Cardiac - Nursing 201
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? A. Amiloride B. Clonidine C. Bumetanide D. Methyldopa
B. Clonidine Rationale: Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.
The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? A. "I'm having trouble going up the steps during the day." B. "I eat six small meals a day when I am hungry." C. "My best time of the day is the morning." D. "I've stopped eating foods with salt, though I miss the taste."
A. "I'm having trouble going up the steps during the day." Rationale: Difficulty with activities like climbing stairs is an indication of a lessened ability to exercise. Eating small meals and not using salt are usually indicated for clients with heart failure. The client's assertion about morning being the best time of day is a vague statement.
Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? A. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." B. "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." C. "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." D. "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."
A. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Rationale: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.
The nurse is teaching a client about recommended follow-up for a person initially diagnosed with prehypertension. What time frame will the nurse advise the client to have the blood pressure (BP) rechecked? A. 1 year B. Confirm within 2 months C. 2 years D. Evaluate within 1 month
A. 1 year Rationale: A client with an initial BP in the prehypertension range should have another BP check in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month.
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? A. 4 or 5 servings per day B 2 or 3 servings per day C. 7 or 8 servings per day D. 2 or fewer servings per day
A. 4 or 5 servings per day Rationale: The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
While performing blood pressure screenings at a health fair, the nurse counsels which of the following visitors as having the greatest risk for developing hypertension? A. 56 year old man whose father died at 62 from a stroke B. 30 year old female advertising agent who is unmarried and lives alone C. 68 year old man who uses herbal remedies to treat his enlarged prostate gland D. 43 year old man who travels extensively with his job and exercises only on weekends
A. 56 year old man whose father died at 62 from a stroke
The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure? A. Brain natriuretic peptide (BNP) B. Blood urea nitrogen (BUN) C. Creatinine D. Complete blood count (CBC)
A. Brain natriuretic peptide (BNP) Rationale: BNP is the key diagnostic indicator of heart failure. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of heart failure. A BUN, creatinine, and CBC are included in the initial workup.
A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? A. Check the client's potassium level. B. Calculate the client's intake and output. C. Notify the health care provider. D. Administer potassium.
A. Check the client's potassium level Rationale: The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the health care provider. Because the client is taking furosemide, a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the health care provider with a more complete database. The health care provider will need to be notified after the nurse checks the latest potassium level. The intake and output will not change the heart rhythm. Administering potassium requires a health care provider's order.
Which medication reverses digitalis toxicity? A. Digoxin immune FAB B. Ibuprofen C. Warfarin D. Amlodipine
A. Digoxin immune FAB Rationale: Digoxin immune FAB binds with digoxin and makes it unavailable for use. The dosage is based on the digoxin concentration and the client's weight. Ibuprofen, warfarin, and amlodipine are not used to reverse the effects of digoxin.
A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? A. Elevated ST segment B. Prolonged PR interval C. Widened QRS complex D. Absent Q wave
A. Elevated ST Segment Rationale: Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.
When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia
A. Hyperkalemia Rational: Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion, without a change in T wave formation.
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. Elevated serum lipids and diabetes mellitus C. Physical inactivity and elevated homocysteine levels D. Obesity and smokeless tobacco use
A. Hypertension and cigarette smoking
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? A. IV nitroglycerin B. Amlodipine C. Atenolol D. IV morphine
A. IV morphine Rationale: IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. B. Instruct the client not to crush the tablet. C. Instruct the client to renew the nitroglycerin supply every 3 months. D. Instruct the client to place nitroglycerin tablets in a plastic pill box.
A. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Rationale: The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.
The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) A. It is viselike and radiates to the shoulders and arms. B. It is relieved by rest and inactivity. C. It subsides after taking nitroglycerin. D. It is sudden in onset and prolonged in duration. E. It is substernal in location.
A. It is viselike and radiates to the shoulders and arms. D. It is sudden in onset and prolonged in duration. E. It is substernal in location. Rationale: Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? A. Postural hypotension resulting injury B. Rebound hypertension C. Sexual Dysfunction D. Postural hypertension and resulting injury
A. Postural hypotension and resulting injury Rationale: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.
What disease process(es) contributes to chronic heart failure? Select all that apply A. Tachyarrhythmias B. Valvular disease C. Renal Failure D. Pulmonary insufficiency E. Pancreatic Disease
A. Tachyarrhythmias B. Valvular disease C. Renal Failure Rationale: Tachyarrhythmias, Valvular disease , Renal failure, Hypertension, cardiomyopathy contribute to chronic heart failure
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A. The abrupt stop can cause a myocardial infarction. B. The abrupt stop can trigger a migraine headache. C. The abrupt stop will precipitate internal bleeding. D. The abrupt stop can lead to formation of blood clots.
A. The abrupt stop can cause a myocardial infarction Rationale: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A. The abrupt stop can cause a myocardial infarction. B. The abrupt stop will precipitate internal bleeding. C. The abrupt stop can trigger a migraine headache. D. The abrupt stop can lead to formation of blood clots.
A. The abrupt stop can cause a myocardial infarction Rationale: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.
A nurse is teaching a client about heart failure. What will the nurse explain is causing the heart to fail? A. The heart cannot pump sufficient blood to meet the body's metabolic needs. B. The heart is pumping too fast to adequately meet the body's metabolic needs. C. The heart is fribrillating D. The heart is pumping too slow to disseminate nutrients to the body.
A. The heart cannot pump sufficient blood to meet the body's metabolic needs. Rationale: Heart failure is the inability of the heart to pump sufficient blood to meet the body's metabolic needs. Heart failure does not mean the heart pumps too fast or to slow; it means it cannot contract effectively to eject the blood in the ventricles. A fibrillating heart involves a problem with conduction, not failure.
The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? A. The kidney excretes sodium and water. B. The kidney retains water and excretes sodium C. The kidney retains sodium and water. D. The kidney retains sodium and excretes water.
A. The kidney excretes sodium and water. Rationale: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together
The nurse is performing an assessment for an older adult client with reports of chest pain. What assessment finding correlates with a potential age-related change? A. The presence of an S4 sound B. A progressive decrease in systolic blood pressure C. A shortened pulse pressure D. A heart rate of 92 beats/minute
A. The presence of an S4 sound Rationale: With age, the heart rate will decrease, and heart block can occur with changes in the conduction system. Auscultation may reveal the presence of an S4 sound. Pulse pressure will widen, and the systolic pressure will increase because of stiffening of the blood vessels. The heart rate should decrease.
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? A. Ventricular Fibrillation B. Ventricular Tachycardia C. Atrial fibrillation D. Third-degree heart block
A. Ventricular Fibrillation Rationale: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations.
A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing A. decompensated heart failure with pulmonary edema. B. tuberculosis. C. acute exacerbation of chronic obstructive pulmonary disease. D. bilateral pneumonia.
A. decompensated heart failure with pulmonary edema. Rationale: The production of large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), indicates acute decompensated heart failure with pulmonary edema. These signs can be confused with those of pneumonia and tuberculosis. However, auscultation reveals coarse crackles, which indicate pulmonary edema. A patient with acute COPD would have diminished lung sounds bilaterally.
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures A. differ no more than 5 mm Hg between arms. B. may vary 10 mm Hg or more between arms. C. may vary, with the higher pressure found in the left arm. D. must be equal in both arms.
A. differ no more than 5 mm Hg between arms Rationale: Normally, in the absence of disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.
The nurse is teaching a client about medications prescribed for severe volume overload from heart failure. What diuretic is the first-line treatment for clients diagnosed with heart failure? A. furosemide B. spironolactone C. metolazone D. mannitol
A. furosemide Rationale: Loop diuretics such as furosemide, bumetanide, and torsemide are the preferred first-line diuretics because of their efficacy in patients with and without renal impairment. Spironolactone is a potassium diuretic. Mannitol is an osmotic diuretic not used for heart failure. Metolazone is a potassium diuretic not used for first treatment for heart failure. Diuretics should never be used alone to treat HF because they don't prevent further myocardial damage.
A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of A. pulmonary embolism. B. pneumonia C. pulmonary edema. D. myocardial infarction
A. pulmonary embolism Rationale: Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? A. 40% B. 25% C. 35% D. 45%
B. 25% Rationale: The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.
Approximately what percentage of adults in the United States have hypertension? A. 20 B. 30 C. 40 D. 50
B. 30% Rationale: About 32.6% of the adults in the United States have hypertension.
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 have some type of fish at least three times a week" B. "Most of my fat intake should be from olive oil or the oils in nuts" C. "If I reduce the fat in my diet to about 5% of my calories, I will be much healthier" D. "I should not eat any red meat such as beef, pork, or lamb"
B. B. "Most of my fat intake should be from olive oil or the oils in nuts"
The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? A. By measuring the client's abdominal girth B. By questioning how many pillows the client normally uses for sleep C. By observing the client's diet during the day D. By collecting the client's urine output
B. By questioning how many pillows the client normally uses for sleep Rationale: The nurse should ask the client about nocturnal dyspnea by questioning how many pillows the client normally uses for sleep. This is because being awakened by breathlessness may prompt the client to use several pillows in bed. Collecting the client's urine output, observing the client's diet, or measuring the client's abdominal girth does not help assess for nocturnal dyspnea.
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A. Diltiazem B. Clopidogrel C. Metoprolol D. Isosorbide mononitrate
B. Clopidogrel Rationale: Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.
A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? A. Increase in CVP B. Decrease in central venous pressure (CVP) C. Absence of cough D. Decrease in blood pressure
B. Decrease in central venous pressure (CVP) Rationale: A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.
A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient? A. Clopidogrel B. Digoxin C. Heparin D. Enoxaparin
B. Digoxin Rationale: Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.
A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) A. Jugular vein distention B. Dyspnea C. Ascites D. Pulmonary crackles E. Cough
B. Dyspnea D. Pulmonary crackles E. Cough Rationale: The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: A. low LDL level B. High LDL level C. Fasting LDL level D. Normal LDL level
B. High LDL level Rationale: LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? A. Hyponatremia B. Hyperkalemia C. Hypernatremia D. Hypokalemia
B. Hyperkalemia Rationale: Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.
The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition? A. Inclination to ventricular fibrillation B. Impaired myocardial contractility C. Increased risk of heart block D. Enhanced sensitivity to digitalis
B. Impaired myocardial contractility Rationale: Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? A. Administer 1 mg of IV atropine B. Initiate transcutaneous pacing C. Obtain a 12-lead ECG D. Prepare for defibrillation
B. Initiate transcutaneous pacing Rationale: The client is experiencing a third-degree heart block. Transcutaneous pacing should be implemented first. A permanent pacemaker may be indicated if the block continues. Defibrillation is not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not completed first.
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for receiving oxygenated blood from the lungs? A. Right atrium B. Left atrium C. Right ventricle D. Left Ventricle
B. Left Atrium Rationale: The left atrium receives oxygenated blood from the lungs. The left ventricle pumps that blood to all the cells and tissues of the body. The right atrium receives deoxygenated blood from the venous system. The right ventricle pumps that blood to the lungs to be oxygenated.
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? A. Keep the client flat for one hour after administration B. Monitor vital signs and cardiac rhythm C. Document heart rate before and after administration D. Administer every five minutes during cardiac resuscitation
B. Monitor vital signs and cardiac rhythm Rationale: The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.
A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? A. Calcium level B. Potassium level C. Sodium level D. Magnesium level
B. Potassium level Rationale: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker.
The most significant factor in the positive outcome 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. Rapid institution of emergency services and procedures
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication? A. Urine output of 90 mL 1 hour after medication administration B. Serum potassium value of 3.0 mEq/L C. Blood glucose value of 160 mg/dL D. Electrocardiogram (EGG) tracing demonstrating peaked T waves
B. Serum potassium value of 3.0 mEq/L Rationale: Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect post administration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? A. The registered nurse stating to administer all medications except those which are cardiotonics B. The registered nurse administering atropine sulfate intravenously C. The registered nurse stating to administer digoxin D. The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute
B. The registered nurse administering atropine sulfate intravenously Rationale: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.
The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? A. creatine kinase B. troponin C. lactate dehydrogenase D. myoglobin
B. Troponin Rationale: This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of muscle injury, but the studies are less specific indicators of myocardial damage than troponin.
The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents? A. oral B. continuous IV infusion C. sublingual D. intramuscular
B. continuous IV infusion Rationale: The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.
A client has a blockage in the proximal portion of a coronary artery and decides to undergo percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse expect to administer during the procedure? A. ceftriaxone B. ticagrelor C. metoprolol D. hydrochlorothiazide
B. tricagrelor Rationale: During PTCA, the client receives heparin, an anticoagulant (ticagrelor), as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses do not routinely give antibiotics such as ceftriaxone during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive like metoprolol and a diuretic like hydrochlorothiazide may cause hypotension, which should be avoided during the procedure.
During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? A. stridor B. wheezes with wet lung sounds C. high-pitched sounds D. laborious breathing
B. wheezes with wet lung sounds Rationale: If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client? A. "Both terms refer to the same disorder and can be used interchangeably." B. "Both are disorders in which the lining of the vessels become narrowed due to plaque." C. "Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque." D. "Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining."
C. "Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque." Rationale: Arteriosclerosis refers to the loss of elasticity or hardening of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the lumen of arteries fills with fatty deposits called plaque. The two terms do not refer to the same disorder, nor can they be used interchangeably. The other responses provide the client with inaccurate information.
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? A. "I don't have the same appetite I used to." B. "My pants don't fit around my waist." C. "I sleep on three pillows each night." D. "My feet are bigger than normal."
C. "I sleep on three pillows each night." Rationale: Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? A. "Place the nitroglycerin tablet between cheek and gum." B. "Only take one nitroglycerin tablet for each episode of angina." C. "See if rest relieves the chest pain before using the nitroglycerin." D. "Call 911 if you develop a headache following nitroglycerin use."
C. "See if rest relieves the chest pain before using the nitroglycerin" Rationale: Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? A. Review the client's medication record. B. Prepare to client for cardioversion. C. Administer an IV bolus of atropine. D. Send the client to the cardiac catheterization laboratory.
C. Administer an IV bolus of atropine. Rationale : Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Cardioversion is used to treat a fast heart rate. Reviewing the medication record will not help the client initially.
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? A. Administer oxygen, attach a cardiac monitor, and notify the health care provider. B. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. C. Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team. D. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.
C. Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team. Rationale: Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? A. Atrial fibrillation B. Ventricular Tachycardia C. Atrial Flutter D. Ventricular fibrillation
C. Atrial Flutter Rationale: Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A. nitrate B. diuretic C. calcium-channel blocker D. beta-adrenergic blocker
C. Calcium-channel blocker Rationale: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium-channel blocker.
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A. Furosemide B. Digoxin C. Carvedilol D. Nitroprusside
C. Carvedilol Rationale: A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient? A. Heparin B. Clopidogrel C. Digoxin D. Enoxaparin
C. Digoxin Rationale: Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.
A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? A. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. B. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction C. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. D. The pericardial space is eliminated with scar tissue and thickened pericardium.
C. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. Rationale: The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD), and distant (muffled) heart sounds. Increased pericardial pressure, reduced venous return to the heart, and decreased carbon dioxide result in cardiac tamponade (e.g., compression of the heart).
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? A. Digoxin B. hypothyroidism C. hypovolemia D. vagal stimulation
C. Hypovolemia Rationale: The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, hypothyroidism, and digoxin will cause a sinus bradycardia.
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body? A. left atrium B. right atrium C. left ventricle D. right ventricle
C. Left ventricle Rationale: The left ventricle pumps blood to all the cells and tissues of the body. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs to be oxygenated. The right atrium receives deoxygenated blood from the venous system.
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? A. Ativan 1 mg orally B. Serum electrolytes C. Nitroglycerin SL D. Chest x-ray
C. Nitroglycerin SL Rationale: Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired, and the nurse should anticipate administering nitroglycerin to assess whether the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the client's chest pain.
The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as A. Normal B. Elevated C. Stage 1 hypertension D. Stage 2 hypertension
C. Stage 1 hypertension Rationale: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association indicate that Systolic blood pressure of 135 mm Hg is classified as stage 1 hypertension. The guidelines are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.
Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit? A. The client is experiencing heart failure. B. The client is in the early stage of right-sided heart failure. C. The client is going into cardiogenic shock. D. The client shows signs of aneurysm rupture.
C. The client is going into cardiogenic shock Rationale: This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? A. The patient has an ejection fraction of 65%. B. The patient has had angina longer than 3 years. C. The patient has at least a 70% occlusion of a major coronary artery. D. The patient has compromised left ventricular function.
C. The patient has at least a 70% occlusion of a major coronary artery Rationale: For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first? A. Beta-blocker B. ACE inhibitors C. Thiazide diuretic D. Calcium channel blocker
C. Thiazide diuretic Rationale: Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation at his office. When reviewing the health care provider's admission orders, which of the following orders is it most important for the nurse to question? A. Oxygen at 4L/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/minute and increase at 5 mcg/minute every 3-5 minutes
C. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours
The nurse is assisting in the care of a client who is receiving cardiopulmonary resuscitation (CPR). For which reason will the client be prescribed to receive amiodarone during the resuscitation efforts? A. Prevent the development of hypotension. B. Reduce the development of torsade de pointes. C. Treat pulseless ventricular tachycardia. D. Correct metabolic acidosis.
C. Treat pulseless ventricular tachycardia Rationale: During CPR, the medications provided will depend upon the client's condition and response to therapy. Amiodarone is used to treat pulseless ventricular tachycardia. Sodium bicarbonate is used to correct metabolic acidosis. Norepinephrine and dopamine are used to prevent the development of hypotension. Magnesium sulfate is used for the client with torsade de pointes.
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? A. Atrial fibrillation B. Ventricular tachycardia C. Ventricular fibrillation D. Third-Degree Heart Block
C. Ventricular Fibrillation Rationale: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations
The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? A. lactate dehydrogenase B. myoglobin C. troponin D. creatine kinase
C. troponin Rationale: This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of muscle injury, but the studies are less specific indicators of myocardial damage than troponin.
A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge? A. "The medication patch causes headaches so you should remove it daily." B. "You do not need the effects of nitroglycerine while you sleep." C. "Skin irritation is common when the patch is worn for more than 12 hours." D. "The patch should be worn for 12 hours and then removed for 12 hours."
D. "The patch should be worn for 12 hours and then removed for 12 hours." Rationale: A transdermal nitroglycerin patch is prescribed for the prevention of angina pectoris. Nitroglycerin transdermal patches are typically applied for 12 to 14 hours, and then removed for the same amount of time. Though it is true that common adverse effects of nitroglycerin are headaches and contact dermatitis and that there is less demand on the heart when the client rests, these are not the reasons for applying and removing the patch for the same length of time in a 24-hour period.
The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? A. "What is your pain level on a scale of 1 to 10?" B. "Do your parents have heart disease?" C. "How many sublingual nitroglycerin tablets did you take?" D. "What time did your chest pain start today?"
D. "What time did your chest pain start today?" Rationale: The client may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the client's chest pain lasts longer than 20 minutes and is unrelieved by nitroglycerin, if ST-segment elevation is found in at least two leads that face the same area of the heart, and if it has been less than 6 hours since the onset of pain. The most appropriate question for the nurse to ask is in relations to when the chest pain began. The other questions would not aid in determining whether the client is a candidate for thrombolytic therapy.
The nurse is assigned the following client on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? A. A new myocardial infarction client B. A client with third-degree heart block C. A client with poor kidney perfusion D. A client with atrial arrhythmias
D. A Client with atrial arrhythmias Rationale: The nurse is correct to identify a client with atrial arrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker.
The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? A. Bile acid sequestrants B. Calcium channel blocker C. Diuretic D. ACE inhibitor
D. ACE inhibitor Rationale: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics (Table 29-3). Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival (Fonarow et al., 2010). Calcium channel blockers are no longer recommended for patients with HF because they are associated with worsening failure (ICSI, 2011).
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? A. Listening to breath sounds B. End-tidal CO2 C. Pulse oximetry D. Arterial blood gases
D. Arterial blood gases Rationale: In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation.
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? A. Assess for reduced blood sodium levels. B. Assess for elevated blood potassium levels. C. Assess for reduced urine output. D. Assess for elevated blood urea nitrogen levels.
D. Assess for elevated blood urea nitrogen levels. Rationale: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Amlodipine B. Diltiazem C. Felodipine D. Clopidogrel
D. Clopidogrel Rationale: Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? A. After the procedure, the dysrhythmia will not recur. B. The procedure will occur in the operating room under general anesthesia. C. The procedure takes less time than a cardiac catheterization. D. During the procedure, the dysrhythmia will be reproduced under controlled conditions.
D. During the procedure, the dysrhythmia will be reproduced under controlled conditions. Rationale: During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia. The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia.
Which area of the heart that is located at the third intercostal space to the left of the sternum? A. aortic area B. pulmonic area C. epigastric area D. Erb point
D. Erb Point Rationale: Erb point is located at the third intercostal space to the left of the sternum. The aortic area is located at the second intercostal space to the right of the sternum. The pulmonic area is at the second intercostal space to the left of the sternum. The epigastric area is located below the xiphoid process.
The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider? A. Removing anti-embolism stockings B. Decreasing intravenous fluids C. Assessing blood glucose level D. Evaluating laboratory values
D. Evaluating laboratory values Rationale: Evaluating laboratory values such as complete blood count for anemia is an appropriate intervention because the anemia will cause tachycardia. Treating autonomic dysfunction or postural orthostatic tachycardia includes increasing intravenous fluid and applying anti-embolism stockings. Hypoglycemia is associated with bradycardia.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? A. Nausea B. Fever C. Hypotension D. Fluttering
D. Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
The nurse cares for a client in the emergency department who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse recognizes that this finding is most indicative of which condition? A. ventricular hypertrophy B. pulmonary edema C. myocardial infarction D. heart failure
D. Heart Failure Rationale: A BNP level greater than 100 pg/mL is suggestive of heart failure. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of heart failure in settings such as the emergency department. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the healthcare provider correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of heart failure.
The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? A. Pulmonary embolism B. Pericarditis C. Myocardial infarction D. Heart Failure
D. Heart Failure Rationale: An ejection fraction of less than 40% indicates that the patient has decreased left ventricular function and likely requires treatment for heart failure.
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: A. sufficient blood pressure. B. inherent electrons in muscle tissue. C. inherent rhythmicity of all muscle tissue. D. inherent rhythmicity of cardiac muscle tissue.
D. Inherent rhythmicity of cardiac muscle tissue. Rationale: Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively
Which technique is used to surgically revascularize the myocardium? A. Gastric bypass B. Balloon bypass C. Peripheral bypass D. Minimally invasive direct coronary bypass
D. Minimally invasive direct coronary bypass Rationale: Several techniques are used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the client is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.
The nurse cares for a client with clubbing of the fingers and toes. The nurse should complete which action given these findings? A. Assess the client for pitting edema. B. Obtain a 12-lead ECG tracing. C. Assess the client's capillary refill. D. Obtain an oxygen saturation level.
D. Obtain an oxygen saturation level Rationale: Clubbing of the fingers and toes indicates chronic hemoglobin desaturation (decreased oxygen supply) and is associated with congenital heart disease. The nurse should assess the client's O2 saturation level and intervene as directed. The other assessments are not indicated.
You are working on a telemetry unit. Your client was admitted with a cardiac event and is now on a cardiac monitor. You know a cardiac monitor reveals the heart's electrical but not its mechanical activity. How would you assess the mechanical activity of the client's heart? A. Auscultate the carotid artery. B. Take the blood pressure in both arms C. Percuss the perimeter of the heart. D. Palpate a peripheral pulse.
D. Palpate a peripheral pulse Rationale: A cardiac monitor reveals the heart's electrical but not its mechanical activity. The healthcare provider must palpate a peripheral pulse or auscultate the apical heart rate to obtain this information. You cannot obtain information on the mechanical activity of the heart by taking the client's blood pressure, auscultating the carotid artery, or attempting to percuss the perimeter of the heart.
What is the drug of choice for a stable client with ventricular tachycardia? A. Atropine B. Lidocaine C. Amiodarone D. Procainamide
D. Procainamide Rationale: Procainamide is used for stable VT in clients who do not have acute MI or severe heart failure. Amiodarone administered IV is the medication of choice for a client with impaired cardiac function or acute MI. Atropine is used for bradycardia. Lidocaine had been commonly used for treating ventricular dysrhythmias but has no proven efficacy in cardiac arrest.
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? A. Left side of sternum, fourth intercostal space B. Mid-clavicular line, fifth intercostal space C. Midway between V2 and V4 D. Right side of sternum, fourth intercostal space
D. Right side of sternum, fourth intercostal space Rationale: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space.
Which dysrhythmia is common in older clients? A. Sinus tachycardia B. Ventricular tachycardia C. Sinus arrhythmia D. Sinus bradycardia
D. Sinus bradycardia Rationale: Sinus bradycardia and atrial fibrillation are common dysrhythmia'a in older clients. Sinus tachycardia, sinus arrhythmmai, and ventricular tachycardia are not common dysrhythmias in older clients.
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? A. The development of cor pulmonale B. The development of chronic obstructive pulmonary disease (COPD) C. The development of right-sided heart failure D. The development of left-sided heart failure
D. The development of left-sided heart failure Rationale: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Cor pulmonale is a condition in which the heart is affected secondarily by lung damage
The nurse is preparing to administer adenosine for a patient diagnosed with atrial flutter. How should the nurse administer this medication? A. The medication is followed by a slow saline flush. B. The dose is administered slow IV push. C. The medication is followed by a rapid lactated Ringer's (LR) flush D. The dose is administered rapid IV push.
D. The dose is administered rapid IV push Rationale: The dose is administered by rapid IV push (1 to 2 seconds), followed with a rapid saline flush. LR is not used during administration of this medication.
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). How should the nurse document this sound? A. a fourth heart sound (S4). B. a first heart sound (S1). C. a murmur. D. a third heart sound (S3).
D. a third heart sounds (S3) Rationale: An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? A. lateral. B. inferior. C. posterior D. anterior
D. anterior Rationale: An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.
The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? A. decreased renal perfusion B. decreased peripheral perfusion to the extremities C. decreased right ventricular workload D. decreased left ventricular workload
D. decreased left ventricular workload Rationale: The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The therapeutic effect is decreased left ventricular workload. The IABP does not change right ventricular workload. The IABP increases perfusion to the coronary and peripheral arteries. The renal perfusion is not affected by IABP.
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? A. calcium level of 7.5 mg/dL B. sodium level of 152 mEq/L C. magnesium level of 2.5 mg/dL D. potassium level of 2.8 mEq/L
D. potassium level of 2.8 mEq/L Rationale: Conditions that may predispose a client to digoxin toxicity include: hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.
A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? A. streptokinase, aspirin, and morphine administration B. morphine administration, stress testing, and admission to the cardiac care unit C. serial liver enzyme testing, telemetry, and a lidocaine infusion D. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
D. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry Rationale: The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.
A client who is resting quietly reports chest pain to the nurse. The cardiac monitor indicates the presence of reversible ST-segment elevation. What type of angina is the client experiencing? A. intractable angina B. silent angina C. stable angina D. variant angina
D. variant angina Rationale: Variant or Prinzmetal's angina is distinguished by pain occurrence during rest. Stable angina occurs with activity. Silent angina occurs without symptoms, Intractable angina is evidenced by incapacitating pain
