
Don't interfere!
b. Dizziness c. Headache e. Ankle edema
During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.) a. Insomnia b. Dizziness c. Headache d. Angioedema e. Ankle edema f. Hacking cough
A patient who has chest pain is admitted to the ED, and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first?
ECG
What is the most common complication of permanent pacemakers in early hours?
Electrode displacement
What does plan of care include?
Elevated legs, anticoagulation therapy (aggressive: generally IV heparin), Be alert for signs of PE.
What is the nursing care associated with chemical stress tests (persantine stress test)?
Explain procedure, stress importance of reporting symptoms. INSTRUCT THE PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE THE TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH THE TEST!!! (No vasodilators or calcium channel blockers bc will give for test and pt will end up with double. Digoxin is okay to take prior to testing).
Adverse reaction: Platelets
FEBRILE reactions
What are the S&S of superior vena cava syndrome?
Feeling of fullness in head, tightness around shirt collar, or rings/jewelry that suddenly seem tight, swelling in face, hands, arms, and swollen/cyanotic lips, dyspnea, coughing, hoarseness, chest pain, hemotysis, visable collateral chest wall veins, JVD, confusion, HA, and visual disturbances.
What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
During inspection of the carotid arteries the nurse assesses a bounding pulse. The nurse should evaluate the client for which additional findings?
Fever
What should you teach someone with arterial insufficiency?
File toe nails, if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
hyperkalemia
Flat P waves
What ECG finding only in hyperkalemia is different from hypermagnesemia different?
Flat P waves & Tall peak t waves
What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op, do not lift more than 10 or 15 lbs. And avoid excessive pushing, pulling, or twisting.
ways to remember difference in venous insufficiency versus arterial
For venous, you're mostly adding something - normal pulses (vs. none), elevate (vs. dangle), normal color or petechiae(vs. pale), normal temp (not cool), edema is present (vs. none), dark color around ankles (vs. thin and shiny hair loss), ulceration is higher up on leg (vs. feet and toes), compression is used (vs. not). The ONLY difference where you're not adding something-on venous, none to aching pain and arterial has intermittent claudication to rest pain
Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
What kind of symptoms may a women having a ACS/MI/UA present with?
GI symptoms, aching jaw, triad, feeling of fullness, chronic fatigue, inability to catch breath
What body systems are affected by digoxin toxicity? S&S?
GI, neuro, and cardiac. S&S= yellow/green vision, N&V, bradycardia, and anorexia.
A patient who has recently started taking rosuvastatin (Crestor) and niacin (Nicobid) reports all the following symptoms to the nurse. Which is most important to communicate to the health care provider?
Generalized muscle aches and pains
What is the correct way to insert an oropharyngeal airway?
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the posterior wall of the pharynx. (180* TURN)
What is the goal for a pt with a STEMI?
Get them to cath lab for PCI in <90min
Vitamin B12
Give PO with food or mixed with fruit- egg yolk, seafood, meats.
Nursing considerations: Plasma, should be given when and what is the reason?
Give as quickly as possible bc coagulation factors become unstable
What should you do to treat pulmonary edema?
Give furosemide (lasix) 40-60 mg IV, O2 administration, morphine sulfate 3-5 mg IV, have patient sit up with feet lowered (decreases venous return to the heart), nitroglycerin given sublingual or IV, and rotating tourniquets (can reduce intrathoracic blood volume). (NO EPI GIVEN)
A patient with hyperlipidemia has a new order for the bile-acid sequestrant medication colesevelam (Welchol). Which nursing action is appropriate when giving the medication?
Give the patient's other medications 2 hours after the Welchol.
Acetylsalicylic Acid (Aspirin)
Given so platelets don't stick -Maintenance dose is determined by the doctor (81-325 mg)
Treatment for Acute Coronary Syndrome: Fibrinolytics (what is the goal and what are some examples?)
Goal: to dissolve the clot that is blocking blood flow to the heart muscle. This decreases the size of the infarction -Streptokinase (Strepase) -Alteplase (t-PA) -Tenecteplase (TNKase) (one time push) -Reteplase (Retavase) ASE!!
SE of vasodilators
HA, palpitations, tachycardia, GI, edema, nasal congestion.
What factors affect CO?
HR & certain arrhythmias, blood volume, decreased contractility. Remember that arrhythmias are no big deal UNLESS they affect CO
What will a leg with arterial insufficiency look like?
Hair loss, muscle mass loss, pallor when elevated, dependent rubor, and prolonged cap refill time.
What is important to remember when removing a CVC from a patient?
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
How do you prepare a patient for Impedance cardiography monitoring?
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session, locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process), connect leads in BPGO order (blue, purple, green, and orange), turn on power, advise patient to remain still till print out forms, print status reports as necessary and REPLACE THE SENSORS EVERY 24 HOURS.
A patient's sinus rhythm rate is 62. The PR interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 12:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take?
Hold the ordered metoprolol (Lopressor) and call the health care provider.
Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for which electrolyte imbalance of this drug? Hyponatremia Hyperkalemia Hypokalemia Hypernatremia
Hyperkalemia Rationale: ACE inhibitors block aldosterone secretion, which results in sodium loss and potassium retention. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.
When using ARBs what should you watch out for and what do they end in
Hyperkalemia, hypotension, and renal dysfunction. -Sartan.
What do you need to watch for when using ACEs?
Hyperkalemia, orthostatic syncope, hypotension, and renal dysfunction. Angioedema-laryngeal swelling, can be fatal dry, nonproductive-reversible when drug is stopped. Fall precautions-orthostatic hypotension
Blood transfusion reactions: cause of Allergic reaction/Hypersensitivity
Hypersensitivity to antibodies in donor's blood
Amiodarone important side effect
Hypotension (watch bc can lead to further arrhythmias)
What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure, hypertension, or dyspnea.
In what time period is the greatest risk of sudden death from an MI?
IN the first 72 hours!!!!!
If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded, dizzy, or heart palpitations but feel no shock from the ICD.
When would an arterial disorder be a medical emergency?
If you have an acute arterial occlusion (numb, pain, cold, no pulse)
In what locations should you not place electrodes?
In fatty areas or over major muscles, large breasts, or bony prominences.
4
Infuse blood within ____ hours
contractility
Inherent ability of the myocardium to alter contractile force and velocity. Sympathetic stimulation increases myocardial contractility so stroke volume increases.
What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ISH
Isolated Systolic Hypertension
What kind of exercises does a pt with Chronic Stable Angina need to avoid?
Isometric exercise (exercises that make your muscles squeeze and tense up)
How does Nitroglycerin (Nitrostat) SL tablet or spray work to treat Chronic Stable Angina?
It causes venous and arterial dilation, decreases preload and afterload and also causes dilatation of the coronary arteries
What is a chemical stress test (persantine stress test)?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the heart by increasing the strength of the heart muscles contraction.
What is cardioversion?
It is an elective procedure, where the client is awake, it is synchronized with "QRS", the patient is sedated, a consent form must be signed prior to, they are placed on an EKG monitor, and they are shocked with 50-200 Joules.
How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
What should you teach your patient about an exercise ECG (stress test)?
It is noninvasive. You must not eat, smoke, or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES AND LOOSE LIGHTWEIGHT SHORTS OR SLACKS, YOU MAY GET AN INJECTION OF THALLIUM, after your blood pressure and ECG are monitored for 10-15 mins. Wait 1 hour before showering and use warm water.
How does an A-line Dx HF?
It measure BP continuously on monitor
Permanent pacemaker malfunction S/S and possible causes?
It's possible that no mechanical event or contraction follows the stimuli (loss of capture) * or any symptom of decreased CO or decreased rate. Causes are PM may not be programmed correctly, dislodged electrode, depleted battery
Describe noninvasive temporary pacing.
It's transcutaneous and two large electrode pads are applied to client and on pacing mode. It will hurt, so you need to give analgesics
With blood and blood products, RN ask pt to report?
Itching, flank pain over kidneys
Which of these assessment data obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider?
Jugular vein distension (JVD) to the level of the jaw
When administering Digoxin you need to monitor electolytes and most especially which one
K+
What should you teach someone after they have had a pacemaker placed?
Keep clean and dry for 72 hours, DON'T LIFT THE ELBOW OR ARM ON THE INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES), DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS, take pulse and wt each day, CALL CARDIOLOGIST IF EXPERIENCE CONTINUOUS RHYTHMIC HICCUPING, TELL DENTIST THAT HAVE (should be given an antibiotic before having procedures done, STAY AWAY FROM ELECTROMAGNETIC FIELDS, DON'T STOP IN MIDDLE OF ANTI-THEFT DEVICES OR LEAN ON THEM, KEEP CELL PHONES AT LEAST 6 INCHES AWAY FROM PACEMAKER. (ANTIBIOTICS ARE NEEDED FOR A MANICURE).
How do you assess CO in a pt?
LOC, lung sounds clear, no SOB, pulse norm, UO, no chest pain
Iron Deficiency Anemia- Nursing Care
Lack of Iron- S/S: Brittle nails, Cheilosis (ulcer in corner of mouth), Sore tongue, Koilonchyia (concave or spoon-shaped fingernails), Pica.- Tx: Iron Replacement, give, ferrous sulfate (Feosol)/ iron dextran infection (Inferon)- IM iron is IMferon, Gi, ve with Orange juice, give with straw. IM Z track, stool dark green or black
depression
Lack of energy, sleep disturbances, abnormal eating patterns ( OVER EATING) Feelings of despair, guilt, hopelessness Most common mental health disorder of elderly adults. Is associated w/ dysfunction of neurotransmitters in the brain connected with cognition and emotion.
What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
What is a digitalizing dose?
Loading dose
Sequestration
Loss of plasma volume to hemorrhage, drainage, or extracellular fluid movement to a so-called 'third space', such as the abdominal or thoracic cavities.
For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
LMWH
Low-Molecular-Weight- Heparin
What should you do if you are going to ventilate someone with an ambu bag?
Lower HOB, place patient supine, assess LOC, open airway, assess breathing, get ambu bag, put on gloves, connect tubing from O2 source, adjust flow to 10 to 15 liters. FIRST RESCUER: PLACE APEX OF MASK OVER BRIDGE OF NOSE AND BASE BETWEEN LOWER LIP AND CHIP TO ENSURE A TIGHT SEAL, extend neck to open airway. SECOND RESCUER: COMPLETELY SQUEEZE THE BAG FOR 2 SECONDS UNTIL SEE CHEST RISE, THEN LET RE-INFLATE, provide ventilation every 5 seconds.
Where is the tricuspid valve landmark on the chest?
Lower left sternal border
The client is prescribed captopril (Capoten) for treatment of HF. The nurse teaches that the primary action of the drug is to Prevent influx of calcium. Lower peripheral resistance and reduce blood volume. Increase strength of ventricular contractions. Increase heart rate.
Lower peripheral resistance and reduce blood volume. Rationale: ACE inhibitors decrease peripheral resistance and reduce blood volume by enhancing the excretion of sodium and water. This results in decreased afterload and increased cardiac output.
What disease can cause right sided heart failure?
Lung disease
A patient has a dysrhythmia that requires careful monitoring of atrial activity. Which lead will be best to use for continuous monitoring?
MCL1
Acute Coronary Syndrome=
MI, Unstable Angina
What may alter contractility?
MI, medication, muscle disease
What is the treatment for myocardial infarction?
MONA=Magnesium sulfate, O2, Nitroglycerin, Aspirin (mona has a heart so EKG also if select all that apply).
What should you teach your patient about MRI?
MRI is painless, you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel, a pacemaker, or any surgically implanted joints, pins, clips, valves, or pumps containing metal you can't have the test. The scanner makes loud clicking, whirring, and thumping noises as it moves around to obtain different images so you may get earplugs. YOU MUST REAMIN STILL.
How is Chronic Stable Angina treated?
Medications Cardiac Catheterization
When caring for a client receiving triamterene (Dyrenium), the nurse places priority on which nursing intervention? Monitor electrolytes for hyperkalemia. Monitor electrolytes for hypernatremia. Monitor heart rate closely. Monitor blood pressure closely.
Monitor electrolytes for hyperkalemia. Rationale: Dyrenium is a potassium-sparing diuretic. The client should be monitored for signs of hyperkalemia. Hyponatremia, not hypernatremia may occur. BP and heart rate should be monitored, but are not priority with this drug.
Post-procedure care for permanent pacemakers?
Monitor incision, immobilize arm, passive ROM to prevent a frozen shoulder, keep the client from raising their arm too high
A patient who is receiving dobutamine (Dobutrex) for the treatment of ADHF has all of the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN?
Monitor the patient's BP every hour.
A client is being started on lisinopril (Zestril). Nursing interventions during initial therapy with this medication must include Monitoring blood pressure. Monitoring intake and output. Monitoring EKG. Monitoring serum levels.
Monitoring blood pressure. Rationale: Lisinopril is an ACE inhibitor, which can cause severe hypotension with initial doses. The nurse should monitor the client closely for several hours.
What is the safest time of day for sex?
Morning, when client is well rested (MI's are more likely in the morning)
STEMI
Most worrisome patients...get to cath lab for PCI in <90 minutes -ST-Segment Elevation Myocardial Infarction
What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Lithium
Must have salt or it will cause retention of this drug? patients should not avoid salt when taking this drug because it reduces its effects. salt is needed.
What cardiac lab increases 1 hour and peaks in 12 hours and negative results are good?
Myoglobin
What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE, NO SHEETS/BLANKETS, NO COMPRESSION DEVICES, (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Should the tubing for a venous access port be included under the dressing site?
NO because it isn't sterile so keep out.
Can a femoral artery compression device be assigned to an NA?
NO!!!
MAOI
Nardil is an ____. This class of drugs has many drug and food interactions that may cause a hypertensive crisis.
What drug do you need to make sure turned off 2 hours prior to drawing BNP?
Natrecor. If you don't, otherwise you will get a false high
What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Need for follow up blood tests, Need to take oral warfarin for at least 3 months, and to reduce current risk encourage weight loss, smoking cessation, and regular exercise.
Stretch Receptors
Nerve endings located in the vena cava and the right atrium that respond to pressure changes affecting circulatory blood volume. BP dec. bc of hypovolemia then sympathetic reponse occurs causing inc. HR & blood vessel constriction. BP inc. bc. of hypervolemia the opposite occurs.
chemoreceptors
Nerve endings located n the aortic arch and carotid bodies that are stimulated by hypoxemia and that subsequeintly transmit impulses to the CNS
Lidocaine toxicity, expect _____ changes.
Neuro
What does Lidocaine toxicity cause?
Neuro changes
What drugs are most commonly used for angina?
Nitrates, Beta blockers, and Calcium channel blockers
What medications are used to tx Chronic Stable Angina?
Nitroglycerin (Nitrostat) SL tablet or spray, BBs, CCBs, ASA
Do crackles clear with coughing?
No
A patient is receiving fibrinolytic therapy 2 hours after developing an AMI. Which assessment information will be of most concern to the nurse?
No change in the patient's chest pain
What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular-irregular ventricular response.
Is crossmatching required for platelet transfusion?
No it is not, but it is usually done
What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
No magnets (cell phone 6 inches away from), DO NOT DRINK CAFFEINATED BEVERAGES, DO NOT ENGAGE IN ROUGH ACTIVITIES (FOOTBALL OR WRESTLING), and no tight clothing over site.
What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
If your CO is decreased, will you perfuse properly?
No. LOC will go down, may complain of chest pain, SOB, cold & clammy skin, UO goes down, peripheral pulses are weak. Remember that arrhythmias are no big deal UNLESS they affect CO
Major diff between Hodgkin's lymphoma & non-hodgkin's lymphoma
Non-Hodgkin's can manifest in multiple organs
What does a patient with decreased CO look like?
Not perfusing properly LOC decreases chest pain short of breath (wet lung sounds) cold and clamy urinary output decreases weak peripheral pulses
A patient who has developed acute pulmonary edema is hospitalized and diagnosed with dilated cardiomyopathy. Which information will the nurse plan to include when teaching the patient about management of this disorder?
Notify the doctor about any symptoms of heart failure such as shortness of breath.
O can only recieve blood from
O
what blood type is the universal donor
O
O blood can donate blood to
O, A, B, AB
A can recieve blood from
O,A
AB can recieve blood from
O,A,B,AB
A patient develops sinus bradycardia at a rate of 32 beats/min, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take?
Obtain and apply the transcutaneous pacemaker (TCP).
A patient who is complaining of a "racing" heart and nervousness comes to the emergency department. The patient's blood pressure (BP) is 102/68. The nurse places the patient on a cardiac monitor and obtains the following ECG tracing. Which action should the nurse take next?
Obtain further information about possible causes for the heart rate.
What are the S/S of Raynaud's Disease?
Occurs in female fingers (bilaterally, usually in tips), turns white/blue/red d/t vasoconstriction or if she gets cold/upset/smokes, very painful, can cause ulceration. Avoid causes!
How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
How long is contrast media in the body?
Only for a few hours
A patient who has had recent cardiac surgery develops pericarditis and complains of severe chest pain with deep breathing. Which of these ordered PRN medications should the nurse administer?
Oral ibuprofen (Motrin) 800 mg
In analyzing a patient's electrocardiographic (ECG) rhythm strip, the nurse uses the knowledge that the time of the conduction of an impulse through the Purkinje fibers is represented by the __________________
PR interval.
What lab value is used to evaluate a patient on coumadin? What is the normal value?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
dilaudid
Pain med of choice for sickle cell anemia
When evaluating a client's circulation the nurse should include which assessments? Select all that apply.
Palpation of pulses, Skin temperature of bilateral extremities, Skin color, Hair on the legs and feet
PTA
Percutaneous Transluminal Angioplasty
What are all the S&S of pericarditis?
Pericardial friction rub, chest pain (sharp and aggravated with breathing), abnormal EKG findings, possible fever and tachycardia.
What is the hallmark clinical finding associated with pericarditis?
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits, leans forward, and breaths out.
How do you treat cardiac tamponade?
Pericardiocentesis to remove fluid from around the heart; Surgery
PAD
Peripheral Artery Disease
PVD
Peripheral Vascular Disease
B12
Pernicious anemia results from a deficiency in _____ usually caused by lack of the intrinsic factor in gastric juice
PRA
Plasma Renin Activity
PTFE
Polytetrafluoroethylene
What places someone at risk for an aortic dissection?
Poorly controlled hypertension
What is a assessment finding with DVT?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
capillary pressure/hydrostatic pressure
Pressure exerted against the capillary wall, normally 25 to 30 mm Hg at the arterial end and 10 to 15 mm Hg at the venous end.
arterial pressure
Pressure of blood against arterial walls measured by sphygmomanometer or directly by arterial catherter.
Hypocalcemia
Prolonged S-T
hypokalemia
Prominent U wave
TCA antidepressants
Psychomotor symptoms, tachycardia, hypertension, increase in respiratory rate, and tardive dyskinesias are potential adverse effects of ______?
How is HF Dxed?
Pulmonary artery catheter (Swan Ganz catheter), A-line, BNP, CXR, echocardiogram
PCWP
Pulmonary capillary wedge pressure, is the measure obtained during momentary balloon inflation of a pulmonary artery catheter; reflects oef ventricular end diastolic pressure. Ranges between 6 to 12 mm Hg
Right-sided HF has these S/S?
Pulmonary congestion, dyspnea, cough, blood-tinged frothy sputum restlessness, tachycardia, orthopnea, nocturnal dyspnea
What can result from left sided heart failure if left untreated?
Pulmonary edema
What should be checked in a patient on a beta blocker?
Pulse before and after giving.
5 P's for circulation/neuro checks
Pulselessness Pallor Pain Paresthesia Paralysis (also could have skin temp and cap refill)
What should you go when applying nitroglycerin ointment for angina?
Put on gloves, remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose, squeeze the prescribed ointment in a thin layer onto a clean ruled application paper, choose an unused site on the chest back or upper arm and place the application paper on the skin drug side down, secure it with transparent dressing or strip of tape. Don't apply to broken or irritated skin, Don't massage or rub the ointment, and don't get on your own skin.
When analyzing the waveforms of a patient's ECG, the nurse will need to investigate further upon finding a _________
QRS interval of 0.14 second.
A 21-year-old college student arrives at the student health center at the end of the quarter complaining, "My heart is skipping beats." The nurse obtains an ECG and notes the presence of occasional PVCs. What action should the nurse take first?
Question the patient about current stress level and coffee use.
What should be done for someone on bleeding precautions?
RANDI= Razor-electric, Aspirin- NO, Needles- small gauge, Decrease-needle sticks, and Injury- protect from. No percodan or NSAIDS, no open toed shoes.
When auscultating the apical pulse the nurse should assess for which characteristics? Select all that apply
Rate, Regularity, and Rhythm
During a cardiovascular assessment the nurse notes that the client has a heart rhythm with a pause after each beat and a skip every third beat. What is the appropriate interpretation of this findings?
Regularly Irregular
RAAS
Renin Angiotensin Aldosterone System
What are the steps for adult 2 rescuer CPR?
Rescuer arrives with AED, turn AED on, select proper pads and apply, clear victim to analyze, clear victim to shock/press shock, resume chest compressions after 1 shock, delivers cycle of compressions at correct rate, pause to allow other rescuer to give 2 breaths, delivers cycle of compressions, pauses for 2 more breaths, switches places after 2 cycles.
After repair of an abdominal aortic aneurysm, the nurse notes that the patient does not have popliteal, posterior tibial, or dorsalis pedis pulses. The legs are cool and mottled. Which action is appropriate for the nurse to take first?
Review the preoperative assessment form for data about the pulses.
How does the blood flow through the heart? (valves?)
Right atrium, TRICUSPID VALVE (tissue), right ventricle, PULMONIC VALVE (paper), lungs, left atrium, MITRAL VALVE (My), left ventricle, AORTIC VALVE (Assets). TISSUE PAPER MY ASSETS!
If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
What are the S&S of cardiac tamponade?
SOB, dyspnea, anxiousness, diaphoresis, cool/clammy skin, distended neck veins, mental status changes, narrowed pulse pressure, hypotension, and faint or muffled heart sounds.
Which electrocardiographic (ECG) change will be of most concern to the nurse when admitting a patient with chest pain?
ST-segment elevation
Zoloft
Selective serotonin reuptake inhibitor (SSRI) drug.can reduce your sex drive. its been nicknamed "so soft".
Rest pain in an artery signifies what
Severe obstruction of the artery.
In preparing to perform a cardiovascular assessment, the nurse should initially place the client in which position?
Sitting upright
What is Raynauds disease? Tx?
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking, avoid stress & cold, use a vasodilator (calcium channel blocker). No skiing or butcher for career.
baroreceptors
Specialized nerve endings located in the walls of the aortic arch and carotid sinuses, affected by changes n blood pressure.
What are the steps to perform the heimlich maneuver?
Stand behind the victim, wrap arms around waist (IF PREGNANT WRAP ABOVE THE BABY), make a fist with one had and place thumb against abdomen midline, grasp fist with other hand, press into victims abdomen with quick upward thrusts.
What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication, address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
What should a patient do if they feel chest pain or discomfort?
Stop what they are doing, sit down and rest, if prescribed nitroglycerin tablets place one under tongue, if it still remains take another tablet in 5 mins, and if still in pain take another after an additional 5 mins, if still pain after 3 tablets and 15 mins of rest call 911 and DONT TRY TO DRIVE YOURSELF TO THE HOSPITAL.
Without prompt surgery for an aortic dissection what is someone at risk for developing?
Stroke, renal or heart failure, paraplegia secondary to compromised blood flow, or death from aortic rupture.
heart can't contract and eject, what type of HF
Systolic
What is the normal lab for the troponin isomers?
T < 0.20 I < 0.03
True of false? During an Allen's test don't compress one artery before the other.
TRUE
How should a pt take Nitroglycerin?
Take 1 q 5min up to 3 doses under tongue; teach that it may or may not burn or fizz and tell pt that they may get a headache
A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene?
The LPN/LVN has the patient sit in a bedside chair for 90 minutes.
drug holiday
The ____ is to decrease the risk of dependence and to evaluate behavior.
automaticity
The ability of cardiac cells to initiate and impulse spontaneously and repetitively without neurohormonal control.
excitability
The ability of cardiac muscle cells to depolarize in response to stimulus. Influenced by hormones, electrolytes, nutrition, oxygen supply, meds, infections, and nerve characteristics.
Stroke Volume
The amount of blood ejected from the left ventricle with each contraction. Normal stroke vol = 70 -130 mL/heartbeat
Stroke Volume
The amount of blood pumped out of the ventricles with each beat
What is an acute peripheral arterial occlusion?
The arteries have narrowed, decreased O2 to tissues= hypoxia to cells.
c. To block the beta1-adrenergic receptors in the cardiac tissues
The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug? a. To increase the beta1 and beta2 receptors in the cardiac tissues b. To increase the flow of oxygen to the cardiac tissues c. To block the beta1-adrenergic receptors in the cardiac tissues d. To block the beta2-adrenergic receptors in the cardiac tissues
b. "It's best to keep it in its original container away from heat and light."
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry it in your pocket." d. "It's best to lock them in the glove compartment to keep them away from heat and light."
b. Hyperkalemia
The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia
b. Rhabdomyolysis
The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for? a. Myasthenia gravis b. Rhabdomyolysis c. Dyskinesia d. Agranulocytosis
a. It is in the high (elevated) range.
The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? a. It is in the high (elevated) range. b. It is in the low (decreased) range. c. It is within the normal range. d. It is in the low average range.
What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pulse pressure
The difference between systolic and diastolic pressure. Normal pulse pressure is 30 to 40 mm Hg
What is crossmatching?
The donor's red blood cells are combined with the recipient's serum and Coombs' serum; The crossmatch is compatible if no reed blood cell agglutination occurs
Venous Pressure
The force exerted by the blood against the vein walls. Normal pressures are highest in the extremities 5-14 cm H2O in the arm and 6-8 cm H2O in the inferior vena cava
diastolic pressure
The force of blood exerted on the artery walls when the heart relaxes or filled.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker? a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. c. The beta blocker dose should be maintained while taking another antianginal drug. d. Half the beta blocker dose should be taken for the next several weeks.
Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
The nurse obtains the following data when caring for a patient who experienced an AMI 2 days previously. Which information is most important to report to the health care provider?
The lungs have crackles audible to the midline.
Systolic Pressure
The maximum pressure of blood exerted against the artery walls when the heart contracts.
c. Decrease heart rate and decrease myocardial contractility.
The nurse acknowledges that beta blockers are as effective as antianginals because they do what? a. Increase oxygen to the systemic circulation. b. Maintain heart rate and blood pressure. c. Decrease heart rate and decrease myocardial contractility. d. Decrease heart rate and increase myocardial contractility.
a. Diuretic
The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug? a. Diuretic b. Alpha blocker c. ACE inhibitor d. Alpha/beta blocker
a. Hypokalemia
The nurse acknowledges that which condition could occur when taking furosemide? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia
a. Impaction
The nurse would question an order for cholestyramine (Questran) if the client has which condition? a. Impaction b. Glaucoma c. Hepatic disease d. Renal disease
The nurse is admitting a patient who is complaining of chest pain to the emergency department (ED). Which information collected by the nurse suggests that the pain is caused by an acute myocardial infarction (AMI)?
The pain has persisted longer than 30 minutes.
Decrease drug dependence and assess status
The parents of a patient receiving methylphenidate (Ritalin) express concern that the health care provider has suggested the child have a "holiday" from the drug. The nurse explains that the drug-free holiday is designed to: a. Reduce the risk of drug toxicity b. Allow the child's "normal" behavior to return c. Decrease drug dependence and assess status d. Prevent hypertensive crisis
Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider?
The patient complains of chest pain associated with ambulation.
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?
The patient exercises indoors during the winter months.
Which information obtained by the nurse when assessing a patient admitted with mitral valve stenosis should be communicated to the health care provider immediately?
The patient has crackles audible to the lung apices.
Systole
The phase of contraction of the heart especially of the ventricles during which blood is forced into the aorta and pulmonary artery.
What should you teach your patient about a cardiac catheterization?
The physician injects a local anesthetic into the site, inserts a catheter, and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next, a dye is injected which may cause flushing, nausea, or chest pain, they may be asked to COUGH OR DEEP BREATH for a better view of the heart (and help aid catheter movement). They should keep their bandaged arm or leg straight and still for up to 6 hours. Once they're allowed to resume their diet drink plenty of fluids. (angioplasty can be done at the same time and stents can be placed). Nurse should check pulses before and after.
Afterload
The pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out -referred to as resistance -The resistance the LV has to overcome to get the blood out
What does a swan ganz measure?
The right and left ventricular pressures, cardiac output, arterial venous O2 difference, and pulmonary artery pressure.
What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
preload
The volume of blood stretching the left ventricle at the end of diastole.
SSRI
These should not be started within 14 days of taking MAOI. use with a MAOI can cause serotonin sydrome (autonomic hyperactivity, hyperthermia, rigidity, diaphoresis, and neuroleptic malignant syndrome, hypertensive crisis.
How do beta blockers work?
They BLOCK the BETA cells (receptor sites for catecholamines- the epi and norepi) decreasing the contractility--decreasing CO and workload on the heart.
What should you tell someone about taking nitroglycerin tablets (SE)?
They may feel a slight stinging under there tongue when they are dissolving, and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.
What should you teach your patient about a holter monitor?
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body, you need to log your activities for a 24 hour period (walking, sleeping, urinating, physical symptoms, and medications). Don't tamper with the monitor and avoid magnets, metal detectors, and electric blankets.
For what disease should you do the Allen's test?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall, veins, and nerves where they become blocked. It is associated with smoking/tobacco use.
Complication of hyperviscosity of polycythemia
Thrombosis
What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings, vena cava filters, and intermittent sequential external compression devices.
cardiac output
Total volume of blood pumped through the heart in one minute, normal values are 4 to 7 L/min
TEE
Transesophageal Electrocardiography
TIA
Transient Ischemic Attack
What type of invasive temporary pacemaker that has pacing wires placed into the heart muscle and connected to power source outside of body?
Transvenous.
What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Cardiac biomarker specific to myocardial damage and has 2 specific isomers and elevates 3-4 hours and remains elevated for up to 3 weeks (helpful in the pt that delays)
Troponin
Which cardiac biomarker is the most sensitive to MI?
Troponin
Which biomarker is most helpful when client delays seeking care
Troponin (it stays elevated for 3 weeks)
A patient who has had severe chest pain for the last 4 hours is admitted with a diagnosis of possible AMI. Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an MI?
Troponin levels
UH
Unfractionated Heparin
What is defibrillation?
Used in an emergency (Vfib/defib), used with Vfib or Vtach, NO CARDIAC OUTPUT, client is unconscious, EKG monitor, NO CONSENT NEEDED, begin with 200 Joules and up to 360.
What should you teach your patient about an abdominal ultrasonography?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated into graphic images.
How does Digoxin work to treat PE?
Used to get the blood moving in a forward direction
What should you teach your patient about angiography (arteriography)?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unusual taste will pass. They'll need to keep their arm or leg extended and immobile for approximately 6 hours. Once able they should plenty of fluids. The nurse should check pulses distal to the insertion site.
What should you do immediately if you suspect someone of developing a hematoma?
Using both gloved hands, apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider.
What are the treatments/ S&S of peripheral venous disease?
Varicose veins, elevate legs, weight reduction, brawny in color, ted hose, topical steroids, ulcers, and skin color changes.
What condition can cause left sided heart failure?
Vascular-artery disease causing fluid to back up into the lungs.
How do Natrecor and Primacor help treat PE and how administered?
Vasodilates veins and arteries and has a diuretic effect Remember to think that nature's effects are to DILATE veins. Administer via infusion, short term therapy. Should NOT to be given >48 hours
What is the antidote for coumadin?
Vitamin K (aqua myphiton)
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
b. Continuous blood pressures d. Presence of chest pain
What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) a. Continuous oxygen saturation b. Continuous blood pressures c. Hourly ECGs d. Presence of chest pain e. Serum nitroglycerin levels f. Visual acuity
d. "This medication will work for 24 hours and you will need to change the patch daily."
What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? a. "This medication works faster than sublingual nitroglycerin works." b. "This medication is the strongest of any nitroglycerin preparation available." c. "This medication should be used only when you are experiencing chest pain." d. "This medication will work for 24 hours and you will need to change the patch daily."
hemolytic
What type of blood transfusion reaction manifests in flank pain, chest pain, fever, chills, tachycardia, and tachypnea
c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? a. Apply the nitroglycerin patch every other day. b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. d. Use the nitroglycerin patch for acute episodes of angina only.
c. Hydrochlorothiazide
What would cause the same client's electrolyte imbalance? a. High dose of digoxin b. Digoxin taken daily c. Hydrochlorothiazide d. Low dose of hydrochlorothiaizde
a. Inhibits absorption of dietary cholesterol in the intestines.
When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what? a. Inhibits absorption of dietary cholesterol in the intestines. b. Binds with bile acids in the intestines to reduce LDL levels. c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver. d. Forms insoluble complexes and reduces circulating cholesterol in blood.
a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders
When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders
How should you palpate the apical pulse?
When not visable, place the patient in the left lateral position, ask them to exhale fully and stop breathing for a few seconds.
What is pulsus paradoxus?
When the BP > 10 mmHg on expiration than on inspiration
When should bleeding precautions be implemented?
When: using anticoagulants, liver disease, decrease in platelets (less than 150,000), hemophilia, using thrombolytic meds, DIC, CA, HIV, chemo, bone marrow problems, and ASA/NSAIDS.
What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
a. Decreased intracranial pressure
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)? a. Decreased intracranial pressure b. Decreased potassium c. Increased urine osmolality d. Decreased serum osmolality
a. Client states that she has no chest pain.
Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Client states that she has no chest pain. b. Client states that the swelling in her feet is reduced. c. Client states the she does not feel dizzy. d. Client states that she feels stronger.
c. The client who has stopped taking a beta blocker due to cost.
Which client will the nurse assess first? a. The client who has been on beta blockers for 1 day. b. The client who is on a beta blocker and a thiazide diuretic. c. The client who has stopped taking a beta blocker due to cost. d. The client who is taking a beta blocker and Lasix (furosemide).
d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)? a. "The medication may cause constipation, so I will increase fluid and fiber in my diet." b. "I should take this medication 1 hour after or 4 hours before my other medications." c. "I might need to take fat-soluble vitamins to supplement my diet." d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." b. "I should keep my nitroglycerin in a cool, dry place." c. "I should change positions slowly to avoid getting dizzy." d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications? a. "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." b. "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." c. "I will stop taking the medication if it causes nausea and vomiting." d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
Within how many hour should fresh frozen plasma be administered after thawed?
Within two hours
What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating, bathing, or during physical therapy or skin assessment.
Polycythemia Vera- Nursing Care
a condition marked by an abnormally large number of RBC's in the circulatory system- S/S: Ruddy or flushed (plethoric) complexion, burning sensation in fingers and toes, life expectancy is 2 years if not treated. -Tx: elevate legs, phlebotomies, hydration, support hose. -Risk for CVA, MI, bleeding from dysfunctional platelets
During the administration of the fibrinolytic agent to a patient with an AMI, the nurse should stop the drug infusion if the patient experiences _______________
a decrease in level of consciousness.
In myelodysplastic syndrome expected lab result findings
a deficiency of all cellular blood components
DIC is a disorder in which
a disease process stimulate coagulation processes w/ resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting & hemorrhage
Hemophilia- Nursing Care
a group of bleeding disorders in which it takes a long time for the blood to clot- S/S: bleeding/bruising easily- Tx: Rest, Ice, Compress, elevate, No rectal temps, avoid aspirin, no contact sports, cushion furnitures, use soft toothbrush.
Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the Nipride rate if the patient develops ____________
a systolic BP <90 mm Hg.
Sickle Cell Anemia- Nursing Care
abnormal crescent shaped RBC resulting in obstruction of blood flow and destruction of RBC due to decrease in oxygen flow- Tx: HHOP: Heat, Hydration, Oxygen, Pain relief, Bed rest.
Abnormal bronchial breath sounds indicate what?
abnormal sound transmission bc of consolidation of lung tissue
When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an AMI, the nurse will anticipate teaching the patient _______________
about the purpose of outpatient Holter monitoring.
A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. An appropriate nursing diagnosis based on these findings is ______________
activity intolerance related to fatigue and arthralgia.
what is the #1 cause of hypovolemic shock
acute blood loss
A patient admitted to the coronary care unit (CCU) with an MI and frequent premature ventricular contractions (PVCs) has health care provider orders for continuous amiodarone infusion, IV nitroglycerin infusion, and morphine sulfate 2 mg IV every 10 minutes until there is relief of pain. The patient says, "This is the worst pain I have ever had. Am I going to die?" Based on these data, the nurse identifies a priority nursing diagnosis of ___________________
acute pain related to myocardial ischemia.
The nurse reviews data from the cardiac monitor indicating that a patient with a myocardial infarction experienced a 50-second episode of ventricular tachycardia before a sinus rhythm and a heart rate of 98 were re-established. The most appropriate initial action by the nurse is to ________________
administer IV antidysrhythmic drugs per protocol.
The nurse identifies a nursing diagnosis of risk for altered peripheral tissue perfusion related to bypass graft thrombosis for a patient following an abdominal aneurysm repair. An appropriate intervention to prevent this problem in the immediate postoperative period is to _______________
administer IV fluids at a rate to keep the arterial BP within a normal range.
A patient in the intensive care unit with ADHF complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to _______________
administer IV morphine sulfate 2 mg.
A patient with supraventricular tachycardia (SVT) is hemodynamically stable and requires cardioversion. The nurse will plan to _______________
administer a sedative before the procedure is begun.
Thalassemia- Nursing Care
an inherited blood disorder that causes mild or severe anemia due to reduced hemoglobin and few red blood cells than normal- Tx:
hypertension is
an intermittent or sustained elevation of the diastolic bp
The nurse identifies the collaborative problem of potential complication: pulmonary edema for a patient in ADHF. When assessing the patient, the nurse will be most concerned about ______________
an oxygen saturation of 88% on room air.
Following an acute myocardial infarction, a previously healthy 67-year-old patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about _______________
angiotensin-converting enzyme (ACE) inhibitors, such as captopril (Capoten).
What is the role of ASA in Chronic Stable Angina?
anti-platelet (prevents platelets from sticking together)
A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that further treatment of the patient will require ____________
anticoagulant therapy with warfarin (Coumadin).
what bp is considered to be htn
anything over 140/90
Where are bronchial breath sounds considered abnormal?
anywhere over posterior/lateral chest
During change-of-shift report, the nurse learns that a patient with a large myocardial infarction has been having frequent PVCs. When monitoring the patient for the effects of PVCs, the nurse will check the patient's _____________
apical radial heart rate.
In planning care for a patient with a venous stasis ulcer on the right lower leg, the nurse understands that the most important intervention in promoting healing of the ulcer is
application of external compression to the lower leg.
Nursing considerations: Albumin,if pt is in shock how is it given?
as quickly as possible
Platelets can be given?
as quickly as possible or 4 units/hour
Nursing considerations: Platelets, how long do you given them?
as quickly as possible over 4 units/hr
A patient with chronic heart failure who has been following a low-sodium diet tells the nurse at the clinic about a 5-pound weight gain in the last 3 days. The nurse's first action will be to _______________
assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring.
in which patients do you hear high-pitched wheezes?
asthma or emphysema (narrowed-airway diseases)
how long should you stay with a patient after beginning a transfusion
at least 15 to 30 minutes
when a doc takes three diff bp readings at diff times how far apartmust the measurements be made
at least one week
how many measurements must be made before you can say a person has htn
at least three
A 69-year old patient is admitted to the hospital for elective repair of an abdominal aortic aneurysm. The history includes hypertension for 25 years, hyperlipidemia for 15 years, and smoking for 50 years. The patient asks the nurse what caused the aneurysm. The nurse's best response includes the information that ______________
atherosclerotic plaques damage the artery and may lead to aneurysms.
During an assessment of a 63-year-old patient at the clinic, the patient says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." The nurse should _____________
attempt to palpate the dorsalis pedis and posterial tibial pulses.
TCA's
atypical use of ____ is for the treatment of enuresis (bed wetting)
A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. The patient has pitting edema in both ankles, blood pressure (BP) of 170/100, an apical pulse rate of 92, and respirations 28. The most important assessment for the nurse to accomplish next is to ________________
auscultate the lung sounds.
The health care provider orders a continuous IV heparin infusion for a patient with swelling and pain of the upper leg caused by a DVT. While the patient is receiving the heparin infusion, the nurse should _____________
avoid any IM medications to prevent localized bleeding.
What else do you need to teach your client with Chronic Stable Angina?
avoid overeating, wait 2 hrs after eating to exercise, rest frequently, avoid excess caffeine/drugs that up HR, dress warmly in cold, take Nitro prophylactically, stop smoking, lose weight
7. A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what?
b. Elevated INR range
The nurse hears a heart murmur on a client and wants to grade this soft but very audible sound. How should this heart murmur be described? a. Grade 3 b. Grade 2 c. Grade 4 d. Grade 1
b. Grade 2
1. A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?
b.Hypokalemia
3. A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level?
b.It is the desired level of HDL.
6. The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?
b.Rhabdomyolysis
9. A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?
b.abciximab (ReoPro
4. The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
b.hydrochlorothiazide
6. A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?
b.warfarin (Coumadin)
type of reaction: contaminated blood products
bacterial infection
Sickle Cell Syndrome
bean shape blood cells that prevents oxygen from reaching the spleen, liver, kidneys, lungs, heart, or other organs, causing a lot of damage. Without oxygen, the cells that make up these organs will begin to die.
htn is more common in blacks or whites
blacks
Several hours following a surgical repair of an abdominal aortic aneurysm, the patient develops left flank pain and a urinary output of 20 ml/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for a(n) _____________
blood urea nitrogen (BUN) and creatinine.
What is patho for cardiac tamponade and when can it happen?
blood, fluid, or exudates have leaked into pericardial sac resulting in compression of cardiac muscle. Can happen in MVA, right ventricular biopsy, MI, pericarditis, or hemorrhage post-CABG
Aplastic Anemia- Nursing Care
body stops producing enough new blood cells- S/S: Leukopenia (low WBC count) , Thrombocytopenia (low platelet count)
Where is a pleural friction rub heard: on expiration/ inspiration?
both
when you take the bp of the client with htn you would measure
both arms, with client lying sitting and standing
what four organs does htn affect the most
brain-stroke eyes-blindness heart- MI kidney- renal failure
check blood for
bubbles, dark color, or cloudiness
8. The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?
c.To block the beta1-adrenergic receptors in the cardiac tissues
what would you do if the client had an increasing temp and was to get blood
call MD bc blood is often held with an elevated temp
what other things are appropriate to do after a reaction?
call MD, get a blood sample, get a urine sample, monitor vitals, send blood to lab
The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient ________________
calls when the weight increases from 124 to 130 pounds in a week.
name the two most common dietary rx used to treat htn
calorie reduction for wt loss and sodium restriction
A 55-year-old patient with inoperable coronary artery disease and end-stage heart failure asks the nurse whether heart transplant is a possible therapy. The nurse's response to the patient will be based on the knowledge that ____________
candidacy for heart transplant depends on many factors.
CVA
cerebrovascular accident or stroke
what are the first two signs of hypovolemic shcok
change in LOC and tachy
For each unit of blood , the RN needs to?
change the entire IV line.
How often does a RN check VS in elderly pt?
check VS q 15 min throughout infusion.
what does blood-typing mean?
check for surface antigen on the red blood cell
most common type of leukemia in older adults
chronic lymphocytic leukemia (CLL)
type of reaction: large volume over short time
circulatory overload
Plasma should be given as quickly as possible, why?
coagulation factors become unstable
Nursing considerations: Factor VIII (8), what is used?
componet drip set or syringe
A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that ___________
compression stockings should be applied before getting out of bed.
Blood transfusion reactions: cause of bacterial infection
contaminated blood products
the clients skin will be
cool pale and clammy
what test identifies rh factor?
coombs test detects antibodies to RH
Which lung sound occurs with the sudden opening of small airways that contain fluid?
crackles
Anemia-Nursing Care
decrease in the number of RBC or decrease in the capability to carry oxygen- Children S/S: Otitis media and Upper respiratory infections.
Nifedipine (Procardia) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that Procardia will ____________
decrease spasm of the coronary arteries.
what two non dietary lifestyle changes are used commonlyto treat htn
decrease stress and increase activity
The nurse is caring for a patient receiving IV furosemide (Lasix) 40 mg and enalapril (Vasotec) 5 mg PO bid for ADHF with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is ____________________
decreased dyspnea with the head of the bed at 30 degrees.
what happens to bp
decreases
lithium toxicity
dehydration can lead to?
What kind of blood does the pulmonary artery carry?
deoxygenated blood (away from heart)
In microcytic, hypochromic anemia question pt about
dietary intake of iron
A patient with ADHF who is receiving nesiritide (Natrecor) asks the nurse how the medication will work to help improve the symptoms of dyspnea and orthopnea. The nurse's reply will be based on the information that nesiritide will ___________
dilate arterial and venous blood vessels, decreasing ventricular preload and afterload.
While caring for a patient with mitral valve prolapse with mild valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient tells the nurse she will _______________
discuss the diagnosis of mitral valve prolapse with the dentist.
DIC
disseminated intrvascular coagulation meaningwhen fibrin clots form within the vascular system of the critically ill and in Sx
The goal of fibrinolytics and their major complication
dissolve clot; decreases workload; increases CO Major comp-Hem. so get bleeding history
what class of drug i used first to treat htn
diuretics
A patient has a normal cardiac rhythm strip except that the PR interval is 0.34 seconds. The appropriate intervention by the nurse is to ________________
document the finding and continue to monitor the patient.
multiple drug combinations to tx leukemia & lymphoma because
drugs work by different mechanisms to maximize killing of malignant cells
Bacterial reaction to blood transfusion S/S
due to contaminated blood- Tachycardia, Hypotension, Fever, chills, Shock- treat shock
In severe anemia expect to find
dyspnea & tachycardia
During the assessment of a patient with IE, the nurse would expect to find _________
dyspnea and a dry, hacking cough.
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for ______________
dyspnea and hemoptysis.
When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for ____________
dyspnea.
Pts at high risk for circulatory overload include?
elderly, heart disease, children
During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates _____________
elevated right atrial pressure.
With permanent pacemakers, electrodes are anchored where
endocardium and attached to a battery source implanted in a Sub Q pocket. Demand PM is only if HR drops below setting.
for each unit of blood, the Rn should change
entire IV lines
The nurse determines that a patient has ventricular bigeminy when the rhythm strip indicates that ________________
every other QRS complex is wide and starts prematurely.
pt w/ von Williebrand disease undergoing surgery would be tx'd w/ vWF &
factor VIII
aging decreases risk T/F
false
What is the most common blood transfusion reaction?
febrile reaction
how long should it take for one unit of blood to infuse
from one hour to 3 hours
The nurse is developing a nursing care plan for a client diagnosed with congestive heart failure. A nursing diagnosis of "decreased cardiac output related to inability of the heart to pump effectively" is written. Which short-term goal would be best for the client? The client will: 1. Be able to ambulate in the hall by date of discharge. 2. Have an audible S1 and S2 with no S3 heard by end of shift. 3. Turn, cough, and deep breathe every two (2) hours. 4. Have a pulse oximeter reading of 98% by day two (2) of care.
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what medication should you hold 48 hours before cardiac cath?
glucophage because it can be bad for the kidneys with the dye and the glucophage
what does stridor sound like?
harsh, high pitched noises on inspiration
An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg). After 2 weeks, the patient returns to the clinic. The assessment finding that will be of most concern to the nurse is that the patient ______________
has BP of 88/42.
HDL
high density lipoprotein friendly or good bc it removes cholesterol from blood stream d delivers it to the liver to excrete in bile
what are the signs/symptoms of an allergc reaction to the transfusion?
hives, uticaria, wheezing, pruritis, joint pain (arthralgia
The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client? 1. Apical pulse rate of 110 and 4+ pitting edema of feet. 2. Thick white sputum and crackles that clear with cough. 3. The client sleeping with no pillow and eupnea. 4. Radial pulse rate of 90 and capillary refill time <3 seconds.
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During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding ______________
how to monitor anticoagulation therapy.
of all of the following which increase in hypovolemic shock- hr bp uo loc pulse pressure rr
hr and rr
When the nurse is developing a teaching plan to prevent the development of heart failure in a patient with stage 1 hypertension, the information that is most likely to improve compliance with antihypertensive therapy is that _______________
hypertension eventually will lead to heart failure by overworking the heart muscle.
A patient with diabetes mellitus is admitted unresponsive to the emergency department (ED). Initial laboratory findings are serum potassium 2.8 mEq/L (2.8 mmol/L), serum sodium 138 mEq/L (138 mmol/L), serum chloride 90 mEq/L (90 mmol/L), and blood glucose 628 mg/dl (34.9 mmol/L). Cardiac monitoring shows multifocal PVCs. The nurse understands that the patient's PVCs are most likely caused by _______________
hypokalemia.
Important side effect of Amiodarone
hypotension (and this can lead to more arrhythmias)
In developing a teaching plan for a patient who has stable angina and is started on sublingual nitroglycerin (Nitrostat), the nurse identifies an expected patient outcome of
identifying the need to call the emergency medical services (EMS) if chest pain persists 5 minutes after taking nitroglycerin.
A patient who has a history of sudden cardiac death has an ICD inserted. When performing discharge teaching with the patient, it is important for the nurse to instruct the patient and family that ______________
if the ICD fires and the patient loses consciousness, 911 should be called.
A patient with a history of a 4-cm abdominal aortic aneurysm is admitted to the emergency department with severe back pain and bilateral flank ecchymoses. The vital signs are blood pressure (BP) 90/58, pulse 138, and respirations 34. The nurse plans interventions for the patient based on the expectation that treatment will include ____________
immediate surgery.
A patient who is seen in the clinic tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for ______________
immune disorders.
During a visit to an elderly patient with chronic heart failure, the home care nurse finds that the patient has severe dependent edema and that the legs appear to be weeping serous fluid. Based on these data, the best nursing diagnosis for the patient is _________________
impaired skin integrity related to peripheral edema.
when are hemolytic transfusion reactions likely to occur?
in the first 10 to 15 minutes
Enuresis
inability to control the flow of urine and involuntary urination
A patient with myocardial infarction develops symptomatic hypotension. The monitor shows a type 1, second-degree AV block with a heart rate of 30. The nurse administers IV atropine as prescribed. The nurse determines that the drug has been effective on finding a(n) _________________
increase in the patient's heart rate.
if the bp is <80 systolic what do you do
increase o2 flow rate
SE of CCBs
increased angina, peripheral edema, dizziness, HA, bradycardia, nausea, constipation. Interacts w/ grapefruit.
which pressure is most damaging
increased diastolic
Expected lab findings following a splenectomy
increased platelet count
Increased PCWP
indicates hypervolemia, left ventricular failure, or mitral regurgitiation
Decreased PCWP
indicates hypovolemia
In elderly pt, each unit is unfused?
infuse each unit over 3-4 hours.
Are crackles heard during inspiration or expiration?
inspiration
With autologous transfusions, what supplement may be ordered?
iron
pulse pressure
it narrows
apolipoproteins
its a combination of HDL and LDL
A patient recovering on a general surgical unit from an aortic valve replacement 1 week ago develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and _______________
keep the patient in bed in the supine position.
what gauge needles is used with a blood transfusion?
large gauge, 18
A 21-year-old woman is scheduled for an open mitral valve commissurotomy for treatment of mitral stenosis. When explaining the advantage of valve repair instead of valve replacement to the patient, the nurse will include the information that _____________
long-term anticoagulation is necessary after mechanical valve replacement.
What do bronchial breath sounds sound like?
loud, high-pitched sounds that resemble air blowing thru a hollow pipe
When developing a health teaching plan for a 65-year-old patient with all these risk factors for coronary artery disease (CAD), the nurse will focus on the __________
low activity level the patient reports.
what are the s/s of a febrile transfusion reaction
low back pain, shaking, HA, -- same as hemolytic- increasing temp, confusion, hemoptysis
LDL
low density lipoprotein or bad bc it contains 50% to 60% cholesterol in the blood stream when elevated there is a greater risk for developing atherosclerotic plaque and HD
In which patients would you hear abnormal bronchial breath sounds?
lung mass, atelectasis, or pneumonia
What kind of symptoms does an elderly pt with ACS/MI/UA present with?
may just faint, SOB, acute behavioral changes
Serotonin syndrome
may occur when taking another drug that affects reuptake of serotonin, causing sertonin to accumulate in the body. Can also be caused from SSRI with MAOI. Symptoms include confusion, anxiety, restlessness, hyperpyrexia, ataxia.
which acid base disorder is most commonly associated with hypovolemic shock
met acid
Symptoms: uritcaria, itching, flushing
mild allergic reaction
When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include ________________
milk, yogurt, and other milk products.
what does blood cross matching mean?
mixing a little of the clients blood with donor blood and looking for agglutination
where do high-pitched wheezes occur: expiration or inspiration?
mostly expiration but can be both
A patient is admitted to the hospital with possible acute pericarditis. The nurse will plan to teach the patient about the purpose of ______________
multiple ECGs.
Febrile reactions are often seen in pts w/
multiple transfusions
what do high-pitched wheezes sound like?
musical sounds that predominate in expiration
can htn be cured
no just treated
can blood be given immediately after removal from refrigeration
no, it has to be warmed first for only about 20-30 minutes
Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should _____________
note when Korotkoff sounds are audible during both inspiration and expiration.
The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin), hydrochlorothiazide (HydroDIURIL), and a potassium supplement. Appropriate instructions for the patient include _______________
notify the health care provider immediately if nausea or difficulty breathing occurs.
In what kind of pts would you hear rhonchi?
obstruction in trachea or bronchi
in what positions would you place a client in suspected hypovolemic shock
on the back with arms and legs elevated
what is the routine for VS measurement with a transfusion
once before admin and q 15 x2 after it has begun, then q hour x 1 after transfusion has stopped
BIPOLAR DISORDER
once known as Manic depression- Shift from emotions of extreme depression to extreme rage & agitation.
Where are bronchovesicular breath sounds normally heard?
over the first and second intercostal spaces at the sternal border anteriorly and at the T4 level medial to the scapula posteriorly (over major bronchi)
What kind of blood do the pulmonary veins carry?
oxygenated blood (to the heart)
what is the difference between whole blood and packed red blood cells
packed cells don't have nearly as much plasma or volume as whole blood does
A patient admitted to the hospital with an exacerbation of chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse can best document this assessment information as _______________
paroxysmal nocturnal dyspnea.
PSVT
paroxysmal supraventricular tachycardia
When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, the information that is most significant when the nurse is assessing for the return of peristalsis is ______________
passing of flatus with ambulation.
Priapism
persistent abnormal erection of the penis accompanied by pain and tenderness
To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should _____________
place the diaphragm of the stethoscope at the lower left sternal border of the chest.
What lung sound sounds like a superficial, low-pitched, coarse grating sound that sounds like 2 rough surfaces moving against each other?
pleural friction rub
In which patients would you hear a pleural friction rub?
pleural inflammation often associated with pleurisy, pneumonia, or pleural infarction
what are mast trousers
pneumatic device placed around the legs and lower body to force blood centrally
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this problem is to ______________
position the patient in Fowler's position, leaning forward on the overbed table.
ferrous sulfate (Femiron, Feostat, IMferon)
prevents and treat iron deficency- assess for anaphylaxis, bluish lips, avoid antacids, coffee, tea, dairy, whole grain with PO iron, Dilute liquid iron with water or citrus juice with straw.
Hypocalcemia
prolonged Q-T intervals
The nurse performing an assessment with a patient who has chronic peripheral arterial disease (PAD) of the legs would expect to find _______________
prolonged capillary refill.
A patient admitted to the hospital with DVT has health care provider's orders for bed rest with the feet elevated. The best method for the nurse to use in elevating the patient's feet is to _____________
put one pillow under the thighs and two pillows under the lower legs.
often do you check VS for elderly pts?
q 15 min throughout transfusion
Nursing considerations:Packed Red Cells, how often are the cells mixed?
q 20-30 min
If a pt has chest pain after a PCI, what should you think
re-occlusion, call MD immediately!
Hydroxyurea (Droxia)
reduce painful crises in sickle cell- monitor for leukopenia, anemia, thrombcytopenia.
While admitting an 80-year-old patient with heart failure to the medical unit, the nurse obtains the information that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." The nurse makes a note that discharge planning for the patient will need to include _____________
referral to a home health care agency.
The nurse administers IV nitroglycerin to a patient with an MI. In evaluating the effect of this intervention, the nurse should monitor for _______________
relief of chest discomfort.
what is the #1 medical tx of hypovolemic shock
replace fluids and blood
give three reasons for a blood transfusion
restore blood volume secondary to hemorrhage, maintain hemoglobin in anemia, replace specific blood components
What lung sound is low-pitched, coarse, loud snoring/ moaning?
rhonchi
Tyramine
rich in wines and cheese, yogart, beef or chicken liver; these foods are contraindicated in patients on MAO inhibitors
Hemoglobin Electrophoresis
separates normal hemoglobin from abnormal. It is used to detect thalassemia and sickle cell disease.
A home health care patient has recently started taking oral digoxin (Lanoxin) and furosemide (Lasix) for control of heart failure. The patient data that will require the most immediate action by the nurse is if the patient's _________________
serum potassium level is 3.0 mEq/L after 1 week of therapy.
hypokalemia
shallow flat inverted T wave
what are the signs and symptoms of a hemolytic transfusion reaction
shivering, HA, low back pain, increased pulse and respirations, decreasing bp, oliguria, hematuria
hypercalcemia
shortened S-T segment
SOB
shortness of breath
A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care?
sildenafil (Viagra)
Two days after having an MI, a patient tells the nurse, "I wish I had died when I had this heart attack. I won't be able to do anything now." The most appropriate nursing diagnosis is ___________________
situational low self-esteem related to perceived role changes.
Nursing considerations:Packed Red Cells, how does the nurse mix the blood?
squeeze the bag
17. A patient has a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response. The nurse teaches the patient that the pacemaker will ____________
stimulate a heart beat if the patient's own heart rate drops too low.
what would you do if you suspected transfusion reaction?
stop the blood and start the saline
Nursing considerations: Plasma, is administered w?
straight line set
Nursing considerations: Prothrombin, what type of line set is used?
straight line set
how do you calculate pulse pressure
subtract diastolic from systolic
which heart rate is associated with hypovolemic shock
tachy
The community health nurse involved in programs to prevent rheumatic fever knows that the most important intervention to decrease the incidence of the disease is ________________
teaching people to seek medical diagnosis and treatment for streptococcal pharyngitis.
A patient with chronic stable angina is being treated with metoprolol (Lopressor). The nurse will suspect that the patient is experiencing a side effect of the metoprolol if __________________
the cardiac monitor shows a heart rate of 45.
The nurse includes the definition of HF in the teaching plan for the client. An accurate description of the mechanism of HF is that [Hint] there is too much fluid in the heart. the heart cannot get oxygen. the heart is unable to pump effectively. there is too much fluid in the lungs.
the heart is unable to pump effectively.
A patient hospitalized with a streptococcal infective endocarditis tells the nurse," I know that I need antibiotics, but I do not want to be hospitalized for very long." The nurse explains that _______________
the patient will be able to receive outpatient IV antibiotic therapy if complications such as heart failure do not develop.
what do crackles sound like?
the sound of a lock of hair being rubbed between the thumb and forefinger
A 72-year-old patient is hospitalized for an aortic dissection of the abdominal aorta that stabilizes with treatment. The nurse develops a teaching plan for the patient's discharge that includes information about _______________
the use of antihypertensive medications to lower the risk of further dissection or bleeding.
electroconvulsive therapy (ECT)
therapy for *severely depressed patients in which a brief electric current is sent through the brain. serious complications are seizure activity and anesthesia
hypovolemic shock
there is a decrease in the circulating blood volume - this decreases tissue perfusion with oxygen
A patient experiences dizziness and shortness of breath for several days. During cardiac monitoring in the ED, the nurse obtains the following ECG tracing. The nurse interprets this cardiac rhythm as _______________
third-degree AV block.
repetitive transcranial magnetic stimulation (rTMS)
this treatment requires surgical implant of device. somatic treatment
A nursing action that is indicated for the collaborative problem of potential complication: cardiac dysrhythmia in a patient who has had a repair of a descending thoracic aortic aneurysm is to ______________
titrate oxygen to keep O2 saturation greater than 90%.
Where are bronchial breath sounds normally heard in the resp tract?
trachea and immediately above the manubrium
These complications of transfusion are decreased by use of leukocyte depletion or reduction of RBC transfusion
transmission of cytomegalovirus & fever
obesity increases risk T/F
true
oral contraceptives increase bp T/F
true
Swan catheter
type of central line that measures the pressures inside the heart, helps to determine the cause of decreased CO
In what kind of pts would you hear stridor?
upper airway obstruction, airway edema
The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with IE based on the assessment finding of _____________
urine output less than 30 ml/hr.
When needing to estimate the ventricular rate quickly for a patient with a regular heart rhythm using an ECG strip, the nurse will ______________
use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
Schilling Test
used to dx pernicious anemia- missing intrinsic factor in gut, urine test, 24-48 hours, evaluates Vb12 absorption, radioactive VB12 given orally, nonradioactive VB12 given IM, have to sign consent for this test
what treats htn
vasodilators
A patient hospitalized with IE develops sharp left flank pain and hematuria. The nurse notifies the health care provider, recognizing that these symptoms may indicate ______________
vegetative embolization.
The nurse obtains a monitor strip on a patient admitted to the coronary care unit with a myocardial infarction and makes the following analysis: P wave not apparent; ventricular rate 162, R-R interval regular; PR interval not measurable; and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as _______________
ventricular tachycardia.
VLDL
very low density lipocadprotein a better indicator of
A patient is admitted to the ED after an episode of severe chest pain, and the physician schedules the patient for coronary angiography and possible percutaneous coronary intervention (PCI). The nurse prepares the patient for the procedure by explaining that it is used to ________________________
visualize any coronary artery blockages and dilate any obstructed arteries.
Best exercise for MI patient
walking
Teach signs and symptoms of heart failure
weight gain ankle edema shortness of breath confusion
For a patient who has been admitted the previous day to the coronary care unit with an AMI, the nurse will anticipate teaching the patient about _______________
when patient cardiac rehabilitation will begin.
Epicardial pacing is what?
when the wires are attached to the epicardium during surgery
hypermagnesemia or hyperkalemia
widened Q-R-S complex
hypercalcemia
widened T wave
when is febrile reaction likely to occur?
within 30 minutes of beginning the transfusion
Blood transfusion reactions: Likely Time of occurrence: Acute Hemolytic reaction
within min to 24 hours
Blood transfusion reactions: Likely Time of occurrence: Febrile reaction
within min to hours
Blood transfusion reactions: Likely Time of occurrence: circulatory overload
within min to hours
Blood transfusion reactions: Likely Time of occurrence: Bacterial reaction
within min to less than 24 hours
do they have to have a foley
yes to meaure output- when uo >30cc per hour shock has resolved
Aortic Aneurysm
- Abnormal dilation of the arterial wall - Antihypertensives - Report any chest or back pain, SOB, dysphagia, or hoarseness immediately. - Has own pulse; hear, feel thrill, pt. feels, hear bruit
Cardiac Tamponade
- Accumulation of fluid in pericardial cavity. - Restricts V. filling and CO drops. - Admin fluids, Pericardiocentesis
Preinfarction Angina
- Acute coronary insufficiency - Longer than 15 mins - Occurs after MI
Pericarditis
- Acute or chronic inflammation of pericardium - Pains worse when laying down. - Pericardial friction rub
Hyperkalemia
- Asystole, V. dysrhythmias - ECK- tall peaked T waves, widened QRS, prolonged PR, or flat P waves.
Cardiac Meds
- CCB, BB (Lopressor), ACE-I, anticoag's and antidotes (Warfarin ->Vitamin K; Coumadin -> Protamine Sulfate), narcotics, diuretics, aspirin
Cardiac Enzymes
- CK-MB - LDH - Troponin - Myoglobin
Intractable Angina
- Chronic - Unresponsive to interventions
Angina
- Cx pain resulting from myocardial ischemia - Stable, Unstable, Variant, Intractable, Preinfarction - ECT, stress test, cardiac enzyme and troponin levels, catheterization - O2, nitro, antiplatelet therapy
Myoglobin
- Found in cardiac and skeletal muscle. - Binds to oxygen. - Levels rise 2 hrs after cell death and rapid decline after 7 hrs.
CHF
- Inability of heart to maintain adequate CO - Can include congestion in lungs and periphery.
Cardiac Catheterization
- Invasive - Info on structure and performance of heart. - Pre: allergies, ht and wt., may feel fatigues and fluttery feeling, warm feeling, desire to cough. - WITHHOLD METFORMIN 48 hrs prior and after - Post: sandbag, keep extremity extended for 4-6 hrs, strict bed rest for 6-12 hrs.
PTCA (angioplasty)
- Invasive - One or more arteries are dilated with balloon catheter to open vessel and improve blood flow.
Serum Lipids
- Lipid profile assessed for risk of CAD. - Cholesterol = <200 - LDL = <130 - HDL = 30-70
Variant Angina
- May occur at rest
CAD
- Narrowing or obstruction of one or more coronary arteries. - Cx pain, dyspnea, syncope - ECT, catheterization, blood lipid levels - PTCA and stents - Meds: Nitrates, CCB, Beta blockers
Holter Monitoring
- Noninvasive - IDs dysrhythmias and evaluates effectiveness of tx. - Avoid tub baths or showers.
Stress Test
- Noninvasive - Studies heart during activity. - Detects and evals CAD. - Withhold beta blockers and CCB (24 hrs), theophylline (12 hrs). - Avoid hot bath or shower for at least 1-2 hrs.
Magnesium
- Normal = 1.6-2.4 - Low: causes V. tach and fib. - High: cause muscle weakness, hypotension, bradycardia
Sodium
- Normal = 135-147 - Decre. c diuretics - ^ in HF, indicating water excess
Phosphorus
- Normal = 2.5-4.5 - Checked c Ca
Potassium
- Normal = 3.5-5.2
BUN
- Normal = 6-20 - ^ in heart disorders that adversely affect renal circulation. - HF and cardiogenic shock.
Calcium
- Normal = 8.8-10.3
Blood Glucose
- Normal = <100 - ^ in acute cardiac episode.
HTN
- Normal BP = 120/80 - PreHTN BP = 120-139/80-89 - HTN = >140/>90
CABG
- Occluded CA are bypassed c clients own venous or arterial blood vessels. - Pre: ET tube placed, splint incision.
Valvular Heart Disease
- Occurs when heart cannot fully open or close. - Mitral stenosis, Mitral insufficiency, mitral valve prolapse, aortic stenosis, aortic insufficiency. - Balloon valvuloplasty, mitral annuloplasty, valvotomy
PAD
- Partial or total arterial occlusion deprives lower extremities of O2 and nutrients. - Tissue damage occurs
Pacemakers
- Provides electrical stimulation and maintains HR when clients own heart isn't pumping right.
Hypercalcemia
- Shortened ST, widened T, AV block, tachycardia or bradycardia - Cardiac arrest
MI
- Signs and symptoms: pain (crushing, radiating, unrelieved by nitro), diaphoresis, dyspnea, dysrhythmias, feelings of fear and anxiety, pallor, cyanosis - Administer morphine - Slow and progressive, dull ache
Microalbuminuria
- Small amt of protein in urine.
Stents
- Supportive scaffold in artery. - Reopens blocked artery. - Acute thrombosis major concern
AAA
- Surgical resection or excision of aneurysm, the excised section replaced c graft sewn end to end.
Unstable Angina
- Unpredictable - May not be relieved c nitro
Hypokalemia
- V. dysrhythmias, ^ risk of dig tox. - ECK- flattening and inversion of T wave; U wave, ST depression.
Hypocalcemia
- V. dysrhythmias, prolonged ST and QT - Cardiac arrest
Raynaud's Disease
- Vasospasm of the arterioles and arteries of the upper and lower extremities.
CK-MB
- ^ indicates myocardial damage. - Normal = 0%-5% of total. - Total CK = 26-174
Homocysteine
- ^ may ^ risk of cardio disease. - Levels = <14
Follow-up therapy and meds with Fibrinolytic therapy
-Antiplatelets are another important component for fibrinolytic therapy -Acetylsalicylic Acid (Aspirin) -Clopidogrel (Plaxix) -Abciximab (ReoPro IV)...continuous infusion to prevent platelet aggrevation
Signs of an immediate transfusion reaction:
-Chills and diaphoresis -Muscle aches, back pain, or chest pain -Rashes, hives, itching, and swelling -Rapid, thready pulse -Dyspnea, cough, or wheezing -Pallor and cyanosis -Apprehension -Tingling and numbness -Headache -Nausea, vomiting, abdominal cramping, and diarrhea
What kind of patients are washed red blood cells usually prescribed to?
-Patients with a history of allergic transfusion reactions -Patients who underwent hematopoeitic stem cell transplant
In which patients is autologous donation not an option?
-Patients with leukemia -Patients with bacteremia
How do you evaluate the effectiveness of the administration of packed red blood cells?
-Resolution of the symptoms of anemia -An increase in the erythrocyte, hemoglobin, and hematocrit count
Patient teaching for Pacemakers
-check pulse daily -ID card -Avoid electromagnetic fields (cell phones, large motors, arc welding, electric substations) -Avoid MRIs -They will set off alarms at the airport -Avoid contact sports
Chronic Stable Angina Patho
-decreased blood flow to the myocardium causes ischemia and there is temporary pain and pressure in the chest -Usually caused by CAD -Low O2 due to exertion usually brings this pain on -Rest or nitro relieves this pain
Absolute Contraindications for Fibrinolytic therapy
-intracranial neoplasm -intracranial bleed -suspected aortic dissection -internal bleeding
Coronary Artery Bypass Graft (CABG)
-scheduled or emergency procedure -used with multiple vessel disease -left main artery occlusion (which supplies the entire left ventricle) widowmaker
Cardiac Rehab Teaching Points
-smoking cessation -stepped care plan (increase activity gradually) -diet changes: decrease fat, salt, and cholesterol -No isometric exercise-these increase the heart workload -no valsalva -No straining, no suppository -Use Colace (softener)
Temporary Pace Maker
-used in acute or emergency situations like after heart surgeries or an acute MI -used until the client is stable enough for a permanent pacemaker to be inserted. -Can be classified as invasive or noninvasive
A client is being seen in the clinic to R/O mitral valve stenosis. Which assessment data would be most significant? 1. The client complains of shortness of breath when walking. 2. The client has jugular vein distention and 3+ pedal edema. 3. The client complains of chest pain after eating a large meal. 4. The client's liver is enlarged and the abdomen is edematous.
...
Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction? 1. Midepigastric pain and pyrosis. 2. Diaphoresis and cool clammy skin. 3. Intermittent claudication and pallor. 4. Jugular vein distention and dependent edema.
...
The charge nurse is making assignments for clients on a cardiac unit. Which client should the charge nurse assign to a new graduate nurse? 1. The 44-year-old client diagnosed with a myocardial infarction. 2. The 65-year-old client admitted with unstable angina. 3. The 75-year-old client scheduled for a cardiac catheterization. 4. The 50-year-old client complaining of chest pain.
...
The charge nurse is making shift assignments for the medical floor. Which client should be assigned to the most experienced registered nurse? 1. The client diagnosed with congestive heart failure who is being discharged in the morning. 2. The client who is having frequent incontinent liquid bowel movements and vomiting. 3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood pressure of 94/62. 4. The client who is complaining of chest pain with inspiration and a nonproductive cough.
...
The client diagnosed with a myocardial infarction asks the nurse, "Why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response? 1. "Your heart is damaged and needs about four (4) to six (6) weeks to heal." 2. "There is necrotic myocardial tissue that puts you at risk for dysrhythmias." 3. "Your doctor has ordered bedrest. Therefore, you must stay in the bed." 4. "Just because your chest doesn't hurt anymore doesn't mean you are out of danger."
...
The client diagnosed with a myocardial infarction is on bedrest. The unlicensed assistive personnel (UAP) is encouraging the client to move the legs. Which action should the nurse implement? 1. Instruct the UAP to stop encouraging the leg movements. 2. Report this behavior to the charge nurse as soon as possible. 3. Praise the UAP for encouraging the client to move legs. 4. Take no action concerning the UAP's behavior.
...
The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse? 1. The client is keeping the affected extremity straight. 2. The pressure dressing to the right femoral area is intact. 3. The client is complaining of numbness in the right foot. 4. The client's right pedal pulse is 3+ and bounding.
...
The client diagnosed with congestive heart failure is complaining of leg cramps at night. Which nursing interventions should be implemented? 1. Check the client for peripheral edema and make sure the client takes a diuretic early in the day. 2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. 3. Determine if the client has gained weight and instruct the client to keep the legs elevated. 4. Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.
...
The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first? 1. Administer sublingual nitroglycerin. 2. Obtain a STAT electrocardiogram. 3. Have the client sit down immediately. 4. Assess the client's vital signs.
...
The client has chronic atrial fibrillation. Which discharge teaching should the nurse discuss with the client? 1. Instruct the client to use a soft-bristle toothbrush. 2. Discuss the importance of getting a monthly partial thromboplastin time (PTT). 3. Teach the client about signs of pacemaker malfunction. 4. Explain to the client the procedure for synchronized cardioversion.
...
The client has just received a mechanical valve replacement. Which behavior by the client indicates the client needs more teaching? 1. The client takes prophylactic antibiotics. 2. The client uses a soft-bristle toothbrush. 3. The client takes an enteric-coated aspirin daily. 4. The client alternates rest with activity.
...
The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse? 1. The client's BP is 110/70 and pulse is 90. 2. The client's groin dressing is dry and intact. 3. The client refuses to keep the leg straight. 4. The client denies any numbness and tingling.
...
The client is exhibiting sinus bradycardia, is complaining of syncope and weakness, and has a BP of 98/60. Which collaborative treatment should the nurse anticipate being implemented? 1. Administer a thrombolytic medication. 2. Assess the client's cardiovascular status. 3. Prepare for insertion of a pacemaker. 4. Obtain a permit for synchronized cardioversion.
...
The client is exhibiting ventricular tachycardia. Which intervention should the nurse implement first? 1. Administer lidocaine, an antidysrhythmic, IVP. 2. Prepare to defibrillate the client. 3. Assess the client's apical pulse and blood pressure. 4. Start basic cardiopulmonary resuscitation.
...
The client is in complete heart block. Which intervention should the nurse implement first? 1. Prepare to insert a pacemaker. 2. Administer atropine, an antidysrhythmic. 3. Obtain a STAT electrocardiogram (ECG). 4. Notify the health-care provider.
...
The client is in ventricular fibrillation. Which interventions should the nurse implement? Select all that apply. 1. Start cardiopulmonary resuscitation. 2. Prepare to administer the antidysrhythmic adenosine IVP. 3. Prepare to defibrillate the client. 4. Bring the crash cart to the bedside. 5. Prepare to administer the antidysrhythmic amiodarone IVP.
...
The client is one (1) day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first? 1. Medicate the client with intravenous morphine. 2. Assess the client's chest dressing and vital signs. 3. Encourage the client to turn from side to side. 4. Check the client's telemetry monitor.
...
The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure? 1. Perform passive range-of-motion exercises. 2. Assess the client's neurovascular status. 3. Keep the client in high Fowler's position. 4. Assess the gag reflex prior to feeding the client.
...
The client shows ventricular fibrillation on the telemetry at the nurse's station. Which action should the telemetry nurse implement first? 1. Administer epinephrine IVP. 2. Prepare to defibrillate the client. 3. Call a STAT code. 4. Start cardiopulmonary resuscitation.
...
The client who has had a myocardial infarction is admitted to the telemetry unit from intensive care. Which referral would be most appropriate for the client? 1. Social worker. 2. Physical therapy. 3. Cardiac rehabilitation. 4. Occupational therapy.
...
The client who is one (1) day postoperative coronary artery bypass surgery is exhibiting sinus tachycardia. Which intervention should the nurse implement? 1. Assess the apical heart rate for one (1) full minute. 2. Notify the client's cardiac surgeon. 3. Prepare the client for synchronized cardioversion. 4. Determine if the client is having pain.
...
The client with coronary artery disease asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse? 1. "Chest pain is caused by decreased oxygen to the heart muscle." 2. "There is ischemia to the myocardium as a result of hypoxemia." 3. "The heart muscle is unable to pump effectively to perfuse the body." 4. "Chest pain occurs when the lungs cannot adequately oxygenate the blood."
...
The client with coronary artery disease is prescribed a Holter monitor. Which intervention should the nurse implement? 1. Instruct client to keep a diary of activity, especially when having chest pain. 2. Discuss the need to remove the Holter monitor during a.m. care and showering. 3. Explain that all medications should be withheld while wearing a Holter monitor. 4. Teach the client the importance of decreasing activity while wearing the monitor.
...
The client's telemetry reading shows a P wave before each QRS complex and the rate is 78. Which action should the nurse implement? 1. Document this as normal sinus rhythm. 2. Request a 12-lead electrocardiogram. 3. Prepare to administer the cardiotonic digoxin PO. 4. Assess the client's cardiac enzymes.
...
The elderly client has coronary artery disease. Which question should the nurse ask the client during the client teaching? 1. "Do you have a daily bowel movement?" 2. "Do you get yearly chest x-rays?" 3. "Are you sexually active?" 4. "Have you had any weight change?"
...
The health-care provider has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with congestive heart failure. Which discharge instructions should the nurse include? 1. Instruct the client to take a cough suppressant if a cough develops. 2. Teach the client how to prevent orthostatic hypotension. 3. Encourage the client to eat bananas to increase potassium level. 4. Explain the importance of taking the medication with food.
...
The intensive care department nurse is assessing the client who is 12 hours post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement? 1. Notify the health-care provider immediately. 2. Elevate the head of the client's bed. 3. Document this as a normal and expected finding. 4. Administer morphine intravenously.
...
The male client is diagnosed with coronary artery disease (CAD) and is prescribed sublingual nitroglycerin. Which statement indicates the client needs more teaching? 1. "I should keep the tablets in the dark-colored bottle they came in." 2. "If the tablets do not burn under my tongue, they are not effective." 3. "I should keep the bottle with me in my pocket at all times." 4. "If my chest pain is not gone with one tablet, I will go to the ER."
...
The nurse and an unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP? 1. Assist the client to go down to the smoking area for a cigarette. 2. Transport the client to the intensive care unit via a stretcher. 3. Provide the client going home discharge-teaching instructions. 4. Help position the client who is having a portable x-ray done.
...
The nurse enters the room of the client diagnosed with congestive heart failure. The client is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first? 1. Sponge the client's forehead. 2. Obtain a pulse oximetry reading. 3. Take the client's vital signs. 4. Assist the client to a sitting position.
...
The nurse has written an outcome goal "demonstrates tolerance for increased activity" for a client diagnosed with congestive heart failure. Which intervention should the nurse implement to assist the client to achieve this outcome? 1. Measure intake and output. 2. Provide two (2)-g sodium diet. 3. Weigh client daily. 4. Plan for frequent rest periods.
...
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication? 1. The client's apical pulse is 64. 2. The client's calcium level is elevated. 3. The client's telemetry shows occasional PVCs. 4. The client's blood pressure is 90/62.
...
The nurse is assessing the client diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective? 1. The client's peripheral pitting edema has gone from 3+ to 4+. 2. The client is able to take the radial pulse accurately. 3. The client is able to perform ADLs without dyspnea. 4. The client has minimal jugular vein distention
...
The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement? Select all that apply. 1. Administer morphine intramuscularly. 2. Administer an aspirin orally. 3. Apply oxygen via a nasal cannula. 4. Place the client in a supine position. 5. Administer nitroglycerin subcutaneously.
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The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select all that apply. 1. Notify health-care provider of a weight gain of more than one (1) pound in a week. 2. Teach client how to count the radial pulse when taking digoxin, a cardiac glycoside. 3. Instruct client to remove the saltshaker from the dinner table. 4. Encourage client to monitor urine output for change in color to become dark. 5. Discuss the importance of taking the loop diuretic furosemide at bedtime.
...
The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina? 1. Put a nitroglycerin tablet under the tongue. 2. Stop the activity immediately and rest. 3. Document when and what activity caused angina. 4. Notify the health-care provider immediately.
...
The nurse is discussing the importance of exercise with the client diagnosed with coronary artery disease. Which intervention should the nurse implement? 1. Perform isometric exercises daily. 2. Walk for 15 minutes three (3) times a week. 3. Do not walk outside if it is less than 40˚F. 4. Wear open-toed shoes when ambulating.
...
The nurse is preparing to administer a beta blocker to the client diagnosed with coronary artery disease. Which assessment data would cause the nurse to question administering the medication? 1. The client has a BP of 110/70. 2. The client has an apical pulse of 56. 3. The client is complaining of a headache. 4. The client's potassium level is 4.5 mEq/L.
...
The nurse is teaching a class on valve replacements. Which statement identifies a disadvantage of having a biological tissue valve replacement? 1. The client must take lifetime anticoagulant therapy. 2. The client's infections are easier to treat. 3. There is a low incidence of thromboembolism. 4. The valve has to be replaced frequently.
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The nurse on the telemetry unit has just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with myocardial infarction who has an audible S3 heart sound. 2. The client diagnosed with congestive heart failure who has 4+ sacral pitting edema. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 94%. 4. The client with chronic renal failure who has an elevated creatinine level.
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The telemetry nurse is unable to read the telemetry monitor at the nurse's station. Which intervention should the telemetry nurse implement first? 1. Go to the client's room to check the client. 2. Instruct the primary nurse to assess the client. 3. Contact the client on the client call system. 4. Request the nursing assistant to take the crash cart to the client's room.
...
Which assessment data would the nurse expect to auscultate in the client diagnosed with mitral valve insufficiency? 1. A loud S1, S2 split, and a mitral opening snap. 2. A holosystolic murmur heard best at the cardiac apex. 3. A midsystolic ejection click or murmur heard at the base. 4. A high-pitched sound heard at the third left intercostal space.
...
Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction? 1. Creatine kinase (CK-MB). 2. Lactate dehydrogenase (LDH). 3. Troponin. 4. White blood cells (WBCs).
...
Which client problem has priority for the client with a cardiac dysrhythmia? 1. Alteration in comfort. 2. Decreased cardiac output. 3. Impaired gas exchange. 4. Activity intolerance.
...
Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? Select all that apply. 1. Encourage a low-fat, low-cholesterol diet. 2. Instruct client to walk 30 minutes a day. 3. Decrease the salt intake to two (2) g a day. 4. Refer to counselor for stress reduction techniques. 5. Teach the client to increase fiber in the diet.
...
Which intervention should the nurse implement when administering a loop diuretic to a client diagnosed with coronary artery disease? 1. Assess the client's radial pulse. 2. Assess the client's serum potassium level. 3. Assess the client's glucometer reading. 4. Assess the client's pulse oximeter reading.
...
Which intervention should the nurse implement when defibrillating a client who is in ventricular fibrillation? 1. Defibrillate the client at 50, 100, and 200 joules. 2. Do not remove the oxygen source during defibrillation. 3. Place petroleum jelly on the defibrillator pads. 4. Shout "all clear" prior to defibrillating the client.
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Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning diet? 1. "I will not eat more than six (6) eggs a week." 2. "I should bake or grill any meats I eat." 3. "I will drink eight (8) ounces of whole milk a day." 4. "I should not eat any type of pork products."
...
what IV solution is hung with a blood transfusion
.9 ns, NO glucose
When assessing a patient with possible PAD, the nurse obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the patient's ankle-brachial index (ABI) as ______.
0.78 or 0.79
What is the companion IV solution for platelets?
0.9% NaCl
Nursing considerations: Packed Red Cells, what is the companion solution?
0.9% Normal saline
When a patient requires defibrillation, in which order will the nurse accomplish the following steps?
1 Turn the defibrillator on. 2 Select the appropriate energy level 3 Place the paddles on the patient's chest. 4 Check the location of other personnel and call out "all clear." 5 Deliver the electrical charge.
Each unit of packed red blood cells increases the hemoglobin level by
1 g/dL (The change in laboratory values takes 4-6 hours after the completion of the blood transfusion)
How long after the transfusion of platelets is the platelet count usually elevated?
1 hour and 18 to 24 hours after the transfusion
Nursing considerations: 25% Albumin is given how?
1 mL/min
719. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. A physician prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 0.5 to 2 ng/mL
What are contraindications for autologous disease?
1. Acute infection. 2.Chronic disease 3. Hemoglobin less than 11 g/L or HCT less than 33% 4.Cerebrovascular disease 5. Cardiovascular disease
A nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. the digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following: 1. An increase in the client's digoxin dose. 2. A decrease in the client's digoxin dose. 3. No change in the client's digoxin dose. 4. Dicontinuation of the client's digoxin dose.
1. An increase in the client's digoxin dose.
procedure of blood products
1. Ask about allergies or previous blood reaction. 2. Check by RNs. 3. Check baseline VS, including temp 4. Start w/ NS (0.9% NaCl) 5. Run blood slowly for first 15 min 6. Stay w/ pt for 15-30 min 7. Re-check VS 15 min after infusion started 8.If no untowered effects, increase rate; should be infused in 2 hours for each unit
Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for the development of which of teh following adverse effects of this drug? SELECT ALL THAT APPLY 1. Hyperkalemia 2.Hypocalcemia 3. Cough 4. Dizziness 5. Heartburn
1. Hyperkalemia 2.Hypocalcemia 3. Cough 4. Dizziness
What is the procedure to give blood?
1. Obtain baseline vitals, temp. 2. Start w/ Normal Saline. 3.Run blood slowly for first 15 min. 4. Staw w/ pt for 15-30 min. 5.Recheck vital signs 15 min after infusion started. 6.If no untowered effects, increase rate; should be infused in 2 hours for each unit. 7.Take VS every hour until completed, then hourly for 3 hours after.
What to do if transfusion reaction suspected
1. Stop blood or blood products 2.Restart NS 3. Save blood container, tubing, & return to blood bank 4. Draw blood sample for plasma, hemoglobin, culture, retyping 5. Collect urine specimen & send to lab for hemoglobin determination 6. Monitor voiding for hematuria
What to do if a transfusion reaction is suspected?
1. Stop blood or blood products. 2. Restart NS. 3. Save blood container and tubing and return them to blood bank. 4. Draw blood sample for plasma, hemoglobin, culture, retyping 5. Collect urine sample and send to lab for hemoglobin determinations. 6. Monitor voiding for hematuria.
What to do if febrile reaction occurs?
1. Stop blood. 2. Supportive care= aspirin
Which 3 arrhythmias cause no cardiac output?
1. V-fib 2. pulseless V-tach 3. asystole
Blood transfusion reactions: SS of Febrile reaction
1. fever* 2. chills 3. n 4. HA* 5.flushing 6. tachycardia 7. palpitations*
Blood transfusion reactions: SS of Anaphlaxis Allergic reaction/ Hypersensitivity
1. hypotension* 2. dyspnea* 3. decreased oxygen saturation* 4. flushing
Blood transfusion reactions: SS of Mild Allergic reaction/ Hypersensitivity
1. uritcaria* 2. itching* 3. flushing
