Cardiac

1,4,5 (Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial oxygen consumption, BP and HR. Morphine also reduces anxiety and fear due to its sedative effects and by slowing the HR. It can depress RR; however such an effect may lead to hypoxia, which should be avoided in the treatment of chest pain. Angiotensin-converting enzyme inhibitor drugs, not morphine may help to prevent ventricular remodeling)

A client with acute chest pain is receiving IV morphine sulfate. Which is the expected effect of morphine? Select all that apply 1. reduces myocardial oxygen consumption 2 promotes reduction in RR 3 prevents ventricular remodeling 4. reduces BP and HR 5 reduces anxiety and fear

3 (The client taking nifedipine should inspect the gums daily to monitor for gingival hyperplasia. This is an uncommon adverse effect but one that requires monitoring and intervention if it occurs. The client taking nifedipine might be taught to monitor BP but more often than monthly. These clients would not generally need to perform daily wights or limit intake of green leafy veges)

A client with angina is taking nifedipine. What instruction should the nurse give the client? 1. monitor BP monthly 2. perform daily weights 3. inspect gums daily 4. limit intake of green leafy veges

4 (The thrombolytic agent t-PA administered IV, lyses the clot blocking the coronary artery The drug is most effective when administered within the first 6 hrs after onset of MI The drug does not reduce coronary artery vasospasm. nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs, Surgical approaches are used to open the coronary artery and re establish a blood supply to the area)

Alteplase recombinant, or tissue plasminogen activator (t-PA) a thrombolytic enzyme, is administered during the first 6 hrs after onset of myocardial infarction to : 1 control chest pain 2. reduce coronary artery vasospasm 3. control the arrhythmias associated with MI 4. revascularize the blocked coronary artery

2 (All of the 1200 hour assessments are signs of decreased Cardiac output and can be an ominous sign in a client who has recently experienced an MI. The nurse should notify the hCP of these changes.. Cardiac output and BP may continue to fall to dangerous levels which can induce further cardiac ischemia and extension of the infarct. While the client is currently hypotensive, giving a fluid challenge/bolus can precipitate increased workload on a damaged heart and extend the MI. Exercise or walking for this client will increase both the HR and stroke volume, both of which will increase cardiac output, but the increased CO will increase O2 needs especially in the heart muscle and can induce further cardiac ischemia and extension of the infarct. The client is hypotensive Although the client has decreased urinary output, this is the bodys response to a decreasing cardiac output and it is not appropriate to administer furosemide)

An older adult had a MI 4 days ago. At 0930 the clients BP is 102/64 mmHg. After reviewing the cients progress notes below, the nurse should first: @0030; Urinary output last 4 hrs: 90 mL Capillary refill >3 sec BP 128/82 Extremities Cool 1. Give a fluid challenge bolus 2 notify the HCP 3. assist the client to walk 4. administer furosemide as prescribed

1 (The client is having symptoms of a myocardial infarction. The first action is to prevent platelet formation and block prostaglandin synthesis. The Client should place the tablet under the tongue and wait until it is absorbed. Nitroglycerin tablets are not effective if chewed, swallowed or placed between the cheek and gums)

An older adult has chest pain and shortness of breath. The HCP prescibes nitroglycerin tablets. What should the nurse instruct the client to do? 1 put the tablet under the tongue until its absorbed 2. swallow the tablet with 120 mL of water 3. chew the tablet until its dissolved 4. place the tablet between the cheek and gums until it disappears

3 (nitro produces peripheral vasodilation which reduces myocardial o2 consumption. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitro decrease myocardial o2 demand, does not have an effect on pericardial spasticity or conductivity in the myocardium)

As an initial step in treating a client with angina the HCP prescribes nitro tablets 0.3 mg given sublingually This drugs principal effects are produced by : 1. antispasmodic effects on the pericardium 2.. causing an increased myocardial o2 demand 3. vasodilation of peripheral vasculature 4. improved conductivity in the myocardium

3 (nitro can be used prophylactically before stressful physical activity)

Following diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain Which instruction would most likely help the client prevent this problem? 1 climb the steps early in the day 2.. rest for at least an hour before climbing the stairs 3. Take nitroglycerin tablet before climbing the stairs 4 lie down after climbing the stairs

3 (pasta, tomato sauce, salad and coffee would be the best selection for the client. )

The client who experiences angina has been told to follow a low cholesterol diet. Which meal would be best? 1. hamburger, salad, and milk shake 2. baked liver green beans and coffee 3. spaghetti with tomato sauce, salad, and coffee 4. fried chicken green beans and skim milk

4 (Sinus tachycardia is characterized by normal conduction and a regular rhythm. but with a rate exceeding 100 bpm A P wave precedes each QRS, and the QRS is normal)

The nurse is assessing a client who has had a MI. The nurse notes the cardiac rhythm shown on the ECG strip. The nurse interprets this rhythm as: 1. atrial fibrillation 2. ventricular tachycardia 3. premature ventricular contractions 4. sinus tachycardia

2,5,6 (Simvastatin is used in combination with diet and exercise to decrease elevated cholesterol. The client should take simvastatin in the evening and the nurse should instruct the client that if a dose is missed to take it as soon as remembered but not to take at the same time as the next scheduled dose. It is not necessary to take the pill with food The client does not need to limit greens (that would be with warfarin) but the nurse should instruct the client to avoid grape fruit juices which can increase the amount of the drug in the bloodstream. A serious side effect is myopathy and the client should report muscle pain or tenderness to the HCP)

The nurse is developing a teaching plan for a client who will be starting a prescription for simvastatin 40 mg/day/ What instructions should the nurse give the client? SATA 1. take once a day in the morning 2. if you miss a dose take it when you remember 3. limit greens such as lettuce to prevent bleeding 4. Be sure to take the pill with food 5. report muscle pain or tenderness to your HCP 6. continue to follow a diet that is low in saturated fats

2 (late onset of puberty is not generally considered to be a risk factor for the development of atherosclerosis. Risk factors for atherosclerosis include family history of atherosclerosis, cigarette smoking, hypertension, high cholesterols, male gender, diabetes mellitus, obesity and physical inactivity)

What is not a risk factor for the development of atherosclerosis? 1 family history of early heart attack 2. late onset puberty 3. total blood cholesterol >220 4. elevated fasting blood glucose

1 (changes in patterns may indicate increasing severity of CAD. Pain occurring during the other activities listed is not uncommon... take nitro for)

Which symptom should the nurse teach the client with unstable angina to report immediately to the HCP? 1.. a change in the pattern of chest pain 2. pain during sexual activity 3. pain during an argument 4. pain during or after physical activity

1 (although obtaining the ECG, chest radiograph and CBC are all important, the nurses priority action should be to relieve the crushing chest pain. Therefore administering the morphine sulfate is the priority action)

A 60 year old comes into the ER with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Admission prescriptions include O2 by nasal cannula at 4L/min. CBC, chest radiograph, a 12 lead ECG and 2 mg of morphine sulfate given IV. The nurse should first: 1.. administer the morphine 2. obtain a 12 lead ECG 3. obtain blood work 4. prescribe the chest radiograph

1 (further assessment is needed in this situation. It is premature to initiate other actions until further data has been gathered. Inquiring about the onset, duration, location, severity, and precipitating factors of the chest heaviness will provide pertinent info to convey to the HCP)

A 68 year old client on day 2 after a hip surgery has no cardiac history, but reports having chest heaviness. The nurse should first: 1. inquire about the onset duration and severity and precipitating factors of the heaviness 2. administer oxygen via nasal cannula 3. offer pain medication for the chest heaviness 4. inform the HCP of the chest heaviness

3 ( IN health coaching unlike traditional client education techniques in which the nurse provides information, the goal of coaching is to encourage the client to explore the reasons for behavior and establish a vision for health behavior and the way he or she can make changes to improve their health behavior and reduce or eliminate health risks. When coaching a nurse does not withhold praise or instill fear)

A client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. The nurse can coach this client to improve health by 1. explaining how the risk factors lead to poor health 2 withholding praise until the client changes the risky behavior 3 helping the client establish a wellness vision to reduce health risks 4 instilling mild fear into the client about the potential outcomes of the risky health behaviors

1 (An S3 heart sound occurs early in diastole as the mitral and tricuspid valves open and blood rushes in the ventricles. To distinguish an S3 from a physiologic S2, split a split S2 occurs during inspiration and S3 remains constant during the respiratory cycle. Its pitch is softer and best heard with the bell at the apex, and it is one of the first clinical findings in Left ventricular failure. An S4 is heard in late diastole when atrial contraction pumps volume into a stiff, noncompliant ventricle. An S4 is not heard in a client with atrial fibrillation because there is no atrial contraction. Murmurs are sounds created by turbulent blood flow through an incompetent or stenotic valve.)

A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as: 1. heart rate irregular with S3 2. heart rate irregular with S4 3. heart rate irregular with aortic regurgitation 4. heart rate irregular with mitral stenosis

1 (the tablet needs to be absorbed in the mouth, no water. Lying supine may increase headache. It is expected common side effect, take a tylenol)

A client with a throbbing headache when nitro is taken for angina. The nurse should instruct the client that: 1. acetaminophen or ibuprofen can be taken for this common side effect 2 nitro should be avoided if the client is experiencing this serious side effect 3. taking the nitro with a few glasses of water will reduce the problem 4. the client should lie in a supine position to alleviate the headache

2 (nitroglycerin is a vasodilator that will lower BP. The client is having chest pain and ST elevation indicates injury to the myocardium, which may benefit from nitroglycerin. The potassium and HR are wnl)

A client with chest pain is prescribed IV nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip? 1 Serum K is 3.5 mEq/L 2 BP is 88/46 mm Hg 3. ST elevation is present on the ECG 4. Heart rate is 61 bpm

2 (advanced cardiac life support recommends that at least one or two IV lines be inserted in one or both of the antecubital spaces. Calling the HCP, obtaining a portable chest radiograph, and drawing blood for the lab are important but secondary to starting the IV line)

A middle aged client being admitted to the hospital has a history of hypertension and informs the nurse that his father died from a heart attack at the age of 60. The client reports having indigestion. The nurse connects the client to a cardiac monitor which reveals eight premature ventricular contractions per minute. The nurse should next: 1. call the HCP 2. start an IV line 3. obtain a portable chest radiograph 4 draw blood for lab studies

4 The nurse should instruct the client that correct protocol for using sublingual nitro involves immed. administration when chest pain occurs. Sublingual nitro appears in the bloodstream within 2-3 mins and is metabolized within 10 mins. The client should sit down and place the tablet under the tongue If the chest pain is not relieved in 5 mins the client should call 911 Although some HCPs recommend taking a 2nd pill or 3rd 5 mins apart and then calling 911. It is not appropriate to take 2 pills at once, nitro acts within 2-3 mins and the client should not wait 15 mins to take further actions. The client should cll 911 not the HCP)

How should the nurse instruct the client with unstable angina to use sublingual nitro tablets when chest pain occurs? "sit down and then: 1. take one tablet every 2-5 mins until the pain stops 2.. take one tablet and rest for 15 mins call the HCP if pain lasts longer than 15 mins 3. take one tablet, then if pain persists, take additional 2 tablets in 5 min. Call the HCP if pain persists longer than 15 mins 4. take one tablet if pain persists after 5 mins call 911

4 (The nurse should first assess the clients tolerance to the drop in HR by checking the blood pressure and level of consciousness and determine if atropine is needed. If the clients is symptomatic, atropine and transcutaneous pacing are interventions for symptomatic bradycardia. Once the client is stable further physical assessments can be done)

The nurse notices that a clients HR decreases from 63 to 50 bpm on the monitor. The nurse should first: 1. administer atropine 0.5mg push IV 2. auscultate for abonrmal heart sounds 3. prepare for transcutaneous pacing 4 take the clients BP

2 (thrombolytic drugs are give within the first 6 hrs after onset of an MI to lyse clots and reduce the extent of myocardial damage)

When administering a thrombolytic drug to the client who is experiencing a MI and who has premature ventricular contractions the expected outcome of the drug is to: 1. promote hydration 2. dissolve clots 3 prevent kidney failure 4 treat dysrhythmias

4 (The woman who is 65 years old is overweight and has an elevated LDL is at greatest risk. Total cholesterol >200 LDL >100, HDL<40 in men, HDL <50 in women, men 45 years and older, women 55 years and older, smoking and obesity increase the risk of CAD. ATorvastatin reduces LDL and decreases risk of CAD. The combination of postmenopausal, obesity and high LDL places this client at greatest risk)

Which client is at risk for coronary artery disease? 1. a 32 year old female with mitral valve prolapse who quit smoking 10 years ago 2. A 43 year old male with a family history of CAD and cholesterol level of 158 3. A 56 year old male with an HDL of 60 who takes atorvastatin 4. a 65 year old female who is obeses with a LDL of 188

2 (furosemide is a loop diuretic that acts to increase urine output. Furosemide does not increase BP, decrease pain, or decrease arrhythmias)

Which is an expected outcome when a client is receiving an IV administration of furosemide? 1. increased blood pressure 2. increased urine output 3. decreased pain 4 decreased premature ventricular contractions

2 (Metoprolol is indicated in the treatment of hemodynamically stable clients with an acute MI to reduce cardiovascular mortality. Cardiogenic shock causes severe hemodynamic instability and a beta-blocker will further depress myocardial contractility. The metoprolol should be discontinued. The decrease in cardiac output will impair perfusion to the kidneys. Cardiac output, hemodynamic measurements, and appropriate interventions can be determined with a PA catheter. Dobutamine will improve contractility and increase the cardiac output that is depressed in cardiogenic shock)

A client admitted for MI develops cardiogenic shock. An arterial line is inserted Which prescription from the HCP should the nurse verify before implementing? 1. Call for urine output <30 mL/h for 2 consecutive hrs 2 administer metoprolol 5 mg IV push 3. prepare for a pulmonary artery catheter insertion 4. Titrate dobutamine to keep systolic BP >100 mm Hg

24

A client is receiving an IV infusion of heparin sodium at 1200 units/h. The dilution is 25000 units/500 mL How many milliliters per hour will this client receive? Round answer to a whole number____________________mL/h

2 (cardiac cath is done in clients with angina primarily to assess the extent and the severity of the coronary artery blockage. A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization result Coronary bypass surgery would be used to bypass obstructed vessels. Although cardiac cath can be used to assess the functional adequacy of the valves, and heart muscle, in this case the client has unstable angina and therefore would need the procedure to assess the extent of arterial blockage)

A client with unstable angina is scheduled to have a cardiac catheterization The nurse explains to the client that this procedure is being used to : 1. open and dilate blocked coronary arteries 2 assess the extent of arterial blockage 3. bypass obstructed vessels 4. assess the functional adequacy of the valves and heart muscle

3 (encouraging the client to move the legs while in bed is a preventative strategy taught to all clients who are hospitalized and no bed rest to promote venous return. The muscular action aids in venous return and prevents venous stasis in the lower extremities These exercises are not intended to prepare the client for ambulation . These exercises are not associated with promoting urinary and intestinal elimination These exercises are not perfomed to decrease the risk of pressure ulcer formation.)

After a MI, the hospitalized client is taught to move the legs while resting in bed. What is the expected outcome of this exercise? 1. prepare the client for ambulation 2. promote urinary and intestinal elimination 3 prevent thrombophlebitis and blood clot formation 4. decrease the likelihood of pressure ulcer formation

1 (IV nitroglycerin requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system and more frequently than q4. Hourly urine outputs are not always required. Obtaining a serum K level is not associated with nitro infusion)

The HCP prescribes continuous IV nitroglycerin infusion for the patient with MI. The nurse should: 1. obtain an infusion pump for the medication 2 take the BP every 4 hrs 3. monitor the urine output hourly 4. obtain serum K levels daily

1 (Nitroglycerin acts to decrease myocardial oxygen consumption. Vasodilation makes it easier for the heart to eject blood, resulting in decreased oxygen needs Decreased oxygen demands reduces pain caused by heart muscle not receiving sufficient oxygen. While BP may decrease ever so slightly due to the vasodilation effects of nitroglycerin, it is only secondary and not related to the angina the client is experiencing Increased BP would mean the heart would work harder increasing oxygen demand and thus angina Decreased heart rate is not an effect of nitro)

The client has been managing angina episodes with nitroglycerin Which finding indicates that the therapeutic effect of the drug has been achieved? 1. decreased chest pain 2. increased BP 3. decreased BP 4. decreased HR

2 (A history of cerebral hemorrhage is a contraindication to administration of t-PA because the risk of hemorrhage may be further increased. Age >60, history of HF, and cigarette smoking are not contraindications)

prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug? 1 age > 60 years 2. history of cerebral hemorrhage 3. history of HF 4. cigarette smoking

4 (nursing management for a client with a myocardial infarction should focus on pain management and decreasing myocardial oxygen demand. Fluid status should be closely monitored. Client education should begin once the client is stable and amenable to teaching. Visitation should be based on client comfort and maintaing a calm environment)

A client has a chest pain rated at 8 on a 10 point visual analog scale. The 12 lead ECG reveals ST elevation in the inferior leads, and troponin levels are elevated. What should the nurse do first? 1 monitor daily weights and urine output 2. limit visitation by family and friends 3. provide client education on medications and diet 4 reduce pain and myocardial oxygen demand

3 (When wedged the catheter is pointing indirectly at the left end-diastolic pressure. The pulmonary artery wedge pressure is measure when the tip of the catheter is slowly inflated and allowed to wedge into a branch of the pulmonary artery Once the balloon is wedged, the catheter reads the pressure in front of the balloon. During diastole, the mitral valve is open, reflecting left ventricular end-diastolic pressure. Cardiac output is the amount of blood ejected by the heart in 1 minute and is determined through thermodilution and not wedge pressure. Cardiac index is calculated by dividing the clients cardiac output by the clients body surface area and is considered a more accurate reflection of the individual clients cardiac output. Right atrial blood pressure is not measured with the pulmonary artery catheter.)

A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse should wedge the catheter to gain information about: 1. cardiac output 2 right arterial blood flow 3. left end diastolic pressure 4 cardiac index

4 (an elevated troponin level should be reported to the HCP prior to the stress test as this change indicates myocardial damage. Sending the client to walk on a treadmill for stress testing would be contraindicated with evidence of recent myocardial injury and could further extend the damage. The other blood levels are helpful but not critical to this clients welfare at this point in time)

A client is admitted with chest pain and ept overnight for stress testing the next morning Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the HCP prior to the stress test? 1. cholesterol level 2. ESR 3. Prothrombin time 4. positive troponin

2,5 (It is important for clients to wear hearing aids to this procedure so that they can hear the questions posed to them by the healthcare team. Chest pain often occurs when the balloon within the stent is inflated and deployed into the coronary artery. It is expected and brief but should still be reported by the client. During the procedure and for a prescribed amount of time after the procedure the client will need to remain flat in bed with the right leg straight., NOT flexed, to prevent bleeding from the access site. The site is not routinely stitched. It is a puncture rather than an incision requiring sutures. The client may be given IV medication to help with comfort, but the client is kept awake to answer questions and to hear instructions and explanations. General anesthesia is not given)

A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this clients pre- operative teaching plan? select all that apply 1. If you have a hearing aid you will need to remove it for the procedure 2. If you have chest pain during the procedure please tell the staff when or if this occurs 3. The stitches at your right groin will be able to be removed in 7-10 days following the procedure 4. you will be given general anesthesia and will be asleep throughout the procedure 5. You will need to remain flat throughout the procedure 6 You will need to keep your right leg in a flexed position for 1-2 hrs following the procedure

2 (to monitor that the clients circulation remains intact. the dorsal surface of the right foot should be palpated. when the left side is catheterized, the cannula enters via an artery. In this instance, the right femoral artery was accessed. While all options assess arterial points of the right leg, the dorsal surface of the right foot ; the pedal pulse; is the most distal. If this pulse point is present and unchanged from before the procedure, the other pulse points should also be intact)

A client returns from a L heart catheterization, The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client? 1. anterior to the right tibia 2 dorsal surface of the right foot 3. posterior to the right knee 4 right mid-inguinal area

3 4 2 1 (The nurse should first connect the client to the monitor by attaching the electrodes. ECG can be used to identify myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement, electrolyte imbalances and the effects of drugs on the clients heart The nurse should next obtain VS to establish a baseline. Next the nurse should administer the morphine, morphine is the drug of choice in relieving myocardial infarction pain it may cause a transient decrease in BP. When the client is stable, the nurse can obtain a history of the clients drug use)

The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? Use all options. do not separate with comma. 1. obtain a history of which drugs the client has used recently 2. administer the prescribed dose of morphine 3. position the electrodes on the chest 4.. take VS

2 (A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of left-sided HF Crackles, edema and weight gain should be monitored closely, but the levels are not as high a priority With atrial fibrillation, there is a loss of atrial ick, but the BP and HR are stable)

The nurse has completed an assessment on a client with decreased cardiac output Which findings should receive the highest priority? 1. BP 110/62, atrial fibrillation with HR 82, bilateral basilar crackles 2. confusion, urine output 15 mL over the last 2 hrs, orthopnea 3 SpO2 92 on 2L nasal cannula, RR 20, 1+edema of lower extremities 4. weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with excercise

3 (The client is experiencing a single PVC. PVC's are characterized by a QRS of longer than 0.12 second and by a wide, notched or slurred QRS complex. There is no P wave related to the QRS complex, and the T wave is usually inverted. PVC's are potentially serious and can lead to ventricular fibrillation or cardiac arrest when they occur more than 6 to 10 in an hour in clients with MI. The nurse should continue to monitor the client and note if the PVCs are increasing It is not necessary to notify the HCP or call the rapid response team at this point Lidocaine is not indicated from the data on this ECG)

The nurse is assessing a client who has had a MI. the nurse notes the cardiac rhythm on the monitor. The nurse should: 1. notify the HCP 2. call the rapid response team 3. assess the client for changes in the rhythm 4. administer lidocaine as prescribed

1 (The nurse should first don gloves and apply direct pressure over the site to stop blood loss from the femoral artery. While the nurse will later observe the site for further bleeding and record the extent of the bleeding, this is not the first action that is needed. If the bleeding cannot be controlled, the HCP who performed the surgery should be contacted, but first an attempt to manually stop the bleeding with direct pressure is warranted. PRotamine sulfate is the antidote for heparin sodium but this is not an initial action to control the bleeding)

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving IV heparin sodium at 1000 Units per hr. During the second postprocedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. The nurse should first: 1. don gloves and apply direct pressure over the site 2. observe and document the bleeding 3. notify the HCP 4. prepare protamine sulfate for IV administration

1 (The nurse should first obtain VS as changes in VS will reflect the severity of the sudden drop in Cardiac Output; decrease in BP, increase in HR, and increase in RR. Infarction of the papillary muscles is a potential complication of an MI causing ineffective closure of the mitral valve during systole. Mitral regurgitation results when the left ventricle contracts and blood flows backward into the L atrium, which is heard at the 5th intercostal space, midclavicular line The murmur worsens during expiration and in the supine or left side position and can best be heard when the client is in thses positions, not with the client leaning forward A 12 lead ECG views the electrical activity of the heart; an echocardiogram views valve function)

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur of the apex. The nurse should first: 1 assess for changes in VS 2. draw an ABG 3. evaluate heart sounds with the client leaning forward 4. obtain a 12 lead ECG

1 2 4 3 (When a client returns from having a transluminal balloon angioplasty with femoral access, the nurse should first obtain baseline VS and O2 sat to determine evidence of bleeding or decreased tissue perfusion. The nurse should next assess the pedal pulses to determine if the client has adequate peripheral tissue perfusion Next the nurse should inspect the cath site and then determine color and sensation in the affected leg)

The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty with femoral artery access. In which order, from first to last, should then nurse obtain information about the client? use all options, do not separate with commas 1. VS and O2 sat 2. pedal pulses 3. color and sensation of extremity 4. cath site

1,3,4 Clopidogrel is generally well absorbed and may be take with or without food it should be taken at the same time every day and while food may help prevent potential GI upset, food has no effect on the absorption of the drug. Bleeding is the most common adverse effect of clopidogrel, the client must understand the importance of reporting any unexpected, prolonged, or excessive bleeding including blood in urine or stool. Increased bruising and bleeding gums are possible side effects of clopidogrel, the client should be aware of this possibility. Plavix is an antiplatelet agent used to prevent clot formation in clients that have experienced or are at risk for MI, ischemic stroke, peripheral artery disease, or acute coronary syndrome. It is not necessary to drink a glass of water after taking clopidogrel)

The nurse is caring for a client who recently experienced a MI and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply 1. the client should report unexpected bleeding or bleeding that lasts a long time 2. the client should take clopidogrel with food 3. The client may bruise more easily and may experience bleeding gums 4. Clopidogrel works by preventing platelets from sticking together and forming a clot 5 The client should drink a glass of water after taking clopidogrel

1 (oliguria occurs during cardiogenic shock because there is a reduced blood flow to the kidneys. Typical signs of cardiogenic shock include low BP, rapid and weak pulse, decreased urine output, and signs of diminished blood flow to the brain such as confusion and restlessness. Cardiogenic shock is a serious complication of MI, with a mortality rate approaching 90%. Fever is not a typical sign of cardiogenic shock. The other changes in the clients VS on the clients chart are not as significant as the decreased urinary output)

The nurse is monitoring a client admitted with an MI who is at risk for cardiogenic shock. The nurse should report which changes noted from the clients chart to the HCP? @1300 BP 110/70 T 98.7 HR 70 RR 20 Urine output 90 mL/h @1500 BP 100/65 T 99 HR 75 RR 26 Urine output 20 mL/h 1. Urine output 2. HR 3. BP 4. RR

1 (cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperfusion of the cardiac tissue. Hypotension is commonly observed with administration of t-PA. Seizures and hypothermia are not generally associated with reperfusion of cardiac tissue)

When monitoring a client who is receiving t-PA the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in : 1. cardiac arrhythmias 2 hypertension 3. seizure 4. hypothermia

1,2,3,4 (When preparing a client for a cardiac angiogram, the nurse should determine if the client has an allergy to the liquid contrast medium used in the procedure. Contrast dyes contain iodine and the administration of a dye could lead to an anaphylactic response in clients who are allergic to the dye. An IV infusion will be started before the procedure to administer the dye The clients should not eat or drink for 8 hrs prior to the procedure. The client may experience flushing sensation, but this is a normal response and does not indicate a life-threatening reaction. The client may receive light sedation, but not an anesthetic as the client must be awake to follow instructions. The client should be instructed to lie still during the procedure.)

When preparing a client for a cardiac angiogram, which actions should the nurse take? SELECT ALL THAT APPLY: 1. Determine if the client has an allergy to the liquid contrast media 2. inform the client that an IV infusion will be started before the procedure 3. remind the client to have nothing to drink before the procedure 4 instruct the client to remain still during the procedure 5. explain that the client will receive a fast acting anesthetic

4 (By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Severe chest pain should not be present on day 2 after an MI. Day 2 may be too soon for clients to be able to identify risk factors for MI or begin a walking program. however the client may be sitting up in a chair as part of the cardiac rehab program)

Which is an expected outcome for a client on the 2nd day of hospitalization after a MI? The client: 1 continues to have severe chest pain 2 can identify risk factors for MI 3. participates in a cardiac rehabilitation walking program 4. can perform personal self care activities without pain

2 (recommended dietary principles in the acute phase of MI include avoiding large meals because small easily digested foods are better tolerated. Fluids are given according to the clients needs and sodium restrictions may be prescribed especially for clients with manifestations of heart failure. Cholesterol restrictions may be prescribed as well clients are not prescribed diets of liquids only or restricted to NPO unless their condition is very unstable)

Which is the most appropriate diet for a client during the acute phase of myocardial infarction? 1. liquids as desired 2 small easily digested meals 3. three regular meals a day 4. NPO

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

While caring for a client who has sustained a MI, the nurse notes eight premature ventricular contractions (PVC's) in 1 minute on the cardiac monitor. The client is receiving an IV infusion of 5% dextrose in water (D5W) at 125 mL/h and oxygen at 2L/min. The nurse should first: 1. increase the IV infusion to 150 mL/h 2 notify the HCP 3. increase the oxygen concentration to 4L/min 4. administer prescribed analgesic