cardiac practice questions

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." Explanation: This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client.

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He likes to stop and squat wherever he walks" The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance

The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client?

- Avoid handheld screening devices in airports - Check pulse daily reporting sudden slowing -wear a medical alert, noting the presence of a pacemaker Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the client should be instructed initially to restrict activity on the side of implantation. Clients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Client should walk through antitheft devices quickly and avoid standing in or near these devices. Client can safely use microwave ovens and electronic tools.

The pathophysiology of pericardial effusion is associated with:

-Increased right and left ventricular end diastolic pressures -Atrial compression -Inability of the ventricles to fill adequately Explanation Venous return is decreased (not increased) with Pericardial effusion because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart. Increased right and left ventricular end-diastolic pressures, inability of the ventricles to fill adequately, and atrial compression are all effects of pericardial effusion

Which patient does the nurse recognize as being most likely to be affected by sickle cell disease? 1.A 14-year-old African American boy 2.A 26-year-old Eastern European Jewish woman 3.An 18-year-old Chinese woman 4.A 28-year-old Israeli man

A 14 year old African American Boy The HbS gene is inherited in people of African descent and to a lesser extent in people from the Middle East, the Mediterranean area, and aboriginal tribes in India. Sickle cell anemia is the most severe form of sickle cell disease

When assessing the client with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding?

A systolic blood pressure that is lower during inhalation Explanation Systolic blood pressure that is markedly lower during inhalation is called pulsus paradoxus. The difference in systolic pressure between the point that is heard during exhalation and the point that is heard during inhalation is measured. Pulsus paradoxus exceeding 10 mm Hg is abnormal.

Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis?

Acute pain related to sickle cell crisis Explanation In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, Acute pain related to sickle cell crisis is the appropriate choice. Although nutrition is important, poor nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus.

An infant with congenital heart disease is to undergo surgery to correct the defect. The mother states, "I guess I'm going to have to stop breastfeeding her." Which response by the nurse would be most appropriate?

Breast milk may help to boost her immune system, so you can continue to use it. Breastfeeding a child before and after cardiac surgery may boost the infant's immune system, which can help fight postoperative infection. If breastfeeding is not possible, mothers can pump milk and the breast milk may be given via bottle, dropper, or gavage feeding. In addition, breastfeeding is associated with decreased energy expenditure during the act of feeding.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

Cardiac tamponade Explanation The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade (see Chapter 29).

The cardiac nurse is caring for a client who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?

Decreased ejection fraction DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in clients with DCM.

The nurse is caring for a client experiencing a rapidly developing pericardial effusion. Which assessment findings indicate to the nurse that the client is developing cardiac tamponade?

Dyspnea Tachycardia Distant heart sounds JVD Explanation Pericardial fluid may build up slowly without causing noticeable symptoms until a large amount (1 to 2 L) accumulates. However, a rapidly developing effusion can quickly stretch the pericardium to its maximum size and cause an acute problem. As pericardial fluid increases, pericardial pressure increases, reducing venous return to the heart and decreasing CO. This can result in cardiac tamponade, which causes low CO and obstructive shock. Symptoms of cardiac tamponade include dyspnea, tachycardia, distant heart rounds, and jugular vein distention.

A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis?

Echocardiography Explanation Echocardiography is useful in detecting the presence of pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.

Which of the following describes what occurs in aortic stenosis?

Emptying of blood from the left ventricle is impaired

A client with a new onset of rib and spine pain is being evaluated for multiple myeloma. For which manifestations will the nurse assess this client? Select all that apply.

Hypercalcemia Renal dysfunction Anemia Bone destructions Explanation Clinical manifestations of multiple myeloma result not only from the malignant cells themselves, but also from the abnormal protein they produce. The classic clinical manifestations of multiple myeloma are referred to as the CRAB features and include anemia, hypercalcemia, renal dysfunction, and bone destruction. Lymph enlargement is associated with lymphomas, but not with multiple myeloma.

What is the treatment of choice for ventricular fibrillation?

Immediate bystander CPR The treatment of choice for ventricular fibrillation is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services.

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?

Initiate transcutaneous pacing 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.

The nurse is analyzing the cardiac rhythm of a client with a pacemaker and notes the QRS complex is absent after pacer spike. The nurse knows that reading can be caused by which of the following factors?

Lead wire fracture A pacemaker is an electronic device that provides electrical stimuli to the heart muscle. Pacemakers are usually used when a client has a permanent or temporary slower-than-normal impulse formation, or a symptomatic AV or ventricular conduction disturbance. They may also be used to control some tachyarrhythmias that do not respond to medication. When analyzing the function of the pacemaker, a loss of capture is indicated by a QRS complex not following the pacer spike. This could be caused by lead dislodgment, lead wire fracture, catheter malposition, a depleted battery, or myocardial ischemia. A total absence of pacer spikes indicates a loss of pacing. Pacer spikes occurring at preset intervals indicates undersensing. Pacer spikes not occurring at present intervals indicates oversensing.

A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease? Select all that apply.

Lungs Central Nervous System Spleen Explanation Any organ can be the site of a thrombotic event in sickle cell disease; however, the lungs, central nervous system, and the spleen are at greatest risk due to these areas having slower circulation. The liver is often involved in sequestration in adults, and hemolysis may occur. Anemia affects the heart.

A client with type 2 diabetes and persistent atrial fibrillation is prescribed atenolol. Which actions will the nurse take when providing the medication to the client? Select all that apply.

Monitor heart rate monitor blood pressure monitor blood glucose level Explanation Beta-blockers are classified as Class II antiarrhythmic medications. This classification of medication decreases automaticity and conduction to treat atrial arrhythmias, however, it has the potential for adverse effects such as bradycardia, therefore the heart rate should be monitored. Because it can cause hypotension, the blood pressure should be assessed. The medication also affects blood glucose level. Since the client has type 2 diabetes, the blood glucose level should be monitored. This medication does not affect liver or renal function.

If the arteries become plugged with thrombi (clots of fibrin, platelets, and cholesterol), what can happen to the body's tissues?

Oxygen is prohibited from reaching the tissues, which may result in death

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic?

Place him in a knee-chest position Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant's health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although it is becoming a controversial practice, antibiotic therapy such as oral amoxicillin may be prescribed before oral surgery.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position. Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

The nurse in an intensive care unit is caring for a client who requires blood work to assess for changes in blood coagulation due to heparin therapy. Which test should the nurse expect to see prescribed for this value to be assessed?

Prothrombin time (PTT)

Each normal heartbeat is initiated by which of the following?

SA node

The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first?

Stay with the patient, use a calm voice, and ask for assistance via call light Universal Misconception Explanation The nurse stays with the patient and continues to assess and record signs and symptoms while intervening to decrease patient anxiety. The pulse pressure is narrowing, and the patient is experiencing neck vein distention, indicative of rising central venous pressure. After reaching assistance via the call light from the patient's beside, the nurse notifies the physician immediately and prepares to assist with diagnostic echocardiography and pericardiocentesis. A left lateral recumbent position is used when administering enemas. Morphine would be given to someone who may be experiencing a myocardial infarction, not cardiac tamponade.

What disease processes contribute to chronic heart failure?

Tachyarrhythmias Valvular disease Renal failure

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?

This is caused by an opening that usually closes by 1 week of age A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first?

Use a calm, comforting approach and place the child in knee-to-chest position Explanation: Tetralogy of Fallot is a cyanotic heart defect. Hypercyanosis can develop suddenly. The symptoms are increased cyanosis, hypoxemia, dyspnea, and agitation. The nurse should use a calm, comforting approach with the child and place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. This position increases pulmonary blood flow by increasing systemic vascular resistance. The additional interventions for a hypercyanotic spell are to administer oxygen and give morphine, IV fluids, and propranolol. A child will not understand to calm down and cannot be expected to listen during a temper tantrum. Assessing the child's heart rate and respirations are not priority. Perfusion is priority for this client at this time.

A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?

Warfarin prevents clot formation in the atria of clients with atrial fibrillation Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. Warfarin is ordered in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically ordered to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.

what is a common sign of chronic bleeding that patients need to notice?

bleeding from the gums when brushing teeth

What is the function of the coronary arteries?

bring oxygenated blood to the myocardium

The nurse examines a patient for decreased circulation in the lower extremities. Which of the following would indicate adequate circulation?

capillary refill <3 seconds

what is the most common reason for blood beginning to clot?

damage to the blood vessels or tissues

What best describes the action of propranolol?

decreases cardiac output decreases HR, contractility, O2 demand and BP

What types of plant based food should patients consume at a constant level if they are on warfarin?

leafy greens and cauliflower

Which chamber of the heart is largest and has the thickest myocardium?

left ventricle

What causes fatigue in patients with chronic aortic stenosis

left ventricular failure

A nurse is caring for a client who is on a continuous cardiac monitor. When evaluating the client's rhythm strip, the nurse notes that the QRS interval has increased from 0.08 second to 0.14 second. Based on this finding, the nurse should withhold continued administration of which drug?

metoprolol Explanation Procainamide may cause an increased QRS complexes and QT intervals. If the QRS duration increases by more than 50%, then the nurse should withhold the drug and notify the physician of her finding. Metoprolol may cause increased PR interval and bradycardia. Propafenone and verapamil may cause bradycardia and atrioventricular blocks.

What occurs in mitral regurgitation?

mitral regurgitation is backflow of blood into the left atrium

How is heart failure managed in order to reduce associated symptoms?

patients are given a variety of cardiovascular drugs

Which of the following separates the right and left sides of the heart?

septum

Your elderly patient is taking a diuretic. What side effects do you need to watch for other than dehydration?

signs of low potassium

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?

"He gets sweaty when he eats" Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding.

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse?

Correct response: "Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." Explanation: To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand.

A mother asks the nurse if the reason the infant has a congenital heart defect is because of something she did while pregnant. What is the best response by the nurse?

Correct response: There are several reasons an infant can have a heart defect; let's talk about those causes. Explanation: Parents who have a newborn who has a defect are always concerned they did something wrong to cause the defect. They carry a large amount of guilt. The nurse should focus on the therapeutic communication in this situation, while still obtaining more information. A nurse should never blame the parent because it is not only nontherapeutic, but there are many reasons why congenital heart defects occur. The reason for the infant's heart defect may not be known. Using therapeutic communication will reduce the parent's anxiety and guilt. Congenital heart defects can be caused by genetic defects such as chromosomal anomalies but this is not always the case.

A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order?

Heparin Heparin is generally prescribed initially if the dysrhythmia persists longer than 48 hours

The nurse understands that asystole can be caused by several conditions. Select all that apply.

Hypoxia Hypovolemia Hypothermia Acidosis Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the "Hs and Ts": hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).

The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching?

I will report if I feel lightheaded and dizzy at my next doctor's appointment The clients with newly implanted devices are told to treat lightheadedness and dizziness as an emergency so these symptoms should be reported as an emergency. Handheld security devices may should be avoided because of the electromagnetic interference. MRI studies may deactivate the devise so they need to be avoided. The CPR training is recommended for family as an emergency backup.

A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?

Pulmonary embolism

A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation?

This is due to a decreased amount of oxygen to the peripheral tissue Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and, in general, does not usually need immediate surgery nor is it a sign of heart failure.

Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles?

cardiac tamponade Explanation Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high pulmonary artery wedge pressure, central venous pressure, and pulmonary artery diastolic pressure, as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.

A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition?

chronic alcohol use disorder Explanation Chronic alcohol ingestion is one of the main causes of dilated cardiomyopathy. Other causes include history of viral myocarditis, an autoimmune response, and exposure to other chemicals in addition to alcohol. Heredity is considered the main cause of hypertrophic cardiomyopathy. Scleroderma is a connective tissue disorder thought to cause restrictive cardiomyopathy. Scar tissue that forms after a myocardial infarction is thought to be a cause of restrictive cardiomyopathy.

A client with severe anemia is prescribed 2 units of packed red blood cells. The client refuses to sign the consent form for blood administration because to do so conflicts with the client's Jehovah's Witness faith. What did the nurse fail to assess prior to witnessing consent?

cultural beliefs Explanation Clients may not accept health treatments if those treatments conflict with the values of their culture. The nurse was not aware of the client's cultural values as a Jehovah's Witness, which include prohibition of the transfusion of blood, prior to attempting to gain consent for the prescribed treatment.

A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease?

echocardiogram Explanation The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily. Cardiac catheterization will focus on coronary vessels. The serial enzymes are done to detect heart muscle damage. The phonocardiogram is helpful for valve function.

A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?

semi-fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child's cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.

what is the purpose of the endocardium?

the endocardium lines the inside of the heart to prevent abnormal clotting

The heart receives blood returning from the body through which vessel?

vena cavae

The mitral and tricuspid valves prevent the backflow of blood from which of the following?

ventricles to atria when the ventricles contract