Cardiac Meg Surg
Greatest risk for coronary artery disease
65-year old obese woman with an LDL of 188
Patient post-op 3 vessel CABG with high cholesterol asks how to lower their cholesterol. The nurse should advise the client:
A dietician can talk to the client about modifying their diet
A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports nausea, diaphoresis, and shortness of breath. What is the nurse's priority action?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
What is an advanced directive?
Allows decisions of heath care to be carried out when individual is unable to speak for themself
A client admitted with a massive myocardial infarction rapidly develops cardiogenic shock. Ideally, the physician would use the intra-aortic balloon pump (IABP) to support the injured myocardium. However, this client has a history of unstable angina pectoris, aortic insufficiency, hypertension, and diabetes mellitus. Which condition is a contraindication for IABP use?
Aortic insufficiency
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). Their blood pressure is 104/68 mm Hg. Their pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?
Contact the physician and report the findings - client is developing a hematoma at the puncture site
A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention?
Control the pain and support breathing and oxygenation.
The nurse observes that an older female has small to moderate, distended and tortuous veins running along the inner aspect of her lower legs. The nurse should:
Encourage client to avoid standing in one position for long periods of time
Which indicates hypovolemic shock in a client who has had a 15% blood loss?
Systolic BP < 90 mm Hg
A nurse administers the first dose of nadolol to a client with a blood pressure of 180/96. During an assessment 4 hours later, which information indicates that the client needs immediate intervention?
The client has wheezing throughout the lung fields
The nurse is evaluating the therapeutic goal of a client with history of cardiac dysrhythmias and newly completed radio frequency catheter ablation. Which client-centered goal is most appropriate?
The nurse is evaluating the therapeutic goal of a client with history of cardiac dysrhythmias and newly completed radio frequency catheter ablation. Which client-centered goal is most appropriate?
The nurse is monitoring a client with a pacemaker. Which finding shows that the client's pacemaker is functioning correctly?
The nurse observed a spike on the electrocardiogram (EKG) with pacing initiated.
The nurse connects a client to the electrocardiogram (EKG) monitor. The nurse would plan the need for transcutaneous pacing with observation of which heart rhythm?
Third degree AV block
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as
Third heart sound (S3)
The primary goal for the client with Buerger's disease is to prevent:
Thrombus formation
The nurse is caring for a client post myocardial infarction (MI). Orders include strict bed rest and a clear, liquid diet. What is the nurse's best response to the client who is inquiring about the purpose of the new diet?
To reduce the metabolic workload of digestion
What is the greatest risk for Buerger's disease?
Tobacco use
The nurse is developing a discharge plan for a client who has had a myocardial infarction and been in the cardiac care unit for 2 days. The client will be transferred to a telemetry unit tomorrow. When can the client begin cardiac rehabilitation?
Today with a gradual increase in daily activities
The client is admitted in septic shock. Which assessment data warrants immediate intervention by the nurse?
Urinary output of 50ml in the past 3 hours
A client is receiving digoxin, and the pulse range is normally 70 to 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should do what first?
Withhold the digoxin
A client with homonymous hemianopsia following an acute stroke may do what while eating?
Eat food on only half of the plate
The nurse should give which discharge instructions about thermal injury to a client with peripheral vascular disease? Select all that apply.
"Avoid sunburn during the summer." "Wear extra socks in the winter." "Choose loose, soft, cotton socks."
Client that may need a reduced dose of dig
Client with CKD
A client is scheduled to undergo right axillary-to-axillary artery bypass surgery. Immediately following surgery, what should the nurse do as a priority to prevent infection?
Avoid using the arm for an venipuncture
Patient teaching for client with implantable cardioverter device
"I'll keep a log of each time my ICD discharges."
What order should the nurse assess post femoral popliteal bypass surgery?
1. Peripheral pulses 2. Incision site 3. Urine output 4. Post-op pain
What client in the ER should the nurse assess first? A. Blood pressure of 170/95 B. Client c/o ripping sensation in the chest C. Client with urine output of 240ml/24 hr D. Client with blood in the stool who is taking Coumadin
B. Client c/o ripping sensation in the chest Indicative of ruptured thoracic aneurysm
What position will relieve pain that is associated with acute pericarditis?
Leaning forward while sitting
A client with peripheral vascular disease has poor circulation. The nurse should assess the client for changes in:
Skin temperature Pain in extremity Nail bed color
How can a client with arterial occlusive disease promote vasodilation of the effected extremity?
Stop smoking
Which symptom, identified by the client, is the most common and consistent with that of a heart attack (myocardial infarction)?
Substernal pain
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction?
"Client walks 4 miles in 1 hour every day" This is an excessive amount of exercise 4 weeks post-MI. The client should aim for 2 miles in less than 1 hour.
A client is receiving cilostazol for peripheral artery disease causing intermittent claudication. Which statement by the client indicates to the nurse that this medication is effective?
"I am able to walk further without leg pain"
A client is being given discharge instructions by the nurse after a permanent pacemaker insertion. Which client statement would indicate the teaching has been effective?
"I may set off the security alarm at the airport."
Which client statement most strongly suggests angina pectoris?
"The pain occurred while I was mowing the lawn." Decreased oxygen supply to the myocardium causes angina pectoris; lawn mowing increases cardiac workload
The recipient of a donated organ asks the nurse, "What did the donor die from?" Which response by the nurse is most appropriate?
"The transplant coordinator can give you information about the donor's medical history."
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in their left chest. The client tells the nurse how excited they are because the client's planning to go rifle hunting with a grandson. How should the nurse respond?
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
A number of clients have come to the emergency department after a possible terrorist act involving arsenic overexposure. The nurse should assess these clients for which signs or symptoms immediately following the poisoning? Select all that apply.
Abdominal pain Violent vomiting Severe diarrhea
A client has blood loss following an automobile accident. The blood pressure on admission to the emergency department is 80/40 mm Hg. What is the primary goal for the care of the client at this time?
Achieve adequate tissue perfusion
A client is hospitalized following a report of dizziness, shortness of breath, and chest pain. Based on the ECG rhythm, the client is scheduled for a transesophageal echocardiogram (TEE) today. Which nursing intervention would be appropriate at this time?
Administer O2 via NC as prescribed
Which is an expected outcome for a client on the second day of hospitalization after a myocardial infarction (MI)?
Client can perform self-care activities without pain
A client in the emergency department reported vomiting and diarrhea for the previous 24 hours. The client's blood pressure is 90/60 mm Hg, respiration is 20 breaths per minute, heart rate is 92 beats per minute, and temperature is 37.5° C (99.5° F). Which intervention will the nurse perform first?
Assess for dehydration
A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m. (0700), before the morning meal. The client had an INR reading of 4.The nurse's first priority should be to
Assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. Normal INR for client on warfarin is 2-3.5
A client is admitted to the hospital with a diagnosis of suspected pulmonary embolism. Prescriptions include oxygen 2 to 4 L/min per nasal cannula, oximetry at all times, and IV administration of 5% dextrose in water at 100 mL/h. The client has increasing dyspnea and has a respiratory rate of 32 breaths/minute. The oxygen flow rate is set at 2 L/min. What should the nurse do first?
Increase O2 from 2 to 4L/min
A client with migraine headaches and a history of angina asks the nurse why the health care provider does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that:
Sumatriptan is contraindicated in clients with angina
Which complication does a third heart sound (S3) indicate?
Ventricular dilation
Signs of dig toxicity
Visual disturbances Fatigue, weakness, delirium ECG changes, N/V
The nurse is preparing the client newly diagnosed with peripheral arterial disease for discharge with the medication atorvastatin. What laboratory work should the nurse obtain to establish a baseline before starting the medication?
creatinine and LFTs
A fourth heart sound (S4) indicates a
failure of the ventricle to eject all blood during systole
Which lab results requires the nurse to take action? A. INR 1.6 B. creatine kinase 90 C. troponin 2.1 D. myoglobin 90
troponin 2.1 is elevated and indicates the cardiac muscle has been damaged
An older adult with a history of heart failure is admitted to the emergency department with pulmonary edema. During admission, what should the nurse assess first?
Blood pressure
A client is scheduled for an arteriogram. The nurse should explain to the client that the arteriogram will confirm the diagnosis of occlusive arterial disease by:
Showing the location of the obstruction and the collateral circulation
A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking?
Carvediolol
The client has had hypertension for 20 years. The nurse should assess the client for?
Renal insufficiency and failure
A client is participating in a cardiac research study in which the client's physician is directly involved. Which statement indicates a need for additional teaching about the client's rights as a research study participant?
"I'll have to find a new physician if I don't complete this study."
A client weighs 300 lb (136 kg) and has a history of deep vein thrombosis and thrombophlebitis. When coaching a client about behaviors to maintain health, the nurse determines that the client has understood the nurse's instructions when the client makes which statement?
"I'll try to lose weight by following a reduced-calorie, balanced diet."
A client is started on digoxin. The health care provider (HCP) prescribes IV push doses of 0.5 mg now, 0.25 mg in 8 hr., and another 0.25 mg in another 8 hr. The client has a 1,000 mL bag of normal saline infusing at 25 mL/hr. What action should the nurse perform?
Administer each dose of medication over 5 minutes via IV push
A client with a history of cardiac problems reports severe chest pain. What should be the nurse's first response?
Assess the client's pain
The nurse is evaluating arterial wave formation from an arterial line and notes a slow upstroke. What is the best action by the nurse?
Auscultate heart sounds - upstroke indicates aortic stenosis
Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension who has been initially treated with furosemide and ramipril. The nurse should evaluate the client for which expected therapeutic effect?
Decrease in heart rate
A client receiving a continuous infusion of lidocaine for ventricular dysrhythmias states "I am so tired. Even my vision is blurry." What is the nurse's best action?
Decrease the lidocaine infusion rate
The nurse is planning care for a client who has just returned to the medical-surgical unit following repair of an aortic aneurysm. What is a priority assessment for this client?
Decreased urinary output
Teaching for nitroglycerin ointment
Do not rub or massage the ointment into the skin Use applicator paper to measure amount Rotate application sites to avoid skin irritation Remove any remaining ointment with a tissue before applying new
What pulse site would a nurse check post-femoral bypass surgery?
Dorsalis pedis - strong pulse indicates there is circulation to the extremity distal to the surgery
A client with heart failure has assessment findings of jugular vein distention (JVD) when lying flat in bed. What is the best nursing intervention?
Elevate HOB 30-45 degrees and reassess JVD
The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation and the client becomes unresponsive. The nurse should anticipate which intervention?
Immediate defibrillation
Dobutamine major clinical use
Increase cardiac output
A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? A. sodium of 152 B. potassium of 3.1 C. magnesium of 2.5 D. calcium of 11.2
Potassium of 3.1 Hypokalemia predisposes a client to dig toxicity
A client has severe arterial occlusive disease and gangrene of the left great toe. Which finding is expected?
Loss of hair on the lower leg
A client is talking with the nurse about unsightly varicose veins and their discomfort. What information should the nurse provide to the client?
Keep the legs elevated when sitting or lying down
The correct landmark for obtaining an apical pulse is the
L-fifth intercostal space, mid-clavicular line
The nurse is admitting a client who takes digoxin daily, reported seeing green halos around the lights, and has not wanted to eat breakfast. The laboratory report shows that serum sodium = 135 mEq/L, potassium = 3.2 mEq/L, magnesium = 2.5 mg/dL, and calcium = 10.2 mg/dL. Which nursing action is appropriate?
Administer a potassium supplement
What nutritional modifications should a client with HTN make?
Limit salt intake to 2 grams per day
What clinical manifestation would indicate complete arterial obstruction in the left lower leg in a client with peripheral artery disease?
Coldness of the left foot and ankle
Characteristic of atrial fibrillation
Irregular rhythm with pulse rate > 100 BPM
An older adult is admitted to the telemetry unit for placement of a permanent pacemaker because of sinus bradycardia. What is a priority goal for the client within 24 hours after insertion of a permanent pacemaker?
Maintain cardiac conduction stability
What adverse effect of HCTZ should the client report to the health care provider?
Muscle weakness - may indicate hypokalemia which can occur with thiazide diuretics
Creatine kinase MB (CK-MB) increases as a result of
Myocardial necrosis
A client has a coxsackie B (viral) or trypanosomal (parasite) infection. The nurse should further assess the client for which health problem?
Myocarditis
When a client has a troponin level of 0.9 ng/mL, which nursing intervention should be implemented?
Notify the HCP
A client admitted to the telemetry unit with newly diagnosed atrial fibrillation has been started on warfarin. What should the nurse instruct the client to do when taking this medication? Select all that apply.
Avoid injury to prevent bruising. Be careful using a razor or fingernail clippers. Report any change in color of urine or stool.
A client is returning from the operating room after inguinal hernia repair. The nurse notes that the client has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?
Bibasilar crackles
Which client has a need for prophylactic antibiotic therapy prior to dental manipulations?
Client who had an aortic valve replacement 5 years ago - major risk factor for infective endocarditis
What female client is at risk for varicose veins?
Client with thrombophlebitis
The nurse is assessing a client who has a long history of uncontrolled hypertension. The nurse should assess the client for damage in which area of the eye?
Retina
The nurse is reviewing the electrocardiogram of a client who has elevated ST segments visible in leads II, III, and aVf. Which choice is the nurse's best action?
Notify the HCP - indicates client is experiencing an MI
While receiving a heparin infusion to treat deep vein thrombosis, a client reports that their gums bleed when they brush their teeth. What should the nurse do first?
Notify the physician
Before discharge from the hospital after a myocardial infarction, the nurse teaches the client to exercise by gradually increasing the distance walked. What should the nurse teach the client to do to determine whether to increase or decrease the exercise level?
Obtain HR for 1 minute at the end of the walk
A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to:
Weigh daily
What is the most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program?
Walking decreases venous congestion
Nurse would assess the client with right-sided heart failure for what?
Dependent edema (bilateral edema of feet and ankles) Splenomegaly Hepatomegaly Neck vein distention
What the priority nursing assessment in the first 24 hours after admission for a thrombotic stroke?
Pupil size and pupillary response - indicates changes in the cranial nerves
A client with deep vein thrombosis has been receiving warfarin for 2 months. The client is to go to an anticoagulant monitoring laboratory every 3 weeks. The last visit to the laboratory was 2 weeks ago. The client reports bleeding gums, increased bruising, and dark stools. What should the nurse should instruct the client to do?
Return to lab to have PT drawn
A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?
Rheumatic fever
An obese diabetic client has bilateral leg aching is to start a cardiac rehabilitation with an exercise program. Using which exercise equipment will be most helpful to the client?
Stationary bicycle
